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Cao H, Xu X, You H, Gu J, Hu H, Jiang S. Healthcare Expenditures among the Elderly in China: The Role of Catastrophic Medical Insurance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14313. [PMID: 36361192 PMCID: PMC9656772 DOI: 10.3390/ijerph192114313] [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: 09/11/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
China has been piloting the catastrophic medical insurance (CMI) program since 2012 and rolled it out nationally in 2016 to reduce the incidence of catastrophic health expenditure among Chinese residents. Few studies have been conducted to determine its effect on healthcare expenditures, particularly among the elderly. The purpose of this study is to examine the effect of CMI on healthcare expenditures among China's elderly population. The data for this study were derived from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, which included 344 and 1199 individuals in the treatment and control groups, respectively. To examine the effect of CMI on healthcare expenditures among the elderly, we used difference-in-differences and fixed-effects models. Additionally, a heterogeneity analysis was used to examine the differences in the impact of CMI on different groups. Finally, we confirmed the robustness of the results using robustness and placebo tests. CMI increased total health and out-of-pocket expenditures significantly, as well as inpatient and corresponding out-of-pocket expenditures. The reassults of the heterogeneity analysis indicated that CMI had a greater impact on elderly residents of rural areas. Economic burden protection has been enhanced for low-income groups and patients with serious diseases over the last two years. Our research indicated that CMI can promote the use of inpatient medical services for the elderly to a certain extent. Targeted measures such as expanding the CMI compensation list, establishing a more precise compensation scheme, and specific diseases associated with high healthcare expenditures can be considered in the practice of CMI implementation.
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Affiliation(s)
- Hongmei Cao
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
- Center for Health Policy and Management Studies, Nanjing University, Nanjing 210093, China
| | - Xinpeng Xu
- Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing 211166, China
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Hua You
- Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing 211166, China
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jinghong Gu
- College of Art and Sciences, University of Washington, 1400 NE Campus Parkway, Seattle, WA 98105, USA
| | - Hongyan Hu
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Shan Jiang
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
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Wu QL, Tang L. What Satisfies Parents of Pediatric Patients in China: A Grounded Theory Building Analysis of Online Physician Reviews. HEALTH COMMUNICATION 2022; 37:1329-1336. [PMID: 33601987 DOI: 10.1080/10410236.2021.1888437] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Patient satisfaction is an important intermediate outcome of patient-provider encounters, linking face-to-face interactions between patients and medical professionals with patients' well-being after consultations. Today, physician review websites provide a new venue for the study of patient satisfaction, as patients are utilizing such websites to evaluate their encounters with physicians. This study examined how parents of pediatric patients in China evaluated their pediatricians and factors associated with patient satisfaction through a qualitative content analysis of reviews (n = 7230) on the "Good Doctor Website" (haodf.com), China's largest physician review platform. Reviews were chosen from all reviews of pediatricians in eight top-tier hospitals in four major cities. Three dimensions of patient satisfaction were identified: pediatricians' interpersonal manners (including friendliness, listening to patients, heartfelt encouragement, and clear explanation), ethics (including rejecting red envelopes and kickbacks and cost awareness), and medical competence/overall health outcome. This study contributes to a culturally sensitive understanding of patient satisfaction and further explains the tense physician-patient relationship in China. Practically, our findings can inform the training of pediatricians in China.
