Assessment of Medical Service Pricing in China's Healthcare System: Challenges, Constraints, and Policy Recommendations

Medical service pricing reform was considered as one of the focuses of China's remarkable health reform. This paper preliminarily assessed the roles of medical service pricing in the context of China's healthcare system. Specifically, we described the potential roles of medical service pricing in China and pointed out relevant challenges that emerged in practice as the result of reform-related activities. Multiple constraint factors that might have induced undesired outcomes were then recognized, including the excessive diversity and specialization of medical services, the price inelasticity of patients' demand, and the inadequate capability of both medical institutions and administrations. Finally, we provided policy recommendations to inform the ongoing medical service pricing reform in China from a long-term perspective.

Dr Vladimir Kalaydzhiev or the Embodiment of Modernity

The text attempts an experimental “double reading” of a significant figure in the history of Bulgarian health care – Dr. Vladimir Kalaydzhiev, initiator and organiser of a large-scale public health care reform in Bulgaria in the 1960s. The authors' different approaches make it possible, on the one hand, to interpret the specifics of the health reform and the reasons for its (partial) repeal in the context of synchronous developments in Europe and controversial, on the other hand, to contraversially offer a diachronic analysis with basic characteristics of the "Catholic West" and the "Orthodox socialist East".

The Agency of Recipient Countries in Transnational Policy-Related Knowledge Transfer

Current research on transnational knowledge transfer has a strong bias toward (often conditionality-based) advice originating in the core OECD world and focuses nearly exclusively on the link from a source to a target of knowledge transfer. This contribution provides a broader and more nuanced picture by looking at the reverse logic of non-OECD countries proactively searching abroad for policy advice and assessing this advice based on their own requirements. Based on the role of conditionality and on the attitude of the recipient country toward cooperation with foreign sources of advice, five demand-side strategies in transnational policy-related knowledge transfer are distinguished, each of which is analyzed utilizing the example of health reform. The results highlight systematic differences in the attitude toward and employment of foreign advice.

Breast Cancer Treatment Following Health Reform: Evidence From Massachusetts

There are well-documented differences in breast cancer treatment by insurance status. Insurance expansions provide a context to assess the relationship between insurance and patterns of breast cancer care. We examine the association of Massachusetts health reform with use of breast conserving surgery, reconstruction, and adjuvant radiation using data from the Massachusetts Cancer Registry and Surveillance Epidemiology and End Results registries for 2001-2013 and a difference-in-differences approach. We observe statistically significant increases in breast conserving surgery among nonelderly women in Massachusetts relative to trends in states and age groups not affected by health reform. We also observe relative increases in reconstruction and adjuvant radiation, though trends in these outcomes were not the same across states prior to reform, limiting our ability to draw conclusions about the relationship between reform and these outcomes. Our results suggest that health reform was associated with some improvements in breast cancer treatment.

National Health Reforms in Georgia during 1994-2021 and their Success

The Health Reform of the country is a very difficult burden for two reasons: firstly, we need an appropriate economy level in the country, that can bear the new health model, established through reform, and secondly, the country needs a health system that is appropriate either for its economic system or for its tradition and history. Health reformers need to match all the points of the health reform concept, its implementation, and the systems of the country. Due to its Soviet past, Georgia struggled in the last twenty years to find an effective and cost efficient health model for its citizens. Starting from the 90s, Georgia instituted three health reforms and finally found some sustainable measures. The present article explores the three waves of the Georgian Health Care reforms, and analyses the factors of their success and the reasons for their failures. The importance of studying the Health Care systems is derived from Sustainable Development Goals targeting Health issues including health-related topics to improve the population’s health and wellbeing as well as achieve universal coverage of health services. The research contributes to the knowledge regarding the Health Care Reforms, and their practical implications on a country.

Effect of the Health Promotion Plan on the Performance of Hospitals: Evidences from East of Iran

Background: Hospitals are considered as the most central and resource-consuming units in the healthcare system. They use from 50 to 80% of public expenditures. As hospitals become more efficient, the better the allocated resources in health sector will be used. Objectives: The aim of this study was to assess hospitals’ efficiency in South Khorasan using the Pabon Lasso model. Methods: In this quasi-experimental and time-series study, we investigated the efficacy of South Khorasan hospitals during 2010 - 2018 (before and after the implementation of the health reform plan). All public hospitals in South Khorasan province were enrolled. Data including bed occupancy rate (BER), bed turnover (BT), and patient length of stay (LOS) were collected from hospitals in summer 2018 and analyzed using SPSS, version 21. Results: The means of the Pabon Lasso performance indicators for eight years were 74.4% for bed occupancy rate, 89.9 times for bed turnover, and 3.01 days for the length of stay. The coefficient of occupancy index after the implementation of the health reform plan was 5.7% higher than before, the bed turnover index increased 4.1 times, and the average length of stay increased by 0.08 day. On average, 35% of the hospitals were located in region 1, while 38% in region 2, 21% in Region 3, and 6% in Region 4 in the Pabon Lasso Diagram. Conclusions: Only 21% of the hospitals were in the region 3 of the Pabon Lasso Diagram, which is the desirable region for the efficiency of hospitals. This situation is not desirable and acceptable for hospitals. To increase productivity, interventions are required, and health planners and authorities need to apply economic tools for the improvement of this situation.

Assessing the impact of the 2008 health reform in Ecuador on the performance of primary health care services: an interrupted time series analysis

Background In 2008, Ecuador started a national health reform based on the principles of Alma Ata to achieve Universal Health Coverage. While coverage indicators have increased, a systematic assessment of the impact of the reform on the delivery of health services at primary level is lacking. The aim of this study was to assess the impact of the 2008 health reform on the performance of primary health care services in Ecuador. Methods Ambulatory Care Sensitive Conditions (ACSC) are a subset of diseases where hospital admission is potentially avoidable by high quality well-functioning primary care. Thus, observing the behaviour of ACSC hospitalizations can serve as an indicator of how the primary health care level is performing. Crude and adjusted rates, stratified by sex, were calculated from ten selected ACSC hospitalization discharges during 22 years of data representing 11 years before and after the health reform. An interrupted time series analysis was then conducted by applying a negative binomial regression and adjusting for overdispersion and autocorrelation. Results Overall higher crude and adjusted rates for ACSC hospitalizations were observed in women compared to men; both increased gradually since the start of the observation, reaching a peak around 2010, and then started a downwards trend. In men, the incidence rate ratio increased significantly by 3 % per year during the period before the intervention. During the first year after intervention, an increase (13 %) was detected, and then a statistically significant 1 % decrease (IRR = 0.99; 95 % CI: 0.98, 0.99) was observed in the ACSC rate ratio per year in the period after the intervention. Similar trends and effect sizes were found for women. Conclusions The study revealed significant decreasing trends of the ACSC hospitalization rates in both sexes, indicating an improvement of the performance of the primary health care services following the 2008 national health reform. A continuous strengthening of the primary care model as well as a regular monitoring of ACSC hospitalization rates in the country is recommended. A health economic evaluation considering hospitalizations avoided and associated costs is also advisable.