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Yang G, Zhang X, Xu Z, Zhang L. Social Medical Insurances, Choices of Medical Institutions and the 'Siphon Effect' in the Health Service Market: Evidence from 2021 Yangtze River Delta Region of China. Risk Manag Healthc Policy 2024; 17:1287-1299. [PMID: 38770148 PMCID: PMC11104391 DOI: 10.2147/rmhp.s458178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose The siphon effect in the health service market is notably pronounced in many countries. How to measure and identify the determinants contributing to the siphon effect presents a substantial challenge. This study aimed to analyse the effect of two different social medical insurances, the Basic Medical Insurance System for Urban Employees (BMISUE), and the Basic Medical Insurance System for Urban and Rural Residents (BMISURR), on the siphon effect in the health services market. Methods The data used in this study were from the 2021 Health Life Satisfaction Survey of Yangtze River Delta (HLSSYRD) conducted by Shanghai Jiao Tong University. The logistic model was used to evaluate the association between social medical insurances and individual choices of medical institutions, and the Propensity Score Matching method (PSM) was used to check the robustness of basic results. Results Residents covered by BMISUE were more likely to choose a general hospital when they first sought medical treatment (OR = 5.377, 95% CI: 4.887, 5.915) relative to those insured by BMISURR. Further analysis showed that BMISUE would accelerate the siphon effect of general hospitals, people insured by BMISUE were still more likely to choose general hospitals despite being close to primary hospitals compared to those insured by BMISURR (OR = 3.240, 95% CI: 2.945, 3.565). Heterogeneity analysis indicated BMISUE had a greater impact on residents aged 15-59 years and those with high income compared to older people and individuals with low income. Conclusion Different social medical insurances can substantially affect residents' first choice of medical institutions. BMISUE with higher benefits level could exacerbate the siphon effect in the health service market. More equitable medical security system should be strengthened to bridge the benefits gap between BMISUE and BMISURR.
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Affiliation(s)
- Guang Yang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Xiaodong Zhang
- Institute of Population Research, Peking University, Beijing, People’s Republic of China
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Zhaopeng Xu
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Lufa Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
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Masoud A, Dehnavieh R, Yazdi-Feyzabadi V, Poursheikhali A, Noori Hekmat S, Kazemi M, Moghadam MG. What is the mind map of the hospital's future changes in a developing country like Iran? A qualitative study. BMC Health Serv Res 2023; 23:732. [PMID: 37407977 DOI: 10.1186/s12913-023-09507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 05/05/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Hospitals have a vital role in the future of health systems with upcoming structure, resources, and process changes. Identifying the potential aspects of change helps managers proactively approach them, use the opportunities, and avoid threats. This study presents a mind map of future changes in Iranian hospitals to develop a base for further related studies or prepare evidence for interventions and future-related decisions. METHODS This study is a qualitative-exploratory one, conducted in two phases. In the first phase, in-depth and semi-structured interviews were conducted to identify future hospital changes over 15 years. The interviews were analyzed using the content analysis method and MAXQDA 2018 software and holding two expert panels to develop the mind map using the 2016 Visio software. RESULTS In the first phase, 33 interviews led to 144 change patterns. In the second phase, a mind map of changes was drawn according to experts' opinions with ten categories: structure and role, knowledge management and research, service delivery, health forces, political and legal, economic, demographic and disease, technological, and values and philosophy, and environmental. CONCLUSIONS Many changes affecting hospitals rooted in the past continue to the future, but the point is the increasing intensity and speed of changes. Healthcare systems need a systematic approach to monitoring the environment to be updated, agile and proactive. These monitoring systems are essential in providing evidence for Macro-level decision-makers.
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Affiliation(s)
- Ali Masoud
- Department of Healthcare Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Reza Dehnavieh
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Atousa Poursheikhali
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Department of Healthcare Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Mohammad Kazemi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Ghasemi Moghadam
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, University of Medical Sciences, Kerman, Iran
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Hu L, Chen C, Zhu J, Zhang Y, Chen Y, Jia Y. Relationship Between Psychological Contract Violation and Physicians’ Destructive and Constructive Behaviors in Tertiary Public Hospitals: An Empirical Evidence in Beijing. J Multidiscip Healthc 2023; 16:997-1010. [PMID: 37056979 PMCID: PMC10088903 DOI: 10.2147/jmdh.s397501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/17/2023] [Indexed: 04/08/2023] Open
Abstract
Background In China, physicians have long faced long working hours, high stress levels, and tensions between physicians and patients, which can lead to negative behaviors. Understanding physicians' expectations and requirements of the hospital and increasing satisfaction with their psychological contract can help improve physician motivation and stabilize the hospital team. Aim The study aims to analyze the relationship between physicians' psychological contract violations and different behavioral choices, encourage hospitals to conclude a balanced psychological contract with physicians, and provide governance and intervention strategies for hospital human resource management. Methods Stratified cluster sampling was used to select 321 physicians from four public hospitals in Beijing for questionnaire surveys. Descriptive statistical analysis, t-test, ANOVA, correlation analysis, and regression models were performed using Stata 15.0 and SPSS 26.0 to analyze the relationship between psychological contract violations, physicians' EVLN behaviors and organizational justice. Results Psychological contract violation had a positive effect on exit behavior and neglect behavior, and a negative effect on voice behavior and loyalty behavior. Organizational justice plays a mediating role between psychological contract violation and physicians' exit, voice and loyalty behaviors. Conclusion Psychological contract violation can drive negative behavior among physicians, and organizational justice can play a mediating role in this. Public hospitals should establish a healthy psychological contract with physicians and place a premium on organizational justice to promote constructive behaviors and prevent destructive behaviors. This study constructs a more complete theoretical framework to explain physicians' behavior, and further dynamic tracking investigations are necessary because the evolution of physicians' behavior is a dynamic and long-term process.
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Affiliation(s)
- Lujia Hu
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People’s Republic of China
- Department of Basic Health Care, Tianjin Hedong District Health Commission, Tianjin, People’s Republic of China
| | - Chen Chen
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People’s Republic of China
| | - Junli Zhu
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People’s Republic of China
- Correspondence: Junli Zhu, School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, No. 10, Xitoutiao, Youanmen Wai, Fengtai District, Beijing, 100069, People’s Republic of China, Tel +86 18701515093, Fax +86 01083911578, Email
| | - Yao Zhang
- Department of Human Resources, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yun Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Yufei Jia
- Department of Human Resources, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Association between multimorbidity patterns and healthcare costs among middle-aged and older adults in China. Arch Gerontol Geriatr 2023; 109:104959. [PMID: 36804649 DOI: 10.1016/j.archger.2023.104959] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND This study investigated multimorbidity patterns among middle-aged and older Chinese people and whether healthcare costs varied among different multimorbidity patterns. METHODS Data were from the 2011-2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We included 20,855 unique observations with information coming from their last wave of interviews and aged at least 45 years or older. Latent class analysis (LCA) was performed to classify individuals with common multimorbidity clusters based on 14 self-reported chronic diseases. Healthcare costs were from participants' self-reports and categorized into outpatient, inpatient, and self-treatment. Two-part regression was performed to analyze the association of multimorbidity patterns with healthcare costs. RESULTS Five multimorbidity clusters were identified: minimal disease, arthritis, cardiovascular disease (CVD), lung/asthma, and multisystem morbidity. The multisystem morbidity group had the highest use in all three types of healthcare and the highest self-treatment cost. Compared with the minimal disease group, the other four groups did not show significant differences in outpatient costs. Relative to the minimal disease group, the lung/asthma group reported lower inpatient costs. CONCLUSION Healthcare use and costs varied across multimorbidity patterns among middle-aged and older Chinese people. Implementing an integrated care plan for multimorbidity is suggested to improve the cost-effectiveness of healthcare provision and reduce the financial burden of the healthcare system. Reimbursement policy design should also take multimorbidity patterns into account.
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Li J, Guo B, Huang X, Wang H, Zuo G, Lu W. Study of the medical service efficiency of county-level public general hospitals based on medical quality constraints: a cross-sectional study. BMJ Open 2023; 13:e059013. [PMID: 36690403 PMCID: PMC9872475 DOI: 10.1136/bmjopen-2021-059013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/08/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Since the new medical reform in 2009, county-level hospitals in China have achieved rapid development, but health resource waste and shortage issues still exist. DESIGN We applied the meta-frontier and slacks-based measurement-undesirable data envelopment analysis model to measure the medical service efficiency with or without medical quality constraints of the county-level public general hospitals (CPGHs). The assessment includes four inputs, three desirable outputs and one undesirable output. We conducted the assessment via Max-DEA V.8.19 software. Moreover, we analyse the factors affecting CPGHs' medical service efficiency based on the fractional response model. SETTING A total of 77 sample CPGHs were selected from Shanxi province in China from 2013 to 2018. RESULTS The results of this study showed that the efficiency level of county-level public hospitals in Shanxi Province is relatively low overall (the mean value of efficiency is 0.61 without quality constraints and 0.63 under quality constraints). This showed that ignoring medical quality constraints will result in lower efficiency and lower health resource usage for high medical quality hospitals. The medical service efficiency of CPGHs differs greatly among different regions. Under the meta-frontier, the hospitals in the central region had the highest efficiency (efficiency score 0.70), followed by those in the south (efficiency score 0.63) and the hospitals in the north had the lowest efficiency (efficiency score 0.54). Factors that have larger impacts on the service efficiency of county public hospitals are the average length of hospital stay, per capita disposable income and financial subsidy income. CONCLUSIONS To improve CPGHs' medical service efficiency, the government should increase investment in the northern region, and hospitals should improve the management level and allocate human resources rationally.
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Affiliation(s)
- Jing Li
- School of Economics, Hefei University of Technology, Hefei, China
| | - Binbin Guo
- School of Economics, Hefei University of Technology, Hefei, China
| | - Xiaojun Huang
- School of Management, Hainan Medical University, Haikou, Hainan, China
| | - Huakang Wang
- School of Management, Hainan Medical University, Haikou, Hainan, China
| | - Guangyan Zuo
- School of Management, Hainan Medical University, Haikou, Hainan, China
| | - Wei Lu
- School of Management, Hainan Medical University, Haikou, Hainan, China
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Rouhifard M, Vosoogh-Moghaddam A, Moshiri E. The roles and functions of future hospitals in health promotion: A systematic review in Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:316. [PMID: 36439011 PMCID: PMC9683459 DOI: 10.4103/jehp.jehp_1661_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/31/2022] [Indexed: 06/16/2023]
Abstract
As a main pillar of the health and social welfare system, hospitals affect the public health status in two ways: (1) Prevention, treatment, and rehabilitation services and (2) external effects on society and the environment. The present study aimed to identify the roles and functions of future hospitals in the world. The present study was a systematic review in which all studies about the roles and functions of future hospitals in different countries with a time limit of 2000 to August 2021 were extracted from foreign databases, including PubMed, Cochrane, Scopus, and Web of Science, and search engine, Google Scholar, as well as Persian databases, including Magiran, SID, and Iran Medex. We utilized the STROBE checklists for quantitative studies and SRQR checklists for qualitative studies to critique and evaluate the quality of qualitative studies. We then extracted their results and classified the content according to the main and subtopics. A total of 16 articles met the inclusion criteria of the present study. Hospitals can play four roles: stand-alone, dominant, collaborative, and partner. Findings were classified into six general groups: the role and mission of future hospitals, the way of providing care, funding, staff and patients, technology and information of future hospitals, and the challenges and barriers of current hospitals. Health service policy-makers need to pay special attention to technological innovations and advances as well as changes in the roles and functions of hospitals and seek to turn the threats arising from external changes into opportunities for better hospital performances.
