Interview with Ms. Qian Li
Qian Li is a research fellow at the West China Research Center for Rural Health Development, Sichuan University. She is currently a doctoral student in Epidemiology and Health Statistics at Sichuan University School of Public Health. Ms. Li obtained a Master’s degree in Clinical Medicine from Sichuan University School of Clinical Medicine in 2006 and a Master’s degree in Health Policy at the London School of Hygiene and Tropical Medicine in 2011. Ms. Li’s current research focuses on incentive mechanisms and policy of the health workforce, especially on how rural areas attract and retain health personnel. Her current projects include incentives in the decision of medical school graduates to work in the rural areas, satisfaction-based factors impacting attraction and retaining of rural health workers (Alliance for Health Policy and Systems Research, AHPSR) and policy analysis and evaluation of allocation and retaining of health workforce in China’s underserved western areas (China Medical Board, CMB).
李茜，四川大学西部农村卫生发展中心研究人员，目前就读于四川大学公共卫生学院，流行病学与卫生统计学博士。2006年 毕业于四川大学华西临床医学院，获临床医学硕士学位；2011年于伦敦卫生与热带病学院获卫生政策学硕士学位。她目前的主要研究领域为卫生人力资源激励机 制和相关政策研究，特别是如何在农村地区吸引和稳定卫生人员的政策研究。目前承担和参与的主要项目有：医学毕业生赴农村地区就业激励对策研究；基于工作满 意度的农村卫生工作者吸引和稳定影响因素研究(AHPSR)；中国西部卫生人力资源配置与保留的系统分析和政策评估（CMB）等。
Dr. Zhehui Luo is an assistant professor of Epidemiology and Biostatistics at the Department of Epidemiology and Biostatistics, Michigan State University in the US.
罗哲慧博士为美国密歇根州立大学流行病和生物统计学系助教授。
Dr. LUO: Please introduce you and your co-investigators.
罗哲慧: 请介绍一下您和您此次公开竞标申请项目的合作者。
Qian: I am a research fellow at the West China Research Center for Rural Health Development, Sichuan University. My project is “How to attract medical graduates to underserved western China? A discrete choice experiment”, which will be carried out in four provinces and autonomous regions-- Inner Mongolia, Ningxia, Sichuan and Guizhou-- that are diverse in socioeconomic, ethno-cultural and medical educational capacities. I met some of my collaborators from these regions through the CMB Rural Network. In addition, I work closely with my mentor, Dr. Mylene Lagarde at the London School of Hygiene and Tropical Medicine and other senior investigators I met from previous research projects, including Professor Lingui Li at Ningxia Medical University and Dr. Krishna D. Rao at Public Health Foundation of India. It is also a great pleasure to have my colleague, Dr. Jay Pan as a Co-PI when he joined our department last year. This multi-disciplinary team with researchers from human resources for health (HRH), health economics, sociology and epidemiology will provide various expertise needed for the project.
李茜: 我 是四川大学华西公共卫生学院的研究人员。我此次申请项目是“如何吸引医学院毕业生前往中国西部欠发达地区就业？——一项离散选择试验”。我们的项目将在内 蒙古，宁夏，四川和贵州四个省和自治区开展。这几个地区在社会经济，少数民族文化和医学教育水平方面都有较大差异。我通过美国中华医学基金会（CMB）的 农村网络认识了我在这些地区的合作者。另外，我和我在伦敦卫生与热带医学学院导师Mylene Lagarde博士以及我通过以往的研究项目认识的其他资深学者，包括宁夏医科大学的李林贵教授和印度公共卫生基金会的Krishna D. Rao博士都有密切的合作。我很高兴能够由去年加入我们院系Jay Pan博士担任我们此次项目的合作研究者。这支集合了卫生人力资源，卫生经济，社会学和流行病学等多学科的研究团团队将为我们的项目提供其所需的各种知识 和技能。
Dr. LUO: Why did you choose this topic and this area of research?
