Chinese Public Hospitals Research Articles

Chinese Hospital Culture Profile for Better Performance and Staff Satisfaction: A Case Study

Background: Chinese public hospitals are facing ‘business-like’ transformation challenges in the Health Care Reform policy era, with increasing focus on lean management and efficiency. At the same time, other issues have occurred, including tense physician-patient relations, heavy workloads and high job stress which have led to low job satisfaction and burnout among medical staff. This paper aims to explore a Chinese hospital culture profile with the possibility of combining a culture of a patient wellness-centered approach and a business-like approach. Methods: A questionnaire (n=110) using convenience sampling was carried out at Sun Yat-sen University Cancer Center (SYSUCC). Observation and interview (n=8) data on the hospital’s operations were also collected. Results: SYSUCC’s culture profile includes clan culture (mean = 4.35), hierarchical culture (mean = 4.40) and rational culture (mean = 4.32). The Chief Clinical Professor Responsibility System is a key strategy that enables this culture profile to be successful in the hospital. Conclusion: This culture profile focuses on teamwork inside and outside of the medical teams to achieve a positive and cohesive effect, with standardized operational and formal procedures, as well as, a performance assessment system to reach the goal of operational stability, efficiency and better financial outcomes.

The Impact of Patient Satisfaction on Patient Loyalty with the Mediating Effect of Patient Trust

This research is primarily focused on the issues of customer loyalty in the healthcare industry, particularly from the perspective of public hospitals in China. The research developed a theoretical model to test the relationship between patient satisfaction (PS), patient trust (PT), and patient loyalty (PL). The empirical data were collected from 1696 patients through the survey questionnaires from the public hospitals in Henan province. This research is an explanatory study, and adopts quantitative method. The measurement scales used in the survey were assessed and refined and the data analysis was performed using AMOS 19.0 to test the theoretical model and hypotheses developed. In addition, an exploratory factor analysis was used to identify the dimensions of PS, PT, and PL. Their reliability and validity were established through confirmatory factor analysis, and the structural equation modeling (SEM) was used in the related hypotheses. The findings indicate that PT is an important antecedent of PL, and PS has no direct relationship with PL. It is worth noting that PS can lead to PL with PT as the mediating variable. The survey results will help public hospital managers to formulate effective strategies and provide a basis for studying PL. The research will prompt hospital managers to pay attention to the factors which contribute to PS, PT, and PL, and maintain the loyalty of patients to medical institutions. This study is one of the few studies on the relationship between PS, PT, and PL in Chinese public hospitals, and it also explores the direct and indirect effects of PT on PL. The results have practical implications for the Chinese healthcare industry.

Doctors in Chinese public hospitals: demonstration of their professional identities

BackgroundAn increase in the number of medical disputes and violence against doctors indicates a lack of trust in the medical profession by society in Chinese public hospitals. Empirical evidence confirms that one cause is the lack of professional identity demonstrated by doctors. Medical professionals are required to maintain high standards of competence and moral responsibility, and demonstrate qualities such as respect, compassion, integrity, responsiveness to needs, and commitment to sound ethical practice in order to maintain professional privilege. These principles and appropriate professional conduct are the foundation of the professional identity of the medical profession.MethodsA quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China.FindingsIn total, 614 doctors and 1184 inpatients on discharge from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the variation amongst doctors in demonstrating their professionalism in terms of respecting patients’ views and preferences when determining diagnostic procedures and treatment plans, and when making ethical decisions. Although 90% patients indicated that they showed respects to doctors, close to 20% of the doctors disagreed that they received high respect from patients. About 12% of doctors prescribed unnecessary diagnostic procedures to patient for the purpose of generating profit and more than 20% of patients indicated that they gave gifts to doctors in order to receive better treatment.ConclusionsAlthough about 80% of doctors demonstrated certain aspects of professionalism required by practitioners, the inconsistency across the medical workforce may exacerbate tense doctor-patient relationships. A review of medical curricula and focus of the internship program is required in order to assist medical graduates with forming required professional identity in order to improve patient satisfaction and better clinical outcomes. To be effective, a more systematic approach is recommended.

