{"id":"https://openalex.org/W7159762899","doi":"https://doi.org/10.3390/systems14050481","title":"Mixed Provider Payment System and Medical Service Efficiency: Evidence from China\u2019s Sanming Healthcare Reform","display_name":"Mixed Provider Payment System and Medical Service Efficiency: Evidence from China\u2019s Sanming Healthcare Reform","publication_year":2026,"publication_date":"2026-04-29","ids":{"openalex":"https://openalex.org/W7159762899","doi":"https://doi.org/10.3390/systems14050481"},"language":"en","primary_location":{"id":"doi:10.3390/systems14050481","is_oa":true,"landing_page_url":"https://doi.org/10.3390/systems14050481","pdf_url":"https://www.mdpi.com/2079-8954/14/5/481/pdf?version=1777460956","source":{"id":"https://openalex.org/S4210219410","display_name":"Systems","issn_l":"2079-8954","issn":["2079-8954"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Systems","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.mdpi.com/2079-8954/14/5/481/pdf?version=1777460956","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5031991478","display_name":"Z LIU","orcid":null},"institutions":[{"id":"https://openalex.org/I90610280","display_name":"South China University of Technology","ror":"https://ror.org/0530pts50","country_code":"CN","type":"education","lineage":["https://openalex.org/I90610280"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Zhihui Liu","raw_affiliation_strings":["School of Public Administration, South China University of Technology, Guangzhou 510641, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Public Administration, South China University of Technology, Guangzhou 510641, China","institution_ids":["https://openalex.org/I90610280"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5100764456","display_name":"Yan Huang","orcid":"https://orcid.org/0000-0002-0575-0156"},"institutions":[{"id":"https://openalex.org/I90610280","display_name":"South China University of Technology","ror":"https://ror.org/0530pts50","country_code":"CN","type":"education","lineage":["https://openalex.org/I90610280"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Yan Huang","raw_affiliation_strings":["School of Public Administration, South China University of Technology, Guangzhou 510641, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Public Administration, South China University of Technology, Guangzhou 510641, China","institution_ids":["https://openalex.org/I90610280"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5100764456"],"corresponding_institution_ids":["https://openalex.org/I90610280"],"apc_list":{"value":1600,"currency":"CHF","value_usd":1782},"apc_paid":{"value":1600,"currency":"CHF","value_usd":1782},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.54564635,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":"5","first_page":"481","last_page":"481"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.4690999984741211,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.4690999984741211,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.4027000069618225,"subfield":{"id":"https://openalex.org/subfields/2003","display_name":"Finance"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11590","display_name":"Primary Care and Health Outcomes","score":0.029100000858306885,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/payment","display_name":"Payment","score":0.7250000238418579},{"id":"https://openalex.org/keywords/incentive","display_name":"Incentive","score":0.6869000196456909},{"id":"https://openalex.org/keywords/payment-system","display_name":"Payment system","score":0.4860999882221222},{"id":"https://openalex.org/keywords/service","display_name":"Service (business)","score":0.4643999934196472},{"id":"https://openalex.org/keywords/empirical-evidence","display_name":"Empirical evidence","score":0.4569000005722046},{"id":"https://openalex.org/keywords/service-provider","display_name":"Service provider","score":0.4562000036239624},{"id":"https://openalex.org/keywords/health-care-reform","display_name":"Health care reform","score":0.42899999022483826},{"id":"https://openalex.org/keywords/exploit","display_name":"Exploit","score":0.40560001134872437},{"id":"https://openalex.org/keywords/service-delivery-framework","display_name":"Service delivery framework","score":0.4025999903678894},{"id":"https://openalex.org/keywords/empirical-research","display_name":"Empirical research","score":0.38850000500679016}],"concepts":[{"id":"https://openalex.org/C145097563","wikidata":"https://www.wikidata.org/wiki/Q1148747","display_name":"Payment","level":2,"score":0.7250000238418579},{"id":"https://openalex.org/C29122968","wikidata":"https://www.wikidata.org/wiki/Q1414816","display_name":"Incentive","level":2,"score":0.6869000196456909},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.66839998960495},{"id":"https://openalex.org/C2776983043","wikidata":"https://www.wikidata.org/wiki/Q986008","display_name":"Payment