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A model to estimate the cost of the National Essential Public Health Services Package in Beijing, China Yin, Delu; Wong, Sabrina T; Chen, Wei; Xin, Qianqian; Wang, Lihong; Cui, Mingming; Yin, Tao; Li, Ruili; Zheng, Xiaoguo; Yang, Huiming; Yu, Juanjuan; Chen, Bowen; Yang, Weizhong Jun 6, 2015

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RESEARCH ARTICLEA model to estimate the cH, LKeywords: Cost estimate, National essential public health services, Public health, Primary healthcare, Chinahypertension,cable diseasesuse of moreevention anddevelopmentYin et al. BMC Health Services Research  (2015) 15:222 DOI 10.1186/s12913-015-0902-4the same public health services regardless of geographicChangPing District, Beijing 102206, ChinaFull list of author information is available at the end of the articleOne such program is the National Essential PublicHealth Services Package (NEPHSP). It aims to provide1Capital Institute of Pediatrics, 2 YaBao Road, #328, ChaoYang District, Beijing100020, China2Chinese Center for Disease Control and Prevention, 155 ChangBai Road,China rapidly improved. The average life expectancy in-creased from 71.4 to 74.8 years between 2000 and 2010[1]. The maternal mortality rate was reduced from 51.3to 26.1 per 100,000 population, and the infant mortalityfaces new public health challenges ofobesity, diabetes, and other non-communi[6, 7]. To address these issues and curbcostly secondary and tertiary care, early printervention programs have been undersince 2009.* Correspondence: 1726137684@qq.com; yangwz@chinacdc.cnBackgroundIn the past few decades, the public health system inrate from 29.2 to 12.1 per 1,000 live births between 2002and 2011 [2–5]. Even with such achievements, ChinaXiaoguo Zheng , Huiming Yang , Juanjuan Yu , Bowen Chen and Weizhong YangAbstractBackground: In order to address several health challenges, the Chinese government issued the National EssentialPublic Health Services Package (NEPHSP) in 2009. In China’s large cities, the lack of funding for community healthcenters and consequent lack of comprehensive services and high quality care has become a major challenge.However, no study has been carried out to estimate the cost of delivering the services in the package. This projectwas to develop a cost estimation approach appropriate to the context and use it to calculate the cost of theNEPHSP in Beijing in 2011.Methods: By adjusting models of cost analysis of primary health care and workload indicators of staffing needdeveloped by the World Health Organization, a model was developed to estimate the cost of the services in thepackage through an intensive interactive process. A total of 17 community health centers from eight administrativedistricts in Beijing were selected. Their service volume and expenditure data in 2010 were used to evaluate thecosts of providing the NEPHSP in Beijing based on the applied model.Results: The total workload of all types of primary health care in 17 sample centers was equivalent to the workloadrequirement for 14,056,402 standard clinic visits. The total expenditure of the 17 sample centers was 26,329,357.62USD in 2010. The cost of the workload requirement of one standard clinic visit was 1.87 USD. The workload of theNEPHSP was equivalent to 5,514,777 standard clinic visits (39.23 % of the total workload). The model suggests thatthe cost of the package in Beijing was 7.95 USD per capita in 2010. The cost of the NEPHSP in urban areas waslower than suburban areas: 7.31 and 8.65 USD respectively.Conclusions: The average investment of 3.97 USD per capita in NEPHSP was lower than the amount needed tomeet its running costs. NEPHSP in Beijing is therefore underfunded. Additional investment is needed, and adynamic cost estimate mechanism should be introduced to ensure services remain adequately funded.National Essential PublicPackage in Beijing, ChinaDelu Yin1,2,3, Sabrina T. Wong4, Wei Chen5, Qianqian Xin11 1 1© 2015 Yin et al. This is an Open Access articl(http://creativecommons.org/licenses/by/4.0),provided the original work is properly creditedcreativecommons.org/publicdomain/zero/1.0/Open Accessost of theealth Servicesihong Wang1, Mingming Cui1, Tao Yin1, Ruili Li1,1,3* 2*e distributed