Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-25T00:24:11.272Z Has data issue: false hasContentIssue false

Is the pro-competition policy an effective solution for China’s public hospital reform?

Published online by Cambridge University Press:  27 June 2016

Jay Pan
Affiliation:
West China School of Public Health, Sichuan University, Sichuan, China West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
Xuezheng Qin*
Affiliation:
School of Economics, Peking University, Beijing, China
Chee-Ruey Hsieh
Affiliation:
The Duke Global Health Institute, Duke University, Durham, NC, USA Global Health Research Center, Duke Kunshan University, Kunshan, China
*
*Correspondence to: Xuezheng Qin, School of Economics, Peking University, Beijing 100871, China. Email: [email protected]

Abstract

The new round of health care reforms in China achieved significant initial results. New and emerging problems coinciding with the deepening of the reforms, however, require further institutional changes to strengthen the competition mechanism and promote public hospital efficiency. This paper provides a conceptual framework and preliminary assessment of public hospital competition in China. Specifically, we distinguish between two closely related concepts – competition and privatization, and identify several critical conditions under which hospital competition can be used as a policy instrument to improve health care delivery in China. We also investigate the current performance and identify several unintended consequences of public hospital competition – mainly, medical arms race, drug over-prescription and the erosion of a trusting relationship between patients and physicians. Finally, we discuss the policy options for enhancing the internal competition in China’s hospital market, and conclude that public investment on information provision is key to reaping the positive outcomes of pro-competition policies.

