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Study of the formation mechanism and governance logic of the service motivation for community doctors' first contact

Xiaohe WANG ; Wan FENG ; Yu QIAN ; Wenfeng FANG ; Guoguan ZHENG ; Hui WANG ; Peng LI

Chinese Journal of Health Policy.2017;10(4):57-64. doi:10.3969/j.issn.1674-2982.2017.04.010

The service capabilities and sustainable development of community doctors' first contact are undoubtedly the critical factors to promote the construction of grassroots clinics and tiered health care system.Based on the review of motivation-related concepts and its development, as well as the analysis of the current conditions of community first contact and characteristics of community doctors in China, this paper puts forward and defines the concept and connotation of service motivation for community doctors' first contact by logically summarizing the concept of force in physical sciences ,motivation in service science, Based on analyzing the extrinsic motivations to form community doctors' first contact such as attraction, support, constraint, and stress the intrinsic motivations produced by professional identity, self-efficacy and achievement,as well as the interactions and relationships between them, this paper contructs a formation mechanism of the service motivation for community doctors' first contact, which is visual and intuitive.This paper provides a logical path and basis for scientific governance and upgrade of the service motivation for community doctors's first contact to effectively promote community first contact system in China.

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Paths and methods of decision-making transformation for health technology assessment in Germany

Lanting LV ; Ronghua FU

Chinese Journal of Health Policy.2017;10(4):51-56. doi:10.3969/j.issn.1674-2982.2017.04.009

Germany has a similar health insurance system as China, and has already formed standardized management processes as well as efficient decision-making transformation paths for health technology assessment (HTA) that perform well mainly based on three major HTA institutions at the national level.The HTA decision-making transformation system in Germany has proven to be a typical representative in evidence-based decision-making for health policies worldwide.Based on the outcomes of literature analysis and field research, this paper summarizes the paths and methods of Germany's HTA decision-making transformation, and finally proposes several targeted policy recommendations to promote the HTA decision-making transformation in China.

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Economic evaluation of ultrasonography and mammography for breast cancer screening among women in China

Li SUN ; Legood ROSA ; Li YANG

Chinese Journal of Health Policy.2017;10(4):42-50. doi:10.3969/j.issn.1674-2982.2017.04.008

Objective: This study aims to analyze the cost-effectiveness and cost-utility of ultrasonography screening, mammography screening and no screening for breast cancer among Chinese women.Methods: A Markov model was developed from a societal perspective among asymptomatic Chinese women over 40 years who are at risk for breast cancer over a lifetime horizon.The decision model was populated with data derived from China, discounted at 3%.After getting the incremental cost-utility ratio (ICUR), this paper explores the parameter uncertainty using one-way sensitivity analysis and probabilistic sensitivity analysis.Subgrouping analysis was conducted based on different city levels and geographical areas in China.Results: Compared to no screening, the incremental cost-utility ratio of ultrasonography screening is ￥102653/QALY and the ICUR of mammography screening is ￥201309/QALY.In probabilistic sensitivity analyses, the probabilities of the ICUR being a threshold of ￥140000/QALY are 54.5% for annual ultrasonography and 26.2% for annual mammography.The subgrouping analysis shows that compared with no screening the ultrasonography screening for breast cancer has high cost-utility in all levels of cities and all geographic areas in China.The ICUR of mammography screening compared with no screening is very close to the threshold in eastern China.Conclusions: Ultrasonography screening could be used as the primary method for breast cancer screening in China, while mammography screening could only be used in economically developed areas in eastern China.

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Analysis of synergistic service of health institutions: A case study of Changzhou City in Jiangsu Province

Jiannan LV ; Fang WANG ; Miaomiao TIAN ; Shuang LIU ; Xueyan JIA

Chinese Journal of Health Policy.2017;10(4):37-41. doi:10.3969/j.issn.1674-2982.2017.04.007

Objective: This research is conducted to analyze the background, the main practices and the results of the synergistic service of health institutions in Changzhou city, as well as to provide references for promoting the construction of integrated medical and health service system.Methods: This paper uses qualitative interviews and questionnaires to collect information and analyzes the data based on synergetic management theory.Results:Changzhou city has tentatively achieved the synergy of its health institutions by introducing relevant policies, setting up healthcare unions at the municipal level, integrating internal resources among healthcare unions, establishing health information platform and feedback mechanism, etc.Conclusion: The regional synergistic service of health institutions can be effectively promoted by introducing policies at the municipal level, promoting the mutual sharing and communication on information, and integrating internal resources among healthcare unions.But, as there still exist problems such as the distribution of benefits is not perfect, the degree of synergy is not close, etc., thus, the government is suggested to expand the implementation scope of the close-type medical service synergy and further improve the distribution policy of benefits.

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Why some rural health policies are difficult to be implemented in F counties: A case study of New Rural Cooperative Medical System and the Basic Public Health Policy

Meng TIAN

Chinese Journal of Health Policy.2017;10(4):65-70. doi:10.3969/j.issn.1674-2982.2017.04.011

Rural health policies are difficult to be implemented at the village level in China.From the perspective of health administrative departments and township health centers, this is due to the lack of the basic conditions of rural health policy and the basic ability of the rural health policy.But from the point of view of village doctors, this is because of the lack of personnel, funding and other embarrassing situations, especially due to crisis and risks are taken to the village clinics and village doctors by the township health centers.In fact, the main reason why the health policy is difficult to land at the village level is that the relationship between the township health centers and village clinics have not been rationalized, as can be specifically seen in weak position of village clinics compared with township health centers.The key to rationalize the relationship between the township health centers and village clinics is to strengthen the development capacity of village doctors, at the same time to get rid of the misunderstanding for village doctors in some of the thinking and policy and strengthen the accountability of primary authorities, and finally open up the relationship between the township health centers and village clinics.

