Exploring China’s western and central county systems performance measured by outcomes framework scores—A cross-sectional survey of routine healthcare data

Abstract

This study was designed to measure the performance of county health systems in central and western China utilizing routine healthcare data. Drawing on a literature review and expert consultation, the study established a theoretical framework and an indicator system for performance review. Questionnaires were designed and disseminated to collect empirical data on health system performance in four counties of two central and western provinces. Quantitative data were subjected to descriptive statistical analysis through SPSS12.0. Three dimensions were introduced in the performance review framework—health outcomes, financial risk protection and consumer and provider satisfaction. Health outcomes were assessed from four secondary indicators: infant mortality rate; maternal mortality rate; under-5 child mortality rate; and the incidence of Class A and Class B notifiable diseases. Financial risk was assessed using two secondary indicators: the proportion of the cost of inpatient care that was reimbursed under the New Cooperative Medical System (NCMS) insurance scheme, and the rate of NCMS funds utilization. The assessment of satisfaction was made using two secondary indicators: the overall satisfaction of local residents with healthcare services, and the satisfaction of health practitioners at the township and village level. The study indicated better health system performance in the two counties in Chongqing than those in Shanxi. It was concluded that outcome framework scores can fairly reveal performance differences among county health systems in central and western China, and can provide practical evidence for optimizing the operation and inputs of county health systems. Caution needs to be exercised in generalizing such performance outcomes as many factors such as spending and organization that contribute to county health system performance were not included in the study.

Keywords

county / health systems / performance / outcome / measurement

References

[1] SmylieJ., AndersonI., RatimaM., et al.. Indigenous health performance measurement systems in Canada, Australia, and New Zealand. Lancet, 2006, 367(9527): 2029-2031

[2] PeiL.K.. Australia health system performance review framework. Chin J Hosp Admin (Chinese), 2004, 20(8): 510-512

[3] World Health Organization.. . The world health report 2000: health systems: improving performance, 2000, Geneva, World Health Organization

[4] MarcJ.R., WilliamsH., PeterB., et al.. . Getting health reform right: A guide to improving performance and equity. Background material for flagship course on health reform and sustainable financing, 2001, Washington, World Bank

[5] AtunR., NiamhL.C.. . Background and framework of SYSRA toolkit. Public health leadership programme. Center for health management, 2006, London, Tanaka Business School, Imperial College

[6] LiuY., RaoK., WuJ., et al.. China’s health system performance. Lancet, 2008, 372(9653): 1914-1923

[7] PersaudD.D., NestmanL.. The utilization of systematic outcome mapping to improve performance management in health care. Health Serv Manage Res, 2006, 19(4): 264-276