Publications in English

2024 

  • Fu, Hongqiao, Terence C. Cheng, Jiajia Zhan, Duo Xu, Winnie Yip. 2024. “Dynamic effects of the COVID-19 pandemic on the demand for telemedicine services: Evidence from China.” Journal of Economic Behavior & Organization 220:531-557. doi:10.1016/j.jebo.2024.02.015 

The COVID-19 pandemic has accelerated the adoption of telemedicine worldwide. Understanding how demand for telemedicine services expands during and after the pandemic is important in assessing its sustainability into the future. This study uses detailed transaction data from one of China’s largest online healthcare platforms to examine the effect of the COVID-19 pandemic on the demand for telemedicine services in China. Prefectures that recorded higher COVID-19 cases experienced a larger and more persistent increase in patient demand for online medical consultations. Heightened demand for telemedicine persisted up to nine months after the strict lockdown was relaxed. The dynamics of expansion in telemedicine demand varied by service types, clinical specialties, and provider-patient location. Read more…

  • Wang, Xiangnan, Xuanyi Nie. 2024. “The uneven distribution of medical resources for severe diseases in China: An analysis of the disparity in inter-city patient mobility.” Applied Geography 165:103226. doi:/10.1016/j.apgeog.2024.103226 

The uneven distribution of medical resources in China has been a persistent concern. This is particularly evident among patients with severe diseases, who often seek better medical resources, resulting in inter-city patient mobility. Using patients’ information (n = 202,817) collected from a nationwide severe disease mutual aid platform, we explored variations in travel willingness, travel time, and travel distance between 2018 and 2021. Findings from disparity in inter-city patient mobility suggest that medical resources accessed by patients with higher health awareness, with digestive and bone marrow or blood diseases, and those not seeking acute care are relatively more unevenly distributed. Modern medicine and higher-quality hospitals accessed by patients are also more unevenly distributed. Read more…

  • Levy, Muriel, John Buckell, Robert Clarke, Nina Wu, Pei Pei, Dianjianyi Sun, Daniel Avery, Hua Zhang, Jun Lv, Canqing Yu, Liming Li, Zhengming Chen, Winnie Yip, Yiping Chen, Borislava Mihaylova. 2024. “Association between health insurance cost-sharing and choice of hospital tier for cardiovascular diseases in China: a prospective cohort study.” The Lancet Regional Health – Western Pacific 45:101020. doi:10.1016/j.lanwpc.2024.101020

Hospitals in China are classified into tiers (1, 2 or 3), with the largest (tier 3) having more equipment and specialist staff. Differential health insurance cost-sharing by hospital tier (lower deductibles and higher reimbursement rates in lower tiers) was introduced to reduce overcrowding in higher tier hospitals, promote use of lower tier hospitals, and limit escalating healthcare costs. In a 9-year follow-up of a prospective study of 0.5 M adults from 10 areas in China, we examined the associations between differential health insurance cost-sharing and choice of hospital tiers for patients with a first hospitalisation for stroke or ischaemic heart disease (IHD) in 2009–2017. Read more…

2023 

  • Si, Yafei, Hao Xue, Huipeng Liao, Yewei Xie, Dong (Roman) Xu, Kumi Smith, Winnie Yip, Weibin Cheng, Junzhang Tian, Weiming Tang, Sean Sylvia. 2023. “The quality of telemedicine consultations for sexually transmitted infections in China.” Health Policy and Planning czad119. doi:10.1093/heapol/czad119

The burden of sexually transmitted infections (STIs) continues to increase in developing countries like China, but the access to STI care is often limited. The emergence of direct-to-consumer (DTC) telemedicine offers unique opportunities for patients to directly access health services when needed; However, the quality of STI care provided by telemedicine platforms remains unknown. After systemically identifying the universe of DTC telemedicine platforms providing on-demand consultations in China in 2019, we evaluated their quality using the method of unannounced standardized patients (SPs). SPs presented routine cases of syphilis and herpes. Of 110 SP visits conducted, physicians made a correct diagnosis in 44.5% (95% CI: 35.1% to 54.0%) of SP visits, and correctly managed 10.9% (95% CI: 5.0% to 16.8%). Read more…

  • Ren, Minghui, Tuohong Zhang, Jin Xu, Jie Qiao, Jianrong Qiao, Siyan Zhan, Jiangmei Qin, Daping Song, Yanru Fang, Yifang Lin, Xiaopeng Jiang, Yan Guo, Qingyue Meng, Xu Qian, Yunguo Liu, Sophia Siu Chee Chan, Feng Zhao, Winnie Yip, Hong Wang, Minmin Wang, Hui Yin, Zuokun Liu, Na Li, Xinyi Song, Fangfang Liu, Yinzi Jin, Fangjing Liu, and Yangmu Huang. 2023. “Building quality primary health care development in the new era towards universal health coverage: a Beijing initiative.” Global Health Research and Policy (2023)8:53. doi:10.1186/s41256-023-00341-y 

Primary health care (PHC) is the most effective way to improve people’s health and well-being, and primary care services should act as the cornerstone of a resilient health system and the foundation of universal health coverage. To promote high quality development of PHC, an International Symposium on Quality Primary Health Care Development was held on December 4–5, 2023 in Beijing, China, and the participants have proposed and advocated the Beijing Initiative on Quality Primary Health Care Development. The Beijing Initiative calls on all countries to carry out and strengthen 11 actions. Read more…

  • Yip, Winnie, Hongqiao Fu, Weiyan Jian, Jue Liu, Jay Pan, Duo Xu, Hanmo Yang, Tiemin Zhai. 2023. “Universal health coverage in China part 2: addressing challenges and recommendations.” The Lancet Public Health 2023;8(12):e1035-e1042. doi:10.1016/S2468-2667(23)00255-4

This report analyses the underlying causes of China’s achievements and gaps in universal health coverage over the past 2 decades and proposes policy recommendations for advancing universal health coverage by 2030. Although strong political commitment and targeted financial investment have produced positive outcomes in reproductive, maternal, newborn, and child health and infectious diseases, a fragmented and hospital-centric delivery system, rising health-care costs, shallow benefit coverage of health insurance schemes, and little integration of health in all policies have restricted China’s ability to effectively prevent and control chronic disease and provide adequate financial risk protection, especially for lower-income households. Read more…

  • Yip, Winnie, Hongqiao Fu, Weiyan Jian, Jue Liu, Jay Pan, Duo Xu, Hanmo Yang, Tiemin Zhai. 2023. “Universal health coverage in China part 1: progress and gaps.” The Lancet Public Health 2023;8(12):e1025-e1034. doi:10.1016/S2468-2667(23)00254-2

Over the past 2 decades, China has made remarkable progress in health-care service coverage, especially in the areas of reproductive, maternal, newborn, and child health, infectious diseases, and service capacity and access. In these areas, coverage is comparable to those in high-income countries. Inequalities of service coverage in these areas have been reduced. However, there remain large gaps in the service coverage of chronic diseases. This paper comprehensively evaluates China’s progress towards universal health coverage by identifying the achievements and gaps in service coverage and financial risk protection that are crucial to achieve universal health coverage goals by 2030. Read more…

  • Xiang, Jia, Terence C. Cheng, Hongqiao Fu, Winnie Yip. 2023. “Price dispersion in an online health marketplace: Evidence from telemedicine services in China.” Economics Letters 2024(234):111435. doi:10.1016/j.econlet.2023.111435

Online health care marketplaces have emerged with the adoption of telemedicine during the COVID-19 pandemic. Despite its readily available information on price and quality, we document substantial price dispersion for telemedicine services in China’s internet health market. We further examine the sources of such price variation: observable characteristics of physicians, hospitals, and local markets explain slightly over half of this variation. The un-explained portion is greater for physician specialties where search frictions are likely larger. Read more…

  • Nie, Xuanyi. 2023. “The ivory tower in China’s speculative urbanism: instrumentalizing the university-healthcare nexus.” Urban Geography. doi: 10.1080/02723638.2023.2267878

This research investigates how the public university engages in China’s speculative urbanism by establishing and operationalizing the university-healthcare nexus through both real estate and healthcare businesses. Drawing on open company data and expert interviews, the organizational structure of public and private actors in the university-healthcare nexus of the Peking University Healthcare City was unfold as a case study. Findings reveal that the university-healthcare nexus was established by Peking University and its subsidiary private companies. The nexus enables speculative urban development by aligning stakeholders’ interests, branding healthcare businesses, and camouflaging profit-driven real estate development. Future comparative studies could help test the scalability of the implications. Read more…

  • Liang, Wangnian, Kun Tang, Jiming Zhu, Zhihui Li, Winnie Yip, Vivian Lin, Rifat Atun, Margaret Chan. 2023. “Tsinghua–Lancet Commission on health and poverty alleviation in China.” [Comment] The Lancet. doi: 10.1016/S0140-6736(23)01856-1

Previous evaluations of health-related poverty alleviation efforts in China have been narrow in scope, fragmented, and largely subjective. The Tsinghua-Lancet Commission plans to comprehensively assess the efforts by conducting a series of independent investigations into the different dimensions and the effects of China’s Health and Poverty Alleviation Campaign. They will utilize extensive data from the National Health Commission of the People’s Republic of China, report on six rounds of nationally representative health service surveys, and conduct field studies in rural western China. The main findings are expected to be available by 2024. Read more…

  • Xu, Duo, Yushu Huang, Sian Tsuei, Hongqiao Fu, Winnie Yip. 2023. “Factors influencing engagement in online dual practice by public hospital doctors in three large cities: A mixed-methods study in China.” Journal of Global Health 13:04103. doi: 10.7189/jogh.13.04103

