Public hospital reform, family health consumption and health inequality: evidence from China Family Panel Studies.

Background: In 2017, China launched a comprehensive reform of public hospitals and eliminated drug markups, aiming to solve the problem of expensive medical treatment and allow poor and low-income people to enjoy basic health opportunities. This study attempts to evaluate the policy impact of public hospital reform on the health inequality of Chinese residents and analyze its micro-level mechanism from the perspective of household consumption structure. Studying the inherent causal connection between public hospital reform and health inequality is of paramount significance for strengthening China's healthcare policies, system design, raising the average health level of Chinese residents, and achieving the goal of ensuring a healthy life for individuals of all age groups. Methods: Based on the five waves of data from the China Family Panel Studies (CFPS) conducted in 2012-2020, We incorporates macro-level statistical indicators such as the time of public hospital reforms, health insurance surplus, and aging, generating 121,447 unbalanced panel data covering 27 provinces in China for five periods. This data was used to explore the impact of public hospital reform on health inequality. Logical and empirical tests were conducted to determine whether the reform, by altering family medical care and healthy leisure consumption expenditures, affects the micro-pathways of health inequality improvement. We constructed a two-way fixed model based on the re-centralized influence function (RIF_CI_OLS) and a chained mediation effects model to verify the hypotheses mentioned above. Results: Public hospital reform can effectively improve the health inequality situation among Chinese residents. The reform significantly reduces household medical expenses, increases healthy leisure consumption, promotes the upgrading of family health consumption structure, and lowers the health inequality index. In terms of indirect effects, the contribution of the increase in healthy leisure consumption is relatively greater. Conclusion: Public hospital reform significantly alleviates health inequality in China, with household health consumption serving as an effective intermediary pathway in the aforementioned impact. In the dual context of global digitization and exacerbated population aging, enhancing higher education levels and vigorously developing the health industry may be two key factors contributing to this effect.

Influence of public hospital reform on public health: Evidence from a quasi-natural experiment in China.

Public health is an important symbol of national wealth and prosperity. At present, China's public health is hindered by the poor management of public hospitals, which impacts the demographic structure and socioeconomic development. Therefore, taking the implementation of public hospital reform in China as a quasi-natural experiment, this study employed the time-varying DID model and the mediating effect to evaluate the influence of public hospital reform on public health. The results were as follows: (1) Public hospital reform can significantly improve public health, and a series of robustness tests have also confirmed the effects; (2) Government's financial support is a transmission mechanism for public hospital reform to promote public health; (3) After taking control variables into consideration, the effect of public hospital reform is stronger in the western region with a poorer economy. This research provides a vital policy reference for promoting the scope of reform and improving the health of the general public.

The impacts of public hospital comprehensive reform policies on hospital medicine cost, revenues and healthcare expenditures 2014-2019: An analysis of 103 tertiary public hospitals in China.

Objective: To explore the impact of implementation of the comprehensive public hospital reform policy (CPHRP) on medicine costs, revenues and medical expenditures in tertiary public hospitals in China. Methods: The data of this study was collected from local administrations to obtain operational data of healthcare institutions and medicine procurement data for 103 tertiary public hospitals from 2014 to 2019. The propensity matching score method and the difference-in-difference method were used jointly to assess the impact of reform policies on tertiary public hospitals. Results: After the implementation of the policy, drug revenue in the intervention group decreased by ¥ 86.3 million (p = 0.076) compared to the control group; medical service revenue increased by ¥ 108.5 million (p < 0.001); government financial subsidies increased by ¥ 20.3 million (p = 0.085); the average medicine cost per outpatient and emergency visit decreased by ¥ 15.2 (p = 0.062); the average medicine cost per hospitalization decreased by ¥ 504 (p = 0.040); however, the medicine cost decreased by ¥ 38.2 million (p = 0.351), the average cost per visit for outpatient and emergency decreased by ¥ 0.562 (p = 0.966), the average cost per hospitalization decreased by ¥ 152 (p = 0.844), which are not significant. Conclusions: The implementation of reform policies has changed the revenue structure of public hospitals; the proportion of drug revenue decreased, while the proportion of service income increased, especially in service income and government subsidies. Meanwhile, the average medicine cost of outpatient, emergency, and inpatient visits per time were all reduced, which played a certain role in reducing the disease burden of patients.

