Article type
Year
Abstract
Background: 'Equalization of basic public health services' (EBPHS) policy in China is a strategy to promote universal health care (UHC) by a series of measures strengthening the public health system. Some implementation strategies were applied to universal delivery of the basic public health services package. However, quantity and quality of basic health care was lower at baseline in economically disadvantaged regions and their populations face more barriers to health care. It is critical to monitor the differences in utilization, quality of services and outcomes for different population subgroups to ensure that it is a viable strategy towards UHC.
Objectives: to synthesize evidence from literature and secondary data in order to assess the changes in coverage of two tracer services and the inequalities between different population subgroups following the EBPHS implementation.
Methods: we reviewed 65 relevant articles, which we retrieved from four databases and screened by relevance and the quality of studies. We also collected secondary data on national and local government health expenditure, basic public health coverage, intermediary health outcome indictors and health indicators in 2003 to 2016 to supplement data from the literature.
Results: progress to UHC varies for different services, and the analysis of two basic public health services shows that EBPHS expanded the coverage of services, and the disparities in coverage among different population subgroups show the narrowing trend. The quality of public health services, especially the disparities in qualified services were insufficiently addressed within the current policy and remain the biggest challenge for achieving UHC in China.
Conclusions: equalization in funding level for service delivery cannot ensure equity in the final utilization of services, especially qualified services. In order to accelerate progress to UHC, the design of similar essential service package policy should balance the rapid expansion of the essential service package and maintenance of quality of services. It is critical to monitor and address the differences in utilization, quality of services and outcomes for different population subgroups to ensure real progress towards UHC.
Patient or healthcare consumer involvement: the implications of the review may remind policymakers that they should focus not only on the coverage of services, but should pay more attention to the quality of services and health outcomes of residents.
Objectives: to synthesize evidence from literature and secondary data in order to assess the changes in coverage of two tracer services and the inequalities between different population subgroups following the EBPHS implementation.
Methods: we reviewed 65 relevant articles, which we retrieved from four databases and screened by relevance and the quality of studies. We also collected secondary data on national and local government health expenditure, basic public health coverage, intermediary health outcome indictors and health indicators in 2003 to 2016 to supplement data from the literature.
Results: progress to UHC varies for different services, and the analysis of two basic public health services shows that EBPHS expanded the coverage of services, and the disparities in coverage among different population subgroups show the narrowing trend. The quality of public health services, especially the disparities in qualified services were insufficiently addressed within the current policy and remain the biggest challenge for achieving UHC in China.
Conclusions: equalization in funding level for service delivery cannot ensure equity in the final utilization of services, especially qualified services. In order to accelerate progress to UHC, the design of similar essential service package policy should balance the rapid expansion of the essential service package and maintenance of quality of services. It is critical to monitor and address the differences in utilization, quality of services and outcomes for different population subgroups to ensure real progress towards UHC.
Patient or healthcare consumer involvement: the implications of the review may remind policymakers that they should focus not only on the coverage of services, but should pay more attention to the quality of services and health outcomes of residents.