In the digital age, a rising number of public sector doctors are providing private telemedicine and telehealth services on online health care platforms. This study aims to understand the factors influencing doctors’ engagement in online dual practice. This study collected quantitative demographic and practice data (n = 71 944) and semi-structured interview data (n = 32) on secondary and tertiary public hospital doctors in Beijing, Shanghai and Guangzhou. Our quantitative analysis shows that at least 47.1% of public hospital doctors are involved in online dual practice. This practice is more prevalent among doctors who are male, senior, and non-managerial. Different specialties, hospital ownership, hospital levels, and locations are also significantly associated with this practice. Read more…

  • Nie, Xuanyi, Mo Han, Dingliang Yang. 2023. “Escaping from the identity enclave: Social inclusion events and floating migrants’ settlement intention in China.” Population, Space and Place, e2695. doi: 10.1002/psp.2695

China has undergone unprecedented waves of internal migration over the past decades. However, the discriminatory hukou system puts migrants into an ‘identity enclave’ which challenges migrants’ perception of place and identity, thus reducing their settlement intention. This research explores the relationship between migrants’ participation in social inclusion events (SIE) and their intention to stay (ITS) in host cities. Drawing data from the 2017 China Migrants Dynamic Survey (CMDS), this research constructs a multistep model and uses the self-perceived inclusion level to examine this relationship. The results show that participating in SIE helps with migrants’ ITS. Particularly, it also helps migrants to feel more included, which is an important trigger for them to stay. Read more…

  • Wang, Zhenjie, Hanmo Yang, Chenxi Sun, Shenda Hong. 2023. “Estimating causal effects of physical disability and number of comorbid chronic diseases on risk of depressive symptoms in an elderly Chinese population: a machine learning analysis of cross-sectional baseline data from the China longitudinal ageing social survey.” BMJ Open 13(7), e069298. doi: 10.1136/bmjopen-2022-069298

This study aims to explore the causal effects of physical disability and number of comorbid chronic diseases on depressive symptoms in an elderly Chinese population. Cross-sectional, baseline data were obtained from the China Longitudinal Ageing Social Survey, a stratified, multistage, probabilistic sampling survey conducted in 2014 that covers 28 of 31 provincial areas in China. The causal effects of physical disability and number of comorbid chronic diseases on depressive symptoms were analysed using the conditional average treatment effect method of machine learning. This study provides evidence that the presence of one or more functional limitations affects the occurrence of depressive symptoms among elderly people. Read more…

  • Huang, Yushu, Duo Xu, Sian Hsiang-Te Tsuei, Hongqiao Fu, and Winnie Yip. 2023. “Understanding Impacts of Online Dual Practice on Health System Performance: A Qualitative Study in China.” Health Systems & Reform 9(1):2215552. doi: 0.1080/23288604.2023.2215552

An increasing number of public hospital doctors are providing online services on private third-party healthcare platforms, creating a new form of dual practice—online dual practice. To explore the impacts of online dual practice on health system performance as well as potential policy responses, we undertook a qualitative approach that uses in-depth interviews and thematic analysis. We interviewed 57 Chinese respondents involved in online dual practice. We asked respondents for their opinions on the effects of online dual practice on access, efficiency, quality of care, and advice on regulatory policy. The results suggest that online dual practice can generate mixed impacts on health system performance. Read more…

  • Nie, Xuanyi, Haijing Liu. 2023. “Medical institutions in the geography of innovation: evidence from public tertiary hospitals and biotech start-ups in Chinese cities.” Regional Studies. doi: 10.1080/00343404.2023.2199780

Concerning China’s growth in biotechnology, the research on biotech start-ups in China yields significant implications. However, studies have not given enough attention to hospitals, which are critical players in the biotech industry. Because of the hospital-centric healthcare system, public tertiary hospitals in China are important partners for biotech start-ups. This study investigates the geographical relationship between public tertiary hospitals and biotech start-ups in Chinese cities. The findings suggest evidence of collocation, which reflects their alliances. This research thereby contributes to the existing knowledge of the biotech industry by integrating the healthcare system into the location of biotech firms. Read more…

  • Yang, Hanmo, Runlin Han, Zhenjie Wang. 2023. “Third-child fertility intention and its socioeconomic factors among women aged 20–34 years in China.” BMC Public Health 23:821. doi: 10.1186/s12889-023-15719-3

The low birth rates and rapid population aging has drawn considerable attention in China. In 2021, China launched the policy and supportive measures that allow up to 3 children per couple. This study aims to explore the influencing factors of the third-child fertility intention among women aged 20–34 years in China. Data from a total of 61,588 valid samples aged 20–34 years old were obtained from the National Fertility Survey conducted in 2017. Fertility desire and behavior, childbearing and service use, and potential influencing factors of fertility intention such as the history of pregnancy were assessed. Our study concludes a series of socioeconomic factors, and previous childbearing and childrearing experiences are crucial for women’s fertility intention for a third child. Read more…

  • Nie, Xuanyi. 2023. “The ‘medical city’ and China’s entrepreneurial state: Spatial production under rising consumerism in healthcare.” Urban Studies, 60(6), 1102–1122. doi: 10.1177/00420980221131246

The role of hospitals has significantly changed over the past decades and the ‘medical city’ has emerged as a new urban phenomenon in China. This paper situates China’s medical city in the theory of state entrepreneurialism and rethinks consumerism in healthcare. Particularly focusing on the state–market and production–consumption dyads, the paper argues that the state has engineered the institutional and market legitimacy for the rise of consumerism in healthcare and allows the medical city to capitalise on the provision and consumption of high-end healthcare services to advance the healthcare reform and capture economic opportunities. This argument is substantiated by a case study on the Shanghai New Hongqiao International Medical Center. It is found that while the production of the medical city is based on private sector participation, the state’s presence is diffused in the governance of the medical city through public–private partnerships, which reflect the characteristics of state entrepreneurialism. Read more…

  • Liu, Hao-Ran, Si-Yuan Chen, Lan-Yue Zhang, Hong-Qiao Fu, and Wei-Yan Jian. 2023. “Expanding outpatient benefits package can reduce diabetes-related avoidable hospitalizations.” Frontiers in Public Health 11. doi: 10.3389/fpubh.2023.964789

China has the largest number of diabetic patients in the world. In 2021, diabetes-related health costs in China were as high as $165.3 billion. This study evaluates the policy effect of replacing hospitalization service with outpatient service and reducing diabetes-related avoidable hospitalizations by improving outpatient benefits package.  A difference-in-difference model was used to analyze the effect of improving outpatient benefits package level of diabetes from 1800 yuan (about $252.82) to 2400 yuan (about $337.09) per capita per year. The avoidable hospitalization rate of diabetes mellitus decreased by 0.21 percentage points, the average total cost of hospitalization increased by 7.89%, and the average length of stay per hospitalization increased by 5.63%. Improving the outpatient benefits package of diabetes can play a role in replacing hospitalization service with outpatient service, reducing diabetes-related avoidable hospitalizations, and reducing the disease burden and financial burden. Read more…

  • Fu, Hongqiao, Yi Lai, Yuanyuan Li, Yishan Zhu, and Winnie Yip. 2023. “Understanding medical corruption in China: a mixed-methods study.” Health Policy and Planning czad015. doi: 10.1093/heapol/czad015

By employing a mixed-methods design and combining data from three resources, this study attempts to examine patterns of medical corruption in China, explore its key drivers and investigate the perceived effectiveness of recent anti-corruption interventions. Using extracted data from 3546 cases on the China Judgments Online website between 2013 and 2019, we found that bribery, embezzlement and insurance fraud accounted for 68.1%, 22.8% and 9.1% of all medical corruption cases, respectively. Using a nationally representative household survey, we further found that the prevalence of informal payments from patients remained at a low level between 2011 and 2018. Finally, we conducted interviews with 17 key informants to explore drivers of medical corruption and investigated the perceived effectiveness of recent anti-corruption interventions in China. Read more…

  • Xue, Qingping, Dong Roman Xu, Terence C. Cheng, Jay Pan, and Winnie Yip. 2023. “The Relationship between Hospital Ownership, in-Hospital Mortality, and Medical Expenses: An Analysis of Three Common Conditions in China.” Archives of Public Health 81(1):19. doi: 10.1186/s13690-023-01029-y.

Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals. In our study, we found that the public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Read more…

  • Hsiao, William C., Winnie Yip. 2023. “Financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution?” Social Science & Medicine, 115730. doi:10.1016/j.socscimed.2023.115730

The international consensus in support of universal health coverage (UHC), though commendable, thus far lacks a clear mechanism to finance and deliver accessible and effective basic healthcare to the two billion rural residents and informal workers of low- and lower-middle-income countries (LLMICs). Importantly, the two preferred financing modes for UHC, general tax revenue and social health insurance, are often infeasible for LLMICs. We identify from historical examples a community-based model that we argue shows promise as a solution to this problem. This model, which we call Cooperative Healthcare (CH), is characterized by community-based risk-pooling and governance and prioritizes primary care. We defend cooperative healthcare’s suitability for this bridging role and urge LLMIC governments to launch experiments testing it out, with careful adaptation to local conditions. Read more…

2022 

  • Chen, Xinxin, John Giles, Yao Yao, Winnie Yip, Qinqin Meng, Lisa Berkman, He Chen, Xi Chen, Jin Feng, Zhanlian Feng, Elena Glinskaya, Jinquan Gong, Perry Hu, Haidong Kan, Xiaoyan Lei, Xiao Liu, Andrew Steptoe, Gewei Wang, Harold Wang, Huali Wang, Xiaoyu Wang, Yafeng Wang, Li Yang, Luxia Zhang, Quan Zhang, Jing Wu, Zunyou Wu, John Strauss, James Smith, Yaohui Zhao. 2022. “The path to healthy ageing in China: a Peking University–Lancet Commission.” The Lancet. 400(10367):1967-2006. doi:10.1016/S0140-6736(22)01546-X

Around the world, populations are ageing at a faster pace than in the past and this demographic transition will have impacts on all aspects of societies. While rapid population ageing poses challenges, China’s rapid economic growth over the last forty years has created space for policy to assist older persons and families in their efforts to improve health and well-being at older ages. As China is home to 1/5 of the world’s older people, China is often held up as an example for other middle-income countries. This Commission Report aims to help readers to understand the process of healthy ageing in China as a means of drawing lessons from the China experience. In addition, with the purpose of informing the ongoing policy dialogue within China, the Commission Report highlights the policy challenges on the horizon and draws lessons from international experience. Read more…

  • Li, Yuanyuan, Chunfeng Zhang, Peng Zhan, Hongqiao Fu, and Winnie Yip. 2022. “Trends and projections of universal health coverage indicators in China, 1993–2030: An analysis of data from four nationwide household surveys.” The Lancet Regional Health – Western Pacific. 31:100646. doi:10.1016/j.lanwpc.2022.100646

Universal health coverage (UHC) is a core element of Sustainable Development Goals and has become a global healthcare priority. This study aims to comprehensively evaluate the progress towards UHC in China by examining trends in service coverage and financial protection, and estimating the probability of achieving UHC targets by 2030. We selected 12 prevention service indicators, 12 treatment service indicators, and two financial protection indicators to evaluate China’s progress towards UHC. We used data from four nationally representative household surveys to assess the trends in service coverage and financial protection between 1993 and 2018. Of the 24 service coverage indicators used in this study, most of them experienced improvements between 1993 and 2018. Based on our projections, most indicators except ones in the area of non-communicable diseases (NCD) will achieve the 80% coverage target by 2030. Read more…

  • Jia, Yusheng, Min Hu, Hongqiao Fu, and Winnie Yip. 2022. “Provincial Variations in Catastrophic Health Expenditure and Medical Impoverishment in China: A Nationwide Population-Based Study.” The Lancet Regional Health – Western Pacific 100633. doi: 10.1016/j.lanwpc.2022.100633.

Financial protection, as a key dimension of Universal Health Coverage (UHC), has been under increasing attention in recent years. A series of studies have examined the nationwide extent of catastrophic health expenditure (CHE) and medical impoverishment (MI) in China. However, disparities in financial protection at the province level have rarely been studied. Using data from the 2017 China Household Finance Survey (CHFS), this study estimated the incidence and intensity of CHE and MI for 28 Chinese provinces, and revealed large provincial variations in financial protection within the nation. Policymakers should pay special attention to low-income households in central and western provinces. Provision of better financial protection for these vulnerable groups will be key to achieving UHC in China. Read more…

  • Hu, Min, Wenhui Mao, Ruyan Xu, Wen Chen, and Winnie Yip. 2022. “Have Lower-Income Groups Benefited More from Increased Government Health Insurance Subsidies? Benefit Incidence Analysis in Ningxia, China.” Health Policy and Planning czac054. doi: 10.1093/heapol/czac054.

China’s government subsidies on the demand side – such as subsidizing medical insurance premiums – have accelerated progress towards universal health coverage. We conducted two rounds of household surveys and collected the annual claims reports of a rural medical insurance scheme in Ningxia (a relatively underdeveloped region in Western China). We used benefit incidence analysis to evaluate the distribution of benefit for different health services received by individuals with different living standards, as measured by the household wealth index. Increased government subsidies for the rural medical insurance scheme mainly contributed to inpatient care and allowed the poor to use more services at county and higher-level hospitals. Read more…

  • Lim, Kai Shen, Wei Aun Yap, and Winnie Yip. 2022. “Consumer Choice and Public‐private Providers: The Role of Perceived Prices.” Health Economics hec.4554. doi: 10.1002/hec.4554.

We investigate the role of perceived price and quality on consumer choice for four different health conditions across public and private providers using a nationally representative survey in Malaysia. We estimate a mixed logit model and show that consumers value different dimensions of quality depending on the health condition. Furthermore, increasing perceived prices for private providers reduces demand for minor, more frequent health conditions such as flu, fever, or cough, but increases demand for more complex, severe conditions such as coronary artery bypass graft. These findings provide empirical support for price regulation which differentiates the severity of underlying health conditions. Read more…

  • Zhang, Hao, Luying Zhang, Roman Xu, Jay Pan, Min Hu, Weiyan Jian, and Winnie Yip. 2022. “Can a Global Budget Improve Health Care Efficiency? Experimental Evidence from China.” Health Economics hec.4531. doi: 10.1002/hec.4531.

The Analysis of Provider Payment Reforms on Advancing China’s Health (APPROACH) project shifted the payment method of China’s rural health insurance scheme for county hospitals from fee-for-service to a novel global budget. APPROACH conducted a large-scale RCT of the global budget in 56 counties (22 million enrollees) of Guizhou province from 2016–2017. Applying randomization inference to claims data, we find a significant shift of inpatient utilization and expenditure from out-of-county hospitals to county hospitals. At county hospitals, average expenditure per admission and length of stay decreased, though not significantly. Effects on readmissions show no clear sign of compromised quality. Read more…

  • Li, Mingqiang, Zhihui Li, and Chi-Man (Winnie) Yip. 2022. “Informal Payments and Patients’ Perceptions of the Physician Agency Problem: Evidence from Rural China.” Social Science & Medicine 298:114853. doi: 10.1016/j.socscimed.2022.114853.

Informal payment for medical services is a common phenomenon in China. Patients make informal payments, in cash or in kind, to physicians in addition to official charges billed for medical services. This paper assesses the associations between patients’ perceptions of the physician as an agent for the patient’s interests (physician agency problem) and informal payment behavior. Using data of 24,000 and 6700 rural households respectively from the Health Development of Rural China Program database (collected in 2008) and Ningxia data source (collected in 2015), we find that patients’ concern about physician agency problems is significantly associated with informal payments. We explain that patients may initiate informal payments to physicians in order to mitigate the physician agency problem, which suggests that improving alignment between doctors’ incentives and patients’ interests is essential to mitigating informal payments. Read more…

  • Cheng, Terence C., Hongqiao Fu, Duo Xu, and Winnie Yip. 2022. “Technology Platforms Are Revolutionizing Health Care Service Delivery in China” [Commentary]. NEJM Catalyst. doi:10.1056/CAT.21.0414.

In this article, we describe China’s Internet health market and illustrate how technology platforms are revolutionizing health care delivery. We utilize two unique data sources: data from the Internet portals of major four Internet health platforms (extracted using Web-scraping tools), together with billing data from one of the four platforms. While China’s Internet health market encompasses a variety of different health care services and products, we focus our discussion on the delivery of online medical consultations, as this segment of the Internet health market provides the most interesting narrative on how service delivery in the online market differs from the traditional physical market. Read more…

  • Xu, Duo, Jiajia Zhan, Terence Cheng, Hongqiao Fu, and Winnie Yip. 2022. “Understanding Online Dual Practice of Public Hospital Doctors in China: A Mixed-Methods Study.” Health Policy and Planning czac017. doi: 10.1093/heapol/czac017.

As Internet companies enter the healthcare market, a rising number of online healthcare platforms have emerged worldwide. In some countries like China, public hospital doctors are providing direct-to-consumer telemedicine services on these commercial platforms as independent providers. Such online service provision creates a new form of dual practice. Using a mixed-methods design, this study aims to investigate the prevalence of online dual practice, doctors’ time allocation, motivations for engaging in it, and the potential impacts on the health system in China. Read more…

  • Chen, Qiulin, Duo Xu, Hongqiao Fu, and Winnie Yip. 2022. “Distance Effects and Home Bias in Patient Choice on the Internet: Evidence from an Online Healthcare Platform in China.” China Economic Review 72:101757. doi: 10.1016/j.chieco.2022.101757.

Telemedicine and telehealth hold promise for reducing access barriers caused by travel distance. However, little is known about how the Internet affects patients’ online provider choices and thus the spatial distribution of healthcare utilization. This study investigates the effect of distance on flows of online medical consultations using a unique dataset from one of the leading third-party online healthcare platforms in China: Haodf.com. We show that the geographic distance between doctors and patients is negatively associated with online service utilization, though this effect is almost 40% ~ 50% weaker for online medical services than it is for offline medical services. We also find a strong “home bias” in which patients and doctors tend to locate in the same prefecture and in the same province. Further analyses suggest that prior in-person visits before online consultations, the potential need for a follow-up physical visit after an online consultation, and information friction may contribute to the distance effect. These findings have policy implications for improving healthcare access in China and other nations. Read more…

  • Hu, Min, Wen Chen, and Winnie Yip. 2022. “Hospital Management Practices in County-Level Hospitals in Rural China and International Comparison.” BMC Health Services Research 22(1):64. doi: 10.1186/s12913-021-07396-y.

