Status of public–private partnership recognition and willingness to pay for private health care in China

Abstract

Summary Objectives The Chinese government has been increasingly engaging and interacting with the private sectors to initiate public–private partnerships (PPPs) to enhance the capacity of the health care system. Thus, the availability of private health services and copays are increasing. However, Chinese residents appear to be more accustomed to public health care because it has long been the dominant health service provider in China. Therefore, learning how the Chinese recognize PPPs, whether they would like to use private health services and how much they are willing to pay out of pocket are important for policymakers. Methods A bibliographical search was performed through PubMed in Medline, the Chinese National Knowledge Infrastructure and key government websites using a combination of keywords from seminal papers on PPPs and then sequentially added “willingness to pay (WTP), health, and private.” The papers selected were closely related to PPPs and WTP for health care in China, and then, over 100 peer‐reviewed literature, opinion, or commentary papers and postgraduate theses on the particular topics were carefully reviewed. Results Out of 139 papers closely related to WTP for private health care, 37 were extensively reviewed and substantially analyzed. The results corroborate that Chinese residents are generally willing to pay for high‐risk disease screening, improved therapies, and health insurance, although the WTP intentions and the amounts they are willing to pay are different among distinct populations for the various types of health services. The results also present conditions that the responders are not explicitly willing to pay for or are willing to pay additional fees for their health promotion. Education level, family per capita income, self‐reported health status, and dwelling districts (such as urban or rural residents) are the main factors that affect cost‐sharing intention. Conclusions PPPs are increasingly recognized as an effective means to mobilize resources in the private sector to relieve the pressure/burden placed on the public system during medical reform in China. Responders in China are generally willing to pay reasonable fees out of pocket for primary health care services or for improved therapies; however, cost‐sharing intentions are affected by multiple factors. Health‐related policymakers should learn the general health concerns/demands of the residents and their WTP status to perfect the design of PPPs for the benefit of the majority population in China.

Evaluating the Intention and Behaviour of Private Sector Participation in Healthcare Service Delivery via Public-Private Partnership: Evidence from China

“…e need for medical resource supply is literally urgent in China given the challenges of ageing, increasing prevalence of chronic diseases, and incompleteness of healthcare delivery [112]. Alternately, Wang and Zhang pointed out that CHM contains several opportunities for the private sector, where most individuals are willing to pay for PPP healthcare services at a reasonable level [15]. Pharmaceutical corporations and medical industry property investment companies are provided huge potential and market volume in China to build large-scale clinical trials of new medicines, devices, and surgical procedures via PPP [113].…”

“…It exhibits the confidence of controlling the resource, which is needed by the private capital. Wang and Zhang indicated that PPP has become a component of China's medical reform; several available approaches have emerged as references for private sector investment in CHM [15]. To improve attractiveness, multiple barriers should be removed to establish an easy access by NHC, whilst private investors participate in elderly care and healthcare service delivery, including free provision for certain procedures [88].…”

“…Emerging countries are considered a proper market in extensively promoting PPP to improve the quality of medical infrastructures [14]. Four representative types are applied for private sector investment in CHM via PPP modality, namely, build-operate-transfer (BOT), renovateoperate-transfer (ROT), transfer-operate-transfer (TOT), operation and management contracts (O&M) [15] (Table 1).…”

“…Despite PPP's substantial contribution to creating high capacity and quality of health system in China [15], challenges remain. Firstly, numerous private capital entities, including construction companies and property developers, lack technical knowledge and experience to operate healthcare facilities [16].…”

Patient-provider relationships in China: A qualitative study on the perspectives of healthcare students and junior professionals

“…Though the Commission on Health and Family Planning in China wants to realign incentives [26], China has a mostly fee-for-service single-payer system with strict price control policies [16]. The development of private healthcare and commercial insurances may help supplement the income of healthcare providers [27,28]. Non-government non-profit healthcare could play a role in changing the pattern and revenue model of quality healthcare services [29].…”