Intended and unintended impacts of the comprehensive reform of urban public hospitals: A mixed-method study in Hangzhou, China.

Objectives: Public hospital reform is a key area in the Chinese healthcare system reform with the aim of controlling excessive growth of medical expenditures. This study aims to evaluate the impacts of two rounds of urban public hospital reforms respectively starting in 2018 and 2019. Method: A mixed-method method was conducted in Hangzhou. In the quantitative phase, monthly data covering 7 provincial, 12 municipal, and 35 district hospitals from March 2017 to June 2020 was analyzed using a panel-interrupted time-series. Thematic content analysis was conducted using qualitative data collected from 32 in-depth interviews. Results: Quantitative data showed a considerable reduction in the proportion of drug revenue (provincial hospitals: -4.937%; municipal hospitals: -2.765%; district hospitals: -2.189%) and an increase in the proportion of consumable (provincial hospitals: ß 2 = 2.025; municipal hospitals: ß 3 = 0.206) and examinations (provincial hospitals: ß 2 = 1.354, ß 3=0.159; municipal hospitals: ß 2 = 1.179) revenue after the first reform. In post-reform 2, The respective instant decrease and increase in the proportion of consumable (provincial hospitals: -2.395%; municipal hospitals: -0.898%) and medical services (provincial hospitals: 2.115%; municipal hospitals: -2.604%) revenue were observed. Additionally, quantitative and qualitative data indicated inpatient expenditures dropped considerably after the reform. However, insufficient compensation for medical services and increased financial pressure on hospitals were repeatedly mentioned as unintended consequences in qualitative interviews. Conclusions: Overall, the urban public hospital reforms in China created positive effects in adjusting hospital revenue structure and constraining soaring medical expenditures. Unintended consequences remind policymakers to establish rational and dynamic compensation mechanisms for public hospitals.

Impacts of price changes on public hospital reforms in China: evidence from 25 million patients at tertiary hospitals.

China's public hospital price change reform was progressively piloted at urban-level tertiary hospitals in 2015, aiming to adjust the healthcare expenditure structure, reorient public hospitals towards social objectives and control inflated healthcare expenditure. This study investigates the impacts of price changes on inpatient expenditure, service quantity, quality and efficiency and whether the impacts varied in different specialities, treatments and hospitals. A difference-in-differences analysis was conducted using data from 25 million patients from 124 nationally representative tertiary hospitals between 2013 and 2018. The study analyses changes in total expenditure, drug, medical services and diagnostic test/medical consumables expenditure per admission, the use of antibiotics, performed surgery, readmission within 30 days and length of stay (LOS). These factors are examined before and after adjusting the price changes for demographic, socioeconomic and clinical covariates. The price changes decreased drug expenditure per admission (-13.5%, P < 0.001, USD 96.6) and increased medical services expenditure per admission (30.9%, P < 0.001, USD 153.3). They also reduced the LOS (-1.2%, P = 0.019, 0.1 days) while not significantly affecting total expenditure per admission, diagnostic test/medical consumables per admission and the use of antibiotics, surgery performed and readmission rates. In heterogeneity analysis, price changes reform increased efficiency in major diagnostic categories (MDCs) with high drug share and improved quality in nonoperating room surgical groups and hospitals with high drug share; however, it increased total expenditure in MDCs with low drug share or surgical groups. China's public hospital price change reform generally adjusted the inpatient expenditure structure and reduced the LOS in tertiary public hospitals. Sufficient compensation from medical services and government subsidies that minimize the income effects may be the key to the success of price change reform.

Changes in efficiency of tertiary public general hospitals during the reform of public hospitals in Beijing, China.

BACKGROUND: In March 2009, the Chinese government formally launched a new round of healthcare reform. As the city with the highest concentration of high-quality medical resources in China, in the past 10 years, Beijing has also been exploring medical reforms. This article studied the performance and development of the 10 tertiary general public hospitals managed by Beijing Municipal Hospital Management Centre to provide policy basis for further deepening Beijing public hospital reform and improving hospital efficiency. METHODS: The 2011, 2015 and 2018 'Beijing Health Work Statistics' were used to evaluate the performance of Beijing's tertiary public general hospitals, based on the Pabon Lasso model and the data envelopment analysis (DEA) model. RESULTS: Based on the Pabon Lasso model, 60%, 70% and 70% of the hospitals were entirely efficient (zone 3) in 2011, 2015 and 2018. It shows that among the 10 general public hospitals in Beijing, efficient hospitals accounted for the majority and further increased during the reform period. The DEA model further illustrates this point and shows more effective hospitals (80%) than the Pabon Lasso model, showing the efficiency of these hospitals to be improved during the reform period. CONCLUSIONS: The efficiency of the 10 hospitals has gradually improved during the reform period, and the difficulty of seeing a doctor in Beijing at a national medical centre has been relieved to a certain extent. Combining the Pabon Lasso model and the DEA model can analyse hospital efficiency more comprehensively, and can prompt initial information for improving hospital efficiency, but the results also reflect some problems.

