Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2024 Apr 22;24(1):496.
doi: 10.1186/s12913-024-10941-0.

Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China

Yingbei Xiong  1 , Kunhe Lin  1 , Yifan Yao  1 , Zhengdong Zhong  1 , Li Xiang  2   3
Affiliations
Comparative Study

Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China

Yingbei Xiong et al. BMC Health Serv Res. .

Abstract

Background: China initiated the Medical Alliances (MAs) reform to enhance resource allocation efficiency and ensure equitable healthcare. In response to challenges posed by the predominance of public hospitals, the reform explores public-private partnerships within the MAs. Notably, private hospitals can now participate as either leading or member institutions. This study aims to evaluate the dynamic shifts in market share between public and private hospitals across diverse MAs models.

Methods: Data spanning April 2017 to March 2019 for Dangyang County's MA and January 2018 to December 2019 for Qianjiang County's MA were analyzed. Interrupted periods occurred in April 2018 and January 2019. Using independent sample t-tests, chi-square tests, and interrupted time series analysis (ITSA), we compared the proportion of hospital revenue, the proportion of visits for treatment, and the average hospitalization days of discharged patients between leading public hospitals and leading private hospitals, as well as between member public hospitals and member private hospitals before and after the reform.

Results: After the MAs reform, the revenue proportion decreased for leading public and private hospitals, while member hospitals saw an increase. However, ITSA revealed a notable rise trend in revenue proportion for leading private hospitals (p < 0.001), with a slope of 0.279% per month. Member public and private hospitals experienced decreasing revenue proportions, with outpatient visits proportions declining in member public hospitals by 0.089% per month (p < 0.05) and inpatient admissions proportions dropping in member private hospitals by 0.752% per month (p < 0.001). The average length of stay in member private hospitals increased by 0.321 days per month after the reform (p < 0.01).

Conclusions: This study underscores the imperative to reinforce oversight and constraints on leading hospitals, especially private leading hospitals, to curb the trend of diverting patients from member hospitals. At the same time, for private hospitals that are at a disadvantage in competition and may lead to unreasonable prolongation of hospital stay, this kind of behavior can be avoided by strengthening supervision or granting leadership.

Keywords: Health equity; Market share; Medical alliances (MAs); Public-private partnership.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ITSA results of the effect on the proportion of hospital revenue
Fig. 2
Fig. 2
ITSA results of the effect on the proportion of total outpatient visits
Fig. 3
Fig. 3
ITSA results of the effect on the proportion of total inpatient visits
Fig. 4
Fig. 4
ITSA results of the effect on the average hospitalization days of discharged patients
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Dai G, Li R, Ma S. Research on the equity of health resource allocation in TCM hospitals in China based on the Gini coefficient and agglomeration degree: 2009–2018. Int J Equity Health. 2022;21(1):145. - PMC - PubMed
    1. Glasziou P, Straus S, Brownlee S, Trevena L, Dans L, Guyatt G, et al. Evidence for underuse of effective medical services around the world. Lancet Lond Engl. 2017;390(10090):169–77. - PubMed
    1. Amelung V, Stein V, Suter E, Goodwin N, Nolte E, Balicer R. Handbook Integrated Care. Cham: Springer International Publishing; 2021. https://link.springer.com/10.1007/978-3-030-69262-9.
    1. Su M, Zhou Z, Si Y, Wei X. Effect of health alliances on the quality of primary care in urban China: a coarsened exact matching difference-in-differences analysis. Lancet. 2019;394:S86.
    1. Gao H, Du X, li, Liao Jzhi, Xiang L. The pathway of China’s Integrated Delivery System: based on the analysis of the Medical Consortium policies. Curr Med Sci. 2022;42(6):1164–71. - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources