Status of public-private partnership recognition and willingness to pay for private health care in China

Acceptance and willingness to pay for DTaP-HBV-IPV-Hib hexavalent vaccine among parents: A cross-sectional survey in China

DTaP-HBV-IPV-Hib hexavalent vaccine has been used in high-income countries for many years to prevent diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and invasive Haemophilus influenzae type b disease. Currently, no hexavalent vaccines have been approved for use in China. Evidence of parental acceptance and interest in hexavalent vaccines can help policy makers and manufacturers make decisions about entering the vaccine market and the immunization program in China. We measured parental acceptance and willingness-to-pay (WTP) for a hexavalent vaccine to provide such evidence. We conducted a cross-sectional survey of children's caregivers in 16 vaccination clinics in seven cities in China and obtained information on socio-demographics, knowledge of disease, confidence in vaccines, previous vaccination experience, and acceptance of and WTP for hexavalent vaccine. Multivariate logistic regression was used to determine factors influencing acceptance, and multivariate tobit regression was used to identify factors impacting WTP. Between April 28 and June 30, 2023, a total of 581 parents of children aged 0-6 years participated in the survey; 435 (74.87%, 95% CI:71.3%-78.4%) parents indicated acceptance of hexavalent vaccine. Residence location, parents' education level, experience paying for vaccination, and disease knowledge scores were key factors affecting parents' choices for vaccination. Mean (SD) and median (IQR) willingness to pay for full 4-dose course vaccination were 2266.66 (1177.1) CNY and 2400 (1600-2800) CNY. Children's age (p < .001), parents' education level (p = .024), and perceived price barriers (p < .001) were significantly associated with WTP. Parents have high acceptance and willingness to pay for hexavalent vaccine. The less money parents have to pay out of pocket, the more willing they can be to accept the vaccine. Therefore, acceptance may increase even further if the vaccine is covered by medical insurance, provided free of charge by the government, or if its price is reduced. Our results provide reference for optimizing and adjusting immunization strategies in China.

Evaluating community-embedded elder care: A case study of supply and demand in Hangzhou, China

INTRODUCTION

With China's urbanization and demographic shifts significantly affecting elder care, this study examines the alignment of community-based elder care services in Hangzhou's Hemu Community. It addresses the gap in understanding how these services meet the needs of an aging population in a rapidly changing social context.

METHODS

A comprehensive mixed-methods approach was utilized, involving interviews with community residents, observations of elder care service operations and thorough document analysis. The objective was to evaluate the adequacy, utilization and satisfaction levels concerning these elder care services.

RESULTS

The research identified that, although the services generally meet the community's needs, there are notable challenges in content specificity, quality assurance and promotional efforts. These challenges lead to resistance among older adults. Additionally, issues with service visibility and the lack of robust feedback mechanisms were noted.

CONCLUSION

This study highlights the critical need for a cooperative strategy involving government, community organizations, social entities and businesses in enhancing elder care services. It suggests that improvements in service visibility, content quality and targeted promotion are crucial to address the evolving needs of the aging population and to reduce reluctance in service utilization.

Regulation and participation of the private sector in the pursuit of universal health coverage: Challenges and strategies for health systems

The 1978 Alma Ata Declaration established recommendations for health systems, which significantly impacted low-income countries. These guidelines marked improvements in access to health, coverage and financial equity, especially in Latin American countries.

Objectives

This paper focuses on the role of the private sector (including for-profit and non-profit organizations) in achieving Universal Health Coverage (UHC). It examines their involvement in the management, service delivery, resource investment and financing of primary health care (PHC) within the sustainable development goals (SDGs).

Methods

The study covers a review of health systems, emphasizing the influence of private institutions on public health, and evaluates how private sector experiences contribute to system functions and progress towards UHC.

Results

The findings indicate the crucial role of the private sector in global health systems, notably expanded in several countries. Private actors are essential to improve access and coverage, particularly in countries with low health indicators. The article highlights the importance of primary care physicians understanding these dynamics since their management is vital in implementing public policies for UHC.

Campaign Governance and Partnerships: Unraveling COVID-19 Vaccine Promotion Efforts in China's Neighborhoods

Background

COVID-19 vaccine promotion helps counter vaccine hesitancy and raise vaccine acceptance. Therefore, the Chinese state created collaborative infrastructures of COVID-19 vaccine promotion programs to promote stakeholder engagement and unload the burden of policy practitioners. However, partnerships in COVID-19 vaccine promotion programs have been underrepresented.

