Privatization and Its Discontents—The Evolving Chinese Health Care System

Department of Health Policy and Management , Harvard University, Cambridge, Massachusetts, United States
New England Journal of Medicine (Impact Factor: 55.87). 10/2005; 353(11):1165-70. DOI: 10.1056/NEJMhpr051133
Source: PubMed
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    • "Furthermore, private healthcare systems tend to lack published data by which to evaluate their performance (Basu et al., 2012). Privatization compromises equity and accessibility for poor and vulnerable populations in particular (e.g., Palmer, 2014), as user fees instituted in private clinics deter ill people from seeking care or adhering to treatments (e.g., Baker, 2014; Basu et al., 2012; Blumenthal & Hsiao, 2005; Herrera, 2014; Navarro et al., 2006). In contrast, public clinics are subsidized by the government and thus have limited or no costs to patients, and studies emphasize the costs for prescription drugs are significantly lower in public clinics in comparison to private providers (e.g., Basu et al., 2012). "
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    ABSTRACT: Tuberculosis remains a persistent global health problem and key threat to development in poor countries. While many nations pursue privatization of healthcare, some accounts suggest that private health services are inadequate in addressing the TB burden. We utilize panel regression to empirically investigate data from 99 less-developed nations from 1995 to 2010. The results illustrate private health expenditures do not significantly impact TB rates, while public health expenditures reduce TB rates in developing nations over time. Thus, we caution against international development strategies which promote cuts in public spending and encourage privatization of healthcare as a means to stimulate growth or efficiency.
    World Development 02/2016; 78:450-460. DOI:10.1016/j.worlddev.2015.10.027 · 1.73 Impact Factor
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    • "2 TABEA BORK-HÜFFER & FRAUKE KRAAS shortages, taking place much quicker in rural areas than in urban areas (for a detailed overview of the steps of privatisation see Lim et al. 2002). Compared with the wide range of research on the public sector, analyses of the quality and the organisation of the private sector still remain scant, though research on this topic is on the increase (examples are Blumenthal and Hsiao 2005; Eggleston et al. 2010; Tam 2010). Private for-profit hospitals and clinics have emerged as important players in China's health care market (Ma et al. 2008), but the public health care provision system and within it especially public hospitals are still dominant (only 12.2% of all visits to medical institutions in 2008 were visits to private facilities , China Health Survey 2009; MoH 2009). "
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    ABSTRACT: One of the unintended effects of China's health care reforms is the emergence of unregistered practitioners. We discuss reasons for their development and their role in the urban health care provision system under consideration of general developments in health care provision and health governance – thereby drawing scientific attention to a by far under-researched topic. We analyse the basic characteristics and strategies of clinic-based unregistered practitioners in Guangzhou and examine their perception and utilisation by rural-to-urban migrants. The research design followed a qualitative dominant mixed methods research approach, which included expert interviews with representatives of administration, indepth interviews with practitioners and migrants, a quantitative survey with 450 migrants and field observations. According to our results, gaps in the formal health care system – especially lack of access of marginalised population groups and inadequate responsiveness – poor enforcement of regulation and corrupt executive person-nel are responsible for their emergence and prevalence.
    Tijdschrift voor Economische en Sociale Geografie 07/2015; 106(3). DOI:10.1111/tesg.12116 · 0.68 Impact Factor
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    • "From 1979, the Chinese health-care system gradually transferred from a planned to a market economy (Hsiao 2008). Since then, the State subsidy has been cut annually, from 30% to less than 7% of total hospital expenditure (Blumenthal and Hsiao 2005). Due to a lack of valid monitoring mechanisms in Chinese hospitals (Ma et al. 2008, Wu 1997), the hospital managers are reluctant to admit that nurses are important to the quality and safety of care based on a profit motive driver (Hsiao 2008, Zhu et al. 2014). "
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    ABSTRACT: The paper aims to understand how the Chinese nursing education and recruitment policy impacts nurses to leave nursing practice. There is a lack of feasible strategies to maintain a sustainable effective nursing workforce with an increasing trend of nurses' leaving clinical care. In its efforts to resolve the nursing shortage, the Chinese government currently emphasizes expanding nursing education while controlling staffing ratios. This qualitative research design was based on the framework of symbolic interactionism. The in-depth interviews with 19 nurses who have left the nursing practice were theoretically sampled from one provincial capital city in China. The core category "Mismatched Expectations: Individual vs. Organization" emerged from five subcategories, which illustrates how the mismatched individual and organizational expectations of nursing were created through nurses educational and employment processes within the Chinese health care system. When the individual and organizational expectations of nursing are highly mismatched, there is a risk that highly educated nurses will leave nursing practice. Students should be enabled to have realistic expectations of nursing, and new graduates need sufficient supports to adapt to the health care environment without losing their vision of nursing for future.
    17th Annual International Conference on Education, Athens, Greece; 04/2015
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