Although management is important in healthcare, low- and middle-income countries (LMICs) have little experience measuring the competence of hospital management. This study assessed the management practices of county-level hospitals in Guizhou in southwest China during 2015 using the Development World Management Survey (D-WMS) instrument to interview 273 managers in 139 hospitals and score the hospitals’ management practices. We scored the management practices of the sampled hospitals, overall and in four dimensions (operations, monitoring, targets, personnel management) and three processes (implementation, usage, monitoring). China ranked seventh of 10 countries, after six HICs and higher than one HIC and two other LMICs (Brazil and India). The study concludes that Chinese county-level hospitals should improve their low quality of management by prioritizing target-setting and process implementation. Read more…

2021

  • Kleinman, Arthur, Hongtu Chen, Sue E. Levkoff, Ann Forsyth, David E. Bloom, Winnie Yip, Tarun Khanna, Conor J. Walsh, David Perry, Ellen W. Seely, Anne S. Kleinman, Yan Zhang, Yuan Wang, Jun Jing, Tianshu Pan, Ning An, Zhenggang Bai, Jiexiu Wang, Qing Liu, and Fawwaz Habbal. 2021. “Social Technology: An Interdisciplinary Approach to Improving Care for Older Adults.” Frontiers in Public Health 9:729149. doi: 10.3389/fpubh.2021.729149.

How to integrate global population aging and technology development to help address the growing demands for care facing many aging societies–such as China–is both a challenge and an opportunity for innovation. The authors propose a social technology approach that promotes use of technologies to assist individuals, families, and communities to cope more effectively with the disabilities of older adults who can no longer live independently due to dementia, serious mental illness, and multiple chronic health problems. The main contributions of the social technology approach include: (1) fostering multidisciplinary collaboration among social scientists, engineers, and healthcare experts; (2) including ethical and humanistic standards in creating and evaluating innovations; (3) improving social systems through working with those who deliver, manage, and design older adult care services; (4) promoting social justice through social policy research and innovation, particularly for disadvantaged groups; (5) fostering social integration by creating age-friendly and intergenerational programs; and (6) seeking global benefit by identifying and generalizing best practices. Read more…

  • Zhou, Wuping, Weiyan Jian, Zhifan Wang, Jay Pan, Min Hu, and Winnie Yip. 2021. “Impact of Global Budget Combined with Pay-for-Performance on the Quality of Care in County Hospitals: A Difference-in-Differences Study Design with a Propensity-Score-Matched Control Group Using Data from Guizhou Province, China.” BMC Health Services Research 21(1):1296. doi: 10.1186/s12913-021-07338-8.

In 2016, a number of counties in rural Guizhou, China, implemented global budget (GB) for county hospitals with quality control measures. The aim of this study is to measure the impact of GB combined with pay-for-performance on the quality of care of inpatients in county-level hospitals in China. Inpatient cases of four diseases from 16 county-level hospitals in Guizhou province that implemented GB in 2016 were selected as the intervention group, and similar inpatient cases from 10 county-level hospitals that still implemented fee-for-services were used as the control group. Propensity matching score (PSM) was used for data matching to control for age factors, and difference-in-differences (DID) models were constructed using the matched samples to perform regression analysis on quality of care for the four diseases. The study concludes that inclusion of pay-for-performance in the global budget payment system will help reduce the quality risks associated with the reform of the payment system and improve care quality. Read more…

  • Lai, Yi, Hongqiao Fu, Ling Li, and Winnie Yip. 2022. “Hospital Response to a Case-Based Payment Scheme under Regional Global Budget: The Case of Guangzhou in China.” Social Science & Medicine 292:114601. doi: 10.1016/j.socscimed.2021.114601.

Both developed and developing countries have been searching for effective provider payment methods to control health expenditure inflation. In January 2018, Guangzhou city in Southern China initiated an innovative case-based payment method for inpatient care under the framework of the regional global budget, called the Diagnosis-Intervention Packet (DIP). The DIP payment scheme includes a price adjustment mechanism through which the actual reimbursement for each case is determined ex post. By employing the difference-in-difference method and using data from Beijing and Guangzhou, we evaluate the effects of the DIP payment on medical expenditures and provider behaviors. We find that total health expenditures per case have decreased by 3.5%. However, the average point volume per case for local inpatients with social health insurance coverage has increased by more than 3%. We also find suggestive evidence of up-coding. All these results suggest that healthcare providers have taken strategic behaviors in response to the DIP payment. Read more…

  • Cai, Shu, Albert Park, and Winnie Yip. 2021. “Migration and Experienced Utility of Left-behind Parents: Evidence from Rural China.” Journal of Population Economics. doi: 10.1007/s00148-021-00869-8

This paper examines the impact of children’s migration on the well-being of left-behind parents using panel data on experienced utility measured by the Day Reconstruction Method. Exploiting exogenous variation in exposure to employment shocks at migration destinations for identification, we find that left-behind parents experience lower utility when their adult children migrate. This is partly due to increased working time and less time spent in social activities, and partly due to reduced utility within activity type. The latter effect is consistent with the finding of less physical care and psychological support from children who have migrated. These negative effects dominate the possible benefits of greater income associated with children’s migration. Read more…

  • Zhao, Xiaoshuang, Yumeng Zhang, Yili Yang, and Jay Pan. 2021. “Diabetes‐related Avoidable Hospitalisations and Its Relationship with Primary Healthcare Resourcing in China: A Cross‐sectional Study from Sichuan Province.” Health & Social Care in the Community hsc.13522. doi: 10.1111/hsc.13522.

The reduction of diabetes-related avoidable hospitalisations (AHs) can be achieved via the provision of timely and effective primary healthcare (PHC), which has made diabetes AHs rate a widely adopted indicator for evaluating the performances of PHC systems. This study reported the AHs rate of diabetes and further explored its relationship with PHC resourcing in China. Hospital discharge data of the fourth quarters of 2016 and 2017 in Sichuan Province, China were used. The number of PHC doctors per 10,000 population and the proportion of PHC doctors on all doctors were used as indicators reflective of PHC resourcing. A 10% increase in the number of PHC doctors per 10,000 population was associated with a reduction of 2.574 per 100,000 population in the age-standardised AHs rate of diabetes. In addition, 10% increase in the proportion of PHC doctors on all doctors was associated with a reduction of 10.839 diabetes-related AHs per 100,000 population. We also found that increased PHC resourcing was associated with decreased diabetes-related AHs rates. Read more…

  • Hu, Haiyan, Weiyan Jian, Hongqiao Fu, Hao Zhang, Jay Pan, and Winnie Yip. 2021. “Health service underutilization and its associated factors for chronic diseases patients in poverty-stricken areas in China: a multilevel analysis.” BMC Health Services Research. doi: 10.1186/s12913-021-06725-5.

This study aims to describe health services underutilization for people diagnosed with chronic diseases in impoverished regions and to identify its associated factors, which is expected to have practical implications for the implementations of interventions tailored to the specific needs of disadvantaged residents in rural China to achieve effective utilization of health services in a timely manner. Our results suggested that the implementation of a series of comprehensive strategies should be addressed throughout the policy-making process to improve the provision of regular source of care as a significant determinant for reducing health services underutilization, thus ultimately achieving equal utilization of health services in impoverished regions, especially among chronic disease patients. Read more…

2020

  • Cai, Shu, Albert Park, and Winnie Yip. 2020. “Time Well Spent versus a Life Considered: Changing Subjective Well-Being in China.” Oxford Economic Papers (gpaa051). doi: 10.1093/oep/gpaa051.

Using unique longitudinal survey data that employed the Day Reconstruction Method to measure experienced utility (EU) in rural China, this study reveals striking differences in the trends for life satisfaction and EU. We find that reported life satisfaction changed little over the period from 2006 to 2009. However, EU increased significantly during the same period. The improvement in EU is mainly due to more positive feelings about specific activities rather than changes in the time spent on different activities. These findings are consistent with the predictions of aspiration adaptation theory. Read more…

  • Song, Ze, Yishan Zhu, Hong Zou, Hongqiao Fu, and Winnie Yip. 2020. “A Tale of Transition: Trends of Catastrophic Health Expenditure and Impoverishment in Urban China, 1986-2009.” Health Systems & Reform 6(1):e1836731. doi: 10.1080/23288604.2020.1836731.

From 1986 to 2009, China’s health system reform first adopted a market-oriented approach and later reemphasized the role of the government starting from 2002. China’s oscillating health care financing policies present us a unique opportunity to examine the consequences of government-led financing and market-oriented financing measures. This study uses the Urban Household Survey, a diary data in China that covers the period of 1986 to 2009 to examine the long-run trends in the incidence and intensity of catastrophic health expenditure and medical impoverishment. Four major findings emerge. First, the incidence and intensity of catastrophic health expenditure in urban Chinese households increased rapidly between 1986 and 2002, whereas they stabilized after 2002. Second, the incidence of medical impoverishment and its depth in the poverty gap remained stable before 2002 and decreased rapidly after 2002. Third, income and regional inequality in measures of catastrophic health expenditure widened from 1986 to 2002. They narrowed in the 2000s but remain wide. Fourth, income and regional inequality in medical impoverishment remained unchanged between 1986 and 2002 and narrowed substantially after 2002. All these results suggest that China’s two cycles of health care reform generated significantly different outcomes in financial protection, holding lessons for the ongoing health care reform in China and other countries. Read more…

  • Feng, Zhanlian, Elena Glinskaya, Hongtu Chen, Sen Gong, Yue Qiu, Jianming Xu, and Winnie Yip. 2020. “Long-Term Care System for Older Adults in China: Policy Landscape, Challenges, and Future Prospects.” The Lancet 396(10259):1362–72. doi: 10.1016/S0140-6736(20)32136-X.

