Table 5.
Impacts | Beijing | Chengdu | Hangzhou |
---|---|---|---|
Revenues/ expenditures of CHCs | Proportion of drug expenditure and service charges declined as % of the total health expenditure of CHC; CHCs might not be to receive the payment from governments timely to cover the expenditure [19]. |
District/county governments increased funding to CHCs Ave expenditure per outpatient visit declined CHCs sometimes did not receive payments from governments or social health insurance timely |
District/county governments increased financial inputs under SRES; Ave expenditure of outpatient visit declined; CHCs might not receive the payments from government timely [24,27]. |
Quantity of services provided | The quantity of outpatient visits and public health services provided in CHCs increased significantly; No changes in home visits [21]. |
The quantity of outpatient visits increased significantly While more NCD patients have been effectively managed, many NCD patients bypassed CHCs to seek tertiary care |
The use of CHCs increased; CHCs provided more public health services related to NCDs control [25]. |
Quality of care | Patients' satisfaction with outpatient services increased, as more patients chose CHC as the first contact with professional care; No changes in the management of NCDs [22]. |
Patients' satisfaction with the services increased, resulting in high use rate. Lack of qualified general practitioners prevented further increase of quality of care |
Overall satisfaction with the CHC services increased significantly; Lack of qualified general practitioners resulted in slow development of CHCs [26]. |
Perceptions of community health workers (CHWs) | SERS can ensure the income of CHWs, and reduce unnecessary treatments that used to produce profits for CHCs, making healthcare at community level more affordable; SERS does not provide CHWs with financial incentive to work hard [23]. |
Most CHWs were satisfied with the reform, while others were less keen to provide public health services, as defined in the SERS. | Increased workload, particularly related to NCD control, at CHCs may not be sustainable; While salaries of CHWs are secured, the income level did not match the increased level of workloads. Many CHWs were not satisfied with their income levels after the reform [24,27]. |