The Financing and Components of Recurrent Health Expenses in Primary Healthcare Institutions in Beijing-based on SHA2011

Background Primary healthcare institutions are the key link in hierarchical diagnosis and treatment, and national policies emphasize the need to deepen the "strong grassroots" reform and play its role as the "bottom of the net". Objective To understand the development and resource utilization of primary healthcare services in Beijing, and provide policy suggestions for optimizing the resource allocation of primary healthcare institutions in the next step. Methods Based on SHA2011, a combined method of stratified and simple random sampling was used to select a total of 29 medical and health institutions. A database was formed based on the International Classification of Diseases (ICD-10) coding to complete the accounting of recurrent health expenses in Beijing. The data concerning Beijing health expenses were derived from China Health Statistics Yearbook, Beijing Health Statistics Yearbook, Beijing Municipal Government Healthcare Subsidies Monitoring System, Beijing Public Health Information Center, and so on. The overview, funding sources, and functional flow of health expenses (including treatment service expenses and prevention service expenses) in primary healthcare institutions from 2014 to 2020 were analyzed. Results The recurrent health expenses for Beijing's primary healthcare institutions increased from 12.231 billion yuan to 32.761 billion yuan, with an average annual growth rate of 15.53%, and its proportion in health expenses increased from 7.93% to 13.61%. The inputs were mainly from medical insurance reimbursement programs and Beijing municipal government subsidies, while the proportion of household health expenses has decreased from 18.65% to 8.30%. The proportion of treatment service expenses fluctuated from 87.49% to 77.73%, mainly consumed by endocrine, traditional Chinese medicine and circulatory system diseases, accounting for more than 60.00% cumulatively. The main population of primary treatment services was elderly patients over 60 years old, and the proportion of expenses increased from 48.92% to 64.31%. The proportion of preventive service expenses fluctuated from 12.51% to 22.27%, and the resources of grassroots preventive services were mainly consumed by preventive services such as traditional Chinese medicine health management, immunization planning, health education, elderly health management, and chronic disease management. Conclusion The results of hierarchical diagnosis and treatment are initially obvious, and the primary healthcare resources develop rapidly, which plays an important role in the medical and health system of the capital. The government has assumed important funding responsibilities at the grassroots level, the personal burden of residents has declined, the grassroots patients are mainly elderly and chronic non-communicable disease patients, and the prevention service capacity has been continuously improved.