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Essays on evaluating payment reforms in China

Zhao, Xiaozhou (2023) Essays on evaluating payment reforms in China. PhD thesis, London School of Economics and Political Science.

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Identification Number: 10.21953/lse.00004632


Since the New Health Reform in 2009, China initiated the health payment reform, proposing to actively promote new payment methods other than Fee-for-Service (FFS), including Global Budgets (GB) and Prospective Payment Systems (PPS), to control rising health care costs and reduce over treatment. However, there are potential difficulties in developing new payment methods in China. First, the new payment methods are designed with relatively simple payment mechanisms at the initial stage of payment reforms, and may not be the same effective on cost control. Second, cost control may cause a decrease in the quality of health services after payment reforms. It is therefore important to investigate the changes in expenditure as well as the change in patients’ health outcomes after payment reforms in China, and provide empirical evidence for improving the new payment methods. This dissertation focuses on investigating the effects of different payment reforms on patients and hospitals in China. The dissertation provides a theoretical framework to predict the changes in bills, length of stay (LoS) for patients and service volumes for hospitals after replacing fee-for-service (FFS) with global budget (GB) and to predict the changes in bills, out-of-pocket payments (OOPs), LoS and patient health outcomes after replacing FFS with prospective payment system (PPS). Then the dissertation conducts three empirical studies on the GB and PPS reforms in Chengdu in China. The first empirical study investigates the GB effect on bills, LoS and the number of patients, and the results indicate that GB reform in Chengdu has no initial effect either on bills, LoS or service volumes. The second empirical study evaluates the PPS reform in Chengdu in 2011, and finds that bills, OOPs and LoS decrease after the reform, while the patients’ health outcomes are worsened after the reform. The third empirical study investigates effect of the PPS reform in Chengdu in 2018 on the frail elderly patients, and finds that bills decrease and LoS increase for the frail elderly patients after the reform. However, these findings may not be very reliable due to the limited sample size of the data.

Item Type: Thesis (PhD)
Additional Information: © 2023 Xiaozhou Zhao
Library of Congress subject classification: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets: Departments > Health Policy
Supervisor: Street, Andrew and Friebel, Rocco

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