Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data

In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.China, New Rural Cooperative Medical Scheme, Technical efficiency, data envelopment analysis, Township Hospitals.

The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China

Since 2003, the New Rural Cooperative Medical Scheme, a community-based health insurance, is gradually implemented in China, in order to increase the access of the poor to healthcare services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 randomly selected township hospitals of Weifang prefecture (Shandong province, China), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. Estimations highlight three main results. First, the New Rural Cooperative Medical Scheme has a positive impact on the utilization of township hospitals, mainly on inpatient services, but none effect on their financial structure. In addition, the positive impact on the volume of discharged patients is higher in poor areas rather than the non-poor, reflecting a decrease of the burden of hospitalization costs. Lastly, the marginal impact of the reform is decreasing over time.China, New Rural Cooperative Medical Scheme, Impact analysis, Township Hospitals.

The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China

Since 2003, the New Rural Cooperative Medical Scheme is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.China;New Rural Cooperative Medical Scheme;Impact analysis;Township Hospitals.

The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China

Since 2003, the New Rural Cooperative Medical Scheme is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.China;New Rural Cooperative Medical Scheme;Impact analysis;Township Hospitals.

Curative Activities of Township Hospitals in Weifang Prefecture, China: An Analysis of Environmental and Supply-Side Determinants

Township hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized.Health insurance, China, Healthcare services, Hausman-Taylor, Fixed-effects vector decomposition

Curative Activities of Township Hospitals in Weifang Prefecture, China: An Analysis of Environmental and Supply-Side Determinants

International audienceTownship hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized.Les hôpitaux municipaux, qui sont un maillon essentiel du système de santé rural Chinois, ont été affectés par les réformes économiques successives depuis les années 1980 et ont ainsi vu leur fréquentation s’affaiblir. À partir d’observations longitudinales sur neuf années (2000-2008) et 24 hôpitaux municipaux sélectionnés de façon aléatoire dans la préfecture de Weifang (Province du Shandong, Chine), cet article analyse les facteurs d’environnement et d’offre qui influencent le volume des activités curatives des hôpitaux municipaux, mesurépar le volume de consultations externes et d’hospitalisations. Afin d’estimer l’effet de variables invariantes dans le temps, deux estimateurs sont utilisés : Hausman-Taylor et Fixed-Effect Vector Decomposition. Les résultats des estimations des deux estimateurs sont similaires. Ils montrent que le système d’assurance mutualiste graduellement introduit à partir de 2003 influence positivement l’activité des hôpitaux municipaux, même s’il subsiste des barrières financières à l’accès aux soins de santé coûteux. L’analyse souligne aussi queles liens de référencement entre les différents niveaux de structures de santé devraient être renforcés et que la taille des hôpitaux municipaux, qui semble surestimée, doit être adaptée en fonction des facteurs environnementaux

Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data

In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.China;New Rural Cooperative Medical Scheme;Technical efficiency;data envelopment analysis;Township Hospitals.

1,1′-[o-Phenyl­enebis(nitrilo­methyl­idyne)]di-2-naphthol ethanol hemisolvate

The asymmetric unit of the title compound, C28H20N2O2·0.5C2H5OH, contains two independent mol­ecules of 1,1′-[o-phenyl­enebis(nitrilo­methyl­idyne)]di-2-naphthol, denoted A and B, and one ethanol solvent mol­ecule. The hydr­oxy groups are involved in intra­molecular O—H⋯N hydrogen bonds influencing the mol­ecular conformations, which are slightly different in mol­ecules A and B, where the two bicyclic systems form dihedral angles of 51.93 (9) and 58.52 (9)°, respectively. In the crystal structure, a number of short inter­molecular C⋯C contacts with distances of less than 3.5 Å suggest the existence of π–π inter­actions, which contribute to the stability of the crystal packing

Deterministic, probabilistic and risk-based design for progressive collapse of RC structures based on a novel method

Progressive or disproportionate collapse is a structural failure mechanism accompanied with a significant disproportion between the initiating event and the ensuing failure consequence. Facing a possible huge economic loss and even large casualties, structures must be designed with sufficient robustness. Several structural design codes and standards have presented guidelines to increase the robustness of structures. However, these guidelines are largely of deterministic nature and may not be effective, because structures involve large variation in loading, material properties, etc. These variations can lead to significant uncertainty in the degree of robustness of structures and should be dealt with in a probabilistic framework. Based on a new direct design method developed by the authors recently, this study showed that how probabilistic and risk-based design for progressive collapse can be accomplished from a case study. The method can not only help engineers quickly conduct probabilistic performance-based design of structures against progressive collapse, but also communicate with stakeholders more efficiently if adopting risk-based design strategy.This research was partially supported by National Key Research Program of China (grant number 2016YFC0701400), National Natural Science Foundation of China (grant number 51338004), and the Discovery Grant program of the Natural Science and Engineering Research Council (NSERC) Canada. The study was conducted during the first authors visiting research at Ryerson University. The funding support from the China Scholarship Council (CSC) for the first author is also gratefully acknowledged