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Wang X, Xu J. Evaluating private hospital performance before and during COVID-19 in China. Medicine (Baltimore) 2024; 103:e38327. [PMID: 38787968 PMCID: PMC11124748 DOI: 10.1097/md.0000000000038327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic had a tremendous impact on the global medical system. The development of private hospitals is an important measure to deepen the reform of China's medical and health system, and an important driving force to improve the effective supply of medical services. This study aims to compare the performance of China's private hospitals before and during COVID-19 and determine the factors that affect hospital profitability between the 2 periods. Data are collected from 10 private listed hospitals from 2017 to 2022, and ratio analysis is used to measure hospital performance in 5 aspects, namely profitability, liquidity, leverage, activity (efficiency), and cost coverage. Multiple regression analysis is used to determine the influencing factors of hospital profitability. The results show a negative impact of COVID-19 on private hospital performance. Specifically, regardless of region, hospital profitability, liquidity, and cost coverage were reduced due to COVID-19, while hospital leverage was increased. COVID-19 had also an impact on hospital efficiency. In addition, before COVID-19, current ratio and cost coverage ratio were the determinants of hospital profitability, while only cost coverage ratio affected hospital profitability during the COVID-19 outbreak. We provide evidence that COVID-19 had an impact on China private hospitals, and the findings will aid private hospitals in improving their performance in the post-COVID-19 era.
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Affiliation(s)
- Xiaowen Wang
- Financial Department, Qingdao Qingte Zhongji Axle Co., Ltd., Qingdao, China
| | - Jian Xu
- Department of Economics and Management, Qingdao Agricultural University, Qingdao, China
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Zhang X, Zimmerman A, Zhang Y, Ogbuoji O, Tang S. Rapid growth of private hospitals in China: emerging challenges and opportunities to health sector management. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:100991. [PMID: 38156262 PMCID: PMC10753080 DOI: 10.1016/j.lanwpc.2023.100991] [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: 09/15/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/30/2023]
Abstract
China's private hospital market has experienced rapid growth over the last decade, with private hospitals now outnumbering public hospitals by a factor of two. This policy analysis uses available data and existing literature to analyze China's rapidly changing hospital market, identify key challenges resulting from rapid private hospital growth, and present recommendations to ensure future sustainable private hospital development in the country. Our analysis shows that while private hospitals outnumber public hospitals, outpatient visits and hospitalizations remain higher among public hospitals, while per-patient expenditure remains higher among private hospitals. Key challenges to private hospital development include limited government financial support, high tax burdens, difficulty in workforce recruitment and retainment, poor government regulation and oversight, and dissipating public trust. Recommendations to address these challenges include opening government contract bidding to private hospitals, creating a system that allows private hospitals to enter national health insurance schemes, reducing tax pressure on private hospitals, defining a legal system for market entry and exit of private hospitals, improving a system of supervision, and monitoring and evaluation of private hospital operation and performance.
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Affiliation(s)
- Xiaoxi Zhang
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Armand Zimmerman
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, United States
| | - Yanyan Zhang
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, United States
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina, United States
| | - Shenglan Tang
- Duke Department of Population Health Sciences, Duke University, Durham, North Carolina, United States
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Li S, He L, Huang Y, Wang D, Zhu W, Chen Z. Incentive policy for the comprehensive development of young medical talents: an evolutionary game study. Front Public Health 2024; 12:1325166. [PMID: 38371237 PMCID: PMC10869509 DOI: 10.3389/fpubh.2024.1325166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Currently in China, there is a lack of well-defined and viable incentive mechanisms at the governmental and hospital levels to support the development of young medical talents, thereby hindering their growth Existing studies primarily investigate the current state and trajectory of incentives, yet they inadequately address the distinctive characteristics of various stakeholders involved in medical talent incentive processes, particularly the lack of research on incentive mechanisms with Chinese attributes. Methods This study adopts evolutionary game theory to investigate the dynamics of replication and the strategies for achieving evolutionary stability in the comprehensive development of young medical talents, considering both scenarios with and without supportive policies. Results In the absence of any supportive policy measures, the evolutionarily stable strategy (ESS) point is O(0,0), the unstable equilibrium point is C(1,1), and the saddle points are A(0,1), B(1,0). The initial state of the system is at the unstable equilibrium point C(1,1), which means that the young medical talents and medical institutions adopt a combination of strategies (actively seeking comprehensive development and taking incentive measures). Under the scenario with supportive policies, the ESS point is C(1,1), the unstable equilibrium point is O(0,0), and the saddle points are A(0,1), B(1,0). The initial state of the system is at the unstable equilibrium point O(0,0), which means that young medical talents and medical institutions adopt (N,N) strategy combinations (inactively seeking comprehensive development, implementing no incentive measure). Discussion (1) Government incentives play a crucial role in motivating young medical talents to seek comprehensive development. (2) The level of government incentive support for young medical talents should exceed the cost increment of individual efforts. Additionally, the policy support provided by the government to medical institutions should surpass the incentive support offered by these institutions to young medical talents. This will enhance the motivation and encouragement efforts of medical institutions in actively promoting comprehensive development among young medical talents. (3) With the backing of certain government incentive policies, medical institutions implementing incentive measures and young medical talents actively seeking comprehensive development will establish a virtuous cycle of mutual promotion.
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Affiliation(s)
- Si Li
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lijuan He
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yaxin Huang
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Dan Wang
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Weihua Zhu
- Department of Personnel and Party Affairs, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhisong Chen
- Business School, Nanjing Normal University, Nanjing, China
- Stern School of Business, New York University, New York, NY, United States
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Hu D, Liu H, Xiao S. Medical Malpractice Litigation After Spine Surgery in Beijing Between 2013 and 2018. World Neurosurg 2023; 175:e1144-e1148. [PMID: 37146878 DOI: 10.1016/j.wneu.2023.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the characteristics of alleged medical malpractice litigation involving spine surgery in Beijing between 2013 and 2018. METHODS Two online legal databases, Wusong and Weike, were queried for court verdicts involving spine surgery from January 2013 to December 2018 in Beijing. For all included cases, data pertaining to defendants, plaintiffs, case outcomes, allegations, and verdicts were abstracted, and descriptive analyses were performed. RESULTS A total of 186 legal cases were identified, and 122 cases were excluded because of irrelevance or insufficient information. Of the patients in the 64 cases included in this investigation, 40.6% were male. The mean age of the plaintiffs was 53.2 ± 18.6 years. The most common complaint addressed in this study is inadequate consent (53.1%; n = 34), followed by additional surgery required (40.2%; n = 26), being unsatisfied with the outcome of surgery (17.6%; n = 11), postoperative paralysis (15.6%; n = 10), and postoperative infection (15.6%; n = 10). The most common primary disease among all the cases is lumbar spinal stenosis (28.1%; n = 18), followed by spinal tumor (18.8%; n = 12), cervical spondylosis (17.2%; n = 11), vertebral fracture (14.1%; n = 9), deformity (12.5%; n = 8), and others (9.3%; n = 6). Spine surgeons successfully defended themselves in 13 cases (20.3%), which resulted in no indemnity payment. The remaining 51 cases (79.7%) were closed with an average verdict payout of U.S. $22,597, which was significantly lower than the average compensation claimed by the plaintiff (U.S. $11,3762) (P < 0.05). CONCLUSIONS This study comprehensively summarized the medical alleged malpractice litigation after spine surgery in Beijing. Given the rapid growth rate of spine surgery and the burden of related alleged medical malpractice litigation, it is valuable for spine surgeons to understand the potential legal impact of spine surgery. The most common complaint addressed in this study is inadequate consent. The findings in the present study highlight that in China, spine surgeons should pay more attention to communication with patients and perform spine surgery based on abnormal imaging as opposed to what the history and physical examination dictate, which can help reduce the litigation rate and improve the patient experience.
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Affiliation(s)
- Dong Hu
- Department of Orthopedics, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huawei Liu
- Department of Orthopedics, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Songhua Xiao
- Department of Orthopedics, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
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Xue Q, Xu DR, Cheng TC, Pan J, Yip W. The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China. Arch Public Health 2023; 81:19. [PMID: 36765426 PMCID: PMC9911958 DOI: 10.1186/s13690-023-01029-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/21/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals. METHODS A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively. RESULTS The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions. CONCLUSION The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals' performances among different ownership types under China's context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.