Methods

To address this lacuna, we qualitatively explored how partnerships in the COVID-19 vaccine promotion campaign (CVPC) were organized in China's neighborhoods. Specifically, we recruited participants via personal networks, referrals from acquaintances, and snowballing approaches, and conducted the qualitative thematic analysis following interviews with 62 Chinese stakeholders.

Results

This study indicates that to promote partnerships in CVPCs, neighborhood managers formed leadership in CVPCs, expanded the collaborative network, trained Health Promotion Practitioners (HPPs), and coordinated with HPPs to shape partnership agreements, produced COVID-19 vaccine promotional materials and advertised COVID-19 vaccines via diverse media tools. Although coproduction of CVPCs to a certain extent promoted state-society interaction in neighborhoods and state responsiveness to public demands, partners' disagreements on strategies applied by states for promoting COVID-19 vaccines eroded partnerships in CVPCs.

Conclusion

To construct a robust partnership in CVPCs, depoliticizing CVPCs and creating shared values among stakeholders in CVPCs are expected. Our study will not only deepen global audiences' understanding of CVCPs in China but also offer potential neighborhood-level solutions for implementing local and global health promotion efforts.

Willingness to pay for medical care and its determinants in private health care facilities among Gondar city residents, Northwest Ethiopia: Cross sectional study

Medical care is a type of health service that mainly consists of investigation and diagnosis, treatment, rehabilitative care, and nursing care for the purpose of maintaining the structure or function of the body. A medical care payment is a sort of payment made for the diagnosis, cure, mitigation, treatment, or prevention of disease, sickness, or damage, which includes checkups and periodic exams. In low-income nations, out-of-pocket expenditures account for 60 % of overall health spending, compared to 20 % in high-income ones. Willingness to pay is perhaps the highest money that a person is willing to provide to ensure that a particular wellbeing care action is undertaken. Previous research works focused mainly on the patients' willingness to pay but not the amount they can afford. The focus of this study is to determine the level of willingness to pay, the mean amount of willingness to pay for medical care, and its major determinants. A community-based cross-section study was carried out among Gondar city residents from February 2022 to March 2022. The study participants were recruited by systematic random sampling. Four data collectors conducted interviews using a questionnaire. For analysis, the dataset was entered into Epi Info version 7 and transferred to STATA version 14. The descriptive part was summarized using summary statistics like mean, median, and standard deviation. Determinants of willingness to pay were identified using a Tobit regression model with a significance of p-value ≤ 0.05 and confidence interval (CI ≠ 0). Finally, the analyzed data was presented using tables and figures accordingly. The study involved 414 participants, with a response rate of 95.8 %. About 53.62 % of the participants were willing to pay for medical care and the average willingness to pay was 24.17 USD per year. They were more willing to pay if they were still working (β = 19.66), currently married (β = 14.49), had a family history of medical care (β = 25.74), had good knowledge (β = 36.16), had a history of medical illness (β = 16.64), lived a long distance from the health facility (β = 1.98), and had a high wealth index (β = 29.51). The willingness to pay for medical care is below the actual cost. Designing a cost-recovery strategy with multi-tiered programs assigned to the most vulnerable individuals, such as the elderly, less educated, or seriously sick, is a strategic approach of the raising demand for service uptake and accessibility.

Preferences for private health insurance in China: A discrete choice experiment

Introduction

There is limited evidence on the sustainability and optimal design of China's private health insurance market, especially from the demand-side. With the increasing medical cost burden on both patients and the social security system, policy makers need data on potential clients' demand for private health insurance.

Methods

A discrete choice experiment was conducted to explore potential clients' preferences for a type of government-involved private supplementary health insurance, Huimin Insurance, in China. A mixed logit model was used to evaluated participants' preferences for six attributes. Willingness to pay, subgroup analysis and interaction effects were estimated based on the initial model.

Results

Among the 947 participants, 883 (93.2%) were aged 18 to 59 years and 578 (61.0%) were female. Participants had a strong preference for government involvement, extensive benefit packages, high reimbursement ratio and compensation for pre-existing conditions. With respect to the attribute of deductible, participants were indifferent between the level of CNY15,000 and CNY18,000 but had strong and significant preference for the level of CNY15,000 than CNY20,000. The premium was significantly correlated with a decline in the utility of PHI.

Conclusions

All attributes had a significant impact on participants' preference for Huimin Insurance. Providing a reference point for the development of private health insurance in China, our results inform the optimal design of PHI, especially Huimin Insurance's products.