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Affiliation(s)
- Qiwei L Wu
- Department of Communication, Texas A&M University, College Station
| | - Lu Tang
- Department of Communication, Texas A&M University, College Station
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Xie H, Cui X, Ying X, Hu X, Xuan J, Xu S. Development of a Novel Hospital Payment System – Big Data Diagnosis & Intervention Packet. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2022.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Bad to All? A Novel Way to Analyze the Effects of Fee-for-Service on Multiple Grades Hospitals Operation Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312723. [PMID: 34886448 PMCID: PMC8656721 DOI: 10.3390/ijerph182312723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/15/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
It is a consensus that Fee-for-Service (FFS) is a traditional medical insurance payment scheme with significant disadvantages, namely the waste of health care resources. However, the majority of the prior works that draw such conclusions from the perspective of social welfare while analyzing the impacts of FFS on operation outcomes of hospitals still lack attention from the existing literature, considering the fact that the majority of public hospitals are self-founding. Under this motivation, we collected operation data of 301 public hospitals with different grades (grade II and III) in central China. Here, we present a novel statistical evaluation framework on the impact of FFS on hospital operation outcomes from four dimensions (financial income, efficiency, medical service capacity, and sustainability) using fixed-effects multivariate regression. With verification by the robustness test, our results indicate that: (i) The classification of the hospital (COH) significantly affected the impacts of FFS on hospitals’ operations. (ii) For grade III hospitals, FFS leads to higher financial income, medical service capacity (MSC) and longer length-of-stay (LOS). (iii) However, as for grade II hospitals, hospitals with FFS adoptions achieve lower financial income, lower MSC and shorter LOS, which violates the common sense from previous works. (iv) FFS has a significant negative impact on public hospital’s sustainable development; however, there is lack of evidence showing that sustainability would be affected by the interaction effects between FFS and COH. We believe these new findings from the perspective of hospital operation provide insights and could serve as a reference for the healthcare payment hierarchical reform by COH in low and middle-income countries (LMICs), which are going through the primary stage of the healthcare reform.
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Yu M, Zhong J, Hu R, Chen X, Wang C, Xie K, Guzman M, Gui X, Kong STJ, Qu T, Eggleston K. The Impact of Catastrophic Medical Insurance in China: A five-year patient-level panel study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 13:100174. [PMID: 34527979 PMCID: PMC8358690 DOI: 10.1016/j.lanwpc.2021.100174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 11/02/2022]
Abstract
Background: In an effort to provide greater financial protection from the risk of large medical expenditures, China has gradually added catastrophic medical insurance (CMI) to the various basic insurance schemes. Tongxiang, a rural county in Zhejiang province, China, has had CMI since 2000 for their employee insurance scheme, and since 2014 for their resident insurance scheme. Methods: Compiling and analysing patient-level panel data over five years, we use a difference-in-difference approach to study the effect of the 2014 introduction of CMI for resident insurance beneficiaries in Tongxiang. In our study design, resident insurance beneficiaries are the treatment group, while employee insurance beneficiaries are the control group. Findings: We find that availability of CMI significantly increases medical expenditures among resident insurance beneficiaries, including for both inpatient and outpatient spending. Despite the greater financial protection, out-of-pocket expenditures increased, in part because patients accessed treatment more often at higher-level hospitals. Interpretation: Better financial coverage for catastrophic medical expenditures led to greater access and expenditures, not only for inpatient admissions-the category that most often leads to catastrophic expenditures-but for outpatient visits as well. These patterns of expenditure change with CMI may reflect both enhanced access to a patient's preferred site of care as well as the influence of incentives encouraging more care under fee-for-service payment. Funding: Stanford University's Freeman Spogli Institute for International Studies' Policy Implementation Lab and a Shorenstein Asia Pacific Research Center faculty research award provided funding for this project. Chinese translation of the abstract (Appendix 1).