罗哲慧: 您为什么会选择这一课题和研究方向？
Qian: Many rural areas in China are plagued by the problem of low health service capacity due to unbalanced distribution of health workforce between urban and rural areas. For decades, the government has expanded the enrollment of higher medical education aiming to increase quality and quantity of Human Resource for Health (HRH). However, the annual increment of actually employed health workers accounted for only 20-40% of medical graduates, indicating that many graduates do not enter clinical practice. Paradoxically, this surplus of medical graduates is accompanied by severe shortage of health workers in the rural area. As a result, my study aims to identify incentives that might attract new medical graduates to rural underserved areas and factors related to their career changes afterwards.
李茜: 由于卫生事业劳动力城乡分 配不均造成了中国许多农村地区的卫生服务能力低下。过去几十年来，政府不断扩大高等院校医学院的招生，希望通过这一方法提高卫生人力资源的数量和质量。但 是每年增加的卫生工作者只占医学院毕业生总数量的百分之二十到四十，也就是说许多毕业生并未参加临床工作。在医学院毕业生过量的同时，农村地区卫生工作者 的短缺十分严重。正因为如此，我研究的目的是发掘能够吸引医学院毕业生前往农村欠发达地区的激励机制，以及了解与他们职业改变相关的因素。
Dr. LUO: Do you anticipate any difficulties or problems in carrying out the project?
罗哲慧: 您预计在项目实施过程中会出现怎样的困难和问题？
Qian: I have adopted a discrete choice experiment design which is an emerging quantitative method in HRH study. Because this is the first study of its kind in China, I expect there to be challenges related to the application of the methodology; however, with the support of my collaborators who have experience from similar studies in other developing counties, I feel confident to face these challenges. Moreover, because my study is a prospective cohort study, how to minimize levels of attrition and maintain an adequate sample size is also a challenge.
李茜: 我此次项目采取了离散选择试验的设计，这是在卫生人力 资源中刚刚兴起的一种定量研究方法。因为我们这一类型的研究在中国还是首例，我预计在方法实施的过程中会有一定的挑战。但是我的合作者有许多在其他发展中 国家开展这类研究的经验，有他们的支持，我相信我们能够克服这些困难。另外，因为我的研究是前瞻性队列研究，如何最大程度的减少样本损耗从而保证足够的样 本数量也是一项挑战。
Dr. LUO: How do you expect your research results to be used by other investigators to build the evidence base in rural health care?
罗哲慧: 您认为您的其他研究者可以如何运用您的研究结果为农村医疗的实证研究作出贡献？
Qian: The phenomena studied in my project, namely high quit rates in medical career and over-supply of medical students in urban areas, are not isolated incidences. Other areas in health care can also use similar design to examine, for example, factors related to patient retention and treatment uptakes. My project will seek evidence as to what extent policies can reduce these problems.
李茜: 在我项目中研究的现象，包括医学院毕业生放弃医学工作以及城镇地区的过度供给并非独立现象。医疗研究的其他领域也可以运用类似的研究设计，例如研究与病人留院和选择治疗相关的因素。我的研究将为如何运用政策解决此类问题提供依据。
Dr. LUO: What areas for future investment in rural health research would you recommend that CMB consider?
罗哲慧: 您建议CMB未来可以考虑在哪些有关农村卫生研究的领域进行投资？
Ms. LI: I have noticed that during the recent years, CMB has spared no effort in creating favorable nurturing environment for young researchers, including providing various training and grants opportunities. I would encourage CMB to continue its support to young researchers in the field of health policy and systems science and to promote exchange among young scholars. The established CMB rural network engaging 13 medical universities is an excellent platform to scale up rural health research. Collaborations among young researchers within the network should be incentivized.
李茜: 我注意到近几年来，CMB致力于为年轻学者提供有利的成长环境，包 括提供各类培训和研究经费申请的机会。我鼓励CMB继续为卫生政策和体系科学领域的年轻学者提供支持，并促进年轻学者之间的交流。 已经成立的CMB农村网络包含了13所医科大学，为扩大农村卫生研究规模提供了非常好的平台。CMB应当继续鼓励网络内的年轻学者进行合作交流。
Dr. LUO: What is your most important learning experience from the CMB OC grant application? How do you think it will affect your future academic career?
