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Dilemmas and countermeasures of private medical institutions：A case in Wenzhou, Zhejiang Province

Chinese Journal of Health Policy.2014;(5):37-41. doi:10.3969/j.issn.1674-2982.2014.05.007

In this article, we summarize the main policy on encouraging nongovernmental investors to establish medical institutions in Wenzhou , Zhejiang Province.Based on the survey of private medical institutions in Wenzhou , we find that there are still many issues that should be resolved in terms of nongovernmental investors establishing pri -vate hospitals , such as the difficulty in implementing construction projects , spending too long time applying for the medical insurance unit , the complicated application procedures of incentive funds , the unequal status with public health hospitals in financing and the development of human resource for health , and the low-level administration and social reputation.Therefore , for promoting the sustainable development of private health hospitals , it is of great im-portance to have a breakthrough in the implementation of the policy ,such as supporting policies reform , financing and talent support , strengthening supervision , and so on.

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The development of non-profit private hospitals in China：Institutional obstacles and policy suggestions

Suizhang MEI ; Hongxia HUANG

Chinese Journal of Health Policy.2014;(5):33-36. doi:10.3969/j.issn.1674-2982.2014.05.006

This paper summarizes the positive significance of non-profit private hospitals development , and an-alyzes the institutional obstacles on the development of non-profit private hospitals in terms of autonomous manage-ment, fair competition, investment and profit , tax relief, management and supervision .Finally, the paper provides some proposals to improve the development of non-profit private hospitals:revising the medical institution regulation , establishing and improving the non-profit private hospital assets finance management system , implementing the opera-tion system, establishing a scientific and standardized supervision mechanism , etc.

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Status quo of international mental health financing and its implications for China

Suwei YUAN ; Jin MA

Chinese Journal of Health Policy.2014;(5):27-32. doi:10.3969/j.issn.1674-2982.2014.05.005

Insufficient financial investments and insufficient raised funds are a common dilemma in mental health service worldwide .The primary sources of mental health financing worldwide are taxes , social insurance , and out-of-pocket expenditure by the patient or family .Government plays the primary role in fund raising .China has a low level of mental health service and poor equity in mental health financing as well as irrational allocation of funds . Mental health financing system in China should be improved by adding the financing system into mental health law and the outline of the central mental health work while making it clear that government , especially central govern-ment, is the main subject of mental health financing .Community mental health should also have the priority over fund allocation in order to increase the efficiency of raising funds .

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Integrating mental health and social development in theory and practice

Plagerson SOPHIE

Chinese Journal of Health Policy.2014;(5):19-26. doi:10.3969/j.issn.1674-2982.2014.05.004

In many low and middle income countries , attention to mental illness remains compartmentalized and consigned as a matter for specialist policy .Despite great advances in global mental health , mental health policy and practice dovetail only to a limited degree with social development efforts .They often lag behind broader approa-ches to health and development .This gap ignores the small but growing evidence that social development unavoidably impacts the mental health of those affected , and that this influence can be both positive and negative .This article ex-amines the theoretical and practical challenges that need to be overcome for a more effective integration of social de -velopment and mental health policy .From a theoretical perspective , this article demonstrates compatibility between social development and mental health paradigms .In particular , the capability approach is shown to provide a strong framework for integrating mental health and development .Yet, capability-oriented critiques on ‘happiness ’ have re-cently been applied to mental health with potentially detrimental outcomes .With regard to policy and practice , hori-zontal and vertical integration strategies are suggested .Horizontal strategies require stronger devolution of mental health care to the primary care level , more unified messages regarding mental health care provision and the gradual expansion of mental health packages of care .Vertical integration refers to the alignment of mental health with related policy domains ( particularly the social , economic and political domains ) .Evidence from mental health research rein-forces aspects of social development theory in a way that can have tangible implications on practice .First, it encoura-ges a focus on avoiding exclusion of those affected by or at risk of mental illness .Secondly , it underscores the impor-tance of the process of implementation as an integral component of successful policies .Finally, by retaining a focus on the individual , it seeks to avoid uneven approaches to development .

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Equity, choice and outcome in metropolitan health insuran ce portabilty：A case in A city, Guangdong p rovince

Chinese Journal of Health Policy.2014;(5):42-48. doi:10.3969/j.issn.1674-2982.2014.05.008

Objectives:This paper tested the hypothesis of adverse selection and cost shift in the implementa -tion of health insurance portability policy and evaluated the impact to metropolitan health insurance funds .Methods:With data from health insurance information system in A city ,we used chi-square and t-test to test the variations be -tween transferredi-n group and transferred -out group, and we used multiple regression to explore the factors affecting reimbursement of outpatient costs and inpatient costs .Results:The chi-square test indicated that age and chronic dis -eases between transferred-in group and transferred-out group was statistically significant , and this proved that adverse selection existed in the health insurance portability .The t-test indicated that inpatient cost per capita and reimburse-ment of inpatient costs per capita between transferred i-n group and transferred -out group statistically significant.Mul-tiple regressions indicated that age and chronic diseases significantly affected reimbursement of outpatient and inpatient costs.Policy analysis showed that health insurance funds had rules of shift cost .Conclusion:Because of the effect of healthy migrants and risk-selection , the outpatient and inpatient costs of the transferred i-n group did not greatly influ-ence medical insurance funds .Therefore , local government should implement the portability policy boldly .