PP194 Research On The Correlation Mechanism Between The Psychological Contract Of Physicians In Public Hospitals And Their Turnover Intention

IntroductionGuiding and motivating doctors' attitudes and behaviors in the public welfare of public hospitals is the key to promoting medical reform. This study explored the correlation between the hospital responsibilities perceived by physicians and their turnover intention in Chinese public hospitals, as well as the moderating effects of variables such as sex, hospital level, working period, department, and reason for career choice on the correlation models.MethodsA pre-developed, reliable, and valid scale for the physicians’ psychological contract was developed. Survey data from 123 public hospitals in three provinces in the east, central, and west areas of China were analyzed. The authors constructed and tested the correlation mechanism model and then analyzed the effects of particular variables.ResultsThe fulfillment of hospital transactional and developmental responsibility had a significant negative effect on the intent of physicians to leave the hospital and front-line clinical practice, respectively. Working pleasure, fairness perception, and occupational satisfaction were mediator variables in the impact. In addition, hospital level, working period, department, and reason for career choice had a moderating effect on the correlation mechanism model, with the effects varying between different paths.ConclusionsThe fulfillment of hospital transactional responsibility had a more negative effect on the intent of physicians to leave the hospital than other responsibilities, whereas fulfillment of hospital developmental responsibility had a more negative impact on the intent of physicians to leave front-line clinical practice. Furthermore, the results suggested that hospital administrators need to consider the differences between various types of physicians in order to improve the effects of guidance and motivation in these health professionals.

PP193 Research On The Correlation Mechanism Between The Psychological Contract Of Physicians In Public Hospitals And Their Medical Professionalism

IntroductionGuiding and motivating doctors' attitudes and behaviors in the public welfare of public hospitals is the key to promoting medical reform. This study explored the correlation between the hospital responsibilities perceived by physicians and their medical professionalism practices in Chinese public hospitals, and the moderating effects of variables such as sex, hospital level, working period, department, and reason for career choice on the correlation model.MethodsA pre-developed, reliable, and valid scale for the physicians’ psychological contract was developed. Survey data from 123 public hospitals in three provinces in the east, central, and west areas of China were analyzed. The authors constructed and tested the correlation mechanism model and then analyzed the effects of particular variables.ResultsThe fulfillment of hospital ideological responsibility has a significant positive effect on physicians' medical professionalism practices, with occupational satisfaction mediating the effect. In addition, hospital transactional, developmental, and relational responsibility can improve physicians’ medical professionalism practices through fairness perception and work pleasure. Hospital level, working period, department, and reason for career choice had a moderating effect on the correlation mechanism model, with the effects varying between different paths.ConclusionsThe fulfillment of hospital responsibilities can have a positive effect on physicians’ practices of medical professionalism, especially in the domain of ideological responsibility where the largest and most direct impact was observed. Furthermore, the results suggested that hospital administrators need to consider the differences between various types of physicians in order to improve the effects of guidance and motivation in these health professionals.

Impact of the zero-mark-up drug policy on drug-related expenditures and use in public hospitals, 2016–2018: an interrupted time series study in Shaanxi

ObjectiveThe aim of this study was to measure the impact of zero-mark-up drug policy (ZMDP) on drug-related expenditures and use in urban hospitals.DesignThis was a retrospective observational study of trends...

The effectiveness of a video-based smoking cessation intervention focusing on maternal and child health to help Chinese expectant fathers quit smoking: an open-label, single-blind, three-arm, randomised controlled trial

