China's health care sector in transition: resources, demand and reforms

Spatio-Temporal Disparity and Driving Forces of the Supply Level of Healthcare Service in the Yangtze River Delta

The equalization of healthcare supply is not only related to the people's need for a better life, but can also provide a strong guarantee for the high-quality and sustainable development of the Yangtze River Delta integration. By using exploratory spatial analysis techniques, this study analyzed the spatio-temporal evolution characteristics and heterogeneous influence effects of the supply level of healthcare service in the Yangtze River Delta from 2007 to 2019. It was found that the supply level of healthcare service in the Yangtze River Delta had improved significantly. The differences in the supply level of healthcare service between cities had tended to narrow without polarization, and the supply level of healthcare service generally showed a high spatial pattern in the south delta and low spatial pattern in the north delta. The higher the supply level of healthcare service was, the weaker the interannual variability was. The supply level of healthcare service in the Yangtze River Delta region presented obvious spatial association and differentiated tendency of local high and low spatial clusters. The relative length and curvature of the supply level of healthcare service in the Yangtze River Delta generally presented a spatial pattern with low values in the northeast and high values in the southwest. Population density and urban-rural income gap generally exhibited negative spatio-temporal impact on the supply level of healthcare service across most cities. On the other hand, urbanization level and per capita disposable income generally had positive spatio-temporal impact on the supply level of healthcare service across most cities. Per capita gross domestic product (GDP) showed an increasingly positive spatio-temporal impact on the supply level of healthcare service across most cities. While per capita fiscal expenditure exhibited significantly negative impact on the supply level of healthcare service across most cities in space.

Study on the Experience of Public Health System Construction in China's COVID-19 Prevention

Background: China's experience in the process of COVID-19 prevention provides a reference for other countries in the world. This article studied the experience of public health system construction in China's COVID-19 prevention. Methods: Based on literature review and theoretical analysis, this paper constructs a theoretical framework of national public health system construction in health crisis. Based on this theoretical framework, combined with the policies and measures formulated by the Chinese government in the process of COVID-19 prevention, this article evaluate the advantages and deficiencies of China's public health system construction in response to COVID-19. Results: The Chinese government ensured the adequate supply of health resources, improved people's ability to pay medical expenses, and adopted advanced public health propaganda methods based on the Internet to help people grasp the basic information and development trend of COVID-19 in the process of COVID-19 prevention. At the same time, the utilization efficiency of health resources was low in China, people's ability to pay for medical expenses was unequal, and the disclosure of virus information in the early stage of the outbreak of COVID-19 is not timely. Conclusions: Other countries can learn from the advantages of China's public health system construction and avoid China's deficiencies in the process of public health system construction, which will help them improve the efficiency of COVID-19 prevention.

Equity and efficiency of maternal and child health resources allocation in Hunan Province, China

BACKGROUND

A reasonable allocation of health resources is often characterized by equity and high efficiency. This study aims to evaluate the equity and efficiency of maternal and child health (MCH) resources allocation in Hunan Province, China.

METHODS

Data related to MCH resources and services was obtained from the Hunan maternal and child health information reporting and management system. The Gini coefficient and data envelopment analysis (DEA) were employed to evaluate the equity and efficiency of MCH resources allocation, respectively.

RESULTS

The MCH resources allocation in terms of demographic dimension were in a preferred equity status with the Gini values all less than 0.3, and the Gini values for each MCH resources' allocation in terms of the geographical dimension ranged from 0.1298 to 0.4256, with the highest values in the number of midwives and medical equipment (≥ CNY 10,000), which exceeds 0.4, indicating an alert of inequity. More than 40% regions in Hunan were found to be relatively inefficient with decreased return to scale in the allocation of MCH resources, indicating those inefficient regions were using more inputs than needed to obtain the current output levels.

