The growth of private hospitals and their health workforce in China: a comparison with public hospitals

BACKGROUND: China significantly opened its healthcare market through a series of market-opening policies in 2000-1. This study aims to explore the direct consequences of these policies-the growth of private hospitals, their workforce characteristics compared with public hospitals in China and the source of their healthcare workforce. METHODS: First, we performed a segmented regression analysis of a longitudinal data series of the number of hospitals in China between 1990 and 2009 to examine the before and after effects of the market-opening policy on private hospitals. Then, to highlight the workforce differences between private and public hospitals, provincial survey data collected in 2009 were compared with data from a second database collected in 2002 to detect the mobility of medical staff from the public to the private hospitals. RESULTS: The number of private hospitals rapidly increased after 2001, and the yearly growth rate increased from 19 to 205, represented primarily by an increase in specialty hospitals. Approximately 22.03% of the physicians in private hospitals are over the age of 60, whereas this proportion in public hospitals is only 2.97%. In 2008, at least 4.1% of the staff working in private hospitals had previously worked in local public hospitals in 2001. CONCLUSION: The broad expansion of private hospitals since 2001 is most likely the result of an unbiased market policy environment for private hospitals. Moreover, specific features of the hospital-physician relationship in China may account for the unbalanced age distribution feature among doctors and the mobility of the healthcare workforce in private hospitals.