Evaluating private hospital performance before and during COVID-19 in China

The coronavirus disease 2019 (COVID-19) pandemic had a tremendous impact on the global medical system. The development of private hospitals is an important measure to deepen the reform of China's medical and health system, and an important driving force to improve the effective supply of medical services. This study aims to compare the performance of China's private hospitals before and during COVID-19 and determine the factors that affect hospital profitability between the 2 periods. Data are collected from 10 private listed hospitals from 2017 to 2022, and ratio analysis is used to measure hospital performance in 5 aspects, namely profitability, liquidity, leverage, activity (efficiency), and cost coverage. Multiple regression analysis is used to determine the influencing factors of hospital profitability. The results show a negative impact of COVID-19 on private hospital performance. Specifically, regardless of region, hospital profitability, liquidity, and cost coverage were reduced due to COVID-19, while hospital leverage was increased. COVID-19 had also an impact on hospital efficiency. In addition, before COVID-19, current ratio and cost coverage ratio were the determinants of hospital profitability, while only cost coverage ratio affected hospital profitability during the COVID-19 outbreak. We provide evidence that COVID-19 had an impact on China private hospitals, and the findings will aid private hospitals in improving their performance in the post-COVID-19 era.

Rapid growth of private hospitals in China: emerging challenges and opportunities to health sector management

China's private hospital market has experienced rapid growth over the last decade, with private hospitals now outnumbering public hospitals by a factor of two. This policy analysis uses available data and existing literature to analyze China's rapidly changing hospital market, identify key challenges resulting from rapid private hospital growth, and present recommendations to ensure future sustainable private hospital development in the country. Our analysis shows that while private hospitals outnumber public hospitals, outpatient visits and hospitalizations remain higher among public hospitals, while per-patient expenditure remains higher among private hospitals. Key challenges to private hospital development include limited government financial support, high tax burdens, difficulty in workforce recruitment and retainment, poor government regulation and oversight, and dissipating public trust. Recommendations to address these challenges include opening government contract bidding to private hospitals, creating a system that allows private hospitals to enter national health insurance schemes, reducing tax pressure on private hospitals, defining a legal system for market entry and exit of private hospitals, improving a system of supervision, and monitoring and evaluation of private hospital operation and performance.

Annual incidence and fatality rates of notifiable infectious diseases in southeast China from 1950 to 2022 and relationship to socioeconomic development

Background

Over the past 70 years, China has advanced significantly in the prevention and treatment of infectious diseases while simultaneously undergoing a socioeconomic transformation, making it a useful source of data for analysing relationships between public health policy and the control of infectious diseases.

Methods

We collected data on the incidence of notifiable infectious diseases and associated fatalities in Jiangsu province in southeast China from the Provincial Center for Disease Control and Prevention, Provincial Institute of Parasitic Diseases, and the Nationwide Notifiable Infectious Diseases Reporting Information System. We compared data from different historical periods using descriptive statistical methods, joinpoint regression, and correlation analysis.

Results

During 1950-2022, 75 754 008 cases of 46 notifiable infectious diseases were reported in Jiangsu, with an average annual incidence was 1679.49 per 100 000 population and a fatality rate of 1.82 per 1000 persons. The incidence of classes A-B decreased (average annual percent change (AAPC) = -2.1) during the entire study period, while the incidence of class C increased (AAPC = 10.8) after 2004. The incidence of intestinal diseases (AAPC = -4.4) and vector-borne and zoonotic diseases (AAPC = -8.1) decreased rapidly, while the incidence of sexually transmitted and blood-borne diseases (AAPC = 1.8) increased. The number of medical and health institutions and the per capita gross domestic product correlated negatively with the annual incidence of diseases in classes A-B, but not with fatality rates.

Conclusions

Although the annual incidence of many severe infectious diseases has decreased in Jiangsu since 1950, the incidence of sexually transmitted and blood-borne diseases increased. Socioeconomic growth and sustainable investment in health systems are associated with better control of infectious diseases.

Functions, advantages and challenges facing private healthcare organisations in China's healthcare system: a qualitative analysis through open-ended questionnaires

OBJECTIVES

The medical reform in 2009 stimulated the growth of private healthcare organisations in China, but there is still room for their further development in the healthcare market. The objectives of the study were to provide more information about the healthcare market in China and to explore the challenges private healthcare organisations faced.

