Health service delivery in china a literature review

Health service delivery in china a literature review

We report the results of a review of the Chinese‐ and English‐language literatures on service delivery in China, asking how well China's health‐care providers perform and We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their Estimated Reading Time: 11 mins Jun 21,  · The authors report the results of a review of the Chinese-language and English-language literatures on service delivery in China, asking how well China's health care providers perform, what determines their performance, and how the government can improve it

(PDF) Health service delivery in China: a literature review | Karen Eggleston - blogger.com

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Need an account? Click here to sign up. Download Free PDF. Health service delivery in China: a literature review Health economics, Karen Eggleston. Meng Qingyue. Download Download PDF Full PDF Package Download Full PDF Package This Paper.

A short summary of this paper. Download Download PDF, health service delivery in china a literature review. Download Full PDF Package. Translate PDF. We find current performance leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector, or by simply encouraging providers—public and private—to compete with one another for individual patients.

By contrast, substantial improvements could be and in some places have already been made by changing the way providers are paid—shifting away from fee-for-service and the distorted price schedule toward prospective payments. Active purchasing by insurers could further improve outcomes.

Corresponding author: Adam Wagstaff, World Bank, health service delivery in china a literature review, H Street NW, health service delivery in china a literature review, Washington, D. Fax Email: awagstaff worldbank. Keywords: health service delivery; provider payments; China. World Bank Policy Research Working PaperAugust The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues.

An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the view of the World Bank, its Executive Directors, or the countries health service delivery in china a literature review represent.

Acknowledgements: The authors benefited from the comments of Mr. Fei Zhaohui of the Chinese Ministry of Finance, who was the discussant for this review at a workshop held in Beijing in Julyand from the comments on health service delivery in china a literature review drafts by Dick Meyers of the World Bank. What determines their performance? How can the government improve it?

To answer these questions, we undertook a review of the Chinese-language and English-language literatures on service delivery in China, as well as looking at lessons from abroad, health service delivery in china a literature review.

There is broad agreement that the health service delivery system is not functioning well, but there is considerable disagreement about how to fix it. Some argue for turning over the entire system to a free market.

Others recall the benefits of a centrally planned health system. The truth—this paper argues—lies somewhere between these two extreme views. Like many countries, China does not have a strong system for monitoring the quality of care. But several indicators suggest quality could be better. The skill of providers is low, especially at the village level. In the case of village clinics, only 0. There is some evidence that health care quality in China has improved over time, but these improvements seem to be confined primarily to urban areas.

In some situations, unnecessary care may also have adverse health consequences. In recent years, the number of providers has increased while caseload has been falling. Bed-occupancy rates are, as a result, falling, especially in township hospitals where bed occupancy was low to start with.

Provider productivity—measured in terms of patients per provider per day—is also falling in rural areas, from a relatively low base.

There is also evidence of waste in the use of high-tech equipment. Costs have risen much faster than per capita income and prices generally. This reflects in part a more complex caseload less infectious diseases, more NCDs and the adoption of new technology. But what is clear is that the extensive overuse of drugs and high-tech medical procedures is a matter for concern. Rapidly rising health care costs in China have probably been one of the factors behind the fall in demand for health care over the last 10 years.

How far these can be blamed on providers is unclear—utilization and outcomes reflect demand-side and supply-side factors.

What can be said, however, is that in recent years—in contrast to the s—the health service delivery system in urban areas has developed much faster than in rural areas, and there is a growing gap in quality of care between rural and urban areas. What explains this weak performance? And how can the government improve it?

One hypothesis—often expressed in China—is that poor provider performance reflects the heavy emphasis on public ownership above village level. The international evidence on whether ownership matters—mostly from the United States—is mixed. The limited evidence available from the Chinese health sector is consistent with the international literature: it suggests that ownership probably matters less than people often think. For-profit and public providers are just as likely as one another to over-prescribe drugs, and for- profit providers are just as likely to deliver preventive activities as public ones, provided they are paid properly to do so.

