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Objective@#To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas.@*Methods@#Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis.@*Results@#This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms.@*Conclusions@#The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.
ABSTRACT
Objective:To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas.Methods:Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis.Results:This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms.Conclusions:The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.
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The experience of various countries proves that the hierarchical diagnosis and treatment model can lead to reasonable resources allocation and utilization, however, the waste of China''s disordered treatment model has not been estimated.Nowadays, it is very important to establish a hierarchical diagnosis and treatment system during China''s healthcare system reform.Therefore, it is necessary to estimate the benefit the reform may bring.We take Zhejiang Province as an example, and adopted the system dynamics model to build the health delivery system, to emulate the hierarchical diagnosis and treatment model and the disordered model, and to evaluate the benefit.Results showed that if first option at the primary health institutions increased 10%, it could save 0.251 billion yuan, and if increased 15%, it could save 0.39 billion yuan.If the first option at the primary health institution reached 72.35% and the treatment in county reached 90%, the outpatient in tertiary hospital could reduce by 13 million, and those in primary healthcare institutions could increase by 74 million yuan.The direct healthcare cost could reduce 3.016 billion Yuan.
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Objective To find a selection method system appropriate for China's essential drug list.Methods Collection and analysis of technical paper literature on essential drug list developement,adjustment technical papers,and literature on evidence-based medicine,pharmacoeconomics evaluation,and medical insurance budget analysis from WHO and other countries.On such basis,a method system for selecting China's essential medicine list can be proposed,with its feasibility analyzed and demonstrated.Results The GRADE assessment proposed by WHO was used to evaluate the efficacy and safety of the drug;the pharmacy economics evaluation is added to assess the economic efficiency;these were aided by the pharmacoeconomics evaluation for a comprehensive evaluation of the pharmacoeconomics of the drug in question,supplementing analysis of the medical insurance,and ensuring its affordability of essential medicine so selected.The theory of this system is well developed,and supporting software ready for application.Examples in Zhejiang Province regarding essential medicine for diabetes have proved this method feasible.Data acquisition constitutes a major roadblock for scientific selection due to barriers against medical insurance data sharing.Conclusions Theoretic basis and method tools are fully available for essential medicine selection,and the selection method system as proposed in this study prove feasible to some extent.Decision makers are recommended to scientifically select the essential drugs,and to encourage data sharing,in order to make the list more scientific and pragmatic.