Suchergebnisse

We explore the competition impact on patient management in healthcare (length of stay and technical procedure's probability to be performed) by difference-indifference , exploiting time variations in the intensity of local competition caused by the French pro-competition reform (2004-2008). Models are estimated with hospital fixed effects to take into account hospital unobserved heterogeneity. We use an exhaustive dataset of in-hospital patients over 35 admitted for a heart attack. We consider the period before the reform from 2001 to 2003 and a period after the reform from 2009 to 2011. Before the reform, there were two types of reimbursement systems. Hospitals from private sector, were paid by fee-for-service. Hospitals from public sector were paid by global budget. They had no current activity's link, and a weak competition incentive. After the DRG-based payment reform, all hospitals compete with each other to attract patients. We find the reform a sizeable positive competition effect on high-technical procedure for the private sector as well as a negative competition effect on the length of stay for public hospitals. However, the overall local competition effect of the reform explained a very marginal part of the explanatory power of the model. Actually, this period is characterised by two contradictory components: a competition effect of the reform and in-patients who are more concentrated. Results suggest that if competition impacted management patient's change, it is through a global competition included in a global trend much more than a local competitive aspect of the reform.

We explore the competition impact on patient management in healthcare (length of stay and technical procedure's probability to be performed) by difference-indifference , exploiting time variations in the intensity of local competition caused by the French pro-competition reform (2004-2008). Models are estimated with hospital fixed effects to take into account hospital unobserved heterogeneity. We use an exhaustive dataset of in-hospital patients over 35 admitted for a heart attack. We consider the period before the reform from 2001 to 2003 and a period after the reform from 2009 to 2011. Before the reform, there were two types of reimbursement systems. Hospitals from private sector, were paid by fee-for-service. Hospitals from public sector were paid by global budget. They had no current activity's link, and a weak competition incentive. After the DRG-based payment reform, all hospitals compete with each other to attract patients. We find the reform a sizeable positive competition effect on high-technical procedure for the private sector as well as a negative competition effect on the length of stay for public hospitals. However, the overall local competition effect of the reform explained a very marginal part of the explanatory power of the model. Actually, this period is characterised by two contradictory components: a competition effect of the reform and in-patients who are more concentrated. Results suggest that if competition impacted management patient's change, it is through a global competition included in a global trend much more than a local competitive aspect of the reform.

Background: Is there any difference in performance based on ownership of rehabilitation structures? In France, they can be private for-profit, non-profit or public. The type of ownership impacts the activity of the rehabilitation unit (as a public service mission), the management of healthcare institution staff and the institution healthcare's organization. As a consequence, it may affect the performance. However, what do we mean by performance? This indicator is, in fact, multidimensional. We propose 5 outcomes as performance indicators based on a literature survey. Methods: We consider six samples set up on the frequency of Major Diagnostic Category (MDC) stays. As a sensitivity analysis, we also set up samples for stroke, chronic obstructive pulmonary disease (COPD), heart failure, and total hip replacement. We run incremental four models on these samples. Results: For-profit hospitals appear to provide better performance than other types of hospital ownership. Patient characteristics and hospital equipment as well as number of medical staff and non-medical staff explain part of differences in performance based on ownership. It remains that for-profit rehabilitation unit perform better in terms of probability of death, probability to return-to-home and improvement in both, physical score and cognitive score. This result is obtained with a more efficient patient care (less daily care's activity per patient measured as rr-score). Considering separately Research public hospital from other public hospital centre, results obtained are very heterogeneous. Conclusion: The performance level differs from type of ownership to the other. For-profit rehabilitation's centres get better results, with control for patient's heterogeneity of demographic aspects and level of severity. However, we do not control for the social vulnerability that impacts the profit of rehabilitation units. That raises the political question on the role of healthcare centres to support social vulnerability.

