Round Of Healthcare Reform Research Articles

Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health.

Long-term care insurance (LTCI) is a significant approach in the effort to actively manage aging and the currently unmet need for aged care in China. Based on data from the 2011, 2013, 2015, and 2018 phases of the China Health and Retirement Longitudinal Study, we used the propensity score matching-difference in difference (PSM-DID) approach to explore the impact of LTCI on out-of-pocket medical expenses and self-rated health. Results showed that LTCI can significantly reduce out-of-pocket medical expenses by 37.16% (p < 0.01) per year and improve self-rated health by 5.73% (p < 0.01), which conforms to the spirit of “value-based health care”. The results were found to be stable in the robustness tests conducted. Currently, China is at the intersection of “low-value-based health care” and “value-based health care”. Improving the health level of aged individuals while keeping medical costs under reasonable control is crucial for formulating and implementing a new round of healthcare reform in China.

Current status of prevention and treatment of respiratory diseases in primary care in China: a cross-sectional study

BackgroundChina launched its new round of health care reform to develop primary care in 2009, establishing 954,390 primary care institutions that employed over 10 million staff by 2019. However, some studies have shown that the prevention and management of respiratory diseases is inadequate in these institutions.MethodsWe conducted a cross-sectional survey of grassroots institutions throughout China between September and December 2020 based on the standardized Prevention and Treatment System and Capacity Building Project of Respiratory Diseases in primary care settings. The operation of the respiratory department in primary health care institutions was evaluated in terms of facilities, drugs, personnel and management of chronic diseases by means of questionnaires. Descriptive analyses were performed to calculate percentages and frequencies of key parameters.ResultsA total of 144 primary health care institutions were surveyed, including 51 in the east, 82 in the west, 9 in the central and 2 in the northeast. Approximately 60% of institutions had spirometers and pulse oximeters. The majority had short-acting bronchodilators, theophylline, systemic corticosteroids, antibiotics, and traditional Chinese medicine. More than half had at least one respiratory physician and operator for spirometry. Half of the institutions carried out screening of chronic obstructive pulmonary disease within the jurisdiction. The institutions in the east were superior to those in the west regarding the equipment, common drugs, medical staff, and management of respiratory diseases.ConclusionsThe study reveals that the overall operation of the respiratory department in primary care settings needs to be further strengthened. It is crucial to provide adequate essential equipment, medical professionals, and medicines for proper diagnosis and treatment of chronic respiratory diseases, as well as improving the management of diseases.

Heterogeneous effects of hospital competition on inpatient expenses: an empirical analysis of diseases grouping basing on conditions\u2019 complexity and urgency

BackgroundMultiple pro-competition policies were implemented during the new round of healthcare reform in China. Differences in conditions’ complexity and urgency across diseases associating with various degrees of information asymmetry and choice autonomy in the process of care provision, would lead to heterogeneous effects of competition on healthcare expenses. However, there are limited studies to explore it. This study aims to examine the heterogeneous effects of hospital competition on inpatient expenses basing on disease grouping according to conditions’ complexity and urgency.MethodsCollecting information from discharge data of inpatients and hospital administrative data of Sichuan province in China, we selected representative diseases. K-means clustering was used to group the selected diseases and Herfindahl-Hirschman Index (HHI) was calculated based on the predicted patient flow to measure the hospital competition. The log-linear multivariate regression model was used to examine the heterogeneous effects of hospital competition on inpatient expenses.ResultsWe selected 19 representative diseases with significant burdens (more than 1.1 million hospitalizations). The selected diseases were divided into three groups, including diseases with highly complex conditions, diseases with urgent conditions, and diseases with less complex and less urgent conditions. For diseases with highly complex conditions and diseases with urgent conditions, the estimated coefficients of HHI are mixed in the direction and statistical significance in the identical regression model at the 5% level. For diseases with less complex and less urgent conditions, the coefficients of HHI are all positive, and almost all of them significant at the 5% level.ConclusionsWe found heterogeneous effects of hospital competition on inpatient expenses across disease groups: hospital competition does not play an ideal role in reducing inpatient expenses for diseases with highly complex conditions and diseases with urgent conditions, but it has a significant effect in reducing inpatient expenses of diseases with less complex and less urgent conditions. Our study offers implications that the differences in condition’s complexity and urgency among diseases would lead to different impacts of hospital competition, which would be given full consideration when designing the pro-competition policy in the healthcare delivery system to achieve the desired goal.