In China, the population is rapidly ageing and the capacity of the system that cares for older people is increasingly a concern. In this Review, we provide a profile of the long-term care system and policy landscape in China. The long-term care system is characterised by rapid growth of the residential care sector, slow development of home and community-based services, and increasing involvement of the private sector. The long-term care workforce shortage and weak quality assurance are concerning. Public long-term care financing is minimal and largely limited to supporting welfare recipients and subsidising the construction of residential care beds and operating costs. China is piloting social insurance long-term care financing models and, concurrently, programmes for integrating health care and long-term care services in selected settings across the country; the effectiveness and sustainability of these pilots remain to be seen. Informed by international long-term care experiences, we offer policy recommendations to strengthen the evolving care system for older people in China. Read more or see interview with lead authors Zhanlian Feng and Winnie Yip by The Lancet in Chinese on WeChat.

  • Lin, Xiaojun, Weiyan Jian, Winnie Yip, and Jay Pan. “Perceived Competition and Process of Care in Rural China.” 2020. Risk Management Healthcare Policy. 2020;13:1161-1173. https://doi.org/10.2147/RMHP.S258812.

Although there is much debate about the effect of hospital competition on healthcare quality, its impact on the process of care remains unclear. This study aimed to determine whether hospital competition improves the process of care in rural China. The county hospital questionnaire survey data and the randomly sampled medical records of bacterial pneumonia patients in 2015 in rural area of Guizhou, China, were used in this study. Our results suggested that the likelihood of receiving antibiotic treatment and first antibiotic treatment within 6 hours after admission was significantly higher in the hospitals perceiving higher competition pressure. However, no significant relationship was found between perceived competition and oxygenation assessment for patients with bacterial pneumonia. This study revealed the role of perceived competition in improving the process of care under the fee-for-service payment system and provided empirical evidence to support the pro-competition policies in China’s new round of national healthcare reform. Read more…

  • Li, Xi, Harlan M. Krumholz, Winnie Yip, Kar Keung Cheng, Jan De Maeseneer, Qingyue Meng, Elias Mossialos, Chuang Li, Jiapeng Lu, Meng Su, Qiuli Zhang, Dong Roman Xu, Liming Li, Sharon-Lise T. Normand, Richard Peto, Jing Li, Zengwu Wang, Hongbing Yan, Runlin Gao, Somsak Chunharas, Xin Gao, Raniero Guerra, Huijie Ji, Yang Ke, Zhigang Pan, Xianping Wu, Shuiyuan Xiao, Xinying Xie, Yujuan Zhang, Jun Zhu, Shanzhu Zhu, and Shengshou Hu. 2020. “Quality of Primary Health Care in China: Challenges and Recommendations.” The Lancet 395(10239):1802–12. doi: 10.1016/S0140-6736(20)30122-7.

China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. Read more…

  • Yip, Winnie Chi-Man. 2020. Health Care Policy in East Asia: A World Scientific Reference: Volume 1: Health Care System Reform and Policy Research in China. Vol. 1. WORLD SCIENTIFIC.

Volume 1 describes and discusses China’s ambitious and complex journey of health care reform since 2009. The Chinese government has achieved universal health insurance coverage and has embarked on reforms of the service delivery system and provider payment methods that are aimed at controlling health expenditure growth and improving efficiency. This volume includes pilot and social experiments initiated by the government and researchers and their evaluations that have guided the formulation of health reform policies. Read more

  • Levy, Muriel, Yiping Chen, Robert Clarke, Derrick Bennett, Yunlong Tan, Yu Guo, Zheng Bian, Jun Lv, Canqing Yu, Liming Li, Winnie Yip, Zhengming Chen, and Borislava Mihaylova. 2020. “Socioeconomic Differences in Health-Care Use and Outcomes for Stroke and Ischaemic Heart Disease in China during 2009–16: A Prospective Cohort Study of 0·5 Million Adults.” The Lancet Global Health 8(4):e591–602. doi: 10.1016/S2214-109X(20)30078-4.

China initiated major health-care reforms in 2009 aiming to provide universal health care for all by 2020. However, little is known about trends in health-care use and health outcomes across different socioeconomic groups in the past decade. Methods: We used data from the China Kadoorie Biobank (CKB), a nationwide prospective cohort study of adults aged 30–79 years in 2004–08, in ten regions (five urban, five rural) in China. Individuals who were alive in 2009 were included in the present study. Read more…

2019

  • Jaacks, Lindsay M. 2019. “The Unintended Consequences of Economic Growth on Child and Adolescent Nutrition.” The Lancet Diabetes & Endocrinology 7(4):247–48. doi: 10.1016/S2213-8587(19)30067-1.

Indiscriminate economic growth driven by increased material consumption was arguably the single most important goal of most governments in the 20th century. Such growth, measured by increases in per capita gross domestic product (GDP), was assumed to directly lead to reductions in poverty and improvements in health and wellbeing. However, the benefits of economic growth have been uneven, resulting in substantial inequities worldwide. Read more

  • Jian, Weiyan, Jose Figueroa, Liana Woskie, Xi Yao, Yuqi Zhou, Zhengxiang Li, Changan Li, Li Yao, and Winnie C. Yip. 2019. “Quality of Care in Large Chinese Hospitals: An Observational Study.” BMJ Quality & Safety 28(12):bmjqs-2018-008938. doi: 10.1136/bmjqs-2018-008938.

To empirically assess the quality of hospital care in China and trends over a 5-year period during which the government significantly increased its investment in healthcare. In 2012/2013, Chinese hospitals had variable performance on AMI measures, including prescribing aspirin on arrival (80.7%), and discharging patients on aspirin (79.2%), β-blockers (60.8%) or statins (75.8%). This was similar for stroke cases and pneumonia cases. Smoking cessation advice was given at high rates across conditions though rates of influenza/pneumococcal vaccines were performed <1%. Read more…

  • Li, Linyan, John D. Spengler, Shi-Jie Cao, and Gary Adamkiewicz. 2019. “Prevalence of Asthma and Allergic Symptoms in Suzhou, China: Trends by Domestic Migrant Status.” Journal of Exposure Science & Environmental Epidemiology29(4):531–38. doi: 10.1038/s41370-017-0007-8.

Rapid urbanization in developing countries, with significant rural-to-urban and between-urban areas migration, presents a natural epidemiological model to better understand population-level trends in asthma and allergy prevalance without confounding by genetic factors. This cross-sectional study, conducted November 2014 to January 2015 in Suzhou, China, investigated differences in asthma and allergic symptoms between domestic migrant residents and long-term residents and their children. Using multivariate logistic regression, the odds ratios for children in migrant families compared to those in long-term resident families in Suzhou for doctor-diagnosed asthma, pneumonia, rhinitis, and eczema were 0.56 (95% CI: 0.42.0.73), 0.60 (95% CI: 0.49, 0.72), 0.63 (95% CI:0.52, 0.77), and 0.73 (95% CI: 0.60, 0.89), respectively. Read more…

  • Yip, Winnie C., Yue-Chune Lee, Shu-Ling Tsai, and Bradley Chen. 2019. “Managing Health Expenditure Inflation under a Single-Payer System: Taiwan’s National Health Insurance.” Social Science & Medicine 233:272–80. doi: 10.1016/j.socscimed.2017.11.020.

As nations strive to achieve and sustain universal health coverage (UHC), they seek answers as to what health system structures are more effective in managing health expenditure inflation. A fundamental macro-level choice a nation has to make is whether to adopt a single- or a multiple-payer health system. Using Taiwan’s National Health Insurance (NHI) as a case, this paper examines how a single-payer system manages its health expenditure growth and draws lessons for other countries whose socioeconomic development is similar to Taiwan’s. Our analyses show that as a single payer, Taiwan’s NHI is able to exercise its monopsony power to manage its health expenditure growth. Read more…

  • Yip, Winnie, Hongqiao Fu, Angela T. Chen, Tiemin Zhai, Weiyan Jian, Roman Xu, Jay Pan, Min Hu, Zhongliang Zhou, Qiulin Chen, Wenhui Mao, Qiang Sun, and Wen Chen. 2019. “10 Years of Health-Care Reform in China: Progress and Gaps in Universal Health Coverage.” The Lancet 394(10204):1192–1204. doi: 10.1016/S0140-6736(19)32136-1.

In 2009, China launched a major health-care reform and pledged to provide all citizens with equal access to basic health care with reasonable quality and financial risk protection. The government has since quadrupled its funding for health. The reform’s first phase (2009–11) emphasised expanding social health insurance coverage for all and strengthening infrastructure. The second phase (2012 onwards) prioritised reforming its health-care delivery system through: (1) systemic reform of public hospitals by removing mark-up for drug sales, adjusting fee schedules, and reforming provider payment and governance structures; and (2) overhaul of its hospital-centric and treatment-based delivery system. Read more…

  • Zhang, Hao, Eddy Doorslaer, Ling Xu, Yaoguang Zhang, and Joris Klundert. 2019. “Can a Results‐based Bottom‐up Reform Improve Health System Performance? Evidence from the Rural Health Project in China.” Health Economics28(10):1204–19. doi: 10.1002/hec.3935.

In 2008, the Rural Health Project (Health XI) was initiated in 40 Chinese counties to pilot interventions aimed at improving local health systems. Performance targets were pre‐specified (results‐based), and project counties were allowed to tailor their interventions (bottom‐up) in recognition of the substantial regional variations. Using household data from the China National Health Services Survey in a difference‐in‐differences strategy combined with matching, we find that project counties have improved outcomes (both incentivized and not‐directly‐incentivized) in all three domains examined—medical care, public health services, and self‐rated health—by 2013. In particular, the decrease in outpatient intravenous drip use and financial strain and the increase in all four components of public health services provision are robust to a variety of tests and alternative matching strategies. Read more…

2018

  • Fu, Hongqiao, Ling Li, and Winnie Yip. 2018. “Intended and Unintended Impacts of Price Changes for Drugs and Medical Services: Evidence from China.” Social Science & Medicine 211:114–22. doi: 10.1016/j.socscimed.2018.06.007.