罗哲慧: 您在此次CMB公开竞标项目申请过程中最重要的收获是什么？您觉得这对您未来的学术生涯有怎样的影响？
Ms. LI: The selection process of CMB OC grants was extremely rigorous: last year all awarded proposals had gone through three rounds of competition before final approval and each time we were asked to revise the proposal based on critical comments from reviewers. I think the journey to being funded by the OC Program is a valuable learning experience because you will learn how to improve your research design based on reviewers’ comments from different perspectives, which is helpful especially for young researchers. This project will allow me to gather primary data to follow up a cohort of health workers, which is useful for future studies.
李茜: 去年CMB公开竞标项目的筛选过程非常严格：所有获奖的申请书都经过了三轮的竞争，每一次我们都需要根据审稿人的意见作出修改。我认为此次项目的申请过程 是一次宝贵的培训经验，因为审稿人的意见有许多不同的出发点，你能够从中学到如何完善研究设计。这对于年轻学者来说尤其重要。另外我还将通过此次项目收集 原始数据并建立卫生工作者的队列，这对今后的研究有很大帮助。
By Zhehui Luo
罗哲慧
Interview with Dr. Li Zhao
Dr. Li Zhao is an associate professor at Sichuan University, adjunct professor at University of Kentucky, coordinator of West China Center for Rural Health Development, health education consultant of Sichuan Center for Disease Control and Prevention, and editorial board member of textbook Health Management and Management Research Method. Dr. Zhao’s research mainly focuses on health and social behavior, health policy and management.
赵莉博士，四川大学副教授，美国肯塔基大学客座副教授，西部农村卫生政策中心项目协调员，兼任四川省疾病预防控制中心健康教育咨询专家, 全国卫生管理专业规划教材《卫生管理学》、《管理研究方法》编委。主要研究领域研究方向为健康与社会行为，卫生政策与管理。
Shuli Qu is an ORISE health economics research fellow.
曲姝丽是ORISE卫生经济学方向研究人员。
Shuli: Could you please tell us about your educational background, your research interests and describe your research proposal submitted to the CMB OC Program? How did you become interested in your focus area?
曲姝丽：请谈谈您的教育背景，研究兴趣和CMB公开竞标项目申请的研究课题。您是如何对您的研究方向产生兴趣的？
Dr. ZHAO: I obtained my bachelor’s degree in Education from Sichuan Normal University in 1997, and got my master’s and PhD degrees in Health Behavior Research and Social Medicine and Health Management in 2002 and 2006 respectively from Sichuan University School of Public Health. In 2010-2011, I was supported by the China Medical Board (CMB) to study health management and policy in University of Kentucky School of Public Health. I became very interested in school-based injury prevention because road traffic injury among children is a growing public health concern. In China, national disease surveillance data showed that road traffic injury was the No. 2 cause of mortality among children. However, most published studies were conducted in developed countries which might not be applicable in developing countries.
赵莉：我 1997年毕业于四川师范大学获教育学学士学位，2003年毕业于四川大学获健康与社会行为学硕士学位，2009毕业于四川大学获社会医学与卫生事业管理 学博士学位。2010-2011，受CMB资助到美国肯塔基大学公共卫生学院学习，研究方向为卫生政策与管理。 我对基于学校的交通伤害预防感兴趣是因为在中国，道路交通伤害是威胁儿童健康的第二大杀手，是日益严重的公共卫生问题。而目前可得的文献都是发达国家的项 目，其结果并不适用于发展中国家。
Shuli: What are the main obstacles in preparing the proposal? What did you learn from this experience? How do you think it will affect your future academic career?
曲姝丽：您在准备申请的过程中最大的障碍是什么？您从这次经验中学到了什么？您认为对您未来的学术事业有怎样的影响？
Dr. ZHAO: The main obstacle in preparing the proposal is time -- preparing everything before the deadline. I think this experience will be beneficial for my future academic career.
赵莉: 最大的障碍是时间，要赶在截止日期之前把一切都准备好。这次经验对我未来的学术事业很有帮助。
Shuli: What are the implications of your project for health policy and systems sciences research in China?
曲姝丽：您的研究项目对于中国卫生政策与体系科学有怎样的意义？
Dr. ZHAO: The major implication of this project is to provide affordable, effective and school-based road traffic injury prevention for children in rural areas where awareness of road safety behavior is lacking.
