Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2024

Open Access 01-12-2024 | Research

Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China

Authors: Yingbei Xiong, Kunhe Lin, Yifan Yao, Zhengdong Zhong, Li Xiang

Published in: BMC Health Services Research | Issue 1/2024

Login to get access

Abstract

Background

China initiated the Medical Alliances (MAs) reform to enhance resource allocation efficiency and ensure equitable healthcare. In response to challenges posed by the predominance of public hospitals, the reform explores public-private partnerships within the MAs. Notably, private hospitals can now participate as either leading or member institutions. This study aims to evaluate the dynamic shifts in market share between public and private hospitals across diverse MAs models.

Methods

Data spanning April 2017 to March 2019 for Dangyang County’s MA and January 2018 to December 2019 for Qianjiang County’s MA were analyzed. Interrupted periods occurred in April 2018 and January 2019. Using independent sample t-tests, chi-square tests, and interrupted time series analysis (ITSA), we compared the proportion of hospital revenue, the proportion of visits for treatment, and the average hospitalization days of discharged patients between leading public hospitals and leading private hospitals, as well as between member public hospitals and member private hospitals before and after the reform.

Results

After the MAs reform, the revenue proportion decreased for leading public and private hospitals, while member hospitals saw an increase. However, ITSA revealed a notable rise trend in revenue proportion for leading private hospitals (p < 0.001), with a slope of 0.279% per month. Member public and private hospitals experienced decreasing revenue proportions, with outpatient visits proportions declining in member public hospitals by 0.089% per month (p < 0.05) and inpatient admissions proportions dropping in member private hospitals by 0.752% per month (p < 0.001). The average length of stay in member private hospitals increased by 0.321 days per month after the reform (p < 0.01).