DESIGN

Qualitative descriptive study using a web-based open-ended questionnaire and thematic content analysis. Data were collected between 12 February and 20 February 2020.

SETTING

This study was conducted in China.

PARTICIPANTS

124 respondents from private healthcare organisations across 20 provinces in China.

RESULTS

Our content analysis identified three themes: (1) functioning and positioning of the healthcare institutions: current private healthcare organisations generally serve as a supplement to public hospitals and focus more on specialised medical and high-end services; (2) institutions' advantages: private healthcare organisations can flexibly respond to market demands, formulate effective strategies, introduce advanced management concepts and methods, provide personalised and diversified services, and introduce new technologies which can stimulate market vitality and promote healthy competition; and (3) institutions' challenges: private healthcare organisations face difficulties in professional development and talent cultivation, branding and establishing a reputation, and the policies for institution establishment, tax and medical insurance pose drawbacks to their development.

CONCLUSION

This study illustrates that private healthcare organisations need more government support for further development, such as providing a fairer insurance strategy and taxation policy, affording ground for a more equitable scientific research environment and promotion opportunities, and evaluating reputation score for healthcare institutions.

Impacts of the medical arms race on medical expenses: a public hospital-based study in Shenzhen, China, during 2009-2013

BACKGROUND

Has the medical arms race (MAR) increased healthcare expenditures? Existing literature has yet to draw a consistent conclusion. Hence, this study aims to reexamine the relationship between the MAR and medical expenses by the data from public hospitals in Shenzhen, China, during the period of 2009 to 2013.

METHODS

This study's data were collected through panel datasets spanning 2009 to 2013 from the Shenzhen Statistical Yearbook, Shenzhen Health Statistical Yearbook, and annual reports from the Shenzhen Municipal Health Commission. The Herfindahl-Hirschman index and hierarchical linear modeling were combined for empirical analysis.

RESULTS

The MAR's impact on medical examination fees differed during the inpatient and outpatient stages. Further analysis verified that the MAR had the most significant impact on outpatient examination fees. Due to the characteristics of China's medical system, government regulations in the healthcare market may consequently accelerate the MAR among public hospitals. Strict government regulations on the medical system have also promoted increased medical examination costs to some extent. Once medical service prices are under strict administrative control, only drug and medical examination fees are the primary forms of extra income for hospitals. After the proportion of drug fees is further regulated, medical examinations will then become another staple method to generate extra revenue. These have distorted Chinese public hospitals' medical fees, which completely differ from those in other countries.

CONCLUSION

The government should confirm that they have allocated sufficient financial investments for public hospitals; otherwise, the competition among hospitals will transfer the burden to patients, and especially to those who can afford to pay for care. A core task for public hospitals involves providing safer, less expensive, and more reliable medical services.

Healthcare preferences of the general Chinese population in the hierarchical medical system: A discrete choice experiment

Background

Chinese health insurance system faces resource distribution challenges. A patient-centric approach allows decision-makers to be keenly aware of optimized medical resource allocation.

Objective

This study aims to use the discrete choice model to determine the main factors affecting the healthcare preferences of the general Chinese population and their weights in the three scenarios (chronic non-communicable diseases, acute infectious diseases, and major diseases).

Methods

This study firstly identified the key factors affecting people's healthcare preferences through literature review and qualitative interviews, and then designed the DCE questionnaire. An online questionnaire produced by Lighthouse Studio (version 9.9.1) software was distributed to voluntary respondents recruited from mainland China's entire population from January 2021 to June 2021. Participants were required to answer a total of 21 questions of three scenarios in the questionnaire. The multinomial logit model and latent class model were used to analyze the collected data.

Results

A total of 4,156 participants from mainland China were included in this study. The multinomial logit and latent class model analyses showed that medical insurance reimbursement is the most important attribute in all three disease scenarios. In the scenario of "non-communicable diseases," the attributes that participants valued were, from the most to the least, medical insurance reimbursement (45.0%), hospital-level (21.6%), distance (14.4%), cost (9.7%), waiting time (8.3%), and care provider (1.0%). As for willingness to pay (WTP), participants were willing to pay 204.5 yuan, or 1,743.8 yuan, to change from private hospitals or community hospitals to tertiary hospitals, respectively.

Conclusions

This study explores the healthcare preferences of Chinese residents from a new perspective, which can provide theoretical reference for the refinement of many disease medical reimbursement policies, such as developing different reimbursement ratios for various common diseases and realizing rational configuration of medical resources.

