Publication: The Role of For-Profit Hospitals in Medical Expenditures : Evidence from Aggregate Data in China
No Thumbnail Available
Date
2009
ISSN
1043-951X
Published
2009
Author(s)
Editor(s)
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 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.
Link to Data Set
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Citations
- Cited 16 times in Scopus (view citations)
Collections
Related items
Showing items related by metadata.
Publication Symposium on Health Economics Issues in China: 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 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.Publication The Impact of SEWA's Medical Insurance Fund on Hospital Utilization and Expenditure : A Household Survey(World Bank, Washington, DC, 2001-09)This paper assesses the impact of the Self-Employed Women's Association's (SEWA's) Medical Insurance Fund, Gujarat, in terms of inclusion of the poor, hospital utilization, and expenditure. Age-matched insured and uninsured women were compared using survey data (2000). The authors found that wealth was not a determinant of membership in the Fund; i.e., the poor were not excluded. Of 28 hospitalizations among Fund members over one year, only five were reimbursed. Membership in SEWA was not significantly associated with increased frequency of hospitalization, but there was a significant association with lower costs of hospitalization, net of reimbursement. Unlike many other CBHI schemes, the Fund has overcome barriers that exclude the poorest. This is due in part to nesting of the Fund within a larger development organization. Utilization of the Fund, and thus impact on hospital utilization and expenditure, was minimal. This may relate to a lack of awareness of benefits among Fund members, or costs and difficulties associated with submitting an insurance claim.Publication The Effect of Health Insurance on Health Care Utilization: Evidence from the Medical Expenditure Panel Survey 2000-2005(2010)This paper exploits the fact that insurance eligibility in the United States changes abruptly at age 65 due to universal coverage provided by Medicare. In that way, we adopt a regression discontinuity design to analyze the effect of health insurance coverage on health care access and utilization. The main findings suggest that groups with lower pre-65 coverage gain higher increases in the probability of being insured at 65. For instance, less educated persons (less likely to have pre-65 health insurance) appear to increase their likelihood of being insured at age 65 by more than their more highly educated counterparts. Furthermore, this increased insurance coverage appears to be associated with reductions in intergroup disparities in health care access. Therefore, the findings suggest that insurance matters in order to access health care services in a way that could potentially reduce inequalities between different ethnic groups.Publication The Role of Trade Costs in Global Production Networks : Evidence from China’s Processing Trade Regime(2010-12-01)In a seminal contribution, Yi (2003) has shown that vertically specialized trade should be more sensitive to changes in trade costs than regular trade. Yet empirical evidence of this remains remarkably scant. This paper uses data from China's processing trade regime to analyze the role of trade costs on trade within global production networks (GPNs). Under this regime, firms are granted duty exemptions on imported inputs as long as they are used solely for export purposes. As a result, the data provide information on trade between three sequential nodes of a global supply chain: the location of input production, the location of processing (in China) and the location of further consumption. This makes it possible to examine the role of both trade costs related to the import of inputs (upstream trade costs) and trade costs related to the export of final goods (downstream trade costs) on intra-GPN trade. The authors show that intra-GPN trade differs from regular trade in that it not only depends on downstream trade costs, but also on upstream trade costs and the interaction of both. Moreover, intra-GPN trade is more sensitive to oil price movements and business cycle movements than regular trade. Finally, the paper analyzes three channels through which intra-GPN trade have amplified the trade collapse during the recent Global Recession.Publication Informality and Profitability : Evidence from a New Firm Survey in Ecuador(World Bank, Washington, DC, 2013-05)This paper estimates the impact of informality on firm profits using a new firm-level survey designed specifically for this study. The survey was administered to about 1,200 firms with 50 employees or less in Ecuador's two largest cities, Quito and Guayaquil, plus two main centers of economic activity near the northern and southern borders. The paper's results confirm that the extent of firms' compliance with a set of regulatory requirements is linked to the perceived costs and benefits of informality, such as the probability of detection by the authorities and the likelihood of being fined. Nonetheless, taking into account the non-random placement of firms along the formality-informality spectrum and controlling for a large set of firm, owner, and location characteristics, the paper finds that more formal firms tend to be more profitable and have higher output per worker. This impact operates, inter alia, through more formal firms' ability to obtain improved access to credit and achieve higher sales by issuing receipts to clients.
Users also downloaded
Showing related downloaded files
No results found.