Abstract
Aim: To provide a framework for provider payment reform for primary care physicians in China. Background: Primary health care is central to health system reform and payment incentives have significant consequences for the equity and efficiency of it. Methods: This paper describes the special payments system for public primary health institutions and the subsequent internal salary remuneration to primary care physicians in China. Based on an analysis of the major challenges, we suggest a reform framework including the pattern of governance, and payments to primary health institutions and employed physicians. Findings: A mixed system of input-based and output-based payments to institutions would probably be appropriate under a long-term and relational contract with the government. It was also advised that internal remuneration is provided by a basic salary plus a bonus based on performance, and an extra-regional allowance. We hope that the results can be used to shift the passive budgeting of in-house staff within the public primary health institutions toward strategic purchasing.
Highlights
Primary health care is central to China’s health system and has great potential to improve the well-being of the population (Zhang et al, 2017)
83.0 and 98.4%, respectively, were to government-run primary health institutions (PHIs) (National Health and Family Planning Commission of the People’s Republic of China, 2016). These PHIs are a kind of Public Service Unit (PSU), operating alongside the government (World Bank, 2005), and the provider payments to primary care physicians (PCPs) are to some extent made under a hierarchical ‘chain of command’ type of administration
This paper describes the system of special payments to PHIs and the subsequent internal salary remunerations made to PCPs in China
Summary
Primary health care is central to China’s health system and has great potential to improve the well-being of the population (Zhang et al, 2017). Based on an analysis of the major challenges (accompanied by the zero-mark-up policy on drugs that was implemented in 2009), we suggest a mixed system of input-based (line-item budgets) and output-based payments (purchasing in internal or quasi-markets) to PHIs under a long-term and relational contract with the government Through these mixed payments to PHIs, we propose that an internal remuneration is made to pay PCPs. Related data were obtained from the statistical yearbook of China (National Health and Family Planning Commission of the People’s Republic of China, 2016), and Health statistical data collections of Zhejiang Province (unpublished material), one of the 31 provincial regions of China, with a population of about 55 million.
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