赵莉: 本项目的最大应用价值是为道路安全意识缺乏的农村地区提供一种廉价，有效，基于现有学校系统的预防儿童道路交通伤害预防干预项目。
Shuli: How do you plan to disseminate your research findings and to prevent road traffic injuries among primary school students in rural west China?
曲姝丽：您计划如何推广您的研究结果并在中国西部农村地区做好小学生道路交通伤害的预防工作？
Dr. ZHAO: We will disseminate our research findings in the following ways: 1) the local government can use our results to develop appropriate policies and regulations to reduce road traffic injuries among children; 2) the local media can increase the publicity of road safety behavior through television, newspaper and the Internet; 3) The local education authority can incorporate road safety behavior as an integral part of the curriculum in primary and secondary schools, train teachers, and improve awareness of road safety among students and parents. My research and coordination team includes leadership from four local county governments, local traffic control authority, educational authority and schools in Chengdu City. They would be able to help in providing an effective channel to disseminate our findings.
赵莉: 我 们将通过以下几个途径推广此项研究成果: 1) 当地党政机关可制定相应政策法规来预防减少道路交通伤害; 2) 媒体部门通过电视、报纸、网络等途径加强道路安全行为的宣传; 3) 当地教育部门可将道路安全行为规范统一编入中小学教材，对教师进行培训，并提高家长和学生的安全意识。 我的研究和咨询团队中有成都市四个县政府的领导, 交通管理部门的领导，成都市教育局领导和学校校长等，他们将为研究结果的传播扩展提供有效渠道。
By Shuli Qu
曲姝丽
Interview with Dr. Guoqing Hu
Dr. Guoqing Hu is a Professor and the Associated Chair of the Department of Epidemiology and Health Statistics at the School of Public Health, Central South University. Dr. Hu’s research interests focus on injury prevention and public health emergency response. He serves as an editorial board member of Injury Prevention and Injury Medicine (electronic version), and referee for several international public health journals. Dr. Hu published over 50 peer-reviewed articles, and wrote or edited 12 books.
胡国清博士、中南 大学公共卫生学院教授、流行病与卫生统计学系副主任，主要研究方向为伤害预防和突发公共卫生事件应对，现担任《Injury Prevention》和《伤害医学（电子版）》 的杂志编委，多家国际公共卫生期刊的审稿人，以第1作者或通讯作者身份发表学术论文50余篇，参与12部学术著作的编写。
Shuli Qu is an ORISE health economics research fellow.
曲姝丽是ORISE卫生经济学方向研究人员。
Shuli: Could you please tell us about your educational background, your research interests and describe your research proposal for the CMB OC grant application? How did you become interested in your focus area?
曲姝丽：请谈谈您的教育背景，研究兴趣和CMB公开竞标项目申请的研究课题。您是如何对您的研究方向产生兴趣的？
Dr. HU: I studied Public Health from 1994 to 1999 as an undergraduate at Xiangya School of Medicine (the former Hunan Medical College), Central South University. I received my Master’s and PhD degrees in Epidemiology and Health Statistics in 2002 and 2006 respectively. In 2007, I had an opportunity to visit and study at Johns Hopkins Bloomberg School of Public Health, working with Professor Susan P. Baker and Professor Timothy D. Baker for a one-year postdoctoral training. During that time, I systematically studied injury prevention and began considering how to apply what I learned in the Chinese context. Given the huge burden of injury in China and that China is lagging far behind the world in injury prevention, I decided to focus my research in this area, even though it is very difficult to get funding in China for injury prevention research. The purpose of this CMB OC research proposal is to develop visual aids for children in the rural area in order to prevent road traffic injuries, because road safety in the rural area is still very underdeveloped compared to that in urban areas.
