Feasibility Analysis of Incorporating Health Education into National Social Heal

Abstract. This article is aimed to conduct the feasibility analysis of incorporating health education into social Health Insurance by combining the summary of relevant experience on overseas health education and health development with recent domestic health education. Foreign experience indicated that health education could significantly reduce medical expenditure. China has the capability to incorporate health education by community health services into national social health insurance. In conclusion， the health education conducted among patients with chronic diseases and potential chronic diseases could eliminate the risk factors and reduce the incidence of disease， disability and death， thus reducing significantly medical expenses. In short， this could be a very effective measure to reduce the growth rate of expenditure and keep balance for China’s medical insurance fund. Therefore， the social health insurance could build health management model with community health services. In the meantime， the partial social health insurance funds are allowed for residents’ health management. That means， community health management could be incorporated into health insurance management.

Key words： Health education；Medical insurance；feasibility

1 Introduction

With the continuous development of medical reform， China’s medical insurance expenses indicates the increasing trend year-on-year， even over the growth of income of the fund. In long term， the unbalance operation would endanger the long-term health development of the health care system. One of important factors in medical insurance expenditure is medical expenditure caused by chronic diseases. With the reference to the analysis from the Institute of Health Economics， Ministry of Health in 2003， the direct medical costs for residents’ five chronic diseases such as malignant tumors， cerebrovascular disease， heart disease and hypertension and diabetes reached 120.95 billion RMB， accounting for 1.03% of GDP， 18.37% of the national health cost and 21.05% of the total national medical costs， which was 3.83 times of the direct medical costs of these five chronic disease in 1993. The average annual growth rate was 14.37%， which was 1.66 times of the average annual growth rate of GDP in the same period and over total health expenditure growth （12.77%） and total medical costs growth （12.88%）. Therefore， this article proposed incorporating health education into social health insurance as the measure of efficient health management and cost control on the basis of learning relevant experience on overseas health education and health development.

2 Review of Health Education

There is no accepted standard for the definition of health education. Domestic health education expert Professor Jingheng Huang defined ‘health education is a planned， organized， systematic educational activities to promote people’s voluntary adoption of healthy behaviors and lifestyles， to eliminate risk factors， to reduce morbidity， disability and mortality， to maintain and promote physical and mental health， to improve quality of life， and to evaluate the educational effect [1].

In 1972， the Finnish government established intervention projects on behavioral risk factors for hypertension and coronary heart disease. Through 15-year efforts， smoking rates decreased from 52% to 35%. Serum cholesterol levels decreased by 11% and mortality ischemic heart disease among middle-aged men declined 38%. Then， the WHO promoted Finland's experience to the global [2].

Throughout the health education achievements of these countries， the summary of some experience is as follows：

① Guided by advanced theory including behavioral change theory in the individual level and in the interpersonal level. Behavioral change theory in the individual level includes the health belief model， stage-change theory and self-efficacy theory. Behavioral change theory in the interpersonal level includes two theories： social cognitive theory and the change theory of doctor-patient relationship [3].

② Participatory research. Participatory research refers to a series of surveys conducted by the participants plagued by the research problems [5]. What we learnt is that to some extent， the success of the project is largely affected by the needs， capability and power of the potential participants with health problems.

③ Systematic assessment. Take European Health Promotion Indicator Model （EUHPID） [4] as an example to explain the guiding role of the theoretical model in the assessment. The EUHPID model has two dimensions. The first dimension has the emphasis on the interaction between individual， community and society. The second dimension is health promotion from pathogenic and health perspective. Thus， assessment based on this model needs to collect indicators such as personal behavior， attitudes and knowledge and establish connection with social indicators and community indicators. Besides that， the assessment needs to measure the extent on the effect of existing resources on health promotion [5].

④ Social workers and volunteers’ enrollment. In recent decades， health institutions in western countries had realized the potential value of social workers in medical and health development. Currently the social health work contains medical social work， public health social work， rehabilitation and social health work for the elder [8]. Their aim is to focus on social psychology and social relationship through voluntary behavior.

3 Feasibility Analysis

3.1 Analysis of China's health care expenditures and health needs

① China’s medical insurance expenses indicates the increasing trend year-on-year which resulted in the unbalance medical insurance fund.

Fig. 1. Growth of the revenue and expenditure of medical insurance fund 2005-2010

From Figure 1， it was the first time that the growth rate of China’s medical insurance expenditure had been over that of income since 2009， especially more serious in 2010. That means， in the long run， the health insurance would make ends meet. Thus， how to maintain the balance operation of the fund in the long term and how to radically reduce the cost of health care expenditure has currently become the focus issue that calls for immediate solution.

② Health expenditure continues to rise while the health fund is limited. Although the health expenditure and other indicators had substantially increased from 2000 to 2007， in contrast with developed western countries， the proportion of health fund in GDP is still low as well as that of health expenditure in total government expenditure （Table. 1 shows an example）.

