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Begin New Search Topic Health Political Geography China Content Type Working Paper Publishing Institution Walter H. Shorenstein Asia-Pacific Research Center

1. Healing One-fifth of Humanity: Progress and Challenges for China’s Health System

Author:
Karen Eggleston
Publication Date:
10-2019
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
China’s national health reforms over the past two decades have brought the system closer to the modern, safe, reliable and accessible health system that is commensurate with China’s dramatic economic growth, improvement in living standards, and high hopes for the next generation. Celebrating a decade this year, China’s national health reforms of 2009 consolidated a system of social health insurance covering the entire population for basic health services, contributing to a surge in healthcare utilization while reducing out-of-pocket costs to patients – which declined from 56% to 28% of total health expenditures between 2003 and 2017. An expanded basic public health service package, funded by per capita government budget allocations that include a higher central government subsidy for lower income provinces, provides basic population health services to all Chinese. A higher percentage of Chinese accessed hospital admissions in 2017 than in the average high-income (OECD) country – a large increase from the turn of the 21st century.i A recent re-shuffle of the governance structure consolidates the purchaser role for social health insurance schemes under the newly created National Healthcare Security Administration, with most other health sector functions under the re-christened National Health Commission, among other changes. China’s world-leading technological prowess in multiple fields spanning digital commerce to artificial intelligence—and accompanying innovative business models such as WeDoctor that have not yet been fully integrated into the health system—hold promise for supporting higher quality and more convenient healthcare for China’s 1.4 billion.
Topic:
Health, Science and Technology, Governance, and Health Care Policy
Political Geography:
China and Asia

2. Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from China's Essential Medications List Policy

Author:
Brian K. Chen
Publication Date:
09-2013
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
How do demand - and supply - side incentives interact, when there are potentially large provider income effects? We develop a simple model and empirically test it with data from China's Essential Medications List (EML) policy, which reduced patient copayments and changed provider incentives by removing a large source of revenue from primary care providers: drug dispensing revenues. Using a panel of patient - level spending and clinical data for Chinese patients with diabetes or hypertension over two and a half years, we find evidence of strategic provider response that dampened the impact of patient copayment reductions. Resource use and patient out - of - pocket spending did not change, when taking account of patient utilization outs ide primary care.
Topic:
Communism, Health, and Governance
Political Geography:
China and Israel

3. Pharmaceutical Price Regulation: Macro-Level Evidence from China between 1997 and 2008

Author:
Qiong Zhang, Binzhen Wu, and Xue Qiao
Publication Date:
01-2012
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
This paper uses macro-level data between 1997 and 2008 to evaluate the effects of China's pharmaceutical price regulations. We find that these regulations had short-run effects on medicine price indexes, reducing them by less than 0.5 percentage points. The effects could have been slightly reinforced when these regulations were imposed on more medicines. However, these regulations failed to reduce household health expenditures and the average profitability of the pharmaceutical industry, and firms on the break-even edge were worse off. Finally, although these regulations have no significant effects on the price of substitutes or complements for medicines, they increased expensive medicine imports.
Topic:
Economics, Health, Human Welfare, Industrial Policy, International Trade and Finance, and Markets
Political Geography:
China

4. Perverse Incentives in the Chinese Health System and Assessment of the April 2009 Reform

Author:
Meghan Bruce
Publication Date:
10-2010
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Since 1978, China has been primarily market-focused in its provision of health care and social services. The market-driven health care system has been characterized by perverse incentives for individual providers, patients, and hospitals that are inducing improper provision of care: overprescription of pharmaceuticals and hightech testing, lack of effective primary care and gatekeeping, and competition for patients instead of referral. The national health care reform document that was made public in April 2009 recognizes this failure of the market in health care in China. The document suggests potential policies for improvement on the current system that are focused primarily on a targeted increase in government funding and an increased, changing role for the government. We assess the potential of this national health care reform to achieve the stated goals, and conclude that the reform as designed is necessary but insufficient. For the reform to meet its goals, the promised increase in funding should be accompanied by improved data collection, regional piloting, and a strong regulatory and purchasing role for the government in aligning incentives for individual and institutional payers, providers, and patients.
Topic:
Health and Markets
Political Geography:
China and Israel

5. 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

6. 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

7. Allocation of control rights and cooperation efficiency in public-private partnerships: Theory and evidence from the Chinese pharmaceutical industry

Author:
Zhe Zhang, Ming Jia, and Difang Wan
Publication Date:
03-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
This article uses incomplete contract theory to study the allocation of control rights in public-private partnerships (PPPs) between pharmaceutical enterprises and nonprofit organizations; it also investigates how this allocation influences cooperation efficiency. We first develop a mathematic model for the allocation of control rights and its influence on cooperation efficiency, and then derive some basic hypotheses from the model. The results of an empirical test show that the allocation of control rights influences how enterprises invest in PPPs. A proper allocation provides incentives for firms to make fewer self-interested and more public-interested investments. Such an allocation also improves the cooperation efficiency of PPPs.
Topic:
Demographics, Health, and Human Welfare
Political Geography:
China, Israel, and Asia

8. 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

9. 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