Judy Xu

Pharmaceutical Pricing: An Empirical Study of Market Competition in Chinese Hospitals

BackgroundHigh pharmaceutical prices and over-prescribing of high-priced pharmaceuticals in Chinese hospitals has long been criticized. Although policy makers have tried to address these issues, they have not yet found an effective balance between government regulation and market forces.ObjectiveOur objective was to explore the impact of market competition on pharmaceutical pricing under Chinese government regulation.MethodsData from 11 public tertiary hospitals in three cities in China from 2002 to 2005 were used to explore the effect of generic and therapeutic competition on prices of antibiotics and cardiovascular products. A quasi-hedonic regression model was employed to estimate the impact of competition. The inputs to our model were specific attributes of the products and manufacturers, with the exception of competition variables.ResultsOur results suggest that pharmaceutical prices are inversely related to the number of generic and therapeutic competitors, but positively related to the number of therapeutic classes. In addition, the product prices of leading local manufacturers are not only significantly lower than those of global manufacturers, but are also lower than their non-leading counterparts when other product attributes are controlled for.ConclusionUnder the highly price-regulated market in China, competition from generic and therapeutic competitors did decrease pharmaceutical prices. Further research is needed to explore whether this competition increases consumer welfare in China’s healthcare setting.

The choice and preference for public-private health care among urban residents in China: evidence from a discrete choice experiment

BackgroundPublic health care dominated the services provision in China before 1980s. However, the number of private health care providers in China has been increasing since then. The growth of private hospitals escalated after a market-oriented reform was implemented in 2001. Through an experimental approach, this study aims to a better understanding of the dynamic change in preference of health care utilisation among the residents in urban China.MethodsBased on a discrete choice experiment (DCE) from a random sample of respondents in urban China, the study evaluated preference over health care attributes affecting individuals’ choice for the utilisation of hospital health care. The marginal willingness-to-pay for five health care attributes was estimated, including public/private provision of health care, by analysing mixed logit and latent class models.ResultsThe results indicated a significantly negative marginal willingness-to-pay for private health care, which was interpreted as representing people’s previous interactions with the health care system. The latent class model further suggested preference heterogeneity across our sample. We found that Hukou type, a typical indicator of socioeconomic background, was significantly related to respondents’ preference for health care utilisation. Permanent urban residents (urban Hukou) valued private health care less; in contrast rural migrants (rural Hukou) were more likely to be indifferent between public/private provision.ConclusionUrban residents in China showed a high disposition to obtain health care from the public providers of health care. Our results have implications in the context of the Chinese government attempts to expand the private health care sector in the short term. Policy makers need to consider residents’ preference for health care in health policy development as the preference can only change in the long term.

Reengineering urban operations management and administration by constructing and using urban hierarchical vulnerability indices: An implication of system of systems and big data

Big data brings great opportunities to gain better understanding of the complexities and dynamics of the system of systems (SoS) of modern megacities and to facilitate their management in a sustainable manner. One of the major performance indicators of city operations management is to guarantee that the city has low vulnerability to natural and man-made hazards. It is necessary to construct urban hierarchical vulnerability indices (HVIs) to quantify and capture the resilience of the urban SoS to disastrous events such as, flooding, pandemics, explosion, infrastructure collapse, terrorist attacks, and financial crises etc. It is also imperative for the city governors and officials to understand how hazardous event(s) might change the HVIs at different levels, how policy interventions might positively or negatively affect the HVIs, and how structural changes (addition of new system or systems components i.e., new roads, buildings, and hospitals) can change the HVIs and in what manner. This paper presents a conceptual framework for defining and implementing HVIs by capturing the characteristics of urban SoS and taking advantage of the value generated by big data. We categorize the HVIs at different levels by considering characteristics of SoS. We then illustrate different dimensions of HVIs and relate them to the current vulnerability indices in literature and in practice. We also show how the value of big data generated and obtained in urban SoSs lead to the construction of a comprehensive HVIs into reality and examine how it could be used to better understanding the dynamic impacts of ever-increasing complexity and uncertainty of urban SoS. Using HVIs as key performance indicator (KPI) in city operations management enable cities to reengineer and reinvent themselves to promote socioeconomic growth and improve quality of life in a sustainable way.

Strengthening the Efferent Arm in Public Health.

The authors discuss the need to collaborate in order to strengthen public health. Topics include addressing shared health problems as a community and through effective communication, the Community Putting Prevention to Work awards initiated by the U.S. Centers for Disease Control and Prevention, and the passage of the U.S. Patient Protection and Affordable Care Act (ACA).