Policy Study of China's Medical System Reform
Author
Fei, HAN
Term
4. term
Publication year
2013
Submitted on
2013-08-31
Abstract
This thesis examines the reform of China’s urban medical system since the 1980s, focusing on how policy choices and institutional changes have shaped system performance and produced persistent challenges. Using a policy-analytic approach, it reconstructs the reform’s historical trajectory in four phases and assesses each phase with empirical evidence from official statistics, reports, and illustrative cases. The analysis is grounded in theories of public versus private goods, state involvement in health care, medical system structure, institutional shift, and government failure. The study finds that reforms substantially expanded sector capacity but also raised financial barriers for patients, encouraged malpractice and unreasonable prescribing, and contributed to perceived declines in availability and quality. Although private hospitals were legalized, they did not develop to compete effectively with state-owned hospitals; instead, a de facto monopoly emerged, shaped by one-party rule, limited public insurance coverage, and insufficient fiscal support. This concentration harms patients and weakens oversight, fostering corruption and administrative failures. The thesis recommends creating independent asset management and expert selection committees to redefine the state–hospital relationship, supporting the growth of private hospitals, and building online complaint and communication platforms to enhance transparency. The analysis is limited to the urban medical system and excludes public health functions.
Dette speciale undersøger reformen af Kinas urbane medicinske system siden 1980’erne med fokus på, hvordan politiske valg og institutionelle ændringer har formet systemets udvikling og de problemer, der er opstået undervejs. Med en policy-analytisk tilgang kortlægger studiet reformens historiske forløb i fire perioder og vurderer hver periode ved hjælp af empiriske oplysninger fra officielle statistikker, rapporter og illustrative sager. Teoretisk bygger analysen på skelnen mellem private og offentlige goder, statens deltagelse i sundhedsydelser, medicinske systemers struktur, institutionelle skift og government failure. Specialet finder, at reformerne markant har udvidet sektorens kapacitet, men samtidig har skabt økonomiske barrierer for patienter, medført malpraksis og urimelige ordinationer samt bidraget til oplevet fald i tilgængelighed og kvalitet. Selvom private hospitaler blev lovlige, udviklede de sig ikke til en skala, der kunne udfordre statsejede hospitaler; der opstod i stedet et de facto monopol, formet af étpartistyre, begrænset offentligt dækkende sygeforsikring og utilstrækkelig finansiel støtte. Denne koncentration skader patienter og svækker tilsynsmekanismer, hvilket begunstiger korruption og forvaltningssvigt. Specialet anbefaler at etablere uafhængige aktivforvaltnings- og ekspertudvælgelseskomitéer for at redefinere relationen mellem staten og statsejede hospitaler, at støtte udviklingen af private hospitaler samt at opbygge online klage- og dialogplatforme for at øge gennemsigtigheden. Studiet afgrænses til det urbane medicinske system og omfatter ikke folkesundhedsområdet.
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