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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.

To assess the characteristics and incidence of medical litigation in China and the potential usefulness of the records of such litigation as an indicator of health-care quality.We investigated 13 620 cases of medical malpractice litigation that ended between 2010 and 2015 and were reported to China's Supreme Court. We categorized each case according to location of the court, the year the litigation ended, the medical specialization involved, the severity of the reported injury, the type of allegation raised by the plaintiff - including any alleged shortcomings in the health care received - and the outcome of the litigation.The annual incidence of medical malpractice litigation increased from 75 in 2010 to 6947 in 2014. Most cases related to general surgery (1350 litigations), internal medicine (3500 litigations), obstetrics and gynaecology (1251 litigations) and orthopaedics (1283 litigations). Most of the reported injuries were either minor (1358 injuries) or fatal (4111 deaths). The most frequent allegation was of lack of consent or notification (1356 litigations), followed by misdiagnosis (1172 litigations), delay in treatment (1145 litigations) and alteration or forgery of medical records (975 litigations). Of the 11 014 plaintiffs with known litigation outcomes, 7482 (67.9%) received monetary compensation.Over our study period, the incidence of litigation over potential medical malpractice increased in China. As many of the cases related to alleged inadequacies in the quality of health care, records of medical malpractice litigation in China may be worth exploring as an indicator of health-care quality.Évaluer les caractéristiques et l'incidence des litiges médicaux en Chine et l'utilité potentielle des données disponibles sur ces litiges en tant qu'indicateurs de la qualité des soins de santé.Nous avons étudié 13 620 actions en justice liées à de mauvaises pratiques médicales, qui se sont terminées entre 2010 et 2015 et ont été portées à la connaissance de la Cour suprême de Chine. Nous avons classé chaque action en justice en fonction de l'emplacement du tribunal saisi, de l'année de résolution du litige, de la spécialité médicale impliquée, de la gravité du préjudice signalé, du type d'allégation de la partie demanderesse (y compris des insuffisances dans les soins dispensés) et de l'issue du litige.L'incidence annuelle des actions en justice liées à de mauvaises pratiques médicales est passée de 75 cas en 2010 à 6 947 en 2014. La plupart de ces affaires étaient liées à la spécialité de chirurgie générale (1 350 litiges), à la médecine interne (3 500 litiges), à la médecine obstétrique et gynécologique (1 251 litiges) et à la médecine orthopédique (1 283 litiges). Dans la majorité des cas, les préjudices signalés ont été mineurs (1 358 blessures mineures) ou fatals (4 111 décès). L'allégation la plus souvent avancée a été une absence de consentement ou d'information (1 356 cas), suivie par une erreur de diagnostic (1 172 cas), un retard dans la mise en place du traitement (1 145 cas) et l'altération ou la falsification des dossiers médicaux (975 cas). Sur les 11 014 parties demanderesses impliquées dans les actions en