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Affiliation(s)
- Mona Rouhifard
- Department of Health Services Management, Islamic Azad University of Semnan, Semnan, Iran
| | - Abbas Vosoogh-Moghaddam
- Governance and Health Training and Research Group, Neuroscience Institute, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Esmaeil Moshiri
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Jeon WH, Kim B, Kim DH, Lee SG, Jang SY, Kim TH. Characteristics of Walk-In Patients and Related Factors in a Dental University Hospital. Healthcare (Basel) 2022; 10:healthcare10081469. [PMID: 36011124 PMCID: PMC9408524 DOI: 10.3390/healthcare10081469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to identify the characteristics of walk-in patients who visited a dental university hospital more than once (returning patient). The factors affecting walk-in visits were analyzed in relation to demographic, appointment, and treatment characteristics among 146,567 cases treated between 1 March 2019 and 29 February 2020. Multiple logistic regression was used to assess factors influencing walk-in visits. The walk-in rate was 14.1%. The likelihood of walk-in visits was higher in men, patients aged 20–39 years, patients residing in Seoul, and hospital employees or their family members. Walk-in visits were more likely to take place from 8:00 to 9:59 and on Saturdays and Mondays. The walk-in odds ratios differed depending on the treatment department and diagnosis. Return patients had higher odds of walk-in visits for treatments not covered by insurance. The probability of being a walk-in patient was lower among patients who also received treatment in other departments on the same day than among those who did not. These results indicate that each examined factor has a predictable pattern. The findings also suggest a relatively high percentage of walk-in cases in dental university hospitals and that walk-in patients differ in their characteristics from patients with appointments.
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Affiliation(s)
- Won Hwa Jeon
- Department of Conservative Dentistry, Kyung Hee University Dental Hospital, 23 Kyungheedae-ro, Seoul 02447, Korea
| | - Bomgyeol Kim
- Department of Public Health, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea
| | - Do Hee Kim
- Department of Public Health, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-1521
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Yin G, Ning J, Peng Y, Yue J, Tao H. Configurational Paths to Higher Efficiency in County Hospital: Evidence From Qualitative Comparative Analysis. Front Public Health 2022; 10:918571. [PMID: 35757646 PMCID: PMC9226547 DOI: 10.3389/fpubh.2022.918571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background The efficient operation of county-level medical institutions is a significant guarantee in constructing Chinese rural tertiary care service networks. However, it is still unclear how to increase the efficiency of county hospitals under the interaction of multiple factors. In this study, 35 county general hospitals in China were selected to explore the configuration paths of county hospitals' high and poor efficiency status under the Environment-Structure-Behavior (ESB) framework and provide evidence-based recommendations for measures to enhance its efficiency. Methods Data envelopment analysis with the bootstrapping procedure was used to estimate the technical efficiency value of case hospitals. A fuzzy-set qualitative comparative analysis approach was carried out to explore the configuration of conditions to the efficiency status. Results Antecedent configurations affecting the efficiency status of county hospitals were identified based on the ESB analytical framework. Three high-efficiency configuration paths can be summarized as structural optimization, capacity enhancement, and government support. Another three types of paths, namely insufficient capacity, aggressive expansion, and poor decision-making, will lead to inefficient configurations. Conclusion Qualitative comparative analysis is necessary when exploring complex causality. The efficiency situation of county hospitals results from a combination of influencing factors instead of the effect of a single one. There is no solitary configuration for high efficiency that applies to all healthcare units. Any measures aimed at efficiency promotion should be discussed within the framework of a case-specific analysis.
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Affiliation(s)
- Gang Yin
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Ning
- Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yarui Peng
- Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jingkai Yue
- The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbing Tao
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yang L, Min Y, Jia Z, Wang Y, Zhang R, Sun B. Medical expenditure for strabismus: a hospital-based retrospective survey. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:27. [PMID: 35752832 PMCID: PMC9233768 DOI: 10.1186/s12962-022-00363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background and aims The misconception of the purpose of strabismus treatment has, on the one hand, affected the motivation of strabismus patients to seek care and, on the other hand, has resulted in strabismus not being covered by health insurance, both of which interact to limit the motivation of strabismus patients and also impose a financial burden on strabismus patients. Previous studies on the cost of strabismus had only addressed the cost utility and functional and psychosocial benefits of strabismus surgery. The aim of this study was to estimate the direct medical expenditure incurred for strabismus surgery and analyze the trend for the period 2014–2019 using the data collected by local eye hospitals in northeast China. Methods This study was based on 6-year strabismus medical expenditure data collected from the eye hospital of the first affiliated hospital of Harbin medical university, covering 3596 strabismus patients who had strabismus surgery. All medical expenditure data were adjusted to 2014 using China’s annual consumer price index to remove the effects of inflation. Results The average direct medical expenditure for strabismus cares (in 2014) was 5309.6 CNY (US$870.4), and the annual growth rates from 2015 to 2019 (compared with the previous year) were 9.3, 7.7, 21.7, 14.5, and 4.3%, respectively. Surgical expenses accounted for the highest proportion (33.1%) of the total medical expenses followed by examinations expenses (19.7%) and medical consumables expenses (18.7%). The regression coefficient for general anaesthesia was 1804.5 and age was less than 0. Conclusion The average direct medical expenditure for strabismus increases year by year, and the growth rate is rapid. Anesthesia was the most important factor increasing medical cost, and age was negatively correlated with cost.
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Affiliation(s)
- Lei Yang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yiduo Min
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhiyan Jia
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Yupeng Wang
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
| | - Rihui Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Bitong Sun
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Ye Z, Jiang Y. Title: the impact of a pilot integrated care model on the quality and costs of inpatient care among chinese elderly: a difference-in-difference analysis of repeated cross-sectional data. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:28. [PMID: 35752860 PMCID: PMC9233857 DOI: 10.1186/s12962-022-00361-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background Recently, integrated care has received tremendous popularity in China, a leading example of which is the Luohu model. In the present analysis, we aimed to examine the impacts of the Luohu model on the quality and costs of inpatient care. Methods We conducted a retrospective analysis using administrative claims databases of Shenzhen City (the city that the Luohu district sits) from Jan 2015–Apr 2017, which encompassed the time before and after the implementation of the pilot model. The outcomes were 30-day readmission, inpatient costs, and length of stay (LOS). Multivariable difference-in-difference analyses were conducted. Results In the first year following the integration, the Luohu model did not have impacts on any of the outcomes. Although its effect on readmission (ratio of odds ratio: 1.082; 95% CI: 0.865 to 1.353) was still not identified in the first four months of the second post-integration year, it decreased inpatient costs by CN¥ 1224.1 (95% CI: 372.7 to 2075.5) and LOS by 0.938 days (95% CI: 0.0416 to 1.835) per hospitalization episode during the same period. Conclusions The Luohu model may reduce costs and LOS in the long term. It is potentially a viable approach to improve the value of inpatient care in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-022-00361-4.
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Affiliation(s)
- Zhaojia Ye
- Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China. .,Sun Yat-sen University, 66 Gongchang Road, Guangming District, Shenzhen, Guangdong, China.
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Hu X, Wang P. Has China's Healthcare Reform Reduced the Number of Patients in Large General Hospitals? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5428. [PMID: 35564824 PMCID: PMC9104654 DOI: 10.3390/ijerph19095428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023]
Abstract
Many studies have shown that the new round of healthcare reform launched by the Chinese government in 2009 has not effectively solved the problem in which patients more readily choose large general hospitals. We aimed to find out if this situation exists in every department of a large general hospital. This study collected the outpatient data of 24 departments for a large general hospital in Beijing. By calculating the average growth rate of outpatients in each department from 2014 to 2019, and the utilization rate of outpatient appointments in different departments in 2020, we found that the average growth rate of outpatients in 4 departments (16.6%) was negative, and the utilization rate of outpatient appointments in 13 departments (54.16%) was less than 80%. This shows that the number of patients in some departments is declining, and that there is an inefficient use of doctor resources. Obviously, this is inconsistent with people's current beliefs. Therefore, it is not entirely true that China's healthcare reform has not reduced the number of patients in large general hospitals. At the same time, the inefficient use of outpatient doctor resources is a phenomenon worthy of attention; if it persists, it will result in significant waste in the healthcare system. We suggest that policy makers and hospital managers in China, and countries similar to China, can attract attention and take measures.
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Affiliation(s)
| | - Ping Wang
- Medical Affairs Department, Peking University First Hospital, Beijing 100034, China;
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Zhao X, Liu Y, Zhang X, Bärnighausen T, Chen S. The impact of retirement on inpatient healthcare utilization in Guangzhou, China: a regression discontinuity analysis of 189,031 health insurance claims. BMC Geriatr 2022; 22:380. [PMID: 35488207 PMCID: PMC9052580 DOI: 10.1186/s12877-021-02664-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies suggest that retirement, a major life event, affects overall healthcare utilization. We examine, the effects of retirement on inpatient healthcare utilization, including effect heterogeneity by gender, disease category, and type of health service. Methods We used routine health insurance claims data (N = 87,087) spanning the period 2021 - September 2013 from the Urban Employee Basic Medical Insurance (UEBMI), a mandatory social health insurance for working and retired employees in urban China. We applied a non-parametric fuzzy regression discontinuity design using the statutory retirement age in urban China as an exogenous instrument to measure the causal effect of retirement on six measures of inpatient healthcare utilization. Results Retirement reduced total hospital costs (-84.71 Chinese Yuan (CNY), 95% confidence interval (CI) -172.03 – 2.61), shortened length of hospital stays (-44.59, 95% CI -70.50 – -18.68), and increased hospital readmissions (0.06, 95% CI 0.00 – 0.12) and primary hospital visits (0.06, 95% CI 0.02 – 0.09) among women. Retirement did not significantly change inpatient healthcare utilization among men. The retirement effects among women varied by disease category. Specifically, retirement substantially increased hospitalizations for non-communicable diseases (NCDs), yet had only modest or no effect on hospitalizations for communicable diseases or injuries. Retirement effects among women also varied by the type of services. For relatively inexpensive services, such as nonoperative treatment, there were surges in the extensive margin (hospital readmission). For relatively expensive and invasive services, such as surgeries, retirement reduced the intensive margin (out-of-pocket expenditures and length of stay). Conclusions Retirement decreases overall use of inpatient healthcare for women. The examination on the disease-related heterogeneous effects helps with the introduction and implementation of integrated healthcare delivery and appropriate incentive schemes to encourage better use of healthcare resources among older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02664-2.
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Affiliation(s)
- Xintong Zhao
- School of Labor and Human Resources, Renmin University of China, Beijing, China.
| | - Yuehua Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xin Zhang
- School of Statistics, Beijing Normal University, Beijing, China
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg Medical School, Heidelberg University, Heidelberg, Germany.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Simiao Chen
- Heidelberg Institute of Global Health, Heidelberg Medical School, Heidelberg University, Heidelberg, Germany. .,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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13
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Chen X. Pharmaceutical Sales Representatives in the United States and China: The Need for Professional Public Space. HEALTH CARE ANALYSIS 2021; 30:35-56. [PMID: 34761311 PMCID: PMC8580741 DOI: 10.1007/s10728-021-00438-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/26/2022]
Abstract
Pharmaceutical sales representatives (PSRs) are one of the most frequently used drug information sources for physicians in both the United States and China. During face-to-face interactions, PSRs use various promotional strategies to impact the prescribing behavior. In the United States, PSRs provide physicians small gifts, free drug samples, and “sincere friendships”, whereas in China, they played an indispensable role in medical corruption over the past three decades. To cope with the undue influence of PSRs, both these countries have taken positive but insufficient measures to eliminate the effect thus far. By comparing the strategies of American and Chinese PSRs, it was found that building a friendly personal relationship with physicians in a relatively closed private environment (such as physician’s office) is a key factor to exert an individualized influence on physicians, even in different social backgrounds and healthcare contexts. Therefore, this essay suggests that it is necessary to limit the establishment of personal relationships and maintain a more professional interaction to reduce the personalized psychological and emotional influences on physicians’ professional judgment. To achieve this goal, it is proposed to transfer the physician-PSR interaction to a professional public space as a supplement to current countermeasures and suggestions. The presence of others and the possibility of third party participation will stimulate more ethical and reputational concerns. It is hoped that the increased transparency of the interaction will promote participants to consider more professional norms and mitigate the undue influence of PSRs’ individualized strategies.