Changes in efficiency of tertiary public general hospitals during the reform of public hospitals in Beijing, China.

In March 2009, the Chinese government formally launched a new round of healthcare reform. As the city with the highest concentration of high-quality medical resources in China, in the past 10 years, Beijing has also been exploring medical reforms. This article studied the performance and development of the 10 tertiary general public hospitals managed by Beijing Municipal Hospital Management Centre to provide policy basis for further deepening Beijing public hospital reform and improving hospital efficiency. The 2011, 2015 and 2018 'Beijing Health Work Statistics' were used to evaluate the performance of Beijing's tertiary public general hospitals, based on the Pabon Lasso model and the data envelopment analysis (DEA) model. Based on the Pabon Lasso model, 60%, 70% and 70% of the hospitals were entirely efficient (zone 3) in 2011, 2015 and 2018. It shows that among the 10 general public hospitals in Beijing, efficient hospitals accounted for the majority and further increased during the reform period. The DEA model further illustrates this point and shows more effective hospitals (80%) than the Pabon Lasso model, showing the efficiency of these hospitals to be improved during the reform period. The efficiency of the 10 hospitals has gradually improved during the reform period, and the difficulty of seeing a doctor in Beijing at a national medical centre has been relieved to a certain extent. Combining the Pabon Lasso model and the DEA model can analyse hospital efficiency more comprehensively, and can prompt initial information for improving hospital efficiency, but the results also reflect some problems.

Differences in regional distribution and inequality in health-resource allocation at hospital and primary health centre levels: a longitudinal study in Shanghai, China

ObjectivesTo analyse differences in regional distribution and inequality in health-resource allocation at the hospital and primary health centre (PHC) levels in Shanghai over 7 years.DesignA longitudinal survey using 2010–2016 data,...

Towards universal health coverage: lessons from 10 years of healthcare reform in China

Universal health coverage (UHC) is driving the global health agenda. Many countries have embarked on national policy reforms towards this goal, including China. In 2009, the Chinese government launched a...

Assessing perceived quality of primary care under hospital-township health centre integration: A cross-sectional study in China.

Since the new round of health care reform in 2009, the vertical integration of hospitals and primary health institutions has become widely implemented in China as an efficient method for improving quality of primary care. This study aimed to answer the following questions: (a) What is the perceived quality of township health centres (THCs) under integration? (B) What differences could be observed among the three typical integration models, namely, private hospital-THC integration, public hospital-THC integration, and loose collaboration? Two rounds of cross-sectional surveys were conducted from November 2016 to June 2018. The Chinese version of the Primary Care Assessment Tool was used to evaluate perceived quality of sample THCs, and 1118 adult patients were interviewed in total. Multiple linear regressions were employed to compare the quality scores between two survey rounds and among different integration models after controlling for potential confounders. The results revealed that the quality of care significantly improved under private hospital-THC integration as observed by comparing two survey rounds, while no change or slight changes were observed in the other two models. The difference observed among the three models was that the perceived quality of THCs integrated with private hospitals was worse than that of THCs integrated with public hospitals and THCs under loose collaboration, while no significant difference was observed between public hospital-THC integration and loose collaboration. Increased attention should be given to highlighting the tight integration between hospitals and THCs and the different roles played by private and public hospitals in the current reform.

GIS-based method to delimit spheres of influence for a medical consortium: Experience of a pediatric medical consortium, Shanghai.

