Health insurance system has been proved to be an effective way to promote the quality of health service in many countries. However, how to control health expenditure under health insurance system remains a problem to be resolved. Some developed countries like UK, Canada and Sweden linked their health technology assessment results with decision making and health insurance management, and made prominent achievements in both expenditure control and quality improvement. China is carrying out its health system reform and running a new health insurance project. Using the experiences of other countries is undoubtedly of great importance in developing and managing our health insurance system.
In order to understand the latest progress of health decision support system (HDSS) construction, grasp the law of HDSS development and adopt the international advanced experience, this paper took Australia for example, presented a comparative analysis on the construction practices, including the contents, features and system functions of national construction guidelines for HDSS in different periods, and showed the integral development level of Australia HDSS was still in the exploratory stage, and its construction goal, function orientation and construction mechanism got improved gradually with the deep development of public health information. Additionally, to assure the accuracy and safety of HDSS function, Australia has been laying stress on the standard specification construction and system function authentication.
Objective To understand the basis and status of setting up the dispensing fee at home and abroad, and to ascertain the scope of dispensing service, so as to offer references to the setting up and implement of dispensing fee in China. Methods According to the evidence-based principle, the descriptive method was adopted to demonstrate the basis of setting up the dispensing fee. The different definition, payment mode and standard were compared at home and abroad. Results Separation of prescribing and dispensing was the basis of setting up the dispensing fee. In western countries, the charge of dispensing fee was almost at the same level, though its definition and scope were different among countries. It was more reasonable to determine the level of dispensing fee according to the visiting frequency, compared with the price, the number and the type of drugs in the prescription. Conclusion China’s calculation of dispensing fee should be based on the prescription fee, the cost of drug administration and store. Dispensing fee should be implemented in the pilot hospitals firstly. Institutions providing primary health care services (rural health clinics, community health service centers etc) which follow a policy of “separating revenue from expenditures” may not adopt the dispensing fee temporarily. In urban hospitals, it is advisable to promote the separation of prescribing and dispensing gradually and bring pharmacists to provide prescription auditing, dispensing and advisory services. For retail pharmacies, pharmacists should be gradually fully staffed as one of the necessary conditions for operating. Performance evaluation of pharmacist’s services and pharmacy administration also should be developed.
Objective To survey the relations between the rural residents’ occupational satisfaction, the health policies and demographic factors in Henan province and then to confirm the health policy order and its key target populations. Methods The questionnaires were distributed to 1 117 rural residents in 156 villages among 44 townships in 19 counties (cities, districts). The frequency analysis, multivariate linear regression analysis and multiple comparisons were conducted. Results The average value of rural residents’ occupational satisfaction scored 68.23, among which the complete dissatisfaction scored 0 accounting for 1.9%, the complete satisfaction scored 100 accounting for 9.0%, the one scoring no more than 50 accounted for 20.9%, and the one scoreing equal 80 or more than 80 accounted for 37.5%. By regarding the occupational satisfaction as the dependent variable, the independent variables stayed in the model were as follows in order according to their influence from heavy to little on the dependent variable: new rural cooperative medical system (NRCMS), occupation, village general practitioner’s work, family formation, age, disease prevention and control efforts. The occupational satisfaction was much higher when there were the following conditions: the higher satisfaction with the NRCMS, the more financial burden relieved by the NRCMS, and the higher satisfaction with village general practitioners’ work. The occupational satisfaction was the highest when villagers lived with their spouses, while it was the lowest when villagers lived with their spouses and children, as well as they lived with their parents, spouses and children. The peasants’ occupational satisfaction was the lowest. The occupational satisfaction had significantly negative correlation with cultural level, and had positive correlation with age. Conclusion The occupational satisfaction is an important indicator for assessing the level of social harmony, and is the basis for policy decision-making, implementation, and evaluation. The overall occupational satisfaction of the rural residents in Henan is lower, so the social harmoniy and stability should be alerted. The priority order of the existing rural health policy should be the NRCMS policy, village general practitioner work policy, and village disease prevention and control policy. When we are formulating and implementing the rural health policy, the key target populations should be considered among the people whose families comprise two or three generations, whose occupations are farmers, whose cultural level is lower, and whose ages are younger.
It is the key for evidence-base decision to gain the high quality evidences. As a valuable method,systematic review has been widely used in medical areas with the improvement of the method, but it cannot be useddirectly in health policy field, because the characters of the health policy such as research topics, methods and objectives.The Center for Health Management and Policy of Shandong University has made some researches which focus on themethod under the support from the Alliance for Health Policy and Systems Research (WHO) from 2006. We haveexplored the two-stage systematic review method of health policy researches and applied it into reality. The purpose of thisarticle is to introduce the key technical of this method, which include quality assessment of the literatures, analysis andintegrated approaches. We also put forward the work which needs to be continued in the future.
