Enhancing community system in China's recent health reform: An effort to improve equity in essential health care

ObjectsThis article reviews China's policy development on community health centers and examines effects on service selection, due to difference in funding level and profit seeking incentive.MethodsWe summarize policies on community health centers since 1997 and identify the importance of joint action from seven government agencies in 2006. Using survey data in 2006 and 2007 from two cities with different financing capability and management strategy, we analyze service selection between these cities and before and after a funding policy change.ResultsWith better financing capability (65 vs. 9 Yuan per resident) and a government backup for any loss, community centers in city A provide more high-cost services than city B such as house visits (275 vs. 6 per 10,000 residents) and house beds (52 vs. 1 per 10,000 residents). Both services are mostly demanded by residents.ConclusionJoint action from related government agencies in 2006 is critical for the rapid development of community health system in China. With less funding, community centers have to restrict high-cost services. There is no evidence of shirking after initiating a fully funded financing policy. Economic disparity among cities is a major barrier for improving equity in basic health care.