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  • 1.
    Dong, Hengjin
    et al.
    School of Public Health, Shanghai Medical University, Shanghai, China.
    Bogg, Lennart
    Karolinska institutet, Stockholm, Sweden.
    Wang, Keli
    School of Public Health, Shanghai Medical University, Shanghai, China.
    Rehnberg, Clas
    Stockholm School of Economics, Stockholm, Sweden.
    Diwan, Vinod
    Nordic School of Public Health, Gothenburg, Sweden; Karolinska institutet, Stockholm, Sweden.
    A description of outpatient drug use in rural China: evidence of differences due to insurance coverage1999In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 14, no 1, p. 41-56Article in journal (Refereed)
    Abstract [en]

    This paper describes the effects of health financing systems (insurance) on outpatient drug use in rural China. 1320 outpatients were interviewed (exit interview) in the randomly selected county, township and village health care facilities in five counties in three provinces of central China. The interview was face to face. Questions were asked by a trained interviewer and were answered by patient him/herself. The main finding was that health insurance appeared to influence drug use in outpatient services. The average number of drugs per visit was 2.56 and drug expenditures per visit was 16.9 yuan. Between insured and uninsured (out-of-pocket) groups, there were significant differences in the number of drugs and drug expenditures per visit. The insured had a lower number of drugs and a higher drug expenditure per visit than the uninsured, implying the use of more expensive drugs per visit than the uninsured. There were also significant differences in the number of drugs and drug expenditures per visit between the types of insurance. One third of the drugs were anti-infectives, most of which were penicillin, gentamycin, and sulfonamides. The results imply that uninsured patients do not receive the same care as the insured do even if they have the same needs. The fee-for-service financing for hospitals and health insurance have changed health providers' and consumers' behaviour and resulted in the increase of medical expenditure.

  • 2.
    Dong, Hengjin
    et al.
    Zhejiang University, Center for Health Policy Studies, China.
    Duan, Shengnan
    Zhejiang University, Center for Health Policy Studies, China.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska institutet, Global health, Sweden.
    Wu, Yuan
    Zhejiang University, Center for Health Policy Studies, China.
    You, Hua
    Zhejiang University, Center for Health Policy Studies, China.
    Chen, Jinhua
    Zhejiang University, Center for Health Policy Studies, China.
    Ye, Xujun
    Zhejiang University, Center for Health Policy Studies, China.
    Seccombe, Karen
    School of Community Health, Portland State University, Portland, Oregon, USA.
    Yu, Hai
    Zhejiang University, Center for Health Policy Studies, China.
    The impact of expanded health system reform on governmental contributions and individual copayments in the new Chinese rural cooperative medical system2016In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 31, no 1, p. 36-48Article in journal (Refereed)
    Abstract [en]

    In 2002, the Chinese central government created a new rural cooperative medical system (NCMS), ensuring that both central and local governments partner with rural residents to reduce their copayments, thus making healthcare more affordable. Yet, significant gaps in health status and healthcare utilization persisted between urban and rural communities. Therefore, in 2009, healthcare reform was expanded, with (i) increased government financing and (ii) sharply reduced individual copayments for outpatient and inpatient care. Analyzing data from China's Ministry of Health, the Rural Cooperative Information Network, and Statistical Yearbooks, our findings suggest that healthcare reform has reached its preliminary objectives-government financing has grown significantly in most rural provinces, especially those in poorer western and central China, and copayments in most rural provinces have been reduced. Significant intraprovincial inequality of support remains. The central government contributes more money for poor provinces than for rich ones; however, NCMS schemes operate at the county level, which vary significantly in their level of economic development and per capital gross domestic products (GDP) within a province. Data reveal that the compensation ratios for both outpatient and inpatient care are not adjusted to compensate for a rural county's level of economic development or per capita GDP. Consequently, a greater financial burden for healthcare persists among persons in the poorest rural regions. A recommendation for next step in healthcare reform is to pool resources at prefectural/municipal level and also adjust central government contributions according to the GDP level at prefectural/municipal level.