BackgroundMore than a third of Chinese expectant fathers are smokers. Secondhand smoke can cause adverse pregnancy outcomes. The implementation of interventions to help expectant fathers quit smoking is crucial. Video-based intervention has been increasingly used in health promotion. We examined the effectiveness of a video-based smoking cessation intervention focusing on maternal and child health in helping expectant fathers quit smoking. MethodsWe did an open-label, investigator-blind, multicentre, three-arm, randomised controlled trial at the obstetrics and gynaecology registration centres of three Chinese tertiary public hospitals. Expectant fathers (≥18 years) were eligible for this study if they had smoked at least one cigarette per day in the past 30 days and had a carbon monoxide concentration in expired air of four parts per million or higher, had smartphones, and were able to read Chinese and communicate in Mandarin. We excluded those who were unable to provide informed consent or receive counselling because of impaired mental status, cognitive impairment, or communication barriers identified from their medical records, or if they had participated in other smoking cessation programmes or services. After providing written informed consent, eligible participants were randomly (1:1:1) allocated using random-number tables into a video-based group, a text message-based group, or a control group. The participants received four 1-min videos (video-based group) or four text messages (text message-based group) on the risks of smoking for maternal and child health via instant messaging every 2 weeks, or a smoking cessation leaflet only (control group). Follow-up visits were done at 1 week and at 1 month, 3 months, and 6 months. The primary outcome, assessed by intention-to-treat, was biochemically validated abstinence at 6 months. This trial was approved by the Institutional Review Board of the University of Hong Kong and Hospital Authority Hong Kong West Cluster (UW 17-269) and Institutional Review Board of the Shenzhen Hospital, and registered with ClinicalTrials.gov (trial number NCT03236025). FindingsFrom Aug 14, 2017, to Feb 28, 2018, 1023 eligible expectant fathers were randomly assigned to a video-based (n=333), text message-based (n=322), or control (n=368) group. At 6 months, we found the video-based group had a significantly higher prevalence of validated abstinence than the text message-based group (75 [22·5%] of 333 participants vs 48 [14·9%] of 322, p=0·013) and control group (75 [22·5%] of 333 vs 34 [9·2%] of 368; p<0·0001), with adjusted odds ratios of 1·64 (95% CI 1·10–2·46, p=0·018, vs text message-based group) and 2·80 (1·79–4·37, p<0·0001, vs control group). InterpretationThe video-based smoking cessation intervention focusing on maternal and child health was effective and feasible in helping expectant fathers quit smoking. The findings could guide health-care professionals to incorporate this simple and effective innovation to promote smoking cessation and other lifestyle habits in clinical practice. FundingSanming Project of Medicine in Shenzhen, China (SZSM201612018).

Admission scheduling of inpatients by considering two inter-related resources: beds and operating rooms

ABSTRACT This paper studies the admission scheduling problem with considering the capacity usage of two inter-related resources (beds and operating rooms) between three consecutive stages of care during surgical patients' admissions to Chinese public hospitals, namely (1) pre-surgical inpatient bed, (2) surgery, (3) post-surgical inpatient bed. Demand comes from two types of patients: (1) emergency patients, who arise randomly and have to be admitted immediately, and (2) elective patients, whose admissions can be scheduled. The authors develop a Markov Decision Process (MDP) model that decides how many elective patients should be admitted each day, with the objective of optimally using both operating room and inpatient bed capacity. The authors demonstrate that the number of elective admissions scheduled each day is monotonically increasing in the state of the system and in the bed capacity, indicating that a higher level of waiting elective patients and available (or total) bed capacity pulls more elective admissions through the system. The total discounted expected cost of the system exhibits decreasing marginal returns as the capacity in each stage increases independently of other stages. Through numerical experiments, there is substantial value in making admission scheduling decisions by jointly considering inpatient beds and operating rooms.

Big data management and environmental performance: role of big data decision-making capabilities and decision-making quality