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The influencing factors of vertical rural health services integration in Jiangsu Province: Based on factor analytic method

Mingjie WEI ; Xueyi LIU ; Dongfu QIAN

Chinese Journal of Health Policy.2017;10(4):31-36. doi:10.3969/j.issn.1674-2982.2017.04.006

Objective: In order to better understand the influencing factors of vertical rural health services integration and put forward policy suggestions for its sustainable development.Methods: 288 residents were investigated through questionnaire survey in three sample areas of Jiangsu province in August 2015.Results: In this study, 4 common factors have been found, namely organizational management, incentive mechanism, policy and supporting measures, as well as information sharing and business communication.The overall scores given by health managers, doctors and nurses, and public healthcare professionals were 0.03, 0.04 and-0.02 respectively.Conclusions: Therefore, in order to succeed, it is very necessary to introduce targeted supporting policies, establish a mutual communication mechanism, and make an effective incentive mechanism.

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The effect evaluation on catastrophic disease medical assistance policy in China: A case study of Qindao City

Wei XU ; Wenwen DU ; Chengliang GENG ; Hao LI ; Shuang YANG ; Zhenzhen DU

Chinese Journal of Health Policy.2017;10(4):14-17. doi:10.3969/j.issn.1674-2982.2017.04.003

Objective: In order to evaluate the effect of catastrophic disease medical assistance policy in Qingdao and provide suggestions for Qingdao policy reform.Methods: This paper selects NSCLC and liver cancer as the typical deceases to analyze the effects of the policy on patients and medical insurance institutions and finally evaluate the effect of the policy.Results: results shows that after the implementation of special medicines and special medical equipment assistance, the rate of co-paying patients decreased 40.57%, and the pressure on medical insurance institutions' expenditure was significantly reduced;while after the implementation of large cost assistance, but rate of co-paying patients only decreased 7.13%, and the pressure on medical insurance institutions' expenditure was not effectively alleviated.Conclusions: Therefore, the policy not only protects patients with catastrophic disease by greatly reducing their medical burdens, but it also achieves the fine management of medical insurance fund and increases the efficiency of the fund.

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The effects of catastrophic disease insurance policy on benefit discrepancy between the patients covered by different medical insurances in Zhuhai City, China

Yawei HAO ; Zhaohui DONG ; Yan LU ; Lihua SUN ; Zhitao CHENG

Chinese Journal of Health Policy.2017;10(4):8-13. doi:10.3969/j.issn.1674-2982.2017.04.002

Objective: This study aims to analyze the effects of catastrophic disease insurance (CDI), especially to evaluate the influences of CDI on the discrepancy of benefits between the patients covered by the Employee's Medical Insurance (EMI) and the Resident's Medical Insurance (RMI).Methods: The data used in the study are collected from the health insurance database of Zhuhai City in the years of 2012 and 2014.A descriptive analysis is made to depict the general situation of CDI in the city, and a logistic regression model is used to analyze the factors that affect the probability to get the benefits of CDI.Moreover, a triple difference model is built up to probe into the CDI's effects on the discrepancy of reimbursement ratio between patients covered by EMI and RMI.Results: The benefits of CDI favor the patients with old age, high medical expenditures and chronic diseases.When other factors are controlled, patients covered by EMI have lower probability to get CDI benefits than those covered by RMI.Within the patients with high medical expenditures who have gotten the CDI benefits, those covered by EMI enjoy higher reimbursement ratio than those covered by RMI, but CDI decreases the discrepancy by 3.2%.Conclusions: Since the CDI gives more favor to the vulnerable population and narrows the gap of the benefits between EMI and RMI, the policy improves the equity of health security.

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The method of defining poverty caused by illness in catastrophic diseases medical assistance systems: A case study of M City in Hubei Province

Ju SUN ; Jia XIE ; Qiang YAO ; Lan YAO

Chinese Journal of Health Policy.2017;10(4):1-7. doi:10.3969/j.issn.1674-2982.2017.04.001

Objective: In order to validate the effectiveness of methods of defining poverty caused by illness which are based on catastrophic health expenditure and impoverishment health expenditure, originated from relative costs theory.Results: This paper uses empirical approach to explore the definition methods by comparing the original methods with modified methods and defined population with the actual situation of poverty alleviation.Results: Study results show that the catastrophic health expenditures incurred ratio is about 20% and shows the aggregation of both low-income and high-income groups.The impoverishment health expenditure incurred ratio is about 12% and they mainly are families at the edge of poverty line.This study found that 70% of the families defined based on our method did not receive medical assistance in reality.Conclusion: Therefore, the definition methods based on relative costs theory are of great value in Chinese medical assistance systems for defining poverty caused by illness.Grouping based on household ability to pay could improve the methods' operability and effectiveness.

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The economic effects of rural residents' health in China: Empirical analysis based on endogeneity

Linlin XU ; Yong LI

Chinese Journal of Health Policy.2017;10(4):71-76. doi:10.3969/j.issn.1674-2982.2017.04.012

As a sort of human capital, health is a concrete manifestation of human productivity.At home and abroad, there are many empirical studies focusing on the economic effects of health that have been conducted, but the research methods have not paid enough attention to the endogeneity of health in those studies.This paper evaluates the effects of health on the income of rural residents in China with the micro panel data from China Health and Nutrition Survey.To get reliable results, the paper controls the endogenity of health by using simultaneous equation model and solves the parameters by using the three-stage least squares method.The study found that health has significantly positive effects on the income of rural residents in China, a conclusion which is in conformity with the economic effects of health.To improve the health of rural residents and fully implement the economic effects of health, the study recommends the government to put more efforts on promoting healthcare services, health-related education, and improving the living standards of rural residents in China.

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