under the terms of the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium,. The Creative Commons Public Domain Dedication waiver (http://) applies to the data made available in this article, unless otherwise stated.area and expand coverage of essential public healthprograms to all residents of China [8]. The programincludes 10 services (see Table 1) that are mainly focusedon children aged 0 to 36 months, pregnant women, thoseaged over 65 and patients with chronic conditions andmental health issues [9, 10].China’s community-based primary healthcare (PHC)facilities are designed to deliver comprehensive PHCservices, from family planning to rehabilitation, and theNEPHSP. These universally-accessible [11] PHC facilitiesinclude village and township clinics in rural areas andcommunity health service facilities in urban areas.The package of services available to all residents wasoriginally funded by local, provincial, and national gov-ernments at 2.38 USD per person [12]. However, thisfunding was insufficient, leading to services that werenot comprehensive, low quality of care and an insuffi-cient volume of services delivered through PHC facilities[13–15]. In China’s large cities, the lack of funding forcommunity health service facilities and consequent lackTable 1 Types of services included in the NEPHSP in 2009Types DetailsHealth recordsmanagementEstablishing and updating health recordsand health information for residents whohave lived in the area for more than 6monthsHealth education Health education and publications aboutunhealthy life style, risk factors, anddiseases to all the residents in the areaHealth services for childrenaged 0 to 36 monthsHome visits to newborn infants, physicalexaminations for children, and healthYin et al. BMC Health Services Research  (2015) 15:222 Page 2 of 7education and guidance to parents ofchildren aged 0 to36 monthsMaternal health services Maternity care before and after delivery,and a post-natal physical examination42 days after deliveryOlder people’s healthservicesPhysical examinations, health advice,guidance and intervention for all thoseaged over 65Immunizations Routine immunizations for children aged 0to 3 and for vulnerable older peopleInfectious disease reportingand treatmentRegistering, reporting, and managingpatients with (suspected) notifiablediseases and their close contactsHealth services for patientswith hypertensionEstablishing health records, screening andfollowing-up and systematic physicalexaminations of anyone aged over 35with hypertensionServices for patients withtype II diabetesEstablishing health records, screening andfollowing-up and systematic physicalexaminations for anyone aged over 35with Type II diabetesServices for patients withsevere mental illnessEstablishing health records and providingfollow-up services for any patients withsevere mental illness who are living athome(Source: National Essential Public Health Services Guidelines, 2009)of comprehensive services and high quality care [16–18]has become a major challenge. Beijing, the home of over20 million people, is not exempt from these challenges.However, little information exists on how to appropri-ately cost services provided by the PHC facilities [19–21].Historically, the ladder-sharing method has been usedby the Chinese government to examine costs of healthservices [22]. The basic steps include collecting the totalcost of the facilities, determining the direct costing depart-ments and indirect costing departments and defining thecosts of each, then distributing the indirect costs to thedirect-cost departments and getting their total costs. Thefinal step is calculating the costs of the targeted healthservices by workload in the direct-costing departments.However, this method cannot be used in PHC settings be-cause of several inherent limitations. First, PHC includesvarious categories and types of services that can be deliv-ered by a single healthcare professional. It is thereforehard to allocate indirect cost to different departments[23]. Second, the ladder-sharing method requires relativelyaccurate data for costing [24, 25], but PHC facilities donot have advanced health information systems or financialmanagement systems. Finally, it is impossible for theladder-sharing method to estimate