Readiness of healthcare providers for e-hospitals: a cross-sectional analysis in China before the COVID-19 period

OBJECTIVES

The growth and development of smartphones and eHealth technologies have enabled the potential for extended care hospitals (e-hospitals) in China in order to facilitate the success of a primary healthcare centre (PHC)-based integrated delivery model. Although the adoption of e-hospitals is essential, few studies have directed their research towards understanding the perspectives of healthcare providers. This study aims to identify the current readiness of healthcare providers to adopt e-hospital technologies, determine the factors influencing this adoption and describe the perceived facilitators and barriers in regard to working at e-hospitals.

DESIGN

A cross-sectional study conducted in Sichuan, China, between June and September 2019.

SETTINGS

Information was collected from healthcare providers who have more than 3 years of work experience from a tertiary hospital, secondary hospital, PHCs and private hospital.

PARTICIPANTS

2298 medical professionals were included in this study.

OUTCOME MEASURE

This study included a self-administered questionnaire that was used to assess participants' sociodemographic characteristics, online medical practices, willingness to use e-hospitals and perceived facilitators/barriers to working at e-hospitals. Multivariate regression analysis was performed in order to evaluate the independent factors associated with e-hospital work.

RESULTS

Overall, 86.3% had a positive response towards working at e-hospitals. Age (p<0.05), familiarity with e-hospitals (p<0.001) and prior work practices in online healthcare settings (p<0.001) were associated with participants' readiness to work at e-hospitals. Gender, education level, professional level, the tier of their affiliated hospital and workload were not statistically associated. Healthcare providers who had positive attitudes towards e-hospitals considered improved efficiency, patient satisfaction, communication among physicians, increased reputation and income, and alleviated workload to be advantages of adoption. The participants who were unwilling to work at e-hospitals perceived lack of time, insufficient authenticity/reliability and underdeveloped policies as potential barriers.

CONCLUSION

Improving operative proficiency in electronic devices, accommodating to work schedules, increasing familiarity with e-hospitals and regulating practices will improve the readiness of healthcare providers to work at e-hospitals.

Compassion fatigue among haemodialysis nurses in public and private hospitals in China

AIM

This study was conducted to identify and compare the levels of compassion fatigue and job satisfaction among haemodialysis nurses in public and private hospitals in China and explore explanatory factors based on sociodemographic and occupational characteristics.

METHODS

A descriptive study was conducted using a self-designed demographic questionnaire, the Professional Quality of Life Scale and the Minnesota Satisfaction Questionnaire, with responses from 283 haemodialysis nurses working at six public and private hospitals in China between June and November 2018.

RESULTS

The compassion fatigue score of public hospital nurses was significantly higher than that of private hospital nurses. Univariate analysis showed that there were significant differences in compassion fatigue among nurses based on the number of years worked, nature of employment, and education level. Correlational analysis showed a negative correlation between overall job satisfaction and compassion fatigue in both public and private hospitals. Multiple regression analysis showed that compassion fatigue among haemodialysis nurses in public hospitals was associated with years worked, type of employment, and intrinsic and extrinsic satisfaction, whereas in private hospitals, education level, years worked, and intrinsic and extrinsic satisfaction were significant.

CONCLUSION

Haemodialysis nurses in public hospitals are more likely to develop compassion fatigue than those in private hospitals.

Deregulation and pricing of medical services: a policy experiment based in China

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 public and private 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. Furthermore, this paper also found that hospitals had larger price changes for dominant diseases than for non-dominant diseases.

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 increasing physician medical services. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well.

The Association of Market Mix of Hospital Ownership With Medical Disputes: Evidence From China

The prevalence and severity of medical disputes in China have attracted the attention of society and academia, and how to alleviate medical disputes has become a major concern. Following the implementation of a series of policies, the private sector in China’s hospital market has expanded rapidly over the past decade. It remains unknown whether the market mix of hospital ownership could alleviate medical disputes, this study aims to bridge the gap. Data are collected from all hospitals (2171) in Sichuan province, China, from 2012 to 2015. Using a negative binomial hurdle model, the results show that for hospitals with disputes, the private hospital market share has an inverted U-shaped relationship with the number of disputes. However, no significant relationship is found between the private hospital market share and the probability of dispute occurrence. For hospitals with disputes, competition plays a protective role in the effect of the private hospital market share on the number of disputes, hindering the increase in the number of disputes and facilitating a more rapid drop. However, medical quality is found to play an insignificant role in that effect. The findings also support encouraging new private hospitals in China rather than privatizing existing public hospitals.

