Reforming public hospital financing in China: progress and challenges

Xu, Jin; Jian, Weiyan; Zhu, Kun; Kwon, Soonman; Fang, Hai

doi:10.1136/bmj.l4015

Cited by 74 publications

(66 citation statements)

References 16 publications

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“…Historically, China's public hospitals collected funds predominantly through service fees from patients, drug sales, and government budget funding. 40 Since the 1980s, the Chinese government has transferred the monetary liability to public hospitals, which increased the financial burden on patients. 41 Hospital financing reform included four areas: removing drug mark-up, increasing government budget allocation, modifying service charges, and altering the existing payment tools.…”

Section: China's Health Financing Reformmentioning

confidence: 99%

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Government health expenditure, out‐of‐pocket payment and social inequality: A cross‐national analysis of China and OECD countries

Zhang

Rahman

2020

Health Planning & Management

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This study aims to assess the association between Chinese out‐of‐pocket payments and government health spending, investigating their variation ratio in the context of OECD countries. Aggregated time‐series data of 37 countries (from China and official OECD members) were collected from the World Bank Open Data source and analyzed using the multiple linear regression models. Benchmarking approach was applied to evaluate the causes of healthcare expenditure rise per capita. The results showed that China's government health expenditure was positively associated with out‐of‐pocket payment rise, with a higher variation score of 42.70%. The association was statistically significant at 5%. Likewise, the association between government expenditure and out‐of‐pocket payment in the OECD countries was positively significant at 1%, and their variation score was 2.41%. Health financing in OECD countries showed higher stability and equity than that in China. Policy implications for China is to reduce the distributional disparity of government health funds by tax adjustments in health services, universal health coverage, the removal of social health insurance disparities, and a single health payment method.

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Section: China's Health Financing Reformmentioning

confidence: 99%

“…39 Additionally, after the payment methods reform, hospitals' annual disposable revenue fell from 19.9% in 2012 to 11.7% in 2017. 40 Chinese hospital enrollee satisfaction has improved by introducing a mixed payment system and maintaining sequential medical orders. 42…”

Section: China's Health Financing Reformmentioning

confidence: 99%

Government health expenditure, out‐of‐pocket payment and social inequality: A cross‐national analysis of China and OECD countries

Zhang

Rahman

2020

Health Planning & Management

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“…In 2017, there were 2340 tertiary hospitals nationwide, which accounted for 7.5% of hospitals and served 44.4% of inpatient visits . Among these tertiary institutions, over 90% are public hospitals which are self‐financing entities responsible for their own balance sheets while receiving some government funding . In this paper, we use data collected in 2017 to explore key factors related to inpatient satisfaction, which will help to have a better understanding of how to incorporate patient satisfaction into hospital evaluation and guide future reforms in improving hospital service quality.…”

Section: Introductionmentioning

confidence: 99%

Influence of patient and hospital characteristics on inpatient satisfaction in China's tertiary hospitals: A cross‐sectional study

Ding

Shi-yang

et al. 2019

Health Expectations

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Background: Patient satisfaction has been seen as a key criterion when evaluating hospitals and is one of the main focuses of the current health-care reform in China.This paper aimed to explore patient-and hospital-level factors associated with inpatient satisfaction, which can provide policy implications for the evaluation and development of a patient-oriented health-care system.Descriptive analysis and multivariable logistic regressions are conducted to identify key factors related to satisfaction.Results: Patient sociodemographic characteristics, including gender, age, income and insurance type, are found to be strongly associated with their satisfaction of inpatient experience. In terms of institutional characteristics, hospital type, size, staffing and financial performance are also significantly correlated with inpatient satisfaction.Patients are more satisfied with specialist hospitals and large hospitals measured by the number of beds and surgeries. Hospitals with higher nurse-to-bed ratio also receive more satisfaction. The financial performance of hospitals, however, is negatively associated with satisfaction. Conclusion:Patient satisfaction contains unique information on service quality and thus should be incorporated into the matrix of hospital evaluation. Meanwhile, differences in patient composition must be adjusted to make fair comparisons across hospitals. Moreover, future reform needs to put greater efforts in the design of comprehensive public insurance scheme, efficient hospital structure and an overall well-functioning health-care delivery system in order to better serve patients in China.

