Comparing public and private hospitals in China: Evidence from Guangdong

Abstract

BackgroundThe literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care.MethodsWe analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes.ResultsCompared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix.ConclusionsIn combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of hospital ownership type.

Comparing public and private emergency departments in China: Early evidence from a national healthcare quality survey

“…Tang et al, for example, reported that the number of private hospitals rapidly increased since 2001 and the yearly growth rate is approximately 205, for all types of private hospital. However, these studies either covered only a single province in China or focused primarily on specialties other than emergency medicine . To the best of our knowledge, this is the first national study using data from 31 provinces reporting private ED status in mainland China.…”

Performance of private sector health care: implications for universal health coverage

“…A recent study of the costs of surgery in India, for example, found the lowest costs in departments with high caseloads regardless of whether ownership was public, charitable or private (30). Data on hospital bed size are patchy and , but consistently show low hospital bed numbers in private hospitals (for example Kutty (31)) find average bed sizes of 26 and 34 in private hospitals in Kerala in 1986 and 1995 respectively; and a study of hospitals in Guangdong province in China found that private for-profit hospitals had an average of 66 beds compared to 256 in the public sector (32).…”

Submerged discontent and patterns of accommodation: a case study of doctors' pay in two public hospitals in China

“…This has forced hospital management to allocate medical resources with greater reliance on market environment, and maintain qualified service despite the declining government funding (Pei et al ., : 104). For example, a survey found that in 2009, 40% to 50% of Chinese hospitals' revenue came from drug sales (Eggleston et al ., ). As a result of the marketization, hospitals' payment systems have been changing.…”