The Analysis Of The Role And Influence Of City Health Insurance System In City Community Health Service System Building

ObjectivesThe aim of the paper was to study the role and influence of city health insurance in city community health service system building by the analysis of the influence of city health insurance to the improvement of equity and efficiency of community health service provision and its compensation impact on the income of community health institutions based on the theories on health insurance and health care provision and the practice of primary heath care reform in 20 countries in Europe.MethodsBoth qualitative and quantitative analyses were applied in the study. The literature review was used to provide the theories on health insurance and health care provision; the ANOVA was applied to comparison of the difference and logistic regression was used to analyze the influencing factors based on the data of the Baseline Survey and Routine Monitoring of National City Community Health Service System Building.Results1. For the theory part:Health insurance helps to achieve the equity and efficiency in providing the health care; the political, economical, cultural and social conditions are need before the implementation of social health insurance; a successful transition to Bismarck Model needs the strong government leadership, sufficient financing, prudently choosing reform program, improving the quality of care, modernizing the primary care, participation of citizen and community, and advancing the public health.2. For the comparison of the primary health care practice in 20 countries:the financing management closely matched with the PHC management and provision; medical training length and method directly influenced the gatekeeping role play of primary health providers; the insufficient health care financing directly caused the high copayment and widespread informal payment in CEE and NIS; efficiency promotion and cost containment were the main themes in the reform in all transitional countries.3. For the analysis of influencing factors of increasing outpatient workload (OW) of health center (HC):several key factors for increasing the OW included:establishing the referral among the different levels of institutions; enhancing the qualification of health personnel and increasing the compensation of health insurance for services provided at HCs. Other key factors with a positive effect on the OW included:the government ownership of the HCs, the scale of the institutions, the medical equipment used, the mix of health services provided and the women in childbearing age in the residence.4. For the difference comparison of city community health institutions with health insurance income (HII) and without HII, there was a significant difference for two types of health station (HS) in the aspects of the demographic characteristic, the basic setup, the health personal allocation, the income and expenditure, and the health service provision while the difference in these eight aspects was not significant for the two types of HC.5. For the analysis of patient's payment income of HC with HII:the percentage of annual total health insurance income (ATHII) and annual total income (ATI) was 17.37%, and the percentage of annual fiscal subsidy income was 18.15%, the percentage of annual other subsidy income was 3.75%; the percentage of three subsidies income and ATI was 39.10%, and the percentage of annual patient payment income (APPI) and ATI was 60.90%.For the analysis of patient's payment income of HS with HII:there was 17.8% of HSs with health insurance income (HII); the percentage of annual outpatient income (AOI) and annual total income (ATI) was 91.44%; the percentage of AOHII and ATI was 26.35%; the percentage of three subsidies income and ATI was 34.91%, and the percentage of annual patient's payment income (APPI) and ATI was 65.09%.6. For the impact of health insurance compensation (HIC) on the income of HC with HII:For 1048 HCs with outpatient HIC income, the percentage of annual outpatient HIC income in annual outpatient income per HC was 17.64%, the percentage of annual outpatient HIC income in annual income per HC was 10.7%. For 444 HCs with inpatient HIC income, the percentage of inpatient HIC income in annual inpatient income per HC was 33.53%, and the percentage of inpatient HIC income in annual income per HC was 6.88%.For the impact of HIC on the income of HS with HII:For 947 HSs with outpatient HIC income, the average percentage of annual outpatient income in annual income was 92.21%, the average percentage of annual outpatient HIC income in annual outpatient income was 26.20%, the average percentage of annual outpatient HIC income in annual income was 24.07%.ConclusionsThe practice of 20countries in the primary health care reform showed that there need some preconditions for the successful implementation of social health insurance; therefore, it needs a long transition. Influence factors analysis of OW increase at HC showed that HII was one of factors to improve the efficiency of HC health care provision. Difference comparison between HC/HS with HII and without HII showed that a difference was in the two types of HS, but it was not clear in two types of HC. PPI analysis showed that HI has played a role in the equity of health service in HC/HS. The HIC had an impact on the income of HS with HII, but its impact on the income of HC with HII was very limited. Thus, the Chinese city health insurance has played an important role in the improvement of efficiency and equity for Chinese city community health service system building. The city health insurance need enlarge the coverage of the population and the community health institutions and increase the compensation rate.InnovationThe innovation of the study lies in that it's the first time to do the evidence-based research on the role and influence of the city health insurance in the Chinese city community health service system building systematically with the data of National City Community health Service System Building Project and Regular indicator Monitoring in 2008 of National Health Service System Building Project under the background of international comparison on primary health care management, and preliminarily give an evaluation of the city health insurance's influence to city community health service system building. It has the practical significance in guiding the development and combination of city health insurance and city community health service system building.Further studyThere is a need to establish an evaluate indicator system including the indicators from the aspects of patient, community, community health institutions, the government and health insurance institution in order to better evaluate the impact of city health insurance on the community health service system building.