investment need whennew services are added to the package, which happensfrequently as China’s fiscal capacity increases. The purposeof this project was to develop a cost estimation approachappropriate to the PHC context and use it to calculate thecost of the NEPHSP in Beijing.MethodsSettingBeijing, in northern China, is China’s capital city,and home to over 20,000,000 people. Most PHC servicesare delivered through publicly-funded community healthcenters (CHCs) and smaller, affiliated, community healthstations. There are 327 community health facilities locatedthroughout Beijing, which provide residents with a compre-hensive set of PHC services delivered by medical, nursing,and paramedical teams. Community health facilities alsoprovide traditional Chinese medicine.We conducted a secondary analysis of data collectedfrom 17 randomly-selected CHCs located in eight adminis-trative districts (Xicheng, Haidian, Chaoyang, Mentougou,Huairou, Miyun, Pinggu and Tongzhou). Seven of thesecenters were in urban districts and 10 in suburban areas.No national information or reporting system for thecommunity-based PHC system currently exists [12]. How-ever, all eligible sites had computerized electronic medicalrecords. The Ethics Committee of the Capital Instituteof Pediatrics approved the study. All the participants in theselected centers provided written informed consent, andall the patient information was anonymized and de-identified prior to analysis.indicators were created for each PHC service.Yin et al. BMC Health Services Research  (2015) 15:222 Page 3 of 7Procedures for data collectionData on costs were collected as part of a larger study.CHC managers were trained in how to collect the neces-sary data. A standardized data collection tool was usedto collect basic information, and the expenditure andvolume of each type of PHC services, including the 10types in the NEPHSP. Data were collected over a 3-weekperiod. Two separate researchers conducted site visits tooversee the data collection.Expenditure in the sampled CHCs was classified basedon the resource inputs used for the service [26, 27].These included human resources, material expenditureand public expenses, as set out by the government. Atthe time, the CHCs in Beijing had separate managementof income and expenditure, so all income was from pub-lic sources. Human resource expenditure included basicsalaries, allowances, bonuses, social insurance, housingaccumulation funds, purchasing subsidies, living subsid-ies, and medical expenses. Material expenditure includedmedicines, health materials and low-valued consumables.Public expenses expenditure included printing, water,electricity, mail services, transportation, travel expenses,and meeting and hospitality costs.ModelBased on methods used by the World Health Organizationin a manual on cost analysis of PHC [28, 29], foursteps were developed to estimate the costs of theNEPHSP in Beijing: 1) determine the standard serviceprotocols of all types of PHC services; 2) define theworkload indicators needed for a set of standardactivities for services, and their equivalent value (EV)compared with a standard clinic visit; 3) calculate theaverage cost of one EV; 4) calculate the cost of NEPHSPper capita.Step 1: Determining the standard service protocolsAll types of PHC services providing by the sampledCHCs were investigated. In total, there were 65 types ofPHC services deemed necessary for inclusion in thestandard service protocols, including medical, nursing,paramedical, the NEPHSP and other public healthservices, and auxiliary examinations. The main types arelisted in Table 2. Only 10 of the 65 were included inthe 2009 NEPHSP guidelines. The remaining 55 serviceswere defined in line with the 2007 Beijing technicalspecification for primary health services [30], and weresimilar across urban and suburban areas.Step 2: Calculating the workload indicator and theequivalent value (EV) of each PHC serviceStep 2.1: Workload indicator of each PHC serviceIn order to create the workload indicator (person-time)of each PHC service, a multi-stage iterative feedback andTo test these workload indicators, eight CHCs (foururban and four suburban) were randomly selectedfrom the sample of 17 to participate in direct obser-vations. Five research