PurposeThis study is undertaken to examine the antecedents and role of big data decision-making capabilities toward decision-making quality and environmental performance among the Chinese public and private hospitals. It also examined the moderating effect of big data governance that was almost ignored in previous studies.Design/methodology/approachThe target population consisted of managerial employees (IT experts and executives) in hospitals. Data collected using a survey questionnaire from 752 respondents (374 respondents from public hospitals and 378 respondents from private hospitals) was subjected to PLS-SEM for analysis.FindingsFindings revealed that data management challenges (leadership focus, talent management, technology and organizational culture for big data) are significant antecedents for big data decision-making capabilities in both public and private hospitals. Moreover, it was also found that big data decision-making capabilities played a key role to improve the decision-making quality (effectiveness and efficiency), which positively contribute toward environmental performance in public and private hospitals of China. Public hospitals are playing greater attention to big data management for the sake of quality decision-making and environmental performance than private hospitals.Practical implicationsThis study provides guidelines required by hospitals to strengthen their big data capabilities to improve decision-making quality and environmental performance.Originality/valueThe proposed model provides an insight look at the dynamic capabilities theory in the domain of big data management to tackle the environmental issues in hospitals. The current study is the novel addition in the literature, and it identifies that big data capabilities are envisioned to be a game-changer player in effective decision-making and to improve the environmental performance in health sector.

Exploring the Determinants of Mobile Health Adoption by Hospitals in China: Empirical Study.

BackgroundAlthough mobile health (mHealth) has the potential to transform health care by delivering better outcomes at a much lower cost than traditional health care services, little is known about mHealth adoption by hospitals.ObjectiveThis study aims to explore the determinants of mHealth adoption by hospitals using the technology-organization-environment (TOE) framework.MethodsWe conducted an interviewer-administered survey with 87 managers in Chinese public hospitals and analyzed the data using logistic regression.ResultsThe results of our survey indicate that perceived ease of use (β=.692; P<.002), system security (β=.473; P<.05), top management support (β=1.466; P<.002), hospital size (β=1.069; P<.004), and external pressure (β=.703; P<.005) are significantly related to hospitals’ adoption of mHealth. However, information technology infrastructure (β=.574; P<.02), system reliability (β=−1.291; P<.01), and government policy (β=2.010; P<.04) are significant but negatively related to hospitals’ adoption of mHealth.ConclusionsWe found that TOE model works in the context of mHealth adoption by hospitals. In addition to technological predictors, organizational and environmental predictors are critical for explaining mHealth adoption by Chinese hospitals.

The Influence of Encounter Service Quality on Patient Satisfaction: An Empirical Study in Chinese Public Hospitals

Purpose: This paper examined the association between perceived service quality and patient satisfaction of Chinese out-patients in the patronage of medical services. Design/Methodology/Approach: Utilizing by novelty specific departments in the hospital’s and logistics multiple regression investigation, the researchers tested and estimated the statistical effects of the department’s services (perceived service quality) as a predictor for out-patients satisfaction. Findings: The analysis shows that patients who exhibited content from the services of selected departments reported greater satisfaction, with it impacts suggesting a measurably noteworthy effect, even in a total medical seller market like China. Practical Implication: The study brings forth implications both for professionals and academics. It encourages more studies, and its findings and application can provide value as a management tool to consider and identify sources as linking the relationship between potential improvements in perceived service quality from as low as departmental levels and patient’s satisfaction to achieve advantage. Originality/Value: It encourages more studies, and its findings and application can provide value as a management tool to consider and identify sources as linking the relationship between potential improvements in perceived service quality.

A Study on the International Strategic Alliance and Partner Selection Priority Factors of Chinese National and Public Hospitals

한국 병원 및 의료기관의 해외진출은 2000년대 일부 대기업 주도 및 중·소형 병원들을 기반으로 민간진출을 시작하였고, 2009년 1월 외국인 환자유치 지원법 시행과 2016년 의료수출지원법의 실행을 거쳐 현재까지 약 20년에 걸쳐 진행되어, 타 산업대비 해외진출 실행기간이 짧은 특성을 보유하고 있다. 따라서 선행연구 및 문헌 등 기반 자료들이 단순 설문조사 결과를 활용하였거나, 현지 시장 진출자 시각에서만 연구된 한계점을 보유하고 있다. 본 연구는 중국현지 국·공립병원업계 전문가들의 현지관점 기반에서 국제 전략적 제휴와 파트너 선정을 위한 주요 요인을 선별하고자 3차에 걸친 델파이 조사와 AHP기법을 적용하여 각 요인 간 상대적 중요도 및 전체 순위를 비교 산출하였다. 연구 결과로는 상위항목 11개중 1위 중국정부정책/제도, 2위 의료기술 및 서비스, 3위 중국 병원산업 및 시장 환경 등이 우선항목으로 도출되었으며, 하위요인 42개중 1위 중국 중앙정부 정책 부합성, 2위 신규 의료서비스 확장, 3위 중국현지 의료법숙지, 4위 시장 경쟁력 확보, 5위 신규 의료서비스 실시 등이 우선요인으로 나타났다. 본 연구 결과는 한국 병원 및 의료기관이 중국 병원 및 의료시장 진출을 준비할 때 진출병원의 입장과 현지병원의 시각 차이를 이해할 수 있는 실무 기반자료로 활용될 수 있을 것으로 보인다.

