The growth of private hospitals and their health workforce in China: a comparison with public hospitals

Abstract

China significantly opened its healthcare market through a series of market-opening policies in 2000-1. This study aims to explore the direct consequences of these policies-the growth of private hospitals, their workforce characteristics compared with public hospitals in China and the source of their healthcare workforce. First, we performed a segmented regression analysis of a longitudinal data series of the number of hospitals in China between 1990 and 2009 to examine the before and after effects of the market-opening policy on private hospitals. Then, to highlight the workforce differences between private and public hospitals, provincial survey data collected in 2009 were compared with data from a second database collected in 2002 to detect the mobility of medical staff from the public to the private hospitals. The number of private hospitals rapidly increased after 2001, and the yearly growth rate increased from 19 to 205, represented primarily by an increase in specialty hospitals. Approximately 22.03% of the physicians in private hospitals are over the age of 60, whereas this proportion in public hospitals is only 2.97%. In 2008, at least 4.1% of the staff working in private hospitals had previously worked in local public hospitals in 2001. The broad expansion of private hospitals since 2001 is most likely the result of an unbiased market policy environment for private hospitals. Moreover, specific features of the hospital-physician relationship in China may account for the unbalanced age distribution feature among doctors and the mobility of the healthcare workforce in private hospitals.