assistants were trained to ob-serve the services and record the length of time foreach PHC service and the number of health workersinvolved. Direct observation took place over a periodof three continuous days in each CHC. Face-to-faceinterviews were conducted to determine the usualtime and the required number of health workers forservices for which these details could not be recordedduring the period of direct observation.The workload indicators were modified based onthe direct observation and interviews. Group inter-views with the staff at the eight centers (n = 32) werethen conducted to test the workload indicators. Fam-ily physicians (n = 8), nurses (n = 8), public healthworkers (n = 8), and other health professionals (n = 8)participated.Step 2.2: Equivalent value of each PHC serviceTo ensure that different types of services can be dir-ectly compared, a “standard clinic visit” was intro-duced as a benchmark to gauge the necessary peopleand time required (workload indicator) for the otherservices. A standard clinic visit was defined a familyphysician consulting with one patient for 15 min [31].The workload indicator of “a standard clinic visit”was defined as one equivalent value (EV). Equivalentvalues of all other PHC services were then calculatedas their workload indicator (step 2.1) compared withthe standard clinic visit. For example, a home visitmay include the time taken to travel to and from thepatient’s home, and to administer medication. Theworkload indicator of one home visit was 60.00revision process were conducted. A series of fourmeetings were held with participants (n = 72). They wereinvited to attend these meetings based on their know-ledge and expertise about PHC and their region (urbanor suburban). Stakeholders included community healthservice managers (n = 36), family physicians (n = 18),nurses (n = 10), and public health workers (n = 8). Dur-ing the meetings, participants discussed the person andamount of time required for each PHC service, anddiscussed the workload assigned to each service in thestandard service protocols. They also discussed sug-gested modifications. Since different time periods areneeded for the same type of service in urban and subur-ban PHC facilities, because of the different populationdensity and delivery model, two sets of specific workloadperson-time in both urban and suburban areas, so itsEV was 4 (60/15). The EV of each PHC service inth60.00 4.00 60.00 4.00Inpatient bed dayit)Yin et al. BMC Health Services Research  (2015) 15:222 Page 4 of 7Rehabilitation clinic (per outpatient visNursing services Intravenous injectionTable 2 Workload and EV of the main PHC services compared wiCategories TypesEssential medical services Clinic visit (per visit)Emergency (per visit)Home visit (per visit)urban and suburban areas was defined separately andis shown in Table 2.Step 3: Calculating the cost of one EV (a standard clinicvisit)The full expenditure and the volume of each PHCservice in the 17 sampled CHCs were investigated. Thevolume was multiplied by the EV of each PHC service,and these figures were added together to get the totalEVs of the 65 types of PHC service across the sampledCHCs. We used the following formula to obtain the costof one EV (a standard clinic visit):Intravenous infusionIntravenous injection, venous bloodCatheterizationProviding prescription (western medicinePharmacy service Providing medication to meet a prescript(per prescription)Advanced pharmacy work, including detadosage calculations (per prescription)Auxiliary examination service Rapid blood sugar testBlood, urine, feces test (per test)Biochemical test (per test)Electrocardiogram (per test)B-mode Ultrasonography (per test)NEPHSP Health records management service(per person year)Health education service (per center)Health services for children aged 0 to 36months (per person year)Maternal health services (per person yearOlder people’s health services (per personImmunizations (per visit)Infectious disease reporting and treatmen(per time)Patients with hypertension (per person yePatients with type II diabetes (per personPatients with severe mental illness (per pe100.05 6.67 180.00 12.0030.00 2.00 30.00 2.007.50 0.50 6.00 0.40a standard clinic visitUrban SuburbanWorkload Mean EV Workload Mean