We explore the competition impact on patient management in healthcare (length of stay and technical procedure's probability to be performed) by difference-indifference , exploiting time variations in the intensity of local competition caused by the French pro-competition reform (2004-2008). Models are estimated with hospital fixed effects to take into account hospital unobserved heterogeneity. We use an exhaustive dataset of in-hospital patients over 35 admitted for a heart attack. We consider the period before the reform from 2001 to 2003 and a period after the reform from 2009 to 2011. Before the reform, there were two types of reimbursement systems. Hospitals from private sector, were paid by fee-for-service. Hospitals from public sector were paid by global budget. They had no current activity's link, and a weak competition incentive. After the DRG-based payment reform, all hospitals compete with each other to attract patients. We find the reform a sizeable positive competition effect on high-technical procedure for the private sector as well as a negative competition effect on the length of stay for public hospitals. However, the overall local competition effect of the reform explained a very marginal part of the explanatory power of the model. Actually, this period is characterised by two contradictory components: a competition effect of the reform and in-patients who are more concentrated. Results suggest that if competition impacted management patient's change, it is through a global competition included in a global trend much more than a local competitive aspect of the reform.

Is there any difference in performance based on ownership of rehabilitation structures? InFrance, they can be private for-profit, non-profit or public. The type of ownership impacts the activity of the rehabilitation unit (as a public service mission), the management of healthcare institution staff and the institution healthcare's organization. As a consequence, it may affect the performance. However, what do we mean by performance? This indicator is, in fact, multidimensional. In this paper, as performance indicators, I used improvement in dependence scores, in-death and discharge home. An administrative 2018-exhaustive rehabilitation stays is mobilized and four disorders are studied: stroke, chronic obstructive pulmonary disease (COPD),heart failure, and total hip replacement. For-profit rehabilitation unit outperform public sector hospitals. This result is obtained with a shorter daily patient care's activity. I investigate mechanisms that cause differential benefits. Patient's case-mix characteristics and hospital equipment as well as number of medical staff and non-medical staff, explain part of differences in performance based on ownership. Controlling for the social vulnerability (individual as well as French Ecological Deprivation Index) that impacts the profit of rehabilitation units, if less clearcut results are found, nevertheless I show for-profit rehabilitation unit outperform public sector hospitals. Using counterfactual, even if the simulations show that performance's difference is explained by patient's social vulnerability composition, a significant part remains unexplained.Living in richest areas implies higher impact in terms of ownership performance differences that shrink. Results demonstrate existing inequalities in health care access in spite of a nearly free of charge healthcare access.

We explore the competition impact on patient management in healthcare (length of stay and technical procedure's probability to be performed) by difference-indifference , exploiting time variations in the intensity of local competition caused by the French pro-competition reform (2004-2008). Models are estimated with hospital fixed effects to take into account hospital unobserved heterogeneity. We use an exhaustive dataset of in-hospital patients over 35 admitted for a heart attack. We consider the period before the reform from 2001 to 2003 and a period after the reform from 2009 to 2011. Before the reform, there were two types of reimbursement systems. Hospitals from private sector, were paid by fee-for-service. Hospitals from public sector were paid by global budget. They had no current activity's link, and a weak competition incentive. After the DRG-based payment reform, all hospitals compete with each other to attract patients. We find the reform a sizeable positive competition effect on high-technical procedure for the private sector as well as a negative competition effect on the length of stay for public hospitals. However, the overall local competition effect of the reform explained a very marginal part of the explanatory power of the model. Actually, this period is characterised by two contradictory components: a competition effect of the reform and in-patients who are more concentrated. Results suggest that if competition impacted management patient's change, it is through a global competition included in a global trend much more than a local competitive aspect of the reform.

We explore the competition impact on patient management in healthcare (length of stay and technical procedure's probability to be performed) by difference-indifference , exploiting time variations in the intensity of local competition caused by the French pro-competition reform (2004-2008). Models are estimated with hospital fixed effects to take into account hospital unobserved heterogeneity. We use an exhaustive dataset of in-hospital patients over 35 admitted for a heart attack. We consider the period before the reform from 2001 to 2003 and a period after the reform from 2009 to 2011. Before the reform, there were two types of reimbursement systems. Hospitals from private sector, were paid by fee-for-service. Hospitals from public sector were paid by global budget. They had no current activity's link, and a weak competition incentive. After the DRG-based payment reform, all hospitals compete with each other to attract patients. We find the reform a sizeable positive competition effect on high-technical procedure for the private sector as well as a negative competition effect on the length of stay for public hospitals. However, the overall local competition effect of the reform explained a very marginal part of the explanatory power of the model. Actually, this period is characterised by two contradictory components: a competition effect of the reform and in-patients who are more concentrated. Results suggest that if competition impacted management patient's change, it is through a global competition included in a global trend much more than a local competitive aspect of the reform.