Satisfaction with Public Hospital Reform and Associated Factors Among Medical Staff: A Cross-Sectional Survey in Wuhan, China.

PURPOSE: To assess whether medical staff are satisfied with public hospital reform and its influencing factors. METHODS: A sample of 2000 medical staff from 13 public hospitals in Wuhan were surveyed with a self-administered questionnaire. Descriptive analysis and binary logistic regression were conducted to identify the status of the medical staff's attitude to the reform and the influencing factors. RESULTS: A total of 61.4% of medical staff satisfied with the reform and the main reason was the promotion of their practice environment and social status brought by the reform. The logistic regression model indicated that the attitude to the reform of medical staff was positively associated with 9-11 hours of daily working time (OR = 2.373, as compared with less than 8 hours), higher income (OR = 1.966), the occupation of the nurse and medical technician (OR = 2.196-1.464 as compared with the doctor) as well as negative attitude towards the effectiveness of reform (OR = 3.676). CONCLUSION: More than half of medical staff are satisfied with the public hospital reform, while some still hold negative attitude to the reform because of the extra working hours, low salary and high expectations due to professional characteristics and high input costs (education and time). Thus, in the current epidemic of prevention and control, more attention should be paid to the work pressure and enthusiasm of medical personnel. Administrators should pay attention to increasing income and improving the practicing environment and social status to prevent medical staff from treating reforms negatively.

Practice of constructing high-quality hospital in Zhejiang Provincial People′s Hospital / 中华医院管理杂志

The construction of high-quality public hospitals is the key to the construction of high-quality and efficient medical service system. The authors introduced the implementation of " 1+ 5″ engine-driven high-quality transformation development strategy in Zhejiang Provincial People′s Hospital, that is, adhering to the party building to lead the development of the hospital, and formulating measures to build a high-quality hospital from the five aspects of quality and safety, operational efficiency, brand influence, innovation driven and sustainable development, so as to provide some reference for other hospitals′ high-quality development.

Impact of public hospital pricing reform on medical expenditure structure in Jiangsu, China: a synthetic control analysis.

BACKGROUND: The synthetic control method (SCM) is a useful tool in providing unbiased analysis on the policy effect in real-world health policy evaluations. Through controlling for a few confounding factors, we aim to apply SCM in analyzing the impact of the pricing reform on medical expenditure structure in Jiangsu Province, China. METHODS: We constructed a synthetic control for Zhenjiang, a city where the reform was piloted in Jiangsu, by selecting weights on those potential control units to define a linear combination of the control outcomes to replicate the counterfactual as if the intervention is in absence. The policy effect was measured by the differences in the percentage of drug expenditure among average outpatient and inpatient care cost per visit in the post-policy period between Zhenjiang and its synthetic control. We also examined the significance of the estimated results by performing placebo tests, and cross-validated the results with a difference-in-differences analysis. RESULTS: The medical pricing reform was found to be effective in reducing the drug expenditure proportions in both outpatient and inpatient care by an estimated mean level of 7.7 and 3.2% (or 16.3 and 9.2% relative decrease to their 2012 levels) respectively. This reform effect was estimated to be significant in the placebo tests and was further confirmed by a cross-validation. CONCLUSION: We conclude that the pricing reform in public hospitals has significantly reduced drug expenditure incurred in both outpatient and inpatient care. This study also highlights the applicability of SCM method as an effective tool for health policy evaluation using publicly available data in the context of Chinese healthcare system.

What do patients care most about in China's public hospitals? Interviews with patients in Jiangsu Province.