Table. 1 Comparison of health expenditure between China and the U.S.

China's huge health expenditures and people's increasing needs in medical insurance require the reforms and adjustments of our health and medical insurance systems. So it is necessary to analyze the focus of the medical expenses and put forward the corresponding solutions.

3.2 Focus of the medical expenditure - chronic diseases

① Chronic disease seriously affect health and impose heavy economic burden. In global， chronic disease has become the biggest killer. It was reported that 49% of annual deaths， 45.9% of the global diseases were caused by cardiovascular disease， cancer， diabetes and respiratory disease by the World Health Organization [7]. With the reference to the analysis from the Institute of Health Economics， Ministry of Health in 2003， the direct medical costs for residents’ five chronic diseases such as malignant tumors， cerebrovascular disease， heart disease and hypertension and diabetes reached 120.95 billion RMB， accounting for 1.03% of GDP， 18.37% of the national health cost and 21.05% of the total national medical costs， which was 3.83 times of the direct medical costs of these five chronic disease in 1993. The average annual growth rate was 14.37%， which was 1.66 times of the average annual growth rate of GDP in the same period and over total health expenditure growth （12.77%） and total medical costs growth （12.88%） [8].

② Chronic disease imposed increasing death and heavy expenditure year by year. With the reference to World Health Report 2002， mortality， morbidity and disability caused by noncommunicable diseases currently account for about 60% of all deaths and 47% of the global diseases. And it is expected to increase to 73% and 60% respectively till 2020 [9]. Our community prevalence of chronic diseases is increasing year by year. The prevalence of chronic diseases has increased by 14.3%in the last 10 years. Medical expenditure per community residents increased by 10 times， which has become the main social health issue， imposing an enormous burden to society and families [10-11].

In summary， solutions to chronic diseases and related health problems will have great significance for keeping healthy and cost control of health care.

3.3 Analysis of health management of chronic disease and health education

Currently China's health management theory and practice in chronic diseases is developing stably with the focus on providing personalized health guidance such as health diet and regular exercise with the original drug treatment for the crowd with unhealthy lifestyle. Health education plays an indispensable role. To be noticed， this health management is largely limited by the geographic and population socio-economic factors.

In terms of the overall environment of health education， the government and society do not pay insufficient attention. The awareness of health education and health promotion has not yet formed. It is reported that health education funding per capita in the first-class， second-class urban communities are 0.086 RMB and 0.009 RMB respectively， accounting for about 0.9% ～ 1.7% and 0.1% of the funding of community health services （minimum standard）. And there is no health funding for health education in the third communities [12].

Although the health management of chronic diseases is in the process of practice， its promotion and benefit is limited. There is still a long way to go in the popularity of health education in the whole society.

4 Discussion of Health Education Model

At present， the implementation of health education in our community health services could not stimulate the participation and enthusiasm of patients with chronic disease and potential patients and lack of interaction between patients and doctor. The measures of health education are relatively homogeneous and backward such as bulletin boards， TV， radio， consultation， followed-up education， health education prescriptions and health education seminars.

The self-management project of chronic disease from the community of Shanghai is build referred to the self-management health education project suitable for all patients with chronic diseases from Stanford University. The main content of this project includes：

① Self-management health education programs. Pair of trained group leaders teach self-management groups consisted of 10-15 patients with various chronic diseases with the uniformed guidance in the community.

② Train community doctors and arrange doctors to take the responsibility for patients’ daily self-management activities.

③ Improve patients’ self efficacy of symptom management through the following measures： behavior tasks， verbal persuasion and support， learning from others’ experience， and improving symptom.

This self-management project improved the participants’ self-management behaviors， self-efficacy and part of health status， reduced the frequency of emergency and hospitalization within six months. In addition， the preliminary analysis suggested that Shanghai’ self-management project could help every course anticipant save 726.79 RMB medical expenditure， equivalent to 9 times of the course [13].

5 Conclusion

Through reviewing models， methodologies and experience of the health education from worldwide and drew on the self-management project of chronic disease from the community of Shanghai， China， this paper put forward the conclusion that the health education conducted among patients with chronic diseases and potential chronic diseases could eliminate the risk factors and reduce the incidence of disease， disability and death， thus reducing significantly medical expenses. In short， this could be a very effective measure to reduce the growth rate of expenditure and keep balance for China’s medical insurance fund. Therefore， the social health insurance could build health management model with community health services. In the meantime， the partial social health insurance funds are allowed for residents’ health management. That means， community health management could be incorporated into health insurance management. Community health services such as community health service center） commissioned by social medical insurance agencies would manage the community residents’ health in long term. In this process， what needs to be noted is how to adopt more effective health education methods to improve patients’ positive engagement and how to determine the cost of health education.

6 Acknowledgements

Project supported by the National Natural Science Foundation of China： ‘Research on the Balance Mechanism of Medical Insurance Fund for Educational Experiment on Insured Employees with Chronic Disease’ （Grant No. 71103033）.

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