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Affiliation(s)
- Qingping Xue
- grid.413856.d0000 0004 1799 3643School of Public Health, Chengdu Medical College, Chengdu, China ,grid.13291.380000 0001 0807 1581Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Dong Roman Xu
- grid.284723.80000 0000 8877 7471Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China ,grid.284723.80000 0000 8877 7471Acacia Lab for Implementation Research, SMU Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Terence C. Cheng
- grid.38142.3c000000041936754XHarvard TH Chan School of Public Health, Boston, USA
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. .,School of Public Administration, Sichuan University, Chengdu, China.
| | - Winnie Yip
- grid.38142.3c000000041936754XHarvard TH Chan School of Public Health, Boston, USA
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Liu P, Gong X, Yao Q, Liu Q. Impacts of the medical arms race on medical expenses: a public hospital-based study in Shenzhen, China, during 2009-2013. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:73. [PMID: 36567370 PMCID: PMC9791778 DOI: 10.1186/s12962-022-00407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Has the medical arms race (MAR) increased healthcare expenditures? Existing literature has yet to draw a consistent conclusion. Hence, this study aims to reexamine the relationship between the MAR and medical expenses by the data from public hospitals in Shenzhen, China, during the period of 2009 to 2013. METHODS This study's data were collected through panel datasets spanning 2009 to 2013 from the Shenzhen Statistical Yearbook, Shenzhen Health Statistical Yearbook, and annual reports from the Shenzhen Municipal Health Commission. The Herfindahl-Hirschman index and hierarchical linear modeling were combined for empirical analysis. RESULTS The MAR's impact on medical examination fees differed during the inpatient and outpatient stages. Further analysis verified that the MAR had the most significant impact on outpatient examination fees. Due to the characteristics of China's medical system, government regulations in the healthcare market may consequently accelerate the MAR among public hospitals. Strict government regulations on the medical system have also promoted increased medical examination costs to some extent. Once medical service prices are under strict administrative control, only drug and medical examination fees are the primary forms of extra income for hospitals. After the proportion of drug fees is further regulated, medical examinations will then become another staple method to generate extra revenue. These have distorted Chinese public hospitals' medical fees, which completely differ from those in other countries. CONCLUSION The government should confirm that they have allocated sufficient financial investments for public hospitals; otherwise, the competition among hospitals will transfer the burden to patients, and especially to those who can afford to pay for care. A core task for public hospitals involves providing safer, less expensive, and more reliable medical services.
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Affiliation(s)
- Paicheng Liu
- grid.443347.30000 0004 1761 2353School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Xue Gong
- grid.10420.370000 0001 2286 1424Department of East Asian Studies, University of Vienna, Vienna, Austria
| | - Qianhui Yao
- grid.443347.30000 0004 1761 2353School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Qiong Liu
- grid.459584.10000 0001 2196 0260School of Politics and Public Administration, Guangxi Normal University, No.15, Yucai Road, Qixing District, Guilin, Guangxi People’s Republic of China
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Yan N, Liu T, Xu Y, Fang X, Ma X, Yang M, Du J, Tan Z, Fan EW, Huang J, Akinwunmi B, Zhang CJP, Ming WK, Luo L. Healthcare preferences of the general Chinese population in the hierarchical medical system: A discrete choice experiment. Front Public Health 2022; 10:1044550. [PMID: 36466449 PMCID: PMC9713319 DOI: 10.3389/fpubh.2022.1044550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chinese health insurance system faces resource distribution challenges. A patient-centric approach allows decision-makers to be keenly aware of optimized medical resource allocation. Objective This study aims to use the discrete choice model to determine the main factors affecting the healthcare preferences of the general Chinese population and their weights in the three scenarios (chronic non-communicable diseases, acute infectious diseases, and major diseases). Methods This study firstly identified the key factors affecting people's healthcare preferences through literature review and qualitative interviews, and then designed the DCE questionnaire. An online questionnaire produced by Lighthouse Studio (version 9.9.1) software was distributed to voluntary respondents recruited from mainland China's entire population from January 2021 to June 2021. Participants were required to answer a total of 21 questions of three scenarios in the questionnaire. The multinomial logit model and latent class model were used to analyze the collected data. Results A total of 4,156 participants from mainland China were included in this study. The multinomial logit and latent class model analyses showed that medical insurance reimbursement is the most important attribute in all three disease scenarios. In the scenario of "non-communicable diseases," the attributes that participants valued were, from the most to the least, medical insurance reimbursement (45.0%), hospital-level (21.6%), distance (14.4%), cost (9.7%), waiting time (8.3%), and care provider (1.0%). As for willingness to pay (WTP), participants were willing to pay 204.5 yuan, or 1,743.8 yuan, to change from private hospitals or community hospitals to tertiary hospitals, respectively. Conclusions This study explores the healthcare preferences of Chinese residents from a new perspective, which can provide theoretical reference for the refinement of many disease medical reimbursement policies, such as developing different reimbursement ratios for various common diseases and realizing rational configuration of medical resources.
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Affiliation(s)
- Ni Yan
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Taoran Liu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuan Xu
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xuanbi Fang
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xinyang Ma
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Meng Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jianhao Du
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zijian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Er-wen Fan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jian Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Babatunde Akinwunmi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital Boston, Boston, MA, United States,Center for Genomic Medicine (CGM), Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, United States
| | - Casper J. P. Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Wai-Kit Ming
| | - Liangping Luo
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China,Liangping Luo
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The Effect of Medical Choice on Health Costs of Middle-Aged and Elderly Patients with Chronic Disease: Based on Principal-Agent Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137570. [PMID: 35805231 PMCID: PMC9265286 DOI: 10.3390/ijerph19137570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: The discussion on how to reduce the health costs of chronic disease patients has become an important public health issue. Limited research has been conducted on how chronic disease patients’ medical choice of public and private medical institutions affect health costs. (2) Methods: This study used the panel data composed of the China Health and Retirement Longitudinal Survey (CHARLS) from 2011 to 2018, adopted the quasi-natural experimental research method, and set up a control group and an experimental group that chose public medical institutions and private medical institutions, to analyze the association between the medical choice and health costs of chronic disease patients. (3) Results: Compared with chronic disease patients who chose private medical institutions, patients who chose public medical institutions increased their total cost by 44.9%, total out-of-pocket cost by 22.9%, and decreased the total out-of-pocket ratio by 0.117%, total drug cost out-of-pocket ratio by 0.075%, and drug cost ratio by 0.102%. (4) Conclusions: According to the triple principal-agent relationships, the resource advantages given by the government to public medical institutions, the salary incentive system of medical institutions, and the information asymmetry advantage held by physicians may be important factors for the increase in health costs for chronic disease patients.
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Real-world Perspectives from Surgeons and Oncologists on Resectability Definition and Multidisciplinary Team Discussion of Stage III NSCLC in China, Hong Kong and Macau: A Physician Survey. JTO Clin Res Rep 2022; 3:100308. [PMID: 35434668 PMCID: PMC9011118 DOI: 10.1016/j.jtocrr.2022.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Decision-making in diagnosis and management of stage III NSCLC remains complex owing to disease heterogeneity and diverse treatment options, and often warrants multidisciplinary team discussion. Specifically, the selection of patients for multimodality approaches involving surgical resection presents notable challenges owing to heterogeneity in guideline definitions and the subjective, case-specific nature of evaluating resectability on the basis of preoperative assessments. Methods An internet- and paper-based survey was conducted in 2020 among lung cancer specialists in the People’s Republic of China, Hong Kong, and Macau. This survey captured perspectives on stage III NSCLC on real-world diagnosis/staging practice, definition and evaluation of resectability using case scenarios, and preferred treatment paradigms. Results A total of 60 completed responses were obtained (60.0% surgeons; 40.0% oncologists). The surgeons’ and oncologists’ responses differed most in the assessment of resectability in specific case scenarios despite overall agreement on top factors determining resectability (T stage, lymph node size, and lymph node location). Of the 17 scenarios, specialists agreed (≥80%) on four “resectable” and six “unresectable” scenarios; of the seven scenarios with less than 80% agreement, surgeons and oncologists had diverging responses for six scenarios. Multidisciplinary team discussions were available in most of the respondents’ institutions but usually covered only selected (<50%) stage III cases. Conclusions This survey used a comprehensive set of stage III NSCLC case scenarios to understand how working definitions of resectability may differ between surgeons and oncologists, and thus, identify types of cases to prioritize for multidisciplinary discussions to maximize limited resources. In parallel, the development of a multidisciplinary expert consensus on treatment approaches could complement local institutional expertise as a reference for decision-making.
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Red Alert: It Is Time to Strengthen the Medical Knowledge of Noncompressible Torso Hemorrhage Among Health-Care Workers. Disaster Med Public Health Prep 2021; 16:2020-2028. [PMID: 34658325 DOI: 10.1017/dmp.2021.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Noncompressible torso hemorrhage (NCTH) is a major challenge in prehospital bleeding control and is associated with high mortality. This study was performed to estimate medical knowledge and the perceived barriers to information acquisition among health-care workers (HCWs) regarding NCTH in China. METHODS A self-administered and validated questionnaire was distributed among 11 WeChat groups consisting of HCWs engaged in trauma, emergency, and disaster rescue. RESULTS A total of 575 HCWs participated in this study. In the knowledge section, the majority (87.1%) denied that successful hemostasis could be obtained by external compression. Regarding attitudes, the vast majority of HCWs exhibited positive attitudes toward the important role of NCTH in reducing prehospital preventable death (90.4%) and enthusiasm for continuous learning (99.7%). For practice, fewer than half of HCWs (45.7%) had heard of NCTH beforehand, only a minority (14.3%) confirmed they had attended relevant continuing education, and 16.3% HCWs had no access to updated medical information. The most predominant barrier to information acquisition was the lack of continuing training (79.8%). CONCLUSIONS Knowledge and practice deficiencies do exist among HCWs. Obstacles to update medical information warrant further attention. Furthermore, education program redesign is also needed.
