JOYCE CHANG, DAVID WOOD, JIA XIAOFENG and BLAIR GIFFORD
Journal of the International Hospital Federation Volume 44 Number 4

In this report, the authors examine a major phenomenon in the Chinese healthcare marketplace: the explosion of a vigorous and demanding middle class and its impact on the future directions the industry should pursue.
Little is known about the expectations of the middle class regarding their healthcare needs other than through anecdotal or informal sources. The views of the middle class are shaped by a variety of influences which include exposure through direct personal contact with international healthcare facilities when traveling abroad or indirectly through increased exposure to the entertainment industry with its abundance of hospital and medical dramas. In addition to a general increased international awareness arising from more advanced education, the perspective of the middle class consumer is also shaped by the reality of what is currently available in China and what is realistic to expect. This report addresses this lack of factual data through an extensive survey of middle class consumers in three major cities in China: Beijing, Shanghai and Chengdu.

The survey took a practical and pragmatic approach to exploring this issue. No attempt was made in this study to explain why the consumer feels the way they do about their healthcare expectations. The purpose was simply to
outline what expectations the middle class have for the healthcare  marketplace in China.

In some respects the results are not surprising. They are the expectations that people have in any country, any where. They expect greater privacy and dignity in the care-giving process. They want to be more involved in the
decisions that are made regarding their care. They would prefer a personal, private physician as opposed to a revolving door of faces they will never see a second time. They rely strongly on family and friends to advise them on
their choice of provider. They expect clean, well-maintained facilities, efficient systems and courteous personnel.

In other respects, the conclusions are not necessarily expected. They feel strongly that their hospital or provider of care should be located in a residential area. They are willing in some circumstances to pay more for their care in order to meet their expectations but not significantly more. Despite acknowledging that many of the facets of care they seek such as greater respect for privacy and a generally perceived more positive attitude in the care-giving process are found in foreign physicians, middle class consumers do not express a strong preference for foreign physicians but opt instead for Chinese physicians.

In conclusion, the results provide an insight into the expectations held by middle class Chinese of their healthcare providers and outlines a direction for future healthcare development.

Gifford, Blair and Kestler, A
Journal of International Management Vol 14, Issue 4, Pages 340-352

This paper describes a current initiative by Newmont Mining Corporation (Newmont) to develop sustainable community benefit in communities around its mining operations in Peru in response to heightened criticism of Newmont by non-government organizations and the media. Using anthropologically oriented methods, a community health assessment project in an area of projected mining is described in detail in this paper. This case adds to London and Hart’s social embeddedness strategy for multi-national enterprises (MNEs) working in developing nations by introducing a locally-based community interaction model, which we describe as a local legitimacy strategy, in an effort to bring about sustainable development in the communities that surround a MNE’s production activities. The components of our local legitimacy strategy include co-analysis of community needs by MNEs and community partners, and planning and investment in developments to enhance the social fabric and the physical infrastructure needs of communities. The developing world is getting better at publicizing and monitoring the work of MNEs. We argue that it will be increasingly necessary for MNEs, like Newmont, to add local sustainable benefit into their strategic mix to gain the social license and legitimacy that is needed to operate in poorer communities. 

Blair Gifford and Andrew Kestler
Journal of International Management Vol. 14, Issue 4, p. 340-352

This paper describes a current initiative by Newmont Mining Corporation (Newmont) to develop sustainable community benefit in communities around its mining operations in Peru in response to heightened criticism of Newmont by non-government organizations and the media. Using anthropologically oriented methods, a community health assessment project in an area of projected mining is described in detail in this paper. This case adds to London and Hart’s social embeddedness strategy for multi-national enterprises (MNEs) working in developing nations by introducing a locally-based community interaction model, which we describe as a local legitimacy strategy, in an effort to bring about sustainable development in the communities that surround a MNE’s production activities. The components of our local legitimacy strategy include co-analysis of community needs by MNEs and community partners, and planning and investment in developments to enhance the social fabric and the physical infrastructure needs of communities. The developing world is getting better at publicizing and monitoring the work of MNEs. We argue that it will be increasingly necessary for MNEs, like Newmont, to add local sustainable benefit into their strategic mix to gain the social license and legitimacy that is needed to operate in poorer communities.

Mary E. Plomondon, David J. Magid, John F. Steiner, Samantha Whinney, Blair D. Gifford, Sarah C. Shih, Gary K. Grunwald and John S. Rumsfeld
American Journal of Managed Care Vol. 13, Issue 8, p. 465-472

Objectives: To examine the association between primary care provider turnover in managed care organizations and measures of member satisfaction and preventive care.

Study Design: Retrospective cohort study of a national sample of 615 managed care organizations that reported HEDIS® data to the National Committee for Quality Assurance from 1999 through 2001.

Methods: Multivariable hierarchical regression modeling was used to evaluate the association between health plan primary care provider turnover rate and member satisfaction and preventive care measures, including childhood immunization, well-child visits, cholesterol, diabetes management, and breast and cervical cancer screening, adjusting for patient and organizational characteristics, time, and repeated measures.

Results: The median primary care provider turnover rate was 7.1% (range, 0%-53.3%). After adjustment for plan characteristics, health plans with higher primary care provider turnover rates had significantly lower measures of member satisfaction, including overall rating of healthcare (P < .01). A 10% higher primary care provider turnover rate was associated with 0.9% fewer members rating high overall satisfaction with healthcare. Health plans with higher provider turnover rates also had lower rates of preventive care, including childhood immunization (P = .045), well-child visits (P = .002), cholesterol screening after cardiac event (P = .042), and cervical cancer screening (P = .024). For example, a 10% higher primary care provider turnover was associated with a 2.7% lower rate of child-members receiving well-child visits in the first 15 months of life.

Conclusions: Primary care provider turnover is associated with several measures of care quality, including aspects of member satisfaction and preventive care. Future studies should evaluate whether interventions to reduce primary care provider turnover can improve quality of care and patient outcomes.

Gifford, B. and Wood, D.
Advances in Healthcare Management Vol. 5, p. 101-115

Globalization of previous term health next term care services is becoming an alternative or complementary strategy for some U.S. previous termhealthnext term care organizations due to increased competition, a stagnant previous termhealthnext term care market, and nationally imposed cost constraints in the U.S. Additionally, entrepreneurial U.S. firms may see globalization as an opportunity to promote their services in new countries with increasing demand for advanced technological services. If an ambitious American previous termhealthnext term care firm decides to globalize its product or service lines, what might be some of the primary strategies it would use to enter an international market? To investigate this question, this chapter considers the strategies of two American firms that have entered the Beijing and Shanghai markets since 2000. We conducted numerous telephone conversations and interviews with executives of these firms in an attempt to understand their market entry and early development strategies. These firms’ market entry strategies range from “greenfield” operations, where the hospital does little to change its corporate and managerial style from what it uses domestically, to a “glocalization” strategy, where the firm is quite sensitive to fitting into the Chinese culture and being accepted by the Chinese government. The strategic challenges for international hospital organization developments in China are many, but the potential rewards from becoming among the leading firms in a large nation with an expanding economy are tremendous. What we learn from the experiences of enterprising American hospital firms in Chinese may well portend the future for international developments by many other American-based previous term health next term organizations.