1
|
Peng Z, Laporte A, Wei X, Sha X, Coyte PC. Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city. HEALTH ECONOMICS REVIEW 2024; 14:39. [PMID: 38850390 PMCID: PMC11162028 DOI: 10.1186/s13561-024-00516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Although countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care. METHODS The dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care. RESULTS We demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual's risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts. CONCLUSION This study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.
Collapse
Affiliation(s)
- Zixuan Peng
- School of Public Health, Southeast University, Suite 137, Kangjian Building, 87 Dingjiaqiao, Nanjing, Jiangsu, 210009, China
| | - Audrey Laporte
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Xiaolin Wei
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Xinping Sha
- Xiangya School of Medicine, Central South University, 172 Tongzipo Rd, Yuelu District, Changsha, Hunan, 410013, China.
| | - Peter C Coyte
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Guo Y, Hong X, Li D, An Q, Fan W, Yang M, Xiao L. The economic effect of financial compensation in China's healthcare system: comprehensive insights regarding supply and demand factors. HEALTH ECONOMICS REVIEW 2024; 14:21. [PMID: 38491307 PMCID: PMC10943810 DOI: 10.1186/s13561-024-00496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES We aim to analyse the effects of government subsidies on residents' health and healthcare expenditure from the perspectives of supply and demand. DATA AND METHODS According to the regional division adopted in the data query system of the National Bureau of Statistics, this study divides 31 provinces and cities into three regions: eastern, central, and western. The data used are from public databases, such as the "China Statistical Yearbook," "China Health Statistical Yearbook," and "Government Final Account Report". In this study, mathematical model derivation is used to construct a fixed effects model, and an empirical study based on cross-sectional data and general linear regression is conducted. To prevent endogeneity issues, this study introduces instrumental variables and uses 2SLS regression to further analyse the output results. RESULTS For every 1% increase in supplementary funding on the supply side, the perinatal mortality rate decreases by 1.765%, while for every 1% increase in financial compensation on the demand side, per capita outpatient expenses increase by 0.225% and per capita hospitalization expenses increase by 0.196%. Regarding medical resources, for every 1% increase in the number of beds per 1,000 people, per capita hospitalization expenses decrease by 0.099%. In the central and eastern regions, where economic levels are higher, supply-side government funding is more effective than demand-side funding. In contrast, demand-side funding is more effective in the western region. CONCLUSIONS The roles of multiple influencing factors and significant regional heterogeneity are clarified. Increasing financial compensation to providers positively impacts perinatal mortality but leads to higher per capita outpatient and hospital expenditures. Finally, this study provides targeted policy recommendations and solid theoretical support for policymakers.
Collapse
Affiliation(s)
- Yi Guo
- Beijing University of Chinese Medicine, No. 11 North Third Ring East Road, Beijing, China
| | - Xuezhi Hong
- Beijing University of Chinese Medicine, No. 11 North Third Ring East Road, Beijing, China.
| | - Dongmei Li
- Beijing University of Chinese Medicine, No. 11 North Third Ring East Road, Beijing, China
| | - Qiannan An
- Beijing University of Chinese Medicine, No. 11 North Third Ring East Road, Beijing, China
| | - Wenwen Fan
- Beijing University of Chinese Medicine, No. 11 North Third Ring East Road, Beijing, China
| | - Minghe Yang
- Beijing University of Chinese Medicine, No. 11 North Third Ring East Road, Beijing, China
| | - Luyang Xiao
- Beijing University of Chinese Medicine, No. 11 North Third Ring East Road, Beijing, China
| |
Collapse
|
3
|
Gong H, Wang X, Zhang T, Li J, Chen B. How Can China's New Health Care Reform Promote the Balance of Interest Game?-Based on Game Evolution and Simulation Analysis. Risk Manag Healthc Policy 2023; 16:1435-1454. [PMID: 37575683 PMCID: PMC10422683 DOI: 10.2147/rmhp.s422296] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The new round of medical reform is a significant exploration of reform in the public service sector in China. Health insurance regulatory departments, medical institutions, and patients, as critical stakeholders in China's medical reform, play a crucial role in the success of the reform through their strategic interactions. Patients and Methods Starting from the perspective of bounded rationality, applies evolutionary game theory to establish an evolutionary game model for the collaborative governance of health insurance regulatory departments, medical institutions, and patients and analyzes the stability of each party's strategy and the sensitivity of parameters in the tripartite game system. Results The study shows that an equilibrium point will be formed when medical institutions provide reasonable treatment, patients choose to accept treatment, and health insurance regulatory departments adopt a lenient regulatory strategy, maximizing the interests of all parties involved in the game. Factors such as the benefits of unreasonable treatment by medical institutions, fines, and regulatory costs impact the decision-making of health insurance regulatory departments. To maximize social welfare, health insurance regulatory departments should reform payment methods, adjust medical service behaviors of medical institutions, and guide the rational allocation of medical resources; the government should increase subsidies for the operation of medical institutions and the intensity of penalties; regulatory departments should reduce regulatory costs and introduce third-party forces to strengthen health insurance supervision further. Conclusion The research findings of this paper will provide valuable insights into some countries' medical and health reform.
