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Begin New Search Political Geography China Publishing Institution Walter H. Shorenstein Asia-Pacific Research Center

11. 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

12. Patient Preferences, Concerns, and Satisfaction with Providers before the Chinese Urban Health System Reform: A Social Groups Analysis

Author:
Qunhong Shen and Liyang Tang
Publication Date:
09-2010
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Many Chinese express dissatisfaction with their healthcare system with the popular phrase Kan bing nan, kan bing gui ("medical treatment is difficult to access and expensive"). Critics have cited inefficiencies in delivery and poor quality of services. Determining the pattern of patient satisfaction with health services in China-and the causes of patient dissatisfaction-may help to improve health care not only in China but in countries in similar predicaments throughout the world.
Topic:
Economics, Markets, Social Stratification, and Health Care Policy
Political Geography:
China

13. 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

14. 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

15. 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

16. Crisis and Consensus; America and ASEAN in a New Global Context

Author:
Donald K. Emmerson
Publication Date:
02-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
No crisis is uniformly global. The suffering and the opportunity that a “global” crisis entails are always unevenly distributed across countries, and unevenly across the population inside any one country. That said, one can nevertheless argue that we—not the old royal “we” but, more presumptuously, the new global “we”—are in January 2009 experiencing the latest of four dramatic changes that major parts of the world have undergone over the last twenty years. In 1989, of course, the Berlin Wall was breached, ending the Cold War, followed by the implosion of Lenin's Soviet dystopia two years later. Nor did the 1989 massacre of proreform demonstrators in Tiananmen Square revive a command economy in China. Instead it kept the polity shut so that Deng's economy could continue to open.
Topic:
International Relations, Globalization, and International Political Economy
Political Geography:
United States, China, America, Israel, Asia, and Berlin

17. 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

18. 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

19. 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

20. Investing in China's Rural Infrastructure and Environment

Author:
Scott Rozelle
Publication Date:
04-2007
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
The purpose of this executive summary is to provide a concise statement about what we have learned about investment into China's rural environment. The overall purpose is to help the Bank understand what is happening in rural China, what farmer's are thinking about the current trends and what they are hoping will happen in the future (if they had a say). One of the most important questions is answer what should the role of the state be.
Topic:
Development, Environment, and Political Economy
Political Geography:
China and Asia