Objective To compare the newest essential medicine lists (EMLs) of China and the World Health Organization (WHO) in 2009, so as to provide the evidence for the selection, adjustment and implementation of the newest national EML of China. Methods Differences in the procedures of selection, implementation and the categories as well as the number of medicines in 2009 EMLs of the WHO and China were compared by descriptive analysis. Result Principles and procedures of selecting and updating EML of China were based on those of the WHO EML. However, the transparency of procedures, methods of selection, and evidence of efficacy, safety, cost-effectiveness and suitability were not enough. Essential medicines of the WHO were categorized by the Anatomical-Therapeutic-Chemical (ATC) classification system, while those of China were classified by clinical pharmacology. Twenty-one identical categories of the first class were found in the two lists. There were 8 and 3 unique categories in the WHO EML and China EML, respectively. A total of 358 and 255 medicines (including medicines in its explanation) were included in the EMLs of the WHO and China, respectively, with 133 identical medicines as well as 206 and 108 unique medicines. There were 51 antiinfective medicines in China EML, accounting for half of the WHO EML. Forty medicines were the same in both lists, and 11 and 60 anti-infective medicines were unique in EMLs of China and the WHO, except for 40 identical medicines. Among them, 22 and 31 antibacterials were included in the lists of the WHO and China with 17 identical medicines. Antifungal, antituberculosis and antiviral medicines in China EML were fewer than those in the WHO EML. The numbers of the identical medicines acting on the respiratory, digestive, and nervous systems and hormones in the both lists were 1, 7, 9, and 17, respectively, while the unique ones in China EML were 6, 12, 7, and 14, respectively. However, most of them were selected without adequate evidence in efficacy and safety. The medicines acting on cardiovascular system were 19 and 29 in both lists with 14 identical medicines. Some antihypertensive and antiarrhythmic medicines were included in China EML with similar mechanism, whereas some of them were excluded by the EML. Conclusion The total numbers of both EMLs are close to each other with half of the identical medicines. The selection of China EML mostly meets the needs of disease burden in China. However, the transparency of selection and evidence are not enough. We suggest that health authorities should cooperate with other stakeholders to promote the transparency of selection, to enhance the capacity of producing high-quality evidence, to develop related technical documents and guidelines, and to disseminate and monitor the implementation of EML.
Objectives To analyze the development and implementation of the national drug policy in order to provide decision-making for the establishment of the Chinese national drug policy. Methods Nineteen electronic databases, the WHO, the World Bank, and governmental websites were included in this study. A pre-designed data extraction form was used to collect information. The data were analyzed and described by a pre-designed analytic framework. Result A total of 182 studies were included in this review. The main points of common concern in the national drug policy were: drug regulation and quality assurance, rational use of drugs, drug supply, the selection of essential drugs, human resource development and training, traditional medicine, drug financing and affordability, drug research, monitoring and assessment of the nation drug policy, technical cooperation, and the national pharmaceutical industry. The selection of essential drugs, quality assurance, supply, pricing, and supply of traditional medicine were gradually carried out in China. Pharmaceutical research, monitoring and evaluation, as well as the development of pharmaceutical industry and technical cooperation within it should be further strengthened. Conclusion China should establish related organizations and working procedures; speed up the implementation of the legislation of national drug policy; integrate the mechanism of essential drugs selection and supply system; regulate the order of medicine production and regulation; establish scientific and reasonable pricing mechanisms for drugs and assessment systems; strengthen the monitoring and evaluation of national drug policy and update and improve the national drug policy.
The Campbell collaboration (C2) is an international research network that produces and disseminates systematic reviews of the effects of interventions in education, criminal justice, and social welfare. It aims to generate the best research evidence to support policy and practice in order to bring about positive social change. This issue introduces the experiences of the author while taking part in the ninth annual Campbell colloquium, and tries to increase awareness about C2.
Objectives To establish a course evaluation model for overseas medical students in West China Medical School of Sichuan University, to identify problems in teaching and to solve problems based on evidence so as to futher improve the quality of teaching. Methods We conducted a preliminary course evaluation to determine the limitations of our evaluation methods and to convey our intention to related stakeholders. Firstly, we identified problems in teaching according to the feedback from our students using a questionnaire. Secondly, we proposed an initial list of possible solutions to these problems based on evidence from literature searching and discussion within the Department of Teaching Affairs. We submitted the initial list to the administrative departments, teaching departments (teachers) and students to identify applicable solutions through two rounds of formal consensus. Their attitudes to this procedure of evaluation and decision-making were collected. Finally, incentives were given out by administrative departments and teaching departments to facilitate the implementation of applicable solutions. Results Teachers’ English ability and the didactic teaching methods were the most concerned problems. In addition, some semesters and courses were not well arranged and there was not enough practice time. An initial list of 14 items was submitted to teaching departments and students. They all agreed with the procedure of evaluation and decision-making. We also found that some aspects of the evaluation methods and styles need to be improved. An additional paper would report further results. Conclusion This preliminary evaluation was helpful for improving teaching and formal evaluation in the future. We need to strengthen the English language skills of younger faculty and gradually adopt a model of student-centered and enquiry-based teaching. This process of evaluation and improvement should be applied as a long-term policy and an evidence-based research group should be established to work together with our quality assurance unit.