A Study on Accounting of Community Health Facilities Expenditure in Shanghai

Presenter: Hansheng Ding, Shanghai Health Development Research Center

Abstract

Objective: To analyze existing problems in the operation of community health facilities (CHF)2 in Shanghai, and to provide scientific proof for completing synthetic reform of community health by assessing and analyzing health expenditure of CHF in Shanghai from 2001 to 2007.

Methods: According to the standardized frame and instructive methods of total expenditure on health, revenue-expenditure data of CHF in Shanghai was collected, analyzed and assessed.

Main Results:

Among Shanghai Total Health Expenditure (STHE by provider), CHF expenditure was RMB 3.6bn (approximately US$ 0.4bn) in 2001 and increased to RMB 7.1bn (approximately US$ 0.9bn) in 2007, with an annual growth rate of 12%. The proportion of CHF expenditure in STHE reduced from 15% in 2001 to 12% in 2007, and the proportion of CHF expenditure in hospital expenditure had a reduction of 3%, from 19% to 16%. Compared with Chinese average level, whose CHF proportion accounting for 8% of China THE and 11% of hospital expenditure, Shanghai still has some advantages.

Revenue of CHF depended on pharmaceuticals excessively. In 2001, pharmaceuticals revenue accounting for 59% of CHF expenditure, and 57% in 2007, with only slight reduction. From 2001 to 2007, subsidies from governments for CHF had an obvious increase, going from RMB 0.2bn (approximately US$ 0.03bn) in 2001 to RMB 1.1bn (approximately US$ 0.15bn) in 2007, whose proportion in total revenue also had a yearly increase, from 6% to 16%, while the proportion of medical service revenue seriously decrease from 31% to 24%.

Primary health care should be a most important function of CHF. In practice, half of financial subsidy was devoted in to primary care and prevention. Although there is some increase in primary care and prevention, it only accounted for 6% of total revenue of CHF in 2005, and 9% in 2007.

Both the revenue and expenditure of CHF increased stably from 2001 to 2007, with the expenditure growth higher than the revenue growth. Especially the growth rate in 2007 compared to that in 2006, revenue growth rate is 6% higher than that of expenditure. The price addition rate decrease obviously since 2003. Although the price addition rate of CHF (24%) drugs was still higher than that of public hospitals (21%) in 2007, a deficit showed up for the first time.

Discussion and Suggestions:

On one hand, the existence and development of CHF greatly depend on pharmaceutical revenue. Since the synthetic reform of community health, a measure of dividing the drug income and expense drugs has been adopted in CHF drug management, and policy deficit showed up. On the other hand, the governmental input of primary care and prevention should also be promoted, in order to ensure the CHF function of primary health care and safeguard the primary health of residents.