Abstract
BACKGROUND: Since the 2009 healthcare system reform, China's National Essential Public Health Service Package (NEPHSP) has made notable progress. However, due to low levels of informatization and limited attention to rural areas, existing research has primarily focused on urban settings, with few studies examining cost estimation and its practical application in rural regions. Moreover, cost estimation findings are rarely used to inform grassroots management practices. This study aims to provide empirical support for improving the efficiency and quality of the NEPHSP at the grassroots level. METHODS: This study employed a multi-stage stratified sampling method to randomly select 50 township health centers in Guangxi. Data on revenue, expenditure, and workload related to primary medical services and the NEPHSP were collected. The equivalent method was used to estimate service costs, and correlation analysis and analysis of variance were conducted to identify factors influencing costs and workload. RESULTS: Per capita actual subsidy (CNY 57.78) < per capita actual expenditure (CNY 60.35) < per capita allocated subsidy (CNY 74) < per capita estimated cost (CNY 110.96). There was a weak positive correlation between the actual revenue from the NEPHSP and county-level GDP (r = 0.375, P < 0.05), and a weak positive correlation between the per capita estimated cost and the proportion of total equivalent value of the NEPHSP (r = 0.414, P < 0.01). Analysis of variance indicated significant differences in the equivalent value proportions of 13 NEPHSP categories and in the unit equivalent values for some services across counties (P < 0.05). CONCLUSION: This study is expected to generate key evidence on the relationships and influencing factors among different per capita costs, as well as the workload and unit efficiency of the NEPHSP, providing empirical support for optimizing resource allocation and improving the efficiency and quality of the NEPHSP.