Impact of adverse media reporting on public perceptions of the doctor-patient relationship in China: an analysis with propensity score matching method.

OBJECTIVES: Numerous studies indicate that the doctor-patient relationship in China is facing serious challenges. This study examined the impact of China Central Television's negative coverage of high medicines prices on both doctors' and patients' opinions of the doctor-patient relationship. SETTING: Data were collected in a national survey conducted during 19 December 2016 to 11 January 2017 which targeted 136 public tertiary hospitals across the country. PARTICIPANTS: All patients and doctors who submitted completed questionnaire were retrieved from the survey database. INTERVENTION: The study used propensity score matching method to match the respondents before and after China Central Television's news report about high medicines prices which was given at 00:00 hours on 24 December 2016. OUTCOME MEASURE: Perception scores were calculated based on the five-point Likert scales to measure the opinions of the doctor-patient relationship. RESULTS: The perception scores of the doctor-patient relationship were significantly affected by the negative media coverage for hospitalised patients, who scored 1.18 lower on the doctor-patient relationship following the report (p=0.006, 95% CI 0.34 to 2.02), and doctors who scored 5.96 points lower on the same scale (p<0.001, 95% CI 4.11 to 7.82). Score for the ambulatory patients was unaffected by exposure to the adverse news report (p=0.05). CONCLUSION: Chinese national media's reporting of adverse news negatively affected the perceptions of the doctor-patient relationship among both inpatients and doctors. A better understanding of the role of mass media in the formation of opinion and trust between doctors and patients may permit strategies for managing the media, in order to improve public perceptions of the doctor-patient relationship.

A review of promoting access to medicines in China - problems and recommendations.

BACKGROUND: Despite recent reforms, distorting funding mechanisms and over-prescribing still maintain severe financial barriers to medicines access in China. Complicated and interrelated problems in the pharmaceutical sector require a common framework to be resolved as fragmented solutions do not work. We present a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and propose policy recommendations for promoting universal access to medicines in China. METHODS: Drawing on multiple sources of information, including a review of published literatures and official national data, field investigations in six provinces and interviews with key opinion leaders, this paper presents a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and proposes policy recommendations for promoting universal access to medicines in China. RESULTS: Public expenditure on medicines has been strictly controlled since the national healthcare reforms of 2009. Yet total pharmaceutical expenditure (TPE) and total health expenditure growth rates continuously outpaced the growth of gross domestic product (GDP). With 2.4% of GDP, TPE now exceeds that of most high income countries. The distorted provider and consumer incentives in the Chinese health system have not fundamentally changed. Price-setting and reimbursement mechanisms do not promote cost-effective use of medicines. Inappropriate price controls and perverse financial incentives are the un-resolved root causes of preference of originator brands for some major diseases and shortages of low-cost and low-consumption medicines. In addition, access to expensive life-saving medicines is yet systematically addressed. CONCLUSIONS: The complicated and interdependent problems interact in a way that leads to significant system problems in China, which create dual challenges that both the developing country and the developed countries are facing. To further promote access to medicines, China should speed up the re-assessment of the quality and efficacy of domestically produced generic medicines; coordinate various reforms of price determination, insurance payments, and procurement policies; address medicine shortages through comprehensive policies and legislation; establish specific mechanisms to achieve sustainable equitable access to expensive essential medicines with health technology assessment as a tool to ensure that policy and priority setting are created in a coherent and evidence-based way.

Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study.

BACKGROUND: It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients' satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods. METHODS: We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05. RESULTS: The monthly average length of waiting time decreased 3.49 min (P = 0.003) for consultations and 8.70 min (P = 0.02) for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P =0.003). There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services (r = -0.71, P = 0.004). CONCLUSIONS: The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives implemented by a taskforce authorized by the hospital managers. This case provides a model of carrying out continuous quality improvement and optimizing management process with the support of relevant evidence.