In 2012, the Chinese government launched a nationwide reform of county-level public hospitals with the goal of controlling the rapid growth of healthcare expenditure. The key components of the reform were the zero markup drug policy (ZMDP), which removed the previously allowed 15% markup for drug sales at public hospitals, and associated increases in fees for medical services. By exploiting the temporal and cross-sectional variations in the policy implementation and using a unique, nationally representative hospital-level dataset in 1880 counties between 2009 and 2014, we find that the policy change led to a reduction in drug expenditures, a rise in expenditures for medical services, and no measurable changes in total health expenditures. However, we also find an increase in expenditures for diagnostic tests/medical consumables at hospitals that had a greater reliance on drug revenues before the reform, which is unintended by policymakers. Read more…

  • Lin, Cheng-Kuan, Ro-Ting Lin, Pi-Cheng Chen, Pu Wang, Nathalie De Marcellis-Warin, Corwin Zigler, and David C. Christiani. 2018. “A Global Perspective on Sulfur Oxide Controls in Coal-Fired Power Plants and Cardiovascular Disease.” Scientific Reports 8(1):2611. doi: 10.1038/s41598-018-20404-2.

Sulfur oxides (SOx), particularly SO2 emitted by coal-fired power plants, produce long-term risks for cardiovascular disease (CVD). We estimated the relative risks of CVD and ischemic heart disease (IHD) attributable to SOx emission globally. National SOx reduction achieved by emissions control systems was defined as the average SOx reduction percentage weighted by generating capacities of individual plants in a country. We analyzed the relative risk of CVD incidence associated with national SOx reduction for 13,581 coal-fired power-generating units in 79 countries. Read more…

In response to increasing demand for rigorous academic research relevant to policy and practice of common interest to social scientists, health policy makers and professionals, Social Science and Medicine established its Health Policy section (SSM-HP) in 1982. Today, SSM-HP is one of the most globally sought-after journals for scholarly inquiry of health policy and health system issues that is also grounded in social science theories and methodologies. In its thirty-five-year history, SSM-HP has published research from more than ninety countries across the globe, serving as a primary outlet for non-US-based health policy research. In earlier years, most publications drew evidence primarily from a wide range of high-income countries such as Germany, the Netherlands, Australia and the U.K. Read more…

2017

  • Fe, Eduardo, Timothy Powell-Jackson, and Winnie Yip. 2017. “Doctor Competence and the Demand for Healthcare: Evidence from Rural China: Doctor Competence.” Health Economics 26(10):1177–90. doi: 10.1002/hec.3387.

The agency problem between patients and doctors has long been emphasised in the health economics literature, but the empirical evidence on whether patients can evaluate and respond to better quality care remains mixed and inconclusive. Using household data linked to an assessment of village doctors’ clinical competence in rural China, we show that there is no correlation between doctor competence and patients’ healthcare utilisation, with confidence intervals reasonably tight around zero. Household perceptions of quality are an important determinant of care‐seeking behaviour, yet patients appear unable to recognise more competent doctors – there is no relationship between doctor competence and perceptions of quality. Read more…

  • Fu, Hongqiao, Ling Li, Mingqiang Li, Chunyu Yang, and William Hsiao. 2017. “An Evaluation of Systemic Reforms of Public Hospitals: The Sanming Model in China.” Health Policy and Planning 32(8):1135–45. doi: 10.1093/heapol/czx058.

Low- and middle-income countries (LMICs) have been searching for effective strategies to reform their inefficient and wasteful public hospitals. Recently, China developed a model of systemic reforms called the Sanming model to address the inefficiency and waste at public hospitals. In this article, we explain and evaluate how the Sanming model reformed its 22 public hospitals in 2013 by simultaneously restructuring the hospital governance structure, altering the payment system to hospitals, and realigning physicians’ incentives. By employing the difference-in-difference (DID) method and using the hospital-level data from 187 public hospitals in Fujian province, we find that the Sanming model has reduced medical costs significantly without measurably sacrificing clinical quality and productive efficiency. Read more…

  • Karan, Anup, Winnie Yip, and Ajay Mahal. 2017. “Extending Health Insurance to the Poor in India: An Impact Evaluation of Rashtriya Swasthya Bima Yojana on out of Pocket Spending for Healthcare.” Social Science & Medicine 181:83–92. doi: 10.1016/j.socscimed.2017.03.053.

India launched the ‘Rashtriya Swasthya Bima Yojana’ (RSBY) health insurance scheme for the poor in 2008. Utilising 3 waves (1999–2000, 2004–05 and 2011–12) of household level data from nationally representative surveys of the National Sample Survey Organisation (NSSO) (N = 346,615) and district level RSBY administrative data on enrolment, we estimated causal effects of RSBY on out-of-pocket expenditure. Using ‘difference-in-differences’ methods on households in matched districts we find that RSBY did not affect the likelihood of inpatient out-of-pocket spending, the level of inpatient out of pocket spending or catastrophic inpatient spending. We also do not find any statistically significant effect of RSBY on the level of outpatient out-of-pocket expenditure and the probability of incurring outpatient expenditure. Read more…

  • Lin, Cheng-Kuan, Huei-Yang Hung, David C. Christiani, Francesco Forastiere, and Ro-Ting Lin. 2017. “Lung Cancer Mortality of Residents Living near Petrochemical Industrial Complexes: A Meta-Analysis.” Environmental Health16(1):101. doi: 10.1186/s12940-017-0309-2.

Background:Lung cancer, as the leading cause of cancer mortality worldwide, has been linked to environmental factors, such as air pollution. Residential exposure to petrochemicals is considered a possible cause of lung cancer for the nearby population, but results are inconsistent across previous studies. Therefore, we performed a meta-analysis to estimate the pooled risk and to identify possible factors leading to the heterogeneity among studies. Methods: The standard process of selecting studies followed the Cochrane meta-analysis guideline of identification, screening, eligibility, and inclusion. Read more…

  • Lin, Ro-Ting, Cheng-Kuan Lin, David C. Christiani, Ichiro Kawachi, Yawen Cheng, Stéphane Verguet, and Simcha Jong. 2017. “The Impact of the Introduction of New Recognition Criteria for Overwork-Related Cardiovascular and Cerebrovascular Diseases: A Cross-Country Comparison.” Scientific Reports 7(1):167. doi: 10.1038/s41598-017-00198-5.

Cardiovascular and cerebrovascular diseases (CVDs) related to overwork are common in Asia, as is death from overwork, known as karoshi. Japan was the first country in the world to introduce criteria for recognizing overwork-related CVDs in 1961. Taiwan followed Japan in putting in place new policies and then updating these in 2010. We aimed to investigate the effect of introducing the new criteria for recognizing overwork-related CVDs in both countries. Read more…

  • Shen, Sipeng, Jianling Bai, Yongyue Wei, Guanrong Wang, Qingya Li, Ruyang Zhang, Weiwei Duan, Sheng Yang, Mulong Du, Yang Zhao, David Christiani, and Feng Chen. 2017. “A Seven-Gene Prognostic Signature for Rapid Determination of Head and Neck Squamous Cell Carcinoma Survival.” Oncology Reports. doi: 10.3892/or.2017.6057.

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer and displays divergent clinical outcomes. Prognostic biomarkers might improve risk stratification and survival prediction. We aimed to investigate the prognostic genes associated with overall survival. A two-step gene selection method was used to develop a seven-gene-based prognostic model based on the training set collected from The Cancer Genome Atlas (TCGA). Read more…

  • Shen, Sipeng, Yongyue Wei, Ruyang Zhang, Mulong Du, Weiwei Duan, Sheng Yang, Yang Zhao, David Christiani, and Feng Chen. “Mutant‑allele Fraction Heterogeneity Is Associated with Non‑small Cell Lung Cancer Patient Survival.” Oncology Letters, November 15, 2017. https://doi.org/10.3892/ol.2017.7428.

Genetic intratumor heterogeneity is associated with tumor occurrence, development and overall outcome. The present study aims to explore the association between mutant‑allele fraction (MAF) heterogeneity and patient overall survival in lung cancer. Somatic mutation data of 939 non‑small cell lung cancer (NSCLC) cases were obtained from The Cancer Genome Atlas. Entropy‑based mutation allele fraction (EMAF) score was used to describe the uncertainty of individual somatic mutation patterns and to further analyze the association with patient overall survival. Read more…

2016

  • Lai, Peggy S., Jing-qing Hang, Feng-ying Zhang, J. Sun, Bu-Yong Zheng, Li Su, George R. Washko, and David C. Christiani. 2016. “Imaging Phenotype of Occupational Endotoxin-Related Lung Function Decline.” Environmental Health Perspectives 124(9):1436–42. doi: 10.1289/EHP195.

Although occupational exposures contribute to a significant proportion of obstructive lung disease, the phenotype of obstructive lung disease associated with work-related organic dust exposure independent of smoking remains poorly defined.Objective: We identified the relative contributions of smoking and occupational endotoxin exposure to parenchymal and airway remodeling as defined by quantitative computed tomography (CT). Methods: The Shanghai Textile Worker Study is a longitudinal study of endotoxin-exposed cotton workers and endotoxin-unexposed silk workers that was initiated in 1981. Spirometry, occupational endotoxin exposure, and smoking habits were assessed at 5-year intervals. Read more…

  • Smith, Peter C., and Winnie Yip. 2016. “The Economics of Health System Design.” Oxford Review of Economic Policy32(1):21–40. doi: 10.1093/oxrep/grv018.