CONCLUSIONS

The equity of MCH resources by population size is superior by geographic area and the disproportionate distribution of the number of medical equipment (≥ CNY 10,000) and midwives between different regions was the main source of inequity. Policy-makers need to consider the geographical accessibility of health resources among different regions to ensure people in different regions could get access to available health services. More than 40% of regions in Hunan were found to be inefficient, with using more health resources than needed to produce the current amount of health services. Further investigations on factors affecting the efficiency of MCH resources allocation is still needed to guide regional health plans-making and resource allocation.

Care and Charges for Acute Cerebral Infarction Inpatients in China: A Hospital Based Study in Soochow

Objective

The objective of the present study is to evaluate the current status of care and charges of acute ischaemic stroke in a university teaching hospital in China, and to identify the main determinants of such charges.

Methods

Acute ischaemic stroke patients from July 2009 to June 2010 were considered. We examined demographic data, clinical data, hospital care and outcomes at discharge and hospital charges retrospectively. The influence of medical factors on total charges was analyzed.

Results

The mean initial National Institutes of Health Stroke Scale score of all acute ischaemic stroke patients was 7.2 points. Thirteen percents were total anterior circulation syndrome, 20% were partial anterior circulation syndrome, 7% were posterior circulation syndrome and 60% were lacunar syndrome. The mean hospital length of stay (LOS) was 8.5 days. All patients underwent neuroimaging studies, 2% of whom received thrombolysis, 93% received traditional Chinese medicine injection, 83% received antiplatelet and 6% received anticoagulation therapy, only 29% received in-hospital rehabilitation. The mean hospital charges per patient was ¥9230.2 (US$1357.3), of which 56.2% was attributed to the charges for medications, 13.4% for imaging studies, 12.1% for laboratory examinations. Total hospital charges were correlated strongly with LOS, admission to care unit, and computed tomography angiography or digital subtraction angiography of the brain.

Conclusions

Total hospital charges correlates significantly with hospital LOS, admission to care unit, investigation with computed tomography angiography or digital subtraction angiography of the brain, while clinical syndromes do not influence total charges independently. The cost of drug is the largest portion of the mean hospital charge. A treatment protocol in acute ischaemic stroke might optimise cost. (Hong Kong j.emerg.med. 2011;18:383-390)

Organization and Finance of China's Health Sector: Historical Antecedents for Macroeconomic Structural Adjustment

China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP). Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China’s shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China’s evolution, adding another layer of complexity to policy.

Evaluation of admission characteristics, hospital length of stay and costs for cerebral infarction in a medium-sized city in China

BACKGROUND AND PURPOSE

Stroke is a heavy economic and health burden for the patients and society. This study aimed to evaluate hospital length of stay (LOS) by admission characteristics and costs correlated with medical insurance status for cerebral infarction in a medium-sized city in China.

METHODS

A total of 557 consecutive patients with principal diagnosis of cerebral infarction were enrolled. Admission characteristics, LOS, and costs were retrospectively analyzed.

RESULTS

The mean LOS was 18.5 days (median, 16 days). Our analysis demonstrated that medical insurance status, stroke severity (National Institutes of Health Stroke Scale score, Functional Independence Measure cognitive and motor score, Glasgow coma scale), Oxfordshire Community Stroke Project (OCSP) classification, some comorbidities (coronary heart disease, chronic obstructive pulmonary disease, and hyperlipemia), and raised leukocytes were the main explanatory factors for LOS by stepwise multiple regression model. The mean per patient costs were US $983.0, and mean daily costs US $67.0. Drugs were the most expensive cost subtype, all subtypes costs except non-medical care were significantly higher in patients with state medicine than in those with new cooperative medical scheme (NCMS) (P < 0.001).

CONCLUSION

Stroke severity, OCSP classification, raised leukocytes on admission, some comorbidities, and medical insurance status may help to predict LOS for patients with cerebral infarction. Healthcare expenditures were heavy burdens to inhabitants. State medicine patients could shorten unnecessary LOS to improve the resources allocation and cost-efficiency.

