How China's new health reform influences village doctors' income structure: evidence from a qualitative study in six counties in China.
BACKGROUND
In 2009, health-care reform was launched to achieve universal health coverage in China. A good understanding of how China's health reforms are influencing village doctors' income structure will assist authorities to adjust related polices and ensure that village doctors employment conditions enable them to remain motivated and productive. This study aimed to investigate the village doctors' income structure and analyse how these health policies influenced it.


METHODS
Based on a review of the previous literature and qualitative study, village doctors' income structure was depicted and analysed. A qualitative study was conducted in six counties of six provinces in China from August 2013 to January 2014. Forty-nine village doctors participated in in-depth interviews designed to document their income structure and its influencing factors. The themes and subthemes of key factors influencing village doctors' income structure were analysed and determined by a thematic analysis approach and group discussion.


RESULTS
Several policies launched during China's 2009 health-care reform had major impact on village doctors. The National Essential Medicines System cancelled drug mark-ups, removing their primary source of income. The government implemented a series of measures to compensate, including paying them to implement public health activities and provide services covered by social health insurance, but these have also changed the village doctors' role. Moreover, integrated management of village doctors' activities by township-level staff has reduced their independence, and different counties' economic status and health reform processes have also led to inconsistencies in village doctors' payment. These changes have dramatically reduced village doctors' income and employment satisfaction.


CONCLUSIONS
The health-care reform policies have had lasting impacts on village doctors' income structure since the policies' implementation in 2009. The village doctors have to rely on the salaries and subsidies from the government after the drug mark-up was cancelled. China's national health reforms are attempting to draw village doctors into the national health workforce, but the policies have impacted their income and independence. Further research into these concerns and monitoring of measures to adequately compensate village doctors should be undertaken. Reasonable compensation strategies should be established, and sufficient subsidies should be allocated in a timely manner.
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. zhangshengfa1988@hotmail.com.
Shengfa
S
Zhang
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. zwj@bnu.edu.cn.
Weijun
W
Zhang
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. chouhuixuan@live.cn.
Huixuan
H
Zhou
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. xhw197@gmail.com.
Huiwen
H
Xu
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. qzy@bnu.edu.cn.
Zhiyong
Z
Qu
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. never_wf@126.com.
Mengqi
M
Guo
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. sabeihu@163.com.
Fugang
F
Wang
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. zy91216@163.com.
You
Y
Zhong
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. gulinni@bnu.edu.cn.
Linni
L
Gu
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. liangxiaoyun@bnu.edu.cn.
Xiaoyun
X
Liang
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. zhihongsa@gmail.com.
Zhihong
Z
Sa
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. wxh@bnu.edu.cn.
Xiaohua
X
Wang
School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. tian65216@hotmail.com.
Donghua
D
Tian
D000328:Adult; D002681:China; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D018166:Health Care Reform; D006291:Health Policy; D006801:Humans; D007182:Income; D007348:Insurance, Health; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D010820:Physicians; D036301:Qualitative Research; D019035:Rural Health Services / Q000191:economics; D012424:Rural Population; D012456:Salaries and Fringe Benefits; D012959:Socioeconomic Factors; D019472:Universal Health Insurance; D000078329:Workforce