Abstract
Healthcare disparity is, to a large extent, ascribable to the uneven distribution of high-quality healthcare resources, which remains insufficiently examined, largely due to data unavailability. To overcome this barrier, we synthesized multiple sources of data, employed integrated methods and made a comprehensive analysis of government administrative structures and the socio-economic environment to build probably the most inclusive dataset of Chinese 3-A hospitals thus far. Calibrated on a sample of 379 hospitals rated by a reputable organization, we developed a realistic and viable evaluation framework for assessing hospital quality in China. We then calculated performance scores for 1246 3-A hospitals, which were aggregated and further analyzed at multiple scales (cities, provinces, regions, and economic zones) using general entropy indexes. This research shows that the fragmented governance and incoordination of “kuai” and “tiao” is rooted deeply in China’s legacy of centrally-planned systems, and has had a far-reaching yet partially contradictory influence over the contemporary distribution and performance of healthcare resources. Additionally, the unevenness in the distribution of healthcare resources is related closely to a city’s administrative rank and power. This study thus suggests that the policy design of healthcare systems should be coordinated with external socio-economic transformation in a sustainable manner.
Highlights
The most recent state-led healthcare reform in China launched since 2009 is characterized by heightened government financial support to tackle the increased disparity in healthcare resource, high-quality healthcare resource distribution
We first report the major findings on how the administrative system, the tiao and kuai system, affect the performance of 3-A hospitals during the process of developing our evaluation framework
We report the overall distribution of 3-A hospitals and the unevenness of their distribution among different sub-populations based on the inequality indices specified in
Summary
The most recent state-led healthcare reform in China launched since 2009 is characterized by heightened government financial support to tackle the increased disparity in healthcare resource, high-quality healthcare resource distribution. In present-day China, the mismatch between the increasing demand for, and the inadequate supply of, affordable and effective healthcare resources has become one of the most pressing social problems, attracting significant attention from the general public [2] It is well-documented that geographical disparities of healthcare have been (re)produced and consolidated to different degrees. One aspect of the uneven geographical distribution of healthcare resources (especially those of high quality) is the agglomeration of large health institutions in the large, more developed cities. Attaining a systematic understanding of healthcare disparities is crucial for the government to formulate equitable and sustainable policies on medical insurance, healthcare resources allocation, and disease prevention To this end, this paper applies co-integration methods to evaluate the performance of top ranked 3-A hospitals and to measure the degree of unevenness in the spatial distribution in.
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