Estimating the costs of the national basic public health services in Zhuhai, China, through activity-based costing: a cross-sectional study

OBJECTIVE: Our research aims to estimate the per capita cost of 13 items in the basic public health service (BPHS) project in Zhuhai, China, and provide an economical basis for the improvement of the cost compensation mechanism used by the government. DESIGN: This research is a cross-sectional study. SETTING: A total of 19 primary healthcare facilities (PHFs) in Zhuhai, China, are involved in this research. PARTICIPANTS: A total of 152 participants (114 personnel engaged in BPHS, 19 financial personnel and 19 PHF heads) were included in this study, which was conducted from May 2017 to July 2017. PRIMARY AND SECONDARY OUTCOME MEASURES: We used the activity-based costing model to calculate the cost of providing BPHS in Zhuhai. An analytical hierarchy process was used to determine the difficulty dimension and workload coefficient. RESULTS: The weights of the difficulty dimensions in the provision of BPHS in Zhuhai were 35.04% (coordination of residents), 24.03% (staff workload), 21.36% (complexity of work-related skills) and 19.59% (basic qualities of staff). The average difficulty coefficient of each subproject was 5.28. The actual per capita cost of BPHS provision in 2016 was 97.48 RMB (12.76 EUR), which was higher than the actual standard compensation of 55 RMB (7.2 EUR) in Zhuhai. Immunisation was the most costly among the 13 service items (17.82 RMB or 2.33 EUR per person), whereas the management of tuberculosis was the least costly item (0.57 RMB or 0.07 EUR per person). CONCLUSIONS: Government funds for basic public health services cannot compensate for the actual costs. Accordingly, subsidies should be increased based on the actual per capita cost for sustainable BPHS development. The government should improve the methods used in cost estimation and measures used as the basis for awarding performance incentives.