Abstract
BackgroundDemand 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.MethodsIn 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.ResultsThe 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).ConclusionsIn 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.
Highlights
Demand for eye care has increased in recent decades in China due to rapid socioeconomic development and demographic shift
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
All the tertiary hospitals and private hospitals responded while 13 secondary hospitals did not
Summary
Demand for eye care has increased in recent decades in China due to rapid socioeconomic development and demographic shift. With the rapid demographic shift towards an aging population and the simultaneous epidemiological change of the disease burden into predominantly non-communicable diseases, especially age-related diseases, it is imperative for China to revamp the existing healthcare delivery system to meet the increasing demand for medical services [3]. Public hospitals are struggling to cater for the rising numbers of patients. The government has implemented numerous favorable policies to facilitate the growth of private services to expand access to healthcare and to alleviate the burden of healthcare delivery [4, 5]. By 2017, the number of private hospitals in China had increased to 447,160 [8], and these hospitals address the shortage of public healthcare services. Careful attention should be given to the efficiency of hospitals to evaluate their performance and to improve the coordination of different sectors
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