胡国清：我 在1994-1999年间于中南大学湘雅医学院（前湖南医科大学）完成公共卫生的本科学习。稍后，我分别于2002年和2006年在中南大学湘雅医学院获 得流行病与卫生统计学专业的硕士和博士学位。2007年，我幸运地得到了在美国约翰霍普金斯布隆伯格公共卫生学院1年的博士后培训机会，Susan P. Baker教授和Timothy D. Baker教授是我的指导老师。在那期间，我系统学习了伤害预防知识和技能，并开始思考如何将所学知识应用于中国。伤害在中国造成了沉重的疾病负担，但中 国的伤害预防工作非常落后，所以尽管在中国做伤害预防的研究很难拿到资助，我仍将大量研究精力集中在伤害预防上。由于农村对于道路安全的建设远落后于城市 地区，我这次所申报的CMB OC标书主要目的是开发一个面向农村儿童的视觉支持干预，以促进农村的道路交通安全的发展。
Shuli: What are the main obstacles in preparing the proposal? What did you learn from this experience? How do you think it will affect your future academic career?
曲姝丽：您在准备申请的过程中最大的障碍是什么？您从这次经验中学到了什么？您认为对您未来的学术事业有怎样的影响？
Dr. HU: The greatest challenge I had in preparing the proposal was to develop a rigorous research design in order to implement the research idea and test the relevant hypotheses. Although I teach Medical Statistics in school, my training is not sufficient for the project. Unfortunately I was not able to recruit a biostatistician to join my team. Nevertheless, this experience is very helpful for my future participation in other international and domestic grant application. In the future, I will establish a long-term collaborative relationship with a biostatistician to support my injury prevention research.
胡国清：在本次 标书撰写过程中，我面临的最大困难是做一个严格的设计，以实现我的研究想法，并检验研究假设。尽管我本人在学校里教医学统计学课程，但我接受的培训并不能 满足这个课题的实际需要，遗憾的是我未能邀请一名生物统计学家加入项目组。不过这次的经验对我未来参与其他国际/国内的项目申请非常有帮助。今后我将与一 名生物统计学家建立长期合作关系，以支持我的伤害预防研究。
Shuli: What are the implications of your project for health policy and systems science research in China?
曲姝丽：您的研究项目对于中国卫生政策与体系科学有怎样的意义？
Dr. HU: The major application of my project is to provide a viable option to prevent child road traffic injury in rural areas where road safety measures are scanty. Compared to other effective environmental and engineering interventions, visual aids are more likely to be accepted by policymakers and are easier to implement in rural areas. Once visual aids are proven to be effective, they can be easily incorporated in the design of school uniforms, backpacks, hat, scarf, etc.
胡国清：本 项目的最大应用价值是为道路安全措施严重缺乏的农村地区提供一种预防儿童道路交通伤害的选择。与其他已被证明有效的环境和工程干预方法相比，视觉支持干预 更容易被决策者接受，更容易在农村地区推广。一旦视觉支持干预被证明有效，它将很容易被应用于校服、书包、帽子、围巾等的设计。
Shuli: How do you plan to disseminate your research findings and to prevent road traffic injuries among primary school students in rural west China?
曲姝丽：您计划如何推广您的研究结果并在中国农村地区做好小学生道路交通伤害的预防工作？
Dr. HU: If the intervention is proven to be effective, I will submit a policy report to the Ministry of Education to promote the application of visual aids in preventing road traffic injuries among rural children. Further, I would like to develop an intervention with visual aids that are of standardized mode, style and size. I would also like to promote the use of visual aids in road traffic injury prevention via newspapers and the Internet in order to raise public awareness.
胡国清：如 果视觉支持干预被证明是有效的，我将向教育部写一个政策建议报告，以推动视觉支持干预在农村儿童道路伤害预防中的应用，并进一步希望制定一个统一类型、款 式和尺寸的视觉支持干预项目。另外，我还准备在报纸和网络上介绍视觉支持干预对预防农村儿童道路交通伤害的作用，以推广公众接受视觉支持干预措施。
By Shuli Qu
曲姝丽
Interview with Dr. Weiyan Jian
Dr. Weiyan Jian is an associate professor in the Department of Health Policy and Administration at School of Public Health, Peking University. He is the Principle Investigator of the CMB Open Competition-awarded research proposal titled “Evaluating the impacts of DRGs Payment Reform in Beijing”.
