The cream‐skimming effect in China's health care services: A mixed methods study

• Published in: The International journal of health planning and management Vol. 36; no. 1; pp. 113 - 133
• Main Authors: Chen, Dongjin, Lang, Youxing
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2021
• Subjects: Cadres; China; Content analysis; Correlation analysis; General public; Health administration; Health care; Health care facilities; health care facility; Health disparities; Health facilities; Health services; Hospitals; inequity; Local economy; Local population; Mixed methods research; Payments; political power; Power; Regional development; Regions; Regression analysis; Skimming; Websites; China; political power; health care facility; inequity; content analysis; China
• ISSN: 0749-6753; 1099-1751
• DOI: 10.1002/hpm.3071

Objective One of the greatest inequities in China's health care service is that between senior cadres, high‐level bureaucrats, and the general public in terms of hospital access and payment. We aim to demonstrate this inequity and to explore its connection with the regional inequity of different levels of health care facilities. Methods In a content analysis of official websites of provincial health bureaus and national top hospitals, we determine whether senior cadres enjoy priority in health services with fewer payments. Then, we employ multiple regression analyses to explore the correlation of the local economy, the local population as well as the regional power and different levels of health care facilities. Results The content analysis suggests that senior cadres indeed enjoy priority in health care services. According to the regression results, the local population has a positive correlation with every level of health care facilities except the highest one, which is responsive only to the local power index. Conclusion We demonstrate a demand‐side cream‐skimming effect in China's health care service. Senior cadres have taken the ‘cream’, the best services, and the individual inequity between senior cadres and the general public is related to the regional inequity of different‐level health care facilities.