China, Hong Kong and Taiwan, Health Systems of

This article describes how health care has been and is currently financed, organized, and delivered in China, Hong Kong, and Taiwan. Each system's performance is assessed on the equity and efficiency axes in terms of how well it deals with important market failures. We conclude by drawing comparative lessons and showing how policymakers are trying or might attempt to rise up to and overcome key challenges.

Clinicians and the governance of hospitals: A cross-cultural perspective on relations between profession and management

This paper explores similarities and differences in the value stances of clinicians and hospital managers in Australia, England, New Zealand and China, and provides some new insights into how we theorise about the health profession and its relations with management. The paper draws on data derived from a closed-ended questionnaire administered to 2637 hospital-based medical, nursing and managerial staff. We examine variations between the countries in the value orientations of doctors, nurses and managers by considering their assessments of issues that are the focus of reform. In particular, we examine the ways in which the Chinese findings differ from those of the other countries. Whereas the results from the Commonwealth hospitals showed a marked division between clinicians and managers about issues that can affect clinical autonomy, this was not the case in the Chinese hospitals. The concluding discussion traces these differences to a number of cultural, organisational and policy-based factors. The implications of our findings on how we conceive the relationship between professionals and organisations are then discussed, as are further lines of research.

What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?

This paper presents the findings of a critical review of studies carried out in low- and middle-income countries (LMICs) focusing on the economic consequences for households of illness and health care use. These include household level impacts of direct costs (medical treatment and related financial costs), indirect costs (productive time losses resulting from illness) and subsequent household responses. It highlights that health care financing strategies that place considerable emphasis on out-of-pocket payments can impoverish households. There is growing evidence of households being pushed into poverty or forced into deeper poverty when faced with substantial medical expenses, particularly when combined with a loss of household income due to ill-health. Health sector reforms in LMICs since the late 1980s have particularly focused on promoting user fees for public sector health services and increasing the role of the private for-profit sector in health care provision. This has increasingly placed the burden of paying for health care on individuals experiencing poor health. This trend seems to continue even though some countries and international organisations are considering a shift away from their previous pro-user fee agenda. Research into alternative health care financing strategies and related mechanisms for coping with the direct and indirect costs of illness is urgently required to inform the development of appropriate social policies to improve access to essential health services and break the vicious cycle between illness and poverty.

Analysis of hospital charges for cerebral infarction stroke inpatients in Beijing, People's Republic of China

OBJECTIVE

Stroke is a heavy economic burden on the individuals, society and health services in China, where health expenditure is rising rapidly. The purpose of the present study is to examine health services and demographic factors associated with inpatient charges for cerebral infarction in China, focusing on hospital charges of insured and uninsured patients.

METHODS

The study subjects were 545 patients with a principal diagnosis of cerebral infarction stroke who were discharged from the China-Japan Friendship Hospital from January 1, 1997 through December 31, 1998. Demographic, clinical and administrative data were retrospectively collected from the medical record and financial database. The influence of social and medical factors on total charges was analyzed with stepwise multiple regression model.

RESULTS

Of 545 subjects, 429 (79%) were the insured patients and 116 (21%) were the uninsured patients. Length of hospital stay (LOHS) for the insured patients (median, 32 days) was significantly longer (P<0.001) than that for the uninsured (median, 23 days). The hospital charges per discharge for the insured was significantly higher (geometric mean, 10407 yuan) (P<0.0001) than that for the uninsured patients (geometric mean, 5857 yuan). With stepwise multiple regression, factors associated independently with the hospital charge were: longer hospital stay, insurance status, increased number of head magnetic resonance imaging (MRI) and computerized tomography (CT), infection in hospital stay, and more severe condition of stroke.

CONCLUSIONS

Inpatient charge for cerebral infarction stroke was positively associated with being the insured. The findings suggest an overuse of health care resources in insured patients and limited use of resources by those who are not.