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Zhu X, Du Y, He W, Dai J, Chen M, Yao P, Chen H, Ren H, Fang Y, Tan S, Lu Y. Ophthalmic services in Shanghai 2017: a cataract-centric city-wide government survey. BMC Health Serv Res 2021; 21:1043. [PMID: 34600508 PMCID: PMC8487503 DOI: 10.1186/s12913-021-07048-1] [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: 10/22/2020] [Accepted: 09/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Demand for eye care has increased in recent decades in China due to rapid socioeconomic development and demographic shift. Knowledge of output and productivity of ophthalmic services would allow policymakers to optimize resource allocation, and is therefore essential. This study sought to map the landscape of ophthalmic services available in Shanghai, China. Methods In 2018, a government-led survey was conducted of all 86 tertiary/secondary hospitals and five major private hospitals providing eye care in Shanghai in the form of electronic questionnaire, which encompassed ophthalmic services (outpatient and emergency room [ER] visit, inpatient admissions, and surgical volume) and service productivity in terms of annual outpatient and ER visits per doctor, inpatient admissions per bed, and surgical volume per doctor. Comparisons were made among different levels of hospitals with categorical variables tested by Chi-square analysis. Results The response rate was 85.7%. The Eye and Ear, Nose, and Throat (EENT) Hospital was the largest tertiary specialty hospital, and alone contributed to the highest 21.0% of annual ophthalmic outpatient and ER visits (visits per doctor: 5460), compared with other 26 tertiary hospitals, 46 secondary hospitals and five private hospitals (visits per doctor: 3683, 4651 and 1876). The annual inpatient admission was 20,103, 56,992, 14,090, and 52,047 for the EENT Hospital, all the other tertiary hospitals, secondary hospitals and five private hospitals, respectively. Turnover rates were highest for the EENT Hospital and private hospitals. The average surgical volume at the EENT Hospital was 72,666, exceeding that of private (15,874.8) and other tertiary hospitals (3366.7). The EENT Hospital and private hospitals performed 16,982 (14.2%) and 55,538 (46.6%) of all cataract surgeries. Proportions of both complicated cataractous cases and complicated cataract surgeries at the EENT Hospital was the highest, followed by other tertiary and secondary/private hospitals (P < 0.0001). Conclusions In Shanghai, public providers dominate ophthalmic services especially for complicated cases, with almost one fifth of services provided by the EENT Hospital alone, while private sectors, though not large in number, still effectively help meet large proportions of eye care demand. Optimization of hierarchical medical system is warranted to improve the efficiency and standardization of ophthalmic services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07048-1.
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Affiliation(s)
- Xiangjia Zhu
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Medical Quality Control Management Center, 1477 West Beijing Road, Shanghai, 200040, China
| | - Yu Du
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Wenwen He
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Jinhui Dai
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Minjie Chen
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Peijun Yao
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Han Chen
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Hui Ren
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Yuan Fang
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Shensheng Tan
- Shanghai Medical Quality Control Management Center, 1477 West Beijing Road, Shanghai, 200040, China
| | - Yi Lu
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China. .,Shanghai Medical Quality Control Management Center, 1477 West Beijing Road, Shanghai, 200040, China.
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Zhang N, Li J, Bu X, Gong ZX. The relationship between ethical climate and nursing service behavior in public and private hospitals: a cross-sectional study in China. BMC Nurs 2021; 20:136. [PMID: 34353309 PMCID: PMC8339387 DOI: 10.1186/s12912-021-00655-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/13/2021] [Indexed: 12/04/2022] Open
Abstract
Background Workplace climate is a great significant element that has an impact on nurses’ behavior and practice; moreover, nurses’ service behavior contributes to the patients’ satisfaction and subsequently to the long-term success of hospitals. Few studies explore how different types of organizational ethical climate encourage nurses to engage in both in-role and extra-role service behaviors, especially in comparing the influencing process between public and private hospitals. This study aimed to compare the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals. Methods This study conducted a cross-sectional survey on 559 nurses from China in May 2019. The questionnaire was distributed to nurses by sending a web link via the mobile phone application WeChat through snowball sampling methods. All participants were investigated using the Ethical Climate Scale and Service Behavior Questionnaire. SPSS 22.0 was used for correlation analysis, t-test, and analysis of variance test, and Mplus 7.4 was used for group comparison (p < .05). Results The law and code climate has a much greater influence on nurses’ in-role service behavior in private hospitals than on that in public hospitals (β = − 0.277; CI 95 % = [-0.452, − 0.075]; p < .01), and the instrumental climate has a stronger influence on nurses’ extra-role service behavior private hospitals than on that in public hospitals (β = − 0.352; CI 95 % = [-0.651, − 0.056]; p < .05). Meanwhile, the rules climate has a greater effect on nurses’ extra-role service behavior in public hospitals than it does in private hospitals (β = 0.397; CI 95 % = [0.120, 0.651]; p < .01). Conclusions As the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals were different, the strategies used to foster and enhance the types of ethical climate are various from public to private hospitals. The caring and instrumental climate are the key to promote extra-role service behavior for nurses in private hospitals. And the independent climate has a great effect on extra-role service behaviors for nurses in public hospitals. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00655-7.
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Affiliation(s)
- Na Zhang
- School of Economics and Management, Beijing Information Science & Technology University, Beijing, China
| | - Jingjing Li
- College of Economics and Management, Beijing University of Technology, Beijing, China.
| | - Xing Bu
- School of Economics and Management, University of Science and Technology Beijing, Beijing, China
| | - Zhen-Xing Gong
- School of Business, Liaocheng University, Liaocheng, China
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13
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Zang W, Zhou M, Zhao S. Deregulation and pricing of medical services: a policy experiment based in China. BMC Health Serv Res 2021; 21:501. [PMID: 34034722 PMCID: PMC8146237 DOI: 10.1186/s12913-021-06525-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Price regulation is a common constraint in Chinese hospitals. Based on a policy experiment conducted in China on the price deregulation of private nonprofit hospitals, this study empirically examines the impact of medical service price regulation on the pricing of medical services by hospitals. Methods Using the claim data of insured inpatients residing in a major Chinese city for the period 2010–2015, this study constructs a DID (difference-in-differences) model to compare the impact of price deregulation on medical expenditure and expenditure structure between public and private nonprofit hospitals. Results The empirical results based on micro data reveal that, price deregulated significantly increased the total expenditure per inpatient visit by 10.5%. In the itemized expenditure, the diagnostic test and drug expenditure per inpatient visit of private nonprofit hospitals decreased significantly, whereas the physician service expenditure per inpatient visit increased significantly. For expenditure structure, the proportions of drug expenditure and diagnostic test expenditure per inpatient visit significantly decreased by 5.7 and 3.1%, respectively. Furthermore, this paper also found that hospitals had larger price changes for dominant diseases than for non-dominant diseases. Conclusions Under price regulation, medical service prices generally become lower than their costs. Therefore, after price deregulation, private nonprofit hospitals increase medical service prices above their cost and achieve the service premium increasing physician medical services. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well.
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Affiliation(s)
- Wenbin Zang
- School of Insurance, Southwestern University of Finance and Economics, Chengdu, China
| | - Mei Zhou
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, China.
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14
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Zeng Y, Wan Y, Yuan Z, Fang Y. Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062969. [PMID: 33799366 PMCID: PMC7998758 DOI: 10.3390/ijerph18062969] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the patterns and predictive factors of healthcare-seeking behavior among older Chinese adults. A sample of 10,914 participants aged ≥60 years from the 2011, 2013 and 2015 China Health and Retirement Longitudinal Study (CHARLS) was included. The bivariate analyses and Heckman selection model was used to identify predictors of healthcare-seeking behavior. Results shows that the utilization rate of outpatient services increased from 21.61% in 2011 to 32.41% in 2015, and that of inpatient services increased from 12.44% to 17.68%. In 2015, 71.93% and 92.18% chose public medical institutions for outpatient and inpatient services, 57.63% and 17.00% chose primary medical institutions. The individuals who were female, were younger, lived in urban, central or western regions, had medical insurance, had poor self-rated health and exhibited activity of daily living (ADL) impairment were more inclined to outpatient and inpatient services. Transportation, medical expenses, the out-of-pocket ratio and the urgency of the disease were associated with provider selection. The universal medical insurance schemes improved health service utilization for the elderly population but had little impact on the choice of medical institutions. The older adults preferred public institutions to private institutions, preferred primary institutions for outpatient care, and higher-level hospitals for hospitalization.
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15
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Xu D, Pan J, Dai X, Hu M, Cai Y, He H, Zhang Y, Liao J, Chen Y, Gong W, Zhou Z, Zhang N, Wang X, Chan KCG, Ying X, Cai Y, Wang R, Xue Q, Yip CMW. Comparing quality of primary healthcare between public and private providers in China: study protocol of a cross-sectional study using unannounced standardised patients in seven provinces of China. BMJ Open 2021; 11:e040792. [PMID: 33436467 PMCID: PMC7805374 DOI: 10.1136/bmjopen-2020-040792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The Chinese government has encouraged the development of private sector in delivering healthcare, including primary healthcare (PHC) in the new round of national health reform since 2009. However, the debate about the role of the private sector in achieving universal health coverage continues with poor support from theories and empirical evidence. This study intends to compare the quality of PHC services between the private and public providers in seven provinces in China, using unannounced standardised patients (USPs). METHODS We are developing and validating 13 USP cases most commonly observed in the PHC setting. Six domains of quality will be assessed by the USP: effectiveness, safety, patient centredness, efficiency, timeliness and equity. The USP will make 2200 visits to 705 public and 521 private PHC institutions across seven provinces, following a multistage clustered sample design. Using each USP-provider encounter as the analytical unit, we will first descriptively compare the raw differences in quality between the private and public providers and then analyse the association of ownership types and quality, using propensity score weighting. ETHICS AND DISSEMINATION The study was primarily funded by the National Natural Science Foundation of China (#71974211, #71874116 and # 72074163) and was also supported by the China Medical Board (#16-260, #18-300 and #18-301), and have received ethical approval from Sun Yat-sen University (#2019-024). The validated USP tool and the data collected in this study will be freely available for the public after the primary analysis of the study. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry: #ChiCTR2000032773.