Type
Articles
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abraham, J., Gaynor, M. and Vogt, W. (2007), ‘Entry and competition in local hospital markets’, The Journal of Industrial Economics, 55: 265288.Google Scholar
Arrow, K. (1963), ‘Uncertainty and the welfare economics of medical care’, The American Economic Review, 53(5): 941973.Google Scholar
Barber, S. L., Borowitz, M., Bekedam, H. and Ma, J. (2014), ‘The hospital of the future in China: China’s reform of public hospitals and trends from industrialized countries’, Health Policy and Planning, 29: 367378.CrossRefGoogle Scholar
Bloom, N., Propper, C., Seiler, S. and Van Reenen, J. (2015), ‘The impact of competition on management quality: evidence from public hospitals’, Review of Economic Studies, 82(2): 457489.CrossRefGoogle Scholar
Bresnahan, T. and Reiss, P. (1991), ‘Entry and competition in concentrated markets’, Journal of Political Economy, 99: 9771009.Google Scholar
China National Bureau of Statistics (2013), Statistical Yearbook of China 2013, Beijing: China Statistical Publishing House.Google Scholar
Communist Party of China (2013), ‘The decision on major issues concerning comprehensively deepening reforms’. Official document. http://www.gov.cn/jrzg/2013-11/15/content_2528179.htm [18 December 2014].Google Scholar
Cooper, Z. (2012), ‘The very English experience with competition: lessons from Britain’s National Health Service’. Submission to the Organisation for Economic Co-Operation and Development roundtable on competition in hospital markets. www.oecd.org/daf/competition/50527122.pdf [14 June 2016].Google Scholar
Cooper, Z., Gibbons, S., Jones, S. and McGuire, A. (2011), ‘Does hospital competition save lives? Evidence from the English NHS patient choice reforms’, The Economic Journal, 121: 228260.CrossRefGoogle ScholarPubMed
Cooper, Z., Gibbons, S., Jones, S. and McGuire, A. (2012), ‘Does competition improve public hospitals’ efficiency? Evidence from a quasi-experiment in the English National Health Service’, CEP Discussion Paper No. 1125, London.Google Scholar
CPC Central Committee and State Council (2009), ‘Opinions of the CPC Central Committee and the State Council on deepening the reform of the medical and health care system’. http://news.xinhuanet.com/newscenter/2009-04/06/content_11138803.htm [14 June 2016].Google Scholar
Currie, J., Lin, W. and Zhang, W. (2011), ‘Patient knowledge and antibiotic abuse: evidence from an audit study in China’, Journal of Health Economics, 30(5): 933949.Google Scholar
Cutler, D., Huckman, R. and Kolstad, J. (2010), ‘Input constraints and the efficiency of entry: lessons from cardiac surgery’, American Economic Journal: Economic Policy, 2: 5176.Google Scholar
Dranove, D. (2011), ‘Chapter Ten – Health Care Markets, Regulators, and Certifiers’, in V. Mark, T. G. M. Pauly and P. B. Pedro (eds), Handbook of Health Economics, Volume 2 Oxford: Elsevier, 639690.Google Scholar
Eggleston, K. and Yip, W. (2004), ‘Hospital competition under regulated prices: application to urban health sector reforms in China’, International Journal of Health Care Finance and Economics, 4: 343368.Google Scholar
Friesner, D. and Rosenman, R. (2009), ‘Do hospitals practice cream skimming?’, Health Services Management Research, 22: 3949.CrossRefGoogle ScholarPubMed
Gaynor, M. (2012), ‘Reform, competition, and policy in hospital markets’. Submission to the Organisation for Economic Co-Operation and Development roundtable on competition in hospital markets. www.oecd.org/daf/competition/50527122.pdf [14 June 2016].Google Scholar
Gaynor, M., Moreno-Serra, R. and Propper, C. (2013), ‘Death by market power: reform, competition and patient outcomes in the National Health Service’, American Economic Journal: Economic Policy, 5(4): 134166.Google Scholar
Gaynor, M. and Town, R. (2011), ‘Chapter Nine – Competition in Health Care Markets’, in V. Mark, T. G. M. Pauly and P. B. Pedro (eds), Handbook of Health Economics Volume 2 Oxford: Elsevier, 499638.Google Scholar
Hafez, R. (2014), ‘The Impact of Health Insurance on Financial Risk Protection in Ningxia, China’, Unpublished Doctoral Dissertation, University of Oxford, Oxford.Google Scholar
He, D., Yu, H. and Chen, Y. (2013), ‘Equity in the distribution of CT and MRI in China: a panel analysis’, International Journal for Equity in Health, 12: 39.Google Scholar
Health and Family Planning Commission of China (2005--2014), Health Statistical Yearbook of China 2005--2014, Beijing: Peking Union Medical College Press.Google Scholar
Hibbard, J., Stockard, J. and Tusler, M. (2005), ‘Hospital performance reports: impact on quality, market share, and reputation’, Health Affairs, 24: 11501160.CrossRefGoogle ScholarPubMed
Jian, W., Lu, M., Chan, K. Y., Poon, A. N., Han, W., Hu, M. and Yip, W. (2015), ‘Payment reform pilot in Beijing hospitals reduced expenditures and out-of-pocket payments per admission’, Health Affairs, 34(10): 17451752.Google Scholar
The Lancet (2014), ‘Violence against doctors: why China? why now? what next?’, Lancet, 383: 1013.Google Scholar