Collapse
Affiliation(s)
- Hanxiang Gong
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, People’s Republic of China
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Xi Wang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, People’s Republic of China
| | - Tao Zhang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, People’s Republic of China
| | - Jinghua Li
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Baoxin Chen
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, People’s Republic of China
| |
Collapse
|
4
|
Nie KX, Wang C, Li XW. Success of Big Infectious Disease Reimbursement Policy in China. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020907788. [PMID: 32075479 PMCID: PMC7036499 DOI: 10.1177/0046958020907788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Big infectious diseases do harm to the whole society, and it is highly crucial to
control them on time. The major purpose of this article is to theoretically
demonstrate that the Chinese government’s intervention in large-scale infectious
diseases is successful and efficient. Two potential strategies were considered:
strategy 1 was infectious disease without government intervention, and strategy
2 was infectious disease with government intervention. By evolution model, this
article illustrates the efficiency of big infectious disease reimbursement
policy in China. Without government reimbursement, this article finds that high
expenditures accelerate the disease infection. The number of infected persons
decreases under big infectious disease reimbursement policy in China. The higher
the treatment costs, the more important the government intervention. Big
infectious disease reimbursement policy in China can serve as an efficient
example to cope with big infectious diseases.
Collapse
Affiliation(s)
- Kun-Xi Nie
- Shihezi University, Guangzhou, P.R. China
| | - Chan Wang
- Guangdong University of Finance & Economics, Guangzhou, P.R. China
| | - Xin-Wu Li
- Guangdong University of Finance & Economics, Guangzhou, P.R. China
| |
Collapse
|
5
|
Evaluation and analysis of hospital efficiency in China based on macro- and micro-level analyses. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
6
|
Lu W, Evans RD, Zhang T, Ni Z, Tao H. Evaluation of resource utilization efficiency in obstetrics and gynecology units in China: A three-stage data envelopment analysis of the Shanxi province. Int J Health Plann Manage 2019; 35:309-317. [PMID: 31637764 DOI: 10.1002/hpm.2908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/21/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022] Open
Abstract
In China, health care resources for expectant mothers and children are still not utilized to full efficiency, with health requirements still not being met. The purpose of this study is to critically examine the efficiency of gynecology and obstetrics hospital (OB/GYN) units in Shanxi province of China, with the overarching objective of exploring methods for improving their efficiency. We employ the three-stage data envelopment analysis (DEA) model to measure the efficiency of 134 OB/GYN units in Shanxi. The results show that the technical efficiency and scale efficiency scores of the sample units were low (0.48 and 0.54, respectively). The efficiency of the OB/GYN units varies by region, city, and county and by type of unit. We conclude that the main reason for the low efficiency of OB/GYN units in Shanxi province lies in the unreasonable scale. The government should, therefore, allocate health resources more reasonably, improving the efficiency of different regions, cities, and counties, as well as different types of OB/GYN units.
Collapse
Affiliation(s)
- Wei Lu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Richard David Evans
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
| | - Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ziling Ni
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hongbing Tao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| |
Collapse
|