Troublemaking in hospitals: performed violence against the healthcare professions in China

ABSTRACT Yi Nao describes a type of violence displayed in Chinese hospitals which involves organised disturbances led by patients’ relatives and/or Yi Nao gangs. Drawing on media reports of Yi Nao, we argue that the phenomenon of Yi Nao transforms hospitals into ‘power arenas’ in which a struggle over moral and political resources (capital) takes place between patients, Yi Nao gangs, doctors, government agencies, and hospital management. Two interrelated rules that are crucial to understanding the ad hoc local strategies of the actors involved in Yi Nao are examined: the ‘publicity rule’, and the ‘rule of risk-avoidance’. We also argue that the political discourse of ‘stability’ has been internalised by the officials in the Chinese government and public hospitals in mediating social disputes. At the same time, Yi Nao actors use this discourse to creatively adapt to social resistance, as reflected in the disposition to use performative disturbance in pursuit of material or symbolic compensation.

A validation study of the Job Crafting Scale among nurses in public hospitals in China

To verify the reliability and validity of the Job Crafting Scale among nurses in Chinese public hospitals. Job crafting is an important organisational variable for medical institutions. Although the Japanese and Spanish versions of the Job Crafting Scale are available, this scale has not been validated in Chinese nurses. A convenience sample of 2,095 registered hospital nurses was recruited from 25 provinces in mainland China from June 2019 to July 2019. Descriptive analyses were performed. Reliability and correlation analyses, exploratory factor analyses and confirmatory factor analyses of data collected using the Chinese version of the Job Crafting Scale were also conducted. The Chinese version of the Job Crafting Scale has good validity and reliability. The goodness-of-fit indices for confirmatory factor analysis were acceptable (CFI=0.933, NFI=0.927, TLI=0.920, IFI=0.933). The Cronbach α coefficient for the total scale was .920, and the coefficients for each dimension of this scale were between .804 and .894. The Chinese version of the Job Crafting Scale has good reliability and validity, which supports its use as an effective tool to measure the working level of job crafting among nurses in public hospitals in China. Nurse managers may use reliable and effective tools, including the Chinese version of the Job Crafting Scale, to determine the level of job crafting at their institutions and to develop effective interventions to improve it.

Pharmaceutical care in Chinese public tertiary hospitals: findings from the 4th National Healthcare Improvement Initiative Survey

