Study On National Basic Public Health Services Efficiency In Shandong Province

BackgroundDeepening reform of medical and health system promotes gradual equalization of basic public health services in 2009,which as one of the five key reforms.The aim of basic public health services equalization is to improve equity and access of essential public health services for residents.With the increase of service content and the expansion of service population,the gap of health service utilization between regions,urban and rural areas and populations has gradually narrowed.Basic public health services funding increases year by year,while the economic development shows a medium-to-high-speed growth.Improving the efficiency of resource utilization becomes the guarantee for the sustainable development of basic public health services.ObjectivesThis study evaluated the status quo of National Basic Public Health Services(NBPHS)efficiency in Shandong Province,explored the influencing factors and improving strategies,expecting to provide scientific basis for promoting sustainable development of NBPHS and improving people’s health.MethodsBased on allocation efficiency theory,organizational environment theory and marginal effect theory,this research conducted a panel data retrospective study on NBPHS efficiency in all 137 counties of Shandong Province.The research studied the status quo of technical efficiency and allocation efficiency and compared the input structure of different allocation efficiency types with Yearbook of Health Statistics and data from Shandong Provincial Health Commission Medical Management Center,using the methods of data envelopment analysis and Malmquist index analysis.The study used Tobit regression quantitative analysis and grounded theory qualitative analysis to identify the factors affecting efficiency in terms of resource input and policy mechanisms,collecting data on the spot.By means of panel binary selection Logit model,SWOT analysis and in-depth interviews with key figures,the measures to improve NBPHS efficiency were explored.This study mainly used Stata16.0,Max DEA 8,Nvivo12.0 and other software to realize data analysis.Results1.The proportion of counties with effective NBPHS technical efficiency in Shandong Province increased from 42.3%in 2014 to 62.0%in 2019.That of effective NBPHS scale efficiency increased from 50.5%in 2014 to 56.9%in 2019.That of effective NBPHS pure technical efficiency increased from 52.5%in 2014 to 71.3%in 2019.The proportion of districts with effective NBPHS technical efficiency in urban increased from 39.4%in 2014 to 63.6%in 2019.The proportion of counties with effective NBPHS technical efficiency in rural increased from 45.3%in 2014 to 60.5%in 2019.2.Among the counties with effective NBPHS technical efficiency in Shandong Province,the proportion of counties with effective NBPHS allocation efficiency increased from 36.2%in 2014 to 50.6%in 2019.The average proportion of financial,human and material investment in counties with effective NBPHS allocation efficiency was 57.0%,41.3%and 1.7%respectively.That of investment in counties with ineffective allocation efficiency was 53.9%,39.9%and 6.2%respectively.The proportion of districts with effective NBPHS allocation efficiency in urban increased from 38.7%in 2014 to 52.0%in 2019.The proportion of counties with effective NBPHS allocation efficiency in rural increased from 33.7%in 2014 to 49.2%in 2019.3.An annual increase of ten thousand yuan for public health personnel in primary health institutions or subsidy expenditure in urban,the counties could be increased the probability of effective allocation by 14.5 and 8.9 percentage points respectively.Each additional public health worker increases the probability of effective allocation by 8.9 percentage points.An annual increase of primary medical and health institution,the counties could be increased the probability of effective allocation by 7.5 percentage point.Each additional time of guidance from professional health institutions increases the probability of effective allocation by 4.6 percentage points.When the corresponding resource input is reduced,the corresponding probability of effective allocation will be reduced.4.An annual increase of ten thousand yuan for public health personnel in primary health institutions or subsidy expenditure in rural,the counties could be increased the probability of effective allocation by 15.5 and 11.0 percentage points respectively.Each additional public health worker increases the probability of effective allocation by 9.9 percentage points.Each additional time of guidance from professional health institutions increases the probability of effective allocation by 9.5 percentage points.An annual increase of primary medical and health institution,the counties could be increased the probability of effective allocation by 1.7 percentage point.When the corresponding resource input is reduced,the corresponding probability of effective allocation will be reduced.5.NBPHS efficiency in Shandong Province was mainly affected by three mechanisms:security system,operation mechanism and project management.The strength of local financial support was the focus of NBPHS efficiency.Local financial infrastructure funds and personnel salary compensation are the key of local financial support.The institutions’own service capacity was an important factor in efficiency.The quantity,quality and structure of public health personnel and village doctors were the embodiment of the service capacity of primary health institutions.Basic public health service fund management,fund allocation method,project cost accounting,and fund use scope standards affected NBPHS efficiency.Professional training guidance significantly promotes NBPHS efficiency.The acceptance capacity of primary medical and health institution and the training intensity of professional health institutions were the keys of training and guidance.NBPHS efficiency was directly affected by performance evaluation of basic public health services.The level of information construction and resident satisfaction were important factors affecting efficiency.Publicity efforts would promote residents’ participation and service effects.6.There were advantages,disadvantages,opportunities and challenges in the implementation of the strategy to improving NBPHS efficiency in Shandong Province.The advantage is that primary medical and health institutions have a good mass foundation and work foundation.The disadvantage is that the service capacity of primary health institutions is limited.Opportunities are the policy dividends of the medical-prevention coordination mechanism and the contracted services of family doctors.The challenge is to win the policy inclination of the editorial department and the financial departmentConclusions and Policy RecommendationsNBPHS efficiency in Shandong Province was low,and the structure of resource input was unreasonable.The increase in subsidies for basic public health services,funding for public health personnel in primary medical and health institutions,and the number of guidance from professional health institutions will promote NBPHS efficiency in urban and rural areas.Strengthening local financial support,institutions’ own service capabilities,and the resident sense of achievement are effective measures to improve efficiency.Fund management and professional training guidance are important tools for promoting efficiency.Perfect performance appraisal system and information construction are conducive to improving the utilization level of basic public health service resources.According to the above conclusions,the following recommendations were proposed:(1)Emphasizing the main responsibility of the government and increasing the proportion of basic public health personnel and personnel funds in urban and rural resource input to improve efficiency.(2)Supporting professional training guidance to improve the capacity and service quality in primary health institutions.(3)Strengthening project costing to refine the management of basic public health service funds.(4)Adjusting service content and improving assessment system to promote efficiency.(5)Improving information construction and increasing project publicity to enhance resource utilization.Innovation and DeficiencyThis study achieved innovations in three aspects.The first is research perspective.We explored NBPHS sustainable development and provided scientific basis and policy recommendations from the direction of health economy,which breaking through the idea of only focusing on project mechanism improvement in previous studies.The second is research content.Using the panel data of all 137 counties in Shandong Province from 2014 to 2019,we systematically studied NBPHS efficiency current status and the impact of investment and mechanism on efficiency and filled the research gap of quantitative adjustment of investment structure to improve project efficiency,which making up for the insufficient research in the existing literature due to lack of data.The third is method application.Allocation efficiency was measured by cost-efficiency model.Panel binary selection Logit model quantified marginal impact of input on efficiency and proposed quantitative improvement measures for efficiency.This research lacks in-depth exploration on population health outcomes and efficiency influencing factors.Population health outcomes were not used as a criterion for evaluating program efficiency,but as the evaluating composition of results for NBPHS.Based on the research purpose,this study incorporated relevant factors,resource input and policy mechanism,into the efficiency influencing factors,but there may still be other factors that affect NBPHS efficiency.