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

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.

Technical Efficiency of Public and Private Hospitals in Beijing, China: A Comparative Study

Objective: With the participation of private hospitals in the health system, improving hospital efficiency becomes more important. This study aimed to evaluate the technical efficiency of public and private hospitals in Beijing, China, and analyze the influencing factors of hospitals’ technical efficiency, and thus provide policy implications to improve the efficiency of public and private hospitals. Method: This study used a data set of 154–232 hospitals from “Beijing’s Health and Family Planning Statistical Yearbooks” in 2012–2017. The data envelopment analysis (DEA) model was employed to measure technical efficiency. The propensity score matching (PSM) method was used for matching “post-randomization” to directly compare the efficiency of public and private hospitals, and the Tobit regression was conducted to analyze the influencing factors of technical efficiency in public and private hospitals. Results: The technical efficiency, pure technical efficiency and scale efficiency of public hospitals were higher than those of private hospitals during 2012–2017. After matching propensity scores, although the scale efficiency of public hospitals remained higher than that of their private counterparts, the pure technical efficiency of public hospitals was lower than that of private hospitals. Panel Tobit regression indicated that many hospital characteristics such as service type, level, and governance body affected public hospitals’ efficiency, while only the geographical location had an impact on private hospitals’ efficiency. For public hospitals in Beijing, those with lower average outpatient and inpatient costs per capita had better performance in technical efficiency, and bed occupancy rate, annual visits per doctor, and the ratio of doctors to nurses also showed a positive sign with technical efficiency. For private hospitals, the average length of stay was negatively associated with technical efficiency, but the bed occupancy rate, annual visits per doctor, and average outpatient cost were positively associated with technical efficiency. Conclusions: To improve technical efficiency, public hospitals should focus on improving the management standards, including the rational structure of doctors and nurses as well as appropriate reduction of hospitalization expenses. Private hospitals should expand their scale with proper restructuring, mergers, and acquisitions, and pay special attention to shortening the average length of stay and increasing the bed occupancy rate.

Comparing public and private emergency departments in China: Early evidence from a national healthcare quality survey

The number of private healthcare facilities has rapidly increased since the progressive open market policies, which began in the 1980s; however, little is known about the development of private emergency departments (EDs). This cross-sectional study was part of the National Control Information System (NCIS) project, which collects data annually from hospitals across China. Emergency services data were extracted and included location, infrastructure, human resources, beds, and number of patients; 4529 hospitals across 31 provinces in mainland China were eventually included, consisting of 988 private and 3541 public EDs. Evidence shows that most private EDs are located in central China, where local economies are relatively developed. Most private EDs (91.6%) are found in secondary hospitals but have significantly fewer beds and smaller workforces compared with public EDs. An imbalance of emergency medical resources was observed across China, and this disparity becomes even more profound in rural hospitals. These findings may initiate collaborative, public-private partnerships in emergency health services provision and suggest there is a need to offer tax breaks to incentivize investors, but further research is required. We may also need to rethink health insurance policies, which could enable more equitable access to private emergency care. Future planning and health policies must be based upon the strongest available evidence, if we are to address imbalanced health services distribution and growing demand.

Do job stress, health, and presenteeism differ between Chinese healthcare workers in public and private hospitals: a cross sectional study

To determine if job stress, health, and presenteeism differ between healthcare workers at Chinese public and private hospitals. This cross-sectional study analyzed the records of 1080 healthcare workers in eastern, central, and western China for the period from January2015 through November2015. Data on challenge stress, hindrance stress, health, and presenteeism were collected. Using univariate and multivariate regression and SPSS, we investigated differences between Chinese public and private hospitals in China. Challenge stress, hindrance stress, and presenteeism, but not health status, significantly differed between healthcare workers at public and private hospitals in China. Challenge stress and hindrance stress were significantly higher in public hospitals, while presenteeism was significantly lower in private hospitals. The significant differences between public and private hospitals are attributable to differences in the business practices and management of public and private hospitals. To achieve successful long-term medical reform in China, the adverse effects of psychosocial factors should be considered in future research plans and policies. Chinese hospitals urgently require improvements in management and leadership. Reform efforts should encompass fields such as management science, psychology, and the behavioral sciences.

