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2. Soft budget constraints in China: Evidence from the Guangdong hospital industry
- Author:
- Karen Eggleston, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, Jing Zhang, and Yu-Chu Shen
- Publication Date:
- 03-2009
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital's probability of receiving government financial support is inversely associated with the hospital's previous net revenue, an association consistent with soft budget constraints.
- Topic:
- Government, Health, and Financial Crisis
- Political Geography:
- China and Asia
3. The Emerging Role of Private Health Care Provision in China
- Author:
- Cunrui Huang, Haocai Liang, Cordia Chu, Shannon Rutherford, and Qingshan Geng
- Publication Date:
- 09-2009
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- China continues to face great challenges in meeting the health needs of its large population. The challenges are not just lack of resources, but also how to use existing resources more efficiently, more effectively, and more equitably. Now a major unaddressed challenge facing China is how to reform an inefficient, poorly organized health care delivery system. The objective of this study is to analyze the role of private health care provision in China and discuss the implications of increasing private-sector development for improving health system performance.
- Topic:
- Government and Health
- Political Geography:
- China and Asia
4. Comparing Public and Private Hospitals in China: Evidence from Guangdong
- Author:
- Karen Eggleston, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, and Jing Zhang
- Publication Date:
- 04-2009
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Government and private roles in this segment of health service delivery remain controversial in China, as in many countries. Using 2004 data from over 360 government-owned and private hospitals in Guangdong Province, we find that non-government hospitals serve an overlapping but distinct market. They are smaller, newer market entrants, more likely to specialize, and less likely to be included in urban social insurance networks. We also document differences in staffing and financial performance, but no systematic ownership differences in simple measures of quality, controlling for size, location, case-mix and other confounding factors.
- Topic:
- Demographics, Government, Health, and Privatization
- Political Geography:
- China, Israel, and Guangdong
5. Incentives in China's Healthcare Delivery System
- Author:
- Karen Eggleston
- Publication Date:
- 10-2008
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- The economic approach of comparative and historical institutional analysis (Aoki 2001, Greif 2006) has virtually never been used in theoretical studies of healthcare incentives. This paper seeks to help fill this gap by exploring the explanatory power of such an approach for understanding incentives in China's healthcare delivery system. It focuses on positive analysis of why China's health system incentives evolved the way they did. The first section analyzes the institution of physician dispensing (MDD) and reforms toward separation of prescribing from dispensing (SPD), in historical and comparative perspective. It shows, for example, how MDD was a self-reinforcing institution; the longer a society remains under MDD, the higher the associated costs of supplier-induced demand can be before implementing SPD becomes the efficient self-enforcing social institution. Rapid technological change and adoption of universal coverage are likely to trigger SPD reforms. The second section seeks to explain the pattern and impact of price regulation and hospital payment reforms in contemporary China, which also reflect the legacy of MDD.
- Topic:
- Government, Health, and Human Welfare
- Political Geography:
- China, Israel, and Asia
6. The Political Economy of Successful Reform: Asian Stratagems
- Author:
- Dennis Arroyo
- Publication Date:
- 06-2008
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Major economic reforms are often politically difficult, causing pain to voters and provoking unrest. They may be opposed by politicians with short time horizons. They may collide with the established ideology and an entrenched ruling party. They may be resisted by bureaucrats and by vested interests. Obstacles to major economic reform can be daunting in democratic and autocratic polities alike.
- Topic:
- Economics, Government, and Political Economy
- Political Geography:
- China, India, Asia, South Korea, Vietnam, Singapore, and Thailand
7. Vote of Confidence, A? Voting Protocol and Participation in China's Village Elections
- Author:
- Xiaopeng Pang and Scott Rozelle
- Publication Date:
- 01-2007
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- The goal of our paper is to provide an empirical basis for understanding progress (or stagnation) in the evolution of China's village committee elections. To meet this goal, we pursue three specific objectives. First, we seek to identify patterns (and trends) of voting behavior and develop ways to measure participation in the voting process. Second, we analyze who is voting and who is not (and document the process by which their votes are cast). Finally, we see to understand the correlation between propensity to vote and the quality of village elections.
- Topic:
- Government and Politics
- Political Geography:
- China and Asia
8. Village Elections, Public Goods Investments and Pork Barrel Politics, Chinese-style
- Author:
- Jikun Huang, Renfru Luo, Linxiu Zhang, and Scott Rozelle
- Publication Date:
- 01-2007
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- A key issue in political economy concerns the accountability that governance structures impose on public officials and how elections and representative democracy influences the allocation of public resources. In this paper we exploit a unique survey data set from nearly 2450 randomly selected villages describing China's recent progress in village governance reforms and its relationship to the provision of public goods in rural China between 1998 and 2004. Two sets of questions are investigated using an empirical framework based on a theoretical model in which local governments must decide to allocate fiscal resources between public goods investments and other expenditures. First, we find evidence—both in descriptive and econometric analyses—that when the village leader is elected, ceteris paribus, the provision of public goods rises (compared to the case when the leader is appointed by upper level officials). Thus, in this way it is possible to conclude that democratization—at least at the village level in rural China—appears to increase the quantity of public goods investment. Second, we seek to understand the mechanism that is driving the results. Also based on survey data, we find that when village leaders (who had been elected) are able to implement more public projects during their terms of office, they, as the incumbent, are more likely to be reelected. In this way, we argue that the link between elections and investment may be a rural China version of pork barrel politics.
- Topic:
- Democratization, Government, Political Economy, and Politics
- Political Geography:
- China
9. Water User Associations and the Evolution and Determinants of Management Reform: A Representative Look at Northern China
- Author:
- Jikun Huang, Qiuqiong Huang, Jinxia Wang, and Scott Rozelle
- Publication Date:
- 02-2007
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Increasing demand for China's limited water resources (across China, but mostly in northern China) from rapidly growing industry, urban populations and agriculture implies potentially dire consequences for the sustainability of water use and drastic changes in cultivation patterns (Zhang, 2001). Problems in the water sector also have significant implications for China's future trade position in key crops and may affect the income of the farming sector (Huang et al., 1999).
- Topic:
- Agriculture, Development, Environment, and Government
- Political Geography:
- China and Asia
10. Water Management Reform and the Choice of Contractual Form in China
- Author:
- Siwa Msangi, Qiuqiong Huang, Jinxia Wang, Jikin Huang, and Scott Rozelle
- Publication Date:
- 02-2007
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- This paper explains the puzzling fact that in organizing the management of surface water, village leaders have provided incentives to canal managers in some areas, but not in all. Our study indicates that the optimal contractual choice depends on the relative abilities of the leader and the manager, the design of the cultivated land, the characteristics of the canal system and the opportunity costs of the leader and the pool of managerial candidates. The unifying mechanism is the relative change in the ability of the leader and manager to perform the unmarketable activities that are needed to provide irrigation services.
- Topic:
- Agriculture, Development, Environment, and Government
- Political Geography:
- China