On the supply of China's healthcare resources in a decentralized healthcare system

Zheng, Xunhua; Jing, Wang; Li, Xilu; Yu, Yihua

doi:10.1016/j.soscij.2014.05.003

Cited by 13 publications

(21 citation statements)

References 35 publications

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“…The higher the per capita GDP means a better economic status of an individual province. Generally, a higher level of the economy suggests that the province has priorities in the allocation of health resources and therefore has a better chance of realizing the full utilization of health resources, which would promote the efficiency of the medical service system [ 69 ]. Furthermore, a better development of economy is usually accompanied by a higher level of technology, more research and development investments, which might indirectly promote the growth of efficiency of medical service systems [ 70 , 71 ].…”

Section: Discussionmentioning

confidence: 99%

Equity and efficiency of medical service systems at the provincial level of China’s mainland: a comparative study from 2009 to 2014

Ding

Zhang

et al. 2018

BMC Public Health

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BackgroundThe astonishing economic achievements of China in the past few decades have remarkably increased not only the quantity and quality of medical services but also the inequalities in health resources allocation across regions and inefficiency of the medical service delivery.MethodsA descriptive analysis was used to compare the inequities in inputs and outputs of the provincial medical service systems, a non-radial super-efficiency data envelopment analysis model was then used to estimate the efficiency, and a regression analysis of the panel data was used to explore the determinants.ResultsThe inputs and outputs of most provincial medical service systems increased gradually from 2009 to 2014. Overall, the eastern region allocated more human and capital resources than the other two regions, and produced more than 50% of the total outpatient and emergency room visits, whereas the western region produced more inpatient services (about 30% of the total volume of inpatient services) according to the distribution of the population. The average efficiency scores of the provincial medical systems in China’s mainland were 0.895, 0.927, 0.929, 0.963, 0.977 and 0.968 from 2009 to 2014, with a slight average improvement of 1.60%. The efficiency score of each provincial medical service system varied greatly from one another: Tibet (1.475 ± 0.057) performed extremely well, whereas several others including Heilongjiang (0.579 ± 0.001) performed poorly. Furthermore, the proportion of high-class medical facilities was negatively associated with efficiency, whereas the proportion of the vulnerable population, the per capita Gross Domestic Product, the proportion of the illiterate population and the improvement of primary health care had positive effects on efficiency.ConclusionInequity in health resources allocation and service provision existed across the regions, but not all the gaps have begun to narrow since 2009. The difference of efficiency was great among provincial medical service systems but minor across regions, and the score changed very little over time. More importantly, the central region held the lowest average efficiency score in the past 6 years, while the western region held the largest average efficiency score at the first 5 years, which should receive enough attention of the government and decision-makers. In practice, efficiency was related to many complicated factors, indicating that the improvement of efficiency is a complex and iterative process that requires the strong cooperation of many sectors.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5084-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Equity and efficiency of medical service systems at the provincial level of China’s mainland: a comparative study from 2009 to 2014

Ding

Zhang

et al. 2018

BMC Public Health

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“…This situation has exacerbated the contradiction between resource space allocation and service utilization. Due to the fiscal decentralization system, local governments have reduced healthcare investment [51] ,fiscal transfer payment methods and government budgetary expenditures have become the main ways to improve the allocation of healthcare resources [52] [53] .In recent years, the higher-level government creatively uses the financial transfer payment method, the basic rigid regulations and subsidies for local governments to increase healthcare investment have enabled the level of resource allocation of primary healthcare institutions to be improved. The study found that the impact of economic indicators on the coupling coordination of primary healthcare institutions began to be significant at the 0.1% level in 2018.…”

Section: Discussionmentioning

confidence: 99%

“…The medical service utilization research mainly discusses the bed utilization rate of different levels of health institutions [20] , urban and rural residents' medical service utilization preference [21] and inequality issues [22] . In terms of factors influencing the equity of healthcare resources allocation, local economic level [23] , demographic characteristics [24] , decision-making mechanism [25] , terrain conditions [16] , information asymmetry and adverse selection [26] are considered to be the main factors. In terms of factors influencing the equity of utilization of healthcare services, demographic characteristics [ 27 ] , urban-rural differences [ 28 ] , institutional equity, income levels [ 29 ] , and medical insurance [ 30 ] are considered to be the main factors.However, there is still a lack of quantitative analysis of the relationship between healthcare resources allocation and service utilization.So what is the relationship between the allocation and utilization of healthcare resources in China; how is this relationship evolving; whether there is a spatial inequity or not; how is this relationship affected by the influencing factors of healthcare resources allocation and service utilization, there is still no reasonable answer.…”

