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Reforming China’s Rural Health System
Figure 7.7
Accounting for Public Health Spending by Institutional Type County A
County B
FPI 6% county hospitals SDPI 11% 7%
FPI 12% SDPI 0%
MCH 3%
MCH 9% THCs 26%
THCs 30%
EPS 41%
county hospitals 13%
village clinics 2%
EPS 39%
village clinics 1%
Source: Public Health County Case Study. Note: THC = township health center; EPS = epidemic prevention station (CDC); MCH = maternal and child health centers; SDPI = skin disease prevention institute; and FPI = family planning institute.
The current fragmentation of the public health system is problematic for many reasons. It undermines the development of comprehensive and coherent public health strategies by restricting information sharing and coordination. It also results in inefficient and costly duplication and competition. For example, there are multiple laboratories in the two case-study counties—in the epidemic prevention stations, hospitals, and in other agencies such as FDA, EPA, and AQSIQ. All these laboratories operate independently, with little information exchange and coordination.80 Similarly, considerable overlap occurs in the services provided by the MCH center, the county hospital, and the county family planning centers, with similar duplications frequently reproduced at the township level. The result is not only inefficiency and redundant capacity; by undermining integrated and coordinated care, it also has implications for quality of care.
Financing Woes: Mission Creep, Profit-Seeking, and Demand Inducement The 1980s brought a series of reforms that gave institutions with public health responsibilities—including both public health institutions and health care providers—considerable latitude to generate business income.81 As with health care providers, the Centers for Disease Control and other institutions also have been given discretion over the use of business revenues. The result has been bonus schemes that link bonuses