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Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Research article

China’s new policy for healthcare cost-control based on global budget: a survey of 110 clinicians in hospitals

Authors: Jianzhou Yan, Hui-Heng Lin, Dan Zhao, Yuanjia Hu, Rong Shao

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

The increasing cost on healthcare exposes China’s healthcare budgets and system to financial crisis. To control the excessive growth of healthcare expenditure, China’s healthcare reforms emphasize the control of the global budget for healthcare, which leads to the release of relevant policy and a series of cost-control actions implemented by different hospitals. This work aims to identify the effects brought by the cost-control policy and actions via surveying and analysing feedback from clinicians.

Methods

Questionnaires on the cost-control policy and actions were designed for surveying 110 clinicians in hospitals from different regions of China. The data on the implementation of the cost-control actions and doctors’ feedback on these actions were analysed using descriptive statistics. Pearson’s chi-squared tests were performed to detect associations between doctors’ opinions and specific cost-control actions. A value of p < 0.05 was considered statistically significant. Association relationships between doctors’ opinions and cost-control actions were modelled into network models, and key factors were identified in a multi-variate framework. Last, we visualized our resultant data using a network model, and further multi-variate analysis was performed.

Results

There were three main findings. (1) The cost-control policy has been widely implemented in the sampled hospitals in different regions of China, with more than 80% of those surveyed acknowledging that their hospitals take actions of reducing average prescription fees for outpatients, drug costs, and in-hospitalization durations. (2) Most doctors have a negative view of some cost-control actions; this is mainly due to concerns about the effects of these actions on the doctors’ own healthcare performance and patient satisfaction. (3) Cost-control actions that had a significant impact on doctors’ performance included limiting average prescription fees for outpatients and limiting the use of examinations/drugs/surgeries. Decreased patient satisfaction was associated with fewer admissions of critically ill patients, reduced use of brand-name drugs, and increased total costs to patients due to increased frequencies of visits to the hospitals.