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Affiliation(s)
- Dong Xu
- ACACIA Lab for Health Systems Strengthening and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Xiaochen Dai
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Mengyao Hu
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Yiyuan Cai
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Hua He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Yaoguang Zhang
- Center for Health Statistics and Information, National Health Commission, Beijing, China
| | - Jing Liao
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Medicial statistics and epidemiology School of public health, Sun Yat-sen university, Guangzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Wenjie Gong
- School of Public Health, Central South University, Changsha, China
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Nan Zhang
- Department of Health Management, School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | | | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
| | - Yue Cai
- Center for Health Statistics and Information, National Health Commission, Beijing, China
| | - Ruixin Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qingping Xue
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Chi-Man Winnie Yip
- Department of Global Health and Population, Harvard University, Cambridge, Massachusetts, USA
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Lan T, Pan J. The Association of Market Mix of Hospital Ownership With Medical Disputes: Evidence From China. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020971403. [PMID: 33233980 PMCID: PMC7691921 DOI: 10.1177/0046958020971403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The prevalence and severity of medical disputes in China have attracted the
attention of society and academia, and how to alleviate medical disputes has
become a major concern. Following the implementation of a series of policies,
the private sector in China’s hospital market has expanded rapidly over the past
decade. It remains unknown whether the market mix of hospital ownership could
alleviate medical disputes, this study aims to bridge the gap. Data are
collected from all hospitals (2171) in Sichuan province, China, from 2012 to
2015. Using a negative binomial hurdle model, the results show that for
hospitals with disputes, the private hospital market share has an inverted
U-shaped relationship with the number of disputes. However, no significant
relationship is found between the private hospital market share and the
probability of dispute occurrence. For hospitals with disputes, competition
plays a protective role in the effect of the private hospital market share on
the number of disputes, hindering the increase in the number of disputes and
facilitating a more rapid drop. However, medical quality is found to play an
insignificant role in that effect. The findings also support encouraging new
private hospitals in China rather than privatizing existing public
hospitals.
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Affiliation(s)
- Tianjiao Lan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,Instiute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,Instiute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
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Du Y, Du Y, Yao N. Patient-provider relationships in China: A qualitative study on the perspectives of healthcare students and junior professionals. PLoS One 2020; 15:e0240747. [PMID: 33085691 PMCID: PMC7577488 DOI: 10.1371/journal.pone.0240747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mistrust and conflicts in patient-provider relationships (PPR) have become prevalent in China. The frequency of verbal and physical violence against healthcare workers has been increasing, but few interventions seem to be effective. Limited prior research has focused on the perspectives of healthcare professionals in training. This paper aimed to understand their viewpoints and conceptualize potentially actionable areas for future policy interventions. METHODS We analyzed de-identified training registration data of a convenience sample of 151 healthcare students and 38 junior professionals from 20 provinces in China. One open-ended question in the registration form asked the participant to comment on PPRs in China. We used qualitative thematic coding to analyze the narrative data. All answers were categorized into three overarching frames: patients, providers, and external agencies/regulations. Frequently mentioned themes in each frame were evaluated to generate an overall theoretical framework. FINDINGS Although fewer than 25% indicated that current PPRs are "good" or acceptable, 98% of respondents were optimistic about the future improvement of these relationships. The leading factors of PPRs mentioned as patient-relevant were eroding trust in the physician, unrealistic expectations, and ineffective communication. The provider-relevant themes highlighted were poor service quality, ineffective communication, and heavy workload. Leading themes relevant to external agencies or regulations were dysfunctional administration system, negative media reports, and disparity in healthcare resource distribution. INTERPRETATION Healthcare professionals in training had a negative view of the current situation but had confidence in future improvement. Patient, provider, and societal factors all contributed to the tension between patients and providers. All aspects of the healthcare sector should be carefully considered when contemplating policy or social interventions to improve the patient-provider relationship.
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Affiliation(s)
- Yuxian Du
- Hutchinson Institute for Cancer Outcome Research (HICOR), Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Data Generation and Observational Studies, Bayer Healthcare U.S. LLC, Whippany, New Jersey, United States of America
- School of Health Care Management, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Yan Du
- School of Nursing, the University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Nengliang Yao
- School of Health Care Management, Shandong University, Jinan, Shandong, People’s Republic of China
- School of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
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18
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Effect of socioeconomic status on the healthcare-seeking behavior of migrant workers in China. PLoS One 2020; 15:e0237867. [PMID: 32813702 PMCID: PMC7444513 DOI: 10.1371/journal.pone.0237867] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/04/2020] [Indexed: 12/04/2022] Open
Abstract
In recent years, China has made great efforts to resolve the health inequality caused by household registration restrictions, and the unequal allotment of health services faced by migrant workers has been effectively alleviated. However, inequality in health services may exist not only between migrant workers and local citizens but also among migrant workers. Thus, the unbalanced utilization of health services among migrant workers deserves attention. Using data from the 2017 China Migrants Dynamic Survey (CMDS), we examined the relationship between socioeconomic status (SES) and healthcare-seeking behavior through multivariate regression analysis. Then, from the perspective of SES, this study divided migrant workers into different groups to explore the characteristics of healthcare-seeking behavior in different groups. The results showed that SES had a significant relationship with healthcare-seeking behavior. Those with high SES were more likely to use high-quality health services. By subdividing the category of migrant workers, we found that the utilization of health services among migrant workers was unbalanced. Education and income had significant gradients in multiple measures of healthcare-seeking behavior, while occupation had no significant difference in the behavior. Migrant workers with higher income and education were more likely to use high-quality health services. Especially for migrant workers who had high incomes (above 15,000 CNY) or whose educational backgrounds were graduate level or above, their utilization of health resources was significantly higher than that of other groups. When designing particular policies to improve the healthcare-seeking behavior of different SES migrant workers, we should pay attention to the low-education groups and low-income groups. Policymakers can reduce the current health inequality of migrant workers by strengthening health education and increasing medical subsidies to achieve health equality among migrant workers and between migrant workers and local citizens.
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Hyzam D, Zou M, Boah M, Saeed A, Li C, Pan S, Zhai J, Wu LJ. Health information and health-seeking behaviour in Yemen: perspectives of health leaders, midwives and mothers in two rural areas of Yemen. BMC Pregnancy Childbirth 2020; 20:404. [PMID: 32664887 PMCID: PMC7359610 DOI: 10.1186/s12884-020-03101-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022] Open
Abstract
Background Humanitarian crises can lead to the rapid change in the health needs of women and newborns, which may give rise to a complex situation that would require various interventions as solutions. This study aimed to examine the health education and promotion patterns, health-seeking behaviour of mothers, and barriers to the use of maternal health services from public health facilities in two rural areas of Yemen. Methods We used a qualitative approach. We conducted in-depth interviews and focus group discussions with frontline health professionals and mothers respectively. Nine in-depth interviews were conducted with the health professionals, including 4 health leaders and 5 midwives, and 2 focus group discussions with mothers aged 18–45 years in Abyan and Lahj. Thematic analysis approach was used to analyze the data in Atlas.ti (version 8) Software. Results Our data showed that health education and promotion activities on maternal health were ad hoc and coverage was poor. Maternal health services were underutilized by women. According to the data from the focus group discussions, the poor quality of services, as indicated by inadequate numbers of female doctors, lack of medical equipment and medicines, and costs of services were barriers to use maternal health services. Moreover, the use of prenatal and postnatal care services was associated with women’s’ perceived need. However, according to the health professionals, the inadequate human resource, workload, and inadequate funding from government have contributed significantly to the perceived quality of maternal health services provided by public health facilities. Despite the identified barriers, we found that a safe motherhood voucher scheme was instituted in Lahj which facilitated the use of maternal health services by disadvantaged women by removing financial barriers associated with the use of maternal health services. Conclusion This study identified several obstacles, which worked independently or jointly to minimize the delivery and use of health services by rural women. These included, inadequate funding, inadequate human resources, poor quality of health services, and high cost of services. These barriers need to be addressed to improve the use of reproductive health services in Yemen.
