Qualitative analysis of direction of public hospital reforms in China

Abstract

Reforms in public hospitals are among the most important improvements in China’s health care system over the last two decades. However, the reforms that should be implemented in public hospitals are unclear. Thus, a feasible direction of reforms in Chinese public hospitals is suggested and reliable policy suggestions are provided for the government to reform public hospitals. The data used in this study were mainly derived from a qualitative study. Focus group discussions and in-depth interviews were conducted in Shanghai, Guangdong, and Gansu between May and December 2014. Government funding accounted for approximately eight percent of the total annual revenue of public hospitals in China, and the insufficient government subsidy considerably affects the operation mechanism of public hospitals. However, solely increasing this subsidy cannot address the inappropriate incentives of public hospitals in China. The most crucial step in setting the direction of reforms in public hospitals in China is transforming inappropriate incentives by implementing a new evaluation index system for directors and physicians in public hospitals.

Keywords

public hospital / government hospital / public funding / operation mechanism

References

[1] Kikuzawa S, Olafsdottir S, Pescosolido BA. Similar pressures, different contexts: public attitudes toward government intervention for health care in 21 nations. J Health Soc Behav 2008; 49(4): 385–399

[2] Blomqvist A. The doctor as double agent: information asymmetry, health insurance, and medical care. J Health Econ 1991; 10(4): 411–432

[3] O’Neill C, Largey A. The role of quality standards—accreditation in redressing asymmetry of information in health care markets. Health Policy 1998; 45(1): 33–45

[4] Maynard A. Can competition enhance efficiency in health care? Lessons from the reform of the U.K. national health service. Soc Sci Med 1994; 39(10): 1433–1445

[5] Ko M, Derose KP, Needleman J, Ponce NA. Whose social capital matters? The case of U.S. urban public hospital closures and conversions to private ownership. Soc Sci Med 2014; 114:188– 196

[6] Anderson RJ, Boumbulian PJ, Pickens SS. The role of U.S. public hospitals in urban health. Acad Med 2004; 79(12): 1162–1168

[7] Horwitz JR. Making profits and providing care: comparing nonprofit, for-profit, and government hospitals. Health Aff (Millwood) 2005; 24(3): 790–801

[8] Neumann BR. A statistically based method for identifying hospital classification criteria. Public Health Rep 1980; 95(3): 232–242

[9] Liu Y, Rao K, Wu J, Gakidou E. China’s health system performance. Lancet 2008; 372(9653): 1914–1923

[10] Barber SL, Borowitz M, Bekedam H, Ma J. The hospital of the future in China: China’s reform of public hospitals and trends from industrialized countries. Health Policy Plan 2014; 29(3): 367–378

[11] Pan J, Qin X, Hsieh CR. Is the pro-competition policy an effective solution for China’s public hospital reform? Health Econ Policy L 2016; 11(4):337–357

[12] Eggleston K, Lu M, Li C, Wang J, Yang Z, Zhang J, Quan H. Comparing public and private hospitals in China: evidence from Guangdong. BMC Health Serv Res 2010; 10(1): 76–87

[13] Yip WC, Hsiao W, Meng Q, Chen W, Sun X. Realignment of incentives for health-care providers in China. Lancet 2010; 375(9720): 1120–1130

[14] Frølich A, Talavera JA, Broadhead P, Dudley RA. A behavioral model of clinician responses to incentives to improve quality. Health Policy 2007; 80(1): 179–193

[15] Hu S, Tang S, Liu Y, Zhao Y, Escobar ML, de Ferranti D. Reform of how health care is paid for in China: challenges and opportunities. Lancet 2008; 372(9652): 1846–1853

[16] Yueh L. Thirty years of legal and economic reform in China: growth, institutions, and laws. J Chin Econ Bus Stud 2010; 8(2): 117– 132

[17] Lim MK, Yang H, Zhang T, Feng W, Zhou Z. Public perceptions of private health care in socialist China. Health Aff (Millwood) 2004; 23(6): 222–234

[18] Guan X, Qi L, Liu L. Controversy in public hospital reforms in China. Lancet Glob Health 2016;4(4):240

[19] Liu GG,  Vortherms SA,  Hong X. China’s health reform update. Annu Rev Public Health 2017; 38: 431–448.

[20] Zhao DH, Rao KQ, Zhang ZR. Patient trust in physicians: empirical evidence from Shanghai, China. Chin Med J (Engl) 2016;129 (7):814–818

[21] Fang P, Luo Z, Fang Z. What is the job satisfaction and active participation of medical staff in public hospital reform: a study in Hubei province of China. Hum Resour Health 2015; 13(1): 34

[22] Blumenthal D,  Hsiao W. Lessons from the East—China’s rapidly evolving health care system. N Engl J Med 2015; 372(14): 1281–1285

[23] Chen A. Thirty years of Chinese reform: transition from planned economy to market economy. Asian Soc Sci 2009; 5(3): 52–56

RIGHTS & PERMISSIONS

Higher Education Press and Springer-Verlag Berlin Heidelberg