Health reform, public health, and public hospitals in China

Zhu, Jingmin (2022). Health reform, public health, and public hospitals in China. University of Birmingham. Ph.D.

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Abstract

This thesis consists of three empirical studies on health reform, public health and public hospitals in China. The first study evaluates the health impact of a major public health programme implemented during the 2009-2011 New Health Reform in China. Using panel data from the China Health and Nutrition Survey from 1991 to 2015, Difference-in- Differences estimation and Propensity Score Matching methods are combined to identify a causal effect of the rural water improvement programme on adults’ health. It is suggested that the rural water improvement programme is marginally effective in improving adults’ health mainly through promoting water quality. Water improvement in rural areas has resulted in a reduction of diseases including diarrhea and stomachache in adults. There is no significant health inequality associated with individual education and household income. Public health equalization is achieved.
The second study focuses on a basic public health programme implemented during the new health reform. It investigates the extent to which prenatal exposure to the new health reform improves children’s health and the extent to which prenatal care utilisation can explain the resulting effects upon health. It is suggested that children’s height-for-age z score is significantly higher in 2011 following prenatal exposure to the new health reform. However, the risk of stunting is not affected. Having at least five prenatal examinations is a plausible explanation for the positive effect of the new health reform on children's health. In addition, children in households with a better long-term wealth status experience significantly greater improvements in their health.
The third study applies stochastic frontier analysis to estimate the technical efficiency of Chinese public hospitals over the period 2009-2018. The existence of technical inefficiency is supported. The average technical efficiency is about 0.73. County-level public hospitals are found to be more efficient than city-level public hospitals. By contrast, tertiary public hospitals are not always more efficient than secondary public hospitals. Furthermore, the role of government subsidies in hospital’s total income is examined. It is reported that government subsidies have a negative effect on hospitals’ technical efficiency.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):