Xue Qingping, Xu Dong Roman, Cheng Terence C, Pan Jay, Yip Winnie
School of Public Health, Chengdu Medical College, Chengdu, China.
Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
Arch Public Health. 2023 Feb 10;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.
A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively.
The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions.
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. Our results added evidences on hospitals' performances among different ownership types under China's context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.
自2009年中国进行国家卫生改革鼓励民营资本进入医院领域以来，私立医院迅速扩张。尽管长期以来一直存在关于不同类型医院绩效的争论，但在发展中国家背景下的实证证据仍然很少。我们调查了公立、私立非营利性和私立营利性医院在医疗质量和医疗费用方面的差异。
选取2016年、2017年和2018年第四季度在中国四川省528家二级医院住院的64171名患者（其中51933例为肺炎（PNA）患者，9022例为心力衰竭（HF）患者，3216例为急性心肌梗死（AMI）患者）进行本研究。分别在调整相关医院和患者特征后，采用多水平逻辑回归和多水平线性回归来评估医院所有制类型与住院死亡率以及PNA、HF和AMI的医疗费用之间的关系。
私立非营利性医院（调整后的OR为1.69；95%CI为1.08，2.64）和私立营利性医院（调整后的OR为1.67；95%CI为1.06，2.62）在治疗PNA时的住院死亡率高于公立医院，但在治疗AMI和HF时并非如此。不同所有制类型的医院在AMI医疗费用方面未发现显著差异，但私立非营利性医院治疗HF的医疗费用高出9%，而私立非营利性医院和私立营利性医院治疗PNA的医疗费用分别比公立医院高出10%和11%。私立非营利性医院和私立营利性医院在这三种疾病的住院死亡率和医疗费用方面均未发现差异。
在中国，公立医院的医疗质量至少与私立医院相当甚至更高，且医疗费用更低，而私立非营利性医院和私立营利性医院在这些方面表现相似。我们的研究结果为中国背景下不同所有制类型医院的绩效增加了证据，这对于面临类似挑战的发展中国家优化医疗体系具有很大的参考价值。