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Affiliation(s)
- Dalia Hyzam
- Department of Children's and Adolescent Health, and Maternal Health Care, Public Health College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Mingyang Zou
- Department of Children's and Adolescent Health, and Maternal Health Care, Public Health College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Michael Boah
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang, China.,Ghana Health Service, Private Mail Bag Bolgatanga, Upper East Region, Bolgatanga, Ghana
| | - Abeer Saeed
- Community Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Chenrui Li
- Department of Children's and Adolescent Health, and Maternal Health Care, Public Health College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Shixu Pan
- Department of Children's and Adolescent Health, and Maternal Health Care, Public Health College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Jinhe Zhai
- Department of Children's and Adolescent Health, and Maternal Health Care, Public Health College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Li-Jie Wu
- Department of Children's and Adolescent Health, and Maternal Health Care, Public Health College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China.
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20
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Cowley P, Chu A. Comparison of Private Sector Hospital Involvement for UHC in the Western Pacific Region. Health Syst Reform 2020; 5:59-65. [PMID: 30924748 DOI: 10.1080/23288604.2018.1545511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Peter Cowley
- a Division of Health Systems , World Health Organization Regional Office for the Western Pacific , Manila , Philippines
| | - Annie Chu
- a Division of Health Systems , World Health Organization Regional Office for the Western Pacific , Manila , Philippines
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21
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Nie J, Zhang L, Gao J, Li J, Zhou Q, Shi Y, Sylvia S, Congdon N. Using incognito standardised patients to evaluate quality of eye care in China. Br J Ophthalmol 2020; 105:311-316. [DOI: 10.1136/bjophthalmol-2019-315103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 03/08/2020] [Accepted: 04/17/2020] [Indexed: 11/03/2022]
Abstract
Background/aimsFew studies have objectively examined the quality of eye care in China. We assessed refractive care using the incognito standardised patient (SP) approach, a gold standard for evaluating clinical practice.MethodsA total of 52 SPs were trained to provide standardised responses during eye examinations, and underwent automated and non-cycloplegic, subjective refraction by a senior ophthalmologist from Zhongshan Ophthalmologic Center, a national-level clinical and research centre. SPs subsequently received subjective refraction and eye exams at a randomly selected sample of 40 public hospitals and 93 private optical shops in Shaanxi, Northwestern China. Difference between expert and local refraction in the better-seeing eye was calculated by the vector diopteric method, and completeness of exams assessed against national standards. SP and provider demographic information and provider clinical experience were recorded.ResultsSPs (n=52, mean (range) age, 25.7 (22–31) years, 28.8% male) underwent 133 eye exams (mean total duration 15.0±11.7 min) by 133 local refractionists (24–60 years, 30.3% male). Only 93 (69.9%), 121 (91.0%) and 104 (78.2%) of local refractionists assessed vision, automated and subjective refraction, respectively. The median inaccuracy was −0.25 diopters (D), while 25.6% of results differed by an absolute value of ≥1.0 D and 6.0% by ≥2.0 D. Predictors of inaccurate refraction included spectacle power <−6.0 D (OR=2.66; 95% CI, 1.27 to 5.56), service at a public (vs private) hospital (OR=2.01; 95% CI, 1.11 to 3.63) and provider male sex (OR=2.03; 95% CI, 1.11 to 3.69).ConclusionInaccurate refractions are common in Northwestern China, particularly in public facilities. Important assessments, including subjective refraction, are frequently omitted.
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Technical Efficiency of Public and Private Hospitals in Beijing, China: A Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010082. [PMID: 31861922 PMCID: PMC6981764 DOI: 10.3390/ijerph17010082] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 11/21/2022]
Abstract
Objective: With the participation of private hospitals in the health system, improving hospital efficiency becomes more important. This study aimed to evaluate the technical efficiency of public and private hospitals in Beijing, China, and analyze the influencing factors of hospitals’ technical efficiency, and thus provide policy implications to improve the efficiency of public and private hospitals. Method: This study used a data set of 154–232 hospitals from “Beijing’s Health and Family Planning Statistical Yearbooks” in 2012–2017. The data envelopment analysis (DEA) model was employed to measure technical efficiency. The propensity score matching (PSM) method was used for matching “post-randomization” to directly compare the efficiency of public and private hospitals, and the Tobit regression was conducted to analyze the influencing factors of technical efficiency in public and private hospitals. Results: The technical efficiency, pure technical efficiency and scale efficiency of public hospitals were higher than those of private hospitals during 2012–2017. After matching propensity scores, although the scale efficiency of public hospitals remained higher than that of their private counterparts, the pure technical efficiency of public hospitals was lower than that of private hospitals. Panel Tobit regression indicated that many hospital characteristics such as service type, level, and governance body affected public hospitals’ efficiency, while only the geographical location had an impact on private hospitals’ efficiency. For public hospitals in Beijing, those with lower average outpatient and inpatient costs per capita had better performance in technical efficiency, and bed occupancy rate, annual visits per doctor, and the ratio of doctors to nurses also showed a positive sign with technical efficiency. For private hospitals, the average length of stay was negatively associated with technical efficiency, but the bed occupancy rate, annual visits per doctor, and average outpatient cost were positively associated with technical efficiency. Conclusions: To improve technical efficiency, public hospitals should focus on improving the management standards, including the rational structure of doctors and nurses as well as appropriate reduction of hospitalization expenses. Private hospitals should expand their scale with proper restructuring, mergers, and acquisitions, and pay special attention to shortening the average length of stay and increasing the bed occupancy rate.
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Jin K, Zhang H, Seery S, Fu Y, Yu S, Zhang L, Sun F, Tian L, Xu J, Yue XZ. Comparing public and private emergency departments in China: Early evidence from a national healthcare quality survey. Int J Health Plann Manage 2019; 35:581-591. [PMID: 31721297 DOI: 10.1002/hpm.2968] [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: 10/22/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 11/11/2022] Open
Abstract
The number of private healthcare facilities has rapidly increased since the progressive open market policies, which began in the 1980s; however, little is known about the development of private emergency departments (EDs). This cross-sectional study was part of the National Control Information System (NCIS) project, which collects data annually from hospitals across China. Emergency services data were extracted and included location, infrastructure, human resources, beds, and number of patients; 4529 hospitals across 31 provinces in mainland China were eventually included, consisting of 988 private and 3541 public EDs. Evidence shows that most private EDs are located in central China, where local economies are relatively developed. Most private EDs (91.6%) are found in secondary hospitals but have significantly fewer beds and smaller workforces compared with public EDs. An imbalance of emergency medical resources was observed across China, and this disparity becomes even more profound in rural hospitals. These findings may initiate collaborative, public-private partnerships in emergency health services provision and suggest there is a need to offer tax breaks to incentivize investors, but further research is required. We may also need to rethink health insurance policies, which could enable more equitable access to private emergency care. Future planning and health policies must be based upon the strongest available evidence, if we are to address imbalanced health services distribution and growing demand.
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Affiliation(s)
- Kui Jin
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Zhang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sam Seery
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Department of Humanities and Social Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangyang Fu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shanshan Yu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lili Zhang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Sun
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liyuan Tian
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Xu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xue Zhong Yue
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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24
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Yang T, Ma M, Guo Y, Li Y, Tian H, Liu Y, Chen Q, Zhang S, Deng J. Do job stress, health, and presenteeism differ between Chinese healthcare workers in public and private hospitals: a cross sectional study. PSYCHOL HEALTH MED 2019; 25:653-665. [PMID: 31537117 DOI: 10.1080/13548506.2019.1668564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To determine if job stress, health, and presenteeism differ between healthcare workers at Chinese public and private hospitals. This cross-sectional study analyzed the records of 1080 healthcare workers in eastern, central, and western China for the period from January2015 through November2015. Data on challenge stress, hindrance stress, health, and presenteeism were collected. Using univariate and multivariate regression and SPSS, we investigated differences between Chinese public and private hospitals in China. Challenge stress, hindrance stress, and presenteeism, but not health status, significantly differed between healthcare workers at public and private hospitals in China. Challenge stress and hindrance stress were significantly higher in public hospitals, while presenteeism was significantly lower in private hospitals. The significant differences between public and private hospitals are attributable to differences in the business practices and management of public and private hospitals. To achieve successful long-term medical reform in China, the adverse effects of psychosocial factors should be considered in future research plans and policies. Chinese hospitals urgently require improvements in management and leadership. Reform efforts should encompass fields such as management science, psychology, and the behavioral sciences.