  • 3.
    Korlén, S.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Amer-Wåhlin, I.
    Karolinska Institutet, Stockholm, Sweden.
    Lindgren, P.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Exploring staff experience of economic efficiency requirements in health care: A mixed method studyIn: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751Article in journal (Refereed)
    Abstract [en]

    Background: Economic resources are limited in health care, and governance strategies are used to push provider organizations to use resources efficiently. Although studies show that hybrid managers are successful in reconciling economic efficiency requirements with professional values to meet patient needs, surprisingly few studies focus on staff. The aim of this study is to explore staff members' experience of economic efficiency requirements. Methods: A mixed method design was applied, targeting multi-professional staff in the Department of Rehabilitation Medicine in a Swedish university hospital. Survey data was collected (n = 93), followed by focus-group interviews to support the understanding of the quantitative findings. Findings: The findings show that health care staff is knowledgeable and intrinsically motivated to consider efficiency requirements, albeit it should not dominate clinical decisions. However, staff experiences little influence over resource allocation and identifies limitations in the system's abilities to meet patient needs. Staff experience incorporates a local unit and a system perspective. Conclusion: Staff members are aware of economic efficiency requirements and will behave accordingly if patients are not at risk. However, their engagement seems to rely on how economic efficiency requirements are handled at multiple system levels and their trust in the system to fairly support patient needs. 

  • 4.
    Wihlman, Ulla
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Stålsby-Lundborg, Cecilia
    Karolinska Institutet, Stockholm, Sweden .
    Holmström, Inger
    Uppsala University, Uppsala, Sweden.
    Axelsson, Runo
    Nordic School of Public Health, Göteborg, Sweden.
    Organising vocational rehabilitation through interorganisational integration – a case study in Sweden2011In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 26, no 3, p. 169-183Article in journal (Refereed)
    Abstract [en]

    This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable.

  • 5.
    Zhang, Luying
    et al.
    Fudan University, Shanghai.
    Cheng, XM
    Fudan University, Shanghai, China.
    Liu, XY
    Liverpool University, School of Tropical Medicine, UK.
    Zhu, K
    Peking Union Medical College, Beijing, China.
    Tang, Shenglan
    Liverpool University, School of Tropical Medicine, UK.
    Bogg, Lennart
    Karolinska institutet, Sweden.
    Tolhurst, Rachel
    Liverpool University, School of Tropical Medicine, UK.
    Balancing the funds in the New Cooperative Medical Scheme in rural China: determinants and influencing factors in two provinces2010In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 25, no 2, p. 96-118Article in journal (Refereed)
    Abstract [en]

    In recent years, the central government in China has been leading the re-establishment of itsrural health insurance system, but local government institutions have considerable flexibility inthe specific design and management of schemes. Maintaining a reasonable balance of funds iscritical to ensure that the schemes are sustainable and effective in offering financial protectionto members. This paper explores the financial management of the NCMS in China through acase study of the balance of funds and the factors influencing this, in six counties in twoChinese provinces. The main data source is NCMS management data from each county from2003 to 2005, supplemented by: a household questionnaire survey, qualitative interviews andfocus group discussions with all local stakeholders and policy document analysis. The studyfound that five out of six counties held a large fund surplus, whilst enrolees obtained onlypartial financial protection. However, in one county greater risk pooling for enrolees wasaccompanied by relatively high utilisation levels, resulting in a fund deficit. The opportunitiesto sustainably increase the financial protection offered to NCMS enrolees are limited by thefinancial pressures on local government, specific political incentives and low technicalcapacities at the county level and below. Our analysis suggests that in the short term, effortsshould be made to improve the management of the current NCMS design, which shouldbe supported through capacity building for NCMS offices. However, further medium-terminitiatives may be required including changes to the design of the schemes.

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