Reimbursement scheme for China’s public hospitals from perspective of stakeholders

Abstract

Purpose Public hospitals in China usually rely on revenues from medical services and medications to compensate for major costs given their nonprofit nature. The lack of government subsidies and unreasonable prices of medical services have led to high medical costs and unbalanced reimbursement system for public hospitals. There is a critical need of research on improvement of reimbursement system that will create positive effect on China’s health-care system. This paper aims to focus on four dimensions of stakeholders (government, patients, medical insurance agencies and social organization) and six major expenditures to explore reimbursement scheme for public hospitals in China with the purpose of relieving unbalanced income and expenditure of hospitals, avoiding medication markups and reducing medical expenses from patients. Design/methodology/approach In this paper, the authors study reimbursement scheme for public hospitals from the perspective of four dimensions of stakeholders and how stakeholders reimburse six major expenditures of hospitals. A total of 128 effective samples were collected from financial data of 32 public hospitals through 2009-2012. This paper analyzes the econometric models of the selected revenue and expenditure. This paper analyzes the econometric models of the selected revenue and expenditure using linear regression. The linear relationship between each cost and different types of incomes (i.e. reimbursements from government, patients, insurance agencies and social organization) is analyzed before and after cancelling the medication markups. Findings Results from empirical research verify that government reimbursement is insufficient, and using medication markups to compensate for medical service costs has become a serious problem for China’s public hospitals. To avoid the medication markups and improve the reimbursement scheme, government should reimburse labor cost, fixed assets cost and research cost; patients and medical insurance agencies should reimburse the costs of medical service, medication and administration/operations; and social organization should supplement the fixed assets cost. Originality/value In this study, the authors defined and classified stakeholders of reimbursement scheme for public hospitals in China, which help understand the roles and effects that different stakeholders can play in compensation. Along with the proposed reimbursement scheme framework, this study will help make effective implementation of new health-care reform program in China.

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“…Medical service fees, encompassing examinations, nursing care, treatments, and operations, more accurately reflect the labor value and technological complexity involved. Research indicates that the current pricing of medical service fees in public hospitals significantly underestimates the labor value of healthcare professionals [ 26 ]. In recent years, increased monitoring measures have led to higher costs associated with these services.…”