Abstract
BackgroundIn the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China's rural public health system performance.MethodsThe data were collected from a cross-sectional survey conducted in 2011, which used a multistage stratified random sampling method to select 12 counties and 118 villages from China. Three sets of indicators were chosen to measure the trends in access to coverage, equality and effectiveness of rural public health services. Data were disaggregated by provinces and by participants: hypertension patients, children, elderly and women. We examined the changes in equality across and within region.ResultsChina's rural public health system did well in safe drinking water, children vaccinations and women hospital delivery. But more hypertension patients with low income could not receive regular healthcare from primary health institutions than those with middle and high income. In 2010, hypertension treatment rate of Qinghai in Western China was just 53.22% which was much lower than that of Zhejiang in Eastern China (97.27%). Meanwhile, low performance was showed in effectiveness of rural public health services. The rate of effective treatment for controlling their blood pressure within normal range was just 39.7%.ConclusionsThe implementation of health reform since 2009 has led the public health development towards the right direction. Physical access to public health services had increased from 2008 to 2010. But, inter- and intra-regional inequalities in public health system coverage still exist. Strategies to improve the quality and equality of public health services in rural China need to be considered.
Highlights
[17] Researches (Mays et al, 2006; Scutchfield et al, 2009) of public health performance in U emphasize the national measurement for public health system is effective to monitor the progress, identify the determinants of achieving goals, and provide performance data for policy planning. [18,19] This study aimed at providing the up-to-date evidence and a performance-assessment toolbox for assessing the trends of public health services accessibility and financial protection in rural China from 2008 to 2010, as well as the current situation about the China’s rural public health system performance
Performance-assessment toolbox Performance measurement of public health system has been a popular research topic among the Centers for Disease Control and Prevention of the US, World Bank, researchers of Canada, and other researchers and organizations in the past 12 years. [20,21,22] In 2001, American researchers developed a conceptual framework to measure the performance of public health system, which was based on the instruments for assessing the performance of local and state public health departments developed by the Centers for Disease Control and Prevention’s National Public Health Performance Standards Program
The implement of essential public health services has a rapid increase during the three years, especially in the aspects of establishing health records for rural residents, maternal systematic management, systematic management of hypertension and diabetes
Summary
China’s health system has experienced remarkable changes over the past few decades since the market-oriented reforms launched in 1980s, which led China into a rapid economic growth period with dramatic social and political transitions. [1] The dramatic socioeconomic transitions have had significant impacts on health: overall, people in China live longer and healthier, their average life expectancy increased from 67.9 years in 1981 to 73.5 years in 2010. [2] From 1990 to 2010, the infant mortality rate (per 1,000 live births) decreased from 50.2 to 13.1, and the maternal mortality rate (per 100,000 live births) fell from 88.9 to 30.0. [3,4] the performance of urban health system and rural health system did not improve at the same pace, with urban areas on balance prospering far more than rural ones. [5,6] In 2008, the infant mortality rate in urban areas was 6.6 (per 1,000 live births), whereas it was up to 18.4 in rural areas. Growing inequalities in the accessibility of public health services and health outcomes between rural and urban areas are the key problems that the China Government has to face, and the weakest link of public health is still in rural areas. Along with the policy actions implemented in rural areas, crucial questions can be raised: how has the China’s rural public health system performance been? Will the China’s health reform improve the rural public health system performance? In the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China’s rural public health system performance
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