justice dont nous connaissons l'issue, 7 482 (67,9%) ont perçu une indemnisation financière.Sur la période que nous avons étudiée, l'incidence des actions en justice liées à de potentielles mauvaises pratiques médicales a augmenté en Chine. Étant donné que de nombreuses affaires portent sur des inadéquations potentielles de la qualité des soins de santé, les données disponibles sur les actions en justice liées aux mauvaises pratiques médicales en Chine pourraient éventuellement être exploitées en tant qu'indicateurs de la qualité des soins de santé.Evaluar las características y la incidencia de litigios médicos en China y la posible utilidad de los registros de dichos litigios como un indicador de la calidad de la atención sanitaria.Se investigaron 13 620 casos de litigios por negligencias médicas que acabaron entre 2010 y 2015 y se enviaron al Tribunal Supremo de China. Cada caso se categorizó según la ubicación del tribunal, el año de finalización del litigio, la especialidad médica implicada, la gravedad del daño denunciado, el tipo de denuncia planteada por el demandante (incluida cualquier deficiencia de la atención sanitaria recibida) y el resultado del litigio.La incidencia anual de los litigios por negligencias médicas aumentó de 75 en 2010 a 6 947 en 2014. La mayoría de los casos estaban relacionados con cirugía general (1 350 litigios), medicina interna (3 500 litigios), obstetricia y ginecología (1 251 litigios) y ortopedia (1 283 litigios). La mayoría de los daños denunciados fueron o menores (1 358 daños) o mortales (4 111 mortales). La denuncia más frecuente fue la ausencia de consentimiento o notificación (1 356 litigios), seguida del diagnóstico equivocado (1 172 litigios), el retraso del tratamiento (1 145 litigios) y la alteración o falsificación de registros médicos (975 litigios). De los 11 014 demandantes con resultados de litigación conocidos, 7 482 (67,9%) recibieron una compensación económica.Durante el periodo de estudio, la incidencia de los litigios por posibles negligencias médicas aumentó en China. Dado que muchos de los casos estaban relacionados con la denuncia de deficiencias en la calidad de la atención sanitaria, puede ser necesaria una exploración de los registros de litigios por negligencias médicas en China a modo de indicador de la calidad de la atención sanitaria.تقييم خصائص الدعاوى القضائية للحالات الطبية في الصين ومدى تأثيرها بالإضافة إلى الفوائد المحتملة لسجلات مثل تلك الدعاوى القضائية كمؤشر لجودة الرعاية الصحية.قمنا بالتحري عن 13,620 حالة من حالات الدعاوى القضائية المتعلقة بالإهمال الطبي التي انتهت في الفترة بين 2010 و2015 وتم إبلاغ المحكمة العليا الصينية بشأنها. كما قمنا بتصنيف كل حالة وفقًا لموقع المحكمة، وتاريخ انتهاء الدعوى القضائية، والتخصص الطبي المعني، وشدة الإصابة المبلغ عنها، وموضوع الدعوى الذي أثاره المدعي – بما في ذلك أي قصور مزعوم في الرعاية الصحية المقدمة – ونتيجة الدعوى القضائية.ارتفع المعدل السنوي للدعاوى القضائية المتعلقة بالإهمال الطبي من 75 حالة في عام 2010 إلى 6947 في عام 2014. وكانت أغلب الحالات تتعلق بالجراحة العامة (1350 دعوى قضائية)، والطب الباطني (3500 دعوى قضائية)، وأمراض النساء والتوليد (1251 دعوى قضائية) وطب العظام (1283 دعوى قضائية). كما كانت أغلب الإصابات المبلغ عنها إما طفيفة (1358 إصابة) أو قاتلة (4111 حالة وفاة). وكانت الدعاوى القضائية الأكثر شيوعًا تتعلق بعدم موافقة المريض أو إبلاغه (1356 دعوى قضائية)، يتبعها التشخيص الخاطئ (1172 دعوى قضائية)، والتأخير في العلاج (1145 دعوى قضائية)، وتغيير السجلات الطبية أو تزويرها (975 دعوى قضائية). من بين 11,014 مدعيًا من أصحاب الدعاوى القضائية المفصول فيها، حصل 7482 (67.9‏%) منهم على تعويض مالي.