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Affiliation(s)
- Tianan Yang
- School of Management and Economics, Beijing Institute of Technology , Beijing, China.,Sustainable Development Research Institute for Economy and Society of Beijing , Beijing, China.,Chair of Sport and Health Management, School of Management, Technical University of Munich, Uptown Munich Campus D , Munich, Germany
| | - Mingxu Ma
- School of Management and Economics, Beijing Institute of Technology , Beijing, China.,Sustainable Development Research Institute for Economy and Society of Beijing , Beijing, China
| | - Yina Guo
- School of Management and Economics, Beijing Institute of Technology , Beijing, China.,Sustainable Development Research Institute for Economy and Society of Beijing , Beijing, China
| | - Yaxin Li
- School of Management and Economics, Beijing Institute of Technology , Beijing, China.,Sustainable Development Research Institute for Economy and Society of Beijing , Beijing, China
| | - Huilin Tian
- School of Management and Economics, Beijing Institute of Technology , Beijing, China.,Sustainable Development Research Institute for Economy and Society of Beijing , Beijing, China
| | - Yuanling Liu
- Human Resources Department, Guangdong Women's and Children Hospital , Guangzhou, China
| | - Qian Chen
- Medical Affair Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing, China
| | - Shiyang Zhang
- Hospital Infection Management Department, the First Affiliated Hospital of Xiamen University , Xiamen, China
| | - Jianwei Deng
- School of Management and Economics, Beijing Institute of Technology , Beijing, China.,Sustainable Development Research Institute for Economy and Society of Beijing , Beijing, China
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25
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Deng J, Li Y, Sun Y, Lei R, Yang T. Public service motivation as a mediator of the relationship between job stress and presenteeism: a cross-sectional study from Chinese public hospitals. BMC Health Serv Res 2019; 19:625. [PMID: 31481038 PMCID: PMC6724293 DOI: 10.1186/s12913-019-4483-5] [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: 02/21/2019] [Accepted: 08/28/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Job stress is a strong indicator of presenteeism, but few studies have examined its diverse effects and mediators on presenteeism. This study explored the relationships between job stress, public service motivation (PSM) and presenteeism and how job stress and PSM influence presenteeism in a large national sample of Chinese healthcare workers. METHODS A cross-sectional survey including 1392 healthcare workers from 11 Class A tertiary hospitals in eastern, central and western China was used in the analysis. Descriptive statistical analysis, correlation analysis and structural equation modeling were used to test the research hypothesis. RESULTS Hindrance stress was inversely associated with PSM (β = - 0.27; P < 0.001) but significantly positively associated with presenteeism (β = 0.35; P < 0.001). PSM was directly inversely associated with presenteeism (β = - 0.35; P < 0.001). PSM partially mediated the relation of hindrance stress with presenteeism. CONCLUSIONS The findings suggest that efforts to prevent presenteeism among healthcare workers in China should emphasize PSM improvement and reduction of hindrance stress.
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Affiliation(s)
- Jianwei Deng
- School of Management and Economics, Beijing Institute of Technology, No. 5 South Zhongguancun Street, Beijing, 100081, People's Republic of China
- Sustainable Development Research Institute for Economy and Society of Beijing, No. 5 South Zhongguancun Street, Beijing, 100081, China
| | - Yaxin Li
- School of Management and Economics, Beijing Institute of Technology, No. 5 South Zhongguancun Street, Beijing, 100081, People's Republic of China
| | - Yangyang Sun
- School of Management and Economics, Beijing Institute of Technology, No. 5 South Zhongguancun Street, Beijing, 100081, People's Republic of China
| | - Run Lei
- School of Management and Economics, Beijing Institute of Technology, No. 5 South Zhongguancun Street, Beijing, 100081, People's Republic of China
| | - Tianan Yang
- School of Management and Economics, Beijing Institute of Technology, No. 5 South Zhongguancun Street, Beijing, 100081, People's Republic of China.
- Sustainable Development Research Institute for Economy and Society of Beijing, No. 5 South Zhongguancun 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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26
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Luo J, Chen G, Li C, Xia B, Sun X, Chen S. Use of an E2SFCA Method to Measure and Analyse Spatial Accessibility to Medical Services for Elderly People in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1503. [PMID: 30018190 PMCID: PMC6068715 DOI: 10.3390/ijerph15071503] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022]
Abstract
Current studies on measuring the accessibility of medical services for the elderly (AMSE) have ignored the potential competition among supply and demand and the distance decay laws. Hence, an enhanced two-step floating catchment area (E2SFCA) method (i.e., the road network-based Gaussian 2SFCA method) is proposed to calculate AMSE scores after considering different types of roads, including urban rail transit, freeways, major roads, minor roads and rural roads. Based on the first National Geographic Conditions Monitoring (NGCM) data, this study took Wuhan, China, as a case study and assessed the variation of AMSE using two different threshold times (i.e., Platinum Ten and Golden Hour). Next, global (i.e., sensitivity and hot spot analysis) and local analyses (i.e., three regional area internal comparisons) of AMSE scores were conducted to accurately identify details in the variation of spatial accessibility. It was observed that the E2SFCA method could be easily applied to measure AMSE. The results showed that 48.63% of the elderly population in Wuhan had a higher or the highest level of medical accessibility in "Platinum Ten", while 72.97% had a higher or the highest level in the "Golden Hour", and hot spots of AMSE scores were located in central urban areas and presented an enclosure structure using both threshold travel times, which could provide guidance to governments or planners on issues of spatial planning and identifying elderly medical services shortage areas.
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Affiliation(s)
- Jing Luo
- Key Laboratory for Geographical Process Analysis and Simulation, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
- The College of Urban and Environmental Sciences, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
| | - Guangping Chen
- Key Laboratory for Geographical Process Analysis and Simulation, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
- The College of Urban and Environmental Sciences, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
| | - Chang Li
- Key Laboratory for Geographical Process Analysis and Simulation, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
- The College of Urban and Environmental Sciences, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
| | - Bingyan Xia
- Key Laboratory for Geographical Process Analysis and Simulation, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
- The College of Urban and Environmental Sciences, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
| | - Xuan Sun
- Key Laboratory for Geographical Process Analysis and Simulation, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
- The College of Urban and Environmental Sciences, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
| | - Siyun Chen
- Key Laboratory for Geographical Process Analysis and Simulation, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
- The College of Urban and Environmental Sciences, Central China Normal University, No.152 Luoyu Road, Wuhan 430079, China.
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27
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Xu X, Liu D, Rao Y, Zeng H, Zhang F, Wang L, Xie Y, Sharma M, Zhao Y. Prolonged Screen Viewing Times and Sociodemographic Factors among Pregnant Women: A Cross-Sectional Survey in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030403. [PMID: 29495439 PMCID: PMC5876948 DOI: 10.3390/ijerph15030403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/10/2018] [Accepted: 02/19/2018] [Indexed: 11/28/2022]
Abstract
Objectives: This study aimed to assess the prevalence of prolonged television, computer, and mobile phone viewing times and examined related sociodemographic factors among Chinese pregnant women. Methods: In this study, a cross-sectional survey was implemented among 2400 Chinese pregnant women in 16 hospitals of 5 provinces from June to August in 2015, and the response rate of 97.76%. We excluded women with serious complications and cognitive disorders. The women were asked about their television, computer, and mobile phone viewing during pregnancy. Prolonged television watching or computer viewing was defined as spending more than two hours on television or computer viewing per day. Prolonged mobile phone viewing was watching more than one hour on mobile phone per day. Results: Among 2345 pregnant women, about 25.1% reported prolonged television viewing, 20.6% reported prolonged computer viewing, and 62.6% reported prolonged mobile phone viewing. Pregnant women with long mobile phone viewing times were likely have long TV (Estimate = 0.080, Standard Error (SE) = 0.016, p < 0.001) and computer viewing times (Estimate = 0.053, SE = 0.022, p = 0.015). Pregnant women with long TV (Estimate = 0.134, SE = 0.027, p < 0.001) and long computer viewing times (Estimate = 0.049, SE = 0.020, p = 0.015) were likely have long mobile phone viewing times. Pregnant women with long TV viewing times were less likely to have long computer viewing times (Estimate = -0.032, SE = 0.015, p = 0.035), and pregnant women with long computer viewing times were less likely have long TV viewing times (Estimate = -0.059, SE = 0.028, p = 0.035). Pregnant women in their second pregnancy had lower prolonged computer viewing times than those in their first pregnancy (Odds Ratio (OR) 0.56, 95% Confidence Interval (CI) 0.42-0.74). Pregnant women in their second pregnancy were more likely have longer prolonged mobile phone viewing times than those in their first pregnancy (OR 1.25, 95% CI 1.01-1.55). Conclusions: The high prevalence rate of prolonged TV, computer, and mobile phone viewing times was common for pregnant women in their first and second pregnancy. This study preliminarily explored the relationship between sociodemographic factors and prolonged screen time to provide some indication for future interventions related to decreasing screen-viewing times during pregnancy in China.
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Affiliation(s)
- Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Dengyuan Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Yunshuang Rao
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Huan Zeng
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Fan Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Lu Wang
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Yaojie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS 39213, USA.
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
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28
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Zhao D, Zhang Z. Qualitative analysis of direction of public hospital reforms in China. Front Med 2017; 12:218-223. [PMID: 28674836 DOI: 10.1007/s11684-017-0534-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
Reforms in public hospitals are among the most important improvements in China's health care system over the last two decades. However, the reforms that should be implemented in public hospitals are unclear. Thus, a feasible direction of reforms in Chinese public hospitals is suggested and reliable policy suggestions are provided for the government to reform public hospitals. The data used in this study were mainly derived from a qualitative study. Focus group discussions and in-depth interviews were conducted in Shanghai, Guangdong, and Gansu between May and December 2014. Government funding accounted for approximately eight percent of the total annual revenue of public hospitals in China, and the insufficient government subsidy considerably affects the operation mechanism of public hospitals. However, solely increasing this subsidy cannot address the inappropriate incentives of public hospitals in China. The most crucial step in setting the direction of reforms in public hospitals in China is transforming inappropriate incentives by implementing a new evaluation index system for directors and physicians in public hospitals.
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Affiliation(s)
- Dahai Zhao
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Zhiruo Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China.
