Publication: Symposium on Health Economics Issues in China: The Role of For-Profit Hospitals in Medical Expenditures: Evidence from Aggregate Data in China
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Date
2009
ISSN
1043951X
Published
2009
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Abstract
The health care delivery system in China, which is dominated by state hospitals, is being increasingly challenged by public concerns: it is too expensive and too inaccessible, a complaint commonly phrased as "kai bin nan, kan bin gui" in Chinese. As the penetration of for-profit hospitals has gradually increased, there is a growing need for policy research to assess their impact on medical spending from the patient perspective. Using panel data at the provincial level in China, this paper examines the impact of the penetration of for-profit hospitals on average medical expenditures for both outpatient and inpatient services in public general hospitals. Based on fixed-effect model estimates, the study shows that the penetration of for-profit hospitals has lowered the average medical expenditures for both inpatient and outpatient services across regions, especially for pharmaceuticals. Together with other results, this study finds no evidence that private for-profit hospitals drive up average medical expenditures while serving their profit-maximization objectives. Rather, they help increase the market supply of health care, which in turn better serves the increasing demand.
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Publication The Role of For-Profit Hospitals in Medical Expenditures : Evidence from Aggregate Data in China(2009)The health care delivery system in China, which is dominated by state hospitals, is being increasingly challenged by public concerns: it is too expensive and too inaccessible, a complaint commonly phrased as "kai bin nan, kan bin gui" in Chinese. As the penetration of for-profit hospitals has gradually increased, there is a growing need for policy research to assess their impact oil medical spending from the patient perspective. Using panel data at the provincial level in China, this paper examines the impact of the penetration of for-profit hospitals on average medical expenditures for both outpatient and inpatient services in public general hospitals. Based on fixed-effect model estimates, the study shows that the penetration of for-profit hospitals has lowered the average medical expenditures for both inpatient and Outpatient services across regions, especially for pharmaceuticals. Together with other results, this study finds no evidence that private for-profit hospitals drive up average medical expenditures while serving their profit-maximization objectives. Rather, they help increase the market supply of health care, which in turn better serves the increasing demand. (C) 2009 Elsevier Inc. All rights reserved.Publication The Limited Job Prospects of Displaced Workers: Evidence from Two Cities in China(2008)The economic restructuring in China over the past decade has resulted in displacement of millions of workers who had been employed in the state sector. This has posed tremendous challenges economically, socially, politically, and culturally. For several years, Chinese policies attempted to cushion the shock by requiring state-owned enterprises to provide living allowances and reemployment services to workers who had been displaced. There have been few empirical studies that have tracked the experiences of these displaced or xiagang workers. This study uses survey data from two large industrial cities covering the period 1998-2000 to analyze the labor market situation of over 2,000 workers 2 years after they had been observed as displaced and unemployed. The findings point to the high rates of labor force withdrawal and a low proportion who find another wage job in the formal sector. It also documents the large number of workers who find work in the informal sector which seems to act as an important safety net. Not surprisingly, education is an important determinant of post-layoff labor market outcomes. Active labor market interventions do not seem to make a substantial difference although there is some evidence from the duration analysis that training does help workers find employment more quickly than they would have otherwise.Publication Evidence for an Incipient Decline in Numbers of Missing Girls in China and India(2009)The apparently inexorable rise in the proportion of "missing girls" in much of East and South Asia has attracted much attention among researchers and policymakers. An encouraging trend was suggested by the case of South Korea, where child sex ratios (males to females under age 5) were the highest in Asia but peaked in the mid-1990s and normalized thereafter. Using census data, we examine whether similar trends have begun to manifest themselves in the two most populous countries of this region, China and India. The data indicate that child sex ratios are peaking in these countries, and in many subnational regions are beginning to trend toward lower, more normal values. This suggests that, with continuing economic and social development and vigorous public policy efforts to reduce son preference, the "missing girls" phenomenon could eventually disappear in Asia.Publication The Impact of Migration on Rural Poverty and Inequality : A Case Study in China(2010)Large numbers of agricultural labor moved from the countryside to cities after the economic reforms in China. Migration and remittances play an important role in transforming the structure of rural household income. This article examines the impact of rural-to-urban migration on rural poverty and inequality in a mountainous area of Hubei province using the data of a 2002 household survey. Since migration income is a potential substitute for farm income, we present counterfactual scenarios of what rural income, poverty, and inequality would have been in the absence of migration. Our results show that, by providing alternatives to households with lower marginal labor productivity in agriculture, migration leads to an increase in rural income. In contrast to many studies that suggest that the increasing share of nonfarm income in total income widens inequality, this article offers support for the hypothesis that migration tends to have egalitarian effects on rural income for three reasons: (1) migration is rational self-selection--farmers with higher expected return in agricultural activities and/or in local nonfarm activities choose to remain in the countryside while those with higher expected return in urban nonfarm sectors migrate; (2) households facing binding constraints of land supply are more likely to migrate; (3) poorer households benefit disproportionately from migration.Publication The Impact of the Global Financial Crisis on Off-Farm Employment and Earnings in Rural China(2011)This paper examines the effect of the financial crisis on off-farm employment of China's rural labor force. Using a national representative dataset, we find that there was a large impact. By April 2009 off-farm employment reached 6.8% of the rural labor force. Monthly earnings also declined. However, while we estimate that 49 million were laid-off between October 2008 and April 2009, half of them were re-hired in off-farm work by April 2009. By August 2009, less than 2% of the rural labor force was unemployed due to the crisis. The robust recovery appears to have helped avoid instability.
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