To improve the utilization efficiency of health care services, the concept of a "regional medical consortium" has attracted more attention during the most recent round of health care reform in China. Shanghai, a municipality of China, has made many efforts to promote its regional medical consortium project. In this paper, the pediatric medical consortium of Shanghai will serve as an example to introduce the main tasks and groundwork of the Shanghai medical consortium and will underscore Shanghai's exploration of the vertical integration of medical resources. This study delimits the service areas of leading hospitals, which can help determine the spheres of influence of top hospitals geographically. With this information, regional hospitals or community hospitals can find alliance hospitals and leading hospitals more easily. These efforts can be realized using ArcGIS for spatial data analysis. According to the locations of leading hospitals and actual patient distributions at these hospitals, the natural areas of influence of leading hospitals are illustrated. Then, hospitals other than leading hospitals can select allied hospitals in the same area of influence. In this way, connections in a medical consortium will be tighter, and hospitals will be better able to meet the actual demands of patients. In this paper, we introduce a geographic method to delimit the spheres of influence of hospitals based on actual health-seeking behaviors of patients by analyzing the spatial distribution of hospitalization probability. Within the boundaries of a sphere of influence, a geographic connection between the leading hospital and the general hospital is established automatically. Based on this geographic connection, leading hospitals should provide technological support to general hospitals located in their sphere of influence, while the general hospitals should provide spare medical resources in return. Thus, the medical consortium can be formed geographically and operate more smoothly.

The impact of healthcare reform on the efficiency of public county hospitals in China

BackgroundThe new round of Healthcare Reform in China has implemented over 3 years since 2009, and promoted greatly the development of public county hospitals. The purpose of this study is to evaluate county hospitals efficiency before and after the healthcare reform, and further assess the reform effectiveness through the comparative analysis of the efficiency.MethodsData envelopment analysis (DEA) was employed to calculate the efficiency of 1105 sample hospitals which were selected from 31 provinces of China, also, Tobit regression was used to regress against those main external environmental factors.ResultsOur results show that the scales and amounts of service of hospitals had increased sharply, however, the efficiency was relatively low and decreased slightly from 2008 to 2012. Thirteen (1.18%) in 2008 and six (0.54%) hospitals in 2012 were defined as technically efficient, and the average scores were 0.2916 and 0.2503. The technical efficiency average score of the post-reform was significantly less than that of the pre-reform (p < 0.001), and the score of eastern region was highest and the western was lowest among three regions of China.ConclusionsIt suggests the reform had not well improved county hospital efficiency although hospitals have reached a fair developing scale, and the corresponding policies and measures should be put into effect for improving efficiency, especially in the level and structure of health investment, operation and supervision mechanism of county hospitals.

Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China

In 2009, the Chinese government launched a new round of healthcare reform, which encourages development of private hospitals. Meanwhile, many public hospitals in China also became increasingly profit-oriented. These trends have led to concerns about social justice and regional disparity. However, there is a lack of empirical scientific analysis to support the debate. We started to fill this gap by conducting a regional-level analysis of spatial variation in spatial access to hospitals in the Sichuan Province. Such variation is an important indication of (in) equity in healthcare resource allocation. Using data of 2012, we intended to provide a snapshot of the situation that was a few years later since the new policies had set out. We employed two methods to quantify the spatial access: the nearest-neighbor method and the enhanced two-step floating catchment area (E2SFCA) method. We recognized two sub-regions of Sichuan: the rural West Sichuan and the well-developed East Sichuan. We classified the hospitals using both ownership and level. We applied the analysis to the resulting groups of hospitals and their combinations in the two sub-regions. The two sub-regions have a high contrast in the spatial access to hospitals, in terms of both quantity and spatial pattern. Public hospitals still dominated the service in the province, especially in the West Sichuan, which had been solely relying on public hospitals. Private hospitals only occurred in the East Sichuan, and at the primary level, they had surpassed public hospitals in terms of spatial accessibility. However, the governmental health expenditures seemed to be disconnected with the actual situation of the spatial access to hospitals. The government should continue carrying on its responsibility in allocating healthcare resources, be cautious about marketizing public hospitals, and encourage private hospitals to expand into rural areas. Methodologically, the results from the two methods are concurring but not identical. The E2SFCA method calculates population-adjusted density of hospitals, which measures deviation from the expected pattern, and therefore is more meaningful in assessing associations of the spatial access to hospitals with other factors (e.g., population density and investment).

Dilemma of healthcare reform and invention of new discipline of health fiscalogy.