We explore the competition impact on patient management in healthcare (length of stay and technical procedure's probability to be performed) by difference-indifference , exploiting time variations in the intensity of local competition caused by the French pro-competition reform (2004-2008). Models are estimated with hospital fixed effects to take into account hospital unobserved heterogeneity. We use an exhaustive dataset of in-hospital patients over 35 admitted for a heart attack. We consider the period before the reform from 2001 to 2003 and a period after the reform from 2009 to 2011. Before the reform, there were two types of reimbursement systems. Hospitals from private sector, were paid by fee-for-service. Hospitals from public sector were paid by global budget. They had no current activity's link, and a weak competition incentive. After the DRG-based payment reform, all hospitals compete with each other to attract patients. We find the reform a sizeable positive competition effect on high-technical procedure for the private sector as well as a negative competition effect on the length of stay for public hospitals. However, the overall local competition effect of the reform explained a very marginal part of the explanatory power of the model. Actually, this period is characterised by two contradictory components: a competition effect of the reform and in-patients who are more concentrated. Results suggest that if competition impacted management patient's change, it is through a global competition included in a global trend much more than a local competitive aspect of the reform.

Background:Is there any difference in performance based on ownership of rehabilitation structures? In France, they can be private for-profit, non-profit or public. The type of ownership impacts the activity of the rehabilitationunit (as a public service mission), the management of healthcare institution staff and the institution healthcare's organization. As a consequence, it may affect the performance. However, what do we mean by performance? This indicator is, in fact, multidimensional. We propose 5 outcomes as performance indicators based on a literature survey. Methods: We consider six samples set up on the frequency of Major Diagnostic Category (MDC) stays. As a sensitivity analysis, we also set up samples for stroke, chronic obstructive pulmonary disease (COPD), heart failure, and total hip replacement. We run incremental four models on these samples. Results: For-profit hospitals appear to provide better performance than other types of hospital ownership. Patient characteristics and hospital equipment as well as number of medical staff and non-medical staff explain part of differences in performance based on ownership. It remains that for-profit rehabilitation unit perform better in terms of probability of death, probability to return-to-home and improvement in both, physical score and cognitive score. This result is obtained with a more efficient patient care (less daily care's activity per patient measured as rr-score).Considering separately Research public hospital from other public hospital centre,results obtained are very heterogeneous. 2 Conclusion: The performance level differs from type of ownership to the other. For-profit rehabilitation's centres get better results, with control for patient's heterogeneity of demographic aspects and level of severity. However, we do not control for the social vulnerability that impacts the profit of rehabilitation units. That raises the political question on the role of healthcare centres to support social vulnerability.

International audience ; Health insurance in China is the topic of this chapter. Up until the economic reforms of the 1980s, communities (a village or a group of villages) were managing the social welfare of their inhabitants. The system was extremely decentralized. With the collapse of the community medical system, existing public establishments were either replaced by private ones, or put into competition with them. As a result, the healthcare access system was no longer free of charge and became unaffordable to many. During the period of absence of a centralized public insurance system, this lack of access to treatment became a major problem; at first for the most vulnerable part of the population, and gradually for a greater and greater proportion of rural dwellers. As the question of healthcare costs causing widespread poverty became a pressing issue, different public health insurance programmes were implemented. Today, geographical inequity is still observed for these programmes. There is variability not only in terms of funding eligibility, types of illness or services to be covered, but also in terms of levels of benefits and payments methods. Concerning the private health insurance market, it was next to nothing in the early 2000s. Today, the rise of private health insurance schemes is supported by the Chinese government and is finding an audience among the emerging upper middle class.