BACKGROUND: Evaluations on different aspects of the performance of public hospitals in China have been conducted, usually based on indicators developed by literature review and expert suggestions. The patient perspective was not always considered. This study aims to identify what patients care most about in China's public hospitals exclusively from a patient perspective. METHODS: A mix of stratified sampling and typical sampling was used to select 15 public hospitals in Jiangsu Province of China. In each sampled hospital, a convenient sample of six outpatients and six inpatients was selected to conduct face-to-face individual interviews. An interview guide consisting of six open-ended questions was designed. Donabedian's quality of care framework was applied to categorize themes and subthemes, which were generated from patients' interviews by using the conventional content analysis approach. Frequencies of themes and subthemes were counted. RESULTS: Nine key themes were identified regarding patients' concerns about hospital care, which were environment and facilities, professional competence, hospital reputation, and morals of medical staff in the "structure" category of Donabedian's framework, caring attitudes and emotional support, medical costs, communication and information, and efficiency and coordination of care in the "process" category, and health outcomes in the "outcome" category. CONCLUSIONS: This study has identified and prioritized the aspects that patients care most about in China's public hospitals in Jiangsu Province exclusively from a patient perspective. A measurement tool of patient-reported experiences in public hospitals could be built based on this study. Efforts should be made to represent the patient perspective to further improve the reform of public hospitals in China.

Preliminary exploration on state-owned capital in the reform of state-owned corporate hospitals / 中华医院管理杂志

State-owned capital not only had the social public welfare characteristic, but also the vitality and driving force of capital. In this research, Zhejiang Medical and Health Group was studied based on analyzing questions of state-owned corporate hospitals. We also introduced practice and effectiveness of state-owned capital in the reform of 3 state-owned corporate hospitals in this group. This paper aimed to explore a new way for state-owned capital to participate in public hospital reform. At the same time, it also provided suggestions for the transformation and development of state-owned corporate hospitals.

Modern hospital management system in a new era:Evolving pathways and policy linkings / 中国卫生政策研究

The paper categories the modern hospital management and finds that there is an important and in-ner-relationship between the paper documents on public hospital reform and the policies on modern hospital manage-ment system construction. Secondly, it seems to be appropriate to coordinate the relation between deepening health reform and social governance in the pathway of modern hospital management system. Hence,this paper puts forward a series of countermeasures to address the difficulties.(1) Scientifically balancing the issues on unification and legaliza-tion with the reform and the system are raised;(2) The introduction of rules and implementation measures are men-tioned;(3) Guideline should be specialized to different hospital properties; (4) Non-public medical sector need more exploration;(5) The adaption and capacity of governance and government transformation are required.

Investigation and Evaluation on the Implementation Situation of Financial Information Disclosure Policy for Public Hospitals in Pilot Cities / 中国卫生经济

Objective:To investigate and evaluate the status of financial information disclosure in public hospitals.Methods:Taking the method of policy analysis,descriptive statistics,consult the relevant policy and the hospital website of 200 countries for public hospital reform pilot cities,sum up the change trend and implementation status of public hospital financial information disclosure regulation policy from 2006 to 2017.Results:There were obvious differences in public financial information in public hospitals from various regions,only 130 hospitals(65％) disclosed financial information in the website,the goal of "hospitals in comprehensive reform of all urban public hospitals should disclose financial information to the public by the end of 2016" was not fully achieved,the standardization and comparison of financial information was not high.Conclusion:In order to achieve the goal of "opening the financial information disclosure system to all public hospitals and all regions in China by the end of 2018",it suggested to integrate the existing documents,combined with the beneficial practices in pilot cities,unified public hospital financial disclosure guidelines and perfect supporting measures for policy implementation.

Effects of Public Hospital Reform on Inpatient Expenditures in Rural China.

Public hospital reform is one priority area in the healthcare system reform that China launched in 2009. The Chinese government invested over $10bn for pilot projects in public hospital reform in rural China. However, little evidence exists on their effects. Using a quasi-natural experiment design, we evaluated the effects of a public hospital pilot project in Hubei province on inpatient spending. We obtained inpatient claims data from 1/1/2011 through 6/30/2013 for enrollees in the New Cooperative Medical Scheme in two counties: Danjiangkou, one of the pilot counties selected for reform in September 2012, and Laohekou, a similar, adjacent county serving as the control group. Using a difference-in-differences approach with propensity score weighting, we found that total inpatient spending increased ¥1160 (95% CI 1155-1166), out-of-pocket spending increased ¥385 (95% CI 382-389), length of stay increased 0.51 days (95% CI 0.50-0.52), but inpatient medication spending decreased ¥147 (95% CI 145-150), post-policy in Danjiangkou, relative to the control group. The overall reimbursement rate increased by 5.7 percentage points. One of the goals of the recent public hospital reform is to make inpatient services affordable to patients. We found that although patients spent less on inpatient medications, total out-of-pocket spending increased considerably after reform. Copyright © 2016 John Wiley & Sons, Ltd.

The status quo and trend of research about hospital performance:A social network analysis based on the periodical data / 中国卫生政策研究

With a combination of the periodical data of the CNKI database,and the literature with the keyword hospital performance,this paper makes a study on statistical analysis and visualization of relevant keywords.This research has found that study of hospital performance covers four areas:the doctor-patient relationship and medical quality,system reform,management innovation,and practice research.Hospital performance research covers three levels:performance management analysis within the hospital,institutional analysis,and analysis of relevant factors.This paper argues that scholars should regard people-oriented as the foothold,and expand research field from the following aspects:the medical insurance payment methods,the hospital linkage and government regulation and so on.

Discussion on controlling proportion of medical consumables / 医疗卫生装备

Objective To explore the method for controlling the proportion of medical consumables.Methods The objective and significance of controlling the proportion of medical consumables were introduced,and the method was analyzed from the aspects of bidding procurement,total control mechanism,administrative approval and involvement in department management by objectives.Results The effective management of medical consumables decreased irrationality and procurement price of medical consumables.Conclusion Controlling the proportion of medical consumables promotes public hospital reform and the economic burden of the patient.

The status quo and trend of research about hospital performance:A social network analysis based on the periodical data / 中国卫生政策研究

With a combination of the periodical data of the CNKI database,and the literature with the keyword hospital performance,this paper makes a study on statistical analysis and visualization of relevant keywords.This research has found that study of hospital performance covers four areas:the doctor-patient relationship and medical quality,system reform,management innovation,and practice research.Hospital performance research covers three levels:performance management analysis within the hospital,institutional analysis,and analysis of relevant factors.This paper argues that scholars should regard people-oriented as the foothold,and expand research field from the following aspects:the medical insurance payment methods,the hospital linkage and government regulation and so on.

Discussion on controlling proportion of medical consumables / 医疗卫生装备

Objective To explore the method for controlling the proportion of medical consumables.Methods The objective and significance of controlling the proportion of medical consumables were introduced,and the method was analyzed from the aspects of bidding procurement,total control mechanism,administrative approval and involvement in department management by objectives.Results The effective management of medical consumables decreased irrationality and procurement price of medical consumables.Conclusion Controlling the proportion of medical consumables promotes public hospital reform and the economic burden of the patient.

Research and Review on Fiscal and Taxation Policie Improvement in the Reform of Public Hospitals / 中国卫生经济

It combed the research progress of public hospital fiscal and taxation policy of international and domestic scholars,summarized the current research,found that the existing research was lagging,scattered,giving priority to qualitative analysis,more confined to the emphasis on increasing financial investment,establishing a link between fiscal subsidies and the results of budget implementation,etc.There was no systematic analysis for the impact of the fiscal and taxation system reform to public hospitals.The reform of public hospitals needed to carry out the research on relevantfiscal and taxation policies,so as to find the problems and come up with policy recommendations on the full implementationof fiscal and taxation system reformrequest for public hospitals.

Evaluating the effectiveness of public hospital reform from the perspective of efficiency and quality in Guangxi, China.

The evaluation of hospital reform effectiveness in health care reform is very important and beneficial since it helps the government to understand the current situation of pilot county public hospitals and smoothly start the reform in all county hospitals. This study used sample hospitals data from 2010 to 2012 to evaluate the effectiveness of public hospital reform through comparisons between 2010 and 2012 in hospital operating efficiency, clinical terminal quality, the average medical expense of patients, patient and medical staff overall satisfaction. The results highlight that there was no improvement in hospitals' operating efficiency, pilot hospitals' clinical terminal quality was lower than its counterpart, and the two objectives had been improved: medical expense control and inpatients' satisfaction, however, nearly 68.46% medical staffs were dissatisfied with the outcomes of the reform in pilot hospitals staff satisfaction. Nevertheless, the reform was helpful to improve the hospital current situation with some of the objectives having been achieved. It has not completely succeeded in Guangxi, China.