The multi-tiered medical education system and its influence on the health care market-China's Flexner Report

BACKGROUND

Medical education is critical and the first step to foster the competence of a physician. Unlike developed countries, China has been adopting a system of multi-tiered medical education to training physicians, which is featured by the provision of an alternative lower level of medical practitioners, or known as a feldsher system since the 1950s. This study aimed to illustrate the impact of multi-tiered medical education on both the equity in the delivery of health care services and the efficiency of the health care market.

METHODS

Based on both theoretical reasoning and empirical analysis, this paper documented evidence upon those impacts of the medical education system.

RESULTS

First, the geographic distribution of physicians in China is not uniform across physicians with different educational training. Second, we also find the evidence that high-educated doctors are more likely to be hired by larger hospitals, which in turn add the fuel to foster the hospital-center health care system in China as patients choose large hospitals to chase good doctors. Third, through the channels of adverse selection and moral hazard, the heterogeneity in medical education also imposes costs to the health care market in China.

DISCUSSION

Overall, the three-tiered medical education system in China is a standard policy trade-off between quantity and quality in training health care professionals. On the one hand, China gains the benefit of increasing the supply of health care professionals at lower costs. On the other hand, China pays the price for keeping a multi-tiered medical education in terms of increasing inequality and efficiency loss in the health care sector. Finally, we discuss the potential policy options for China to mitigate the negative impact of keeping a multi-tiered medical education on the performance of health care market.

Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective

Background: The maldistribution of licensed doctors is one of the major challenges faced by the Chinese health sector. However, this subject remains underexplored, as the underlying causes of licensed doctor distribution have not been fully mapped out. To fill the research void, this study theoretically modeled and empirically measured various determinants of licensed doctor distribution from both the supply and demand sides while taking the spillover effect between the adjacent geographical units into consideration. Methods: The theory of demand and supply is adopted to construct a research framework so as to explain the imbalance in the licensed doctor distribution. Both direct effects and spillover effects of the supply-side factors and demand-side factors are empirically measured with the spatial panel econometric models. Results: The health service demand was found, as expected, to be the major driving force of the licensed doctor distribution across the nation. That is, the increase in health services demands in a province could significantly help one unit attract licensed doctors from adjacent units. Unexpectedly but intriguingly, the medical education capacity showed a relatively limited effect on increasing the licensed doctor density in local units compared with its spillover effect on neighboring units. In addition, government and social health expenditures played different roles in the health labor market, the former being more effective in increasing the stock of clinicians and public health doctors, the latter doing better in attracting dentists and general practitioners. Conclusions: The results provide directions for Chinese policy makers to formulate more effective policies, including a series of measures to boost the licensed doctor stock in disadvantaged areas, such as the increase of government or social health expenditures, more quotas for medical universities, and the prevention of a brain drain of licensed doctors.

The association of hospital competition with inpatient costs of stroke: Evidence from China

The main purpose of this article is to analyze the association between hospital competition and stroke inpatient costs. Stroke is selected as the representative of a class of diseases characterized by asymmetric information and lack of autonomy of service choice. A total of 98,061 observations are selected from a medical record dataset in the Sichuan Province. The fixed radius approach of 15 miles and Herfindahl-Hirschman Index (HHI) are employed to define the hospital market and measure the competition intensity, respectively. The log-linear multivariate regression model is used to analyze the association between competition and stroke inpatient costs. The results show that every 10% increase in competition (0.1 unit decrease of HHI value) associated with an average 2.38% decrease in stroke inpatient total costs. We also explore the relationship between competition and sub-group costs of stroke inpatient, finding that hospitals facing more competition incur lower treatment, drug, and consumable costs. Further analysis shows that for-profit, private, and low-level hospitals are more sensitive when facing changes in market competition degree. Our study offers empirical evidence to support the introduction of pro-competition in China's new round of national health reform and provide implications for other countries facing similar health care challenges.

Exploring determinants of health provider choice and heterogeneity in preference among outpatients in Beijing: a labelled discrete choice experiment

OBJECTIVE

For a long time in China, public hospitals have been the most prominent provider of healthcare. However, recent policy reforms mean the private sector is experiencing rapid development. Thus, the purpose of this study is to detect whether the policies published by the government aimed to improve the quality of healthcare services were catering to patient's preferences.

