Pediatrics Hospital Care in China Before and After Policy Change: A Case Study (original) (raw)
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Health Policy, 2004
During the transition from a centrally planned to a market economy, China's urban health insurance system is being reformed. The control of the rapidly increasing hospital expenses will be a major determinant of the success of the reform. This study aims to examine the impact of the reform on hospital charges by comparing changes between two cities with different insurance systems and identifying determinants for those changes. Data was collected from six hospitals in two cities, one city implemented an urban health insurance reform, the other did not. Acute appendicitis and normal childbirth were used as tracers for calculating hospital charges. Methods included the retrospective review of medical records, interviews with health policy makers and hospital staff, focus group discussions, and the review of hospital and health insurance documents. The results showed that hospital charges per case of acute appendicitis and childbirth increased 101 and 94%, respectively, in the city without reform, and 41 and 34% in the city with reform, between 1995 and 1999. Health insurance arrangements and average LOS were the major determinants for hospital charges. Drugs and non-pharmacological treatments were the major service categories for charge containment. The combined measures of a single insurer, selective contracts, a new payment system, and use of an essential drug list, is regarded as the key features for an effective hospital charge control, and would appear to be successful measures for hospital expenditure containment within health insurance reform.
The Lancet Global Health, 2013
Background Limited access to essential medicines is a global problem. Improving availability and aff ordability of essential medicines is a key objective of the National Essential Medicine Policy (NEMP) in China. In its initial implementation in 2009, the NEMP targeted primary hospitals with policies designed to increase availability of essential medicines and reduce patients' economic burden from purchasing medicines. We assessed medicine availability and price during the early years of the health reform in Shaanxi Province in underdeveloped western China.
Journal of Health Care Finance, 2014
Background Since the market economy reform healthcare expenditures have escalated in China, especially out-of-pocket payments. A new policy intervention begun in 2005, aimed to reshape the health care system. Objectives To examine effects of the new health care reform on hospital performance and patients' economic burdens in China, and provide evidence of the need for further public hospital reform in China. Methods Discharge records from 2005-2011 in a tertiary cancer hospital were abstracted. Changes in total charges, revenue structures, length of hospital stay and illness burden of patients were analyzed. Results During the seven-year period, total charges per discharge increased at a cumulative growth rate of 7.0%, which was far slower than that of the local GDP (105.9%). The hospital volume increased by 138.9%, annual revenues grew by 206.4%, and average length of stay declined by 28.4%. Prescription drugs accounted for 60.2% of the revenues. The ratio of total hospital charges to the per capita annual disposable income decreased from 1.38 to 0.84, and the percentage of out-of-pocket payment was reduced by 20 percent. Similar trends were observed in the national statistics. Conclusions The new health reform policy showed positive effects on alleviating both hospital operation and patients' economic burden; however, only short-term effects on containing the increase in total charges of hospitalization were observed. The highest proportion of hospital revenues was generated from prescription drugs, and the lowest proportion from bed fees and nursing fees which remained virtually unchanged. More effective approaches are merited to adjust hospitals' revenue structure and make hospital care more efficient.
International Journal for Equity in Health, 2013
Background China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000–2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Methods Health expenditures data came from the China National Health Accounts study in 1990–2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure pe...
China's health care reform: A tentative assessment
China Economic Review, 2009
China has recently unveiled an ambitious new health-care reform plan, entailing a doubling of government health spending as well as a number of concrete reforms. While the details of the plan have not yet been completely announced, we offer a preliminary assessment of how well the reform is likely to achieve its stated goal of assuring every citizen equal access to affordable basic health care. The reform is based on three fundamental tenets: strong role of government in health, commitment to equity, and willingness to experiment with regulated market approaches. Within this framework, the reform offers a number of laudable changes to the health system, including an increase in public health financing, an expansion of primary health facilities and an increase in subsidies to achieve universal insurance coverage. However, it fails to address the root causes of the wastes and inefficiencies plaguing China's health care system, such as a fragmented delivery system and provider incentives to over-provide expensive tests and services. We conclude that China should consider changing the provider payment method from fee-for-service to a prospective payment method such as DRG or capitation with pay-forperformance, and to develop purchasing agencies that represent the interests of the population so as to enhance competition.
China's health system and its reform: a review of recent studies
Health Economics, 2009
This paper provides a survey of the recent empirical research on China's ‘old’ health system (i.e. prior to the spate of reforms beginning in 2003). It argues that this research has enhanced our understanding of the system prior to 2003, in some cases reinforcing conclusions (e.g. the demand-inducement associated with perverse incentives) while in other cases suggesting a slightly less clear storyline (e.g. the link between insurance and out-of-pocket spending). It also concludes that the research to date points to the importance of careful evaluation of the current reforms, and its potential to modify policies as the rollout proceeds. Finally, it argues that the research on the pre-2003 system suggests that while the recently announced further reforms are a step in the right direction, the hoped-for improvements in China's health system will far more likely occur if the reforms become less timid in certain key areas, namely provider payments and intergovernmental fiscal relations. Copyright © 2009 John Wiley & Sons, Ltd.
Wide Coverage, Narrow Impact: China's Health Care Reforms 2009-2011
With three decades of rapid economic growth behind them, China is now facing many social consequences of uneven development. The introduction of the market economy, changes in political leaders as well as the decentralization of state roles have drastically transformed the way welfare is distributed. The marketization and commodification of health care over time have created large health disparities not only between the rich and poor but also the rural and urban.