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29
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Al-Jazaeri A, Alshwairikh L, Aljebreen MA, AlSwaidan N, Al-Obaidan T, Alzahem A. Variation in access to pediatric surgical care among coexisting public and private providers: inguinal hernia as a model. Ann Saudi Med 2017; 37:290-296. [PMID: 28761028 PMCID: PMC6150598 DOI: 10.5144/0256-4947.2017.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Faced with growing healthcare demand, the Saudi government is increasingly relying on privatization as a tool to improve patient access to care. Variation in children's access to surgical care between public (PB) and private providers (PV) has not been previously analyzed. OBJECTIVES To compare access to pediatric surgical services between two coexisting PB and PV. DESIGN Retrospective comparative study. SETTINGS A major teaching hospital and the largest PV group in Saudi Arabia. PATIENTS AND METHODS The outcomes for children who underwent inguinal herniotomy (IH) between May 2010 and December 2014 at both providers were with IH serving as the model. Data collected included patient demographics, insurance coverage, referral pattern and access parameters including time-to-surgery (TTS), surgery wait time (SWT) and duration of symptoms (DOS). MAIN OUTCOME MEASURE(S) TTS, SWT and DOS. RESULTS Of 574 IH cases, 56 cases of in-hospital referrals were excluded leaving 290 PB and 228 PV cases. PV patients were younger (12.0 vs 16.4 months, P=.043) and more likely to be male (81.6% vs 72.8%, P=.019), expatriates (18% vs 3.4%, P < .001) and insured (47.4% vs 0%, P < .001). The emergency department was more frequently the source for PB referrals (35.2% vs 12.7%, P < .001) while most PV patients were self-referred (72.8% vs 16.7%, P < .001). Access parameters were remarkably better at PV: TTS (21 vs 66 days, P < .001), SWT (4 vs 31 days, P < .001) and DOS (33 vs 114 days, P < .001). CONCLUSION When coexisting, PV offers significantly better access to pediatric surgical services compared to PB. Diverting public funds to expand children's access to PV can be a valid choice to improve access to care in case when outcomes with the two providers are similar. LIMITATIONS Although it is the first and largest comparison in the pediatric population, the sample may not represent the whole population since it is confined to a single selected surgical condition.
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Affiliation(s)
- Ayman Al-Jazaeri
- Dr. Ayman Al-Jazaeri, Division of Pediatrc Surgery,, Department of Surgery,, King Saud University,, Riyadh 1355, Saudi Arabia, , ORCID: http://orcid.org/0000-0002-6853-0935
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Rannan-Eliya RP, Wijemanne N, Liyanage IK, Dalpatadu S, de Alwis S, Amarasinghe S, Shanthikumar S. Quality of inpatient care in public and private hospitals in Sri Lanka. Health Policy Plan 2016; 30 Suppl 1:i46-58. [PMID: 25759454 DOI: 10.1093/heapol/czu062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To compare the quality of inpatient clinical care in public and private hospitals in Sri Lanka. METHODS A retrospective, cross-sectional comparison was done of inpatient quality, in a sample of 11 public and 10 private hospitals in three of 25 districts. Data were collected for 55 quality indicators from medical records of 2523 public and 1815 private inpatient admissions. These covered treatment of asthma, acute myocardial infarction (AMI), childbirth and five other conditions, along with outcome indicators, and medicine prescribing indicators. RESULTS Overall quality scores were better in the public sector than the private sector (77 vs 69%). Performance was similar for management of AMI and childbirth and somewhat better in the private sector for management of asthma. The public sector performed better in those indicators that are not constrained by resources (94 vs 81%), but worse in indicators that are highly resource intensive (10 vs 31%). Quality was comparable in assessment and investigation, but the public sector performed better in treatment and management (70 vs 62%) and drug prescribing (68 vs 60%), and modestly worse in terms of outcomes (92 vs 97%). CONCLUSIONS For a range of indicators where comparisons were possible, quality of inpatient clinical care in Sri Lanka was comparable to levels reported from upper-middle income Asian countries, and often approaches that in developed countries, although the findings cannot be generalized. Quality in the public sector is better than in the private sector in many areas, despite spending being substantially less. Quality in public hospitals is resource constrained, and needs greater government investment for improvement, but when resource limitations are not critical, the public sector appears able to deliver equal or better quality than the private sector. Overall similarities in quality between the two sectors suggest the importance of physician training and other factors.
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Affiliation(s)
| | | | | | | | - Sanil de Alwis
- Institute for Health Policy, 72 Park Street, Colombo, Sri Lanka
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31
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Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China. Soc Sci Med 2016; 170:124-132. [DOI: 10.1016/j.socscimed.2016.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 09/25/2016] [Accepted: 10/17/2016] [Indexed: 01/09/2023]
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32
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The Impact of Healthcare Privatization on Access to Surgical Care: Cholecystectomy as a Model. World J Surg 2016; 41:394-401. [DOI: 10.1007/s00268-016-3739-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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33
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Xu X, Liu S, Rao Y, Shi Z, Wang L, Sharma M, Zhao Y. Prevalence and Sociodemographic and Lifestyle Determinants of Anemia during Pregnancy: A Cross-Sectional Study of Pregnant Women in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090908. [PMID: 27649213 PMCID: PMC5036741 DOI: 10.3390/ijerph13090908] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/26/2016] [Accepted: 09/07/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed to assess the differences regarding anemia among pregnant women with diverse characteristics and lifestyle factors. METHODS A cross-sectional study of pregnant women was conducted between June and August 2015 in 16 hospitals in five provinces of Mainland China. Self-reported doctor-diagnosed anemia was used in the study. RESULTS We included 2345 pregnant women. Of the participants, 1755 (74.8%) were pregnant women of first pregnancy (PWFP) and 590 (25.2%) were second pregnancy (PWSP). The mean age of the participants was 28.1 years (SD 4.1). Overall, the prevalence of anemia was 12.7% (13.4% and 10.7% among PWFP and PWSP, respectively). The prevalence for not eating breakfast was 11.0%. Compared with PWFP, PWSP was inversely associated with the risk of anemia (odds ratio (OR) 0.66, 95% CI 0.48-0.91). Compared with those being registered in a low ranking hospital, pregnant women who were admitted to a high (OR 0.40, 95% CI 0.28-0.57) or a medium ranking hospital (OR 0.58, 95% CI 0.37-0.92) were inversely associated with the risk of anemia. Compared with women of low income (<¥4,500), those with high income were less likely to have anemia (OR 0.68, 95% CI 0.50-0.94). Compared with women with non-manual jobs, women with manual jobs (OR 1.70, 95% CI 1.17-2.45) and unemployed women (OR 1.42, 95% CI 1.04-1.93) were associated with a greater likelihood of suffering from anemia. CONCLUSIONS Pregnant women not eating breakfast are of concern. Anemia is highly prevalent among pregnant women in China. Lower socio-economic status, manual jobs, PWFP, and those who attend a lower quality hospital have a greater likelihood of suffering from anemia. Tailored interventions are needed to address these issues.
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Affiliation(s)
- Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Sheng Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Yunshuang Rao
- School of Nursing, Chongqing Medical University, Chongqing 400016, China.
| | - Zumin Shi
- Faculty of Health Sciences, School of Medicine, The University of Adelaide, North Terrace, Adelaide, SA 5005, Australia.
| | - LianLian Wang
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Department of Reproduction Health and Infertility, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing 400016, China.
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS 39213, USA.
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
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Abstract
Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole.
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Affiliation(s)
- Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Tim Ensor
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hugh Waters
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Zhao DH, Rao KQ, Zhang ZR. Patient Trust in Physicians: Empirical Evidence from Shanghai, China. Chin Med J (Engl) 2016; 129:814-8. [PMID: 26996477 PMCID: PMC4819302 DOI: 10.4103/0366-6999.178971] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patient trust in physicians, which can be considered a collective good, is necessary for an effective health care system. However, there is a widespread concern that patient trust in physicians is declining under various threats to the physician-patient relationship worldwide. This article aimed to assess patient trust in physicians through a quantitative study in Shanghai, China, and to provide appropriate suggestions for improving the trust in China. METHODS The data from a survey conducted in Zhongshan Hospital and Shanghai Tenth People's Hospital, which are two tertiary public hospitals in Shanghai, were used in this study. Patient trust in physicians was the dependent variable. Furthermore, a 10-item scale was used to precisely describe the dependent variable. The demographic characteristics were independent variables of trust in physicians. Binomial logistic regression was employed to analyze the factors associated with the dependent variable, which was divided into two categories on the basis of the responses (1: Strongly agree or agree and 0: Strongly disagree, disagree, or neutral). RESULTS This study found that 67% of patients trusted or strongly trusted physicians. The mean score of patient trust in physicians was 35.4 from a total score of 50. Furthermore, patient trust in physicians was significantly correlated with the age, education level, annual income, and health insurance coverage of the patients. CONCLUSIONS Patient trust in physicians in Shanghai, China is higher than previously reported. Furthermore, the most crucial reason for patient distrust in physicians is the information asymmetry between patients and physicians, which is a natural property of the physician-patient relationship, rather than the so-called for-profit characteristic of physicians or patients' excessive expectations.
