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<DIV><B>From:</B> <A title=fromkodur@gmail.com
href="mailto:fromkodur@gmail.com">Abraham Thomas</A> </DIV>
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<H1>Doctor´s Thesis from Karolinska Institutet</H1>
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<H2>Meng, Qingyue</H2><B>Health care pricing and payment reforms in
China</B><B> : The implications for health service delivery and cost
containment</B> <BR><BR>Hillarpsalen, Retzius väg 8, Karolinska Instituet.
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<TD class=small vAlign=top><A title=10-Feb-2006
href="http://diss.kib.ki.se/2006/91-7140-576-3/thesis.pdf">Original</A>
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<TD class=small vAlign=top>ISBN: 91-7140-576-3 </TD>
<TD class=small vAlign=top align=right> Diss: 06:26
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<P class=normal><BR><BR><B>Abstract:</B></P>China's transition into a market
economy has exerted some influence on the health sector in terms of a
significant growth of facilities, but it has also produced a range of
destabilizing social costs. This thesis analyzes the relations between
healthcare pricing and payment reforms and the different delivery aspects such
as the exemption program for the poor, public health programs for tuberculosis
control and the provision of hospital services. A health economics and systems
conceptual framework is used for analyzing aspects of the health systems in
terms of market failures and the institutional response from governments and
regulators.
<P><FONT color=#000000>In study I, the exemption programs for hospitals where
the poor are relieved of paying the price or user charges are analyzed. The
study is a case study where patient records from nine hospitals were reviewed,
together with interviews with key informants and community representatives. The
study showed that the discount offered was limited, where only a minority of
indigents received discounts and the hospitals lacked incentives for efficiently
carrying out the programs.</FONT></P>
<P><FONT color=#000000>Study II investigates the effect of the new urban health
insurance system on hospital charges. The study uses two tracers, acute
appendicitis and normal childbirth, at six hospitals from two cities with
different insurance systems. The result showed a lower rate of increase in
hospitals charges in the city implementing the urban health insurance reform.
Regression analysis showed contracting mechanisms and length of stay to be the
main determinants for hospital charges.</FONT></P>
<P><FONT color=#000000>Study III analyzes the operation of TB control programs
in a decentralized financial system. A case study was conducted in four counties
with different economic developments in the Shandong province. Data was
collected from a review of documents and interviews with patients and key
informants. The study showed weak government support to the TB control program
and less developed DOT (directly observed therapy) programs in the poorer
counties. TB patients suffered heavy financial burdens. The decentralized
financing system had negatively affected the provision of public health programs
such as TB control programs.</FONT></P>
<P><FONT color=#000000>In study IV, the impact of retail price control of drugs
on hospital drug expenditures was examined. The study is a case study at two
hospitals. Total drug expenditures were analyzed based on financial records and
a tracer, cerebral infarction, was used for an in-depth examination of prices,
volume, expenditures and rationality of drug use. Findings showed that after the
implementation of the drug pricing policy, total drug expenditures increased as
rapidly as before. Drug expenditure per patient for cerebral infarction showed
indistinct results, indicating that the regulation was not effective.
Utilization rather than price was more determinative for drug
expenditures.</FONT></P>
<P><FONT color=#000000>Study V investigates the development of revenues, costs
and performance in the hospital sector. In a sample of 41 hospitals in two
cities, the use of inputs, investments and productivity was estimated. The
findings showed that hospitals had expanded their staff and invested in new
medical equipment. The corresponding change of outputs in terms of outpatient
and inpatient performance showed a slower increasing rate, resulting in a
diminishing productivity rate over time.</FONT></P>
<P><FONT color=#000000>The market-oriented health care system in China is faced
with different 'market failures' problems such as limited access to health
services for the poor and the inaccuracy in relying on market mechanisms for
services characterized by positive externalities, such as the public health
programs. Financial autonomy has given health providers the incentives to
maximize revenues. Government interventions to contain costs and improve
efficiency show that a sole reliance on the price mechanism is insufficient and
must be combined with other tools set by regulators and insurers. </FONT></P>
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<P class=normal><FONT color=#000000>Keywords: China, financing, pricing policy,
payment, exemption program, tuberculosis, hospital performance and charges, drug
pricing, rational use of drugs</FONT></P><FONT color=#000000></FONT>
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<P class=normal><FONT color=#000000><B>List of papers</B></FONT></P><FONT
color=#000000>
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<TD vAlign=top><IMG height=10 alt=" "
src="http://diss.kib.ki.se/form/bild/general/pil_1rad.gif" width=10></TD>
<TD class=peklist vAlign=top><A
title="Link to bibliographic record in PubMed"
href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12477742&dopt=Abstract"
target=_blank>Hospital charge exemptions for the poor in Shandong,
China.</A><BR>Meng Q, Sun Q, Hearst N<BR><I>Health Policy Plan</I>, 2002;
17 Suppl: 56-63<BR></TD></TR>
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<TD vAlign=top><IMG height=10 alt=" "
src="http://diss.kib.ki.se/form/bild/general/pil_1rad.gif" width=10></TD>
<TD class=peklist vAlign=top><A
title="Link to bibliographic record in PubMed"
href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15063019&dopt=Abstract"
target=_blank>The impact of urban health insurance reform on hospital
charges: a case study from two cities in China.</A><BR>Meng Q, Rehnberg C,
Zhuang N, Bian Y, Tomson G, Tang S<BR><I>Health Policy</I>, 2004; 68(2):
197-209<BR></TD></TR>
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<TD vAlign=top><IMG height=10 alt=" "
src="http://diss.kib.ki.se/form/bild/general/pil_1rad.gif" width=10></TD>
<TD class=peklist vAlign=top><A
title="Link to bibliographic record in PubMed"
href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15686060&dopt=Abstract"
target=_blank>Provision and financial burden of TB services in a
financially decentralized system: a case study from Shandong,
China.</A><BR>Meng Q, Li R, Cheng G, Blas E<BR><I>Int J Health Plann
Manage</I>, 2004; 19 Suppl 1: S45-62<BR></TD></TR>
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<TD vAlign=top><IMG height=10 alt=" "
src="http://diss.kib.ki.se/form/bild/general/pil_1rad.gif" width=10></TD>
<TD class=peklist vAlign=top><A
title="Link to bibliographic record in PubMed"
href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15840634&dopt=Abstract"
target=_blank>The impact of Chinas retail drug price control policy on
hospital expenditures: a case study in two Shandong hospitals.</A><BR>Meng
Q, Cheng G, Silver L, Sun X, Rehnberg C, Tomson G<BR><I>Health Policy
Plan</I>, 2005; 20(3): 185-96<BR></TD></TR>
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<TD vAlign=top><IMG height=10 alt=" "
src="http://diss.kib.ki.se/form/bild/general/pil_1rad.gif" width=10></TD>
<TD class=peklist vAlign=top>Reform of hospital care in China: the
development of costs, revenues and performance in two urbans
cities.<BR>Meng Q, Zhuang N, Bian Y, Tomson G, Tang S, Rehnberg
C<BR>Submitted</TD></TR></TBODY></TABLE></FONT></BODY></HTML>