Reasons behind stymied public hospital governance reform in China
Autoři:
Sheng Nong aff001; Nengliang Aaron Yao aff003
Působiště autorů:
You Jiang Medical University for Nationalities, Baise, China
aff001; Peking University, School of Public Health, Beijing, China
aff002; School of Health Care Management (Key Lab of Health Economics and Policy, National Health Commission), Jinan, China
aff003; University of Virginia, Department of Public Health Sciences, Charlottesville, Virginia, United States of America
aff004
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222204
Souhrn
Background
The public hospital governance reform in China is pledged to improve the governance of public hospitals and deliver affordable and high-quality care. However, progress in public hospital reform has been slow. The reason is poorly understood.
Methods
A research center affiliated with China National Health Commission has conducted 32 workshops to interview 124 public hospital administrators from 30 provincial-level administrative divisions and 105 various-level government officials from three provinces. About 80% of administrators and 78% officials actively participated the discussions. We used a descriptive theoretical approach to understand the relationships between the governance reform and characteristics of its stakeholders. We also analyzed stakeholder interests and their power to influence the reform.
Findings
About 66% of hospital administrators, 72% of health officials, and less than 10% of other officials support a new hospital governing structure. Local leadership, hospital administrators, and health commission said that administrators should have more power over the management of public hospitals. Other government departments and healthcare professionals had reservations on the governance reform. The reform of public hospital governance faces significant obstacles. The interests of most government stakeholders are not aligned with public interests. All stakeholders perceived that their workload would increase in the short term because of the governance reform of public hospitals. Most people involved in the reform are not incentivized to collaborate. The health commission has limited financial resources and insufficient political power to implement a massive reform. Most importantly, the public hospital reform is not, and likely will not be, a top policy priority to the central government or local leaderships.
Interpretation
The health commission needs more political support and resources to speed up the public hospital reform. To fulfill the pledge of affordable, equitable access to quality care, Chinese government needs to overcome significant obstacles in the public hospital reform.
Klíčová slova:
Social sciences – Political science – Public administration – Public policy – Political aspects of health – Economics – Finance – Health insurance – People and places – Geographical locations – Asia – China – Medicine and health sciences – Health care – Health services administration and management – Health economics – Health care policy
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