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Affiliation(s)
- Min Yu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jieming Zhong
- Department of NCD Control and Prevention, Zhejiang CDC, Hangzhou, China
| | - Ruying Hu
- Department of NCD Control and Prevention, Zhejiang CDC, Hangzhou, China
| | - Xiangyu Chen
- Department of NCD Control and Prevention, Zhejiang CDC, Hangzhou, China
| | - Chunmei Wang
- Tongxiang Center for Disease Control and Prevention, Tongxiang, China
| | - Kaixu Xie
- Tongxiang Center for Disease Control and Prevention, Tongxiang, China
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What Does the Chinese Public Care About with Regard to Primary Care Physicians: Trustworthiness or Competence? Medicina (B Aires) 2019; 55:medicina55080455. [PMID: 31405053 PMCID: PMC6723481 DOI: 10.3390/medicina55080455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 01/26/2023] Open
Abstract
Background and Objective: China has launched a series of reforms to enhance primary care. The aims of these reforms are to strengthen the functionality of primary care to encourage patients to use primary care. Patients’ trust in physicians is important in clinical medicine; however, little is known about how Chinese patients’ preferences relate to their trust in primary care physicians. This study’s objectives are to measure the Chinese public’s trust in primary care physicians and to characterize reasons of their preferences for health care. Materials and Methods: This quantitative study comprises a face-to-face survey with a convenience sample (n = 273) of people visiting community health centers or stations (CHCSs) in Wuhan, China. We measured the patients’ preferences for the different level of hospitals and their trust in physicians, as well as the reasons of the patients’ preferences, using a Chinese version of the Wake Forest Physician Trust Scale and other variables (such as demographics, health status, and hospital preference). Results: Approximately two thirds (68.6%) of the participants had experienced a mild or chronic disease in the year before the survey, but only 26.4% preferred to visit CHCSs in such cases. The negative factors related to this lack of preference are the physicians’ competence (odds ratio [OR] = 0.250), the medical equipment (OR = 0.301), and the popularity of hospitals (OR = 0.172). The positive factors were ease of access (OR = 2.218) and affordability (OR = 1.900). The participants expressed a moderate trust in physicians in CHCSs (score of 3.02 out of 5). There is no association between the patients’ trust and their hospital preference (r = 0.019, p = 0.859). Of the participants, 92 suggested that the physicians in CHCSs should improve in terms of their competence (n = 53), attitude (n = 35), and/or medical ethics (n = 16). Conclusions: This study’s results suggest that patients consider improving physicians’ competence to be more important and urgent than improving those physicians’ trustworthiness in terms of reconstructing Chinese primary care. Improving the physicians’ competence would not only reduce the barriers that patients experience regarding CHCSs, but would also increase their trust in the physicians.
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Zhao C, Wang C, Shen C, Wang Q. Diagnosis-related group (DRG)-based case-mix funding system, a promising alternative for fee for service payment in China. Biosci Trends 2018; 12:109-115. [DOI: 10.5582/bst.2017.01289] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Cuirong Zhao
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong University
| | - Chao Wang
- Department of Rehabilitation Medicine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Chengwu Shen
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong University
| | - Qian Wang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong University
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Wang Y, Liu W, Shi H, Liu C, Wang Y. Measuring patient safety culture in maternal and child health institutions in China: a qualitative study. BMJ Open 2017; 7:e015458. [PMID: 28706096 PMCID: PMC5734290 DOI: 10.1136/bmjopen-2016-015458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Patient safety culture (PSC) plays a critical role in ensuring safe and quality care. Extensive PSC studies have been undertaken in hospitals. However, little is known about PSC in maternal and child health (MCH) institutions in China, which provide both population-based preventive services as well as individual care for patients. OBJECTIVES This study aimed to develop a theoretical framework for conceptualising PSC in MCH institutions in China. METHODS The study was undertaken in six MCH institutions (three in Hebei and three in Beijing). Participants (n=118) were recruited through stratified purposive sampling: 20 managers/administrators, 59 care providers and 39 patients. In-depth interviews were conducted with the participants. The interview data were coded using both inductive (based on the existing PSC theory developed by the Agency for Healthcare Research and Quality) and deductive (open coding arising from data) approaches. A PSC framework was formulated through axial coding that connected initial codes and selective coding that extracted a small number of themes. RESULTS The interviewees considered patient safety in relation to six aspects: safety and security in public spaces, safety of medical services, privacy and information security, financial security, psychological safety and gap in services. A 12-dimensional PSC framework was developed, containing 69 items. While the existing PSC theory was confirmed by this study, some new themes emerged from the data. Patients expressed particular concerns about psychological safety and financial security. Defensive medical practices emerged as a PSC dimension that is associated with not only medical safety but also financial security and psychological safety. Patient engagement was also valued by the interviewees, especially the patients, as part of PSC. CONCLUSIONS Although there are some common features in PSC across different healthcare delivery systems, PSC can also be context specific. In MCH settings in China, the meaning of 'patient safety' goes beyond the traditional definition of patients. General well-being, health and disease prevention are important anchor points for defining PSC in such settings.