Section: Introductionmentioning

confidence: 99%

Spatial Equity and Influencing Factors of Coupling Coordination Degree of Healthcare Resources Allocation and Service Utilization in China

jianpeng¹

2020

Preprint

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Abstract Background: The COVID-19 epidemic in early 2020 has made the contradiction between allocation and utilization of healthcare resources in China more prominent. However, there is still no conclusion about the coordination degree of healthcare resources and service utilization in China, especially in the context of hierarchical diagnosis and treatment. Based on the hierarchical analysis framework for healthcare institutions, this paper mainly analyzes the coordination level of healthcare resources of primary healthcare institutions and hospital in China's provincial scale from 2010 to 2018.Method: In this paper, the entropy-weighted TOPSIS evaluation method is used to calculate the healthcare resourcesallocation and service utilization index, the coupled coordination model is used to evaluate the coordination relationship between healthcare resource allocation and service utilization, and the exploratory spatial data analysis method is used to evaluate the spatial distribution characteristics of the coordination level and detect its impact on the surrounding spatial units and the geographic detector is used to analyze the driving factors that affect the spatial inequity of the coordination level. Results: The coupling coordination degree of primary healthcare institutions and hospitals increased from 0.448 and 0.418 in 2010 to 0.519 and 0.534 in 2018, respectively, while the relative development degree increased from 0.469 and 0.466 in 2010 to 0.767 and 0.578 in 2018, respectively. The coupling coordination type has shifted from sligth imbalance to general coordination. The lagging situation of healthcare resources allocation has gradually improved. The coupling coordination degree basically shows the spatial distribution characteristics of higher in the eastern area, central in the central area, and lower in the border areas in the northwest, northeast, and southwest. At the same time, the spatial inequity is more obvious.The coupling coordination degree between China's healthcare resources allocation and service utilization has spatial autocorrelation, and formed hotspot and coldspot areas centered on the middle and lower reaches of the Yangtze River and the Tibetan Plateau respectively. The lag of healthcare resources allocation is the main reason for lowering the degree of coupling coordination between healthcare resources and service utilization in China. The spatial differentiation of coupling coordination degree is influenced by population distribution and structure, economic development level and topographical condition factors, and has obvious spatial and temporal heterogeneity. These results have similarities and differences at the level of hospitals and primary medical institutions.Conclusions: From 2010 to 2018, China's healthcare resources allocation and service utilization coupling coordination system changed from slight imbalance to general coordination. This kind of transformation is more obvious in hospitals than primary healthcare institutions. Whether it is hospitals or primary healthcare institutions, the coordination level has obvious spatial distribution characteristics and spatial inequity. The lag of healthcare resources allocation is the main reason for lowering the level of coupling coordination. This spatial inequity is affected by the distribution and structure of economic population, the level of economic development, and topographical conditions. These conclusions have similarities and differences at the level of hospitals and primary healthcare institutions.

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“…Therefore, they examine significant positive spillover growth shocks to other counties, which suggests that counties whose neighbour grow faster than expected, to grow faster than expected. Zheng, et al (2013) took 21 province data (from time period [1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006] to investigate the supply of healthcare expenditures, which causes to slow down economic growth from last two decades. They use spatial panel data econometrics and find that the supply of healthcare resources is negatively related to the degree of decentralisation.…”

Section: Decentralisation Economic Growth Spillover Effects and Spamentioning

confidence: 99%

Fiscal Decentralisation, Provincial Economic Growth and Spillover Effects: A Spatial Panel Data Analysis

Raza¹,

Hina²

2022

pdr

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This study examines the spatial dependence, direct and indirect effects of fiscal decentralisation on the provincial economic growth of Pakistan. Due to spatial dependence, spatial econometric technique is applied on the augmented growth of Mankiw, et al. (1992) by incorporating the fiscal decentralisation variable in the theoretical framework. The empirical analysis is based on the spatial panel data set, which is used from 1990 to 2011 of provinces. Model is selected on basis of specific to general and general to specific approach, and decided two-way fixed effects Spatial Durbin model (SDM) is appropriate for our data. We have estimated the SDM by maximum likelihood (bias corrected and random effect) estimation technique, otherwise, if we applied OLS and ignore the spillover effect which makes our estimated parameters biased and inconsistent. Results show that revenue decentralisation has positive, while expenditure decentralisation has negative effect to provincial economic growth. Spillover effects are found to be significant in case of revenue decentralisation and insignificant in case of expenditure. Negative and insignificant spillover effect of expenditure decentralisation is due to weak institutions, lack of intra governmental competition, and absence of political vision which may increase the level of corruption and less accountability. On the basis of econometric analysis, it may be suggested that federal government should transfer the resources to provinces as determined in the 18th amendment, and it is the responsibility of provincial government to train their officials in the area of professional ethics, technical and administrative skills by different programmes. JEL Classification: C31, C33, H3, H50 Keywords: Fiscal Decentralisation, Spatial Econometrics, Revenue, Expenditure

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On the supply of China's healthcare resources in a decentralized healthcare system

Cited by 13 publications

References 35 publications

Equity and efficiency of medical service systems at the provincial level of China’s mainland: a comparative study from 2009 to 2014

Equity and efficiency of medical service systems at the provincial level of China’s mainland: a comparative study from 2009 to 2014

Spatial Equity and Influencing Factors of Coupling Coordination Degree of Healthcare Resources Allocation and Service Utilization in China

Fiscal Decentralisation, Provincial Economic Growth and Spillover Effects: A Spatial Panel Data Analysis

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