على مدى فترة الدراسة، ارتفع معدل الدعاوى القضائية في الصين فيما يتعلق بالإهمال الطبي وارد الحدوث. ونظرًا لأن العديد من الحالات تتعلق بأوجه القصور المزعومة في جودة الرعاية الصحية، فقد تكون سجلات الدعاوى القضائية المتعلقة بالإهمال الطبي في الصين جديرة بالاستكشاف باعتبارها مؤشرًا على جودة الرعاية الصحية.旨在评估中国医疗诉讼的特征和发生率以及使用此类诉讼的记录作为医疗护理质量指标的潜在作用。.我们调查了在 2010 至 2015 年间结案并呈报给中国最高法院的 13 620 件医疗事故诉讼案例。 我们根据法院所在地、诉讼结案年份、涉及的医疗规范、呈报损害的严重程度、原告提起的指控类型（包括接受的医疗护理中被指控的任何不足）以及诉讼结果对各案件进行了分类。.医疗事故诉讼的年发生率由 2010 的 75 例增加到 2014 年的 6947 例。大多数案例与普通外科（1350 例）、内科（3500 例）、产科及妇科（1251 例）以及骨科（1283 例）有关。 大多数呈报损害的程度为轻微（1358 件）或致命（4111 件）。 最常见的指控是未征得同意或通知（1356 例），其次是误诊（1172 例）、延误治疗（1145 例）以及医疗记录变更或造假（975 例）。 在已知诉讼结果的 11 014 名原告当中，7482 (67.9%) 人获得了金钱赔偿。.在研究期间，中国潜在医疗事故诉讼的发生率有所增加。 由于许多案例均与指控医疗护理质量不足有关，因此，将中国的医疗事故诉讼记录作为一项医疗护理质量指标进行探究可能很有价值。.Дать оценку характерным особенностям и частоте инициирования судебных разбирательств по медицинским делам в Китае и потенциальной применимости записей о таких судебных разбирательствах в качестве показателя качества медико-санитарного обслуживания.Авторы изучили 13 620 случаев судебных разбирательств по делам о недобросовестной медицинской практике, которые завершились в период между 2010 г. и 2015 г. и о которых было сообщено в Верховный суд Китая. Каждый случай был классифицирован в зависимости от местоположения суда, года завершения судебного разбирательства, вовлеченной медицинской специальности, степени тяжести заявленной травмы, типа выдвинутых истцом обвинений, включающих какие-либо обвинения в неполноценности оказываемых медико-санитарных услуг, и результата судебного разбирательства.Годовая частота инициирования судебных разбирательств по делам о недобросовестной медицинской практике увеличилась с 75 разбирательств в 2010 году до 6947 в 2014 году. Большинство случаев было связано с разделом общей хирургии (1350 разбирательств), внутренних болезней (3500 разбирательств), акушерства и гинекологии (1251 разбирательство) и ортопедии (1283 разбирательства). Большинство заявленных травм были легкой степени тяжести (1358 травм) или смертельными (4111 смертей). Наиболее часто выдвигались обвинения в отсутствии согласия или официального уведомления (1356 разбирательств), постановке неправильного диагноза (1172 разбирательства), несвоевременном предоставлении лечения (1145 разбирательств) и изменении или подделке медицинских записей (975 разбирательств). Из 11 014 истцов, участвовавших в судебных разбирательствах с известными результатами, 7482 (67,9%) получили денежную компенсацию.В течение исследуемого периода частота инициирования судебных разбирательств по делам о возможной недобросовестной медицинской практике в Китае возросла. Поскольку многие судебные разбирательства были связаны с вменяемой в вину неудовлетворительностью медико-санитарного обслуживания, может быть целесообразным исследовать возможность применения записей о судебных разбирательствах по делам о недобросовестной медицинской практике в Китае в качестве показателя качества медицинской помощи.