Hospital services under public-private partnerships, outcomes and, challenges: A literature review

Public-private partnerships (PPP) is used to advance health service access and quality. PPP implementation in hospitals is vital to shorten the service and quality gap. Hospitals are the most significant health budget spender, and this study aimed to identify the PPP effect on hospital performance indicators and its implementation challenges. Thirty-three inclusive articles were filtered and collected from Pubmed, ScienceDirect, Medline, and Sage Publication databases. Results showed that various articles succeeded in implementing PPP and improving the access and quality of health services. Several hospital performance indicators such as diagnosis, therapy, service waiting time, length of stay, referral rate, mortality rate, and patient satisfaction were reported to show better results. However, there was insufficient evidence to say the same on related financial indicators. Policy, resource, communication and trust, risk, and evaluation monitoring were considered challenges in PPP implementation. Its success was not only influenced by major factors such as governance model, finance, politics, and social but also was influenced by the medical practice model applied within the organization. This study contributed to whether PPP affects the hospital performance indicators.

Implementing asthma management guidelines in public primary care clinics in Malaysia

Implementing asthma guideline recommendations is challenging in low- and middle-income countries. We aimed to explore healthcare provider (HCP) perspectives on the provision of recommended care. Twenty-six HCPs from six public primary care clinics in a semi-urban district of Malaysia were purposively sampled based on roles and experience. Focus group discussions were guided by a semi-structured interview guide and analysed thematically. HCPs had access to guidelines and training but highlighted multiple infrastructure-related challenges to implementing recommended care. Diagnosis and review of asthma control were hampered by limited access to spirometry and limited asthma control test (ACT) use, respectively. Treatment decisions were limited by poor availability of inhaled combination therapy (ICS/LABA) and free spacer devices. Imposed Ministry of Health programmes involving other non-communicable diseases were prioritised over asthma. Ministerial policies need practical resources and organisational support if quality improvement programmes are to facilitate better management of asthma in public primary care clinics.

Parents' willingness to pay for children's spectacles in Cambodia

Background/aim

To determine willingness to pay for children's spectacles, and barriers to purchasing children's spectacles in Cambodia.

Methods

We conducted vision screenings, and eye examinations as indicated, for all consenting children at 21 randomly selected secondary schools. We invited parents/guardians of children found to have refractive problems to complete a willingness to pay for spectacles survey, using a binary-with-follow-up technique.

Results

We conducted vision screenings on 12 128 secondary schoolchildren, and willingness to pay for spectacles surveys with 491 parents/guardians (n=491) from Kandal and Phnom Penh provinces in Cambodia. We found 519 children with refractive error, 7 who had pre-existing spectacles and 14 recommended spectacles for lower ametropias. About half (53.2%; 95% CI 44.0% to 62.1%) of parents/guardians were willing to pay KHR70 000 (US$17.5; average market price) or more for spectacles. Mean willingness-to-pay price was KHR74 595 (US$18.6; 95% CI KHR64 505 to 86 262; 95% CI US$16.1 to US$21.6) in Phnom Penh and KHR55 651 (US$13.9; 95% CI KHR48 021 to 64 494; 95% CI US$12.0 to US$16.1) in Kandal province. Logistic regression suggested parents/guardians with college education (OR 6.8; p<0.001), higher household incomes (OR 8.0; p=0.006) and those wearing spectacles (OR 2.2; p=0.01) were more likely to be willing to pay ≥US$17.5. The most common reasons for being unwilling to pay US$17.5 were related to cost (58.8%). The most common barrier to spectacle wear was fear that spectacles weaken children's eyes (36.0%).

Conclusions

With almost half of parents/guardians unwilling to pay for spectacles at the current average market price, financial support through a subsidised spectacle scheme might be required for children to access spectacles in Cambodia.

Patient-provider relationships in China: A qualitative study on the perspectives of healthcare students and junior professionals

BACKGROUND

Mistrust and conflicts in patient-provider relationships (PPR) have become prevalent in China. The frequency of verbal and physical violence against healthcare workers has been increasing, but few interventions seem to be effective. Limited prior research has focused on the perspectives of healthcare professionals in training. This paper aimed to understand their viewpoints and conceptualize potentially actionable areas for future policy interventions.