Li, K. (2011), ‘Deepening the reform of health care system and promoting the establishment of a realistic and balanced health care system’, Qiushi Journal, 22: 310 (in Chinese).Google Scholar
Li, L. (2006), ‘A Research Report on the Medical Care Reform of Suqian Area in Jiangsu District’, National School of Development, Peking University, Beijing.Google Scholar
Li, W. and Huang, E. (2010), ‘The practice of legal person governance reform in Dongyang People’s Hospital’, Health Economics Research, 277(8): 58 (in Chinese).Google Scholar
Li, X. (2012), ‘See your doctor: cannot resolve or do not want to solve?: on health reform trifles, repeated failures of the heavy thinking to change’, Journal of Chengdu University of Technology (Social Sciences), 20(4): 6267 (in Chinese).Google Scholar
Liu, G., Guan, H. and Gao, C. (2013), ‘Analysis on status quo of private care in China’, China Journal of Health Policy, 6(9): 4146 (in Chinese).Google Scholar
Lu, F. (2014), ‘Insurance coverage and agency problems in doctor prescriptions: evidence from a field experiment in China’, Journal of Development Economics, 106: 156167.CrossRefGoogle Scholar
Ma, X. (2001), ‘Management of hospital reputation’, Chinese Journal of Hospital Administration, 17(2): 106108 (in Chinese).Google Scholar
Maarse, H., Jeurissen, P. and Ruwaard, D. (2015), ‘Results of the market-oriented reform in the Netherlands: a review’, Health Economics, Policy and Law, 11: 118.Google Scholar
Maier-Rigaud, F. (2012), ‘Competition in hospital services – the policy dimension’, Organisation for Economic Co-Operation and Development Working Party, (2). www.oecd.org/daf/competition/50527122.pdf [14 June 2016].CrossRefGoogle Scholar
National Development and Reform Commission, National Health and Family Planning Commission and Ministry of Human Resources and Social Security (2014), ‘The announcement of market-oriented pricing mechanism for non-public medical institutions’. http://www.gov.cn/xinwen/2014-04/09/content_2655189.htm [14 June 2016].Google Scholar
Newhouse, J., RHIE G roup (1993), Free for All?: Lessons from the RAND Health Insurance Experiments, Cambridge: Harvard University Press.Google Scholar
Ng, Y. C. (2011), ‘The productive efficiency of Chinese hospitals’, China Economic Review, 22: 428439.CrossRefGoogle Scholar
Pan, J., Liu, D. and Ali, S. (2015a), ‘Patient dissatisfaction in China: what matters’, Social Science & Medicine, 143: 145153.CrossRefGoogle Scholar
Pan, J., Liu, G. and Gao, C. (2013), ‘How does separating government regulatory and operational control of public hospitals matter to healthcare supply?’, China Economic Review, 27: 114.Google Scholar
Pan, J., Qin, X., Li, Q., Messina, J. P. and Delamater, P. L. (2015b), ‘Does hospital competition improve health care delivery in China?’, China Economic Review, 33: 179199.CrossRefGoogle Scholar
Pierson, P. (2001), The New Politics of the Welfare States, Oxford: Oxford University Press.CrossRefGoogle Scholar
Porter, M. and Teisberg, E. O. (2004), ‘Redefining competition in health care’, Harvard Business Review, 6: 6477.Google Scholar
Sichuan Provincial Bureau of Statistics (2013), Statistical Yearbook of Sichuan 2013, Beijing: China Statistical Publishing House.Google Scholar
Smith, P. (2009), ‘Market Mechanisms and the Use of Health Care Resources’, in OECD Achieving Better Value for Money in Health Care, Paris: OECD, 5377.Google Scholar
Smith, P., Preker, A., Ligght, D. and Richard, S. (2005), ‘Role of Markets and Competitions’, in J. Figueras, R. Robinson and E. Jakubowski (eds), Purchasing to Improve Health Systems Performance, Berkshire: Open University Press, 102121.Google Scholar
Song, X. D., Du, T. Y., Zhou, P., Shen, D. W. and Xue, D. (2015), ‘Assessing the quality of public hospital websites in China’, Information, 18(2): 557572.Google Scholar
Stabile, M. and Thomson, S. (2014), ‘The changing role of government in financing health care: an international perspective’, Journal of Economic Literature, 52(2): 480518.Google Scholar
Tam, W.-K. (2012), ‘Health care reform and patients’ trust in physicians in urban Beijing’, The China Quarterly, 211: 827843.Google Scholar
Tang, C., Zhang, Y., Chen, L. and Lin, Y. (2013), ‘The growth of private hospitals and their workforce in China: a comparison with public hospitals’, Health Policy and Planning, 112.Google Scholar
World Bank (2010), ‘Fixing the public hospital system in China’. China health policy notes, No. 2. http://documents.worldbank.org/curated/en/2010/06/16216200/fixing-public-hospital-system-china-vol-2-2 [14 June 2016].Google Scholar
Xinhua News (2012), ‘Ministry of Health declares grading of tier-3 hospitals to be invalid’ (in Chinese), http://news.sina.com.cn/c/2012-08-27/033925040654.shtml [16 December 2015].Google Scholar
Yip, W., Hsiao, W., Chen, W., Hu, S., Ma, J. and Maynard, A. (2012), ‘Early appraisal of China’s huge and complex health-care reforms’, The Lancet, 379(9818): 833842.Google Scholar