Clinicians and the governance of hospitals: a cross-cultural perspective on relations between profession and management.

This paper explores similarities and differences in the value stances of clinicians and hospital managers in Australia, England, New Zealand and China, and provides some new insights into how we theorise about the health profession and its relations with management. The paper draws on data derived from a closed-ended questionnaire administered to 2637 hospital-based medical, nursing and managerial staff. We examine variations between the countries in the value orientations of doctors, nurses and managers by considering their assessments of issues that are the focus of reform. In particular, we examine the ways in which the Chinese findings differ from those of the other countries. Whereas the results from the Commonwealth hospitals showed a marked division between clinicians and managers about issues that can affect clinical autonomy, this was not the case in the Chinese hospitals. The concluding discussion traces these differences to a number of cultural, organisational and policy-based factors. The implications of our findings on how we conceive the relationship between professionals and organisations are then discussed, as are further lines of research.

Health care in China: the role of non-government providers.

While China's health services are primarily financed by out-of-pocket spending (private financing), health care providers, especially the hospital industry, are still dominated by state ownership and government control (public provision). Even though the private sector plays an increasing role in the ambulatory sector, private services are not included in the social insurance benefit package, and thus, it primarily serves self-paying patients. The ambiguity of the government policy toward private provision stems from concerns that an increasing private sector would drive up costs and its services may be of questionable quality. This paper tries to gather evidence on the relative performance of private and public sector in China. Neither literature review nor our primary data analysis provides any support for the notion that the private sector charges a higher price and they serve primarily the better-off people. Quite on the contrary, available data seem to suggest that not only the private sector tends to serve disproportionately the low-middle income groups (this may well be due to its relative lower direct and indirect costs), consumer satisfaction also seems to be higher with regards to certain dimensions of the private than public sector.

Number of dishes as an indicator of nutrient intake in China.

The objectives of this analysis are to investigate if counting the number of dishes consumed per day is a rapid procedure for estimating daily nutrient intake in China, and to explore if urban-rural differences exist in the daily number of dishes. A nutritional survey (including dish number counting) was conducted on 499 adult women in six urban and four rural communities in China. The number of dishes was an influential variable in estimating intake of protein, animal protein, fat, animal fat, and some vitamins (e.g., vitamin B2) and minerals (e.g., zinc), but not of energy and carbohydrate. Intake of some nutrients (e.g., protein) was sufficient when people consume more than 10 dishes per day. Thus, the number of dishes is a useful indicator of sufficient intake of animal protein and fat as well as some micro-nutrients. The application of the dish number counting method showed that there was a significant difference between urban (11.9 dishes per day) and rural populations (7.9 dishes).