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Affiliation(s)
- Xiaoying Chen
- School of Humanities, Southeast University, 2 Southeast University Road, Jiangning District, Nanjing, 211189, People's Republic of China.
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14
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Chen Y, Wang L, Cui X, Xu J, Xu Y, Yang Z, Jin C. COVID-19 as an opportunity to reveal the impact of large hospital expansion on the healthcare delivery system: evidence from Shanghai, China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1297. [PMID: 34532434 PMCID: PMC8422135 DOI: 10.21037/atm-21-2793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/16/2021] [Indexed: 01/10/2023]
Abstract
Background The expansion of large hospitals on the medical service market's supply side has always been an intensely debated topic. In this study, we conducted statistical analysis on the natural shock of COVID-19 to investigate whether the large hospitals will draw health demand from the small hospitals when a supply capacity surplus is present, a phenomenon otherwise known as the "siphon effect". Methods We collected the monthly hospital income and service data, including outpatient income, inpatient income, number of visits, and discharges, from all public hospitals, from January 2018 to July 2020 in Shanghai. A difference-in-differences (DIDs) method was applied to analyze the existence of the large hospitals' siphon effect by identifying the differences in the healthcare service market share change between large and small hospital groups at the height of pandemic (February and March, 2020) and the postpandemic period (April and May, 2020). Case mix index (CMI) was used to verify whether the reduction in healthcare amount and market share of small hospitals was due to unnecessary care. Results In total, 156 public hospitals, including 46 large hospitals and 110 small hospitals, with an average number of beds of 1,079.21 and 345.25, respectively, were involved in this study. At the height of the pandemic, the healthcare service volume and revenue in public hospitals in Shanghai experienced a sharp decline, especially for large hospitals and inpatient services. Compared to small hospitals at the height of the COVID-19 pandemic, large hospitals' market share decreased significantly in outpatient and inpatient services for overall and nonlocal patients (P<0.05). During the postpandemic period, large hospitals' market share increased significantly in outpatient and inpatient services for overall and local patients (P<0.05). This increase was more substantial in inpatient services. Conclusions Under conditions of the COVID-19 pandemic of higher care-seeking costs in the large hospitals, some of the healthcare services typically provided by large hospitals were then supplied by small hospitals. Furthermore, the siphon effect of large hospitals could be clearly observed when a supply capacity surplus was present and external constraint on patients' care-seeking behavior was absent.
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Affiliation(s)
- Yuqian Chen
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
| | - Linan Wang
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China.,School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai, China
| | - Xin Cui
- Department of Data Service, Shanghai Information Center for Health, Shanghai, China
| | - Jiajie Xu
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
| | - Yingqi Xu
- School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai, China
| | - Zhonghao Yang
- Department of Finance, Shanghai Hospital Development Center, Shanghai, China
| | - Chunlin Jin
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
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15
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Li H, Tao H, Li G. Predictors and reasons for inappropriate hospitalization days for surgical patients in a tertiary hospital in Wuhan, China: a retrospective study. BMC Health Serv Res 2021; 21:900. [PMID: 34470637 PMCID: PMC8408966 DOI: 10.1186/s12913-021-06845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/02/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Inappropriate hospitalization day (IHD) is recognized as an important indication of the excessive demand for health-care services, especially for surgical patients. We aim to examine the degree of IHDs, predictors associated with higher incidences of IHDs, and reasons for each IHD in different periods of hospitalization. METHODS A total of 4586 hospital days from 408 cases were evaluated by a cross-sectional and retrospective audit program carried out in a tertiary hospital with 5613 beds and 9623 faculty in Wuhan, China. This study used the revised Chinese version of the Appropriateness Evaluation Protocol (C-AEP) to assess IHDs, and the Delay Tool to ascertain each reason for IHDs. A binary logistic regression model was performed to examine the predictors of higher incidences of IHDs. RESULTS The average frequency of IHDs was 23.24 %, and a total of 322 cases (78.92 %) were reported to have experienced at least one IHD. The multivariate analysis showed that patients at the age of 60-69 with respect to under 50, and with overlength of stay were predictors of higher incidences of preoperative IHDs, while admission from outpatient, multiple diagnosis, higher surgical incision level, and overlength of stay were predictors of higher incidence of postoperative IHDs. The most frequent reasons related to health providers for IHDs were doctor's conservative views of patient management and delays in inspection, prescription, appointment, or result report. Patient factors gave rise to nearly a quarter of postoperative IHDs. CONCLUSIONS Findings from this study indicate that measures including paying more attention to the construction of MDT for diagnosis and treatment in general surgery, reducing laboratory turnaround time, dispelling distrust among health-care providers and patients, setting stricter discharge standards and, providing integrated out-of-hospital services could be adopted accordingly to improve the inappropriateness of hospital stays.
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Affiliation(s)
- Hao Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
| | - Hongbing Tao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
| | - Gang Li
- Department of Outpatient Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
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16
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Millar R. From Mao to McDonaldization? Assessing the rationalisation of health care in China. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1643-1659. [PMID: 34382703 PMCID: PMC9292377 DOI: 10.1111/1467-9566.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
China's 2009 health care reform agenda has been referred to as one of the most ambitious health policy programmes in modern history. Significant investment has combined with new structures, incentives, and regulations that have aimed to improve access, as well as gain greater control over a health care market much criticised for putting profit before patients. A range of health services research has been undertaken to analyse these efforts. Sociological perspectives have also been documented yet up to now a review and synthesis combining these various contributions has not been undertaken. By drawing on the lens of McDonaldization, the paper presents a narrative review that analyses the extent to which China's 2009 reform agenda has increased efficiency, calculability, predictability, and control over service provision. The review identifies elements of McDonaldization within China's 2009 reform agenda, however, notable gaps remain. In response to the limits of McDonaldization as a lens for understanding China's health care reform, the paper calls for alternative perspectives that are better able to understand the sociocultural dynamics shaping service provision, as well as an interdisciplinary research agenda that is able to generate new insights and understanding regarding health care in China.
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Affiliation(s)
- Ross Millar
- Health Services Management CentreUniversity of BirminghamBirminghamUK
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17
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Longitudinal study of the earliest pilot of tiered healthcare system reforms in China: Will the new type of chronic disease management be effective? Soc Sci Med 2021; 285:114284. [PMID: 34388618 DOI: 10.1016/j.socscimed.2021.114284] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In 2016, the tiered healthcare model featuring "specialists + general practitioners + health managers" in Xiamen was recognized by the Medical Reform Office of State Council and was promoted as a model to replace hospital-centric care with community-based care. This study evaluated the impact of the Xiamen's tiered healthcare system reform on health outcomes and healthcare spending among chronic disease patients. METHODS Data were derived from Xiamen's electronic health record (EHR) and medical claims systems. The sample included 154,651 individuals with hypertension and 50,722 individuals with diabetes from Xiamen between 2012 and 2016. The dependent variables included rates of disease under control and total treatment costs. Patients were grouped by the types of chronic disease management: precision management, regular management, or without management. Kaplan-Meier, Cox survival analysis and PSM + DID method (Propensity score matching and difference-in-difference method) were used to compare the management outcomes by group. FINDINGS The precision management group showed better clinical quality performance than the regular management group. Under-control disease rates in the precision management group showed a continuous improvement trend, while the regular management group showed a ceiling effect after ten months. Under-control rates in the precision management group increased over 40% for hypertension and over 30% for diabetes, higher than that increases found in the regular management group. Reform was also associated with consistent reductions in annual per capita total treatment costs across groups. The cost-savings in the precision management group between 2014 and 2016 was 381 Chinese yuan (CNY) for hypertension and 1117 CNY for diabetes, compared with the group without management. INTERPRETATION The results in this study demonstrated the associations between tiered healthcare system reform and better clinical quality performance and improved treatment cost-saving. Developing methods to promote the policy and increase implementation are also important aspects of healthcare reform.
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18
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Liu K, Zhang Q, He AJ. The impacts of multiple healthcare reforms on catastrophic health spending for poor households in China. Soc Sci Med 2021; 285:114271. [PMID: 34352505 DOI: 10.1016/j.socscimed.2021.114271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 06/21/2021] [Accepted: 07/25/2021] [Indexed: 12/28/2022]
Abstract
Many developing nations witness systemic healthcare reforms where the expansion of health financing mechanisms and reforms of the service delivery system are being rolled out simultaneously. Yet, poorly coordinated reforms and negative interactions between multiple policies may offset synergies and undermine intended reform outcomes. This study examines how multiple healthcare reforms affect catastrophic health spending of low-income households in China. We characterize two broad types of health policy reforms: expansion- and constraint-oriented policies in the domains of financing, services delivery, and pharmaceuticals introduced since 2009. We adopt an innovative methodology by matching macro-level policy text data collected using big data techniques with micro-level health expenditure data drawn from a nationally representative survey. Employing a linear probability analysis and controlling for household and year fixed effects, we find that more expansion-oriented policies, especially in the domain of financing, increased the incidence of catastrophic health spending of poor households. In contrast, constraint-oriented policies, particularly in the domain of health services delivery, lead to a lower incidence of catastrophic health spending. This type of policy is thus better able to mitigate the positive relationship between expansion-oriented policies and the incidence of catastrophic health spending. This study suggests that while the expansion of benefit package in the domain of financing is indeed a decisive move towards universal health coverage, the essential financial protection of the poor cannot be achieved without strong and coordinated supply-side reforms towards cost containment. Health policy makers must take a strategic view of the complex interactions of multiple policy interventions in both financing and service delivery domains.
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Affiliation(s)
- Kai Liu
- School of Labor and Human Resources, Renmin University of China, China.
| | - Qian Zhang
- School of Labor and Human Resources, Renmin University of China, China.
| | - Alex Jingwei He
- Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong, China.
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19
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Gu F, Liu X, Qi L, Xu X, Zeng Z. Financial and social impacts of drug price changes: Evidence from 2017 healthcare reform in Liaoning Province, China. Int J Health Plann Manage 2021; 36:2215-2230. [PMID: 34288103 DOI: 10.1002/hpm.3287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/22/2021] [Accepted: 07/07/2021] [Indexed: 01/17/2023] Open
Abstract
Healthcare reform was launched in China in 2017 to reduce the financial burden on both patients and the government by terminating the 15% markup on drug prices at public hospitals. To evaluate this reform's impacts, we conduct a quantitative study based on the operational data from one of the top 10 hospitals in Liaoning, China. Specifically, we utilize log-linear and logistic regression models to examine the policy's impacts on patients' total healthcare expenditures and the hospital's adjustments of its offering list that consists of western medicine (WM), traditional Chinese medicine (TCM) and non-medicine (NM). We find that the reform effectively alters the patients' spending structure and the hospital's profit model: (1) it decreases patients' average per-visit expenditure on WM and TCM while increases their average NM expenditure; (2) it differently affects patients from various socioeconomic groups and leaves space to target on groups that may demand extra financial and healthcare assistance; (3) it slows down the hospital's revenue increase and incentivizes the hospital to shift the WM revenue from margin-driven to volume-driven and to weigh more on NM revenue and (4) it encourages the hospital to keep WMs with steady price and drop WMs whose price keeps rising.
