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Table 5 Impacts of SERS on health care in selected pilot areas of China

From: Controlling cost escalation of healthcare: making universal health coverage sustainable in China

Impacts Beijing Chengdu Hangzhou
Revenues/ expenditures of CHCs Proportion of drug expenditure and service charges declined as % of the total health expenditure of CHC;
CHCs might not be to receive the payment from governments timely to cover the expenditure [19].
District/county governments increased funding to CHCs
Ave expenditure per outpatient visit declined
CHCs sometimes did not receive payments from governments or social health insurance timely
District/county governments increased financial inputs under SRES;
Ave expenditure of outpatient visit declined;
CHCs might not receive the payments from government timely [24, 27].
Quantity of services provided The quantity of outpatient visits and public health services provided in CHCs increased significantly;
No changes in home visits [21].
The quantity of outpatient visits increased significantly
While more NCD patients have been effectively managed, many NCD patients bypassed CHCs to seek tertiary care
The use of CHCs increased;
CHCs provided more public health services related to NCDs control [25].
Quality of care Patients' satisfaction with outpatient services increased, as more patients chose CHC as the first contact with professional care;
No changes in the management of NCDs [22].
Patients' satisfaction with the services increased, resulting in high use rate.
Lack of qualified general practitioners prevented further increase of quality of care
Overall satisfaction with the CHC services increased significantly;
Lack of qualified general practitioners resulted in slow development of CHCs [26].
Perceptions of community health workers (CHWs) SERS can ensure the income of CHWs, and reduce unnecessary treatments that used to produce profits for CHCs, making healthcare at community level more affordable;
SERS does not provide CHWs with financial incentive to work hard [23].
Most CHWs were satisfied with the reform, while others were less keen to provide public health services, as defined in the SERS. Increased workload, particularly related to NCD control, at CHCs may not be sustainable;
While salaries of CHWs are secured, the income level did not match the increased level of workloads. Many CHWs were not satisfied with their income levels after the reform [24, 27].