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Reasons behind stymied public hospital governance reform in China

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  • Sheng Nong
  • Nengliang Aaron Yao

Abstract

Background: The public hospital governance reform in China is pledged to improve the governance of public hospitals and deliver affordable and high-quality care. However, progress in public hospital reform has been slow. The reason is poorly understood. Methods: A research center affiliated with China National Health Commission has conducted 32 workshops to interview 124 public hospital administrators from 30 provincial-level administrative divisions and 105 various-level government officials from three provinces. About 80% of administrators and 78% officials actively participated the discussions. We used a descriptive theoretical approach to understand the relationships between the governance reform and characteristics of its stakeholders. We also analyzed stakeholder interests and their power to influence the reform. Findings: About 66% of hospital administrators, 72% of health officials, and less than 10% of other officials support a new hospital governing structure. Local leadership, hospital administrators, and health commission said that administrators should have more power over the management of public hospitals. Other government departments and healthcare professionals had reservations on the governance reform. The reform of public hospital governance faces significant obstacles. The interests of most government stakeholders are not aligned with public interests. All stakeholders perceived that their workload would increase in the short term because of the governance reform of public hospitals. Most people involved in the reform are not incentivized to collaborate. The health commission has limited financial resources and insufficient political power to implement a massive reform. Most importantly, the public hospital reform is not, and likely will not be, a top policy priority to the central government or local leaderships. Interpretation: The health commission needs more political support and resources to speed up the public hospital reform. To fulfill the pledge of affordable, equitable access to quality care, Chinese government needs to overcome significant obstacles in the public hospital reform.

Suggested Citation

  • Sheng Nong & Nengliang Aaron Yao, 2019. "Reasons behind stymied public hospital governance reform in China," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-11, September.
    • Handle: RePEc:plo:pone00:0222204
    DOI: 10.1371/journal.pone.0222204
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    References listed on IDEAS

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    4. World Bank, 2010. "Fixing the Public Hospital System in China," World Bank Publications - Reports 27720, The World Bank Group.
    5. Song, Xiaoqian & Mu, Xiaoyi, 2013. "The safety regulation of small-scale coal mines in China: Analysing the interests and influences of stakeholders," Energy Policy, Elsevier, vol. 52(C), pages 472-481.
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