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Hospital Ownership and Hospital Institutional Change: A Qualitative Study in Guizhou Province, China

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  • Yu Xie

    (School of Public Health, Fudan University/Key Lab of Health Technology Assessment, National Health Commission, Shanghai 200032, China
    Department of Family Medicine and Public Health, University of California, San Diego, CA 92093, USA)

  • Di Liang
  • Jiayan Huang

    (School of Public Health, Fudan University/Key Lab of Health Technology Assessment, National Health Commission, Shanghai 200032, China
    Department of Family Medicine and Public Health, University of California, San Diego, CA 92093, USA)

  • Jiajie Jin

    (School of Public Health, Fudan University/Key Lab of Health Technology Assessment, National Health Commission, Shanghai 200032, China
    Department of Family Medicine and Public Health, University of California, San Diego, CA 92093, USA)

Abstract

Objectives : To qualitatively compare the influence of different ownership which is considered as a kind of institutional environment in public hospitals, private hospitals, and mixed-ownership hospitals on hospital governance structure and organizational behavior. Design : Qualitative descriptive study, using semi-structured, in-depth interviews and thematic template analysis, theoretically informed by critical realism. Participants : 27 key informants including national policymakers in charge of the health sector, influential researchers, local administrators responsible for implementing policies, and hospital managers who are experienced in institutional change. Results : Hospital ownership has a significant influence on hospitals in terms of decision-making power allocation, residual ownership allocation, market entry level, accountability, and social functions. These five aspects in hospital organizational structure incentivize hospitals to adapt to the internal and external environment of the hospital organization—such as market environment, governance, and financing arrangements—affect the behavior of the hospital organization, and ultimately affect the efficiency of hospital operation and quality of service. The incentives under the public system are relatively distorted. Private hospitals have poor performance in failing their social functions due to their insufficient development ability. Compared to them, mixed ownership hospitals have a better performance in terms of incentive mechanism and organizational development. Conclusion : Public hospitals should improve the governance environment and decision-making structure, so as to balance their implementation of social functions and achieve favorable organizational development. For private hospitals, in addition to the optimization of the policy environment, attempts should be made to strengthen their supervision. The development of mixed-ownership hospitals should be oriented towards socialized governance.

Suggested Citation

  • Yu Xie & Di Liang & Jiayan Huang & Jiajie Jin, 2019. "Hospital Ownership and Hospital Institutional Change: A Qualitative Study in Guizhou Province, China," IJERPH, MDPI, vol. 16(8), pages 1-14, April.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:8:p:1460-:d:225635
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    References listed on IDEAS

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    1. Karen Eggleston & Yu-Chu Shen & Joseph Lau & Christopher H. Schmid & Jia Chan, 2008. "Hospital ownership and quality of care: what explains the different results in the literature?," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1345-1362.
    2. Karen Eggleston & Yu‐Chu Shen & Joseph Lau & Christopher H. Schmid & Jia Chan, 2008. "Hospital ownership and quality of care: what explains the different results in the literature?," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1345-1362, December.
    3. Alexander S. Preker & April Harding, 2003. "Innovations in Health Service Delivery : The Corporatization of Public Hospitals," World Bank Publications - Books, The World Bank Group, number 15145.
    4. Paul L. E. Grieco & Ryan C. McDevitt, 2017. "Productivity and Quality in Health Care: Evidence from the Dialysis Industry," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 84(3), pages 1071-1105.
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