The new round of health care reforms in China achieved significant initial results. New and emerging problems coinciding with the deepening of the reforms, however, require further institutional changes to strengthen the competition mechanism and promote public hospital efficiency. This paper provides a conceptual framework and preliminary assessment of public hospital competition in China. Specifically, we distinguish between two closely related concepts – competition and privatization, and identify several critical conditions under which hospital competition can be used as a policy instrument to improve health care delivery in China. We also investigate the current performance and identify several unintended consequences of public hospital competition – mainly, medical arms race, drug over-prescription and the erosion of a trusting relationship between patients and physicians. Finally, we discuss the policy options for enhancing the internal competition in China’s hospital market, and conclude that public investment on information provision is key to reaping the positive outcomes of pro-competition policies.

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 the 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 evidence upon those impacts of the medical education system. Results First, the geographic distribution of physicians in China is not uniform across physicians with different educational 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 patients 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 the one hand, China gains the benefit of increasing the supply of health care professionals at lower costs. On the other hand, China 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.

The geographic maldistribution of health care resources is one of the most persistent characteristics of health care systems around the world. Based on China’s provincial-level panel data in 1949-2010, this paper empirically investigates whether the geographic distribution of health care resources is convergent or divergent in the long run and whether the rapid economic growth contributes to reducing the regional disparity in health care resources in China. Using a dynamic convergence model that controls unobserved provincial heterogeneity and spatial dependence, the empirical results provide much support for β-convergence in that the provinces with lower initial values of health care resources, including the densities of physicians and hospital beds, are seen to grow faster and to catch up with the provinces with higher initial stocks. In addition, we find that GDP per capita has a significant and non-linear impact on the convergence rate of health care resources, providing support for a Kuznets curve in China’s health sector. That is, the inequality in the distribution of health care resources follows an inverted “U” shape as income increases over time. An important implication of our study is that economic growth per se provides a built-in stabilizer to mitigate health inequality through the convergence of health care resources across regions in the long run.

Promoting competition between brand-name and generic drugs has long been recognized as an approach adopted to save on health care costs. However, there are substantial variations in the extent of the generic competition across countries. This study empirically estimates the determinants of the generic market share in Taiwan, where medical providers are in a position to profit directly from the sale of prescription drugs. Our empirical results point out that the profit-seeking behavior of medical providers plays an important and dominant role behind generic competition in the pharmaceutical market. As a result, there is a positive association between the generic-to-brand price ratio and the generic market share in Taiwan’s pharmaceutical market, which contrasts with the conventional empirical finding that the relationship between the generic-to-brand price ratio and generic market share is negative. An important implication of our study is that the profit-seeking behavior of medical providers undermines the policy effectiveness of using generic competition as the cost containment strategy in the health care market.

This paper empirically investigates the relationship between the health care expenditure of end-of-life patients and hospital characteristics in Taiwan where (i) hospitals of different ownership differ in their financial incentives; (ii) patients are free to choose their providers; and (iii) health care services are paid for by a single public payer on a fee-for-services basis with a global budget cap. Utilizing insurance claims for 11 863 individuals who died during 2005–2007, we trace their hospital expenditures over the last 24 months of their lives. We find that end-of-life patients who are treated by private hospitals in general are associated with higher inpatient expenditures than those treated by public hospitals, while there is no significant difference in days of hospital stay. This finding is consistent with the difference in financial incentives between public and private hospitals in Taiwan. Nevertheless, we also find that the public–private differences vary across accreditation levels. Copyright © 2013 John Wiley & Sons, Ltd.

This paper estimates the labor supply functions for health care professionals in China using Census-based data in 2005. The rapid economic growth and population aging in China led to a substantial increase in the demand for health care services and the derived demand for health care professionals in recent years. However, the increase in the supply of doctors and nurses lags behind the growth in demand, raising the question of whether the excess demand should be met by expanding the health care manpower or by inducing the existing personnel to work more hours through wage increase. Our findings indicate that wage rate adjustment has a significant impact on the length of working time among the self-employed practitioners (with an estimated short-run elasticity of 0.575), while the labor supply of hospital employees is inelastic due to their fixed payment scheme. Instead, hours worked in the employee group are related to non-wage factors such as asset holdings and the hospital ownership type. An important policy implication of our study is that adjustments of labor compensation methods and hospital ownership structure are potentially effective approaches for coping with the excess demand for health care professionals and improving the quality of health care in China.