BackgroundChina's Reform and Open up Policy in 1980s has brought rapid economic development to Chinese society. With the deepening of economic reform, the withdrawal of the state in China has had visible and worrisome consequences for health and for the functioning of health services. The new round of healthcare reform after 2009 has made significant achievements on improving fundamental health and bringing back the nature of welfare of health. However, the financing mechanism of health system has not been established, and the underlying reason behind the healthcare reform dilemma and the theoretical solution need to be found.MethodsThis study used the methods of literature review, theoretical research and comparative research to summarize and analyze the reasons and solutions of current dilemma in healthcare reform, and created the new discipline of health fiscalogy through theoretical analysis and vertical and horizontal comparison of healthcare system, especially health financing.ResultsDilemma in healthcare system emerged from the circumstances of rapid process of industrialization, urbanization and population aging, including the profit-driven phenomena, tendency of excessive marketization in public hospitals, strained doctor-patient relationship, high disease burden on individuals and families, and so on. It can be concluded that the theoretical basis of healthcare system and the nature of health resources are crucial in solving the dilemma of healthcare reform. The theoretical basis of healthcare reform should be health fiscalogy focusing on government as the main body of health care responsibility rather than health economics focusing on anti-monopoly. There are two key differences between health economics and health fiscalogy: responsible person/department of disease and health welfare, and nature of resource. The new discipline of health fiscalogy has universal and important implications on both China’s healthcare reform and the healthcare reform in the world.ConclusionsChina’s healthcare reform should return from the paradigm of health economics and marketization financing model to the paradigm of health fiscalogy and government-led financing model, which is reflected in the main position of government and social welfare.

National equity of health resource allocation in China: data from 2009 to 2013.

BackgroundThe inequitable allocation of health resources is a worldwide problem, and it is also one of the obstacles facing for health services utilization in China. A new round of health care reform which contains the important aspect of improving the equity in health resource allocation was released by Chinese government in 2009. The aim of this study is to understand the changes of equity in health resource allocation from 2009 to 2013, and make a further inquiry of the main factors which influence the equity conditions in China.MethodsData resources are the China Health Statistics Yearbook (2014) and the China Statistical Yearbook (2014). Four indicators were chosen to measure the trends in equity of health resource allocation. Data were disaggregated by three geographical regions: west, central, and east. Theil index was used to calculate the degree of unfairness.ResultsThe total amount of health care resources in China had been increasing in recent years. However, the per 10, 000 km2 number of health resources showed a huge gap in different regions, and per 10, 000 capita health resources ownership showed a relatively small disparities at the same time. The index of health resources showed an overall downward trend, in which health financial investment the most unfair from 2009 to 2012 and the number of health institutions the most unfair in 2013. The equity of health resources allocation in eastern regions was the worst except for the aspect of health technical personnel allocation. The regional contribution rates were lower than that of the inter-regional contribution rates which were all beyond 60 %.ConclusionThe equity of health resource allocation improved gradually from 2009 to 2013. However, the internal differences within the eastern region still have a huge impact on the overall equity in health resource allocation. The tough issues of inequitable in health resource allocation should be resolved by comprehensive measures from a multidisciplinary perspective.

Family practice and the quality of primary care: a study of Chinese patients in Guangdong Province.

In 2009, China launched its new round of health care reform. One of its priorities was to strengthen primary care and establish a family practice system. This study examined the relationship between use of family practice physician for primary care and the quality of primary care. Eight health care organizations were sampled from three cities in Guangdong Province, China. One thousand six hundred and forty five patients of age 18 and older who visited one of the study sites as their usual source of primary care were systematically selected and surveyed using Johns Hopkins China-validated Primary Care Assessment Tool (PCAT). Analyses were performed to compare the quality of primary care experienced between patients who contracted for family practice services and those who did not. Total PCAT score as well as scores in first contact-access, continuity, comprehensiveness and coordination domains were higher among patients who contracted with family practice services, compared to those who did not. In addition, patients who sought care through family practice services reported greater satisfaction with their care experience. This study provided evidence that family practice has the potential to provide higher-quality primary care, which may encourage patients to seek family practice physicians for their primary care needs, and help family practitioners better perform gatekeeping functions.

