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Huang X, Tung CL, Wang X, Xu X, Lam FI, Zhang T. Configurations of the driving factors promoting China's commercial health insurance: A comparative qualitative analysis based on the technology–organization–environment framework. Heliyon 2022; 8:e11522. [PMID: 36387432 PMCID: PMC9663891 DOI: 10.1016/j.heliyon.2022.e11522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/24/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
With the nation's remarkable improvement in living standards, China's health insurance system cannot satisfy people's higher demands; therefore, it is necessary to promote the supply of commercial health insurance (CHI) in China. Based on the technology–organization–environment (TOE) framework, this study constructs a novel analysis framework to investigate the driving path of China's CHI. Employing the data of 31 provincial regions of China in 2018, a fuzzy-set qualitative comparative analysis is conducted to analyze configurations. We also adopt a necessary condition analysis in the robustness check to examine the necessary conditions, determining that no necessary relationship exists between possible conditions and the performance of CHI. More particularly, three sufficient configurations, TOE strategy, government attention (GA)–environment adaptability (EA)–citizen demand (CD) strategy, and dual EA–CD strategy are demonstrated to achieve high performance, and the other three configurations of technological management capability (TMC)–EA-CD strategy, technological infrastructure (TI)–EA strategy, and combined TI–TMC–EA strategy do not result in high performance. In addition, technological conditions (TI and TMC) and EA are relatively more important than the other configurations. Notably, government departments' financial expenditure is found to have a negative effect on CHI promotion.
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Affiliation(s)
- Xiuquan Huang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
| | - Chih-Lin Tung
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
| | - Xi Wang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
| | - Xiaocang Xu
- School of Economics and Management, Huzhou University, Huzhou, 313000, China
| | - Fat-Iam Lam
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
| | - Tao Zhang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
- Corresponding author.
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Hsieh PS, Lin FR. The effect of healthcare policy signals on patients' perceived value, trust and intention to use services offered by a healthcare provider. Hosp Pract (1995) 2022; 50:331-339. [PMID: 35984374 DOI: 10.1080/21548331.2022.2115776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Capitation is a healthcare reimbursement scheme in which a healthcare provider equitable access to funding for services and greater flexibility and budgeting. The objectives of the study are to investigate the effect of capitation signaling on patients' perceived value and trust and on their use intention. METHODS This study was a scenario-based survey to examine interaction design, including capitation policy information and value-added health services information, which act as a combination of to test the hypotheses using signaling theory. Subject may receive the information about health services, information about a capitation policy, both of these two signals, or neither of them. RESULTS The results of this study show that signal capitation policy and value-added health service information positively affects patients' perceived value, but not patients' trust. When a patient receives a signal either capitation policy information or value-added health service information, their perceived value, trust, and use intention are significantly higher than those who receive neither signal. CONCLUSION We suggest that high-quality healthcare institutions should consider distinguishing themselves from other low-quality providers by signaling information and allocate resources on value-added health services to enhance patients' awareness of healthy behavior and benefit from implementing a capitation payment scheme. This research contributes to healthcare stakeholders, especially policymakers and service providers, in terms of how best to engage with patients.