METHODS

We analyzed de-identified training registration data of a convenience sample of 151 healthcare students and 38 junior professionals from 20 provinces in China. One open-ended question in the registration form asked the participant to comment on PPRs in China. We used qualitative thematic coding to analyze the narrative data. All answers were categorized into three overarching frames: patients, providers, and external agencies/regulations. Frequently mentioned themes in each frame were evaluated to generate an overall theoretical framework.

FINDINGS

Although fewer than 25% indicated that current PPRs are "good" or acceptable, 98% of respondents were optimistic about the future improvement of these relationships. The leading factors of PPRs mentioned as patient-relevant were eroding trust in the physician, unrealistic expectations, and ineffective communication. The provider-relevant themes highlighted were poor service quality, ineffective communication, and heavy workload. Leading themes relevant to external agencies or regulations were dysfunctional administration system, negative media reports, and disparity in healthcare resource distribution.

INTERPRETATION

Healthcare professionals in training had a negative view of the current situation but had confidence in future improvement. Patient, provider, and societal factors all contributed to the tension between patients and providers. All aspects of the healthcare sector should be carefully considered when contemplating policy or social interventions to improve the patient-provider relationship.

A critical look at the Portuguese public-private partnerships in healthcare

The pre-conceived idea that contracts in a public-private partnership (PPP) regime, in healthcare or in any other economic sector, are, as a rule, ruinous and appealing for only a share of the stakeholders, lacks a solid basis that confirms it. This idea, outset and nurtured by the media, has been instigating the distrust of the users who, in turn, demand a more rigorous and efficient utilisation of public resources. Being Portugal in the top of countries that resort to PPPs, it is urgent to inquire if its respective contracts originated an inefficient and ineffective management of resources. It is precisely this discussion that we address in this paper, focusing our efforts in the Portuguese healthcare sector.

Surgery simulation teaching based on real reconstruction aid versus traditional surgical live teaching in the acquisition of an adult total hip arthroplasty surgical technique for developmental dysplasia of the hip: a randomized comparative study

BACKGROUND

A simulation and model (SM) teaching aid using 3D printing was developed to improve a training course for total hip arthroplasty of adult developmental dysplasia of the hip (adult DDH-THA). We named this new method Surgery Simulation Teaching based on a Real Reconstruction Aid (RRA-SST). A prospective randomized comparison was performed with the traditional surgical live teaching method to evaluate the training effectiveness of RRA-SST for adult DDH-THA.

METHODS

Twenty-six trainees, who were already practicing but were not experienced, participated in the study. We randomly divided the trainees into two groups: Group A (n = 13) received RRA-SST and group B (n = 13) received traditional surgical live teaching. A surgery simulation test and a questionnaire were used for evaluation. Next, each group received training with the other teaching method, and then the test and questionnaire were used again for evaluation.

RESULTS

After the first test, the RRA-SST method was shown to produce better results than the traditional surgical live teaching method. After the second test, the results showed the training effect in both groups reached the same level, which was level as Group A RRA-SST results. Analysis of the questionnaire results showed that the training effect of RRA-SST was higher than that of traditional surgical live teaching, from multiple perspectives.

CONCLUSIONS

The use of RRA-SST improved participant performance according to simulation assessment. RRA-SST can be helpful for trainees who are already practicing but not experienced when developing proficiency in adult DDH-THA surgical techniques.

Evaluating the Intention and Behaviour of Private Sector Participation in Healthcare Service Delivery via Public-Private Partnership: Evidence from China

Private sector participation in the healthcare market via public-private partnership (PPP) could be considered an available approach to narrow down the medical resource gap and improve the operational efficiency of healthcare facilities. Accordingly, this study aims to examine the influence and relative importance among critical factors for the intention and behaviour of the private sector towards participation in Chinese healthcare market (CHM) via PPP. We defined five hypotheses from previous literature and built a theoretical model based on modified theory of planned behaviour. Then, covariance-based structural equation modelling was applied to analyse the questionnaires provided by 248 respondents from construction companies, real estate developers, pharmaceutical companies, private hospitals, asset management companies, and medical industry property investment companies in China. Results indicated that attitude towards behaviour (β = 0.466, P < 0.001), subjective norm (β = 0.167, P < 0.05), perceived behavioural control (β = 0.231, P < 0.01), and facilitating conditions (β = 0.305, P < 0.001) are positively significant to behavioural intention; behavioural intention also shows a strong linkage with behaviour (β = 0.931, P < 0.001). Findings provide reference for governments and public authorities to exert additional efforts in implementing appropriate measures that will stimulate the private sector's motivation to participate in CHM via PPP.