PARTICIPANTS AND METHODS

Our work uses dental care as an example of services provided in outpatient setting and takes advantage of a labelled discrete choice experiment with a random sample of respondents from Beijing. Participants were asked to make a choice between four healthcare providers with different attributes. Mixed logit and latent class models were used for the analysis.

RESULT

Care provided by high-level private hospitals and community hospitals were valued RMB154 and 216 less, respectively, than care provided by class A tertiary hospitals, while the most disliked provider was private clinics. This was the most valued attribute of dental care. Respondents also value: lower waiting times, the option to choose their doctor, lower treatment costs, shorter travel times and a clean waiting room. However, when the level of provider was analysed, the prevailing notion that patients in China were always likely to choose public services than private services no longer holds. Four classes of patients with distinct preferences for dental care provider choice were identified, which can partly be explained by age, income, experience and Hukou status-a household registration permit.

DISCUSSION

The study to some extent challenged the overwhelming predominance of public healthcare providers in China. The preference heterogeneity we found was relatively large. Our findings are significant for providers in developing more specific services for patients and for policymakers in weighing the pros and cons of future initiatives in medical reform.

Health System in China

The health of China’s population improved dramatically during the first 30 years of the People’s Republic, established in 1949. By the mid-1970s, China was already undergoing the epidemiologic transition, years ahead of other nations of similar economic status, and by 1980, life expectancy (67 years) exceeded that of most similarly low-income nations by 7 years. Almost 30 years later, China’s 2009 health reforms were a response to deep inequity in access to affordable, quality healthcare resulting from three decades of marketization, including de facto privatization of the health sector, along with decentralized accountability and, to a large degree, financing of public health services. The reforms are built on earlier, equity-enhancing initiatives, particularly the reintroduction of social health insurance since 2003, and are planned to continue until 2020, with gradual achievement of overarching objectives on universal and equitable access to health services. The second phase of reform commenced in early 2012. China’s health reforms remain encouragingly specific but not prescriptive on strategy; set in the decentralized governance structure, they avoid the issue of reliance on local government support for the national equity objective, leaving the detailed design of health service financing, human resource distribution and accountability, essential drug lists and application of clinical care pathways, etc. to local health authorities answerable to local government, not the Ministry of Health. Community engagement in government processes, including in provision of healthcare, remains limited. This chapter uses the documentation and literature on health reform in China to provide a comprehensive overview of the current situation of the health sector and its reform in the People’s Republic.

Social Media Users' Perception of Telemedicine and mHealth in China: Exploratory Study

BACKGROUND

The use of telemedicine and mHealth has increased rapidly in the People's Republic of China. While telemedicine and mHealth have great potential, wide adoption of this technology depends on how patients, health care providers, and other stakeholders in the Chinese health sector perceive and accept the technology.

OBJECTIVE

To explore this issue, we aimed to examine a social media platform with a dedicated focus on health information technology and informatics in China. Our goal is to utilize the findings to support further research.

METHODS

In this exploratory study, we selected a social media platform-HC3i.cn-to examine the perception of telemedicine and mHealth in China. We performed keyword analysis and analyzed the prevalence and term frequency-inverse document frequency of keywords in the selected social media platform; furthermore, we performed qualitative analysis.

RESULTS

We organized the most prominent 16 keywords from 571 threads into 8 themes: (1) Question versus Answer; (2) Hospital versus Clinic; (3) Market versus Company; (4) Doctor versus Nurse; (5) Family versus Patient; (6) iPad versus Tablet; (7) System versus App; and (8) Security versus Caregiving. Social media participants perceived not only significant opportunities associated with telemedicine and mHealth but also barriers to overcome to realize these opportunities.

CONCLUSIONS

We identified interesting issues in this paper by studying a social media platform in China. Among other things, participants in the selected platform raised concerns about quality and costs associated with the provision of telemedicine and mHealth, despite the new technology's great potential to address different issues in the Chinese health sector. The methods applied in this paper have some limitations, and the findings may not be generalizable. We have discussed directions for further research.