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Affiliation(s)
- Fulai Gu
- School of Economics and Management, Dalian University of Technology, Dalian, China
| | - Xiaobing Liu
- School of Economics and Management, Dalian University of Technology, Dalian, China
| | - Lian Qi
- Rutgers Business School, Rutgers University, Newark, New Jersey, USA
| | - Xiaowei Xu
- Rutgers Business School, Rutgers University, Newark, New Jersey, USA
| | - Zheng Zeng
- Rutgers Business School, Rutgers University, Newark, New Jersey, USA
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20
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Jia H, Wang S, Liu J, Li L, Liu L. A novel risk score for in-hospital perioperative mortality of five major surgeries. Int J Qual Health Care 2021; 33:6272502. [PMID: 33963847 DOI: 10.1093/intqhc/mzab080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/12/2021] [Accepted: 05/08/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Risk-scoring tools for perioperative mortality adjustment are essential for inter-hospital quality comparisons, which are still lacking in China. Existing scores had significant disadvantages when applied in managerial practice. OBJECTIVE This study aimed to develop a simple risk score using highly accessible information that could appropriately adjust the perioperative mortality from major surgeries across tertiary Chinese public hospitals and provide a reference for other underdeveloped countries with the same need. METHODS A study cohort from 19 hospitals was randomly split into a development set and an internal validation set in the ratio of 7:3. Another cohort from six hospitals was used as an external validation set. All data were obtained from the military-hospital public services database of the National Engineering Laboratory of Application Technology in Medical Big Data. Patients aged above 18 years undergoing one of the five categories of major surgical procedures between 1 January 2010 and 31 December 2020 were identified. The multivariate logistic regression analysis was used to predict the risk of mortality and derive the risk score. The area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test were used to assess the discrimination and calibration of the model, respectively. RESULTS The study set included 45 558 cases, divided into a development set containing 31 891 cases and an internal validation set with 13 667 cases. Another cohort with 14 956 cases was used as an external validation set. The final included predictor variables were age, Elixhauser Comorbidity Index, condition at admission, admission route and the procedure. The predicted risk score ranged from -21.5 to 37.0 points. The model discriminated well in the development set, internal validation set, and external validation set. The AUC for them were 0.753 (Standard Error(SE) 0.016, 95% Confidence Interval(CI): 0.721,0.784), 0.790 (SE 0.025, 95% CI: 0.742,0.839), and 0.766(SE 0.019, 95% CI: 0.728, 0.804), respectively. P values in the Hosmer-Lemeshow goodness-of-fit test were all above 0.05, indicating a good calibration. CONCLUSIONS This risk-scoring model was proved to have satisfactory performance, allowing the rapid and effective risk adjustment of perioperative mortality when comparing the surgical quality in tertiary hospitals in China and other underdeveloped regions.
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Affiliation(s)
- Hongxun Jia
- Department of Human Resources, Chinese People's Liberation Army General Hospital, Outpatient Building, 28 Fuxing Road, Haidian, Beijing 100853, China
| | - Shan Wang
- Department of Innovative Medical Research, Chinese People's Liberation Army General Hospital, Outpatient Building, 28 Fuxing Road, Haidian, Beijing 100853, China
| | - Jianchao Liu
- Hospital Management Institute, Department of Innovative Medical Research, Chinese People's Liberation Army General Hospital, Outpatient Building, 28 Fuxing Road, Haidian, Beijing 100853, China
| | - Lin Li
- Hospital Management Institute, Department of Innovative Medical Research, Chinese People's Liberation Army General Hospital, Outpatient Building, 28 Fuxing Road, Haidian, Beijing 100853, China
| | - Lihua Liu
- Hospital Management Institute, Department of Innovative Medical Research, Chinese People's Liberation Army General Hospital, Outpatient Building, 28 Fuxing Road, Haidian, Beijing 100853, China
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21
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Zhao D, Zhou Z, Shen C, Nawaz R, Li D, Ren Y, Zhao Y, Cao D, Zhai X. Rural and urban differences in patient experience in China: a coarsened exact matching study from the perspective of residents. BMC Health Serv Res 2021; 21:330. [PMID: 33849544 PMCID: PMC8042990 DOI: 10.1186/s12913-021-06328-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patient experience is a key measure widely used to evaluate quality of healthcare, yet there is little discussion about it in China using national survey data. This study aimed to explore rural and urban differences in patient experience in China. METHODS Data regarding this study were drawn from Chinese General Social Survey (CGSS) 2015, with a sample size of 9604. Patient experience was measured by the evaluation on healthcare services. Coarsened exact matching (CEM) method was used to balance covariates between the rural and urban respondents. Three thousand three hundred seventy-two participants finally comprised the matched cohort, including 1592 rural residents and 1780 urban residents. Rural and urban differences in patient experience were tested by ordinary least-squares regression and ordered logistic regression. RESULTS The mean (SD) score of patient experience for rural and urban residents was 72.35(17.32) and 69.45(17.00), respectively. Urban residents reported worse patient experience than rural counterparts (Crude analysis: Coef. = - 2.897, 95%CI: - 4.434, - 1.361; OR = 0.706, 95%CI: 0.595, 0.838; Multivariate analysis: Coef. = - 3.040, 95%CI: - 4.473, - 1.607; OR = 0.675, 95%CI: 0.569, 0.801). Older (Coef. = 2.029, 95%CI: 0.338, 3.719) and healthier (Coef. = 2.287, 95%CI: 0.729, 3.845; OR = 1.217, 95%CI: 1.008, 1.469) rural residents living in western area (Coef. = 2.098, 95%CI: 0.464, 3.732; OR = 1.276, 95%CI: 1.044, 1.560) with higher social status (Coef. = 1.158, 95%CI: 0.756, 1.561; OR = 1.145, 95%CI: 1.090, 1.204), evaluation on adequacy (Coef. = 7.018, 95%CI: 5.045, 8.992; OR = 2.163, 95%CI: 1.719, 2.721), distribution (Coef. = 4.464, 95%CI: 2.471, 6.456; OR = 1.658, 95%CI: 1.312, 2.096) and accessibility (Coef. = 2.995, 95%CI: 0.963, 5.026; OR = 1.525, 95%CI: 1.217, 1.911) of healthcare resources had better patient experience. In addition, urban peers with lower education (OR = 0.763, 95%CI: 0.625, 0.931) and higher family economic status (Coef. = 2.990, 95%CI: 0.959, 5.021; OR = 1.371, 95%CI: 1.090,1.723) reported better patient experience. CONCLUSIONS Differences in patient experience for rural and urban residents were observed in this study. It is necessary to not only encourage residents to form a habit of seeking healthcare services in local primary healthcare institutions first and then go to large hospitals in urban areas when necessary, but also endeavor to reduce the disparity of healthcare resources between rural and urban areas by improving quality and capacity of rural healthcare institutions and primary healthcare system of China.
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Affiliation(s)
- Dantong Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
- Department of Health Policy and Management, Yale University, New Haven, CT, 06520, USA
| | - Rashed Nawaz
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Dan Li
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Yangling Ren
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Xiaohui Zhai
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
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22
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Zheng X, Yang D, Luo S, Yan J, Guo X, Yang H, Bao W, Groop L, Dornhorst A, Weng J. Association of Implementation of a Comprehensive Preconception-to-Pregnancy Management Plan With Pregnancy Outcomes Among Chinese Pregnant Women With Type 1 Diabetes: The CARNATION Study. Diabetes Care 2021; 44:883-892. [PMID: 33627365 PMCID: PMC7985418 DOI: 10.2337/dc20-2692] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/18/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the effect on pregnancy outcome of integrating a comprehensive management plan for patients with type 1 diabetes (T1D) into the World Health Organization universal maternal care infrastructure. RESEARCH DESIGN AND METHODS A comprehensive preconception-to-pregnancy management plan for women with T1D was implemented in 11 centers from 8 Chinese cities from 2015 to 2017. Sequential eligible pregnant women (n = 133 out of 137 initially enrolled) with T1D and singleton pregnancies attending these management centers formed the prospective cohort. The main outcome was severe adverse pregnancy outcome comprising maternal mortality, neonatal death, congenital malformations, miscarriage in the second trimester, and stillbirth. We compared pregnancy outcomes in this prospective cohort with two control groups with the same inclusion and exclusion criteria: a retrospective cohort (n = 153) of all eligible pregnant women with T1D attending the same management centers from 2012 to 2014 and a comparison cohort (n = 116) of all eligible pregnant women with T1D receiving routine care from 2015 to 2017 in 11 different centers from 7 cities. RESULTS The rate of severe adverse pregnancy outcome was lower in the prospective cohort (6.02%) than in either the retrospective cohort (18.30%; adjusted odds ratio [aOR] 0.31 [95% CI 0.13-0.74]) or the contemporaneous comparison cohort (25.00%; aOR 0.22 [95% CI 0.09-0.52]). CONCLUSIONS The substantial improvements in the prospective cohort are evidence of a potentially clinically important effect of the comprehensive management plan on pregnancy outcomes among Chinese pregnant women with pregestational T1D. This supports the development of similar approaches in other countries.
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Affiliation(s)
- Xueying Zheng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sihui Luo
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Guo
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Leif Groop
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Anne Dornhorst
- Faculty of Medicine, Imperial College London, London, U.K
| | - Jianping Weng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Yan J, Yao J, Zhao D. Patient satisfaction with outpatient care in China: a comparison of public secondary and tertiary hospitals. Int J Qual Health Care 2021; 33:6066360. [PMID: 33404594 DOI: 10.1093/intqhc/mzab003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/10/2020] [Accepted: 01/06/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The aims of this study were to investigate and compare patient satisfaction with outpatient care in public secondary and tertiary hospitals in China and to explore the factors affecting patient satisfaction for improving the quality of outpatient care in public hospitals. METHODS This cross-sectional study comprised a sample survey of 11 097 adults in 31 provincial cities in China from February to April 2018. A pretested structured questionnaire was used to collect outpatient experience data through a computer-assisted telephone interviewing system. Patient satisfaction was assessed using nine questions answered on a 4-point Likert scale. Multivariate regression models were employed to examine the relationships of patient satisfaction with outpatient services and healthcare provider level and to identify the factors associated with satisfaction. RESULTS Patient's overall satisfaction score with outpatient care was 27.3 (SD = 3.8), with lower scores observed in tertiary hospitals than in secondary hospitals (27.3 vs. 27.6, P < 0.05). The domain with the highest satisfaction was 'consulting environment', and the domain with the lowest satisfaction was 'patient waiting time in the hospital'. Patients who went to tertiary hospitals reported lower satisfaction in 'patient waiting time in the hospital', 'medical expenses', 'patient length of treatment time' and 'attitudes of other health workers' than patients who went to secondary hospitals (P < 0.05). In secondary hospitals, no significant difference in patient satisfaction was observed between different sociodemographic categories (P > 0.05). In tertiary hospitals, female and single respondents were more likely to have higher satisfaction (P < 0.05), whereas respondents with high school or junior college degrees were more likely to have lower satisfaction (P < 0.05). CONCLUSION The aforementioned results suggested that tertiary hospitals face larger challenges in patient satisfaction with outpatient care than secondary hospitals. Measures must be adopted to improve patient satisfaction with outpatient care in future healthcare reforms. Patient waiting time, medical expenses and treatment duration especially require improvements in tertiary hospitals.
