“No Evidence Appears to Exist”

Here are a few enlightening excerpts from a comprehensive review of health service delivery in China:

On provider payment reform: “In the rural sector, alternatives to FFS [fee-for-service] have also been tried, although no evidence on impacts appears to exist.”

On privatization and ownership: “Very few studies rigorously assess ownership differences of inpatient care in urban areas.”

On integration: “The benefits of vertical integration of village and township providers have not been evaluated formally.”

On management reforms: “To date, very little is known about the impact of management reforms.”

Don’t get me wrong, the article was systematically well written. The problem appears to be that good evidence for health systems reform just doesn’t exist in China.

Which is a real shame, considering the amount of leeway the national Ministry of Health has given local governments in implementing health care reform, and the wide variability that exists in terms of governance, ownership, financing, and management. It’s an abundant godsend of natural experiments, and there is a wealth of information to be gleaned—information that could not only be used to guide future reforms in China but which could also reveal insights about the fields of health economics and health systems in general.

Back in May, a member of the Dean McGee Eye Institute team I worked with had told me that one of the biggest challenges they were facing was a dearth of clear prevalence data. Indeed, estimates for the prevalence rate of cataracts in China varies from 2.5 million to 6.7 million, and estimates for the incidence range from 400,000 new cases per year to 1.3 million. I’ve been told that there are not many people working on health systems and policy research in China. Literature searches on the topic seem to turn up the same small group of big name researchers, i.e. Winnie Yip, William Hsiao, Meng Qingyue, etc. I wonder if the lack of good monitoring and evaluation systems is a deterrent for many researchers looking to enter the field.

On the other hand, experiences in China these past two summers have shown me that hospital doctors and administrators simply abhor having to fill out more forms and records. What’s needed, I think, is a system that is convenient—even necessary—for doctors to use every day from a clinical standpoint, which also happens to serve the function of data collection and report generation. If you could design and implement a system like that (say, an electronic medical records system) across hospitals in China, you could gain access to the goldmine of information currently sitting right under your very nose.

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