Conclusions

This study underscores the imperative to reinforce oversight and constraints on leading hospitals, especially private leading hospitals, to curb the trend of diverting patients from member hospitals. At the same time, for private hospitals that are at a disadvantage in competition and may lead to unreasonable prolongation of hospital stay, this kind of behavior can be avoided by strengthening supervision or granting leadership.
Literature
1.
Dai G, Li R, Ma S. Research on the equity of health resource allocation in TCM hospitals in China based on the Gini coefficient and agglomeration degree: 2009–2018. Int J Equity Health. 2022;21(1):145.PubMedPubMedCentralCrossRef
2.
Glasziou P, Straus S, Brownlee S, Trevena L, Dans L, Guyatt G, et al. Evidence for underuse of effective medical services around the world. Lancet Lond Engl. 2017;390(10090):169–77.CrossRef
3.
4.
Su M, Zhou Z, Si Y, Wei X. Effect of health alliances on the quality of primary care in urban China: a coarsened exact matching difference-in-differences analysis. Lancet. 2019;394:S86.CrossRef
5.
Gao H, Du X, li, Liao Jzhi, Xiang L. The pathway of China’s Integrated Delivery System: based on the analysis of the Medical Consortium policies. Curr Med Sci. 2022;42(6):1164–71.PubMedPubMedCentralCrossRef
6.
Kumah E. The informal healthcare providers and universal health coverage in low and middle-income countries. Glob Health. 2022;18(1):45.CrossRef
7.
Mackintosh M, Channon A, Karan A, Selvaraj S, Cavagnero E, Zhao H. What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries. Lancet. 2016;388(10044):596–605.PubMedCrossRef
8.
Morgan R, Ensor T, Waters H. Performance of private sector health care: implications for universal health coverage. Lancet. 2016;388(10044):606–12.PubMedCrossRef
9.
Montagu D, Goodman C. Prohibit, constrain, encourage, or purchase: how should we engage with the private health-care sector? Lancet. 2016;388(10044):613–21.PubMedCrossRef
10.
McPake B, Hanson K. Managing the public–private mix to achieve universal health coverage. Lancet. 2016;388(10044):622–30.PubMedCrossRef
11.
Siddiqi S, Aftab W, Venkat Raman A, Soucat A, Alwan A. The role of the private sector in delivering essential packages of health services: lessons from country experiences. BMJ Glob Health. 2023;8(Suppl 1):e010742.PubMedPubMedCentralCrossRef
12.
Ow Yong LM, Cameron A. Learning from elsewhere: Integrated care development in Singapore. Health Policy. 2019;123(4):393–402.PubMedCrossRef
13.
14.
Tan KB, Earn Lee C. Integration of Primary Care with Hospital Services for Sustainable Universal Health Coverage in Singapore. Health Syst Reform. 2019;5(1):18–23.PubMedCrossRef
15.
Su D, Chen Y, Gao H, Li H, Shi L, Chang J et al. Does capitation prepayment based Integrated County Healthcare Consortium affect inpatient distribution and benefits in Anhui Province, China? An interrupted time series analysis. 2019;19(3):1.
16.
Aneste E, Lozan O. The perception of competition in the hospital healthcare market of the Republic of Moldova. Int J Health Gov. 2023;28(3):311–8.
17.
Sá LAD, Covre ER, Melo WAD, Gomes RM, Tostes MFDP. Public-private relationship in surgical hospitalizations through the Unified Health System. Rev Lat Am Enfermagem. 2021;29:e3467.PubMedPubMedCentralCrossRef
18.
Erivan R, Rigolot B, Villatte G, Dartus J, Descamps S, Boisgard S. Orthopaedic and trauma surgery in France: do patterns differ across healthcare institution types (public community, public university, private not-for-profit, and private for-profit)? Orthop Traumatol Surg Res. 2022;108(8):103402.PubMedCrossRef
19.
Zhu X, Du Y, He W, Dai J, Chen M, Yao P, et al. Ophthalmic services in Shanghai 2017: a cataract-centric city-wide government survey. BMC Health Serv Res. 2021;21(1):1043.PubMedPubMedCentralCrossRef
20.
Daniels B, Shah D, Kwan AT, Das R, Das V, Puri V, et al. Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India. BMJ Glob Health. 2022;7(10):e009657.PubMedPubMedCentralCrossRef
21.
Dinkashe FT, Haile K, Adem FM. Availability and affordability of priority lifesaving maternal health medicines in Addis Ababa, Ethiopia. BMC Health Serv Res. 2022;22(1):524.PubMedPubMedCentralCrossRef
22.
Mela Osorio MJ, Pavlovsky C, Pavlovsky MA. Inequalities in access to treatment in Argentina: differences in management of CLL and multiple myeloma? Semin Hematol 2023;S0037196323000549.
23.
Poutanen R, Korppi M, Csonka P, Pauniaho SL, Renko M, Palmu S. Use of antibiotics contrary to guidelines for children’s lower respiratory tract infections in different health care settings. Eur J Pediatr. 2023;182(10):4369–77.PubMedPubMedCentralCrossRef
24.
Brument M, Defortescu G, Bugel H, Sibert L, Duflot T, Dupuis H, et al. Differential impact of COVID-19 on urological surgeries in public and private institutions between 2019 and 2021 in France. Prog En Urol. 2023;33(8–9):412–20.CrossRef
25.
Buczak-Stec E, Goryński P, Nitsch-Osuch A, Kanecki K, Tyszko P. The impact of introducing a new hospital financing system (DRGs) in Poland on hospitalisations for atherosclerosis: an interrupted time series analysis (2004–2012). Health Policy Amst Neth. 2017;121(11):1186–93.CrossRef
26.
Rezaei Z, Lotfi F, Bayati M, Kavosi Z. The effect of Covid-19 pandemic on healthcare utilization in public vs private centers in Iran: a multiple group interrupted time-series analysis. BMC Health Serv Res. 2023;23(1):822.PubMedPubMedCentralCrossRef
27.
Tang X, Zhang X, Chen Y, Yan J, Qian M, Ying X. Variations in the impact of the new case-based payment reform on medical costs, length of stay, and quality across different hospitals in China: an interrupted time series analysis. BMC Health Serv Res. 2023;23(1):568.PubMedPubMedCentralCrossRef
28.
Wu C, Tu Y, Li Z, Yu J. An early assessment of the County Medical Community reform in China: a case study of Zhejiang province. J Chin Gov. 2021;6(4):463–85.CrossRef
29.
Cai M, Liu E, Tao H, Qian Z, Fu Q (John), Lin X Does A Medical Consortium Influence Health Outcomes of Hospitalized Cancer Patients? An Integrated Care Model in Shanxi, et al. editors. China. 2018;18(2):7.
30.
