Ningxia Social Experiment From Design to Implementation to

介绍宁夏项目设计、实施及结果Ningxia Social Experiment: From Design to Implementation to Findings 项目专家组 Research Team

Three-tied delivery system: Defining the role of each level 三级医疗网：各级功能定位 Out-of-county hospital �外医院 County hospital ��医院 Township health centre ���生院 Village clinics 村�生室 • Public health 公共卫生 • Common diseases 常见病 • Referral 转诊

COUNTY HOSPITALS Inpatient Gatekeeper (Global Budget + P 4 QL) 县医院扮演住院守门人角色

管理层面的培训 Management Training Financial management 财政管理 Incentives 激励 Human resource management 人力资源管理 Quality management 质量管理 Internal incentives 内在激励 Behaviour 行为

Seek formal outpatient care when ill, by income quintile 不同收入组两周患病门诊服务使用情况 100% 80% 60% +42% +19% +8% -7. 8% 40% 20% 0% 收入组 Q 1 Q 2 Pre-intervention 基� Q 3 Q 4 Q 5 Post-intervention 干� 后

Reduction in catastrophic expenditures 因病致贫降低 35, 0% -8. 3% 30, 0% 25, 0% -5. 3% 20, 0% 15, 0% 10, 0% 5, 0% 0, 0% Catas. 10% 灾� 性� 生支出-10%� 支出 Pre-intervention 基� Catas. nonfood 40% 灾� 性� 生支出-40%食品以外支出 Post-intervention 干� 后

Reduction in antibiotic prescription at township health centres 乡镇卫生院抗生素使用率的降低 7 5 4 Intervention 3 干预 Control 2 对照 1 0 13, 1% 14, 8% 16, 6% 18, 3% 20, 1% 21, 8% 23, 6% 25, 4% 27, 1% 28, 9% 30, 6% 32, 4% 34, 1% 35, 9% 37, 7% 39, 4% 41, 2% 42, 9% 44, 7% 46, 4% 48, 2% 50, 0% 51, 7% 53, 5% 55, 2% 56, 8% 58, 7% 60, 5% 62, 4% 64, 2% Frequency � 数 (x) 6 x = Daily rates of the percentage of visits to a centre with one or more antibiotics prescribed X= � 生院��� 方中有至少一种抗生素的日均比例

Drug as a share of total hospital expenditure (Yanchi) � 池��� 占医�� 用的比例 70, 00% 61, 38% 61, 01% 60, 00% 57, 96% 56, 73% 53, 28% 50, 62% 50, 00% 41, 43% 30, 00% 2009 2010 2011 2012 1 st half 2012 2 nd half 2013 1 st half 2013 2 nd half year 上半年 下半年

% out-of-county admission (Yanchi) � 池�� 外住院人次分流比（%） 25 20 18, 84 17, 85 15 19, 35 15, 35 11, 46 10 5 2009 2010 2011 2012 2013

初诊病人登记数 NUMBER OF PATIENTS REGISTERED FOR THE FIRST TIME 2013 ��� / Experiment Counties 1579 1351 1156 2147 2011 � 照� / Control Counties

咳痰两周病人转诊肺结核检查率 THE REFERRAL RATE FOR COUGH > 2 WKS 89% 92% 海原/Haiyuan 53% 59% � 池/Yanchi 2013 Q 1 2014 Q 1