Health policy and systems research in China has rapidly developed over the past two decades, which helps evidence-based policy making and health systems strengthening.This article aims at reviewing and analyzing, and to come up with a summary of the major progress and future development trend in health policy and systems research are reviewed and analyzed.This article discusses also the current challenges and opportunities of health policy and systems research prevailing in China.

In order to meet the health needs of people, China’s health service system needs continuous reforms and adjustments. Health needs, equity and efficiency, quality of service, and the development history and current situation of the health service system are the four main dimensions to be considered during the building process of the system. This paper argues that building a people-centered health service system is the direction, and it describes its connotation from five different aspects, including human care, interrelated interests, primary health care-oriented, continuous integration, and conditions for support. This paper proposes the strategies and paths to build a people-cen-tered health service system, including to promoting the quality of primary health care, integrating health service sys-tems, and strengthening government’s responsibility.

Objective: To identify the impact of Urban Resident Basic Medical Insurance (URBMI) on medical service utilization. Methods: Based on data of China Health and Nutrition Survey, matching DID model was used to compare the changes in medical service utilization between residents participated in this system and those not participated in this system in 2009. Results:In initial stage of implementation, URBMI in a certain extent promoted medical service utilization of residents participated in the system, but the impact level was still low. The promoting effect on inpatient service utilization was significant, but very limited on outpatient service utilization. Conclusion:Promoting outpatient service utilization and increasing compensation are future priorities for improving URBMI to implement the system.

Objective:To evaluate the technical efficiency and scale efficiency of non-public hospitals in China to provide references for improving efficiency of non-public hospitals with the comparison with the differences among different non-public hospitals with different types.Methods:Input and output data of 160 non-public hospitals in 2014 were collected;C2R and BC2 models were adopted to evaluate the annual total efficiency,technique efficiency and scale efficiency.Results:There were 16 total efficient hospitals(10.00％),41 technical efficiency hospitals(25.63％) and 20 scale efficiency(12.50％),43 at IRS stage,99 at DRS stage.Conclusion:The overall efficiency of non-public hospitals was low relatively and most of them were lower than public hospitals at same level.Scale was an important factor affecting the efficiency of non-public hospitals.

Objective:To analyze the correlated factors on the non-public hospitals efficiency performance and compare different types of them in order to provide reference for improving efficiency.Methods:Based on the result of 160 non-public hospitals total efficiency,questionnaire surveys were taken for collecting the information of region,quality,form of ownership,whether invested by the government,whether under the medical insurance,the total amount of employers,bed and service amount as the independent variables,while the total efficiency as the dependent variable to conduct the Tobit multi regression analysis.Results:Access policy,investment policy,nature of ownership,the number of beds,the proportion of physicians,the per capita services,assets and equipment had significant impact.Conclusion:The development of non-public hospital was related to the policy environment,operation mode and internal management.

In this paper, 172 non-public hospitals have been investigated covering east, central and western regions with structured and semi-structured questionnaire and group interviews. We found that the health insurance policies were the most concerned policies by non-public hospitals, accounting for 26.5% of the total. We also found that non-public hospitals from different areas, levels profit nature have different policy expectations, for example Eastern regional institutions wanted to make a breakthrough of the planning policies, the central region wanted to change the health personnel policy, while the western region is considered to be limited by land policy. Tertiary hospitals were more concerned about research projects and land policy, and secondary hospitals were more concerned about access policy. There were 44.8% of the surveyed institutions considered that regulatory policywasmore stringent public hospitals and public hospitals, and there were no difference between profit and non-profit hospitals. According to the survey results, this paper puts forward suggestion that we should implement more targeted policies, purchasing more services from non-public hospitals and enhanced supervision. Considering the survey results research team puts forward sensitive advice as: provide preferential policies in according with different kinds of institutions reinforce purchasing service and enhance non-public hospitals supervision.

Encouraging and providing guidance to social forces to invest in health care industry is one of the key elements determined to deepen the health care reform.From four aspects of the unclear conception and undefinable functions of non-public hospitals, ambiguity of property rights of non-profit non-public hospitals, gradual reduction of traditional management measures, and deficiency of effective supervision on daily operations, this paper summarizes the major policy issues in non-public hospitals.To solve these problems, this paper conducts a systemic analysis of the historical experiences of the United States, Germany, Japan, and Taiwan.On this basis, this paper suggests that the government should clearly determine the connotation and extension of non-public hospitals, improve non-profit non-public hospital policy system, play a guiding role in planning and health insurance guidance, and strengthen the supervision of business operations.

Based on the related theories of physician behavior analysis, summarize and discuss the incentives mechanism of supplier payment on physician behavior and its inner mechanism, provide theoretical supports and political suggestions for further analysis on payment reform.

The health care system has always faced challenges from two competing fronts: rising costs and quality concerns. The common issue of debate confronted by various health care systems is whether or not rising medi-cal expenditure can lead to quality improvements. The key to addressing this issue is to figure out the correlation be-tween quality of care and medical expenditure. Based on Donabedian’s structure, process and outcome quality theory, this study reviews relevant international studies related to this topic in order to provide empirical evidence in a clearer way. Results show that the analysis of current studies have typically been based on the regional level, health provider level and patient level; the quality indicators used varied among studies while expenditure indicators had much in common;more studies were found to focus on the association between outcome quality and expenditure while less studies explored the link between structure or process quality and expenditure; additionally, the majority of relevant studies were located in the inpatient setting and studies from outpatient settings were found to be lacking. Overall, ac-cording to current knowledge, no inclusive conclusion could be obtained, but quality indicators, data and methods, and limitations revealed in these studies can be reviewed by future study to explore the correlation between quality and expenditure of medical care in a more objective way.

To discuss the influences of government health input on the efficiency of hospital operation. Methods:Taking 16 county-level hospitals in Ningxia as samples, using DEA and DEA-malmqutist indicator method to calculate the technical efficiency scores from 2000 to 2012, then analyze the compositions of technique efficiency(TE) , using Tobit regression to analyze the relationship between government budget health expenditure and medical institution efficiency. Results: The Ningxia governmental health budget expenditure is growing almost 3 times from 2000 to 2012 and the average TE is 0.82-0.94. In the 16 county-level hospitals, the TFP of 6 hospitals (37.5%) was less than 1, and the minimum was 0.82; while the TFP of 10 hospitals (62.5%) were more than 1, the max was 1.699. For the 6 hospitals of which TFP was less than 1, the reason for negative growth of TFP was contributed to the slow technique change, the pure efficiency or small scale. The regression result of TOBIT showed that the government health expenditure increases 1 000 units, the efficiency of medical institutions will increase 0.0031. Conclusion: The relationship between the governmental expenditure and medical institutions is positive, but the technical efficiency of medical institutions expenditure was the result of multiple factors.