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Affiliation(s)
- Da-Hai Zhao
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Ke-Qin Rao
- Chinese Medical Association, Beijing 100710, China
| | - Zhi-Ruo Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
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A Comparison of Quality of Community Health Services Between Public and Private Community Health Centers in Urban China. Med Care 2016; 53:888-93. [PMID: 26366520 DOI: 10.1097/mlr.0000000000000414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study was the first of its kind to evaluate and compare the quality of private and public community health centers (CHCs) in urban China. METHODS A total of 2501 CHCs in 35 cities were chosen in 2011 using a multistage sampling method, and data on human resources, medical equipment and drug inventory were collected. A subset of 422 CHCs was randomly selected and 100 prescriptions from each CHCs were reviewed to evaluate prescribing practice. In total, 12,386 patients who visited the selected 422 CHCs were interviewed to assess patient satisfaction and payments. RESULTS Controlling for population covered per CHC and geographic regions, private CHCs were higher than public CHCs in average building area (2310.96 vs. 2000.92 square meters), average number of medical equipment (6.42 vs. 6.14), average number of physicians and nurses per 10,000 population (4.86 vs. 3.81 and 3.38 vs. 2.62), and average number of medicines in stock (435.08 vs. 375.83), but lower in average percentage of medicines on the national essential medicines list (67.29% vs. 77.55%). Prescriptions from private CHCs had significantly higher number of drugs per prescription (2.38 vs. 2.24), higher percentage of prescriptions with injections (36.44% vs. 30.50%), and higher percentage of prescriptions with antibiotics (37.17% vs. 30.14%). Patient satisfaction was similar between the 2 groups, and patient payments per visit were lower in private CHCs after controlling for patients' sociodemographic characteristics. CONCLUSIONS Private CHCs are better equipped and better staffed than public CHCs but are less compliant with national policy on essential medicines and have poorer prescribing quality in China, warranting more rigorous government supervision.
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Pan J, Liu D, Ali S. Patient dissatisfaction in China: What matters. Soc Sci Med 2015; 143:145-53. [PMID: 26356826 DOI: 10.1016/j.socscimed.2015.08.051] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/15/2015] [Accepted: 08/28/2015] [Indexed: 10/23/2022]
Abstract
Patient satisfaction is a focal concern of health-care delivery and an expected outcome of medical care. Recently, the violent conflict between doctors and patients in China has intensified. Patient dissatisfaction has been recognized as an important concern and an urgent issue in the reform of China's health care. The objectives of this study are to investigate the determinants of patient dissatisfaction attributed to patient, hospital, and health-care market characteristics, as well as to explore the major determinants in the context of China. Data from 2007 to 2010 Urban Resident Basic Medical Insurance Survey (URBMIS) are used in this study. A total of 13,336 patients are selected conditional on health-care utilization. Analysis of satisfaction is based on outpatient utilization (last 2 weeks' reference, 6393 individuals) and inpatient utilization (last 1-year reference, 6943 individuals). Satisfaction was measured as ordinal variables (scales 1-5). Ordinary least squares (OLS) regression and an ordered probit model are applied to investigate the determinants. Blinder-Oaxaca decomposition is further employed to detect the proportion each predictor's contribution. The results indicate that patients' gender, education, and insurance status are significantly related to patient satisfaction. Higher-level hospitals are found to negatively correlate with patient satisfaction. Lower competition in providers' market and a higher market share of private hospitals are found to positively correlate with patient dissatisfaction. Meanwhile, the survey indicates that "medical charges too expensive" is chiefly responsible for patient dissatisfaction. Our study provides empirical evidence on the determinants of patient dissatisfaction in China. In particular, the results indicate that establishing a high competition among various providers in the health-care market will act as a "double-edged sword," with great policy implications.
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Affiliation(s)
- Jay Pan
- West China School of Public Health, Sichuan University, Chengdu, China; West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Dan Liu
- Institute of Regional Economics and Finance, College of Economics, Sichuan Agricultural University, Chengdu, China; Mannheim Institute of Public Health, Social and Prevention Medicine, University of Heidelberg, Mannheim, Germany.
| | - Shehzad Ali
- Department of Health Science, University of York, York, UK
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Xu J, Liu G, Deng G, Li L, Xiong X, Basu K. A comparison of outpatient healthcare expenditures between public and private medical institutions in urban China: an instrumental variable approach. HEALTH ECONOMICS 2015; 24:270-279. [PMID: 24327571 DOI: 10.1002/hec.3015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 08/26/2013] [Accepted: 11/05/2013] [Indexed: 06/03/2023]
Abstract
The growth of healthcare expenditure provokes constant comments and discussions, as countries battle the issues on cost containment and cost effectiveness. Prior to 1978, medical institutions in China were either state-owned or were collective public hospitals. Since 1978, China has been trying to rebuild its healthcare system, which was destroyed during the 'cultural revolution', allowing private medical institutions to deliver healthcare services. As a result, private medical institutions have grown from 0% to 28.57% between 1978 and 2010. In this context, we compare outpatient healthcare expenditures between public and private medical institutions. The central problem of this comparison is that the choice of medical institution is endogenous. So we apply an instrumental variable (IV) framework utilizing geographic information (whether the closest medical institution is private) as the instrument while controlling for severity of health and other relevant confounding factors. Using China's Urban Resident Basic Medical Insurance Survey 2008-2010, we found that there is no difference in expenditure between public and private medical institutions when IV framework is used. Our econometric tests suggest that our IV model is specified appropriately. However, the ordinary least square model, which is inconsistent in the presence of endogenous regressor(s), reveals that public medical institutions are more expensive.
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Affiliation(s)
- Judy Xu
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
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Qiu L, Yu Y, Liu J, Hu H, Wang Y. For-profit medical institutions in China: current status analysis and comparison with non-profit ones. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2014. [DOI: 10.1111/jphs.12047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lan Qiu
- State Key Laboratory of Quality Research in Chinese Medicine; Institute of Chinese Medical Sciences; University of Macau; Macao China
| | - Yuanyuan Yu
- State Key Laboratory of Quality Research in Chinese Medicine; Institute of Chinese Medical Sciences; University of Macau; Macao China
| | - Jingjing Liu
- State Key Laboratory of Quality Research in Chinese Medicine; Institute of Chinese Medical Sciences; University of Macau; Macao China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine; Institute of Chinese Medical Sciences; University of Macau; Macao China
| | - Yitao Wang
- State Key Laboratory of Quality Research in Chinese Medicine; Institute of Chinese Medical Sciences; University of Macau; Macao China
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Chen L, Dai Y, Zhang Y, Wu Q, Rudan D, Saftić V, van Velthoven MHMMT, Su J, Tan Z, Scherpbier RW. A comparison between antenatal care quality in public and private sector in rural Hebei, China. Croat Med J 2013; 54:146-56. [PMID: 23630142 PMCID: PMC3641873 DOI: 10.3325/cmj.2013.54.146] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim To evaluate the quality of antenatal care (ANC) in Hebei Province and compare it between the public and private sector and within the public sector. Methods We conducted a Maternal, Newborn and Child Health Household Survey in 2010 using a two-stage sampling procedure and included 1079 mothers. The quality of ANC was assessed on the basis of the number of ANC visits, the time of the first ANC visit, 16 different ANC procedures, owning a maternal health care booklet, and the type of service provider. Results Almost all women (98%) received ANC services at least once, 80% at least four times, and 54% at least five times. About half of the women (46%) visited ANC facility within their first trimester. Neither public nor private sector provided all 16 standardized services, but significantly more women in public sector received ANC procedures. Most women received ANC in county or higher-level hospitals (75%) and very few in township hospitals (8%). Significantly fewer women were weighed and tested for HIV/AIDS in township than in county or higher-level hospitals. Conclusion The quality of ANC in Hebei was poorer than required by China’s national and World Health Organization norms. Although the public sector performed better than the private sector, the utilization and quality of care of ANC services in this sector varied and women generally visited county or higher-level health facilities.
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Affiliation(s)
- Li Chen
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Tang C, Zhang Y, Chen L, Lin Y. The growth of private hospitals and their health workforce in China: a comparison with public hospitals. Health Policy Plan 2013; 29:30-41. [DOI: 10.1093/heapol/czs130] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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ANJARANI S, SAFADEL N, DAHIM P, AMINI R, MAHDAVI S, MIRAB SAMIEE S. Establishment of national laboratory standards in public and private hospital laboratories. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:96-101. [PMID: 23514840 PMCID: PMC3595627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 11/14/2012] [Indexed: 10/25/2022]
Abstract
In September 2007 national standard manual was finalized and officially announced as the minimal quality requirements for all medical laboratories in the country. Apart from auditing laboratories, Reference Health Laboratory has performed benchmarking auditing of medical laboratory network (surveys) in provinces. 12(th) benchmarks performed in Tehran and Alborz provinces, Iran in 2010 in three stages. We tried to compare different processes, their quality and accordance with national standard measures between public and private hospital laboratories. The assessment tool was a standardized checklist consists of 164 questions. Analyzing process show although in most cases implementing the standard requirements are more prominent in private laboratories, there is still a long way to complete fulfillment of requirements, and it takes a lot of effort. Differences between laboratories in public and private sectors especially in laboratory personnel and management process are significant. Probably lack of motivation, plays a key role in obtaining less desirable results in laboratories in public sectors.
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