BackgroundPharmaceutical care has been playing an increasingly critical role in Chinese hospitals. However, evidence about the most recent development of pharmaceutical care in China is limited. This study analyzed the current situation of pharmaceutical care and the capacities of pharmacists in Chinese public tertiary hospitals.MethodsAll on-duty pharmacists of 143 public tertiary hospitals responded to the Likert-5 pre-set online questionnaire about their pharmaceutical care capacities in eight aspects, and their respective hospitals valued pharmaceutical care in clinical practice from March 18 to 31, 2019. This study measured the appraisals of the responding pharmacists as positive (“strongly agree” and “agree”) or negative (“neither agree nor disagree,” “strongly disagree,” and “disagree”) results. The study performed a descriptive analysis of the responding pharmacists and unconditional multivariate binary logistic regression analysis to predict the influencing factors of the pharmacists’ appraisals of pharmaceutical care. The dependent variable was transformed into binary categories and assigned 1 = positive response and 0 = negative response. The independent variables included the identifications of sample hospitals and the characteristics of the responding pharmacists.ResultsThe survey retrieved 10 815 valid responded questionnaires. 74.5%, 67.5%, and 65.0% of the responding pharmacists made a positive self-appraisal of their abilities of communication with patients and doctors, reviewing prescriptions, and communication with particular patients, respectively. 65.5% had a positive appraisal of their respective hospitals to conduct active monitoring of the clinical use of new medicines, and 68.9% admitted that their respective hospitals valued the clinical pharmaceutical care. The doctor’s degree and senior academic rank of the responding pharmacists, as well as maternal and child hospitals, were predictors of higher appraisals of the responding pharmacists about their pharmaceutical care capacities, and their respective hospitals valued pharmaceutical care (all ORs > 1.5, P < 0.05).ConclusionsThe study suggested that there is a need to strengthen the pharmacy education, training, and staffing of pharmacists with improved professional skills to offer value-added specialized pharmaceutical care in Chinese public hospitals. Patient-centered and inter-disciplinary interactions in medical practice should be promoted. There is also a need for public hospitals to provide a platform for the achievement of the professional values of high-quality pharmacists at different carrier development stages.

Health services provision of 48 public tertiary dental hospitals during the COVID-19 epidemic in China.

ObjectivesTo assess the status of health services provision of public tertiary dental hospitals during the COVID-19 epidemic in China and to evaluate the regional difference of telehealth.Materials and methodsThe health services provision of public tertiary dental hospitals in China mainland during the COVID-19 epidemic was inquired. The status of non-emergency dental services, emergency dental services, and online professional consultation and the hospitals’ geographical distribution were recorded and analyzed.ResultsAll the 48 public tertiary dental hospitals suspended general non-emergency dental treatment while providing emergency dental services only. Ninety percent of them notified the change of dental services online, and 69% of them offered free online professional consultations. The penetration rate of online technology was significantly higher in the eastern region than that of the central and western regions.ConclusionsThere was a significant change in the health service provision of Chinese public tertiary dental hospitals during the COVID-19 epidemic and wider use of telehealth in the eastern region.Clinical relevanceThis report demonstrated that dental health services were significantly affected by the COVID-19 epidemic in China, which might lead to a long-time impact on dental care in the future.

Recovery Experience as the Mediating Factor in the Relationship Between Sleep Disturbance and Depressive Symptoms Among Female Nurses in Chinese Public Hospitals: A Structural Equation Modeling Analysis.

PurposeNurses are suffering from considerable work-related stress, which can result in disturbed sleep and depressive symptoms. Whereas, recovery experience can alleviate sleep disturbance and help maintain well-being in the working environment. The aim of this study was to examine whether recovery experiences play a mediating role in the relationship between sleep disturbance and depressive symptoms of female nurses in Chinese public hospitals.MethodsFrom December 2017 to May 2018, the study with proportional sampling of cross-sectional design was carried out in the public tertiary hospitals from Shenyang of Liaoning Province in China. A total of 1500 female nurses who had been working for one or more years participated in this study. A structural equation model (SEM) was applied to test the assumption that recovery experiences might function as a mediator in the relationship between sleep disturbance and symptoms of depression.ResultsSleep disturbance contributed most to the variance (32.9%) of depressive symptoms and had a significantly positive correlation with depressive symptoms (P<0.01) among nurses. Psychological detachment in recovery experience had a significantly positive correlation with sleep disturbance (P<0.01) and depressive symptoms (P<0.01). Whereas, relaxation, mastery experience, and control in recovery experience were significantly and negatively correlated with sleep disturbance (P<0.01) and depressive symptoms (P<0.01). Recovery experience served as a mediator between sleep disturbance and depressive symptoms (a * b = 0.066, BCa 95% CI: 0.045, 0.095).ConclusionSleep disturbance was the predictor of depressive symptoms for female nurses. Moreover, recovery experience could combat the detrimental impacts of sleep disturbances on symptoms of depression. This study suggested that nurses might benefit from interventions on improving sleep quality to relieve depressive symptoms through mediating path of recovery experience.