EV15.00 1.00 15.00 1.0040.35 2.69 52.50 3.50The cost of one EV = total expenditure in all the sam-pled CHCs /∑ volume × EV of each PHC service in eachsampled CHCs.Step 4: Calculating the cost of the NEPHSP per capitaStep 4.1: Calculating the total workload of the NEPHSP andits total costsThe NEPHSP included 10 types of services. The volumeof these 10 types in the sampled CHCs were multipliedby their EV, and then were added together to producethe total workload of the NEPHSP across all sites. Thetotal EV of the NEPHSP was then multiplied by the cost12.00 0.80 11.70 0.789.30 0.62 9.45 0.6328.95 1.93 19.50 1.30) 4.50 0.30 6.00 0.40ion 19.95 1.33 19.95 1.33iled 63.60 4.24 60.00 4.004.50 0.30 4.65 0.319.00 0.60 9.15 0.6130.00 2.00 27.45 1.8311.25 0.75 10.05 0.6719.95 1.33 19.95 1.331,019.25 67.95 972.00 64.8047,076.00 3,138.40 34,650.00 2,310.00173.40 11.56 203.40 13.56) 210.00 14.00 262.50 17.50year) 60.00 4.00 49.95 3.3325.05 1.67 15.45 1.03t 5,913.6 394.24 4,979.40 331.96ar) 190.05 12.67 152.55 10.17year) 190.05 12.67 147.45 9.83rson year) 472.50 31.50 420.00 28.00Table 3 Basic information for sampled community health centersUrban (n = 7) Suburban (n = 10) Both (n = 17)Average employees per center 134.00 116.00 123.00Average population served* 117,687.00 47,260.00 76,259.00Total annual expenditure (USD) 12,756,127.14 13,573,230.79 26,329,357.62Human resources expenditure (USD) 8,337,175.71 9,099,476.35 17,436,651.90Material expenditure (USD) 1,038,666.67 1,532,670.48 2,571,336.98Public funds expenditure (USD) 3,380,284.76 2,941,083.97 6,321,368.73orYin et al. BMC Health Services Research  (2015) 15:222 Page 5 of 7of one EV to give the total cost of the NEPHSP acrossthe sampled CHCs.Step 4.2: Calculating the cost of the NEPHSP per capitaTo calculate the cost of the NEPHSP per capita, the totalpopulation served by the sampled CHCs was taken fromthe standardized data collection tool. The populationused was those resident for at least 6 months, and wasreported by the sample CHCs to the local governmentalStatistical Bureau. The following formula was used tocompute the cost of the NEPHSP per capita.The cost of the NEPHSP per capita = total cost ofthe NEPHSP across the sampled CHCs/total populationserved by the sampled CHCs.ResultsSample CHCs and their expenditureOn average, each sample CHC had an average of 123employees on the payroll (2,094 employees in 17 cen-ters), serving on average a community of 76,259 people(a total of 1,296,403 people). It had an annual expend-iture of 1.55 million USD (a total of 26,329,357.62 USD).The CHCs in urban areas had more employees, servedmore people and had more annual expenditure thansuburban areas (see Table 3).Mean EV of PHC services (including NEPHSP) and thetotal workloadThe EV of the standard clinic visit was 1.00. Table 2shows the mean EV of some main types of PHC services*The population used here was those resident for at least 6 months, and was repincluding NEPHSP. The EV in urban areas was largerTable 4 EV of the PHC services in 17 sampled community health ceCategories UrbanBasic medical service 1,957,673 26.30 %Nursing service 311,082 4.18 %Pharmacy service 663,543 8.91 %Auxiliary examination service 245,811 3.30 %NEPHSP 3,520,967 47.30 %*Other services 744,342 10.00 %Total 7,443,417 100.00 %*These services cannot be included in any category above. Group interviews suggeCost of the NEPHSP per capitaAs shown in Table 4, the total EVs of the NEPHSP inthe 17 sampled CHCs were 5,514,777, which accountedfor 39.23 % of the total EVs (urban: 3,520,967, 47.30 %;suburban: 1,993,810, 30.15 %). The cost of one EV was1.87 USD. The total cost of the NEPHSP across all thesampled CHCs was 10,312,633 USD in 2010. The totalnumber of served people was 1,296,408, giving an aver-age cost per capita of 7.95 USD. The cost per capita inCost of one EVThe full expenditure and volume of each PHC service inthe 17 sampled CHCs are shown in Table 3. The totalworkload of 65 types of PHC services in the 17 sampledCHCs was 14,056,402 EVs. Table 3 shows that the totalexpenditure in 2010 was 26,329,357.62 USD. It wastherefore estimated that the average cost of one EV was1.87 USD. The cost of one EV in urban areas was higherthan that in suburban areas (see Table 5).than in suburban areas. The reasons