There has been much rhetoric in global health about the need to consider the health sector as a ‘system’, defined by the World Health Organization as all the activities whose primary purpose is to improve health. The need to adopt a system-wide perspective arises from the complexity of the processes for delivering effective health services, and the important interdependencies between elements of the health system. However, there have hitherto been very few contributions from an economic perspective that explicitly address these issues. This paper argues that an economic paradigm of constrained optimization adapted to the systemic nature of the health sector could provide an analytical and practical approach to policy-makers in assessing their health systems and deriving solutions. Read more…

  • Sun, Xiaojie, Xiaoyun Liu, Qiang Sun, Winnie Yip, Adam Wagstaff, and Qingyue Meng. 2016. “The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China.” Health Economics 25(6):706–22. doi: 10.1002/hec.3330.
In this prospective study, conducted in China where providers have traditionally been paid fee‐for‐service, and where drug spending is high and irrational drug prescribing common, township health centers in two counties were assigned to two groups: in one fee‐for‐service was replaced by a capitated global budget (CGB); in the other by a mix of CGB and pay‐for‐performance. In the latter, 20% of the CGB was withheld each quarter, with the amount returned depending on points deducted for failure to meet performance targets. Outcomes studied included indicators of rational drug prescribing and prescription cost. Impacts were assessed using differences‐in‐differences, because political interference led to non‐random assignment across the two groups. Read more…

2015

  • Jian, Weiyan, Ming Lu, Kit Yee Chan, Adrienne N. Poon, Wei Han, Mu Hu, and Winnie Yip. 2015. “Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission.” Health Affairs 34(10):1745–52. doi: 10.1377/hlthaff.2015.0074.

In 2009 China announced plans to reform provider payment methods at public hospitals by moving from fee-for-service (FFS) to prospective and aggregated payment methods that included the use of diagnosis-related groups (DRGs) to control health expenditures. In October 2011 health policy makers selected six Beijing hospitals to pioneer the first DRG payment system in China. We used hospital discharge data from the six pilot hospitals and eight other hospitals, which continued to use FFS and served as controls, from the period 2010–12 to evaluate the pilot’s impact on cost containment through a difference-in-differences methods design. Our study found that DRG payment led to reductions of 6.2 percent and 10.5 percent, respectively, in health expenditures and out-of-pocket payments by patients per hospital admission. Read more…

  • Li, Linyan, Gary Adamkiewicz, Yinping Zhang, John D. Spengler, Fang Qu, and Jan Sundell. 2015. “Effect of Traffic Exposure on Sick Building Syndrome Symptoms among Parents/Grandparents of Preschool Children in Beijing, China” edited by S. Zhu. PLOS ONE 10(6):e0128767. doi: 10.1371/journal.pone.0128767.

Introduction: Sick building syndrome (SBS) includes general, mucosal and skin symptoms. It is typically associated with an individual’s place of work or residence. The aim of this study was to explore the effect of traffic exposure on SBS symptoms in Beijing, China. Methods: From January to May, 2011, recruitment occurred at kindergartens in 11 districts in Beijing. Self-administered questionnaires were distributed by teachers to legal guardians of children and then returned to teachers. Read more…

  • Powell-Jackson, Timothy, Winnie Chi-Man Yip, and Wei Han. 2015. “Realigning Demand and Supply Side Incentives to Improve Primary Health Care Seeking in Rural China: IMPROVING PRIMARY HEALTH CARE SEEKING IN RURAL CHINA.” Health Economics 24(6):755–72. doi: 10.1002/hec.3060.

China’s recent and ambitious health care reform involves a shift from the reliance on markets to the reaffirmation of the central role of the state in the financing and provision of services. In collaboration with the Government of the Ningxia province, we examined the impact of two key features of the reform on health care utilisation using panel household data. The first policy change was a redesign of the rural insurance benefit package, with an emphasis on reorientating incentives away from inpatient towards outpatient care. The second policy change involved a shift from a fee‐for‐service payment method to a capitation budget with pay‐for‐performance amongst primary care providers. Read more…

  • Yip, Winnie, and William C. Hsiao. 2015. “What Drove the Cycles of Chinese Health System Reforms?” Health Systems & Reform 1(1):52–61. doi: 10.4161/23288604.2014.995005.

Since 1978 when China liberalized its economy and moved from a central planning to a socialistic market economy, its health care system has gone through two major cycles of reform–oscillating from relying on the market to fund and deliver health care, to one in which the government plays a central role in financing health care, prioritizes prevention and primary care, and redistributes resources to poorer and rural regions. Consequently, performance of the Chinese health system improved and China was finally able to extend a basic health safety net to more than 95% of its 1.3 billion people over the last decade. Then, in 2013, China launched its new cycle of reform, and vigorously pushed privatization and marketization as a core strategy to reform its public hospitals. What explains China’s oscillating health policies and performances? Read more…

2014

  • Yip, Winnie, and William Hsiao. 2014. “Harnessing the Privatisation of China’s Fragmented Health-Care Delivery.” The Lancet 384(9945):805–18. doi: 10.1016/S0140-6736(14)61120-X.

Although China’s 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government’s latest strategy to promote private investment for hospitals. In this Review, we discuss how China’s health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail—population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. Read more…

  • Yip, Winnie, Timothy Powell-Jackson, Wen Chen, Min Hu, Eduardo Fe, Mu Hu, Weiyan Jian, Ming Lu, Wei Han, and William C. Hsiao. 2014. “Capitation Combined With Pay-For-Performance Improves Antibiotic Prescribing Practices In Rural China.” Health Affairs 33(3):502–10. doi: 10.1377/hlthaff.2013.0702.

Pay-for-performance in health care holds promise as a policy lever to improve the quality and efficiency of care. Although the approach has become increasingly popular in developing countries in recent years, most policy designs do not permit the rigorous evaluation of its impact. Thus, evidence of its effect is limited. In collaboration with the government of Ningxia Province, a predominantly rural area in northwest China, we conducted a matched-pair cluster-randomized experiment between 2009 and 2012 to evaluate the effects of capitation with pay-for-performance on primary care providers’ antibiotic prescribing practices, health spending, outpatient visit volume, and patient satisfaction. Read more…

2012

  • Yip, Winnie Chi-Man, William C. Hsiao, Wen Chen, Shanlian Hu, Jin Ma, and Alan Maynard. 2012. “Early Appraisal of China’s Huge and Complex Health-Care Reforms.” The Lancet 379(9818):833–42. doi: 10.1016/S0140-6736(11)61880-1.

China’s 3 year, CN¥850 billion (US$125 billion) reform plan, launched in 2009, marked the first phase towards achieving comprehensive universal health coverage by 2020. The government’s undertaking of systemic reform and its affirmation of its role in financing health care together with priorities for prevention, primary care, and redistribution of finance and human resources to poor regions are positive developments. Accomplishing nearly universal insurance coverage in such a short time is commendable. However, transformation of money and insurance coverage into cost-effective services is difficult when delivery of health care is hindered by waste, inefficiencies, poor quality of services, and scarcity and maldistribution of the qualified workforce. Read more…

2011

  • Wang, Hong, Licheng Zhang, Winnie Yip, and William Hsiao. 2011. “An Experiment In Payment Reform For Doctors In Rural China Reduced Some Unnecessary Care But Did Not Lower Total Costs.” Health Affairs 30(12):2427–36. doi: 10.1377/hlthaff.2009.0022.

Inefficiency and low quality of health services are common in many developing countries. To mitigate these problems, we conducted an experiment in rural China in which we changed the existing fee-for-service method of paying village doctors to a mixed payment method that included a salary plus a bonus based on performance. The new payment method also removed a feature that previously allowed doctors to purchase medications to prescribe to patients and earn a markup on each prescription. Changing these payment incentives reduced spending at the village level, curbed unnecessary care for healthier patients, and also decreased the prescribing of unnecessary drugs. Read more…

2010

  • Yip, Winnie Chi-Man, William Hsiao, Qingyue Meng, Wen Chen, and Xiaoming Sun. 2010. “Realignment of Incentives for Health-Care Providers in China.” The Lancet 375(9720):1120–30. doi: 10.1016/S0140-6736(10)60063-3.

Inappropriate incentives as part of China’s fee-for-service payment system have resulted in rapid cost increase, inefficiencies, poor quality, unaffordable health care, and an erosion of medical ethics. To reverse these outcomes, a strategy of experimentation to realign incentives for providers with the social goals of improvement in quality and efficiency has been initiated in China. This Review shows how lessons that have been learned from international experiences have been improved further in China by realignment of the incentives for providers towards prevention and primary care, and incorporation of a treatment protocol for hospital services. Although many experiments are new, preliminary evidence suggests a potential to produce savings in costs. Read more…

2009

  • Wang, Hong, Winnie Yip, Licheng Zhang, and William C. Hsiao. 2009. “The Impact of Rural Mutual Health Care on Health Status: Evaluation of a Social Experiment in Rural China.” Health Economics 18(S2):S65–82. doi: 10.1002/hec.1465.

Despite widespread efforts to expand health insurance in developing countries, there is scant evidence as to whether doing so actually improves people’s health. This paper aims to fill this gap by evaluating the impact of Rural Mutual Health Care (RMHC), a community‐based health insurance scheme, on enrollees’ health outcomes. RMHC is a social experiment that was conducted in one of China’s western provinces from 2003 to 2006. The RMHC experiment adopted a pre–post treatment‐control study design. Read more…

  • Yip, Winnie, and William C. Hsiao. 2009. “Non-Evidence-Based Policy: How Effective Is China’s New Cooperative Medical Scheme in Reducing Medical Impoverishment?” Social Science & Medicine 68(2):201–9. doi: 10.1016/j.socscimed.2008.09.066.

