Multifactor Analysis on the Income of Primary Health Care Institutions Implementing EMS in Hubei Province, China: A Cross-sectional Study

Abstract

The objectives of this study are to measure the level of income of primary health care institutions during essential medicines system (EMS) implementation and to identify its main influencing factors for finding the evidence to promote the EMS in China’s deepening health care reform. The field investigation with a stratified sampling method contained primary health institutions from Hubei province, based on the different economic levels. Government-run institutions which implemented EMS were all collected; they were a total of 402. A structured questionnaire survey was carried out at all institutions involving indicators such as income of primary health care institutions, government subsidy, institution staff salaries, institution indebtedness, number of health personnel, drug price cut (per cent) and number of drug use. The Statistical Package for the Social Sciences (SPSS) 12.0 was used for independent variables selection and to perform multiple linear regressions. Government subsidy (X1), institution staff salaries (X2), institution indebtedness (X3) and number of health personnel (X4) are factors chosen into the regression model, the square root of the income of primary health institutions (Y). The model Y = 3.827 + 0.030X1 + 0.045X2 + 0.002X3 + 0.033X4 (F = 164.663, P < 0.001), where coefficient of determination R2 = 0.656. The biggest influence on income of primary health institutions is institution staff salaries (standardized coefficients = 0.398), followed by number of health personnel (standardized coefficients = 0.318) and government subsidy (standardized coefficients = 0.264). To protect the income of primary health care institutions, more attention should be paid to the agency staffing reform, individual performance appraisal and government subsidies. For best outcomes of EMS, the subsequent implementation should be a more completed set of supporting measures besides the design of system itself.