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Affiliation(s)
- Pei-Shan Hsieh
- Department of Business Administration, Tunghai University, Taichung, Taiwan
| | - Fu-Ren Lin
- Institute of Service Science, National Tsing Hua University , Hsinchu, Taiwan
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Yang H, Yan Z, Jia L, Liang H. The impact of team diversity on physician teams’ performance in online health communities. Inf Process Manag 2021. [DOI: 10.1016/j.ipm.2020.102421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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A Systematic Review of Main Factors leading to Irrational Prescription of Medicine. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2017. [DOI: 10.5812/ijpbs.10242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liang C, Gu D, Tao F, Jain HK, Zhao Y, Ding B. Influence of mechanism of patient-accessible hospital information system implementation on doctor–patient relationships: A service fairness perspective. INFORMATION & MANAGEMENT 2017. [DOI: 10.1016/j.im.2016.03.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Panteli D, Wagner C, Verheyen F, Busse R. 'Know before you go': information-seeking behaviour of German patients receiving health services abroad in light of the provisions of Directive 2011/24/EU. J Health Serv Res Policy 2015; 20:154-61. [PMID: 25899483 DOI: 10.1177/1355819615580003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE While Directive 2011/24/EU on cross-border patient mobility makes specific provisions in relation to information availability and accessibility, little empirical evidence exists to guide best practice. This paper explores the information-seeking behaviour of German patients who received planned care abroad. METHODS A postal survey among German patients treated in other European countries was carried out by Techniker Krankenkasse, a major German sickness fund. The influence of certain predictors on whether patients informed themselves before travelling for care was investigated using multiple logistic regression. Types and sources of information were analysed using descriptive statistics. RESULTS Information activity was contingent on patients' level of education, type of service, regularity of treatment abroad and awareness of entitlement to cross-border services. Respondents most frequently enquired about elements of reimbursement, entitlement to services and cost-saving, and consulted their sickness fund for information. Differences in both content and medium of choice were observed between patient groups. CONCLUSION A structured and inclusive approach to information provision should be adopted. National Contact Points should collaborate with a range of stakeholders, who will vary depending on the health care system; however, patient organizations, health professionals and third-party payers should always be represented. Dynamically monitoring cross-border movements can help determine the range, medium and language of relevant information.
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Affiliation(s)
- Dimitra Panteli
- Research Fellow, Department of Health Care Management, Berlin University of Technology, Germany
| | - Caroline Wagner
- Health Economist, Scientific Institute of Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | - Frank Verheyen
- Director, Scientific Institute of Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | - Reinhard Busse
- Head of Department, Department of Health Care Management, Berlin University of Technology, Germany
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Payment mechanism and GP self-selection: capitation versus fee for service. ACTA ACUST UNITED AC 2014; 14:143-60. [DOI: 10.1007/s10754-014-9143-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 03/03/2014] [Indexed: 11/30/2022]
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Allard M, Jelovac I, Léger PT. Treatment and referral decisions under different physician payment mechanisms. JOURNAL OF HEALTH ECONOMICS 2011; 30:880-893. [PMID: 21782263 DOI: 10.1016/j.jhealeco.2011.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 05/26/2011] [Accepted: 05/31/2011] [Indexed: 05/31/2023]
Abstract
This paper analyzes and compares the incentive properties of some common payment mechanisms for GPs, namely fee for service (FFS), capitation and fundholding. It focuses on gatekeeping GPs and it specifically recognizes GPs heterogeneity in both ability and altruism. It also allows inappropriate care by GPs to lead to more serious illnesses. The results are as follows. Capitation is the payment mechanism that induces the most referrals to expensive specialty care. Fundholding may induce almost as much referrals as capitation when the expected costs of GPs care are high relative to those of specialty care. Although driven by financial incentives of different nature, the strategic behaviors associated with fundholding and FFS are very much alike. Finally, whether a regulator should use one or another payment mechanism for GPs will depend on (i) his priorities (either cost-containment or quality enhancement) which, in turn, depend on the expected cost difference between GPs care and specialty care, and (ii) the distribution of profiles (diagnostic ability and altruism levels) among GPs.
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David G, Neuman MD. Physician division of labor and patient selection for outpatient procedures. JOURNAL OF HEALTH ECONOMICS 2011; 30:381-391. [PMID: 21251722 DOI: 10.1016/j.jhealeco.2010.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 10/20/2010] [Accepted: 11/29/2010] [Indexed: 05/30/2023]
Abstract
Little is known about the ability of incentives to influence decisions by physicians regarding choices of settings for care delivery. In the context of outpatient procedural care, the emergence of freestanding ambulatory surgery centers (ASCs) as alternatives to hospital-based outpatient departments (HOPDs) creates a unique opportunity to study this question. We advance a model where physicians' division of labor between ASCs and HOPDs affects the medical complexity of patients treated in low-acuity settings (i.e. ASCs). Analyses of outpatient surgical procedure data show that physicians working exclusively in low-acuity settings (i.e. ASCs) treat patients of significantly higher medical complexity in these settings than do physicians who also practice in higher-acuity settings (i.e. HOPDs). This discrepancy shrinks with increasing procedural risk and with increasing distance between ASCs and acute care hospitals.
