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- Meng, Qingyue
(författare)
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Health care pricing and payment reforms in China : the implications for health service delivery and cost containment
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- China's transition into a market economy has exerted some influence on the health sector in terms of a significant growth of facilities, but it has also produced a range of destabilizing social costs. This thesis analyzes the relations between healthcare pricing and payment reforms and the different delivery aspects such as the exemption program for the poor, public health programs for tuberculosis control and the provision of hospital services. A health economics and systems conceptual framework is used for analyzing aspects of the health systems in terms of market failures and the institutional response from governments and regulators. In study I, the exemption programs for hospitals where the poor are relieved of paying the price or user charges are analyzed. The study is a case study where patient records from nine hospitals were reviewed, together with interviews with key informants and community representatives. The study showed that the discount offered was limited, where only a minority of indigents received discounts and the hospitals lacked incentives for efficiently carrying out the programs. Study II investigates the effect of the new urban health insurance system on hospital charges. The study uses two tracers, acute appendicitis and normal childbirth, at six hospitals from two cities with different insurance systems. The result showed a lower rate of increase in hospitals charges in the city implementing the urban health insurance reform. Regression analysis showed contracting mechanisms and length of stay to be the main determinants for hospital charges. Study III analyzes the operation of TB control programs in a decentralized financial system. A case study was conducted in four counties with different economic developments in the Shandong province. Data was collected from a review of documents and interviews with patients and key informants. The study showed weak government support to the TB control program and less developed DOT (directly observed therapy) programs in the poorer counties. TB patients suffered heavy financial burdens. The decentralized financing system had negatively affected the provision of public health programs such as TB control programs. In study IV, the impact of retail price control of drugs on hospital drug expenditures was examined. The study is a case study at two hospitals. Total drug expenditures were analyzed based on financial records and a tracer, cerebral infarction, was used for an in-depth examination of prices, volume, expenditures and rationality of drug use. Findings showed that after the implementation of the drug pricing policy, total drug expenditures increased as rapidly as before. Drug expenditure per patient for cerebral infarction showed indistinct results, indicating that the regulation was not effective. Utilization rather than price was more determinative for drug expenditures. Study V investigates the development of revenues, costs and performance in the hospital sector. In a sample of 41 hospitals in two cities, the use of inputs, investments and productivity was estimated. The findings showed that hospitals had expanded their staff and invested in new medical equipment. The corresponding change of outputs in terms of outpatient and inpatient performance showed a slower increasing rate, resulting in a diminishing productivity rate over time. The market-oriented health care system in China is faced with different 'market failures' problems such as limited access to health services for the poor and the inaccuracy in relying on market mechanisms for services characterized by positive externalities, such as the public health programs. Financial autonomy has given health providers the incentives to maximize revenues. Government interventions to contain costs and improve efficiency show that a sole reliance on the price mechanism is insufficient and must be combined with other tools set by regulators and insurers.
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| 3. |
- Yu, Baorong, et al.
(författare)
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Analysis of health care utilization in rural Shandong and Ningxia
- 2008
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Ingår i: Chinese Health Economics. ; 27:8, s. 26-28
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Tidskriftsartikel (refereegranskat)abstract
- Study of the sickness prevalence state and utilization of health care for last four weeks for 22,636 rural inhabitants from Shangdong and Ningxia provinces. For last four weeks, 32.8% of the sick inhabitants had visited a health institution, and age, occupation, and education status are factors that affect visiting a doctor or not. Village clinic was the most frequently visited health institution for its geographic convenience; good quality of health care or having an acquaintance was the main reason for selecting township health center, secondary or tertiary hospital; low price was the main reason for selecting a private institution and few people perceived the price in village clinic was low or the quality was good. The mean medical cost of out-of-pocket was 280.0 Chinese Yuan per visit, and accounted for 7.7% of annual net income and 8.7% of annual non-food expenditure per capita. For those fell sick but did not take any measure, 15.9% was because of economic barrier; 9.2% of the outpatients were recommended taking inpatient care, but had not. For outpatients recommended taking inpatient care but had not, 69.7% of them were for economic barrier. Neither the new cooperative medical scheme nor medial aid mechanism has resolved the problem of access to health care.
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