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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.

As the world has moved toward the era of non-communicable diseases, whether the individuals are in a capable position to accurately evaluate their own health status has an important implication on disease prevention in particularly and population health outcome in general. In this paper, we address four important questions surrounding the accuracy of health perception: (1) to what extent that individuals can make an accurate evaluation on their own health status; (2) what are the major factors influencing health misperception if any; (3) what are the causal directions between health behavior and health perception; and (4) whether individuals can learn and update their self-evaluation on health status over time and whether such learning is productive in that it mitigates the health misperception. Specifically, we use a longitudinal data set obtained from Taiwan that covers six waves of survey over about twenty-year period to compare the ex ante subjective perception on health and the ex post mortality hazards. Our results suggest that over one third of the survey respondents are not performing well in the evaluation of their own health status. We also find that smokers are more likely to have an optimistic bias on their own health assessment as compared to nonsmokers. After controlling for the simultaneous causality problem, we find a causal effect of individuals' misperceptions on continuing smoking, but not vice versa. In addition, our results show that individuals update their subjective perception on health over time through the learning from personal health shocks and the provision of public information on smoking hazards. Although the learning process tends to be overshooting among smokers, it is beneficial to mitigate the optimistic bias. We also find the evidence that personal health shock has a stronger impact on updating behavior than public information, indicating that personal experience is a more effective channel through which to correct the bias in health perception, compared to the provision of public information, such as anti-smoking campaign.

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 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.

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.

This paper tests the hypothesis of whether or not financial incentives affect a physician's prescription decision on the choice of generic versus brand-name drugs within a system in which physicians prescribe and dispense drugs. By using data obtained from Taiwan and focusing on diabetic patients, our empirical results provide several consistent findings in support of the hypothesis that profit incentives do affect the physician's prescribing decision, suggesting that physicians act as imperfect agents. An important implication of our findings is that rent seeking for profit margin between the reimbursement and the acquisition price instead of reducing costs is the major driving force behind generic substitution. As a result, the providers instead of the payers or consumers reap the financial benefits of generic substitution.

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 article uses survey data obtained from Taiwan to investigate consumer perceptions of smoking risks and the linkage of these perceptions to smoking behavior. In our analysis, two equations are estimated: (1) risk perception, and (2) smoking probability. The simultaneity problem in estimating risk perception and smoking probability is also considered. Overall, the results indicate that the risk perceptions of cigarette smoking are substantially overestimated and that these risk perceptions in turn, have a significantly negative effect on smoking probability. Also, the results suggest that the determinants of risk perception are consistent with the predictions of a Bayesian learning framework.

Objectives To investigate the impact of adopting pharmaceutical innovations on the growth of pharmaceutical expenditures, focusing specifically on Taiwan's experience. Methods We first provide a descriptive analysis of cost impacts of introducing new drugs into Taiwan's national formulary using data from Taiwan. We then use a statistical method to decompose the growth of pharmaceutical expenditures during 1997–2001 into three components: 1) treatment expansion; 2) treatment substitution; and 3) price effect. By incorporating the estimated benefit from prior studies, we calculate the incremental cost-effectiveness ratio for new drugs as a whole. Results We find that from 1997 to 2001 public expenditures on pharmaceuticals grew 57%. The primary drivers of this expenditure growth were treatment expansion and treatment substitution. Prices declined by 18%. Cost per life-year gained resulting from introduction of new drugs was US$1053 (in 2003 dollars) from the perspective of the public payer and US$1824 from the perspective of society as a whole. Conclusions Overall, our analysis provides evidence with previous studies that the drug reimbursement price is not the primary driver of increased spending. Rather the introduction of new drugs into the formulary leading to expansion of treatment, expansion and substitution of the new drugs for existing drugs may increase spending. Although the adoption of pharmaceutical innovation is costly, the estimated benefit of adopting pharmaceutical innovation generally far exceeds the cost, indicating that the adoption of pharmaceutical innovation is on the whole worthwhile.