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Affiliation(s)
- Guy David
- Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104-6218, USA
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Wang HL, Huang JY, Howng SL. The effect on patient loyalty of service quality, patient visit experience and perceived switching costs: lessons from one Taiwan university hospital. Health Serv Manage Res 2011; 24:29-36. [DOI: 10.1258/hsmr.2010.010011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The reimbursement system changed from fee-for-service to fixed prospective payments in Taiwan, the effect on the physician–patient's relationship is worth being studied. We examined the relationship between patient visit experience, cost perceptions and the two important aspects of quality of care, curing and interpersonal performance, and patients' loyalty to the hospital physicians. A total of 404 patients from an acute care hospital in Taiwan, Kaohsiung Medical University Hospital (KMUH), were investigated using a self-administered mailing survey. All measures including patient loyalty (PL), curing service quality (CSQ), interpersonal service quality (ISQ), visit experience (VE) and perceived switching costs (PSC), were adapted and modified from existing scales. Our results showed that the physician's CSQ and ISQ positively affected patients' loyalty to KMUH. The interaction between the main effects of service quality, patients' VE and three types of switching visit costs, yielded additional insights into the importance of service quality for patient retention. The CSQ of physicians becomes a more important determinant of loyalty than ISQ as patients' VE increases. The importance of CSQ and ISQ increases in relation to PL as the perceived procedural and relational costs of changing care providers increases. Neither CSQ nor ISQ has a reduced relationship with PL as the perceived financial costs of switching hospitals increase. Our study indicates that the impact of CSQ and ISQ on loyalty varies according to the perceived visit costs of changing hospitals and the patients' VE.
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Affiliation(s)
- Hsiu-Ling Wang
- Department of Medical Information Management, Kaohsiung Medical University
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital
| | - Jun-Ying Huang
- College of Management, National Sun Yat-Sen University, Taiwan
| | - Shen-Long Howng
- Department of Neurosurgery, Kaohsiung Medical University Hospital School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
Many healthcare finance mechanisms involve transferring uncertain costs to healthcare providers in lieu of fixed payments or global capitation. Global capitation violates basic principles of risk management through insurance. Risk-theoretic analysis of capitation shows that risk disaggregation forces efficient providers to become inefficient insurers. Risk-assuming providers face lower profitability and increased exposure to operating losses, and must reduce patient benefits. Global capitation causes inefficiency, increases healthcare costs, and threatens patient-provider relationships.
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Affiliation(s)
- Thomas Cox
- Financial reporting and expense analyst based in Gainesville, Florida, USA
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Legal and Ethical Implications of Health Care Provider Insurance Risk Assumption. ACTA ACUST UNITED AC 2010; 12:106-16. [DOI: 10.1097/nhl.0b013e3181ff0fa0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Leung MCM. Primary care delivery, risk pooling and economic efficiency. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2010; 11:161-175. [PMID: 19529966 DOI: 10.1007/s10198-009-0158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 04/24/2009] [Indexed: 05/27/2023]
Abstract
The consequences of consumer-driven health care under different health insurance plans are studied by means of a game theoretic approach. Suitable demand-side cost-sharing can induce consumer behavior that avoids over-treatment when there are information asymmetries between providers and consumers, leading to the efficient recommendations and provision of treatment by providers. If under-treatment can be penalized, then a full insurance model that pays providers a fixed salary and fee-for-service or one that requires patients to present a referral letter before specialist care is delivered also achieves provision efficiency. The two models, however, yield higher welfare for consumers. Hence, the findings in this paper favor some amount of regulation in health-care markets.
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Affiliation(s)
- Michael C M Leung
- School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong.
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