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Gao Y, Guo Y, Deng J. Effects of and Prospects for the Hierarchical Medical Policy in Beijing, China. Healthcare (Basel) 2023; 11:healthcare11081067. [PMID: 37107901 PMCID: PMC10137581 DOI: 10.3390/healthcare11081067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Hierarchical medical policies are widely used worldwide to reduce healthcare costs, rationalize the use of healthcare resources, and improve accessibility and fairness of healthcare services. However, few case studies have evaluated the effects and prospects of such policies. Medical reform efforts in China have distinct goals and characteristics. Therefore, we investigated the effects of a hierarchical medical policy in Beijing and assessed the future potential of the policy to yield insights for other countries, especially developing countries. Different methods were used to analyze multidimensional data from official statistics, a questionnaire survey of 595 healthcare workers from 8 representative public hospitals in Beijing, a questionnaire survey of 536 patients, and 8 semi-structured interview records. The hierarchical medical policy had strong positive effects on improving access to healthcare services, balancing the workload of healthcare workers in various levels of public hospitals, and improving the management of public hospitals. The remaining obstacles include severe job stress among healthcare workers, the high cost of some healthcare services, and the need for improvement in the development level and service capacity of primary hospitals. This study provides useful policy recommendations regarding the implementation and extension of the hierarchical medical policy, including the need for governments to improve the hospital assessment system and for hospitals to actively participate in developing medical partnerships.
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Affiliation(s)
- Yongchuang Gao
- School of Labor and Human Resources, Renmin University of China, 59 Zhongguancun Street, Beijing 100872, China
| | - Yuangeng Guo
- School of Economics and Management, Tsinghua University, 30 Shuangqing Street, Beijing 100084, China
| | - Jianwei Deng
- School of Management and Economics, Beijing Institute of Technology, 5 Zhongguancun South Street, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, 5 Zhongguancun South Street, Beijing 100081, China
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Shi H, Liu Z, Liu HC. A new linguistic preference relation-based approach for failure mode and effect analysis with dynamic consensus reaching process. Inf Sci (N Y) 2022. [DOI: 10.1016/j.ins.2022.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Wang H, Xu C, Di R, Xu Z. Analytic hierarchical process with stochastic uncertainty: A case study of governmental audits in China. Inf Sci (N Y) 2022. [DOI: 10.1016/j.ins.2022.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Zhao M, Wang X, Xu Z, Lin M. A PL-MCDM Method based on the Decision-Making Reliability of Multi-Group for Patients with Chronic Diseases Requiring Downward Referral. APPL INTELL 2022. [DOI: 10.1007/s10489-021-02436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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5
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Does Internet Use Affect Medical Decisions among Older Adults in China? Evidence from CHARLS. Healthcare (Basel) 2021; 10:healthcare10010060. [PMID: 35052224 PMCID: PMC8775657 DOI: 10.3390/healthcare10010060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The rapid growth of the elderly population poses a huge challenge for people to access medical services. The key to get rid of the dilemma is for patients to go firstly to primary medical institutions. Existing studies have identified numerous factors that can affect patients’ health institution choice. However, we currently know little about the role of Internet use in the patients’ medical decisions. The objective of this study is to explore health-seeking behavior and institution choice under the background of the Internet era from the perspective of older adults, and to analyze whether the Internet could guide patients to the appropriate medical institution so as to accomplish hierarchical treatment. Methods: The dataset comprises 9416 people aged 45 or above from the China Health and Retirement Longitudinal Survey (CHARLS), which, through multistage cluster sampling, was conducted in 2011, 2013, and 2015. Logistic regression, PSM, and FE model are used to estimate the influence of Internet use on the health care decision-making behavior. Results: Internet use has a significant positive impact on the self-treatment of common diseases (β = 0.05, p < 0.05). In terms of medical institution choices, those who use Internet are more inclined to choose top-level hospitals than community health service institutions to treat common diseases (β = 0.06, p < 0.01). Conclusions: The Internet has lowered the obstacles to learning about common ailments, resulting in a substitution impact of self-treatment for hospital care. However, Internet use may aggravate older adults’ perception of the risk of disease, which exacerbates the tendency of going to higher-level medical institutions for medical treatment. The finding of the study is useful for further rational planning and utilization of the Internet in order to guide patients to appropriate medical institution, which helps to improve the efficiency of the overall medical and health services.