for this includepopulation density, and delivery model.The total EVs of the 17 sampled CHCs including basicmedical services, nursing, pharmacy, auxiliary examina-tions, and the NEPHSP in 2010 was 14,056,402. The EVsof basic medical services and the NEPHSP accounted forthe majority, 32.10 % and 39.23 % respectively. The aver-age EVs for each center were 826,847 (see Table 4).ted by the sample center to the local governmental Statistical Bureauurban areas was lower than suburban areas (see Table 6).ntersSuburban Both2,553,832 38.62 % 4,511,505 32.10 %226,897 3.43 % 537,979 3.83 %621,532 9.40 % 1,285,075 9.14 %555,615 8.40 % 801,426 5.70 %1,993,810 30.15 % 5,514,777 39.23 %661,298 10.00 % 1,405,640 10.00 %6,612,985 100.00 % 14,056,402 100.00 %sted their workload could account for 10 % of the totalYin et al. BMC Health Services Research  (2015) 15:222 Page 6 of 7DiscussionIn 2009, 2.38 USD per capita was allocated by theChinese central government to cover the operatingcosts of the PHC package. This was increased to 3.97USD in 2011 [9, 10], but is still much lower than theamount needed to meet the standard running costs,which were about 7.95 USD per capita in Beijing.This study confirmed that the NEPHSP program inBeijing is underfunded [13–15].The population density in suburban areas is lower andthese areas are more mountainous, thus it is harder toprovide the same service to suburban residents, espe-cially with home visits included. However, the averagenumber of employees in the sample suburban centerswas lower (Table 2). The labor costs per output andmaterial costs were therefore higher than for urbanareas. The public funding allocation is related to thepopulation served, so is the same per capita for urbanand suburban areas. This made the average cost percapita in suburban areas higher than in urban areas. It ispossible that there was a certain economy of scale atwork in urban areas. It may therefore be possible tolower the cost of services in suburban areas by mergingsome of the providers to serve a larger population. How-ever, this will weaken accessibility. Further studies areneeded to establish whether this would be feasible.Currently, NEPHSP is one of the most importanthealth care systems in Beijing [32]. Our study revealedthat NEPHSP accounted for almost 40 % of the totalPHC provision. Although government-funded, PHC inChina remains underfunded and understaffed [33, 34].With the expanding of NEPHSP, the development ofPHC will be hindered if government investment inNEPHSP remains lower than costs. To provide highquality NEPHSP services, and to address the potentialchallenges, the Chinese government needs to take imme-Table 5 Cost of one EV (USD)Cost items Urban Suburban TotalHuman resources costs 1.12 1.38 1.24Materials costs 0.14 0.23 0.18Public funds 0.45 0.44 0.45Total 1.71 2.05 1.87diate action to increase investment in PHC.Even if the government increased financial input tomeet the real costs, any new allocation would soonbe inadequate as the costs associated with care wouldcontinue to rise. A dynamic cost estimate mechanismshould therefore be established, to keep abreast of changesin primary health service regulations, personnel alloca-tions, commodity prices, salaries, and other costs. Withthe further improvement of the PHC information system,and by using this new model, the costs could be trackedin real time to obtain accurate and timely results. Fundinginputs could then be adjusted to support the developmentof PHC services.The determination of EV needs only to take numberof medical personnel and time into consideration. Thismay potentially reduce the degree of technical difficultyin estimating costs. In 2013, the government increasedthe financial investment of NEPHSP, and adjusted theservice requirements [35]. As new types of services wereadded to the package in the future, the cost estimatemodel used in this study could be adjusted onsite bysimulation to determine the number of medical personneland the amount of time needed. The result could be helpfulto the government in assessing the funding requirementsof the added service(s).We note that this study has certain limitations. First,the estimate of medical personnel and time neededwere based on service protocols, rather than the