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Affiliation(s)
- Jingjing Yan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, 200030, P.R. China
| | - Jiansen Yao
- Institute of Hospital Management, Tsinghua University, Shenzhen, P.R. China
| | - Dahai Zhao
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, 200030, P.R. China.,Shanghai Jiao Tong University-Yale University Joint Center for Health Policy, Shanghai Jiao Tong University, Shanghai, P.R. China
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Wang X, Chen J, Yang Y, Burström B, Burström K. Validation of the patient-reported experience measure for care in Chinese hospitals (PREM-CCH). Int J Equity Health 2021; 20:25. [PMID: 33413446 PMCID: PMC7791723 DOI: 10.1186/s12939-020-01370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A psychometrically validated instrument to measure patient experience in Chinese public hospitals would be useful and is currently lacking. Our research team developed the Patient-Reported Experience Measure for Care in Chinese Hospitals (PREM-CCH). We aimed to validate this PREM-CCH in the present study. METHODS Data were drawn from a cross-sectional patient survey in 2016. Complete responses from 2293 outpatients and 1510 inpatients were included. Separate psychometric evaluation was carried out on outpatient and inpatient PREM-CCHs in terms of exploratory factor analysis, internal consistency, construct validity and criterion validity. RESULTS The validated outpatient PREM-CCH contained 22 items and five Factors, i.e. Communication and information, Professional competence, Medical costs, Efficiency, and Hospital recommendation. The validated inpatient PREM-CCH contained 19 items and six Factors, i.e. Communication and information, Professional competence, Medical costs, Efficiency, Health outcomes, and Hospital recommendation. The PREM-CCH showed satisfactory internal consistency, construct validity and criterion validity. CONCLUSIONS The PREM-CCH is one of the first validated instruments capturing patient experience of care in the context of Chinese public hospitals. It performed well in the psychometric evaluation. It consists of a basic set of items important to patients that could be applicable to public hospitals in China and actionable to inform quality improvement initiatives.
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Affiliation(s)
- Xuanxuan Wang
- School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 Jiangsu Province China
- Institute of Healthy Jiangsu Development, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 Jiangsu Province China
| | - Jiaying Chen
- Institute of Healthy Jiangsu Development, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 Jiangsu Province China
- Centre for Health Policy Studies, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 Jiangsu Province China
- Creative Health Policy Research Group, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 Jiangsu Province China
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, New Radcliffe House, Walton Street, Oxford, OX2 6NW UK
| | - Bo Burström
- Centre for Health Policy Studies, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 Jiangsu Province China
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, 171-77 Stockholm, Sweden
| | - Kristina Burström
- Centre for Health Policy Studies, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 Jiangsu Province China
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, 171-77 Stockholm, Sweden
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171-77 Stockholm, Sweden
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25
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Koucheckyazdi S, Maleki M, Aryan Khesal A, Goharinezhad S. Identifying and prioritizing the drivers of the future of public hospitals in Iran. Med J Islam Repub Iran 2020; 34:119. [PMID: 33315995 PMCID: PMC7722972 DOI: 10.34171/mjiri.34.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Rapid development in today's modern world have made predicting the future difficult. Hospitals, as a major complex in a community, are no exception. Knowing the future facilitates laying plans for it. To predict the future, knowing the factors affecting the future is crucial. This study was therefore conducted to identify and predict the factors affecting the future of hospitals in Iran.
Methods: This study was conducted in three steps. The drivers of the future of hospitals in Iran were listed by analyzing the results of a literature review and then semi-structured interviews with hospital experts. Afterward, the effect of individual drivers was determined using the Fuzzy Analytical Hierarchy Process (FAHP) by formulated in excel software.
Results: Based on the results of the first Phase, 30 effective drivers were identified in 6 areas of modern technology, economy, politics, demography and community, environment, and culture. Prioritization results showed that modern technology (0.246) and economic factors (0.198) had priority over the other factors. Moreover, the effects of sub-factors such as modern information technology and technologies on the future of public hospitals in Iran were more significant compared to those of the other factors.
Conclusion: The present results showed that information technology and modern technology, as well as the economy, were the two main drivers of the future of public hospitals in Iran. Hospitals should identify and lay plans for the mechanisms through which the two factors affect hospitals, given their failure to control the upward trends of the factors.
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Affiliation(s)
- Soheila Koucheckyazdi
- Department of Health Services Management, School of Health Management and Information Sciences, International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Services Management, School of Health Management and Information Sciences, International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryan Khesal
- Department of Health Services Management, School of Health Management and Information Sciences, International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Salime Goharinezhad
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Wang Y, Castelli A, Cao Q, Liu D. Assessing the design of China’s complex health system – Concerns on equity and efficiency. HEALTH POLICY OPEN 2020. [DOI: 10.1016/j.hpopen.2020.100021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Zhang X, Lai H, Zhang L, He J, Fu B, Jin C. The impacts and unintended consequences of the nationwide pricing reform for drugs and medical services in the urban public hospitals in China. BMC Health Serv Res 2020; 20:1058. [PMID: 33225941 PMCID: PMC7682084 DOI: 10.1186/s12913-020-05849-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Since 2015, China has been rolling out the pricing reform for drugs and medical services (PRDMS) in the urban public hospitals in order to reduce drug expenditures and to relieve financial burdens of patients. This study aims at evaluating the effectiveness of the reform and investigating its positive impacts and unintended consequences to provide evidence basis for further policy making. Methods The Difference-in-difference (DID) approach was employed to analyze the reform impacts on the 31 provincial administrative areas in China based on data abstracted from China Statistics Yearbooks and China Health Statistics Yearbooks from 2012 to 2018. Results The reform resulted in a decrease of 7.59% in drug cost per outpatient visit, a decrease of 5.73% in drug cost per inpatient admission, a decrease of 3.63% in total cost per outpatient visit and an increase of 9.10% in surgery cost per inpatient admission in the intervention group. However, no significant change in examination cost was found. The reduction in the medical cost per inpatient admission was not yet demonstrated, nor was that in the total outpatient/ inpatient expenses. The nationwide pricing reform for drugs and medical services in urban public hospitals (PRDMS-U) in China is demonstrated to be effective in cutting down the drug expenditures. However, the revealed unintended consequences indicate that there are still significant challenges for the reform to reach its ultimate goal of curbing the medical expenditures. Conclusion We conclude that the pricing reform alone may not be enough to change the profit-driven behavior of medical service providers as the root cause lies in the unchanged incentive scheme for providers in the service delivery. This holds lessons for policy making of other low- and middle-income countries (LMICs) with similar health systems set up in the achievement of Universal Health Coverage (UHC).
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Affiliation(s)
- Xiaoxi Zhang
- Shanghai Health Development Research Center, 1477 Beijing West Rd., Shanghai, 200040, China
| | - Hongyu Lai
- School of Data Science, Fudan University, 220 Handan Rd, Shanghai, 200433, China
| | - Lidan Zhang
- School of Management, Fudan University, 220 Handan Rd, Shanghai, 200433, China
| | - Jiangjiang He
- Shanghai Health Development Research Center, 1477 Beijing West Rd., Shanghai, 200040, China
| | - Bo Fu
- School of Data Science, Fudan University, 220 Handan Rd, Shanghai, 200433, China.
| | - Chunlin Jin
- Shanghai Health Development Research Center, 1477 Beijing West Rd., Shanghai, 200040, China
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Ning J, Liu L, Cherlin E, Peng Y, Yue J, Xiong H, Tao H. Impact of reimbursement rates on the length of stay in tertiary public hospitals: a retrospective cohort study in Shenzhen, China. BMJ Open 2020; 10:e040066. [PMID: 33444197 PMCID: PMC7678385 DOI: 10.1136/bmjopen-2020-040066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the association between reimbursement rates and the length of stay (LOS). DESIGN A retrospective cohort study. SETTING The study was conducted in Shenzhen, China by using health administrative database from 1 January 2015 to 31 December 2017. PARTICIPANTS 6583 patients with acute myocardial infarction (AMI), 12 395 patients with pneumonia and 10 485 patients who received percutaneous coronary intervention (PCI) surgery. MEASURES The reimbursement rate was defined as one minus the ratio of out-of-pocket to the total expenditure, multiplied by 100%. The outcome of interest was the LOS. Multilevel negative binomial regression models were constructed to control for patient-level and hospital-level characteristics, and the marginal effect was reported when non-linear terms were available. RESULTS Each additional unit of the reimbursement rate was associated with an average of an additional increase of 0.019 (95% CI, 0.015 to 0.023), 0.011 (95% CI, 0.009 to 0.014) and 0.013 (95% CI, 0.010 to 0.016) in the LOS for inpatients with AMI, pneumonia and PCI surgery, respectively. Adding the interaction term between the reimbursement rate and in-hospital survival, the average marginal effects for the deceased inpatients with AMI and PCI surgery were 0.044 (95% CI, 0.031 to 0.058) and 0.034 (95% CI, 0.017 to 0.051), respectively. However, there was no evidence that higher reimbursement rates prolonged the LOS of the patients who died of pneumonia (95% CI, -0.013 to 0.016). CONCLUSIONS The findings indicate that the higher the reimbursement rate, the longer the LOS; and implementing dynamic supervision and improving the service capabilities of primary healthcare providers may be an important strategy for reducing moral hazard in low-income and middle-income countries including China.
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Affiliation(s)
- Jie Ning
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingrui Liu
- Department of Health Policy and Management, Yale School of Public Health, Global Health Leadership Initiative, Yale University, New Haven, Connecticut, USA
| | - Emily Cherlin
- Department of Health Policy and Management, Yale School of Public Health, Global Health Leadership Initiative, Yale University, New Haven, Connecticut, USA
| | - Yarui Peng
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingkai Yue
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoling Xiong
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbing Tao
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Zhou Z, Zhao Y, Shen C, Lai S, Nawaz R, Gao J. Evaluating the effect of hierarchical medical system on health seeking behavior: A difference-in-differences analysis in China. Soc Sci Med 2020; 268:113372. [PMID: 32979776 DOI: 10.1016/j.socscimed.2020.113372] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022]
Abstract
The unbalanced allocation of healthcare resources and the underutilization of primary care facilities are the core problems that restrict the current healthcare reforms in China. In order to encourage residents to go to primary care facilities, China implemented the Hierarchical Medical System (HMS) in 2015. This study aims to evaluate the effect of HMS on health seeking behavior in China using panel data. Statistics for the study were derived from China Family Panel Studies (CFPS) 2012, 2014, 2016 and 2018, and China health and family planning statistical yearbook 2012, 2014, 2016 and 2018. We employed the difference-in-differences (DID) model with multiple periods. In total, 61,932 residents were incorporated for a final sample covered 25 provinces. The results indicated that the implementation of HMS had a significantly positive effect on the probability of urban residents going to primary care facilities for contact. However, the effect of HMS was not significant for rural residents. Basic health insurance was a significant factor for directing residents to primary care facilities. Self-assessed health, chronic disease, economic level and educational status were also found to be focal factors of health seeking behavior. In conclusion, the introduction of HMS has led to improved health seeking behavior and is worth putting more effort into. For policy makers, basic medical insurance is still an important health policy that enables systematic health seeking behavior. Initiatives to continue to expand the adjustment range of economic incentives should be adopted to promote the implementation of HMS. However, the effect of HMS in chronic disease is poor and efforts to formulate chronic disease as a breakthrough to HMS should be carried out. Moreover, the government should increase the publicity of HMS.