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Characteristics of China-Africa health collaboration:The case of Democratic Republic of Congo

Xiaoxiao JIANG

Chinese Journal of Health Policy.2014;(3):64-68. doi:10.3969/j.issn.1674-2982.2014.03.012

China’s relationship with Africa has gained worldwide attention, with substantial scale and wide range of investment and development assistance over the past decades. We argue in this paper that China-Africa health collaboration has four main characteristics:China has a vague definition of the Development Fund for Health;there is no single development agency within Chinese government; the Chinese government is very responsive to re-quests from local government and most of the health programs are co-developed by the two governments;and China's private investment in Africa merges into the field of public development and plays an important role. Thus, China-Af-rica health collaboration has two major problems:resource mismatch and restricted impact. The case of Congo shows that in order to increase the effectiveness of China-Africa health collaboration and to make better use of the advantages of a complex system, decision-makers need to consider the bottom-up innovation and integration with local systems when making policies. They also need to avoid a scattered structure and inefficiency brought about by a complex sys-tem in order to ensure balanced consensus-building mechanisms among all stakeholders in China-Africa health collab-oration.

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Analysis of children’ s health and influential factors in Nujiang prefecture, Yunnan

Yongchao CHEN ; Fang WANG ; Bin CAO ; Xiaoxi LIU ; Xiaochao XU ; Bo ZHANG ; Xue DING

Chinese Journal of Health Policy.2014;(2):57-64. doi:10.3969/j.issn.1674-2982.2014.02.010

Objective:To determine children ’ s health status and influential factors in Nujiang prefecture , Yun-nan.Methods:Rickets morbidity rate , growth retardation rate , and low-weight rate were selected as the key indica-tors to calculate the sample size by using four-stage-sampling procedure .The data was collected through questionnaire survey, in-depth interviews, and focus-group discussions .χ2 test and qualitative analysis were used to analyze the quantitative and qualitative data .Results:The infant mortality rate was 13.14 %in 2011, which was 1.1 and 1.15 times more than the national and provincial average .The mortality rate of children under five was 16.35%in 2011, which was 1.05 and 1.13 times more than the national and provincial average .It was also 2.19 times more than the average in developed countries .The prevalence of medium and severe malnutrition in children under five was 2 .32%, which was 1 .54 times more than the national average .The incidence of low birth weight was 1 .41%.The research shows that the rates of rickets , growth retardation , and low-weight were 36.13%, 25.81%and 20.98%,and nutritional diseases are more serious .Conclusion:There are serious health problems for children in Nujiang pre-fecture, especially nutritional diseases .Influential factors include health policy and system , economic development, customs, geography, health service capacity , and parental health knowledge Suggestion:The government should im-prove top-level design , strengthen policy support , and develop the local economy in order to solve the social and poli-cy environment factors .Institutions and human capacity should be strengthened , access and quality of services should be improved , health education should be popularized , and health awareness and behaviors should be improved .

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A review of the Orphan Drug Act in the United States and its implications for China

Jin DING

Chinese Journal of Health Policy.2014;(2):38-43. doi:10.3969/j.issn.1674-2982.2014.02.007

The United States is the first country that has introduced legislation designed to stimulate orphan drug research and development .In this paper , we analyze three major amendments of the Orphan Drug Act ( ODA) since 1983 and its incentive system .We then discuss the success of the ODA in encouraging orphan drug research and development and boosting the biopharmaceutical industry .Following that , we investigate the high price of orphan drugs caused by market exclusivity and drug repositioning .Finally, we draw experience from the ODA to make some suggestions on how orphan drug legislation can be devised in China with the aim of improving the health of rare -dis-ease patients and facilitating the development of Chinese biopharmaceutical industry .

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Long-term care policy in Japan and its implications for China

Xiaojuan ZHANG ; Kun ZHU

Chinese Journal of Health Policy.2014;(4):55-61. doi:10.3969/j.issn.1674-2982.2014.04.010

This paper reviews the long-term care policy in Japan and discusses successes and challenges in order to provide policy guidelines for China. All Japanese adults aged 65 or over are covered by the long-term care in-surance ( LTCI) program and are eligible for both in-home and institutional-care services following a thorough, sys-tematic care certification process. The program is financed by a mix of general tax revenues from the three levels of gov-ernment , income-tested premiums, and standardized co-payments. A key success of the policy is its universal and compre-hensive coverage. Notwithstanding this success, increasing costs remain a challenge as Japan’s population ages and the number of LTCI users increases. Learning from the experience of Japan, China should establish a long-term care system, which covers all the aged population, mainly focuses on in-home care, and qualifies social funding to invest.

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Dynamic change on the productivity of township health centers after China’s health care sys-tem reform：Based on the nonparametric Malmquist index in Guangzhou, Guangdong Prov-ince, 2009-2013

Chunxiao WANG ; Kinglun NGOK ; Feng ZHOU

Chinese Journal of Health Policy.2014;(4):49-54. doi:10.3969/j.issn.1674-2982.2014.04.009

Objective:To explore the productivity of township health services in Guangzhou. Methods:We use a nonparametric Malmquist index approach to analyze total factor productivity change in Guangzhou’s township health service. The panel data was collected between 2009 and 2013. Results: The average growth rate of Guangzhou’s township health service was 18 . 7% from 2009 to 2013 . This growth was mainly due to improved technical progress but not technical efficiency. Pure technical efficiency and scale efficiency have not developed simultaneously. Conclusion:The change in the total factor productivity was positively affected by technical progress, not by strategic management and business decisions inside township health centers.

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