Public hospital autonomy in China in an international context.

Following decades of change in health care structures and modes of funding, China has recently been making pilot reforms to the governance of its public hospitals, primarily by increasing the autonomy of public hospitals and redefining the roles of the health authorities. In this paper, we analyse the historical evolution and current situation of public hospital governance in China, focussing the range of governance models being tried out in pilot cities across China. We then draw on the experiences of public hospital governance reform in a wide range of other countries to consider the nature of the Chinese pilots. We find that the key difference in China is that the public hospitals in the pilot schemes do not receive sufficient funding from government and are able to distribute profits to staff. This creates incentives to charge patients for excessive treatment. This situation has undermined public service orientation in Chinese public hospitals. We conclude that the pilot reforms of governance will not be sufficient to remedy all the problems facing these hospitals, although they are a step in the right direction.

Report from China: health insurance in China--evolution, current status, and challenges.

The authors review the evolution of health insurance in China and analyze how it has been shaped to its current form by political and economic dynamics. They summarize the current status of health insurance in terms of population coverage, benefit design, scope of service, and its interaction with providers; address challenges regarding future health insurance reform; and propose policy recommendations. Although the recent health insurance reform has made major breakthroughs in population coverage, it is still too early to judge whether the political willingness to appease social unrest can be translated into concrete health care protections for the population.

Social values and health priority setting in China.

PURPOSE: The purpose of this paper is to provide an overview of the organisational and procedural arrangements for healthcare reform in China, and describe the role of social values in the relevant decision-making process. DESIGN/METHODOLOGY/APPROACH: An analysis of recent developments aimed at achieving universal coverage in China was undertaken in the context of describing the influence of underlying social values. FINDINGS: The key underlying social value was found to be social solidarity. Other values were implicit rather than explicitly stated, and were subservient to the overall aim of comprehensive coverage. ORIGINALITY/VALUE: The paper shows that China is embarking on the largest-scale health reforms in the world. There is an eagerness to share experiences with other countries in an attempt to ensure the success of the reforms. There is an increasing understanding of the need to make the values underpinning the reforms more explicit and, in particular, those concerned with efficiency and appropriateness.

The Role of General Attitudes and Perceptions Towards Vaccination on the Newly-Developed Vaccine: Results From a Survey on COVID-19 Vaccine Acceptance in China.

Background: Vaccination has been considered one of the most effective public health interventions. In the context of the global epidemic of coronavirus disease 2019 (COVID-19), it remains unclear what role general vaccination attitudes and perceptions have on the acceptance of COVID-19 vaccine. Objective: This study aims to explore the impact of general attitudes and perceptions toward vaccination on the acceptance of a newly developed vaccine, taking COVID-19 vaccines as an example. Method: A cross-sectional survey was conducted among 2,013 Chinese adult participants. Generalized order logistic regression and path analysis models were used to analyze impacts of general attitudes and perceptions toward vaccination on the acceptance of the COVID-19 vaccine. Results: The prevalence of hesitancy to vaccination in general is 49.9% among the Chinese adult population. General perceptions of vaccination were associated with corresponding perceptions of the COVID-19 vaccine. A "no hesitancy" attitude toward vaccination is a significant determinant (aOR = 1.77, 95% CI = 1.36-2.31) of future COVID-19 vaccination compared to vaccine refusers, and perceptions of COVID-19 vaccine remain a significant determinant for the acceptance of the COVID-19 vaccine. Path analysis indicates that perceptions of the importance and safety of vaccination have a positive overall effect on the acceptance of the COVID-19 vaccine, and that general perceptions of vaccination as a whole on each measure indirectly influence the acceptance of the COVID-19 vaccine. Conclusion: General attitudes and perceptions toward vaccination were associated with those of the COVID-19 vaccine and future vaccination intention. To prepare for possible emergence of diseases in the future, routine health campaigns should be launched by relevant government departments and vaccination authorities to enhance the overall awareness and knowledge of vaccination among the public and to ensure optimal vaccination experience. In addition, targeted knowledge dissemination and mass mobilizations should be urged for newly developed vaccines when some specific infectious diseases emerge, such as COVID-19 at present.

