ArticleFrontiers in public health2025
Spillover effects of military healthcare reform on civilian hospitals in China.
Article in Frontiers in public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Military hospitals in China served a dual role, providing substantial healthcare to civilians alongside their primary mission of supporting military personnel. The 2015 military reform, which restricted military involvement in civilian services, may have unintentionally reshaped China's healthcare landscape. This study examined the reform's impact on civilian public hospitals, focusing on adjustments in service capacity. Methods: Using procurement data from China's Government Procurement Database (2015-2021), we applied a difference-in-differences approach to analyze procurement records of civilian public hospitals across cities with differing levels of military healthcare presence. The analysis controls for city-level socioeconomic characteristics. Heterogeneity analyses explore differential effects by geography, procurement size, hospital types, and medical specialty. Results: Following the reform, civilian hospitals in cities with more military hospitals significantly increased procurement compared to those in cities with fewer military hospitals, particularly after 2019. Specifically, in 2020, the procurement of civilian hospitals in a city with one additional military hospital increased by approximately 43% relative to less-exposed cities, underscoring a significant adjustment. The effect was concentrated in Tier-three hospitals and most pronounced in larger cities and cities located in the Eastern, Western, and Northern Theater Commands. The increase was mainly driven by larger-value purchases (top 50%). Military-specialized procurement (e.g., trauma treatment) showed earlier increases (2018-2019), while non-military specialties (e.g., pediatrics) exhibited delayed responses. Conclusion: The 2015 military reform inadvertently prompted an expansion of civilian hospital services to absorb displaced patient demand, illustrating the spillover effects of policy interventions in hybrid healthcare systems. These findings underscored the interdependence between military and civilian healthcare infrastructures and demonstrated the utility of procurement data for health policy analysis. Future reforms should consider such cross-system dynamics to minimize unintended spillover effects in access to healthcare.
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