Utilization, cost, payment, and patient satisfaction of rehabilitative services in Shandong, China.

OBJECTIVES: China's transformation into a market-based and global economy has had dramatic health policy implications on a system that serves roughly 1.3 billion people. This global perspective is resulting in the integration of Traditional Chinese Medicine (TCM) and western medicine for the treatment of an increasing number of morbidities. However, little research has been conducted that examines patient response to this convergence. This study researches the utilization, cost, payment and patient satisfaction with rehabilitative services received in China. METHODS: A structured questionnaire was administered to 192 patients receiving rehabilitative services in China's Shandong Province. RESULTS: The most frequently ordered TCM therapies were acupuncture (14.1%) and massage therapy (15.6%). The most frequently ordered western therapies were physical therapy (62.5%) and occupational therapy (6.3%). Physical therapy was considered the most cost-effective service at almost half the cost of acupuncture. Almost 85% of respondents had some form of health insurance and 90% expressed satisfaction with their therapy. CONCLUSIONS: Healthcare providers should consider offering TCM and western medicine for morbidities requiring rehabilitative services. In a more global healthcare marketplace, the convergence of these two treatment modalities can lead to higher patient satisfaction and more cost-effective treatments.

Hospital staffing decisions: does financial performance matter?

This study assesses the impact of changes in hospitals' financial conditions on changes in hospitals' staffing decisions. The sample consisted of community hospitals operating between 1995 and 2000. The analysis employed a generalized method of moments (GMM) estimator for its dynamic panel data. Cash flow and patient margin were used to measure financial condition. We estimated the effect of changing financial condition on the number of full-time equivalent personnel (FTEs), registered nurses (RNs), and licensed practical nurses (LPNs) per 1,000 adjusted patient days. Our results suggest that declining financial performance led to cutbacks in LPN FTEs per adjusted patient day, but the effects on total hospital FTEs and RN FTEs were mixed.

Serving billions: a pilot study on clinician-perceived efficacy of rehabilitative services in China.

China has the world's largest number of disabled people, and this number is projected to grow. Although there is ample literature on the utilization and efficacy of Western medicine as it pertains to rehabilitation services, there is far less research on the perceived efficacy of traditional Chinese medicine (TCM). A structured questionnaire was designed for a pilot study on TCM and Western medicine used for rehabilitation services in China, their associated charges, and perceived efficacy. A sample of 33 clinicians responded to the questionnaire. The analysis found that clinicians most frequently prescribed Fenbid and Chinese herbs to treat rehabilitation morbidities, and the most common TCM treatments were acupuncture and massage therapy. The average patient charge for each visit for TCM therapy varied from 56 Yuan (dollars 7.30) for Chinese herbal medicine to 12 Yuan (dollars 1.60) for cupping therapy. The most frequently prescribed Western therapies were occupational, physical, and speech. The average charge for each visit for Western medicine varied from 111 Yuan (dollars 14.60) for physical therapy to 48 Yuan (dollars 6.30) occupational therapy. Clinicians indicated that acupuncture, Chinese herbal medicine, massage, speech, occupational, and physical therapies were "effective" or "highly effective" in treating morbidities requiring rehabilitation services.

Five myths of the Chinese health care system.

As China continues its moves from a socialist ideology to a market economy, the impact of its presence is being felt globally. This is especially true with China's health care system and the challenges that it is experiencing with its 1.3 billion population. The erosion of China's socialist ideology was accompanied by an erosion of the government's subsidy of health services, placing the major responsibilities of providing health care services on regional governments. Unfortunately, the impact of these policies on China's health care system is not commonly understood, resulting in confusion and propagation of myths. For example, many believe that the Chinese government provides free health care for all citizens, and the population has not accepted Western medicine and relies primarily on traditional Chinese medicine. In addition, it is believed that there is no shortage of nurses, as the majority of care is provided at home. Finally, it is commonly believed that China's health care issues are different from those of the United States. Exploration of these myths provides us with a better understanding and an improved ability to engage with this emerging economic global leader.