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Reasons behind stymied public hospital governance reform in China


Autoři: Sheng Nong aff001;  Nengliang Aaron Yao aff003
Působiště autorů: You Jiang Medical University for Nationalities, Baise, China aff001;  Peking University, School of Public Health, Beijing, China aff002;  School of Health Care Management (Key Lab of Health Economics and Policy, National Health Commission), Jinan, China aff003;  University of Virginia, Department of Public Health Sciences, Charlottesville, Virginia, United States of America aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222204

Souhrn

Background

The public hospital governance reform in China is pledged to improve the governance of public hospitals and deliver affordable and high-quality care. However, progress in public hospital reform has been slow. The reason is poorly understood.

Methods

A research center affiliated with China National Health Commission has conducted 32 workshops to interview 124 public hospital administrators from 30 provincial-level administrative divisions and 105 various-level government officials from three provinces. About 80% of administrators and 78% officials actively participated the discussions. We used a descriptive theoretical approach to understand the relationships between the governance reform and characteristics of its stakeholders. We also analyzed stakeholder interests and their power to influence the reform.

Findings

About 66% of hospital administrators, 72% of health officials, and less than 10% of other officials support a new hospital governing structure. Local leadership, hospital administrators, and health commission said that administrators should have more power over the management of public hospitals. Other government departments and healthcare professionals had reservations on the governance reform. The reform of public hospital governance faces significant obstacles. The interests of most government stakeholders are not aligned with public interests. All stakeholders perceived that their workload would increase in the short term because of the governance reform of public hospitals. Most people involved in the reform are not incentivized to collaborate. The health commission has limited financial resources and insufficient political power to implement a massive reform. Most importantly, the public hospital reform is not, and likely will not be, a top policy priority to the central government or local leaderships.

Interpretation

The health commission needs more political support and resources to speed up the public hospital reform. To fulfill the pledge of affordable, equitable access to quality care, Chinese government needs to overcome significant obstacles in the public hospital reform.

Klíčová slova:

Social sciences – Political science – Public administration – Public policy – Political aspects of health – Economics – Finance – Health insurance – People and places – Geographical locations – Asia – China – Medicine and health sciences – Health care – Health services administration and management – Health economics – Health care policy


Zdroje

1. Yip W, Hsiao W. Harnessing the privatisation of China’s fragmented health-care delivery. The Lancet 2014;384:805–18. doi: 10.1016/S0140-6736(14)61120-X

2. Liu GG, Vortherms SA, Hong X. China’s Health Reform Update. Annu Rev Public Health 2017;38:431–48. doi: 10.1146/annurev-publhealth-031816-044247 28125384

3. Meng Q, Fang H, Liu X, Yuan B, Xu J. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. The Lancet 2015;386:1484–92. doi: 10.1016/S0140-6736(15)00342-6

4. Zhang Y, Ma Q, Chen Y, Gao H. Effects of Public Hospital Reform on Inpatient Expenditures in Rural China. Health Econ 2017;26:421–30. doi: 10.1002/hec.3320 26842555

5. Pan J, Liu GG, Gao C. How does separating government regulatory and operational control of public hospitals matter to healthcare supply? China Econ Rev 2013;27:1–14. doi: 10.1016/j.chieco.2013.07.002

6. Sidel VW. The Barefoot Doctors of the People’s Republic of China. N Engl J Med 1972;286:1292–300. doi: 10.1056/NEJM197206152862404 4401952

7. Li X, Lu J, Hu S, Cheng K, De Maeseneer J, Meng Q, et al. The primary health-care system in China. The Lancet 2017;390:2584–94. doi: 10.1016/S0140-6736(17)33109-4

8. Barber SL, Borowitz M, Bekedam H, Ma J. The hospital of the future in China: China’s reform of public hospitals and trends from industrialized countries. Health Policy Plan 2014;29:367–78. doi: 10.1093/heapol/czt023 23612847

9. Organisation, for Economic Cooperation and Development. Health expenditure and financing. 2016. London: 2018.

10. Yip WC-M, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. Lancet Lond Engl 2012;379:833–42. doi: 10.1016/S0140-6736(11)61880-1

11. The World Bank. Fixing the public hospital system in China. The World Bank; 2010.

12. Fu H, Li L, Li M, Yang C, Hsiao W. An evaluation of systemic reforms of public hospitals: the Sanming model in China. Health Policy Plan 2017;32:1135–45. doi: 10.1093/heapol/czx058 28531288

13. Mitchell RK, Agle BR, Wood DJ. Toward a Theory of Stakeholder Identification and Salience: Defining the Principle of Who and What Really Counts. Acad Manage Rev 1997;22:853–86. doi: 10.2307/259247

14. Reed MS, Graves A, Dandy N, Posthumus H, Hubacek K, Morris J, et al. Who’s in and why? A typology of stakeholder analysis methods for natural resource management. J Environ Manage 2009;90:1933–49. doi: 10.1016/j.jenvman.2009.01.001 19231064

15. Morgan DL. Focus Groups as Qualitative Research. SAGE Publications; 1996.

16. Denzin NK, Lincoln YS. The SAGE Handbook of Qualitative Research. SAGE; 2011.

17. Wu B, Xue L, Morrison AM, Leung XY. Frame Analysis on Golden Week Policy Reform in China. Ann Tour Res 2012;39:842–62. doi: 10.1016/j.annals.2011.10.002

18. Song X, Mu X. The safety regulation of small-scale coal mines in China: Analysing the interests and influences of stakeholders. Energy Policy 2013;52:472–81. doi: 10.1016/j.enpol.2012.09.069

19. Tang Y, Mason RJ, Sun P. Interest distribution in the process of coordination of urban and rural construction land in China. Habitat Int 2012;36:388–95. doi: 10.1016/j.habitatint.2011.12.022

20. Liu N, Tang S-Y, Lo CW-H, Zhan X. Stakeholder demands and corporate environmental coping strategies in China. J Environ Manage 2016;165:140–9. doi: 10.1016/j.jenvman.2015.09.027 26431641

21. Chang L, Li W, Lu X. Government Engagement, Environmental Policy, and Environmental Performance: Evidence from the Most Polluting Chinese Listed Firms. Bus Strategy Environ 2015;24:1–19. doi: 10.1002/bse.1802

22. Jing Y, Cui Y, Li D. The politics of performance measurement in China. Policy Soc 2015;34:49–61. doi: 10.1016/j.polsoc.2015.02.001

23. Wang X. Public hospitals to become nonprofit by 2020, State Council says. China Dly 2017.


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