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Affiliation(s)
- Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Rashed Nawaz
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
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30
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Fu M, Wushouer H, Nie X, Shi L, Guan X, Ross-Degnan D. Potentially inappropriate medications among elderly patients in community healthcare institutions in Beijing, China. Pharmacoepidemiol Drug Saf 2020; 29:923-930. [PMID: 32515047 DOI: 10.1002/pds.5064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate potentially inappropriate medications (PIMs) prevalence and predictors in community healthcare institutions (CHIs) for the elderly. METHODS We conducted a retrospective observational study, deriving data of patients aged ≥60 from 66 CHIs in Beijing, 2014-2018. The system of Criteria of PIM for Older Adults in China was applied to identify PIMs. The primary outcome was the prevalence of visits with at least one PIM; secondary outcomes were the frequency and rate per thousand visits of specific PIMs. We used descriptive analysis and generalized linear models to analyzed PIMs and the predictors, and marginal effects methods were applied to estimate the mean adjusted PIMs prevalence. RESULTS Overall, 4 528 884 elderly patient visits from 2014 to 2018 were eligible for inclusion. A total of 719 757 PIMs were detected, with 14.1% of the visits contained at least one PIM. PIM prevalence was significantly correlated with age, number of prescribed medications and number of diagnoses. Overall, 6.0 per thousand elderly patients in CHIs were exposed to at least one high-risk PIM, while 117.5 per thousand were exposed to at least one low-risk PIM. In 2018, 20% of GPs were responsible for more than half of overall PIM visits. CONCLUSION Prescribing of PIMs for older adults is common in CHIs in China, especially for patients who are aged, having multiple medications and diagnostic diseases. Strategies should be developed to enhance prescribing quality for geriatric patients, with special targeting of doctors responsible for a high number of PIMs.
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Affiliation(s)
- Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Haishaerjiang Wushouer
- International Research Center for Medicinal Administration, Peking University, Beijing, China.,Center for Strategic Studies, Chinese Academy of Engineering, Beijing, China
| | - Xiaoyan Nie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Xu J, Mills A. 10 years of China's comprehensive health reform: a systems perspective. Health Policy Plan 2020; 34:403-406. [PMID: 31257418 DOI: 10.1093/heapol/czz026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jin Xu
- China Center for Health Development Studies, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, People's Republic of China
| | - Anne Mills
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK
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32
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Evaluation and analysis of hospital efficiency in China based on macro- and micro-level analyses. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Building a People-Centred Integrated Care Model in Urban China: A Qualitative Study of the Health Reform in Luohu. Int J Integr Care 2020; 20:9. [PMID: 32210740 PMCID: PMC7082827 DOI: 10.5334/ijic.4673] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: China has adopted a people-centred integrated care model to reform its severely hospital-centric and fragmented delivery system. As a template of this model in urban China, the Luohu Hospital Group has generated considerable public and academic interest to scale it up. Methods: Guided by a policy triangle framework, this qualitative study explored the context, actors, content, and process of founding the Luohu Hospital Group. Three semi-structured interviews and five focus groups were conducted among 35 key informants. Content analysis was used to analyse the data. Results: The reform in Luohu took place in a competitive health care market, based on the comprehensive health reform in Shenzhen. Under the strong leadership of the district government, the reform adopted comprehensive strategies to strengthen primary care and care coordination, improve the quality and efficiency of health care delivery, and promote population health. The reform achieved a high level of organisational integration but was still in the process of fulfilling professional and clinical integration. Conclusions and discussion: The establishment of the Luohu Hospital Group transformed the originally fragmented delivery system into a tightly integrated service delivery networks. Though valuable lessons have been generated, the reform and its impacts require ongoing monitoring.
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Zou K, Li HY, Zhou D, Liao ZJ. The effects of diagnosis-related groups payment on hospital healthcare in China: a systematic review. BMC Health Serv Res 2020; 20:112. [PMID: 32050962 PMCID: PMC7017558 DOI: 10.1186/s12913-020-4957-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a growing interest in using diagnosis-related groups (DRGs) payment to reimburse inpatient care worldwide. But its effects on healthcare and health outcomes are controversial, and the evidence from low- and middle- income countries (LMICs) is especially scarce. The objective of this study is to evaluate the effects of DRGs payment on healthcare and health outcomes in China. METHOD A systematic review was conducted. We searched literature databases of PubMed, Cochrane Library, EMBASE, Web of Science, Chinese National Knowledge Infrastructure and SinoMed for empirical studies examining the effects of DRGs payment on healthcare in mainland China. We performed a narrative synthesis of outcomes regarding expenditure, efficiency, quality and equity of healthcare, and assessed the quality of evidence. RESULTS Twenty-three publications representing thirteen DRGs payment studies were included, including six controlled before after studies, two interrupted time series studies and five uncontrolled before-after studies. All studies compared DRGs payment to fee-for-service, with or without an overall budget, in settings of tertiary (7), secondary (7) and primary care (1). The involved participants varied from specific groups to all inpatients. DRGs payment mildly reduced the length of stay. Impairment of equity of healthcare was consistently reported, especially for patients exempted from DRGs payment, including: patient selection, cost-shifting and inferior quality of healthcare. However, findings on total expenditure, out of pocket payment (OOP) and quality of healthcare were inconsistent. The quality of the evidence was generally low or very low due to the study design and potential risk of bias of included studies. CONCLUSION DRGs payment may mildly improve the efficiency but impair the equity and quality of healthcare, especially for patients exempted from this payment scheme, and may cause up-coding of medical records. However, DRGs payment may or may not contain the total expenditure or OOP, depending on the components design of the payment. Policymakers should very carefully consider each component of DRGs payment design against policy goals. Well-designed randomised trials or comparative studies are warranted to consolidate the evidence of the effects of DRGs payment on healthcare and health outcomes in LMICs to inform policymaking.
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Affiliation(s)
- Kun Zou
- Department of Medical Records and Statistics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong-Ying Li
- Department of Medical Records and Statistics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Die Zhou
- Department of Medical Records and Statistics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zai-Jun Liao
- Department of Medical Records and Statistics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Yang J, Song L, Yao X, Cheng Q, Cheng Z, Xu K. Evaluating the Intention and Behaviour of Private Sector Participation in Healthcare Service Delivery via Public-Private Partnership: Evidence from China. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:5834532. [PMID: 32015796 PMCID: PMC6988663 DOI: 10.1155/2020/5834532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/30/2019] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Jie Yang
- School of Management Engineering, Shandong Jianzhu University, Jinan 250101, Shandong, China
| | - Lingchuan Song
- School of Management Engineering, Shandong Jianzhu University, Jinan 250101, Shandong, China
| | - Xiaoyi Yao
- School of Business, University of Leicester, Leicester LE3 5EB, UK
| | - Qian Cheng
- School of Management Engineering, Shandong Jianzhu University, Jinan 250101, Shandong, China
| | - Zichao Cheng
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100069, China
| | - Ke Xu
- School of Management Engineering, Shandong Jianzhu University, Jinan 250101, Shandong, China
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Xu J, Nicholas S, Wang J, Yang Y. A retrospective analysis of hospital treatment expenditures among young and middle age patients with cancer, 2013-2017 under health reform. Int J Health Plann Manage 2020; 35:878-887. [PMID: 31903663 DOI: 10.1002/hpm.2957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 11/08/2022] Open
Abstract
Under 60 year olds represent a rapidly growing segment of the cancer population. They often face longer hospital stays, higher treatment intensity, and hospitalization costs. In this background, we aim to assess the impact of the 2009 reforms on the hospital expenses of younger cancer inpatients. Our study sample included 11 791 young and middle age stomach, lung, colorectal, esophageal, and breast cancer inpatients hospitalized during 2013 to 2017. Hospitalization treatment costs of under 60 cancer inpatients increased, but it fell in 2017 under the impact of the health reforms. However, out-of-pocket expenditures rose, which partly reflected the failure of the health insurance scheme to adequately cover cancer inpatient cost, potentially imposing financial hardships on cancer inpatients and their families. To continue to reduce the economic burden of cancer patients, early screening and diagnosis among younger populations and enhanced hospice care integrated with the ongoing primary health care reform are important.
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Affiliation(s)
- Junfang Xu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Stephen Nicholas
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China.,Guangdong Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangdong, China.,TOP Education Institute 1 Central Avenue Australian Technology Park, Sydney, New South Wales, Australia.,Newcastle Business School, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jian Wang
- Dong Furen Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Yuxia Yang
- Center for Health Economic Experiments and Public Policy, Department of Social Medicine and Administration, School of Public Health, Shandong University, Jinan, China.,The Second Hospital of Shandong University, Jinan, China
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Qin X, Hsieh CR. Understanding and Addressing the Treatment Gap in Mental Healthcare: Economic Perspectives and Evidence From China. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2020; 57:46958020950566. [PMID: 32964754 PMCID: PMC7517998 DOI: 10.1177/0046958020950566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face 4 major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the 4 barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies.
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Zeng J, Chen X, Fu H, Lu M, Jian W. Short-term and long-term unintended impacts of a pilot reform on Beijing's zero markup drug policy: a propensity score-matched study. BMC Health Serv Res 2019; 19:916. [PMID: 31783751 PMCID: PMC6884786 DOI: 10.1186/s12913-019-4764-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background In September 2012, Beijing, the capital of China, selected five tertiary hospitals as pilots to remove the previously allowed 15% markup for drug sales. However, while most research demonstrated the significant decrease in drug sales, the core issue of high health expenditure was not well solved because of the unintended policy impact. This study aimed to empirically evaluate the short-term and long-term unintended impacts on controlling medical expenses of Beijing’s zero markup drug policy from 2012 to 2015. Methods This study extracted 2012–2015 individual-level data from the Beijing Urban Employee Basic Medical Insurance (UEBMI) database and performed a propensity score-matched analysis to evaluate the short-term and long-term impacts on controlling medical expenses. All inpatients in the 5 pilot reform hospitals were selected as the intervention group, while inpatients in other tertiary hospitals were selected as the control group. Results A total of 520,996 inpatients were extracted in this study. For patients in the pilot hospitals, the total expenditures per admission decreased from 17,140.3 yuan in 2012 to 15,430.1 yuan in 2013 and then increased to 16,789.8 yuan in 2015. Expenditure on drugs reduced from 5811.7 yuan in 2012 to 3903.4 yuan in 2015. However, a significant substitution effect of medical consumables was first observed in the third quarter of 2014, which undermined the impact of the policy. In the long-term, the intervention group and control group demonstrated the same trend. Conclusions After the zero markup drug policy, expenditure on drugs revealed a continuous decline. However, the decline in total expenditure was weakened by the substitution effect of medical consumables in the long term.
