Finance Policy for Public Health Disease Prevention: Addressing the Number One Cause of Death in the Western World

Background: The lack of a finance policy to cover heart coronary artery disease CT imaging led to an epidemic of heart disease, the most common cause of death in the United States. The difficulty for many adults to pay $150 for CT heart imaging was the impetus for public health reform through legislative intervention. Methods: The key to finance policy reform was the organization of the medical environment involved in asymptomatic heart disease. Using the ecosystem paradigm for organizational alignment, the legislative goal was financing the $150 heart image to identify and medically prevent symptomatic heart disease, obviating future surgical costs of >$100,000. Results: Assisted by stakeholders for public health reform, a 3-year initiative to pass a legislative bill mandating health insurance coverage of $150 heart imaging was signed into law. Understanding the legislative process was necessary for successful advancement of public health and eliminating unnecessary costs of an established conservative ecosystem. Conclusions: Texas was the first state to achieve this legislative goal and New Mexico soon followed. If political environments, regardless of country following this road map of public health reform, a significant beneficial impact upon heart disease, its cost, and healthier public would result.

The Malaysian health care system:Ecology,plans,and reforms

Malaysia is on its way to achieving developed nation status in the next 4 years.Currently,Malaysia is on track for three Millennium Development Goals(MDG1,MDG4,and MDG7).The maternal mortality rate,infant mortality rate,and mortality rate of children younger than 5 years improved from 25.6%(2012)to 6.6%(2013),and 7.7%(2012)per 100,000 live births,respectively whereas immunization coverage for infants increased to an average of 90%.As of 2013 the ratio of physicians to patients improved to 1:633 while the ratio of health facilities to the population was 1:10,272.The current government administration has proposed a reform in the form of the 10th Malaysian Plan coining the term“One Care for One Malaysia”as the newly improved and reorganized health care plan,where efficiency,effectiveness,and equity are the main focus.This review illustrates Malaysia’s transition from pre-independence to the current state,and its health and socioeconomic achievement as a country.It aims to contribute knowledge through identifying the plans and reforms by the Malaysian government while highlighting the challenges faced as a nation.

The impacts of national essential medicine policies on the rational use of medicines in China: A cross-sectional study in primary health care institution

Irrational use of medicines is a major problem worldwide, and it is believed there would be positive correlation between the National Essential Medicines Policies(NEMPs) and the level of rational use of medicines(RUMs). Though there is some early evidence on the NEMPs’ effects on RUMs in China, the evidence is scarce, and conclusions vary. In the present study, we aimed to evaluate the impacts of the NEMPs of China on the RUMs in the primary health care institutions(PHCs). A cross-sectional survey was conducted in 2010. A total of 201 PHCs from six provinces of China were selected, and 39 181 prescriptions were extracted from January to June, 2010. Six indicators were used and tested by independent-samples T test. We found that the average number of drugs per prescription in PHCs with NEMP implementation(the treatment group) was significantly higher than that of the group without NEMP implementation(the control group)(3.37 vs. 2.83, P<0.01). There was no significant difference in the average cost per prescription(81.43 vs. 75.02). The percentage of prescriptions, including an antibiotic(53.40% vs. 36.48%, P<0.01) or an injection(40.54% vs. 27.94%, P<0.01), was higher in the treatment group, and the percentage of drugs prescribed by general name was significantly lower(83.71% vs. 93.11%, P<0.01). For the percentage of drugs prescribed from essential medicines list, the treatment group exhibited the higher ratio(76.12% vs. 53.45%, P<0.01). From this study, the NEMPs were not likely to have a positive impact on RUMs. China still needed efforts to improve the selection, the absence of physicians’ active involvement, and the patients’ habits of irrational medication use.

The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

Objective:This study focuses on Hangzhou,a Chinese city with a population of nine million urban and rural residents,to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then dis-seminate the findings through international third parties.Methods:Measures such as data analysis,study of documents and regulations,fieldwork,and expert discussions were used to systematically investigate primary health care in Hangzhou.The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs.Results:Community health services in Hangzhou are characterized as follows:They are gov-ernment led;they are guaranteed with enough financing,personnel,facilities,and regulation;sup-ported by the unified information platform;general practitioners have been assigned the key role of health‘gatekeepers’;they provide primary care combined with basic public health services;there are integrated urban and rural health services and insurance coverage;and there is health care-pen-sion-nursing integration and general practitioner-contracted‘smart’services.Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole,and some health indicators in Hangzhou are comparable to those in Western developed countries.Conclusion:It is reasonable to believe that the primary health care level in China,including Hangzhou,will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.

Health professionals’perspective on the impact of community health care reform in different regions of China

Objective:Changes in supplying community health services,degree of satisfaction,and pol-icy suggestions are presented from the perspectives of health professionals in different regions of China with the purpose of further facilitating comprehensive reform of community health services.Methods:Based on geographic location and economic level of development,eight cities were selected and 12 community health service institutions were chosen by random sampling from each city.A questionnaire survey was conducted by the health professionals.Results:With respect to working enthusiasm,reduction in antibiotic drug use,social image and trust of patients,more health professionals in middle and western China showed positive feed-backs than those in eastern China.With respect to preliminary results of the reform,performance and salary,and health care insurance policies,health professionals’satisfaction levels in middle and western China were higher than in eastern China.The health professionals in middle and western China were more concerned about equipment,infrastructure and increasing training op-portunities.The health professionals in both eastern and middle China accentuated improving the variety of essential drugs covered by health insurance,while health professionals in eastern China suggested performance-related payment reform.Conclusions:The performance of health professionals in middle and western China was improved more signifi cantly through comprehensive reform than that of health professionals in eastern China.For health professionals in middle and western China,it is essential to strengthen infrastructure and increase professional training,while health professionals in middle and eastern China would like to see an increase in the variety of essential drugs,and those in eastern China require strengthening performance-related payment reform.

Macro Determinants of Health Expenditure in China

China is facing challenges of the increasing incidence of some chronic diseases. However, the share of government spending on health in total kept fairing during the economic transition and the cost of health care has been rising dramatically. Using the data at the provincial level, I find that income and population aging are significant determinants of increasing health expenditure. Time dummies contribute more than 40% in the growth of health expenditure and nearly one-third in the growth rate of health expenditure, which implies that technological and institutional changes are also very important drivers in China. In the future, the rising of health expenditure is a necessary response to income growth and population aging; but there is still plenty of room to cut the cost through reforming the health care sector.