How efficient is the Chinese healthcare system? Milcent examines the medication market in China against the global picture of healthcare organization, and how public healthcare insurance plans have been implemented in recent years, as well as reforms to tackle hospital inefficiency. Healthcare reforms, demographic changes and an increase in wealth inequity have altered healthcare preferences, which need to be addressed. Significantly, the patient–medical staff relationship is analysed, with new proposals for different lines of communication. Milcent puts forward digital healthcare in China as a tool to solve inefficiency and rising tensions, and generate profit. Where China is leading in the digitalization of healthcare, other countries can learn important lessons. Chinese social models are also put into context with respect to current reforms and experimentation.

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Milcent, Carine

Springer Nature Switzerland AG

Palgrave Macmillan

Springer Nature, Cham, Switzerland, 2018

Palgrave pivot, Cham, Switzerland, 2018

Switzerland, Switzerland

Feb 14, 2018

sm67793311

producers:
Adobe PDF Library 15.0

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Source title: Healthcare Reform in China: From Violence To Digital Healthcare

Acknowledgements 6
Contents 7
List of Figures 9
List of Tables 12
Chapter 1: Introduction 13
Bibliography 24
Chapter 2: The Notion of a Health Good in China and Elsewhere 26
A Health Good: Definition and Implications 27
Public Good and Private Good: General Definitions 27
The Health Good and Assumptions of Pure and Perfect Competition 30
Price Elasticity 33
Should Health be a Universally Accessible Good or One Governed by Supply and Demand? 34
Is Health a Good Accessible to All? 34
Health as a Private Good and the Healthcare Market 36
Differentiated Access According to Type of Good 36
Cases According to the Vital Prognosis (Engaged or Not) 37
Medical Consultations: From Physical to Online 37
Prescription and Non-prescription Drugs 39
Specificities of the Health Good in China 40
Bibliography 44
Chapter 3: Organization of Healthcare in China and its Reforms 45
Structure of Healthcare in China and its Evolution 46
Healthcare Footprint in Rural Zones 47
Healthcare Footprint in Urban Areas 50
The Influence of the Hukou on Access to Healthcare in Urban Areas 52
What Lessons Can be Learned from the Evolution of the Chinese Healthcare System? 54
Current Healthcare Institutions and Ownership 55
Village Clinics and Township Hospitals 55
Community Health Service Institutions 57
Current Situational Analysis 61
Bibliography 68
Chapter 4: Hospital Institutional Context and Funding 73
Public Health Establishments 74
Institutional Context 74
Ownership 74
Governing Bodies 74
Evolution of Funding 78
Improving Healthcare Quality and Reducing Hospital Expenditure Funding 80
Funding of Public Hospitals Today 81
Early Forms of Prospective Payment in China 82
First Implementation of the DRG Payment in China 83
Private Health Establishments 85
Is the Private Hospital Sector Really Booming? 85
How to Explain the Difficulty of Growing the Private Hospital Sector? 86
A True Story of the Challenges Behind Opening a Clinic 89
Regulatory and Para-regulatory Context for Private Health Structures 90
New Series of Policies 90
The Model—Chains of Private Specialized Hospitals 91
Public Funding and Private Healthcare Providers 92
Challenges for Private Health Establishments 92
Bibliography 98
Chapter 5: Medical Staff 100
Overview of Supply 101
Doctors and Nurses 103
Becoming a Doctor 105
From 1949 to the 1980s in Rural Areas 105
Current Situation in Rural Areas 106
Medical Education Programme 108
Doctors in Medicine 108
Nurses 110
Work Status 111
“Civil Servant” Status 111
Village Doctor Status 111
Impact of “Bianzhi” Status on Mobility 112
Working Conditions 115
Salary, Bribery and Financial Interest 115
Working Time and Workload 117
On the Supply Side 117
On the Demand Side 118
Overload 118
Publication 120
Low Social Status 120
Occupation Changes 121
Family Doctors: A Possible Future 121
On the Demand Side 121
On the Supply Side 122
Pilot Trials 122
Internet 122
Bibliography 128
Chapter 6: Health Insurance in China 133
In Urban Areas 134
The Labour Insurance System 134
The Government Insurance System 135
The Urban Employees Basic Medical Insurance System from 1998 135
Urban Residents’ Basic Medical Insurance Programme from 2010 136
In Rural Areas 136
The Community Medical System 136
