Huixuan Zhou1, Shengfa Zhang2, Weijun Zhang3, Fugang Wang4, You Zhong5, Linni Gu6, Zhiyong Qu7, Donghua Tian8. 1. China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China. chouhuixuan@live.cn. 2. China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China. zhangshengfa1988@sina.com. 3. China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China. zwj@bnu.edu.cn. 4. China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China. sabeihu@163.com. 5. China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China. zy91216@163.com. 6. China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China. gulinni@bnu.edu.cn. 7. China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China. qzy@bnu.edu.cn. 8. China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China. tian65216@hotmail.com.
Abstract
BACKGROUND: The Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future. METHODS: Three pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework. RESULTS: Without sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders' positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the transition of the policy. CONCLUSIONS: The innovative fund raising measures could be taken by relatively developed counties of China to conduct public health services. Policymakers could take systems thinking as a useful tool to design plans and predict the unintended outcomes during the process of public health reforms.
BACKGROUND: The Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future. METHODS: Three pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework. RESULTS: Without sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders' positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the transition of the policy. CONCLUSIONS: The innovative fund raising measures could be taken by relatively developed counties of China to conduct public health services. Policymakers could take systems thinking as a useful tool to design plans and predict the unintended outcomes during the process of public health reforms.
Authors: Liwei Cheng; Li Tan; Lan Zhang; Sheng Wei; Li Liu; Lu Long; Jie Zhang; Yaqiong Wu; Qingjun Zhang; Shaofa Nie Journal: BMC Public Health Date: 2013-08-02 Impact factor: 3.295
Authors: Qian Wang; Yuejia Kong; Jiyao Sun; Yue Zhang; Linlin Yuan; Jian Wang Journal: Int J Environ Res Public Health Date: 2019-07-15 Impact factor: 3.390
Authors: Linni Gu; Rui Zhu; Zhen Li; Shengfa Zhang; Jing Li; Donghua Tian; Zhijun Sun Journal: Int J Environ Res Public Health Date: 2020-12-02 Impact factor: 3.390