The academic collaborations that the Harvard China Health Partnership has forged over decades of work in China enable us to conduct meaningful research to answer pressing questions for China’s health system. These engagements simultaneously promote capacity building for the country’s next generation of thought leaders in health economics. As China makes advances in healthcare financing, telemedicine, eldercare, and other areas, this research also carries important lessons for other global health systems facing similar challenges.
Some of the recent research conducted by HCHP members and affiliates was selected for inclusion in the 2021 International Health Economics Association (iHEA) Congress held from July 12-15, 2021. Summaries of the HCHP-related research presentations, many given by early-career academic partners, are below (click to expand).
New Insights on the Impact of Payment Models and Training on Provider Behavior from Field and Natural Experiments in China (Organized Session)
- Can Global Budget Improve Health Care Efficiency and Quality? Experimental Evidence from China
We assessed the effect of an innovative global budget payment system through the Analysis of Provider Payment Reforms on Advancing China’s Health (APPROACH) project, which was introduced in 56 eligible rural counties (covering a population of 21 million people) in China’s Guizhou province in 2016-2017. The project provided incentives to enhance technical efficiency and incentivized allocative efficiency by rewarding rural county hospitals for reducing the loss of local treatable patients to urban hospitals. Our findings suggest that the APPROACH global budget may offer a framework for improving allocative and technical efficiency without significantly compromising the quality of care.
- The Impact of Hospital Internal Pay-for-Performance on Clinical Departments’ Health Services – Evidence from a Single-Center Study in Shanghai, China
We evaluated a pay-for-performance (P4P) program designed to limit the overuse of drugs and control drug prescription by hospitals. Under the P4P program implemented in a tertiary hospital in Shanghai, China, 19 out of 40 departments were rewarded for undertaking labor intensive services and penalized for the irrational prescription of drugs. This study showed that P4P encouraged doctors to provide services beyond drug prescription during the 1-year intervention period. However, this new approach may also induce increased consumable costs to compensate for reduced drug costs.
Internet Healthcare Market in China (Organized Session)
- Direct to Consumer Telemedicine Platforms and Markets for Medical Advice
We measured diagnostic quality of telehealth consultation services based on 500 unannounced standardized patient visits across the different platforms providing these services in China. We investigated the relationship between business structures of the platforms and physicians’ prescription and referral behaviors. Platforms providing both consultation services and drug selling services, platforms on which patients can rate physicians, and those with higher average consultation fees, were found to provide superior diagnostic quality. The latter two types also provide better treatment advice, but there are higher levels of unnecessary drug prescriptions. Online platforms are more likely to refer patients to onsite providers than conventional clinics.
- How do Consumers Respond to Performance Disclosure in the Health Sector? Evidence from Online Medical Consultations in China
We investigate patients’ online responses to the release of physicians’ performance information through annual updates to the “Excellent Doctor” lists on a large Internet healthcare platform. Using regression discontinuity design to compare the changes in service volumes between the physicians falling just above and below the threshold for inclusion on the list, the research finds there are 5%-7% more online medical consultations for doctors whose performance is above the threshold once the list is released. Young patients are more responsive to information disclosure.
- Distance Still Matters: The Geography of Online Medical Consultations in China
We examined whether Internet healthcare can reduce access barriers caused by travel distance. We applied the gravity model to estimate the effects of geographical distance on flows of online telephone medical consultations and compared these results with flows of conventional on-site services. We found a negative association between patient-provider distance and service utilization, with the effect 50% weaker for online services than for offline services. The need for in-person follow-up visits may be a key factor creating a distance barrier for online service utilization.
Impact of the COVID-19 Pandemic on the Use of Health Services: Evidence from Country Case Studies (Organized Session)
- Impact of COVID-19 Outbreak on Hospital Admissions and Quality of Inpatient Care for Acute Ischemic Stroke Patients in China
In this multicenter, observational registry study, we used data from the Chinese Stroke Center Alliance (CSCA) to better understand the impact of COVID-19 on hospital admissions and quality of inpatient care for acute ischemic stroke (AIS). We concluded that hospital admissions for minor strokes decreased significantly for a October 2019 to March 2020 group of patients than what was observed a year prior. This research suggests hospitals should admit AIS patients to the fullest extent of their abilities and provide tailored treatment strategies, especially for patients with minor strokes who may be more reluctant to seek care. Hospitals and communities should also help mitigate residents’ fear of medical contact by enhancing stroke care awareness. This research was conducted in conjunction with Tiantan Hospital’s Cerebrovascular Disease Center in Beijing.
Contemporary Developments in China’s Rapidly Evolving Health System and Its Implications on Health Expenditures, Demand for Care, and Care Quality
- The Relationship between Hospital Ownership and in-Hospital Mortality and Medical Expenses for Three Common Conditions: Cross-Sectional Analysis from China
The number of for-profit and not-for-profit private hospitals in China grew significantly since 2009 following a set of reforms encouraging private investment in the hospital sector. There are long-standing debates on the performance of different types of hospitals and empirical evidence on developing countries is scant. We examined disparities in health care quality and expenditure in public, private not-for-profit, and private for-profit hospitals. In this study, we assessed the relationship between hospital ownership and in-hospital mortality rates for pneumonia, heart failure, and acute myocardial infarction using data for 64,171 inpatients admitted to secondary hospitals in Sichuan province during the fourth quarters of 2016, 2017, and 2019. We also analyzed associated medical expenses. Results showed that the public hospitals were associated with better or equal healthcare quality and lower medical expenses than the private ones in China, with no difference between private not-for-profit and for-profit hospitals.