Emerging issues in public health: A perspective on China’s healthcare system

Ling, Rebecca E.; Liu, F.; Lu, Xiaoqin; Wang, Wei

doi:10.1016/j.puhe.2010.10.009

Cited by 78 publications

(64 citation statements)

References 16 publications

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“…Moreover, consequent to the rapid development of the economy and urbanisation in China, many young adults migrate from rural to urban areas for work. 60 Most of this population was engaged in the New Rural Co-operative Medical Care System (NRCMCS) in local areas, 65 but are no longer entitled to with urban residency status. Since the NRCMCS only supports reimbursement in local areas, which excludes the floating population, 66 they must pay their own medical expenses.…”

Section: Discussionmentioning

confidence: 99%

Practices and attitudes of doctors and patients to downward referral in Shanghai, China

Nong

et al. 2017

BMJ Open

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ObjectivesIn China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics.MethodsDoctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ2 test and stepwise logistic regression analysis were employed for statistical analysis.ResultsOnly 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population.ConclusionsTo increase the rate of downward referral, the Chinese government should optimise the current referral system and conduct universal publicity for downward referral. Doctors and patients should promote understandings of downward referral. Hospitals should realise the necessity of downward referral, effectively reduce workloads and provide continuing education for doctors. Increasing monetary reimbursement is urgent, as is improving the medical insurance system.

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Section: Discussionmentioning

confidence: 99%

Practices and attitudes of doctors and patients to downward referral in Shanghai, China

Nong

et al. 2017

BMJ Open

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“…The Chinese government has introduced three different types of health insurance in recent years each targeting different populations, with basic coverage reaching over 90% of the population in 2011 (33,(35)(36)(37) and 95% in 2013 (33). The ultimate goal is universal coverage by 2020 (35)(36)(37)(38)(39)(40). As a result of increased coverage, total healthcare expenditure increased from 3.5% to 5% of GDP between 1995 and 2010, equating to a ten-fold increase in per capita spending from US$ 21 to 220 (35).…”

Section: Introductionmentioning

confidence: 99%

Ongoing initiatives to improve prescribing efficiency in China; statins as a case history

Zhang

Godman

et al. 2014

GaBI J

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Introduction: Pharmaceutical expenditure rose by 16% per annum in China during the past decade, and now represents 46% of total health care expenditure. Initiatives to moderate growth include pricing regulations for pharmaceuticals and encouraging INN prescribing. However, there is limited monitoring of physician prescribing and current incentives encourage hospitals and physicians to profit from drug procurement. Objective: Assess changes in statin utilisation and expenditure as additional generics are launched. Subsequently, compare results in China with findings among European countries to provide future guidance. Methods: Observational retrospective study of statin utilisation and procurement expenditure from 2004 to 2013 in two large teaching hospital groups. Results: Statin utilisation rose 32 fold in one hospital group and 54 fold in the other. Expenditure also increased but to a lesser extent, i.e. from just over CNY 0.65 million in 2004 to 15.3 million in 2013 in one hospital group and from CNY 0.49 to 19.3 million in the other. Atorvastatin (originator) was the most utilised statin. Utilisation of each generic statin was typically low, e.g. 10% in 2013 in one hospital group. Procurement prices fell over time, greatest for generic simvastatin (-74 to -91%) mirroring data from European countries. However, no increase in their prescribing was observed. In fact, a significant decrease in generic prescribing was seen in one hospital group between 2004 and 2013. Conclusion: There are considerable opportunities to improve prescribing efficiency in China based on European experience. However, current incentives encouraging hospitals and physicians to profit from drug procurement need to be addressed.

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“…For example, the Chinese government introduced three different types of health insurance in recent years targeting different populations, with coverage reaching over 90% of the population by 2011 [3,[6][7][8], although large disparities still exist [9]. The ultimate goal of the authorities in China is universal coverage by 2020 [6][7][8]10]. As a result of increased coverage, healthcare expenditure increased from 3.5% to 5% of GDP between 1995 and 2010, equating to a ten-fold increase in yearly per capita spending from US$ 21 to 220 [8].…”

Section: Introductionmentioning

confidence: 99%

Ongoing Initiatives in China to Enhance Prescribing Efficiency: Impact and Proposals for Improvement

Zhang

Feng

Campbell³

et al. 2015

J Pharma Care Health Sys

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Background: Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate this growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These measures are principally concentrated in hospitals as they account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives enhances irrational prescribing.

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Emerging issues in public health: A perspective on China’s healthcare system

Cited by 78 publications

References 16 publications

Practices and attitudes of doctors and patients to downward referral in Shanghai, China

Practices and attitudes of doctors and patients to downward referral in Shanghai, China

Ongoing initiatives to improve prescribing efficiency in China; statins as a case history

Ongoing Initiatives in China to Enhance Prescribing Efficiency: Impact and Proposals for Improvement

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