Health financing policies - Providers' opinions and prescribing behavior in rural China

Objectives: To describe effects of health financing on providers' opinions and prescribing behavior in rural China. Methods: A multi-stage sampling procedure was used to select county, townsh ip, and village health care facilities. A total of 1,064 health care provid ers in county, township, and village health care facilities in six counties in central China were randomly selected and surveyed during one week by wr itten questionnaire. Results: Patient's health financing systems (insurance or out-of-pocket pay ment), financing methods for health facilities (general budget or fee for s ervice), and payment methods for providers (salary or bonus) influenced pro vider prescribing. Bonuses could improve the quality of health care, but co uld also be an incentive to prescribe more drugs or more expensive drugs an d other services. The providers were of the view that patients' health fina ncing and ability to pay were the main determinants of the type of treatmen t. Insured patients could have more access to expensive drugs, referred to specialized health care facilities, and have a higher cure rate (according to the doctor's opinion) for tuberculosis. Most of the clinical doctors sai d that they prescribed more expensive antibiotics for insured patients and changed prescriptions according to patients' demands, financial ability, an d health financing systems in the treatment of some diseases, such as chron ic bronchitis, tuberculosis, and hypertension. Conclusion: The empirical data suggest that the main factor influencing pro vider prescribing behavior is the economic incentives in relation to health care financing for both health care providers and consumers.