How China's new health reform influences village doctors' income structure: evidence from a qualitative study in six counties in China.

Shengfa Zhang,Donghua Tian,Huixuan Zhou,Linni Gu,Mengqi Guo,Fugang Wang,Huiwen Xu,Xiaohua Wang,Zhiyong Qu,You Zhong,Zhihong Sa,Weijun Zhang,Xiaoyun Liang

doi:10.1186/s12960-015-0019-1

Abstract

BackgroundIn 2009, health-care reform was launched to achieve universal health coverage in China. A good understanding of how China’s health reforms are influencing village doctors’ income structure will assist authorities to adjust related polices and ensure that village doctors employment conditions enable them to remain motivated and productive. This study aimed to investigate the village doctors’ income structure and analyse how these health policies influenced it.MethodsBased on a review of the previous literature and qualitative study, village doctors’ income structure was depicted and analysed. A qualitative study was conducted in six counties of six provinces in China from August 2013 to January 2014. Forty-nine village doctors participated in in-depth interviews designed to document their income structure and its influencing factors. The themes and subthemes of key factors influencing village doctors’ income structure were analysed and determined by a thematic analysis approach and group discussion.ResultsSeveral policies launched during China’s 2009 health-care reform had major impact on village doctors. The National Essential Medicines System cancelled drug mark-ups, removing their primary source of income. The government implemented a series of measures to compensate, including paying them to implement public health activities and provide services covered by social health insurance, but these have also changed the village doctors’ role. Moreover, integrated management of village doctors’ activities by township-level staff has reduced their independence, and different counties’ economic status and health reform processes have also led to inconsistencies in village doctors’ payment. These changes have dramatically reduced village doctors’ income and employment satisfaction.ConclusionsThe health-care reform policies have had lasting impacts on village doctors’ income structure since the policies’ implementation in 2009. The village doctors have to rely on the salaries and subsidies from the government after the drug mark-up was cancelled. China’s national health reforms are attempting to draw village doctors into the national health workforce, but the policies have impacted their income and independence. Further research into these concerns and monitoring of measures to adequately compensate village doctors should be undertaken. Reasonable compensation strategies should be established, and sufficient subsidies should be allocated in a timely manner.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-015-0019-1) contains supplementary material, which is available to authorized users.

Highlights

In 2009, health-care reform was launched to achieve universal health coverage in China
While remuneration for drug sales is generally calculated on the basis of total drug sales, there is always a ceiling on the total government payment; 4) General fee for medical service: In the village clinics that had implemented National Essential Medicines System (NEMS), registration fee, checkup fee, injection fee and dispensing fee were merged into the general medical fee for medical service
The fee for medical services and prescriptions is about 5–10 RMB of which the patient pays 20%, and the rest is paid through the New Rural Cooperative Medical Scheme (NRCMS). [35,36,37]

Summary

Introduction

In 2009, health-care reform was launched to achieve universal health coverage in China. A good understanding of how China’s health reforms are influencing village doctors’ income structure will assist authorities to adjust related polices and ensure that village doctors employment conditions enable them to remain motivated and productive. Retain and motivate health workers in rural areas is a great challenge in the world, especially in low- and middle-income countries, and the underlying reasons for the shortage of health workers. A good understanding of village doctors’ income is essential for the government to develop appropriate strategies to provide strong incentives to improve health workers’ productivity and retain staff in rural areas and form the basis for performance assessment and performance-based financing of village doctors’ work [12,13]

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