Strengthening Local Governance in Health Financing in China: A Text-Mining Analysis of Policy Changes between 2009 and 2020

In the last two decades, developing countries have increasingly engaged in improving the governance of their health systems and promoting policy design to strengthen their health governance capacity. Although many well-designed national policy strategies have been promulgated, obstacles to policy implementation and compliance among localities may undermine these efforts, particularly in decentralized health systems. Studies on health governance have rarely adopted a central-local analysis to investigate in detail local governments’ distinct experiences, orientations, and dynamics in implementing the same national policy initiative. This study examines the policy orientations of prefectural governments in strengthening governance in health financing in China, which has transitioned from emphasizing the approach of fiscal resource input to that of marketization promotion and cost-containment regulation enforcement at the national level since 2009. Employing text-mining methodologies, we analyzed health policy documents issued by multi-level governments after 2009. The analysis revealed three salient findings. First, compared to higher-level authorities, prefectural governments generally opted to use fiscal resource input over marketization promotion and cost-containment regulation enforcement between 2009 and 2020. Second, policy choices of prefectural governments varied considerably in terms of enforcing cost-containment regulations during the same period. Third, the extent of the prefectural government’s orientation toward marketization promotion or cost-containment regulation enforcement was not only determined by the top-down orders of higher-level authorities but was also incentivized by the government’s fiscal dependency and the policy orientations of peer governments. These findings contribute to the health governance literature by providing an overview of local discretion in policy choices, and the political and fiscal dynamics of local policy orientations in promoting health governance in a decentralized health system.

The Effects of Cost Containment and Price Policies on Pharmaceutical Expenditure in South Korea

Background: Policymakers have proposed and implemented various cost-containment policies for drug prices and quantities to regulate rising pharmaceutical spending. Our study focused on a major change in pricing policy and several incentive schemes for curbing pharmaceutical expenditure growth during the 2010s in Korea. Methods: We constructed the longitudinal dataset from 2008-2017 for 11,849 clinics to track the prescriber behavior before and after the implemented policies. Applying an interrupted time series model, we analyzed changes in trends in overall monthly drug expenditure and antibiotic drug expenditure per prescription for outpatient claims diagnosed with three major diseases before and after the policies’ implementation. Results: Significant price reductions and incentives for more efficient drug prescriptions resulted in an immediate decrease in monthly drug expenditures in clinics. However, we found attenuated effects over the long run. The top-spending clinics showed the highest rate of increase in drug costs. Conclusion: Future policy interventions can maximize their effects by targeting high-spending providers.

Comparative Health Care Spending for Dialysis: An Example of Public Cost Containment?

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Unbalanced Treatment Costs of Breast Cancer in China: Implications From the Direct Costs of Inpatient and Outpatient Care in Liaoning Province

Background: The increasing incidence of breast cancer and its financial burden highlights the need for controlling treatment costs. This study aimed to assess the direct costs of inpatient and outpatient care for breast cancer patients in Liaoning Province to provide a policy reference for cost containment. Methods: Based on the System of Health Accounts 2011 (SHA 2011), systematic data collection was conducted via multistage stratified cluster random sampling. A total of 1160 health institutions, including 83 hospitals, 16 public health institutions, 120 primary health institutions, and 941 outpatient institutions were enrolled in 2017. A database was established containing 20 035 patient-level medical records from the information system of these institutions. Curative care expenditure (CCE)was calculated, and generalized linear modeling was performed to determine cost-related factors. Results: In 2017, the CCE for breast cancer was approximately CNY 830.19 million (US$122.96 million) in Liaoning province (0.7% of the total health expenditure and 9.9% of cancer-related healthcare costs). Inpatient care costs were estimated to be CNY 617.27 million (US$91.42 million), accounting for 74.4% of the CCE for breast cancer, almost three times as large as outpatient costs (25.6%). The average inpatient and outpatient costs for breast cancer were estimated to be CNY 12 108 (US$1793) and CNY 829 (US$123) per visit. Medication cost was the main cost driver, which comprised 84.0% of the average outpatient cost and 37.2% of the mean inpatient cost. Conclusion: Breast cancer imposes a large economic burden on patients and the social health insurance system. Results show an irrational cost pattern of inpatient and outpatient services, with patients relying excessively on inpatient services for treatment. Promoting outpatient care whenever relevant is conducive to cost containment and rational utilization of resources.

Denmark

This chapter offers an in-depth look at health politics and the tax-financed, universal health system in Denmark. It traces the development of the Danish healthcare system, characterized by an evolving division of labor between central authorities and decentralized municipal and regional governments. Since the late 1980s, Danish health policy has seen a number of gradual changes and a major structural reform passed in 2005 that amalgamated municipalities and regions and changed healthcare financing rules, thus shifting the balance of shared power toward the center. Other healthcare issues have been cost containment, patient rights, and promotion of local integrated health services. A negotiated policy style contributes to efficient implementation of reforms once a decision has been made.

Analysis of the Household and Health Care System Expenditures in Bulgaria

Health care systems worldwide are experiencing tremendous financial pressure because of the introduction of new targeted health technologies and medicines. This study aims to analyze and compare public and household healthcare expenditures in Bulgaria during the period 2015–2019, as well as present the major cost-containment measures implied by the government and their probable influence on the overall health care cost. Regulatory analysis of the endorsed cost-containment measures, budget analysis of public and household health care expenditures, and their extrapolations were performed. The regulatory analysis reveals that a large number of measures are introduced and valid until January 2021, considering pharmaceuticals, medical devices, and negotiations between the National Health Insurance Fund (NHIF) and Marketing authorization holders (MAHs). NHIF costs due to pharmaceuticals, food supplements, and medical devices are rising from 2015 to 2019. The overall health expenditures average per household and the average per person also grow in this period. The cost extrapolation reveals that an increase in 3-year periods is expected. Despite the implementation of variety of cost-containment measures in Bulgaria, such as HTA, ERP, discounts, and annual negotiations, The National Health Insurance Fund's (NHIF) spending on pharmaceuticals continues to rise in recent years, and further increases are expected in the next 3 years. The average expenditure per household and per person also increased, which confirms the global trend of rising medicine and outpatient services value.

Clinical Pathway for Improving Quality Service and Cost Containtment in Hospital

The explanation begins with the Clinical Pathway in Hospital which describes how the Clinical Pathway is used in relation to 2 things: Components-Linkages and Step-Problems-Optimal Solution, followed by Linkages Clinical Pathway with Quality Improvement and Cost Containment, which describes the relationship of each. Followed by the Clinical Pathway for Service Quality: which consists of: (1) Clinical Pathway for Service Quality, (2) Patient Safety for Service Quality Improvement, (3) The role of alogarithm, thereby clarifying the form of clinical pathways in quality improvement efforts that ensure service improvement by still maintain the quality that is maintained during the cost containment. The Clinical Pathway in Cost Containment describes the roles of: (1) Link of Components, (2) Procedure, (3) Unit Cost, so that cost containment efforts can be made in the form of cost containment optimally while maintaining quality does not need to decrease. Clinical Pathway in New Era is a newly developed algorithm related to current and future conditions. This is related to: (1) New Era in Pandemic Covid-19, (2) Clinical Pathway in Non Curative Service, (3) Clinical Pathway in Technology Services, (4) Clinical Pathway in Technological Rerelated while continuing to carry out quality improvement and cost containment simultaneously. Concluton: clinical pathway in hospital can be used as a system for Quality Improvement and Cost Containment, related to New Era in Pandemic Covid-19, Non Curative Service, Technology Services and Technological Rerelated.