Establishing Appropriate Agency Relationships for Providers in China

Liu, Yu; Saltman, Richard B.

Since 2013, a new round of health care reform returned to a market-oriented direction for provider-related reforms, with promoting private hospitals as a major policy. 20 The Chinese government hopes to create competition among current lowefficiency public hospitals with newly established private hospitals, to improve the overall efficiency and quality of the entire health care system. 7 The "National Planning Guideline for the Healthcare Service System (2015-2020)" released in 2015 reemphasized "strongly develop non-public healthcare facilities" as one of the 5 concrete tasks, 27 though the government's goal of treating 20% of the patient population in private hospitals by 2015 seems not to have been reached. 28 The policy of promoting private hospitals has faced a number of barriers due to current physician-agency relationships. In particular, recruiting physicians to new private hospitals, especially senior physicians, has been a significant challenge. 29 Senior physicians prefer to remain at tertiarylevel public hospitals for professional as well as financial reasons, where senior physician resources and service volume remain concentrated 30 and where service volume is reinforced by the existing pattern of greater trust among patients in large public hospitals compared with other health care facilities. 3 If new private hospitals are to emerge and establish themselves, the relationship between senior and/or more highly respected physicians and tertiary-level public hospitals will have to give way to a more balanced public/private set of physician relationships. Second, the emerging private hospitals owned by social enterprise or investors are more likely to be for-profit, and such profit-driven nature will make the physicians practicing at their facilities profit-making agents as well. Strengthened physicians' professionalism will be even more important in an environment where physicians are practicing at explicitly for-profit facilities.