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Affiliation(s)
- Jianying Zeng
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xiwen Chen
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ming Lu
- Department of Medical Informatics, School of Basic Medicine, Peking University Health Science Center, Beijing, China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
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Liu J, He B, Xu X, Zhou L, Li J, Wang G, Chen Y. Determinants of efficiency growth of county-level public hospitals-evidence from Chongqing, China. BMC Health Serv Res 2019; 19:858. [PMID: 31752822 PMCID: PMC6868819 DOI: 10.1186/s12913-019-4609-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 10/03/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The reform of county-level public hospitals is a breakthrough in the new era of healthcare reform in China and has attracted considerable attention since 2012. Continuous and efficient operations of hospital are primary concerns of this reform. To ensure the effectiveness of county-based intervention reform measures in Chongqing, it is significant to understand how hospital and county characteristics are associated with county-level public hospital efficiency due to significant development differences between counties. This study identifies the trajectory of hospital efficiency over time and determinants. It will also provide preliminary references for advancing reform. METHODS This study employs data from the Chongqing Regional Health Information Platform, Chongqing Health and Family Planning Statistical Yearbook, and Chongqing Statistical Yearbook for 2012-2016. A three-level growth model is used to estimate the efficiency growth trajectories within the contexts of hospitals and counties. RESULTS The intra-hospital level factors that affect the initial efficiency include government financial assistance, daily charge per bed, total assets turnover, number of hospital healthcare technicians, and medical costs per 100-yuan medical income. Inter-hospital variance is explained by hospital type. Inter-county level factors affecting the growth rate include the number of healthcare technicians per 1000 people and population density of the county. The interaction effect of the number of hospital healthcare technicians, hospital type, and number of healthcare technicians per 1000 people on hospital efficiency growth is significant. CONCLUSIONS This study identifies determinants that contribute to efficiency changes in public county-hospitals over time by using a three-level growth model. The differences in efficiency are associated with intra-hospital, inter-hospital, and inter-county characteristics in Chongqing, which provides useful insight into government decision-making and the progress of reform. The stability and reasonable increase in the number of healthcare technicians in a county are the key factors that improve the efficiency. Further reform should focus on maternal and child healthcare hospitals for increasing investment and implementing government compensation.
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Affiliation(s)
- Jing Liu
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, 200032 People’s Republic of China
- Department of Health Management, School of Management, Hainan Medical University, Hainan, 571199 People’s Republic of China
| | - Beibei He
- Hospital Management Institute, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Xiaolan Xu
- Department of Statistics and Development Research, Chongqing Health Information Center, Chongqing, 401120 People’s Republic of China
| | - Leming Zhou
- Department of Statistics and Development Research, Chongqing Health Information Center, Chongqing, 401120 People’s Republic of China
| | - Jiang Li
- Department of Statistics and Development Research, Chongqing Health Information Center, Chongqing, 401120 People’s Republic of China
| | - Gongru Wang
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Yingyao Chen
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, 200032 People’s Republic of China
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Yang Q, Zhang H, Yu M, Hu X, Gu Y, Sun X, Zhen X, Gu S, Huang M, Wei J, Zeng Y, Dong H. Chinese Minority Perceives the Doctor-Patient Relationship Differently: A Cultural and Economic Interpretation. Front Public Health 2019; 7:330. [PMID: 31824907 PMCID: PMC6880764 DOI: 10.3389/fpubh.2019.00330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/24/2019] [Indexed: 01/06/2023] Open
Abstract
In China, doctor-patient relationships (D-P relationships) are cited frequently and attracted international attention. This study assesses whether the D-P relationship experienced by the Chinese is associated with ethnicity, hospital hierarchies, and socioeconomic factors. In a national cross-sectional survey, multi-stage random sampling was adopted to assess regional and socio-economic differences between year 2016 and year 2017. Each area surveyed consisted of about 250 randomly chosen households, and valid results were obtained from 4,173 adults aged 16-99. When provided a choice of eight types of D-P relationship, for doctors in primary care institutions, 63.8% of ethnic minorities indicated having a friend-type relationship with their physicians, with 23.3% having a trading/reciprocal relationship. Han Chinese, however, predicts the opposite relationship between doctors from different hierarchy and the types of D-P relationship. For physicians working in hospitals, this difference in relationship was more pronounced, where 52.9% of ethnic minorities indicated having a friend-type relationship with their physicians, and 30.1% indicated the presence of a trading/reciprocal relationship. For Han Chinese, however, 53.3% indicated having a reciprocal relationship with their doctor. Overall, the prevalence of friendly D-P relationships was correlated with ethnic minorities, lower levels of education, and lower incomes. Ethnic minorities are most likely to perceive their physicians as friends, while Han Chinese are more likely to perceive a trading relationship with their physicians. The primary contribution of this research is the finding that D-P relationships differ for Han Chinese and other ethnic minorities.
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Affiliation(s)
- Qian Yang
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.,Department of Social Medicine, School of Public Health, National Clinical Research Center for Child Health of The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Zhang
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Mengfei Yu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoqian Hu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxuan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueshan Sun
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuemei Zhen
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuyan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Minzhuo Huang
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingming Wei
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhang Zeng
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.,Department of Social Medicine, School of Public Health, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
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Wang Z, Jiang W, Liu Y, Zhang L, Zhu A, Tang S, Liu X. Transforming tuberculosis (TB) service delivery model in China: issues and challenges for health workforce. HUMAN RESOURCES FOR HEALTH 2019; 17:83. [PMID: 31718682 PMCID: PMC6852749 DOI: 10.1186/s12960-019-0420-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/20/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND China's TB control system has been transforming its service delivery model from CDC (Centers for Disease Control and Prevention)-led model to the designated hospital-led model to combat the high disease burden of TB. The implications of the new service model on TB health workforce development remained unclear. This study aims to identify implications of the new service model on TB health workforce development and to analyze whether the new service model has been well equipped with appropriate health workforce. METHODS The study applied mixed methods in Zhejiang, Jilin, and Ningxia provinces of China. Institutional survey on designated hospitals and CDC was conducted to measure the number of TB health workers. Individual questionnaire survey was conducted to measure the composition, income, and knowledge of health workers. Key informant interviews and focus group discussions were organized to explore policies in terms of recruitment, training, and motivation. RESULTS Zhejiang, Jilin, and Ningxia provinces had 0.33, 0.95, and 0.47 TB health professionals per 10 000 population respectively. They met the national staffing standard at the provincial level but with great variety at the county level. County-designated hospitals recruited TB health professionals from other departments of the same hospital, existing TB health professionals who used to work in CDC, and from township health centers. County-designated hospitals recruited new TB health professionals from three different sources: other departments of the same hospital, CDC, and township health centers. Most newly recruited professionals had limited competence and put on fixed posts to only provide outpatient services. TB doctors got 67/100 scores from a TB knowledge test, while public health doctors got 77/100. TB professionals had an average monthly income of 4587 RMB (667 USD). Although the designated hospital had special financial incentives to support, they still had lower income than other health professionals due to their limited capacity to generate revenue through service provision. CONCLUSIONS The financing mechanism in designated hospitals and the job design need to be improved to provide sufficient incentive to attract qualified health professionals and motivate them to provide high-quality TB services.
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Affiliation(s)
- Ziyue Wang
- China Center for Health Development Studies, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191 China
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Weixi Jiang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu Province China
| | - Yuhong Liu
- Beijing Chest Hospital, Capital Medical University, No. 97 Ma Chang, Tongzhou District, Beijing, 101149 China
- Clinical Centre on Tuberculosis, Chinese Center for Disease Control and Prevention, No. 97 Ma Chang, Tongzhou District, Beijing, 101149 China
| | - Lijie Zhang
- Beijing Chest Hospital, Capital Medical University, No. 97 Ma Chang, Tongzhou District, Beijing, 101149 China
- Clinical Centre on Tuberculosis, Chinese Center for Disease Control and Prevention, No. 97 Ma Chang, Tongzhou District, Beijing, 101149 China
| | - Anna Zhu
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu Province China
| | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu Province China
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191 China
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Deng J, Sun Y, Lei R, Guo Y, Liu J, Yang T. Status of healthcare workers after comprehensive reform of urban public hospitals in Beijing, China: sustainable supply, psychological perception, and work outcomes. HUMAN RESOURCES FOR HEALTH 2019; 17:77. [PMID: 31660985 PMCID: PMC6819331 DOI: 10.1186/s12960-019-0421-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/24/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Healthcare reform in China has attracted worldwide interest and reached a new juncture. In an attempt to improve healthcare quality and patient satisfaction, the government of Beijing introduced comprehensive reform of urban public hospitals in 2016 and implemented new policies on personnel, compensation, management, and diagnosis and treatment. As the agents of healthcare service, and a target of reform measures, healthcare workers were greatly affected by these reforms but have not been carefully studied. METHODS This study used mean value analysis, variance analysis, and qualitative content analysis to investigate the status of healthcare workers after comprehensive reform of urban public hospitals in Beijing. RESULTS We found a gradual but constant increase in the number of healthcare workers in poor health in Beijing public hospitals. After the reforms, this population reported high challenge stress, public service motivation, job satisfaction, job performance and quality of healthcare, moderate presenteeism, and low hindrance stress and turnover intention. The status of healthcare workers differed by subgroup and changed during the reform process. CONCLUSIONS Our study provides data useful for policy recommendations regarding the implementation and extension of future reforms and offers important lessons for developing and developed countries that are reforming public hospitals to improve efficiency and reduce costs.
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Affiliation(s)
- Jianwei Deng
- School of Management and Economics, Beijing Institute of Technology, 5 Zhongguancun South Street, Beijing, 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, 5 Zhongguancun South Street, Beijing, 100081, China
| | - Yangyang Sun
- School of Management and Economics, Beijing Institute of Technology, 5 Zhongguancun South Street, Beijing, 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, 5 Zhongguancun South Street, Beijing, 100081, China
| | - Run Lei
- School of Management and Economics, Beijing Institute of Technology, 5 Zhongguancun South Street, Beijing, 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, 5 Zhongguancun South Street, Beijing, 100081, China
| | - Yilun Guo
- School of Management and Economics, Beijing Institute of Technology, 5 Zhongguancun South Street, Beijing, 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, 5 Zhongguancun South Street, Beijing, 100081, China
| | - Jian Liu
- Beijing City Chaoyang District ShuangQiao Hospital, ShuangQiao East Road, Chaoyang District, Beijing, 100024, China
| | - Tianan Yang
- School of Management and Economics, Beijing Institute of Technology, 5 Zhongguancun South Street, Beijing, 100081, China.
- Sustainable Development Research Institute for Economy and Society of Beijing, 5 Zhongguancun South Street, Beijing, 100081, China.
- Chair of Sport and Health Management, School of Management, Technical University of Munich, Uptown Munich Campus D, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
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Guo Y, Sun J, Hu S, Nicholas S, Wang J. Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193526. [PMID: 31547207 PMCID: PMC6801864 DOI: 10.3390/ijerph16193526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 01/24/2023]
Abstract
Background: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families’ financial burden. Methods: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital’s information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. Results: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children’s mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). Conclusions: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty—insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China’s health insurance schemes—especially to allow migrant families to gain basic medical insurance.
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Affiliation(s)
- Yawei Guo
- Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan 250012, China.
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jian 250014, China.
| | - Simeng Hu
- Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan 250012, China.
| | - Stephen Nicholas
- School of Management and School of Economics, Tianjin Normal University, West Bin Shui Avenue, Tianjin 300074, China.
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2038, Australia.
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun, Guangzhou, Guangdong 510420, China.
- Top Education Institute, 1 Central Avenue, Australian Technology Park, Eveleigh, Sydney, NSW 2015, Australia.
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, No.54 Dongsi Lishi Hutong, Dongcheng District, Beijing 100010, China.
- Center for Health Economics and Management at School of Economics and Management, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, Hubei Province 430072, China.