actualprocess or content. The cost calculated was therefore onlytheoretical. The validity of the method to estimate cost ofNEPHSP needs to be tested further in practice. Second,we would have preferred to use national PHC guidelinesfor types other than NEPHSP as the standard serviceprotocols to define their EV. However, these protocolswere not widely-used or tested for validity [36].ConclusionsOur results show that it is possible to establish a mechanismfor estimating the cost of primary healthcare services inBeijing. While more research is needed to validate themethod, the average funding of 3.97 USD per capita inNEPHSP was lower than the amount estimated to meet thestandard running costs in Beijing. This suggests that theservice is underfunded. We suggest that a dynamic costestimate mechanism should be introduced to ensurefunding remains sufficient.Table 6 Cost of the NEPHSP per capita (USD)Cost items Urban Suburban TotalHuman resources costs 4.79 5.82 5.27Materials costs 0.60 0.97 0.76Public funds 1.92 1.86 1.92Total 7.31 8.65 7.95AbbreviationsNEPHSP: National Essential Public Health Services Package; PHC: Primaryhealthcare; CHCs: Community health centers; EV: Equivalent value.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsDY, WC, TY, LW, RL, MC, XZ, HY, JY, WY, and BC were responsible for theconception, design and acquisition of data. DY was responsible for theanalysis and interpretation of data and drafting the initial manuscript. SWand QX revised it critically for important intellectual content. BC was15. Zhu X, Dai T, Wang F, You C. Analysis on the Major Problems in23. Zhu K, Xie Y, Chen X. Comparison of Main Costing Approaches for PublicHealth Project. Chinese Journal of Health Policy. 2010;03(9):45–8.24. Liu C. Challenges for the Development of Health Information Systems forCommunity Health Services in China. Chinese General Practice.2009;12(3):180–3.25. Yan J, Huang G, Zhang J. Major Issue and Countermeasure for CommunityHealth Service Information System Construction. Chinese General Practice.2011;14(34):3908–10.26. BFB. Opinion On Public Expense Of Community Health Service Facilities inBeijing. Beijing: Beijing Finance Bureau; 2010.Yin et al. BMC Health Services Research  (2015) 15:222 Page 7 of 7Implementation of Equalization of Essential Public Health Services in China.Chinese Journal of Social Medicine. 2011;28(2):121–4.16. Liu J. Situation Assessment and Countermeasures on the Equalization ofBasic and Public Health Services between Urban and Rural Areas in Beijing.responsible for reviewing all drafts of the manuscript and giving finalapproval of the version to be published. All authors read and approved thefinal manuscript.AcknowledgmentsWe would like to thank the Beijing Municipal Health Bureau, BeijingAdministration Center of Community Health Service and Health EconomyAssociation of Beijing for their generous support. We are also grateful for thehelp of Professor Onil Bhattacharyya (University of Toronto, Toronto, Canada)and Weiming Tang (Department of Epidemiology, School of Public Health,University of California, Los Angeles, USA) who have offered us valuablesuggestions, insightful criticism and expert guidance in the preparation andrevision of the manuscript. This study was funded by “The Capital HealthResearch and Development of Special” (2011-M-14).Author details1Capital Institute of Pediatrics, 2 YaBao Road, #328, ChaoYang District, Beijing100020, China. 2Chinese Center for Disease Control and Prevention, 155ChangBai Road, ChangPing District, Beijing 102206, China. 3CommunityHealth Association of China, Beijing, China. 4University of British ColumbiaSchool of Nursing and Centre for Health Services and Policy Research, 6190Agronomy Road, #302, Vancouver, BC V6T 1Z3, Canada. 5Beijing University ofChinese Medicine, 11 BeiSanhuan East Road, ChaoYang District, Beijing100029, China.Received: 21 November 2014 Accepted: 3 June 2015References1. Meng Q, Tang S: Universal Coverage of Health Care in China: Challengesand Opportunities. World Health Report (2010) Background Paper, No 72010.2. MOH. Chinese health statistics summary. Beijing: Ministry of Health of thePeople’s Republic of China; 2000.3. MOH. Chinese health statistics summary. 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