Objective: To show the pattern of patient satisfaction with top-level delivery organizations (Level 2 and Level 3 hospitals), and using neo-institutionalism approach to explain the relatively low satisfaction and to explore the limitations with top providers, focusing on how to improve the competence of Level 2 and Level 3 hospitals at both the individual hospital level and the whole delivery system level.

Data Sources/Study Setting: The household survey by the National Bureau of Statistics in China in 2008; China Health Statistics Yearbooks.

Data Collection/Extraction Methods: The analysis uses a 2008 sample medical experiences of 5,036 residents from 17 provinces collected in a household survey by the National Bureau of Statistics in China. The linear regression model, the structural difference regression model, and the ordered probit model are used in our framework.

Principal Findings: The imbalance between the needs of patients and the limited competence of top-level providers, and the conflict between the business expansion and the limited competence of those providers are deeply and widely influenced by patterns of patient needs, the top providers’ expansion, and the institutional environment.

Conclusions: In order to effectively respond to patient needs, top and lower level providers need to set their own individual priorities. The government needs to improve institutional arrangements to respond to patient needs with the development of a fair and appropriate reimbursement and compensation pricing mechanism, and with further evaluation of top level providers’ advanced and limited health services.

Since 1978, China has been primarily market-focused in its provision of health care and social services. The market-driven health care system has been characterized by perverse incentives for individual providers, patients, and hospitals that are inducing improper provision of care: overprescription of pharmaceuticals and high-tech testing, lack of effective primary care and gatekeeping, and competition for patients instead of referral. The national health care reform document that was made public in April 2009 recognizes this failure of the market in health care in China. The document suggests potential policies for improvement on the current system that are focused primarily on a targeted increase in government funding and an increased, changing role for the government. We assess the potential of this national health care reform to achieve the stated goals, and conclude that the reform as designed is necessary but insufficient. For the reform to meet its goals, the promised increase in funding should be accompanied by improved data collection, regional piloting, and a strong regulatory and purchasing role for the government in aligning incentives for individual and institutional payers, providers, and patients.

Many Chinese express dissatisfaction with their healthcare system with the popular phrase Kan bing nan, kan bing gui (“medical treatment is difficult to access and expensive”). Critics have cited inefficiencies in delivery and poor quality of services.  Determining the pattern of patient satisfaction with health services in China—and the causes of patient dissatisfaction—may help to improve health care not only in China but in countries in similar predicaments throughout the world.

Using data from a sample of 5,036 residents from 17 provinces collected in a 2008 household survey by the National Bureau of Statistics of China, we analyze the patterns of patient preferences, concerns, and satisfaction among six social groups, classified by socioeconomic status including education level, income, and type of employment.

From regression results we conclude that the gap between what patients predict their service will entail and what they perceive the service actually did entail is the key determinant of lower satisfaction, especially for patients who care most about the quality of service and patients with higher social positions. Patients from lower social groups are more concerned with price and the attitudes of medical professionals, and generally express higher satisfaction with their health care experiences than their wealthier peers, despite receiving lower-level services. Patients with higher social positions are more concerned with the technical competence and quality of providers, and struggle with what they perceive as a lack of freedom to purchase and receive their desired services, as well as long waiting times and poor physician-patient interactions. These patterns of patient satisfaction appear to be the consequence of China’s unreliable basic delivery system, lack of advanced health service supply, and distorted health market. We discuss how what we have learned about patients’ dissatisfaction can be used to restructure the delivery system to better meet and shape patients’ needs.

Many researchers have concluded that longer life expectancies prompt increased investment in education, as a prolonged labor supply raises the rate of return on education. Besides explaining the empirical evidence behind this conclusion (at an absolute level), there is another issue to be discussed: does time spent in studying and working increase proportionally with higher longevity? Building on an extended life-cycle model with an assumption on a more realistic distribution of life cycle mortality rates, this article considers dynamic effects of prolonging longevity on economic development by directly introducing changes in longevity into the economy, which is more preferable than comparative static analysis that relies on changes in relevant parameters. It shows that prolonged life expectancy will cause individuals to increase their time in education but may not warrant rises in labor input. Later we show that higher improvement rate of longevity will also promote economic growth, even if we exclude the mechanism of human capital formation and only consider the growth effects of the higher improvement rate of life expectancy from physical capital investment.

Forthcoming in The Chinese Journal of Population, Resources and the Environment

Published: Qiong, Zhang. "Longevity, Capital Formation and Economic Development." Chinese Journal of Population Resources and Environment 10.1 (2012): 53-63.

