Health Service Delivery In China: A Literature Review

Abstract

We report the results of a review of the Chinese-language and English-language literatures on service delivery in China, asking how well China's health care providers perform, what determines their performance, and how the government can improve it. We find current performance leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector, or by simply encouraging providers-public and private-to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid-shifting away from fee-for-service and the distorted price schedule toward prospective payments. Active purchasing by insurers could further improve outcomes.

Towards Universal Health Coverage via Social Health Insurance in China: Systemic Fragmentation, Reform Imperatives, and Policy Alternatives

“…Worse, the absence of third-party checks and balances significantly relaxed the external constraints on provider behaviors and made the incentive structure heavily skewed towards encouraging demand-inducing and profit-seeking behaviors, which are largely responsible for the rapid cost inflation and medical impoverishment in China [11]. Receiving only 10 % of their income from direct government subsidies, Chinese hospitals are forced to strive for financial survival by drawing from patients' pockets.…”

Does hospital competition improve health care delivery in China?

“…Following the economic reforms, private sector participation in China's health care system emerged and grew rapidly (Eggleston, Ling, Qingyue, Lindelow, & Wagstaff, 2008;Eggleston, Shen, Lau, Schmid, & Chan, 2008). However, development of the private health care sector never has been fully realized as public health officials restricted the extent of private capital investments within the system (Liu, 2009).…”

“…Patients are able to self-refer to any provider they prefer and can afford. Since secondary and tertiary hospitals are responsible for providing comprehensive health services as well as medical education and research, the Chinese people believe they provide the highest quality services (Brown & Theoharides, 2009;Eggleston, Ling, et al, 2008;Eggleston, Shen, et al, 2008); this is especially true for tertiary hospitals. Table 1 shows that more than 80% of the services (both inpatient and outpatient) are provided in secondary and tertiary hospitals.…”

The attitude of farmers to the New Rural Cooperative Medical Scheme in Northwest China one year after its introduction: a cross-sectional study

“…Not surprisingly, the facilities are deteriorating further and the utilization rate of township hospitals has been continually decreasing since the 1980s (Martineau et al 2004). As a result, county-level hospitals and municipal hospitals have become overcrowded (Eggleston et al 2008), yet the prices for services at these hospitals are far beyond the common farmer's means. Therefore, there is no doubt that township hospitals should play a greater role in the NRCMS.…”