In recent years, many lower to middle income countries have looked to insurance as a means to protect their populations from medical impoverishment. In 2003, the Chinese government initiated the New Cooperative Medical System (NCMS), a government-run voluntary insurance program for its rural population. The prevailing model of NCMS combines medical savings accounts with high-deductible catastrophic hospital insurance (MSA/Catastrophic). To assess the effectiveness of this approach in reducing medical impoverishment, we used household survey data from 2006 linked to claims records of health expenditures to simulate the effect of MSA/Catastrophic on reducing the share of individuals falling below the poverty line (headcount), and the amount by which household resources fall short of the poverty line (poverty gap) due to medical expenses. Read more…

2008

  • Yip, Winnie, and William C. Hsiao. 2008. “The Chinese Health System at a Crossroads.” Health Affairs 27(2):460–68. doi: 10.1377/hlthaff.27.2.460.

The Chinese government has committed to increasing government funding for health care by directing 1–1.5 percent of its gross domestic product to universal basic health care. However, China is at a loss as to how to transform its new money into efficient and effective health care. This paper critically examines the various options currently under heated debate in China. We argue that unless China tackles the root cause of unaffordable health care—rapid cost inflation caused by an irrational and wasteful health care delivery system—much of the new money is likely to be captured by providers as higher income and profits. Read more…

  • Yip, Winnie, and Ajay Mahal. 2008. “The Health Care Systems of China and India: Performance and Future Challenges.” Health Affairs 27(4):921–32. doi: 10.1377/hlthaff.27.4.921.

Both China and India have recently committed to injecting new public funds into health care. Both countries are now deciding how best to channel the additional funds to produce benefits for their populations. In this paper we analyze how well the health care systems of China and India have performed and what determines their performance. Based on the analysis, we suggest that money alone, channeled through insurance and infrastructure strengthening, is inadequate to address the current problems of unaffordable health care and heavy financial risk, and the future challenges posed by aging populations that are increasingly affected by noncommunicable diseases. Read more…

2007

  • Chen, Likwang, Winnie Yip, Ming-Cheng Chang, Hui-Sheng Lin, Shyh-Dye Lee, Ya-Ling Chiu, and Yu-Hsuan Lin. 2007. “The Effects of Taiwan’s National Health Insurance on Access and Health Status of the Elderly.” Health Economics16(3):223–42. doi: 10.1002/hec.1160.

The primary objective of this paper is to evaluate the impact of Taiwan’s National Health Insurance program (NHI), established in 1995, on improving elderly access to care and health status. Further, we estimate the extent to which NHI reduces gaps in access and health across income groups. Using data from a longitudinal survey, we adopt a difference‐in‐difference methodology to estimate the causal effect of Taiwan’s NHI. Our results show that Taiwan’s NHI has significantly increased utilization of both outpatient and inpatient care among the elderly, and such effects were more salient for people in the low‐ or middle‐income groups. Read more…

2004

  • Hanson, Kara, Winnie C. Yip, and William Hsiao. 2004. “The Impact of Quality on the Demand for Outpatient Services in Cyprus.” Health Economics 13(12):1167–80. doi: 10.1002/hec.898.

Health policy reforms in a number of countries seek to improve provider quality by sharpening the incentives they face, for example by exposing them to greater competition. For this to succeed, patients must be responsive to quality in their choice of provider. This paper uses data from Cyprus to estimate the effect of quality on patients’ choice between public and private outpatient care. It improves on the existing literature by using a more comprehensive set of quality attributes which allows the dimensions of quality that have the largest effect on patient choice of provider to be identified. Read more…

  • Yip, Winnie, and Karen Eggleston. 2004. “Addressing Government and Market Failures with Payment Incentives: Hospital Reimbursement Reform in Hainan, China.” Social Science & Medicine 58(2):267–77. doi: 10.1016/S0277-9536(03)00010-8.

This paper examines the role of provider payment policy as an instrument for addressing government and market failures and controlling costs in the health sector, particularly in developing countries. We empirically evaluate the impact of provider payment reform in Hainan province, China, on expenditures for different categories of services that had been subject to distorted prices under fee-for-service. Using a pre-post study design with a control group, we analyze two years of claims data to assess the impact of a January 1997 change to prospective payment for a sub-sample of the hospitals. This difference-in-difference empirical strategy allows us to isolate the supply-side payment reform effects from demand-side policy interventions. Read more…

2003

  • Chou, Y. 2003. “Impact of Separating Drug Prescribing and Dispensing on Provider Behaviour: Taiwan’s Experience.” Health Policy and Planning 18(3):316–29. doi: 10.1093/heapol/czg038.

In many Asian countries, physicians both prescribe and dispense drugs. This practice is hypothesized to have caused high drug expenditure and widespread prescription of antibiotics in Asia. Recently, Taiwan implemented the separation policy on an experimental basis. This paper’s objective is to empirically evaluate the impact of Taiwan’s reform to separate drug prescribing and dispensing on drug expenditure and total health expenditure. Read more…

2001

  • Yip, Winnie, and Peter Berman. 2001. “Targeted Health Insurance in a Low Income Country and Its Impact on Access and Equity in Access: Egypt’s School Health Insurance.” Health Economics 10(3):207–20. doi: 10.1002/hec.589.

Governments are constantly faced with competing demands for public funds, thereby necessitating careful use of scarce resources. In Egypt, the School Health Insurance Programme (SHIP) is a government subsidized health insurance system that targets school children. The primary goals of the SHIP include improving access and equity in access to health care for children while, at the same time, ensuring programme sustainability. Using the Egyptian Household Health Utilization and Expenditure Survey (1995), this paper empirically assesses the extent to which the SHIP achieves its stated goals. Read more…

  • Yip, Winnie, and Karen Eggleston. 2001. “Provider Payment Reform in China: The Case of Hospital Reimbursement in Hainan Province.” Health Economics 10(4):325–39. doi: 10.1002/hec.602.

This paper develops a simple model of payment incentives and empirically evaluates provider payment reform in Hainan Province, China. We use a pre‐post study design with a control group to analyse two years of claims data to assess the impact of a January 1997 change to prospective payment for a sub‐sample of the hospitals. This difference‐in‐difference empirical strategy allows us to isolate the supply‐side payment reform effects from demand‐side changes, in contrast with previous studies of China’s reforms. Our results validate the theory that Chinese providers’ behavioural response to payment incentives is similar to that reported in the literature derived from the experience of industrialized countries. Read more…

2000

  • Shahian, David M., Winnie Yip, George Westcott, and Jerilynn Jacobson. 2000. “Selection of a Cardiac Surgery Provider in the Managed Care Era.” The Journal of Thoracic and Cardiovascular Surgery 120(5):978–89. doi: 10.1067/mtc.2000.110461.

Many health planners promote the use of competition to contain cost and improve quality of care. Using a standard econometric model, we examined the evidence for “value-based” cardiac surgery provider selection in eastern Massachusetts, where there is significant competition and managed care penetration. Methods: McFadden’s conditional logit model was used to study cardiac surgery provider selection among 6952 patients and eight metropolitan Boston hospitals in 1997. Hospital predictor variables included beds, cardiac surgery case volume, objective clinical and financial performance, reputation (percent out-of-state referrals, cardiac residency program), distance from patient’s home to hospital, and historical referral patterns. Read more…

1998

  • Yip, W. 1998. “Determinants of Patient Choice of Medical Provider: A Case Study in Rural China.” Health Policy and Planning 13(3):311–22. doi: 10.1093/heapol/13.3.311.

This study examines the factors that influence patient choice of medical provider in the three-tier health care system in rural China: village health posts, township health centres, and county (and higher level) hospitals. The model is estimated using a multinomial logit approach applied to a sample of 1877 cases of outpatient treatment from a household survey in Shunyi county of Beijing in 1993. This represents the first effort to identify and quantify the impact of individual factors on patient choice of provider in China. The results show that relative to self-pay patients, Government and Labour Health Insurance beneficiaries are more likely to use county hospitals, while patients covered by the rural Cooperative Medical System (CMS) are more likely to use village-level facilities. Read more…

  • Yip, Winnie C. 1998. “Physician Response to Medicare Fee Reductions: Changes in the Volume of Coronary Artery Bypass Graft (CABG) Surgeries in the Medicare and Private Sectors.” Journal of Health Economics 17(6):675–99. doi: 10.1016/S0167-6296(98)00024-1.

The demand inducement hypothesis predicts that physicians will respond to reductions in their income by increasing the volume of their services when the income effect is strong and negative. I test for such inducement in the market for coronary artery bypass grafting (CABG), using a longitudinal panel of physicians in New York and Washington states. The results show that physicians whose incomes were reduced the most by Medicare fee cuts performed higher volumes of CABGs, and they did so in both the Medicare and private markets. Read more…

1997

  • Yip, Winnie C., and William C. Hsiao. 1997. “Medical Savings Accounts: Lessons From China: China’s Medical Savings Accounts Coupled with Catastrophic Insurance Have Yielded Mixed Results, so Far.” Health Affairs 16(6):244–51. doi: 10.1377/hlthaff.16.6.244.

During this era of the triumph of free enterprise and the demise of big government, medical savings accounts (MSAs) have gained rapid popularity as a means for financing health care. The U.S. Congress recently passed a law to experiment with MSAs, and the United Kingdom is heatedly debating this approach.China has been a laboratory for testing health care financing models for many years. Confronted with rapid health cost inflation and a growing uninsured population, China experimented with an ingenious scheme patterned after the Singapore MSA, but with major modifications. Read more…