简伟研博士是北京大学公共卫生学院卫生政策与管理学系副教授。他领导的研究项目“北京病组支付方式效果评估”为CMB公开竞标获奖项目。
Jing Li is a doctoral student in the Health Economics Track of Health Services and Policy Analysis program at University of California, Berkeley.
李婧为加州伯克利大学卫生服务与政策分析专业卫生经济方向博士生。
Jing: What are the most important considerations in the choice of research topic?
李婧：您此次选择研究课题时最重要的考虑是什么？
Dr. JIAN: There are two considerations in the choice of research topic: one is research interest, and the other is the need to address or provide scientific evidence for certain practical issues in China’s health policy. We try our best to take into account both aspects.
简伟研：选择研究课题，一方面是研究兴趣，另一方面是当前中国卫生政策的实际问题中亟待解决或者需要提供科学证据的地方。我们努力把这两个方面考虑结合在一起。
Jing: What are the main obstacles in hospital data access and usage? Do you have any suggestions for researchers who intend to use administrative data records in their research?
李婧: 您在获取和使用医院数据过程中最大的障碍是什么？您对希望在研究中使用医院管理数据的学者有什么建议？
Dr. JIAN: Hospitals submit reports as part of the health statistics system required by the Ministry of Health. The “discharge form” (the front page of a medical record) is at the patient-level and is similar to the discharge data in the United States. This is the main data source for our DRG research. There is significant cost involved in negotiating with multiple hospitals in accessing the data, and support from administrative departments is often needed in the process. There are several limitations in the discharge form data. First, the data only contain variables on medical treatments and expenditures, but no patient socio-demographics. Second, there is significant variation across hospitals not only in data quality but also in diagnosis and procedure coding systems, except in certain areas (e.g. Beijing). These are issues that need particular attention when we are using the discharge data.
简伟研：从 常规数据来看，医院层面的报表主要是卫生部要求上报的“卫统”系列报告，其中“出院病人调查表”（即“病案首页”）是病人个体层面，与美国的 “discharge data”类似，这是我们做DRG相关研究的主要信息来源。和多个医院协商使用这个数据的成本很高，因此，获取这些数据往往需要行政部门的支持。病案首页 数据也有其局限。一方面是病案首页的变量局限在病人住院期间的诊治和费用信息，而没有病人社会经济情况；另一方面，数据质量在不同医院之间往往参差不齐， 而且除了个别地区（如北京），各个医院之间诊断和操作编码的统一性不太好。这是使用病案首页数据时需要特别注意的问题。
Jing: How do you think the research results will affect health policy and systems sciences in China?
李婧: 您认为研究结果对于中国卫生政策和系统科学有何影响？
Dr. JIAN: Provider payment reform is a hot topic in China’s current health reform, and Beijing is the first city in China that adopted hospital DRG payment in a systematic way. Our research could not only help Beijing improve the local health policy, but also provide evidence for policymakers in other areas contemplating DRG payment reform. Moreover, there are many debates internationally regarding the benefit of DRG payment, and our research may be able to inform those debates by providing evidence from China.
简伟研：支付制度改革是中国当前卫生领 域改革的热点问题，而北京是中国第一个系统使用DRGs支付医院费用的试点城市，这个研究不仅有助于北京完善本地的卫生政策，而且，对于其他计划引入 DRG付费的地区，也能提供证据，供决策者参考。再者，国际上对DRG付费也有许多的争议，这次评估的结果，也可能为这些争议性问题提供中国的证据。
Jing: What is your most important learning experience from the CMB OC grant application? How it will affect your future academic career?
李婧：您在此次CMB 公开竞标项目申请过程中最重要的收获是什么？您觉得这对您未来的学术生涯有怎样的影响？
Dr. JIAN: CMB’s Open Competition has provided an opportunity for young scholars in China to compete for research funding as well as the freedom to select research topics based on our own interests. CMB has also organized a strong panel of external reviewers who provided applicants with excellent critique and advice. All of these would not only benefit the OC applicants but also provide additional resources that promote open competition among young scholars in China’s HPSS field. I would like to express my sincere gratitude towards CMB and all external reviewers who contributed to OC!