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Nong S, Yao NA. Reasons behind stymied public hospital governance reform in China. PLoS One 2019; 14:e0222204. [PMID: 31498814 PMCID: PMC6733505 DOI: 10.1371/journal.pone.0222204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The public hospital governance reform in China is pledged to improve the governance of public hospitals and deliver affordable and high-quality care. However, progress in public hospital reform has been slow. The reason is poorly understood. METHODS A research center affiliated with China National Health Commission has conducted 32 workshops to interview 124 public hospital administrators from 30 provincial-level administrative divisions and 105 various-level government officials from three provinces. About 80% of administrators and 78% officials actively participated the discussions. We used a descriptive theoretical approach to understand the relationships between the governance reform and characteristics of its stakeholders. We also analyzed stakeholder interests and their power to influence the reform. FINDINGS About 66% of hospital administrators, 72% of health officials, and less than 10% of other officials support a new hospital governing structure. Local leadership, hospital administrators, and health commission said that administrators should have more power over the management of public hospitals. Other government departments and healthcare professionals had reservations on the governance reform. The reform of public hospital governance faces significant obstacles. The interests of most government stakeholders are not aligned with public interests. All stakeholders perceived that their workload would increase in the short term because of the governance reform of public hospitals. Most people involved in the reform are not incentivized to collaborate. The health commission has limited financial resources and insufficient political power to implement a massive reform. Most importantly, the public hospital reform is not, and likely will not be, a top policy priority to the central government or local leaderships. INTERPRETATION The health commission needs more political support and resources to speed up the public hospital reform. To fulfill the pledge of affordable, equitable access to quality care, Chinese government needs to overcome significant obstacles in the public hospital reform.
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Affiliation(s)
- Sheng Nong
- You Jiang Medical University for Nationalities, Baise, China
- Peking University, School of Public Health, Beijing, China
| | - Nengliang Aaron Yao
- School of Health Care Management (Key Lab of Health Economics and Policy, National Health Commission), Jinan, China
- University of Virginia, Department of Public Health Sciences, Charlottesville, Virginia, United States of America
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Zhang R, Li J, Du X, Ma T, Zhang L, Zhang Q, Xia F. What has driven the spatial spillover of China's out-of-pocket payments? BMC Health Serv Res 2019; 19:610. [PMID: 31470846 PMCID: PMC6716932 DOI: 10.1186/s12913-019-4451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/22/2019] [Indexed: 11/30/2022] Open
Abstract
Background Even though China launched a series of measures to alleviate several financial burdens (including health insurance scheme, increased government investment, and so on), the economic burden of health expenditure has still not been alleviated. Out-of-pocket payments (OPPs) show not only a time correlation but also some degree of spatial correlation. The aims of the current study were thus to identify the spatial cluster of OPPs, to investigate the main factors affecting variation, and to explore the spatial spillover sources of China’s OPP. Methods Global and local spatial autocorrelation tests were validated to identify the spatial cluster of OPPs using the panel data of 31 provinces in China from 2005 to 2016. The Spatial Durbin Model, established in this paper, measured the spatial spillover effect of OPPs and analyzed the possible spillover sources (demand, supply, and socio-economic factors. Results OPPs were found to have a significant and positive spatial correlation. The results of the Spatial Durbin Model showed the direct and indirect effects of demand, supply, and socio- economic factors on China’s OPPs. Among the demand factors, the direct and indirect correlation (elasticity) coefficients were positive. Among the supply factors, the direct and indirect effects of the share of primary health beds on residents’ OPPs were negative. The ratio of health technicians in hospitals to those in primary health institutions on per capital OPPs had a significant indirect effect. Among the socio-economic factors, the direct effects of GDP, government health expenditure, and urbanization on OPPs were found to be positive. There were no significant indirect effects of socio-economic factors on OPPs. Conclusion This paper finds that China’s OPPs are not randomly distributed but, overall, present a positive spatial cluster, even though a series of measures have been launched to promote health equity. Socio-economic factors and those associated with demand were found to be the main influences of variation in OPPs, while demand was seen to be the driver of the positive spatial spillover of OPPs, whereby effective supply could inhibit these positive spillover effects. Electronic supplementary material The online version of this article (10.1186/s12913-019-4451-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruijie Zhang
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Jinghua Li
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Xiaochun Du
- School of Management, Changchun University of Chinese Medicine, No. 1035, Bo Shuo Road, Jing Yue District, Changchun City, 130117, Jilin Province, China
| | - Tianjiao Ma
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Li Zhang
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Qian Zhang
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Fang Xia
- School of Management, Changchun University of Chinese Medicine, No. 1035, Bo Shuo Road, Jing Yue District, Changchun City, 130117, Jilin Province, China.
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Work-Related Accumulated Fatigue among Doctors in Tertiary Hospitals: A Cross-Sectional Survey in Six Provinces of China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173049. [PMID: 31443480 PMCID: PMC6747540 DOI: 10.3390/ijerph16173049] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/19/2022]
Abstract
Objectives: “Karoshi” (death due to overwork) of doctors occurred frequently and attracted increasing attention in recent years in China. This study aimed to determine the prevalence of work-related accumulated fatigue of doctors and its associated factors in tertiary hospitals of China. Methods: A cross-sectional questionnaire survey was conducted on 1729 full-time doctors employed by 24 tertiary hospitals across eastern developed, central developing, and western underdeveloped regions of China. Accumulated fatigue was categorized into four levels using the “Self-diagnosis Checklist for Assessment of Workers’ Accumulated Fatigue” rated on a scale matrix considering both overwork and fatigue symptoms. Ordinal logistic regression analyses were performed to identify factors associated with work-related accumulated fatigue. Results: About 78.8% of respondents reported a “high level” of work-related accumulated fatigue, including 42.0% at a “very high” level. Male doctors and those aged between 30 and 45 years and who had a professional title were found to have higher levels of accumulative fatigue than others. Low salary and poor working conditions (in the western region) were also significantly associated with high levels of work-related accumulated fatigue (p < 0.05). Conclusion: High levels of work-related accumulated fatigue are prevalent in doctors working in tertiary hospitals in China. Male doctors establishing their early- and mid-careers are the high-risk group. Poor working conditions are associated with work-related accumulated fatigue.
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Affiliation(s)
- Jin Xu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Weiyan Jian
- Peking University Health Science Centre, Beijing, China
| | - Kun Zhu
- Chinese Academy of Fiscal Sciences, Beijing, China
| | | | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
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Wang F, Zhang LY, Zhang P, Cheng Y, Ye BZ, He MA, Guo H, Zhang XM, Yuan J, Chen WH, Wang YJ, Yao P, Wei S, Zhu YM, Liang Y. Effect of Physical Activity on Hospital Service Use and Expenditures of Patients with Coronary Heart Disease: Results from Dongfeng-Tongji Cohort Study in China. Curr Med Sci 2019; 39:483-492. [PMID: 31209822 DOI: 10.1007/s11596-019-2063-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 11/30/2018] [Indexed: 01/09/2023]
Abstract
The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.
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Affiliation(s)
- Fang Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Liu-Yi Zhang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ping Zhang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yao Cheng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bei-Zhu Ye
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mei-An He
- Institute of Occupational Medicine and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huan Guo
- Institute of Occupational Medicine and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Min Zhang
- Institute of Occupational Medicine and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing Yuan
- Institute of Occupational Medicine and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei-Hong Chen
- Institute of Occupational Medicine and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - You-Jie Wang
- Institute of Occupational Medicine and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ping Yao
- Institute of Occupational Medicine and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Sheng Wei
- Department of Epidemiology and Biostatistics and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi-Mei Zhu
- School of Media, Communication and Sociology, University of Leicester, Leicester, LE1 7JA, UK
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Shen Z, Valdmanis V. Identifying the contribution to hospital performance among Chinese regions by an aggregate directional distance function. Health Care Manag Sci 2019; 23:142-152. [PMID: 31001734 DOI: 10.1007/s10729-019-09482-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/03/2019] [Indexed: 11/30/2022]
Abstract
In this paper, we examine efficiency and total factor productivity for hospitals operating in China between the years of 2009-2016. Given reforms in China focusing on the hospital sector, it has been demonstrated that efficiency and productivity are important in meeting the overall objective of meeting more accessibility to hospital care for the population. Measuring an aggregate directional distance function is in itself a non-parametric approach, we report on the decomposition of hospital performance and found that between 2009 and 2010, technical inefficiency (using resources inefficiently) dominated overall inefficiency but beyond 2011-2016, mix inefficiency (misallocation of resources) was higher. Furthermore, an additive total factor productivity (TFP) indicator is proposed to capture contributions of individual provincial (or group) hospital performance to the total productivity gain. We also report that mix inefficiency had growth throughout this time period indicating a catching up in the correct mix of inputs. This finding is worth following as hospital reform in China also focuses on utilizing the right labor and capital mix in producing efficient care.
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Affiliation(s)
- Zhiyang Shen
- Anhui University of Finance & Economics, 962 CaoShan RD, Bengbu, 233030, China
- China Eximbank, 30 FuXingMenNei RD, Beijing, 100031, China
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50
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Chen X, Li G, Gan Y, Chu T, Liu D. Availability of benzathine penicillin G for syphilis treatment in Shandong Province, Eastern China. BMC Health Serv Res 2019; 19:188. [PMID: 30902053 PMCID: PMC6431030 DOI: 10.1186/s12913-019-4006-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/12/2019] [Indexed: 11/30/2022] Open
Abstract
Background The shortage of benzathine penicillin G (BPG) worldwide presents a major challenge in the treatment of syphilis. Its availability for syphilis treatment has not been adequately evaluated in China. Methods Two surveys were conducted among hospitals providing sexually transmitted infection clinical services in Shandong Province in 2012 and 2018. Data on the basic information and BPG availability of the surveyed hospitals and related factors were collected and analyzed using SPSS 17.0. Results A total of 433 and 515 hospitals were surveyed in 2012 and 2018, respectively. A significant difference in BPG availability was observed among different levels and types of hospitals both in 2012 (X2 = 9.747, p = 0.008; X2 = 37.167, p = 0.000) and 2018 (X2 = 11.775, p = 0.003; X2 = 28.331, p = 0.000). The BPG availability among surveyed hospitals increased from 45.0% in 2012 to 56.4% in 2018 (X2 = 11.131, p = 0.001). The BPG availability was higher in 2018 than in 2012 among county-level hospitals (52.0% vs. 40.8%, X2 = 7.783, p = 0.005), general western medicine hospitals (62.1% vs. 50.0%, X2 = 6.742, p = 0.009), maternal and child health hospitals (57.1% vs. 26.9%, X2 = 13.906, p = 0.000), and public hospitals (56.8% vs. 45.0%, X2 = 11.361, p = 0.001). However, the county-level availability of BPG (at least one hospital has BPG in a county-level unit) has not improved between 2012 and 2018 (65.93% vs. 70.34%; X2 = 0.563, p = 0.453). The absences of clinical needs, restriction of clinical antibacterial drugs, and lack of qualifications for providing syphilis treatment were the major reasons for the low BPG availability of hospitals. Conclusions BPG availability for syphilis treatment in Shandong Province remains low and presents disparities among different levels and types of hospitals, although it has been improved in recent years. The low availability of BPG for syphilis treatment in China is related to its clinical use by doctors rather than the market supply. Health care reforms should further improve the availability and accessibility of health services. Electronic supplementary material The online version of this article (10.1186/s12913-019-4006-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinlong Chen
- Department of STI and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397, Jingshi Lu, Jinan, 250022, Shandong, China.,School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, 6866, Jingshi Eastern Lu, Jinan, Shandong, China
| | - Guigang Li
- Zhaoyuan Center for Disease Control and Prevention, 125-1, Yingbing Lu, Yantai, Shandong, China
| | - Yanling Gan
- Department of STI and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397, Jingshi Lu, Jinan, 250022, Shandong, China.,School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, 6866, Jingshi Eastern Lu, Jinan, Shandong, China
| | - Tongsheng Chu
- Department of STI and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397, Jingshi Lu, Jinan, 250022, Shandong, China
| | - Dianchang Liu
- Department of STI and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397, Jingshi Lu, Jinan, 250022, Shandong, China.
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