Objective To provide an overview of the use of biologics in Taiwan, including the access to new biologics, the impact of this access on the growth of health-care expenditure, and the utilization patterns. Methods We first conducted a market-level analysis to investigate the availability of global biologics in Taiwan as well as the growth and concentration of aggregate spending on biologics. We then conducted a patient-level analysis to investigate the costs and utilization patterns for selected new biologics. Results We found that the concentration index is such that the 20 leading biologics in Taiwan account for more than 90% of the total spending on biologics. In our patient-level study on four biologics, the annual cost of treatment per patient ranged from NT$100,000 to NT$400,000. The prevalence rate of the user was between 6.5 and 37.2 per 100,000 of population. The treatment costs were inversely related to the prevalence rate of users. We also found that physicians in larger and public hospitals were more likely to prescribe new biologics to their patients compared with their counterparts practicing in smaller and private hospitals. In addition, we found that physicians were more likely to prescribe biologics to patients with more severe diseases and higher comorbidities. Conclusions We conclude that public spending on biologics in Taiwan is highly targeted toward about 20 products with higher annual expenditures and growth rates and that the utilization of these biologics is targeted at a small number of patients. In addition, the access to these costly biologics is not uniform among patients in a country with universal coverage for prescription drugs.

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

This paper empirically investigates the relationship between the health care expenditure of end-of-life patients and hospital characteristics in Taiwan where (1) hospitals of different ownership differ in their financial incentives; (2) patients are free to choose their providers; and (3) health care services are paid for by a single public payer on a fee-for-services basis with a global budget cap. Utilizing insurance claims for 11,863 individuals who died during 2005-2007, we trace their hospital expenditures over the last 24 months of their lives. We find that end-of-life patients who are treated by private hospitals in general are associated with higher inpatient expenditures than those treated by public hospitals, while there is no significant difference in days of hospital stay. This finding is consistent with the difference in financial incentives between public and private hospitals in Taiwan. Nevertheless, we also find that the public-private differences vary across accreditation levels.

Although the technological change in medicine has been widely recognized as the major driver of rising healthcare costs, there is very little research that directly estimates this effect. This paper uses both a single-equation and a simultaneous equations approach to empirically investigate the interactive relationship between technological innovation and the growth of health expenditure in the context of the pharmaceutical market in Taiwan. Based on observing 182 therapeutic groups between 1997 and 2006, we find evidence to support the argument that technological innovation and health expenditure are simultaneously determined as technological innovation and the growth of health expenditure are endogenous rather than exogenous. Specifically, we find that therapeutic groups associated with higher pharmaceutical expenditure are likely to attract more new products to the market. Meanwhile, therapeutic groups with more new products are associated with higher pharmaceutical expenditures. An important implication of the paper is that the cost containment policy will not only affect the growth of health expenditure, but will also affect the progress of technological innovation in the health sector.

A vast body of empirical evidence has accumulated demonstrating that incentives affect health care choices made by both consumers and suppliers of health care services. Decisions in health care are affected by many types of incentives, such as the rate of return pharmaceutical manufacturers expect on their investments in research and development, or disincentives, such as increases in copayments patients must make when they visit physicians or are admitted to hospitals. In this volume, leading scholars in health economics review these new and important results and describe their own recent research assessing the role of incentives in health care markets and decisions people make that affect their personal health. The contexts include demand decisions -- choices made by individuals about health care services they consume and the health insurance policies they purchase -- and supply decisions made by medical students, practicing physicians, hospitals, and pharmaceutical manufacturers. Researchers and students of health economics and policy makers will find this book a valuable resource, both for learning economic concepts, particularly as they apply to health care, and for reading up-to-date summaries of the empirical evidence. General readers will find the book's chapters accessible, interesting, and useful for gaining an understanding of the likely effects of alternative health care policies. ContributorsHenry J. Aaron, Ernst R. Berndt, John Cawley, Julie M. Donohue, Donna Gilleskie, Brian R. Golden, Gautam Gowrisankaran, Chee-Ruey Hsieh, Hirschel Kasper, Thomas G. McGuire, Joseph P. Newhouse, Sean Nicholson, Mark V. Pauly, Anna D. Sinaiko, Frank Sloan.