system","level":3,"score":0.4860999882221222},{"id":"https://openalex.org/C2780378061","wikidata":"https://www.wikidata.org/wiki/Q25351891","display_name":"Service (business)","level":2,"score":0.4643999934196472},{"id":"https://openalex.org/C166052673","wikidata":"https://www.wikidata.org/wiki/Q83021","display_name":"Empirical evidence","level":2,"score":0.4569000005722046},{"id":"https://openalex.org/C116537","wikidata":"https://www.wikidata.org/wiki/Q2169973","display_name":"Service provider","level":3,"score":0.4562000036239624},{"id":"https://openalex.org/C2778584109","wikidata":"https://www.wikidata.org/wiki/Q60603744","display_name":"Health care reform","level":4,"score":0.42899999022483826},{"id":"https://openalex.org/C165696696","wikidata":"https://www.wikidata.org/wiki/Q11287","display_name":"Exploit","level":2,"score":0.40560001134872437},{"id":"https://openalex.org/C68595000","wikidata":"https://www.wikidata.org/wiki/Q2274177","display_name":"Service delivery framework","level":3,"score":0.4025999903678894},{"id":"https://openalex.org/C10138342","wikidata":"https://www.wikidata.org/wiki/Q43015","display_name":"Finance","level":1,"score":0.4009000062942505},{"id":"https://openalex.org/C120936955","wikidata":"https://www.wikidata.org/wiki/Q2155640","display_name":"Empirical research","level":2,"score":0.38850000500679016},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.36410000920295715},{"id":"https://openalex.org/C2781332184","wikidata":"https://www.wikidata.org/wiki/Q7156780","display_name":"Payment by Results","level":2,"score":0.35040000081062317},{"id":"https://openalex.org/C162118730","wikidata":"https://www.wikidata.org/wiki/Q1128453","display_name":"Actuarial science","level":1,"score":0.3499999940395355},{"id":"https://openalex.org/C100001284","wikidata":"https://www.wikidata.org/wiki/Q2248246","display_name":"Public economics","level":1,"score":0.32690000534057617},{"id":"https://openalex.org/C33880087","wikidata":"https://www.wikidata.org/wiki/Q5275276","display_name":"Difference in differences","level":2,"score":0.31769999861717224},{"id":"https://openalex.org/C2983812674","wikidata":"https://www.wikidata.org/wiki/Q134808","display_name":"Delivery system","level":2,"score":0.3122999966144562},{"id":"https://openalex.org/C49630185","wikidata":"https://www.wikidata.org/wiki/Q6980675","display_name":"Natural experiment","level":2,"score":0.3077999949455261},{"id":"https://openalex.org/C15587899","wikidata":"https://www.wikidata.org/wiki/Q7455812","display_name":"Service system","level":3,"score":0.30149999260902405},{"id":"https://openalex.org/C2779245251","wikidata":"https://www.wikidata.org/wiki/Q7250835","display_name":"Prospective payment system","level":3,"score":0.2987000048160553},{"id":"https://openalex.org/C2994015643","wikidata":"https://www.wikidata.org/wiki/Q60603744","display_name":"Health reform","level":4,"score":0.289000004529953},{"id":"https://openalex.org/C191935318","wikidata":"https://www.wikidata.org/wiki/Q148","display_name":"China","level":2,"score":0.27970001101493835},{"id":"https://openalex.org/C21547014","wikidata":"https://www.wikidata.org/wiki/Q1423657","display_name":"Operations management","level":1,"score":0.27900001406669617},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.272599995136261},{"id":"https://openalex.org/C185822510","wikidata":"https://www.wikidata.org/wiki/Q1956140","display_name":"Payment service provider","level":3,"score":0.27219998836517334},{"id":"https://openalex.org/C2992052470","wikidata":"https://www.wikidata.org/wiki/Q31218","display_name":"Medical expenses","level":2,"score":0.26980000734329224},{"id":"https://openalex.org/C2778198094","wikidata":"https://www.wikidata.org/wiki/Q1208158","display_name":"Diagnosis-related group","level":3,"score":0.2678000032901764},{"id":"https://openalex.org/C3019354653","wikidata":"https://www.wikidata.org/wiki/Q5690885","display_name":"Medical costs","level":3,"score":0.265500009059906},{"id":"https://openalex.org/C2988170871","wikidata":"https://www.wikidata.org/wiki/Q11000047","display_name":"Healthcare system","level":3,"score":0.26170000433921814},{"id":"https://openalex.org/C8505890","wikidata":"https://www.wikidata.org/wiki/Q605095","display_name":"Budget constraint","level":2,"score":0.257999986410141},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.25600001215934753}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.3390/systems14050481","is_oa":true,"landing_page_url":"https://doi.org/10.3390/systems14050481","pdf_url":"https://www.mdpi.com/2079-8954/14/5/481/pdf?version=1777460956","source":{"id":"https://openalex.org/S4210219410","display_name":"Systems","issn_l":"2079-8954","issn":["2079-8954"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Systems","raw_type":"journal-article"},{"id":"pmh:oai:doaj.org/article:c7184c8e41544395a8a4104cef6231d3","is_oa":true,"landing_page_url":"https://doaj.org/article/c7184c8e41544395a8a4104cef6231d3","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Systems, Vol 