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Affiliation(s)
- Yuanyuan Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
- Second Outpatient Department, Peking University Third Hospital, Beijing, China
| | - Weiwei Liu
- Second Outpatient Department, Peking University Third Hospital, Beijing, China
| | - Huifeng Shi
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Yan Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
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Tucker JD, Cheng Y, Wong B, Gong N, Nie JB, Zhu W, McLaughlin MM, Xie R, Deng Y, Huang M, Wong WCW, Lan P, Liu H, Miao W, Kleinman A. Patient-physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study. BMJ Open 2015; 5:e008221. [PMID: 26443652 PMCID: PMC4606416 DOI: 10.1136/bmjopen-2015-008221] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To better understand the origins, manifestations and current policy responses to patient-physician mistrust in China. DESIGN Qualitative study using in-depth interviews focused on personal experiences of patient-physician mistrust and trust. SETTING Guangdong Province, China. PARTICIPANTS One hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient-physician relationships. RESULTS One of the most prominent forces driving patient-physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient-physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient-physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient-physician trust. CONCLUSIONS The blind pursuit of financial profits at a systems level has eroded patient-physician trust in China. Restructuring incentives, reforming medical education and promoting caregiving are pathways towards restoring trust. Assessing and valuing the quality of caregiving is essential for transitioning away from entrenched profit-focused models. Moral, in addition to regulatory and legal, responses are urgently needed to restore trust.
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Affiliation(s)
- Joseph D Tucker
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- UNC Project-China Office, Guangdong Provincial STD Control Center, Guangzhou, Guangdong, China
- School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Center for Medical Humanities, Zhongshan School of Medicine, Sun Yat-sen University,Guangzhou, China
| | - Yu Cheng
- School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Center for Medical Humanities, Zhongshan School of Medicine, Sun Yat-sen University,Guangzhou, China
| | - Bonnie Wong
- UNC Project-China Office, Guangdong Provincial STD Control Center, Guangzhou, Guangdong, China
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Ni Gong
- School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Center for Medical Humanities, Zhongshan School of Medicine, Sun Yat-sen University,Guangzhou, China
| | | | - Wei Zhu
- School of Medicine, Fudan University, Shanghai, China
| | | | - Ruishi Xie
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yinghui Deng
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Meijin Huang
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - William C W Wong
- University of Hong Kong, Ap Lei Chau, Hong Kong
- University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Ping Lan
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Huanliang Liu
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Institute of Gastroenterology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wei Miao
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Arthur Kleinman
- Harvard Asia Center, Harvard University, Cambridge, Massachusetts, USA
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Jin P. The physician charter on medical professionalism from the Chinese perspective: a comparative analysis. JOURNAL OF MEDICAL ETHICS 2015; 41:511-4. [PMID: 25341734 DOI: 10.1136/medethics-2014-102318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/03/2014] [Indexed: 05/25/2023]
Abstract
The charter of medical professionalism in the new millennium (Charter) has been endorsed worldwide, including by the Chinese Medical Doctor Association from 2005. Six years later, the association drafted a Chinese version of medical professionalism based on the Charter, the Chinese Medical Doctor Declaration (Declaration). This Declaration encompasses six tenets, which have large areas of overlap with the Charter. Meanwhile, certain differences also exist between the universal professionalism that the Charter aims to disseminate and the ideal Chinese professionalism that the Declaration endeavours to bolster. In this paper, we explore the unique aspects of the Declaration in contrast with the Charter to gain a deeper understanding of professionalism in the particular context of China. The Declaration may omit some valuable commitments found in the Charter, but it includes longstanding Confucian and cultural traditions of China, as well as consideration of current social circumstances. The Declaration thus re-establishes the ideal of universal professionalism in light of the Chinese context.
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Hu L, Yin X, Bao X, Nie JB. Chinese Physicians’ Attitudes toward and Understanding of Medical Professionalism: Results of a National Survey. THE JOURNAL OF CLINICAL ETHICS 2014. [DOI: 10.1086/jce201425207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Jin P, Biller-Andorno N, Wild V. Ethical Implications of Case-Based Payment in China: A Systematic Analysis. Dev World Bioeth 2014; 15:134-42. [DOI: 10.1111/dewb.12055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bulcock JA. Introduction. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2010. [DOI: 10.1093/jmp/jhq028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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