The Disappearance of Any Health Insurance 138
The New Co-operative Medical Scheme 139
Brief Conclusion of Public Health Insurances Launched 140
Medical (Financial) Assistance Programme 141
Current Status of Public Health Insurance Schemes 142
Differences Between the Three Systems of Public Health Insurance 143
The Geographical Inequality 144
Adverse Selection 146
Impact of Insurance on Demand and Prices 147
Induced Demand 147
The Healthcare Price Increase 147
Out-of-Pocket Amounts 148
Public Health Insurance as a Response to a Concentrated Demand 150
First Results: Effect on Health and Healthcare Access 151
Private Health Insurance 152
The Rise of Private Health Insurance 152
Current Obstacles to the Rise 153
Bibliography 158
Chapter 7: The Medical Drug Market and its Reforms 161
Background 162
Structure of the Medical Drug Market 163
On the Supply Side: A Very Fragmented Market 163
An Evolving Distribution Landscape 164
Regulation of the Market Through the EML 165
The Origin of the EML 165
EML and Public Insurance Schemes 167
Central and Local Responsibilities Regarding the EML27 167
The Reform of the EML 169
Impact of the EML in China 169
Beyond the EML 173
Bibliography 177
Chapter 8: The Rise of Violence as a Result of Inefficiency in the Healthcare System 179
Yi nao or Hospital Violence 180
The Origin of Such Violence 182
Changes in Supply 182
Hospital Financing and Personnel Management 182
Consultation and Admission Conditions in Level 3 Hospitals in the Congestion Context 183
Queues Tainted by a Black Market and Bribery 184
The Difficulty of Getting Referred to the Right Specialist 185
The Low Social Recognition of Medical Careers and Lack of Consideration for Medical Staff 185
Lack of Legal Recourse in Cases of Suspected Medical Malpractice 186
Changes in Demand 187
Spatial Changes in Healthcare Demand 187
Including Urbanization 187
Occupation Changes 188
The Dissemination of Information: Internet and Web Platforms 189
For the Public 189
For the Authorities 190
The Medical Literacy Level of Patients and their Relatives 190
How to Restore Trust, Respect and Understanding Between Patients and Medical Staff? 190
Improvements in Physician Qualification and Mobility 190
Police Presence as Short-term Fix 191
In the Mid-term, Family Doctors are Seen as the Way to Re-build Trust 192
Insurance Schemes as a Tool to Streamline Demand 192
The Internet as a Tool for Healthcare Efficiency 193
Bibliography 197
Chapter 9: Digital Healthcare 199
Information Context 201
Smartphone Usage and Apps 201
Institutional Changes 202
Solving Access Challenges 203
Online Appointment Registration Systems 203
Access to Online Healthcare 205
Integrated Model of Online–Offline Services 208
Improving Communication Between Patients and Physicians 210
Restoring the Basics of Communication 211
Mobile Nurse Stations 211
Electronic Health Records (EHRs) 211
Communication Between Physicians 213
Patients are Increasingly Active Actors of their Health 213
mHealth30 and Connected Devices 214
Cloud Computing and Big Data Initiatives 215
Electronic Medical Records (EMRs) 216
Diagnosis Related Groups (DRGs) and Reimbursement 217
Online Drug Market 218
New Models of Drug Purchase 220
Justification of Government Intervention 220
The Upcoming Challenges for E-health 221
Constraints of Data Collection 221
Confidentiality of Data and Patient Privacy 221
Conflicts of Interest 224
Conclusion 226
Bibliography 230
Chapter 10: Conclusion and Discussion 232
A Model Run by Private Insurance Companies 237
The Evolution 237
The Revolution 239
For Whom? 240
A Model Run by Internet Companies 241
For Whom? 243
A Model Run by Public Authorities at a Local Level 243
For Whom? 245
Commonalities Between the Three Models 246
Bibliography 247
Index 249

Front Matter ....Pages i-xv
Introduction (Carine Milcent)....Pages 1-13
The Notion of a Health Good in China and Elsewhere (Carine Milcent)....Pages 15-33
Organization of Healthcare in China and its Reforms (Carine Milcent)....Pages 35-62
Hospital Institutional Context and Funding (Carine Milcent)....Pages 63-89
Medical Staff (Carine Milcent)....Pages 91-123
Health Insurance in China (Carine Milcent)....Pages 125-152
The Medical Drug Market and its Reforms (Carine Milcent)....Pages 153-170
The Rise of Violence as a Result of Inefficiency in the Healthcare System (Carine Milcent)....Pages 171-190
Digital Healthcare (Carine Milcent)....Pages 191-223
Conclusion and Discussion (Carine Milcent)....Pages 225-241
Back Matter ....Pages 243-250

2018-03-04