However, this reflects at least in part the fact that public providers are constrained by the relevant stakeholders in a way that private providers are not. Provider behavior is influenced by a wide range of factors—financing, autonomy, market structure, accountability arrangements, etc.

Ownership may be related with these factors, but often it is not the primary determinant. As a consequence, privatization is not likely to be the panacea that some in China believe it to be. Another commonly heard view in China is that the health sector needs more competition.

The international literature suggests extreme caution on this point, and is very clear on one key point: competition for individual patients is not the answer. Patients lack the knowledge to be informed consumers as in a typical market. This blunts competitive pressures, and makes patients vulnerable to exploitation by providers who take advantage of their superior knowledge of medical matters.

What can be potentially useful, however, is competition among providers for contracts from purchasers e. The evidence is limited, mostly coming again from the U.

Contracting for appropriate clinical care, by contrast, is often more challenging. For example, in many countries there is a competitive labor market for hospital health service delivery in china a literature review, who attract similar compensation packages from both for-profit and non-profit hospitals.

Similarly, competition in the markets for physicians, nurses, and medical equipment and materials, and support services such as maintenance, catering, cleaning, and laundry can help to allocate resources in a way that rewards, and thus stimulates, improved performance. The evidence to date from China on the benefits of competition—be it competition between providers or in markets for inputs—is very limited and research on this topic would be useful.

In the meantime, policy reform in China could usefully learn from the lessons of international experience. In fact, such a policy is likely to exacerbate existing problems. Where competition could be useful is in a market for purchaser contracts, health service delivery in china a literature review, and in input markets. That would mean developing the purchasing capacity of insurers such as BMI and NCMS—an issue we will return to later.

Careful monitoring will be vital, not least to ensure there are no unwanted side-effects. In order to realize the potential benefits of competition in input markets, providers would need be given more autonomy to make decisions about what inputs and services should be contracted for, and from whom to contract.

Again, careful monitoring would be vital. PRICES AND PROVIDER PAYMENT The evidence is not at all clear, then, on how ownership and competition impacts on provider performance.

By contrast, what is clear from studies to date is that how providers are paid matters in health care. Furthermore, payment-related incentives can be improved without changing ownership, and without introducing competition.

Providers in China—like providers in many countries—receive payments from three sources. The prices paid by fee-paying patients are set by government, with the dominant concern being to make sure that basic services are affordable to the whole population. Prices have tended to be set below cost for simple and non-invasive care, and above cost for more complex care. Government subsidies have been based not on performance or throughput, but rather on staff numbers and the stock of beds.

This encourages hospitals to expand their workforce and their bed stock, but not to improve the quality of their care or their efficiency. Health insurers—the final payer—vary in the way they pay providers in China. However, only some have moved beyond fee-for-service FFS. Simple and non-invasive care tends to be under-provided, leading to concerns about low—and in some cases—falling coverage of key public health interventions, while high-tech diagnostics are over-provided.

Because of the markup pricing scheme that has long been in force, drugs are also profitable—hence their over-prescription. Data refer to large hospitals only.

Inthe government sought to reduce the distortions in the price schedule, by increasing the prices of professional services and reducing the price of high-tech care. A study in Shaanxi found that this resulted in a shift in expenditures from high technologies to basic professional services, and a reduction in growth rates of expenditures for secondary and health service delivery in china a literature review hospitals, using four diseases as tracers.

Starting inthe central government began to change its drug pricing policy from controlling the entire range of prices for all pharmaceuticals to controlling retail prices for selected products only. One rationale for the reform was that cost-effective drugs would be utilized more if the prices of these drugs are reduced.

Cost Shifting - The Economics of Health Care Delivery

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Abstract. We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their performance. Although data and methodological limitations suggest caution in drawing conclusions, a critical reading of the available evidence The authors report the results of a review of the Chinese-language and English-language literatures on service delivery in China, asking how well China's health care providers perform, what determines their performance, and how the government can improve it We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their Estimated Reading Time: 11 mins