When one can circle the globe in less than the time of incubation of most infectious pathogens, it is clear every country relies to some extent on the health systems of other countries to prevent and protect their citizens from global health threats. Therefore, creating and maintaining a good health system in one country requires attention to interregional and international cooperation. Domestic and international spheres of public health policies are becoming more intertwined and inseparable.

PUBLISHED: Qiong Zhang, Karen Eggleston (翁笙和), and Michele Barry, 2009. “Pandemic Influenza and the Globalization of Public Health” (流感大流行与公共卫生全球化), Comparative Studies 比较 (42):  (Beijing: China CITIC Press): 47-52.

China continues to face great challenges in meeting the health needs of its large population. The challenges are not just lack of resources, but also how to use existing resources more efficiently, more effectively, and more equitably. Now a major unaddressed challenge facing China is how to reform an inefficient, poorly organized health care delivery system. The objective of this study is to analyze the role of private health care provision in China and discuss the implications of increasing private-sector development for improving health system performance.

This study is based on an extensive literature review, the purpose of which was to identify, summarize, and evaluate ideas and information on private health care provision in China. In addition, the study uses secondary data analysis and the results of previous study by the authors to highlight the current situation of private health care provision in one province of China.

This study found that government-owned hospitals form the backbone of the health care system and also account for most health care service provision. However, even though the public health care system is constantly trying to adapt to population needs and improve its performance, there are many problems in the system, such as limited access, low efficiency, poor quality, cost inflation, and low patient satisfaction. Currently, private hospitals are relatively rare, and private health care as an important component of the health care system in China has received little policy attention. It is argued that policymakers in China should recognize the role of private health care provision for health system performance, and then define and achieve an appropriate role for private health care provision in helping to respond to the many challenges facing the health system in present-day China.

Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital’s probability of receiving government financial support is inversely associated with the hospital’s previous net revenue, an association consistent with soft budget constraints.

Published inInternational Journal of Healthcare Finance and Economics special issue on provider payment incentivesKaren Eggleston, Yu-Chu Shen, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, 2009. “Soft Budget Constraints in China: Evidence from the Guangdong Hospital Industry,” International Journal of Healthcare Finance and Economics 9(2): 233-42.

Government and private roles in health service delivery remain controversial in China, as in many countries.  Using 2004 data from over 360 government-owned and private hospitals in Guangdong Province, we find that non-government hospitals serve an overlapping but distinct market.  They are smaller, newer market entrants, more likely to specialize, and less likely to be included in urban social insurance networks. We also document differences in staffing and financial performance, but no systematic ownership differences in simple measures of quality, controlling for size, location, case-mix and other confounding factors.

UPDATED VERSION PUBLISHED:
BMC Health Services Research 2010, 10:76doi:10.1186/1472-6963-10-76
http://www.biomedcentral.com/1472-6963/10/76

Background

The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care.

Methods

We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes.

Results

Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix.

Conclusions

In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of hospital ownership type.

Published: Eggleston, Karen, et al. "Comparing public and private hospitals in China: evidence from Guangdong." BMC Health Services Research 10.1 (2010): 1.

When both physicians and pharmacists in Taiwan prescribed and dispensed drugs, many elderly people considered the two types of health care providers more or less synonymous (i.e., close substitutes). Two policies mandated in the 1990s changed this perception: National Health Insurance (NHI), which provides insurance coverage to all citizens, and a separation policy (SP) that forbids physicians from dispensing and pharmacists from prescribing drugs. The author finds that by providing an economic incentive to the previously uninsured elderly, NHI raised the probability that they would visit physicians, relative to their continuously insured counterparts. In particular, some previously uninsured elderly who once only visited pharmacists were more likely to also visit physicians after NHI was implemented. Following this, the SP made it more likely that all elderly patients would only visit physicians and buy drugs from on-site pharmacists hired by physicians—a result different than its policy goal.

Published: Chang, Kang-Hung. "The healer or the druggist: effects of two health care policies in Taiwan on elderly patients’ choice between physician and pharmacist services." International journal of health care finance and economics 9.2 (2009): 137-152.

Out-of-pocket (OoP) household health expenditures are among the most difficult factors to measure in the context of National Health Accounts (NHA). Yet their measurement is important: OoP household expenditures are typically the first or second largest source of health care financing in developing countries. Their incorrect measurement can undermine the credibility of total health spending estimates and thus NHA statistics, which are an otherwise important resource for policy makers. In most countries, private expenditures account for the biggest margin of error in national health spending estimates and represent the most substantial barrier to reliable international comparisons. Differences in accounting methods explain much of the discrepancy across nations. To further the academic investigation of this important issue, this paper focuses on OoP household health expenditures in Pakistan’s NHA and suggests steps toward estimating such expenditures more effectively.