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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: 54.42). 10/2005; 353(11):1165-70. DOI: 10.1056/NEJMhpr051133
Source: PubMed
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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.
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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.
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    • "The performance of this Chinese health insurance system turned out to be a surprising success. The health status of the Chinese people rose dramatically during that period, mortality and morbidity rates were greatly reduced, many infectious diseases were effectively controlled, some sexual transmitted diseases were even eradicated, infant mortality fell from 200 to 34 per 1000 live births, and life expectancy increased from about 35 to 68 years [1]. The health improvements in China resulted in an interesting comparison reported by the New York Times [2]: In Shanghai, 10.9 infants out of 1,000 die before their first birthday, while in New York City infant mortality is 13.3 per 1,000 live births. "
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    ABSTRACT: The healthcare system for urban employees in China was established in the early 1950s. The first stage (1950s-1980) mainly consisted of two parts, the Government Insurance Scheme (GIS) and the Labor Insurance Scheme (LIS). The GIS and LIS achieved remarkable success with limited resources, contributed to economic development and social stability, and won high praise from the World Health Organization. The second stage (1980s to date) aimed at controlling costs and expanded the risk pool to the city level, but experienced several problems, was not well received by the public, and drew negative government evaluations. This study examines underlying reasons and offers recommendations for improvement.
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