International audience ; China is currently experiencing an over-utilization of university hospitals and hospitals with high-tech equipment, usually located in main cities. Even though they have a large capacity, they are faced with congestion leading to long queues. In parallel, there is under-utilization of smaller institutions. The Ministry of Health estimates that 70% of patients treated in university hospitals of a higher level (Level 3) could have received adequate treatment in hospitals of a lower category, closer to their home. In 2009, the Chinese government published a large-scale development plan for the health sector, with over RMB 770 billion to be invested. Four years later, RMB 620 billion was already spent, with a public insurance scheme set-up and a network of Community Health Centres created. Yet, this key issue of the Chinese health system, that is, the concentration of demand on a small number of hospitals, still remains, eventually leading to a tense relationship between doctors and patients, and to increasingly common acts of violence. The origin of such violence as well as possible directions to restore trust, respect, and understanding between patients and medical staff is examined. The decentralization of quality care seems to be the key, but there are different ways to achieve this goal. Obviously, digital tools such as connected health object and other online services are likely to play a growing role in addressing this issue.

International audience ; This chapter focuses on hospital ownership and supervision. Public hospitals are mostly, but not always, under the supervision of the Health Ministry. There are a certain number of other governing bodies that are directly involved in the management of hospitals. A cross-ministry group was set up in 2006 to facilitate the implementation of hospital reforms. Apart from the organizational structure, the funding of hospitals and its evolution is studied. Between 1979 and 1991, the government introduced a co-payment system in healthcare establishments. In 1992, the Ministry of Health officially granted greater autonomy to public hospitals. They were authorized to deliver paid services and to make profits, but were made responsible for their losses and debts. By 2003, central government funding had fallen to 8% of the hospital budget. As a result, public hospitals in China behave very similarly to for-profit firms, while being governed as any traditional public structure. The next step is the current experiment of a Diagnostics Related Group-based payment in China. Along with the financial autonomy of public hospitals, different reforms have been directed at developing private hospitals, even though many obstacles still remain.

International audience ; This chapter addresses the increasing role of digital healthcare in the overall Chinese healthcare system. As described in previous chapters, the healthcare system faces many issues, such as the confrontational relationship between doctors and patients, the poor access for populations in rural areas, the significant mark-up throughout distribution channels, a financially heavy burden for chronic diseases, poor quality of healthcare supply and inefficient hospital operation except Level 3 hospitals that have to deal with an over-demand. Many solutions have been proposed, such as the multiplication of healthcare suppliers, the establishment of general practitioners as gatekeepers for hospital admissions, the implementation of public health insurance schemes or the government support for reforms in favour of private health insurance and private healthcare providers. However, they have not proven sufficient to solve all problems yet. Digital healthcare is likely to play an increasing part in addressing these issues. One of the strengths of e-health is the quick and widespread adoption of mobile platforms. This may help solve access challenges, through online appointment registration systems, models of online-offline services, two-communication platforms between patients and physicians, sharing information through the Electronic Health Record (EHR) and Electronic Medical Record (EMR) systems, the generalized implementation of a DRG-based payment system, making patients more increasingly active actors in maintaining the health status, and improving the online drug market. On the flip side, this also raises many concerns regarding the confidentiality of personal medical data and the monopoly situation of some internet companies.

International audience ; China is the second largest pharmaceutical market in the world. This sector grew by 21.4% between 2002 and 2012. In OECD countries, spending on medical drugs accounted for approximately 17% of total health spending or 1.5% of gross domestic product (GDP) in 2009. That same year, spending on pharmaceutical products in China represented 43% of the total healthcare expenditure. Aware of the issue, the Chinese government has reacted. A limitation on the hospital mark-up on drugs has been implemented and a list of key drugs that are considered essential has been set up. Drugs on this list have to be accessible to everyone, with a regulated price to be kept as low as possible. To keep prices low, procurement is made through centralized bidding at provincial level, pharmaceutical companies delivering directly to medical facilities. Yet, in the field, the reality remains at times complex, with different ways to circumvent these constraints.