The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach

Chen, Jiaqi; Xu, Song; Gao, Jing

doi:10.3390/ijerph17051782

Cited by 15 publications

(16 citation statements)

References 35 publications

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“…In addition, the health insurance schemes made it easier for tertiary hospitals to “siphon-off” patients. This is because the health insurance schemes have improved patients’ ability to pay for expensive health services, and more patients were willing to enjoy tertiary hospitals rather than primary care facilities [ 47 ]. The existing Chinese public insurance policies also exacerbated moral hazard by patients.…”

Section: Resultsmentioning

confidence: 99%

The COVID-19 Run on Medical Resources in Wuhan China: Causes, Consequences and Lessons

et al. 2021

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The COVID-19 run on medical resources crashed Wuhan’s medical care system, a medical disaster duplicated in many countries facing the COVID-19 pandemic. In a novel approach to understanding the run on Wuhan’s medical resources, we draw from bank run theory to analyze the causes and consequences of the COVID-19 run on Wuhan’s medical resources and recommend policy changes and government actions to attenuate runs on medical resources in the future. Like bank runs, the cause of the COVID-19 medical resource run was rooted in China’s local medical resource context and a sudden realignment of expectations, reflecting shortages and misallocations of hospital resources (inadequate liquidity and portfolio composition); high level hospitals siphoning-off patients from lower level health providers (bank moral hazard and adverse selection problem); patients selecting high-level hospitals over lower-level health care (depositor moral hazard problem); inadequate government oversight and uncontrolled risky hospital behavior (inadequate bank regulatory control); biased medical insurance schemes (inadequate depositor insurance); and failure to provide medical resource reserves (failure as lender of last resort). From Wuhan’s COVID-19 run on medical resources, we recommend that control and reform by government enlarge medical resource supply, improve the capacity of primary medical care, ensure timely virus information, formulate principles for the allocation of medical resources that suit a country’s national conditions, optimize the medical insurance schemes and public health fund allocations and enhance the emergency support of medical resources.

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Section: Resultsmentioning

confidence: 99%

The COVID-19 Run on Medical Resources in Wuhan China: Causes, Consequences and Lessons

et al. 2021

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“…Although the income of PHIs in China has improved, in order to achieve long-term development, PHIs need to make good use of this income, improve service capability, and create more value [ 15 ]. All in all, the outcome service capability of PHIs in China has been improved on the whole, but the effect is weak, and the reform efforts need to be further strengthened [ 16 , 17 , 18 , 19 ]. On the one hand, they should promote the effective integration of medical resources and improve the sharing system of medical resources in the region to strengthen the ability of PHIs.…”

Section: Discussionmentioning

confidence: 99%

The Service Capability of Primary Health Institutions under the Hierarchical Medical System

Liu

Lin

et al. 2022

Healthcare

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Background: Primary health institutions (PHIs) are the foundation of the whole health system and the basic link to achieve the goal of all people enjoying primary health care. However, the service capability of primary health institutions is not under the hierarchical medical system. Method: Data were collected from the China Health Statistics Yearbook between 2014 and 2020. PHIs included community health centres, community health stations, and township hospitals in our study. The service capability of primary health institutions was analysed from the perspective of structure, process, and results. Structure capability was evaluated using the number of beds, number of personnel, number of health technicians, and proportion of the number of personnel in PHIs accounting for the total number of health personnel. Process capability was evaluated using the number of general practitioners. The number of outpatients and inpatients, medical income, the proportion of drug income, and the average number of patients and beds served by physicians in PHIs per day were employed to evaluate the resulting capability. Results: From 2014 to 2020, the number of community health service centres/stations increased, while the number of township health centres decreased. In the aspect of structure capability, the total number of personnel and health technicians in community health centres/stations and township hospitals both increased during 2014 and 2020. However, the increasing rate in PHIs was a little bit less than that of general medical institutions. The proportion of male health technicians in community health centres and township hospitals both decreased, while the proportion of female technicians in both increased. From 2014 to 2020, the number of beds in PHIs also increased from 138.12 × 104 to 164.94 × 104. However, the proportion of beds in PHIs accounting for the total number of beds in medical institutions decreased. For the resulting capability, from 2014 to 2019, the proportion of diagnosis and treatment times in PHIs decreased from 57.41% to 51.96%, although it increased in 2020. The proportion of inpatients in PHIs decreased from 20.03% to 16.11%. From 2014 to 2020, the utilisation rate of hospital beds in PHIs decreased (from 55.6% to 34% for community health centres and 60.5% to 53.6% for township hospitals). The average daily bed days of doctors in township hospitals was higher than that of doctors in community health service centres. However, the average medical cost of outpatients and the per capita medical cost of inpatients in community health service centres were higher than in township hospitals. Conclusion: In recent years, although the service capability showed an increasing trend in PHIs, the growth rate was lower than the general health institutions. The utilisation rates of PHIs, including beds and physicians, were decreased. Among PHIs, the utilisation in township hospitals was higher than in community health centres with a relatively low price. Under the hierarchical medical system and normalisation period of the COVID-19 epidemic, it is important to improve the service capability to achieve its goal of increasing PHI utilisation and decreasing secondary and tertiary hospital utilisation.

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“…On the other hand, public opinion has also strengthened the government’s political will and decision-making during healthcare reforms [ 20 ]. For example, in response to the public’s demand for equal health services, the Chinese government implemented the “new healthcare reform” in 2009, which led to an increase in the insurance coverage rate while creating a burden for low-income populations due to expensive healthcare services [ 21 ]. This leads to tension in the doctor–patient relationship.…”

Section: Literature Viewmentioning

confidence: 99%

Effects of Healthcare Policies and Reforms at the Primary Level in China: From the Evidence of Shenzhen Primary Care Reforms from 2018 to 2019

Wen

Liao

Yi-lin

et al. 2022

IJERPH

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Countries worldwide are making efforts to achieve health equity. China focuses on the implementation of the policy goal of “improving the primary level” to eliminate the health equity gap. The main purpose of this study is to examine the effects of the healthcare reforms at the primary level in China and to analyze the key factors that can help to improve their effectiveness. From the perspectives of the policy attention mechanism and public policy analysis, this study will explore primary care reforms from policy formulation to policy implementation on the basis of grounded theory and empirical research on primary care reforms in Shenzhen, China, that was conducted from 2018 to 2019. The present study found that the government pays close attention to the medical level and service level of primary care services at the policy formulation phase but less attention to talent level and information sharing. At the same time, this study combined with empirical data from primary care centers in Shenzhen for the period covering 2018 to 2019 evaluates policy implementation and its effect. Multiple regression analysis revealed that the medical level, talent level, service level, and information sharing helped to develop primary care services and improved health equity. Nevertheless, this study reflects a deviation between policy formulation and policy implementation for the development of primary care policies. Empirical experience shows that the development of talent level and information sharing can significantly promote primary care services and health management. Therefore, this study implies that in the process of promoting the health equity at the primary level, more attention should be paid to the consistency between policy formulation and policy implementation. Additionally, the policy promotion and influence mechanism can be improved, particularly in terms of talent development and information sharing, in order to effectively promote the development of health equity at the primary level.

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The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach

Cited by 15 publications

References 35 publications

The COVID-19 Run on Medical Resources in Wuhan China: Causes, Consequences and Lessons

The COVID-19 Run on Medical Resources in Wuhan China: Causes, Consequences and Lessons

The Service Capability of Primary Health Institutions under the Hierarchical Medical System

Effects of Healthcare Policies and Reforms at the Primary Level in China: From the Evidence of Shenzhen Primary Care Reforms from 2018 to 2019

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