Hospital Institutional Context and Funding

This chapter focuses on hospital ownership and supervision. Public hospitals are mostly, but not always, under the supervision of the Health Ministry. There are a certain number of other governing bodies that are directly involved in the management of hospitals. A cross-ministry group was set up in 2006 to facilitate the implementation of hospital reforms. Apart from the organizational structure, the funding of hospitals and its evolution is studied. Between 1979 and 1991, the government introduced a co-payment system in healthcare establishments. In 1992, the Ministry of Health officially granted greater autonomy to public hospitals. They were authorized to deliver paid services and to make profits, but were made responsible for their losses and debts. By 2003, central government funding had fallen to 8% of the hospital budget. As a result, public hospitals in China behave very similarly to for-profit firms, while being governed as any traditional public structure. The next step is the current experiment of a Diagnostics Related Group-based payment in China. Along with the financial autonomy of public hospitals, different reforms have been directed at developing private hospitals, even though many obstacles still remain.

The choice and preference for public-private health care among urban residents in China: evidence from a discrete choice experiment

Background

Public health care dominated the services provision in China before 1980s. However, the number of private health care providers in China has been increasing since then. The growth of private hospitals escalated after a market-oriented reform was implemented in 2001. Through an experimental approach, this study aims to a better understanding of the dynamic change in preference of health care utilisation among the residents in urban China.

Methods

Based on a discrete choice experiment (DCE) from a random sample of respondents in urban China, the study evaluated preference over health care attributes affecting individuals’ choice for the utilisation of hospital health care. The marginal willingness-to-pay for five health care attributes was estimated, including public/private provision of health care, by analysing mixed logit and latent class models.

Results

The results indicated a significantly negative marginal willingness-to-pay for private health care, which was interpreted as representing people’s previous interactions with the health care system. The latent class model further suggested preference heterogeneity across our sample. We found that Hukou type, a typical indicator of socioeconomic background, was significantly related to respondents’ preference for health care utilisation. Permanent urban residents (urban Hukou) valued private health care less; in contrast rural migrants (rural Hukou) were more likely to be indifferent between public/private provision.

Conclusion

Urban residents in China showed a high disposition to obtain health care from the public providers of health care. Our results have implications in the context of the Chinese government attempts to expand the private health care sector in the short term. Policy makers need to consider residents’ preference for health care in health policy development as the preference can only change in the long term.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1829-0) contains supplementary material, which is available to authorized users.

Medical Malpractice in Wuhan, China: A 10-Year Autopsy-Based Single-Center Study

Medical disputes in China are historically poorly documented. In particular, autopsy-based evaluation and its impact on medical malpractice claims remain largely unstudied. This study aims to document autopsy findings and medical malpractice in one of the largest cities of China, Wuhan, located in Hubei Province. A total of 519 autopsies were performed by the Department of Forensic Medicine, Wuhan University School of Medicine, Wuhan, China, over a 10-year period between 2004 and 2013. Of these cases, 190 (36.6%) were associated with medical malpractice claims. Joint evaluation by forensic pathologists and clinicians confirmed that 97 (51.1%) of the 190 claims were approved medical malpractice cases. The percentage of approved malpractice cases increased with patient age and varied according to medical setting, physician specialty, and organ system. The clinico-pathological diagnostic discrepancy was significantly different among various physician specialties (P = 0.031) and organ systems (P = 0.000). Of those cases involved in malpractice claims, aortic dissection, coronary heart disease, and acute respiratory infection were most common. Association between incorrect diagnosis and malpractice was significant (P = 0.001). This is the first report on China's medical malpractice and findings at autopsy which reflects the current state of health care services in one of the biggest cities in China.

A comparison between antenatal care quality in public and private sector in rural Hebei, China

Aim

To evaluate the quality of antenatal care (ANC) in Hebei Province and compare it between the public and private sector and within the public sector.

Methods

We conducted a Maternal, Newborn and Child Health Household Survey in 2010 using a two-stage sampling procedure and included 1079 mothers. The quality of ANC was assessed on the basis of the number of ANC visits, the time of the first ANC visit, 16 different ANC procedures, owning a maternal health care booklet, and the type of service provider.

Results

Almost all women (98%) received ANC services at least once, 80% at least four times, and 54% at least five times. About half of the women (46%) visited ANC facility within their first trimester. Neither public nor private sector provided all 16 standardized services, but significantly more women in public sector received ANC procedures. Most women received ANC in county or higher-level hospitals (75%) and very few in township hospitals (8%). Significantly fewer women were weighed and tested for HIV/AIDS in township than in county or higher-level hospitals.

Conclusion

The quality of ANC in Hebei was poorer than required by China’s national and World Health Organization norms. Although the public sector performed better than the private sector, the utilization and quality of care of ANC services in this sector varied and women generally visited county or higher-level health facilities.