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“…Despite some achievements, there are still some problems that need to be solved urgently, such as insu cient coordination, fragmented systems, and irrational resource allocation. These lead to low utilization of primary health care, [10] increased medical costs, [11] and a large number of patients owing to large hospitals in hierarchical medical systems. [12] To solve the above problems, the Anhui provincial government required its local governments to establish various forms of medical associations, combining price, performance evaluation, and especially medical insurance, focusing on the establishment of compact medical associations and the medical community.…”

Section: Introductionmentioning

confidence: 99%

Suggestions on Linkage Mechanism between Medical Insurance and Hierarchical Medical System in a Southern City of Anhui Province in China: Analysis on Disease Structure of New Rural Cooperative Medical System (NCMS) Inpatients

LUO

Tang

Wang

et al. 2019

Preprint

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Objective: The chief aim of this paper is to explore the characteristics of medical treatment for NCMS inpatients in the central district of the southern city, and identify the main problems, so as to give some suggestions on the promotion of linkage mechanism between medical insurance and hierarchical medical system in the southern city. Methods: Hospitalization person-times and expenses were analyzed using the medical insurance inpatients who have settled in the NCMS information management system in the central district of the sourthen city from 2013 to 2015. Results: Among pieces of data, there were identical 5 system diseases hospitalized both in local and non-local medical institutions from 2013 to 2015: respiratory system diseases, malignant neoplasms, digestive system diseases, genitourinary system diseases, and circulatory system diseases, which also ranked top 5. In the hospitalization ratio of the top 5 systemic diseases in 2015, the respiratory system accounted for the largest proportion of 95.65%, and malignant neoplasms inpatients occupied the largest proportion who hospitalized in non-local medical institutions(36.27%). The proportion of inpatients with genitourinary system diseases hospitalized in non-local medical institutions was higher(10.32%), and the cost was lower(21.44%), compared with that of inpatients with digestive system diseases and circulatory system diseases. We chose the 3 repesentive system diseases to analyze diseases structure: there were 4 diseases of respiratory system diseases, 7 diseases of malignant neoplasms, 3 diseases of genitourinary system diseases both hospitalized in local and non-local medical institutions.Conclusions: All the preliminary results threw light on some defects in the process of medical treatment, which was rationality of choice and direction of diagnosis and treatment. The problem may be caused by included inpatients' incorrect medical concepts, unstandardized diagnosis and treatment behaviours, imperfect medical insurance reimbursement policy, and no adequate capacity to treat difficult and miscellaneous diseases. Under the background of deepening medical reform, the city municipal government needs to further increase the publicity of medical reform and make decisions to adapt to the changes in policy environment, for the medical insurance linkage mechanism with hierarchical medical system.

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Reforming public hospital financing in China: progress and challenges

Abstract: Jin Xu and colleagues describe the effects of the financing reforms of public hospitals and suggests steps to further progress towards equitable, efficient, and good quality care.

Cited by 74 publications

References 16 publications

Government health expenditure, out‐of‐pocket payment and social inequality: A cross‐national analysis of China and OECD countries

Government health expenditure, out‐of‐pocket payment and social inequality: A cross‐national analysis of China and OECD countries

Influence of patient and hospital characteristics on inpatient satisfaction in China's tertiary hospitals: A cross‐sectional study

Suggestions on Linkage Mechanism between Medical Insurance and Hierarchical Medical System in a Southern City of Anhui Province in China: Analysis on Disease Structure of New Rural Cooperative Medical System (NCMS) Inpatients

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