Conclusions

Cost-control actions implemented in hospitals in response to the government’s policy to reduce its national healthcare budget affect both doctors and patients in several ways. Moreover, the cost-control policy and actions can be improved.
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Literature
1.
go back to reference Yip WCM, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China's huge and complex health-care reforms. Lancet. 2012;379:833–42.CrossRef Yip WCM, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China's huge and complex health-care reforms. Lancet. 2012;379:833–42.CrossRef
3.
go back to reference Zhai T, Goss J, Li J. Main drivers of health expenditure growth in China: a decomposition analysis. BMC Health Serv Res. 2017;17:185.CrossRef Zhai T, Goss J, Li J. Main drivers of health expenditure growth in China: a decomposition analysis. BMC Health Serv Res. 2017;17:185.CrossRef
4.
go back to reference Chernew ME, Newhouse JP. Chpater one: health care spending growth. In: Pauly M, McGuire BP, editors. Health care spending growth. Handbook of health economics, vol. 2. Oxford: Elsevier B.V; 2012. p. 1–43. Chernew ME, Newhouse JP. Chpater one: health care spending growth. In: Pauly M, McGuire BP, editors. Health care spending growth. Handbook of health economics, vol. 2. Oxford: Elsevier B.V; 2012. p. 1–43.
5.
go back to reference Yang G, Kong L, Zhao W, Wan X, Zhai Y, Chen LC, et al. Emergence of chronic non-communicable diseases in China. Lancet. 2008;372:1697–705.CrossRef Yang G, Kong L, Zhao W, Wan X, Zhai Y, Chen LC, et al. Emergence of chronic non-communicable diseases in China. Lancet. 2008;372:1697–705.CrossRef
6.
go back to reference Chen B, Fan VY. Strategic provider behavior under global budget payment with price adjustment in Taiwan. Health Econ. 2015;24:1422–36.CrossRef Chen B, Fan VY. Strategic provider behavior under global budget payment with price adjustment in Taiwan. Health Econ. 2015;24:1422–36.CrossRef
7.
go back to reference Kan K, Li SF, Tsai WD. The impact of global budgeting on treatment intensity and outcomes. Int J Health Care Finance Econ. 2014;14:311–37.CrossRef Kan K, Li SF, Tsai WD. The impact of global budgeting on treatment intensity and outcomes. Int J Health Care Finance Econ. 2014;14:311–37.CrossRef
8.
go back to reference Song Z, Safran DG, Landon BE, Landrum MB, He Y, Mechanic RE, Day MP, Chernew ME. The ‘Alternative quality contract,’ based on a global budget, lowered medical spending and improved quality. Health Aff. 2012;(8):1885–94. Song Z, Safran DG, Landon BE, Landrum MB, He Y, Mechanic RE, Day MP, Chernew ME. The ‘Alternative quality contract,’ based on a global budget, lowered medical spending and improved quality. Health Aff. 2012;(8):1885–94.
9.
go back to reference Etter JF, Perneger TV. Health care expenditures after introduction of a gatekeeper and a global budget in a Swiss health insurance plan. J Epidemiol Community Health. 1998;(6):370–6. Etter JF, Perneger TV. Health care expenditures after introduction of a gatekeeper and a global budget in a Swiss health insurance plan. J Epidemiol Community Health. 1998;(6):370–6.
13.
go back to reference Zhang H, Zhang HX, Jin B, Song N. Comparison analysis of subtotal cost among insured outpatients in Beijing before and after the implementation of the total prepaid system. Chin Health Qual Manage. 2018;1:21–3 (Article in Chinese). Zhang H, Zhang HX, Jin B, Song N. Comparison analysis of subtotal cost among insured outpatients in Beijing before and after the implementation of the total prepaid system. Chin Health Qual Manage. 2018;1:21–3 (Article in Chinese).
14.
go back to reference Song Z, Rose S, Safran DG, Landon BE, Day MP, Chernew ME. Changes in health care spending and quality 4 years into global payment. N Engl J Med. 2014;371:1704–14.CrossRef Song Z, Rose S, Safran DG, Landon BE, Day MP, Chernew ME. Changes in health care spending and quality 4 years into global payment. N Engl J Med. 2014;371:1704–14.CrossRef
15.
go back to reference Markovich P. A global budget pilot project among provider partners and blue shield of California led to savings in first two years. Health Aff. 2012;31:1969–76.CrossRef Markovich P. A global budget pilot project among provider partners and blue shield of California led to savings in first two years. Health Aff. 2012;31:1969–76.CrossRef
16.
go back to reference Chang RE, Hsieh CJ, Myrtle RC. The effect of outpatient dialysis global budget cap on healthcare utilization by end-stage renal disease patients. Soc Sci Med. 2011;73:153–9.CrossRef Chang RE, Hsieh CJ, Myrtle RC. The effect of outpatient dialysis global budget cap on healthcare utilization by end-stage renal disease patients. Soc Sci Med. 2011;73:153–9.CrossRef
17.
go back to reference Huang Y, Liu Y, Yang X, Li J, Fang P. Global budget payment system helps to reduce outpatient medical expenditure of hypertension in China. Springerplus. 2016;5(1):1877.CrossRef Huang Y, Liu Y, Yang X, Li J, Fang P. Global budget payment system helps to reduce outpatient medical expenditure of hypertension in China. Springerplus. 2016;5(1):1877.CrossRef
19.
go back to reference Yang Y. The global budget payment system’s effects to healthcare quality, efficiency and cost. The repository of master thesis of the Second Military Medical University. Shanghai: The Second Miliarty Medical University Press. 2014; (Article in Chinese). Yang Y. The global budget payment system’s effects to healthcare quality, efficiency and cost. The repository of master thesis of the Second Military Medical University. Shanghai: The Second Miliarty Medical University Press. 2014; (Article in Chinese).
22.
go back to reference Bastian M, Heymann S, Jacomy M. Gephi: an open source software for exploring and manipulating networks. ICWSM. 2009;8:361–2. Bastian M, Heymann S, Jacomy M. Gephi: an open source software for exploring and manipulating networks. ICWSM. 2009;8:361–2.
23.
go back to reference Kesselheim AS. The backlash against bioequivalence and the interchangeability of brand-name and generic drugs. CMAJ. 2011;183(12):1350–1.CrossRef Kesselheim AS. The backlash against bioequivalence and the interchangeability of brand-name and generic drugs. CMAJ. 2011;183(12):1350–1.CrossRef
24.
go back to reference Kovacic JC, Mehran R, Sweeny J, Li JR, Moreno P, Baber U, et al. Clustering of acute and subacute stent thrombosis related to the introduction of generic clopidogrel. J Cardiovasc Pharmacol Ther. 2014;19(2):201–8.CrossRef Kovacic JC, Mehran R, Sweeny J, Li JR, Moreno P, Baber U, et al. Clustering of acute and subacute stent thrombosis related to the introduction of generic clopidogrel. J Cardiovasc Pharmacol Ther. 2014;19(2):201–8.CrossRef
25.
go back to reference Carter BL. Equivalence of generic and brand-name drugs for cardiovascular disease. JAMA. 2009;301(16):1654.CrossRef Carter BL. Equivalence of generic and brand-name drugs for cardiovascular disease. JAMA. 2009;301(16):1654.CrossRef
27.
go back to reference Ford ES, Ajani UA, Croft JB, Critchley JA, Labrathe DR, Kotteke TE, et al. Explaining the decrease in US deaths from coronary disease, 1980–2000. N Engl J Med. 2007;(23):2388–98. Ford ES, Ajani UA, Croft JB, Critchley JA, Labrathe DR, Kotteke TE, et al. Explaining the decrease in US deaths from coronary disease, 1980–2000. N Engl J Med. 2007;(23):2388–98.
28.
go back to reference Guo D, Qi GY, Hu JW. Application and consideration of clinical path in medical quality management. Jiangsu Health Syst Manage. 2005;3:24–6 (Article in Chinese). Guo D, Qi GY, Hu JW. Application and consideration of clinical path in medical quality management. Jiangsu Health Syst Manage. 2005;3:24–6 (Article in Chinese).
Metadata
Title
China’s new policy for healthcare cost-control based on global budget: a survey of 110 clinicians in hospitals
Authors
Jianzhou Yan
Hui-Heng Lin
Dan Zhao
Yuanjia Hu
Rong Shao
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-3921-8

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