简伟研：CMB-OC项目为中国的年轻学者提供了公平竞争获取研 究资助的机会，让大家可以根据自己的研究兴趣自由选择研究题目。CMB组织了强大的外部评审专家团队，为参评的学者提出了很好的意见和建议。所有这些，不 仅有益于OC项目的申请者本人，更重要的是，在中国HPSS领域形成了另一个可以让年轻学者公开竞标的研究支持资源。衷心感谢CMB和所有为OC做出贡献 的外部评审专家！
By Jing Li
李婧
Interview with Dr. Feng Xinglin
Dr. Xinglin Feng is an associate professor in the Department of Health Policy and Administration at School of Public Health, Peking University. He is the Principle Investigator of the CMB Open Competition-awarded research proposal titled “How does provider payment method enhance/mitigate the effects of demand side subsidies in reducing medical impoverishment for delivery care?”
冯星淋博士是北京大学公共卫生学院卫生政策与管理学系副教授。他主持的研究项目“供方支付方式如何促进／缓和需方补助在减轻住院分娩带来的贫困中发挥的作用”获得了CMB公开竞标项目的支持。
Jing Li is a doctoral student in the Health Economics Track of Health Services and Policy Analysis program at University of California, Berkeley.
李婧为加州伯克利大学卫生服务与政策分析专业卫生经济方向博士生。
Jing: What are the most important considerations in the choice of research topic?
李婧：您此次选择研究课题时最重要的考虑是什么？
Dr. FENG: First, The CMB Open Competition is highly competitive for young researchers. I believed I have to show my previous research experience as evidenced by my publication records. We did some research to understand the coverage of institutional delivery and maternal, child and neonatal mortality in China. We found that changes in hospital delivery could fully explain the trends in maternal mortality and accounted for 48-70% change in neonatal mortality in China. The national strategy in institutional delivery in China has been successful. In 1988, only less than half of all women gave birth in hospitals, yet twenty years later hospital births have become nearly universal. Meanwhile, using national data, Long et al. (2011) reported that institutional delivery care accounts for a substantial proportion of a poor household’s annual income. Based on these observations, we formulated our original idea to understand how households can afford the costs. I think this is the most important reason for choosing the topic.
Second, to achieve universal coverage of health care, demand side subsidies have been widely promoted in China, for which the New Cooperative Medical Scheme (NCMS) is a cornerstone. However, previous research findings on NCMS are mixed. For example, Wagstaff et al. (2009) reported that the NCMS have increased catastrophic spending, particularly among the poor. Zhang et al. (2010), on the other hand, found that the NCMS have promoted equity in health financing as poor inpatients can acquire more protection than the non-poor. We thought that there might be two reasons for the mixed findings in previous researches. Firstly, as methodological considerations, traditional economic analyses have focused on general uptake of inpatient or outpatient care, without qualifying the type or content of specific care received. Data have relied mostly on cross-sectional surveys where catastrophic expenditures have been measured using recalled expenditures and income. No study has investigated the actual consequences of catastrophic health expenditures on a family’s impoverishment over time. Secondly, as health system considerations, former study designs considered the health system as a black box which limited the scope to inform policy by ignoring the interplay of dynamics of health system in the reform. It is widely acknowledged that incentives of Chinese health providers have long been distorted due to the retrospective fee-for-service (FFS) payment system. As a result, the poverty alleviating effects of government subsidies may be diluted or even reversed. China’s safe motherhood policy has a number of inherent characteristics that allow us to address the above limitations and therefore we choose this topic for the CMB OC.