Ran Y, Gao H, Han D, Hou G, Chen Y, Zhang Y. Comparison of inpatient distribution amongst different medical alliances in a county: a longitudinal study on a healthcare reform in rural China. Int J EQUITY Health. 2020;19(1):142.PubMedPubMedCentralCrossRef
31.
Ye Y, Evans R, Jing L, Rizwan M, Xuan Y, Lu W. The impact of County Medical Community Reform on the Medical Service Efficiency of County-Level Public General hospitals in China: a case study of Shanxi Province. Int J Environ Res Public Health. 2022;19(21):13827.PubMedPubMedCentralCrossRef
32.
Iliff AR, Jha AK. Public-Private Partnerships in Global Health - Driving Health improvements without compromising values. N Engl J Med. 2019;380(12):1097–9.PubMedCrossRef
33.
Wang C, Chen Y. hua. Reimbursement and hospital competition in China. Econ Res-Ekon Istraz 2017;30(1):1209–23.
34.
Chen B, Fan VY. Strategic Provider Behavior under Global Budget Payment with Price Adjustment in Taiwan. Health Econ. 2015;24(11):1422–36.PubMedCrossRef
35.
Chen Y, Wang L, Cui X, Xu J, Xu Y, Yang Z, et al. COVID-19 as an opportunity to reveal the impact of large hospital expansion on the healthcare delivery system: evidence from Shanghai, China. Ann Transl Med. 2021;9(16):1297–1297.PubMedPubMedCentralCrossRef
36.
Drake C, Jarlenski M, Zhang Y, Polsky D. Market share of US Catholic Hospitals and Associated Geographic Network Access to Reproductive Health Services. JAMA Netw Open. 2020;3(1):e1920053.PubMedPubMedCentralCrossRef
37.
Fahmy JN, Cichocki MN, Chung KC. Quasi-experimental Design for Health Policy Research: a methodology overview. Plast Reconstr Surg. 2023;151(3):667–75.PubMedCrossRef
38.
Jiang H, Feng X, Lange S, Tran A, Manthey J, Rehm J. Estimating effects of health policy interventions using interrupted time-series analyses: a simulation study. BMC Med Res Methodol. 2022;22(1):235.PubMedPubMedCentralCrossRef
39.
Beiranvand S, Saki M, Behzadifar M, Bakhtiari A, Behzadifar M, Keshvari M, et al. The effect of the Iranian health transformation plan on hospitalization rate: insights from an interrupted time series analysis. BMC Health Serv Res. 2020;20(1):327.PubMedPubMedCentralCrossRef
40.
Kim NH, Jung SH, Kawachi I. Did expanded Dental Insurance reduce out-of-Pocket expenditures on Dental Care among older adults in Korea? Interrupted time-series analysis. Int J Environ Res Public Health. 2021;18(6):3003.PubMedPubMedCentralCrossRef
41.
Linden A. Conducting interrupted time-series Analysis for single- and multiple-group comparisons. Stata J Promot Commun Stat Stata. 2015;15(2):480–500.CrossRef
42.
Dong C, Liu J, Mi J. Information-Driven Integrated Healthcare: an analysis of the Cooperation Strategy of County Medical Community based on Multi-subject Simulation. Healthcare. 2023;11(14):2019.PubMedPubMedCentralCrossRef
43.
Kruse FM, Stadhouders NW, Adang EM, Groenewoud S, Jeurissen PPT. Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review. Int J Health Plann Manage. 2018;33(2):e434–53.PubMedPubMedCentralCrossRef
44.
Xue Q, Xu DR, Cheng TC, Pan J, Yip W. The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China. Arch PUBLIC Health. 2023;81(1):19.PubMedPubMedCentralCrossRef
45.
Gao Q, Ma Y, Zhu P, Chen D. Healthcare professionals’ views of the Integrated County Healthcare Consortium in Zhejiang. China. 2022;22(0):25.
46.
Zhang M, Yang R, Wang W, Gillespie J, Clarke S, Yan F. Job satisfaction of urban community health workers after the 2009 healthcare reform in China: a systematic review. Int J Qual Health Care. 2016;28(1):14–21.PubMedCrossRef
47.
Dong C, Liu J, Mi J. Information-Driven Integrated Healthcare: An Analysis of the Cooperation Strategy of County Medical Community Based on Multi-Subject Simulation. HEALTHCARE. 2023;11(14).
48.
Zhong ZHENGDONG, Yao QI, a. NG, Chen SH a. NQU a. N, Jiang JUNNa, Lin N, Yao KUNHE et al. YIF a. N, China Promotes Sanming’s Model: A National Template for Integrated Medicare Payment Methods. Int J Integr CARE. 2023;23(2):15.
49.
Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet. 2019;394(10204):1192–204.PubMedCrossRef
50.
Shang Zhao L, Yuqing L, Yueping, Dai Yue. Theoretical discussion and countermeasure analysis on the construction of county medical communities in China. Chin J Hosp Adm. 2022;38(5):321–6.
51.
Xiong X, Zhou S, Huo Z, Luo L. GIS-based method to delimit spheres of influence for a medical consortium: experience of a pediatric medical consortium, Shanghai. Int J Health Plann Manage. 2019;34(1):294–308.PubMedCrossRef
52.
Yingbei Xiong,Zhengdong Zhong, Kunhe Lin, Jin Zhou, Li Xiang. Research on the influence of internal and external economic incentives of Sanming County medical alliance on medical service supply. Chin J Health Policy. 2022;15(7):66–73.
53.
Moro Visconti R, Martiniello L, Morea D, Gebennini E. Can Public-private partnerships Foster Investment sustainability in Smart. Hospitals? Sustain 2019;11(6).
54.
Khetrapal S, Acharya A, Mills A. Assessment of the public-private-partnerships model of a national health insurance scheme in India. Soc Sci Med. 2019;243:112634.PubMedPubMedCentralCrossRef
Metadata
Title
Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China
Authors
Yingbei Xiong
Kunhe Lin
Yifan Yao
Zhengdong Zhong
Li Xiang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-024-10941-0

Other articles of this Issue 1/2024

BMC Health Services Research 1/2024 Go to the issue

Research

Employees’ experiences of a large-scale implementation in a public care setting: a novel mixed-method approach to content analysis

Research

Associations between outpatient care and later hospital admissions for patients with chronic obstructive pulmonary disease - a registry study from Norway

Correction

Correction: The complexity of leadership in coproduction practices: a guiding framework based on a systematic literature review

Research

Implementation of remote home care: assessment guided by the RE-AIM framework

Research

Developing criteria for a profession to be considered as profession of allied health in Malaysia: a qualitative study from the Malaysian perspective

Research

Characterizing food environments of hospitals and long-term care facilities in the Netherlands: a mixed methods approach