Impact of the new health care reform on hospital expenditure in China: A case study from a pilot city

Yang, Jinqiu; Hong, Yun Sik; Ma, Shuangge

doi:10.1016/j.chieco.2016.03.005

Cited by 29 publications

(12 citation statements)

References 16 publications

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“…The main reason for this may be because institutional healthcare reform was initiated in 2006 by the Chinese State Council. In the third stage, the healthcare reforms officially launched in 2009 focused on the provision of affordable and equitable basic healthcare for the masses [2,51,52]. From then on, the spatial equity of LLHC was enhanced markedly.…”

Section: Determinants Of the Two Levels Of Healthcare Resourcesmentioning

confidence: 99%

Spatio-Temporal Distribution, Spillover Effects and Influences of China’s Two Levels of Public Healthcare Resources

Song

Wei

Deng

et al. 2019

IJERPH

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In China, upper-level healthcare (ULHC) and lower-level healthcare (LLHC) provide different public medical and health services. Only when these two levels of healthcare resources are distributed equally and synergistically can the public’s demands for healthcare be met fairly. Despite a number of previous studies having analysed the spatial distribution of healthcare and its determinants, few have evaluated the differences in spatial equity between ULHC and LLHC and investigated their institutional, geographical and socioeconomic influences and spillover effects. This study aims to bridge this gap by analysing panel data on the two levels of healthcare resources in 31 Chinese provinces covering the period 2003–2015 using Moran’s I models and dynamic spatial Durbin panel models (DSDMs). The results indicate that, over the study period, although both levels of healthcare resources improved considerably in all regions, spatial disparities were large. The spatio-temporal characteristics of ULHC and LLHC differed, although both levels were relatively low to the north-west of the Hu Huanyong Line. DSDM analysis revealed direct and indirect effects at both short-and long-term scales for both levels of healthcare resources. Meanwhile, the influencing factors had different impacts on the different levels of healthcare resources. In general, long-term effects were greater for ULHC and short-term effects were greater for LLHC. The spillover effects of ULHC were more significant than those of LLHC. More specifically, industrial structure, traffic accessibility, government expenditure and family healthcare expenditure were the main determinants of ULHC, while industrial structure, urbanisation, topography, traffic accessibility, government expenditure and family healthcare expenditure were the main determinants of LLHC. These findings have important implications for policymakers seeking to optimize the availability of the two levels of healthcare resources.

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Section: Determinants Of the Two Levels Of Healthcare Resourcesmentioning

confidence: 99%

Spatio-Temporal Distribution, Spillover Effects and Influences of China’s Two Levels of Public Healthcare Resources

Song

Wei

Deng

et al. 2019

IJERPH

View full text Add to dashboard Cite

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“…One stream of literature discusses the reform's effect on health care expenditures. Yang et al (2016) found that the reform significantly reduced hospitalisation expenses in pilot hospitals [30]. Liu et al (2002), however, suggested that in spite of all of China's reforms up to this study's publication, people with poor socioeconomic status were still disadvantaged in accessing expensive and advanced health services [25].…”

Section: A Review Of China's Health Insurance Reformsmentioning

confidence: 78%

The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach

Chen

Gao

2020

IJERPH

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In 2009, China launched a new health care reform as it endeavoured to develop a tiered system of disease diagnosis and treatment to promote the integration of medical resources. This was important for improving service capacity and building medical alliances that would eventually lead to improved health service utilisation efficiency. However, while the 2009 reform aimed to provide universal health insurance coverage to all citizens, its overall effect on health service utilisation efficiency remains unclear. We aimed to examine the new health care reform’s mixed effect by applying a longitudinal study using China Health and Nutrition Survey (CHNS) data and the difference-in-difference (DID) method to estimate the health reform’s impact on health insurance coverage rate. Then, we studied whether the increase in health insurance coverage rate affected health service utilisation efficiency in China. Our results showed that the increase in insurance coverage rate has indeed made expensive medical services available to low-income individuals. However, it also increased the likelihood of use of hospitals rather than primary care facilities, since there is more insurance cover for outpatient visits, which has led to an increased demand for quality services. This effect has generated a negative impact on health care utilisation which directly pertains to systemic inefficiency. This study thus indicates that China’s latest health reform requires further policies to improve its overall efficiency.

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“…Further, as the hospital's agent, a doctor must not only provide diagnoses for patients but also generate income for the hospital and satisfy other assessment indicators of the hospital. However, while acting as agents, doctors may feel con icted when their personal interests contradict patients' interests [21][22][23][24][25]. For example, Lu [26] pointed out that when offered economic incentives, doctors might deviate from their agent obligations and use information advantages to induce patients with a strong ability to pay to pay for more medical services to maximize their personal interest.…”

Section: Introductionmentioning

confidence: 99%

Deregulation and pricing of medical services A policy experiment based in China

Zang

Zhou

Zhao

2020

Preprint

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Background: Price regulation is a common constraint in Chinese hospitals. Based on a policy experiment conducted in China on the price deregulation of private nonprofit hospitals, this study empirically examines the impact of medical service price regulation on the pricing of medical services by hospitals. Methods: Using the claim data of insured inpatients residing in a major Chinese city for the period 2010–2015, this study constructs a DID (difference-in-differences) model to compare the impact of price deregulation on medical expenditure and expenditure structure between for-profit and nonprofit hospitals. Results: The empirical results based on micro data reveal that, price deregulated significantly increased the total expenditure per inpatient visit by 10.5%. In the itemized expenditure, the diagnostic test and drug expenditure per inpatient visit of private nonprofit hospitals decreased significantly, whereas the physician service expenditure per inpatient visit increased significantly. For expenditure structure, the proportions of drug expenditure and diagnostic test expenditure per inpatient visit significantly decreased by 5.7% and 3.1%, respectively. Conclusions: Under price regulation, medical service prices generally become lower than their costs. Therefore, after price deregulation, private nonprofit hospitals increase medical service prices above their cost and achieve the service premium by providing high-quality medical services and a comfortable medical environment. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well.

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Impact of the new health care reform on hospital expenditure in China: A case study from a pilot city

Cited by 29 publications

References 16 publications

Spatio-Temporal Distribution, Spillover Effects and Influences of China’s Two Levels of Public Healthcare Resources

Spatio-Temporal Distribution, Spillover Effects and Influences of China’s Two Levels of Public Healthcare Resources

The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach

Deregulation and pricing of medical services A policy experiment based in China

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