China's ongoing public hospital reform: initiatives, constraints and prospect

Abstract

The first phase of China's ambitious national health-care reform will be concluded in 2011. However, public hospital reform -its central component -has not been proceeding smoothly. Heavy vested interests, enormous budgetary demands and the congested policy gridlock have made it extremely difficult to succeed. Nevertheless, a number of promising initiatives are presently being undertaken and are expected to make substantive progress. This article reviews the process of this ongoing public hospital reform, examines three central initiatives and analyses major constraints. It argues that with the policy gridlock gradually relaxed, governments should embark on the 'strategic purchasing' of medical services and properly control hospital behaviours by revising the heavily distorted incentive structure.

Seeking policy solutions in a complex system: experimentalist governance in China’s healthcare reform

“…The situation well embodies a complex system. The complex interactions among different components often result in a policy gridlock where problem A must be solved in order to solve problem B, but problem B requires a solution to problem C and the solution to problem C depends on finding a solution to problem A (He, 2011 ). In light of these deep complexities, previous health-sector reforms were mostly piecemeal in nature until 2010 (Fu et al, 2017 ).…”

Developing case-mix standards with the Diagnosis-related Groups for payment reforms and hospital management in China: A case study in Xiamen city

“…[32] A multitude of misaligned incentives has driven hospital staff toward overprescribing drugs, abusing high-tech diagnostic tests, and making inefficient uses of other resources. [33,34] Identifying and repairing the leakages are of long-term critical significance for health planning and hospital management; this is one of the core concerns for government, health insurance administration, and hospitals. DRGs have the potential to act as a useful tool for this purpose.…”

Clinical pathways in China – an evaluation

“…Through this landmark reform, the government vows to overhaul a deteriorating system and build a universal replacement by 2020. In particular, top on the reform agenda is containing skyrocketing cost and alleviate the vast public discontent about affordability (He, 2011). However, cost containment, as witnessed elsewhere, is a formidable task for health policy makers, compounded by highly concentrated numerous hard interests and the system's path dependence.…”

“…The CP program is a prominent initiative. Since 2009, CPs have been executed as pilots, steered by the Ministry of Health (MoH).This program is expected to standardize care provision and thus improve service quality and pave the way for alternative payment methods, especially diagnosis-related groups (DRGs) (He, 2011). All public hospitals participating in the pilot are required to set up executive and assessment committees to facilitate implementation.…”