冯星淋: 首先，CMB公开竞标项目在青年学者中的竞争是非常激烈的。我认为我需要用过去发表的文章来证实我在这方面的工作基础。我们曾做过有关中国医院分娩保险和 妇女儿童及新生儿死亡率的研究，结果发现住院分娩率的变化能够完全解释妇女死亡率的变化，并能解释48-70%的新生儿死亡率的变化。我国关于住院分娩的 国家政策是较为成功的：1988年，只有不到一半的妇女在医院分娩，而二十年后几乎所有的妇女都在医院分娩。与此同时，Long et al. (2011) 报道了住院分娩费用在贫困家庭的年收入中占比很高。依据这些发现，我们形成了关于了解家庭分娩费用负担的最初构想。这是我们选择这一课题最重要的原因。
其次，为了实现全民医保，中国大力开展了需方补贴，新农合是一项标志性的政策。但是现有的关于新农合的研究结论却并不一致。举例来说，Wagstaff et al. (2009) 发现新农合增加了家庭大病卫生支出，在贫困家庭中尤其明显。Zhang et al. (2010) 却发现相对于非贫困家庭，新农合对贫困家庭对住院费用的保障程度更高，起到了促进公平的作用。我们认为两方面的原因可能导致了这样不一致的研究结果。其 一，从研究方法的角度来说，既往的经济学研究只关注一般的住院或门诊服务，而不进一步细分卫生服务的种类和内容。所采用的数据也多来源于横截面调查数据， 家庭收入和卫生支出往往依靠调查对象回忆获得，以此测量大病卫生支出的发生，而没有对卫生支出对家庭的长期影响进行追踪。其二，从卫生系统的角度来说，以 往的研究多数把卫生系统看作一个黑匣子，忽略了卫生改革过程中系统内部各因素的互动作用，这样的研究对政策的贡献是有限的。中国目前按项目付费的制度为医 疗服务者提供了扭曲的激励机制，因而政府为缓解贫困提供的补助有可能事倍功半，甚至适得其反。中国住院分娩政策的诸多特点能够让我们弥补这些过去研究中的 不足，这也是我们选择这一课题的原因。
Jing: What is the proposed empirical methodology used in this study?
李婧: 研究采取的实证方法是什么？
Dr. FENG: This is basically a cohort study. Three counties varying in their payment arrangement for delivery care will be studied. Women are included in the cohort 42 days after delivery and followed up 9-12 months later to observe the impoverishing effect of delivery care.
冯星淋: 我们的研究采用队列研究的设计。调查选取了三个对于住院分娩采取不同支付制度的县，调查对象是42天内在医院分娩的妇女。我们对其进行9-12月的跟踪调查，从而观察住院分娩的因病致贫情况。
Jing: How the research results will impact health policy and systems sciences in China?
李婧: 您认为研究结果对于中国卫生政策和系统科学有何影响？
Dr. FENG: Demand side subsidy is a major strategy in achieving universal coverage of health care. Firstly, by asking the “what” question, we want to find rigorous evidence on the impoverishing effect of delivery care giving substantial demand subsidies carried out in China. Further, by asking the “how” question, we want to understand how incentives induced by various payment arrangement affect providers’ behaviors and therefore the actual financial protection effects. We think the two questions are both important to informing evidence-based policy.
冯星淋: 需方补贴是促进全民健保的重要手段。我们首先问的问题是“是什么”。在现有的需方补助政策下，医院分娩对于贫困状况将产生什么影响？对此我们希望找到相对 科学的证据。我们想问的另一个问题是“为什么”。我们希望了解不同支付制度产生的激励机制如何影响医疗服务者的行为，并最终如何影响医保的财务风险防范能 力。我们认为这两个问题对医疗政策的制定十分重要。
Jing: What is your most important learning experience from the CMB OC grant application? How do you think it will affect your future academic career?
李婧：您在此次CMB 公开竞标项目申请过程中最重要的收获是什么？您觉得这对您未来的学术生涯有怎样的影响？
Dr. FENG: The most important learning experience for me is to be persistent. We submitted the proposal for last year’s CMB OC application and were offered a chance for the full proposal competition. We were not funded last year. I almost gave up this topic this year. However, a senior professor asked me to revise and submit it again. Actually, this might be the first barrel of gold for me to win the OC, of which the direct impact is that I can somehow continue my previous research. I am deeply grateful for CMB’s support of the young generation of researchers in China to further their academic development.
冯星淋: 我最重要的收获是坚持。去年的CMB公开竞标项目我们提交了申请，并且得到了提交完整研究计划的机会，但最终没有通过。今年我几乎放弃了这一课题而转投其 他的课题，但是一位资深教授让我重新修改并提交原来的课题。事实上，能够继续我之前的研究也许是我赢得公开竞标项目所收获的第一桶金。我非常感谢CMB对 青年学者学术发展所提供的支持。
By Jing Li
李婧