Inequality in social health insurance programmes in China: A theoretical approach

Equity is one of the goals of China’s new round of health care reform. Results from existing empirical studies provide evidence for the existence of highly unequal distribution of insurance benefits under China’s current social health insurance programmes. This paper aims to explain inequity in health insurance by connecting the ways through which insurance programmes are financed with benefit distribution. A theoretical approach is employed, and we find that the inconsistency between insurance premiums and expected benefits among different income levels is the main source of inequity in social health insurance programmes. Our results suggest that the design of premium and reimbursement schemes should be aligned with the income level of the insurant.

Does Economic Incentive Matter for Rational Use of Medicine? China’s Experience from the Essential Medicines Program

Before the new round of healthcare reform in China, primary healthcare providers could obtain a fixed 15 % or greater mark-up of profits by prescribing and selling medicines. There were concerns that this perverse incentive was a key cause of irrational medicine use. China's new Essential Medicines Program (EMP) was launched in 2009 as part of the national health sector reform initiatives. One of its core policies was to eliminate primary care providers' economic incentives to overprescribe or prescribe unnecessarily expensive drugs, which were regarded as consequences of China's traditional financing system for health institutions. The objective of the study was to measure changes in prescribing patterns in primary healthcare facilities after the removal of the economic incentives for physicians to overprescribe as a result of the implementation of the EMP. A comparison design was applied to 8,258 prescriptions in 2007 and 8,278 prescriptions in 2010, from 83 primary healthcare facilities nationwide. Indicators were adopted to evaluate medicine utilization, which included overall number of medicines, average number of Western and traditional Chinese medicines, pharmaceutical expenditure per outpatient prescription, and proportion of prescriptions that contained two or more antibiotics. We further assessed the use of medicines (antibiotics, infusion, hormones, and intravenous injection) per disease-specific prescription for hypertension, diabetes, coronary artery heart disease, bronchitis, upper respiratory tract infection, and gastritis. A difference-in-difference analysis was employed to evaluate the net policy effect. Overall changes in indicators were not found to be statistically significant between the 2 years. The results varied for different diseases. The number of Western drugs per outpatient prescription decreased while that of traditional Chinese medicines increased. Overuse of antibiotics remained an extensive problem in the treatment of many diseases, though there was some significant improvement in certain diseases, like diabetes in rural areas. Medicine expenditure per prescription also decreased. It seems that the removal of a perverse economic incentive alone would not lead to improvement of healthcare providers' prescribing patterns. The rationality of the Essential Medicines List and the lack of payers' and providers' meaningful involvement in the development of the policy possibly contribute to the lack of significant changes in prescribing behaviors. It is suggested that China should adopt more comprehensive policies for healthcare facilities, physicians, patients, and payers, rather than just relying on economic incentives to improve rational use of medicines.

Health Care Reform — Where Do We Go from Here?

The President can legitimately claim to have already passed the first round of health care reform in 2009, with the renewal of CHIP and the stimulus bill. Gail Wilensky describes further possible steps in incremental reform.

What Works in Market-Oriented Health Policy?

There is a widespread belief, embraced by President Barack Obama as well as congressional and industry leaders, that the next round of health care reform should leverage market forces to lower the cost of care and improve its quality. The use of market forces in health policy typically involves altering out-of-pocket prices and information for consumers (the demand side) and incentives for providers (the supply side). Such market-oriented reforms — policies that alter the economic environment in which consumers and providers make health care choices in pursuit of their individual interests — can be implemented even in highly regulated settings. . . .

On the compensation mechanism for urban medical services

Reform on medial service compensation mechanism,as a key point in the heahhcare system reform,runs through the entire reform process.It plays a key role for the establishment and improvement of urban medical care system,medical service system,medical management system and operating system,for its guidance and regulation effects.Such a refonn to build a scientific and perfect compensation model and mechanism will be highly significant for the smooth progress of the new round of healthcare reform and its success in the end. Key words: Government; Healthcare; Compensation mechanism; Reform