14, Iss 5, p 481 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.3390/systems14050481","is_oa":true,"landing_page_url":"https://doi.org/10.3390/systems14050481","pdf_url":"https://www.mdpi.com/2079-8954/14/5/481/pdf?version=1777460956","source":{"id":"https://openalex.org/S4210219410","display_name":"Systems","issn_l":"2079-8954","issn":["2079-8954"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Systems","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/17","score":0.45248985290527344,"display_name":"Partnerships for the goals"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7159762899.pdf","grobid_xml":"https://content.openalex.org/works/W7159762899.grobid-xml"},"referenced_works_count":35,"referenced_works":["https://openalex.org/W1666522225","https://openalex.org/W2010721283","https://openalex.org/W2033532106","https://openalex.org/W2039419042","https://openalex.org/W2081268742","https://openalex.org/W2119775317","https://openalex.org/W2125101272","https://openalex.org/W2617106014","https://openalex.org/W2795542725","https://openalex.org/W2905995088","https://openalex.org/W2935946062","https://openalex.org/W2937671064","https://openalex.org/W2944542598","https://openalex.org/W2947380608","https://openalex.org/W2976258142","https://openalex.org/W2977700483","https://openalex.org/W3006875937","https://openalex.org/W3016465862","https://openalex.org/W3157738910","https://openalex.org/W3208233057","https://openalex.org/W3217340555","https://openalex.org/W4224108448","https://openalex.org/W4290729055","https://openalex.org/W4313237050","https://openalex.org/W4313557420","https://openalex.org/W4366603052","https://openalex.org/W4376643581","https://openalex.org/W4379052824","https://openalex.org/W4381930012","https://openalex.org/W4388735956","https://openalex.org/W4392878895","https://openalex.org/W4406478653","https://openalex.org/W4411439382","https://openalex.org/W4412151261","https://openalex.org/W4414511893"],"related_works":[],"abstract_inverted_index":{"Provider":[0],"payment":[1,22,43,176,212],"reform":[2,30,86,105,127,151,177],"is":[3],"widely":[4],"regarded":[5],"as":[6,31,56,87],"an":[7],"important":[8],"policy":[9],"instrument":[10],"for":[11,206],"improving":[12],"medical":[13,61,71,144,197],"service":[14,62,190],"efficiency,":[15],"while":[16,112],"empirical":[17,202],"evidence":[18,171,203],"on":[19,60],"mixed":[20,41,210],"provider":[21,42,175,211],"systems":[23],"remains":[24],"limited.":[25],"Taking":[26],"China\u2019s":[27],"Sanming":[28,74],"healthcare":[29],"a":[32,40,65,88,96,158],"case,":[33],"this":[34],"study":[35,200],"examines":[36],"the":[37,57,81,85,104,108,126,150,163,170,174,184,207],"effects":[38,94],"of":[39,69,84,116,209],"system":[44],"that":[45,103,125,149,173],"combines":[46],"global":[47],"budgets":[48],"with":[49,130],"diagnosis-related":[50],"group":[51],"(DRG)-based":[52],"payment,":[53],"referred":[54],"to":[55,77,153],"\u201cdouble-bundling\u201d":[58],"reform,":[59],"performance.":[63],"Using":[64],"balanced":[66],"panel":[67],"dataset":[68],"public":[70],"institutions":[72],"in":[73,162,214],"from":[75,204],"2014":[76],"2023,":[78],"we":[79],"exploit":[80],"staggered":[82,97],"rollout":[83],"quasi-natural":[89],"experiment":[90],"and":[91,118,138,182,189],"estimate":[92],"its":[93],"using":[95],"difference-in-differences":[98],"approach.":[99],"The":[100],"results":[101,147],"show":[102],"significantly":[106],"reduced":[107],"inpatient-to-outpatient":[109],"admission":[110,132],"ratio":[111],"increasing":[113],"average":[114,164],"length":[115],"stay":[117],"bed":[119,140],"occupancy":[120],"rate.":[121],"These":[122],"findings":[123],"suggest":[124],"was":[128],"associated":[129],"higher":[131],"thresholds,":[133],"fewer":[134],"potentially":[135],"avoidable":[136],"hospitalizations,":[137],"improved":[139],"utilization":[141],"within":[142,193],"county-level":[143,196],"institutions.":[145],"Additional":[146],"indicate":[148],"contributed":[152],"outpatient":[154],"cost":[155,165],"containment":[156],"without":[157],"statistically":[159],"significant":[160],"increase":[161],"per":[166],"inpatient":[167],"admission.":[168],"Overall,":[169],"suggests":[172],"helped":[178],"strengthen":[179],"cost-control":[180],"incentives":[181],"improve":[183],"alignment":[185],"between":[186],"expenditure":[187],"restraint":[188],"delivery":[191,216],"efficiency":[192],"vertically":[194],"integrated":[195,215],"alliances.":[198],"This":[199],"provides":[201],"China":[205],"design":[208],"reforms":[213],"systems.":[217]},"counts_by_year":[],"updated_date":"2026-07-22T07:51:19.307946","created_date":"2026-05-03T00:00:00"}
