Health Care Payment Incentives: A Comparative Analysis of Reforms in Taiwan, Korea and China

Payment incentives have significant consequences for the equity and efficiency of a health care system, and have recently come to the fore in health policy reforms. This paper first discusses the economic rationale for apparent international convergence toward payment systems with mixed demand and supplyside cost sharing. We then summarize the recent payment reforms undertaken in Taiwan, Korea and China. Available evidence clearly indicates that incentives matter, and that supply-side cost sharing in particular can improve efficiency without undermining equity. Further study and monitoring of quality and selection is warranted.

Understanding and addressing the treatment gap in mental healthcare: economic perspectives and evidence from China

A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face 4 major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the 4 barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies

Why most people with mental illness go untreated? economic perspectives and evidence from China

Due to the rapid economic growth and advancement in medical technology, many countries have experienced in the past decades an epidemiological transition from communicable to non- communicable dieses (NCDs). One of the challenges in the era of NCDs is the large treatment gap, measured by the difference between the need for treatment and the actual provision of treatment, among patients with NCDs. This paper investigates the causes of treatment gap in mental healthcare from the perspective of economics. Specifically, we hypothesizes that people with mental illness face four major hurdles in seeking appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to the mental health sector, the high time prices due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We then use China as a study setting to show the country-specific evidence. Our analysis supports the above theoretical argument on the four access barriers, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies

Explaining cross-country heterogeneity in trust in physicians: the role of pharmaceutical expenditure

Trust in physicians is the fundamental social mechanism in the health sector to address the issue of uncertainty in the effectiveness of health care and asymmetric information between patients and physicians. As health systems are so diverse in the world, there are substantial differences across nations in trust in physicians. Few studies have paid attention to the link between the characteristics of health system and patient trust in physicians. This study used 2011 International Social Survey Programme data to explore the potential mechanism in accounting for cross-country heterogeneity in trust in physicians. We hypothesize that physician-induced demand in the pharmaceutical sector shapes the perception that physicians serve as imperfect agents to their patients, which in turn lowers trust in physicians. Specifically, we used the share of pharmaceutical expenditure in total health expenditure as a proxy measure of physician-induced demand in prescription drugs, and we found that individuals were more likely to believe that physicians serve as imperfect agent if their countries spend a high share of health care costs on pharmaceutical products. In addition, our cross-country analysis shows a significant negative relationship between the perception of imperfect agency and trust in physicians

Explaining cross-country heterogeneity in trust in physicians: the role of pharmaceutical expenditure

Trust in physicians is the fundamental social mechanism in the health sector to address the issue of uncertainty in the effectiveness of health care and asymmetric information between patients and physicians. As health systems are so diverse in the world, there are substantial differences across nations in trust in physicians. Few studies have paid attention to the link between the characteristics of health system and patient trust in physicians. This study used 2011 International Social Survey Programme data to explore the potential mechanism in accounting for cross-country heterogeneity in trust in physicians. We hypothesize that physician-induced demand in the pharmaceutical sector shapes the perception that physicians serve as imperfect agents to their patients, which in turn lowers trust in physicians. Specifically, we used the share of pharmaceutical expenditure in total health expenditure as a proxy measure of physician-induced demand in prescription drugs, and we found that individuals were more likely to believe that physicians serve as imperfect agent if their countries spend a high share of health care costs on pharmaceutical products. In addition, our cross-country analysis shows a significant negative relationship between the perception of imperfect agency and trust in physicians

Juries and Justice: Are Malpractice and Other Personal Injuries Created Equal?

A study analyzed the civil jury system and the difference in personal injury awards between automobile and deep-pocket defendants, especially in medical malpractice cases. Six conclusions were reached, including the finding that juries sometimes respond emotionally and award some objectively similar cases higher damages than others

The hidden costs of mental depression: implications on social trust and life satisfaction

Mental health conditions such as depression is a rapidly rising epidemic and a major contributor to the overall global burden of disease. In addition to the direct medical costs and indirect economic costs that falls into the traditional boundary of disease burden estimation, many social costs associated with depression are hidden yet important. This paper provides empirical evidence on the existence of two hidden costs associated with depression: negative impact on social trust and life satisfaction. Based on the data obtained from 2012 China Family Panel Studies, our estimated results indicate that individuals who have a high tendency for depression or depressive symptoms are less likely to trust other people, and they also have significantly lower life satisfaction than their counterparts who are relatively mentally healthy. Given that trust is an important component of social capital, which in turn is an important input to foster economic growth in general and innovation in particular, the reduction in trust induced by the increasing prevalence of depression imposes a significant cost to the society in terms of poor economic performance. Similarly, as life satisfaction has been widely recognized as an important measure of well-being, our study also highlights that the increase in the prevalence of depression leads to a reduction in the well-being that individual can enjoy. All these costs are real, but did not receive sufficient attention in the previous research. The contribution of our research is to shed light on the existence of these hidden costs and to quantify the magnitude of such costs in the context of China

Understanding and addressing the treatment gap in mental healthcare: economic perspectives and evidence from China

A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face four major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the four barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies

The multi-tiered medical education system and its influence on the health care market - a China’s flexner report

Background: Medical education is critical and the first step to foster the competence of a physician. Unlike developed countries, China has been adopting a system of multi tiered medical education to training physicians which is featured by the provision of an alternative lower level of medical practitioners , or known as a feldsher system since 1950s This study aimed to illustrate the impact of multi tiered medical education on both the equity in the delivery of health care services and the efficiency of the health care market. Methods Based on both theoretical reasoning and empirical analysis, this paper documented evidences upon those impacts of the medical education system. Results First, the geographic distribution of physicians in China is not uniform across physicians with different education training. Second, we also find the evidence that high educated doctors are more likely to be hired by larger hospitals, which in turn add the fuel to foster the hospital center health care system in China as pati ents choose large hospitals to chase good doctors. Third, through the channels of adverse selection and moral hazard, the heterogeneity in medical education also imposes costs to the health care market in China. Discussion Overall, the three tiered medical education system in China is a standard policy trade off between quantity and quality in training health care professionals. On one hand, China gains the benefit of increasing supply of health care professionals at lower costs. On the other hand, C hina pays the price for keeping a multi tiered medical education in terms of increasing inequality and efficiency loss in the health care sector. Finally, we discuss the potential policy options for China to mitigate the negative impact of keeping a multi tiered medical education on the performance of health care market

Understanding and addressing the treatment gap in mental healthcare: economic perspectives and evidence from China

A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face four major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the four barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies