Xu Zhihao, Tan Jialong, Nicholas Stephen, Maitland Elizabeth, Meng Zehua, Han Xinru, Wang Jian
Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, Hubei, China.
Australian National Institute of Management and Commerce, Sydney, New South Wales, Australia.
BMJ Open. 2024 Dec 3;14(12):e083964. doi: 10.1136/bmjopen-2024-083964.
The co-development of public-private hospitals in China's healthcare system significantly influences the system's service utilisation, but the public-private hospital interaction is poorly understood. Bridging this knowledge gap is crucial for informed policy-making and promoting a more balanced healthcare system. This study measures China's public-private hospital co-development and the impact of provincial and regional economic development levels on public-private hospital co-development.
We use service utilisation, a comprehensive measure of resource allocation, service capacity and service efficiency, to assess the co-development of China's public and private hospitals. Using the coupling coordination degree model, a novel approach borrowed from physics, we measured the degree of interaction between the public and private pillars of China's hospital system. Second, we measured the relationship between the degree of private-public hospital interaction and the level of provincial-regional economic development, including provincial direct and spillover effects. Data were collected on 2011-2021 service utilisation across 31 Chinese provinces. Fixed-effect models and the spatial Durbin model estimated the direct and spillover effects between the coupling coordination degree and the level of provincial economic development.
We found that national, regional and provincial service utilisation in private hospitals expanded, while service utilisation remained constant in public hospitals. China's private-public hospital co-development improved from the 'barely co-developed' (0.696 in 2011) to the 'partially co-developed' level (0.752 in 2021) in the public-private transitional co-development stage. We identified significant regional heterogeneity, with the eastern region co-development slightly better than the central region and both substantially better than the western region. There was also significant provincial heterogeneity. Increases in regional and provincial economic development promoted the service utilisation of private hospitals, improving the balanced co-development of public-private hospitals in the home and adjacent provinces (p<0.05).
To improve the co-development of public-private hospitals and avoid regional imbalances, regional and provincial hospital policies and regulations should be coordinated and equitable; private hospitals should cooperate with public hospitals through their professional management teams and medical equipment sharing to equalise medical resource allocations; and regional economic disparities should be addressed.
中国医疗体系中公私医院的共同发展对该体系的服务利用有重大影响，但公私医院之间的互动却鲜为人知。弥合这一知识差距对于明智的政策制定和促进更平衡的医疗体系至关重要。本研究衡量了中国公私医院的共同发展以及省级和区域经济发展水平对公私医院共同发展的影响。
我们使用服务利用情况（一种对资源分配、服务能力和服务效率的综合衡量指标）来评估中国公立医院和私立医院的共同发展。我们采用从物理学借鉴而来的耦合协调度模型这一新颖方法，来衡量中国医院体系中公私两大支柱之间的互动程度。其次，我们衡量了公私医院互动程度与省级 - 区域经济发展水平之间的关系，包括省级直接效应和溢出效应。收集了2011 - 2021年中国31个省份的服务利用情况数据。固定效应模型和空间杜宾模型估计了耦合协调度与省级经济发展水平之间的直接效应和溢出效应。
我们发现，私立医院的全国、区域和省级服务利用情况有所扩大，而公立医院的服务利用情况保持不变。在中国公私转型共同发展阶段，中国公私医院的共同发展从“勉强共同发展”（2011年为0.696）提升到了“部分共同发展”水平（2021年为0.752）。我们发现存在显著的区域异质性，东部地区的共同发展略好于中部地区，且两者都远好于西部地区。也存在显著的省级异质性。区域和省级经济发展的提升促进了私立医院的服务利用，改善了本省及相邻省份公私医院的平衡共同发展（p<0.05）。
为了改善公私医院的共同发展并避免区域失衡，应协调和公平制定区域和省级医院政策法规；私立医院应通过其专业管理团队和医疗设备共享与公立医院合作，以均衡医疗资源分配；并应解决区域经济差距问题。