Direct medical burden of antimicrobial-resistant healthcare-associated infections: empirical evidence from China

Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are among the biggest global public health challenges, and overlap widely. These infections cause significant morbidity and mortality, put pressure on health systems, and incur rising direct and indirect costs. This study analysed the direct medical burden attributable to AMR-HAIs in Chinese public tertiary hospitals, and aimed to inform both the medical regulators and hospital managers for better control of HAIs and containment of AMR. The propensity score matching method (γ= 0.25σ, nearest neighbor 1:1 matching) was applied to conduct a retrospective cohort study in five public tertiary hospitals in the Hubei province of China during 2013-2015. Descriptive analysis, Pearson's chi-squared test, Mann-Whitney U-test, Wilcoxon signed-rank test and paired/independent Z/T test were conducted. The statistically significant level was set at P<0.05. From 2013 to 2015 overall, the additional total medical expenditure per HAI-AMR inpatient was US$15,557.25 compared with that of the non-HAIs, and the additional length of per hospital stay of the HAI-AMR inpatient was 41 days compared with that of the non-HAIs (P<0.001). In combination with AMR, HAIs caused significant additional medical expenses and affected the turnover rate of hospital beds. Most of the increased medical costs fell to patients and their families. These findings call for more effective control of HAIs and containment of AMR. A national study is needed to estimate the medical, social and economic burden of HAIs in combination with AMR.

Optimizing quality of life among Chinese physicians: the positive effects of resilience and recovery experience

The physicians in Chinese public tertiary hospitals are exposed to considerable work-related stress because of the imperfections in hierarchical diagnosis and treatment systems, such as the imperfections in referral system and low quality in diagnosis and treatment outcomes in community hospitals, for which most patients visit tertiary hospitals firstly in order to access a higher quality health care service. As a consequence, the health-related quality of life (HRQOL) for Chinese physicians is compromised. However, there is a paucity of research exploring physicians' physical and mental health and positive psychological resource factors such as resilience and recovery experience (RE) which can help maintain well-being. Thus, this study aims to assess HRQOL of Chinese physicians and explore the relationship between HRQOL, resilience, and RE. A cross-sectional study with proportional sampling was conducted in Shenyang, China from February to October 2018. A total of 642 physicians in five public tertiary hospitals were enrolled in this study. They completed the smartphone questionnaire including the 36-item Short-Form Health Survey (SF-36), the EGO Resilience Scale, and Recovery Experience Questionnaire (REQ). Linear regression analysis was conducted to explore the factors associated with HRQOL. Structural equation modeling (SEM) was used to evaluate the mediating effect of RE on the relationship between resilience and HRQOL. Regression analysis indicated that resilience and RE were the most important contributors to both physical and mental component summary scores. SEM showed that RE partially mediated the relationship between resilience and HRQOL in these physicians. Chinese physicians exhibited good physical health, but poor mental health. Resilience could help maintain and improve HRQOL through the partial mediating effect of RE. Resilience and RE enhancement should be provided to effectively manage work-related stress and improve both physical and mental health for the long-term well-being of physicians.

Financial conditions, health care provision, and patient outcomes: Evidence from Chinese public hospitals

This paper investigates the impact of health care providers’ financial conditions on the provision of health care, using a policy shock in China – Zero Markup Drug Policy (ZMDP) – which reduces the profits that hospitals obtain from prescribing and dispensing drugs. The study utilizes a comprehensive data set of 117 public hospitals in a major Chinese city from 2007 to 2015 and adopts the difference-in-differences identification strategy based on the staggered adoption of ZMDP. Our findings show that the policy puts financial pressure on hospitals, as their revenue from prescription drugs per patient decreases significantly. In response to the financial shock, hospitals increase revenues from other treatments and procedures per patient, such as imaging tests. Moreover, as hospital revenues become more dependent on medical tests after the policy shock, hospitals increase their capital expenditure on medical equipment. Nevertheless, the study finds no effect of ZMDP on the quality of health care.