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Future Health Systems is a research consortium working to improve access, affordability and quality of health services for the poor. We are a partnership of leading research institutes from across the globe working in a variety of contexts: in low-income countries (Bangladesh, Uganda), middle-income countries (China, India) and fragile states (Afghanistan) to build resilient health systems for the future. After a successful first five-year phase from 2006-2011 (see our success stories), we are entering a new six-year phase of research, funded mainly by UK aid.

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FHS China launch research project on payment system reform at the county level

Future Health Systems

On 25 March, the China National Health Development Research Center (CNHDRC) hosted a seminar to mark the launch of an FHS research project examining the impact of payment system reform on the delivery of health care services in rural healthcare facilities in China. The seminar took place in Yubei county, Chongqing city. Over 40 delegates attended the meeting, including a number of local and national government officials and grassroots policy makers.

The meeting was opened by Wang Yuxun, the Deputy Director of the Planning and Finance Department of the Ministry of Health, and Xia Yongpeng, the General Secretary of the Health Bureau in Chongqing. Several county-level officials also participated.

The project leader, Professor Zhang Zhenzhong, gave an overview of the project including an outline of each of the study components, the related outcomes and the framework for delivery. This was followed by two presentations; firstly on the prospect of payment system reform by Professor Jiang Qin and secondly on the application of qualitative research in the project by Professor Zhao Kun. Representatives of each case county then gave an introduction to the public health system in their respective regions and described the process of health reform, with a specific focus on the progress of reform, reform outcomes and the challenges they face. This led to an interesting discussion on the existing problems and potential solutions surrounding the implementation of payment system reform. The grassroots policy makers suggested that the excessive rise in medical expense threatens the security provided by the medical insurance fund. With this in mind it was agreed that each region should take “controlling the excessively fast growth of medical insurance expense” as a major aim of payment system reform.

Local stakeholders and other delegates agreed that the reform and supervision measures will not necessarily lead to a decline in quality of service provision. Neither should expense controls necessarily lead to internal restructuring and medication restrictions. Instead reform offers the potential to improve the value of a service, reduce the unreasonable use of consumable items and to transform the hospital’s compensation mechanism, which has not yet been effectively enhanced. The process of reform also hasn’t addressed a lack of support from health workers for reform and this will be crucial moving forward. This will be addressed in greater detail in our future research. CNHDRC concluded the meeting by agreeing to collaborate further with three case counties: Yubei, Changshu and Hanbin.

It is believed that the research into payment system reform will encourage public health policy makers to reconsider current institutional arrangements around health services delivery and to improve their policy making process. Wang Yuxun fully affirmed the importance of payment reform as part of the national health system reform, citing the current fee-for-service mechanism in hospital, distorted pricing and the excessive costs of examination and medicine in hospital treatment as reasons why reform was so important.