Longitudinal study of the earliest pilot of tiered healthcare system reforms in China: Will the new type of chronic disease management be effective?

BACKGROUND: In 2016, the tiered healthcare model featuring "specialists + general practitioners + health managers" in Xiamen was recognized by the Medical Reform Office of State Council and was promoted as a model to replace hospital-centric care with community-based care. This study evaluated the impact of the Xiamen's tiered healthcare system reform on health outcomes and healthcare spending among chronic disease patients. METHODS: Data were derived from Xiamen's electronic health record (EHR) and medical claims systems. The sample included 154,651 individuals with hypertension and 50,722 individuals with diabetes from Xiamen between 2012 and 2016. The dependent variables included rates of disease under control and total treatment costs. Patients were grouped by the types of chronic disease management: precision management, regular management, or without management. Kaplan-Meier, Cox survival analysis and PSM + DID method (Propensity score matching and difference-in-difference method) were used to compare the management outcomes by group. FINDINGS: The precision management group showed better clinical quality performance than the regular management group. Under-control disease rates in the precision management group showed a continuous improvement trend, while the regular management group showed a ceiling effect after ten months. Under-control rates in the precision management group increased over 40% for hypertension and over 30% for diabetes, higher than that increases found in the regular management group. Reform was also associated with consistent reductions in annual per capita total treatment costs across groups. The cost-savings in the precision management group between 2014 and 2016 was 381 Chinese yuan (CNY) for hypertension and 1117 CNY for diabetes, compared with the group without management. INTERPRETATION: The results in this study demonstrated the associations between tiered healthcare system reform and better clinical quality performance and improved treatment cost-saving. Developing methods to promote the policy and increase implementation are also important aspects of healthcare reform.

Patterns of public participation.

Purpose - The paper summarizes data from 12 countries, chosen to exhibit wide variation, on the role and place of public participation in the setting of priorities. The purpose of this paper is to exhibit cross-national patterns in respect of public participation, linking those differences to institutional features of the countries concerned. Design/methodology/approach - The approach is an example of case-orientated qualitative assessment of participation practices. It derives its data from the presentation of country case studies by experts on each system. The country cases are located within the historical development of democracy in each country. Findings - Patterns of participation are widely variable. Participation that is effective through routinized institutional processes appears to be inversely related to contestatory participation that uses political mobilization to challenge the legitimacy of the priority setting process. No system has resolved the conceptual ambiguities that are implicit in the idea of public participation. Originality/value - The paper draws on a unique collection of country case studies in participatory practice in prioritization, supplementing existing published sources. In showing that contestatory participation plays an important role in a sub-set of these countries it makes an important contribution to the field because it broadens the debate about public participation in priority setting beyond the use of minipublics and the observation of public representatives on decision-making bodies.

An evaluation of the policy on community health organizations in China: will the priority of new healthcare reform in China be a success?

OBJECTIVES: The objective of this paper is to assess historical and recent health reform efforts in China. We provide a brief history of the Chinese healthcare system since 1949 as context for the current healthcare; examine the factors that led to recent efforts to reestablish community-based care in China; and identify the challenges associated with attaining a sustainable and quality community healthcare system. METHODS: Based on literature review and publicly available data in China, the paper will present a historical case study analysis of health policy change of CHOs in China and provide policy evaluation, and the paper provided policy suggestions. RESULTS: We find that the government's recent efforts to emphasize the significance of community healthcare services in China have started to change patterns of healthcare use, but many problems still inhibit the development of CHOs, including unsustainable governmental roles, issues of human resource inadequacy and laggard GP practice, poorly designed payment schemes, patient's trust crisis and continue to inhibit the development of community-based primary care. CONCLUSIONS: Additional policy efforts to help CHOs' development are needed. Recent government investments in public health and primary care alone are not sufficient and could not be sustainable. It will not until long-term self-sustaining mechanisms to relieve an omnipotent government are established, including competent community doctors (GP) system, supportive social insurance reimbursement, appropriate financial incentives to providers, better transparency and accountability, as well as a more regulated referral system, a legitimate, sustainable and quality community health system could be attained.