Reshaping public hospitals: an agenda for reform in Asia and the Pacific

Impact of provincial economic development levels on public-private hospital co-development in China: an empirical analysis

INTRODUCTION

The co-development of public-private hospitals in China's healthcare system significantly influences the system's service utilisation, but the public-private hospital interaction is poorly understood. Bridging this knowledge gap is crucial for informed policy-making and promoting a more balanced healthcare system. This study measures China's public-private hospital co-development and the impact of provincial and regional economic development levels on public-private hospital co-development.

METHODS

We use service utilisation, a comprehensive measure of resource allocation, service capacity and service efficiency, to assess the co-development of China's public and private hospitals. Using the coupling coordination degree model, a novel approach borrowed from physics, we measured the degree of interaction between the public and private pillars of China's hospital system. Second, we measured the relationship between the degree of private-public hospital interaction and the level of provincial-regional economic development, including provincial direct and spillover effects. Data were collected on 2011-2021 service utilisation across 31 Chinese provinces. Fixed-effect models and the spatial Durbin model estimated the direct and spillover effects between the coupling coordination degree and the level of provincial economic development.

RESULTS

We found that national, regional and provincial service utilisation in private hospitals expanded, while service utilisation remained constant in public hospitals. China's private-public hospital co-development improved from the 'barely co-developed' (0.696 in 2011) to the 'partially co-developed' level (0.752 in 2021) in the public-private transitional co-development stage. We identified significant regional heterogeneity, with the eastern region co-development slightly better than the central region and both substantially better than the western region. There was also significant provincial heterogeneity. Increases in regional and provincial economic development promoted the service utilisation of private hospitals, improving the balanced co-development of public-private hospitals in the home and adjacent provinces (p<0.05).

CONCLUSIONS

To improve the co-development of public-private hospitals and avoid regional imbalances, regional and provincial hospital policies and regulations should be coordinated and equitable; private hospitals should cooperate with public hospitals through their professional management teams and medical equipment sharing to equalise medical resource allocations; and regional economic disparities should be addressed.

Hospital services under public-private partnerships, outcomes and, challenges: A literature review

Public-private partnerships (PPP) is used to advance health service access and quality. PPP implementation in hospitals is vital to shorten the service and quality gap. Hospitals are the most significant health budget spender, and this study aimed to identify the PPP effect on hospital performance indicators and its implementation challenges. Thirty-three inclusive articles were filtered and collected from Pubmed, ScienceDirect, Medline, and Sage Publication databases. Results showed that various articles succeeded in implementing PPP and improving the access and quality of health services. Several hospital performance indicators such as diagnosis, therapy, service waiting time, length of stay, referral rate, mortality rate, and patient satisfaction were reported to show better results. However, there was insufficient evidence to say the same on related financial indicators. Policy, resource, communication and trust, risk, and evaluation monitoring were considered challenges in PPP implementation. Its success was not only influenced by major factors such as governance model, finance, politics, and social but also was influenced by the medical practice model applied within the organization. This study contributed to whether PPP affects the hospital performance indicators.

40 years after Alma-Ata, is building new hospitals in low-income and lower-middle-income countries beneficial?

Public hospitals in low-income and lower-middle-income countries face acute material and financial constraints, and there is a trend towards building new hospitals to contend with growing population health needs. Three cases of new hospital construction are used to explore issues in relation to their funding, maintenance and sustainability. While hospitals are recognised as a key component of healthcare systems, their role, organisation, funding and other aspects have been largely neglected in health policies and debates since the Alma Ata Declaration. Building new hospitals is politically more attractive for both national decision-makers and donors because they symbolise progress, better services and nation-building. To avoid the ‘white elephant’ syndrome, the deepening of within-country socioeconomic and geographical inequalities (especially urban–rural), and the exacerbation of hospital-centrism, there is an urgent need to investigate in greater depth how these hospitals are integrated into health systems and to discuss their long-term economic, social and environmental sustainability.