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Khajehvand M, Fakharian A, Sedighizadeh M. A risk-averse decision based on IGDT/stochastic approach for smart distribution network operation under extreme uncertainties. Appl Soft Comput 2021. [DOI: 10.1016/j.asoc.2021.107395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Batur Sir GD, Sir E. Pain Treatment Evaluation in COVID-19 Patients with Hesitant Fuzzy Linguistic Multicriteria Decision-Making. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8831114. [PMID: 33604012 PMCID: PMC7872770 DOI: 10.1155/2021/8831114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/02/2021] [Accepted: 01/19/2021] [Indexed: 12/25/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic since March 2020. Although most patients complain of moderate or severe pain, these symptoms are generally underestimated and appropriate treatment is not applied. This study aims to guide physicians in selecting and ranking various alternatives for the treatment of pain in COVID-19 patients. However, the choice of treatment for pain requires the consideration of many different conflicting criteria. Therefore, we have studied this problem as a multicriteria decision-making problem. Throughout the solution procedure, first, the criteria and subcriteria affecting the preferences are defined. Then, weight values are determined with respect to these criteria, as they have different degrees of importance for the problem. At this stage, hesitant fuzzy linguistic term sets (HFLTSs) are used, and thus, experts can convey their ideas more accurately. In this first phase of the study, an HFLTS integrated Analytic Hierarchy Process (AHP) method is utilized. Subsequently, possible treatment alternatives are evaluated by using the Vise Kriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method. According to the results obtained by considering expert evaluations, the most preferred treatment is the administration of paracetamol, followed by interventional treatments, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs), respectively. With this study, it is ensured that a more accurate method is followed by eliminating possible mistakes due to the subjective evaluations of experts in the process of determining pain treatment. This method can also be used in different patient and disease groups.
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Affiliation(s)
- G. Didem Batur Sir
- Department of Industrial Engineering, Gazi University, Ankara 06570, Turkey
| | - Ender Sir
- Department of Algology and Pain Medicine, Health Sciences University, Gülhane Training and Research Hospital, Ankara 06010, Turkey
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Zheng Y, Xu Z, He Y. A novel weight‐derived method and its application in graduate students' physical health assessment. INT J INTELL SYST 2020. [DOI: 10.1002/int.22297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Zeshui Xu
- Business School Sichuan University Chengdu China
| | - Yue He
- Business School Sichuan University Chengdu China
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Ma Q, Sun D, Cui F, Zhai Y, Zhao J, He X, Shi J, Gao J, Li M, Zhang W. Impact of the Internet on Medical Decisions of Chinese Adults: Longitudinal Data Analysis. J Med Internet Res 2020; 22:e18481. [PMID: 32880581 PMCID: PMC7499166 DOI: 10.2196/18481] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The internet has caused the explosive growth of medical information and has greatly improved the availability of medical knowledge. This makes the internet one of the main ways for residents to obtain medical information and knowledge before seeking medical treatment. However, little has been researched on how the internet affects medical decisions. OBJECTIVE The purpose of this study was to explore the associations between internet behaviors and medical decisions among Chinese adults aged 18 or over, including whether to go to the hospital and which level of medical institution to choose. METHODS With the adult residents (≥18 years old) in 12 regions including urban and rural areas taken as the research objects, the differences in medical choices of adults with various characteristics were analyzed, and generalized linear mixed models were adopted to analyze the longitudinal data of the China Health Nutrition Survey from 2006 to 2015. RESULTS Adult groups with different ages, genders, education levels, regions, places of residence, severities of illness and injury, years of suffering from hypertension, and history of chronic diseases showed diverse medical decisions, and the differences were statistically significant (P<.05). After controlling for these potential confounding factors and taking self-care as the reference, the probability of Chinese adults who participated in online browsing activities selecting hospital care was 0.82 (95% CI 0.69-0.98; P=.03) times that of residents who did not participate in online browsing activities. In terms of medical institution choices, adults who participated in online browsing activities were 1.86 (95% CI 1.35-2.58; P<.001) times more likely to opt for municipal medical treatment than primary care. However, the effect of online browsing on the selection probability of county-level hospitals was not significant compared with primary hospitals (P=.59). Robust analysis verified that accessing the internet had a similar effect on Chinese adults' medical decisions. CONCLUSIONS Chinese adults who use the internet are a little less likely to go to the hospital than self-care. The internet has broken down the barriers to obtain knowledge of common diseases and thus has a slight substitution effect of self-care on hospital care. Internet use may increase the probability of adults going to municipal hospitals. The rising tendency of visiting high-level medical institutions may be consequently exacerbated due to knowledge monopoly of severe and complicated diseases that is difficult to eliminate, and the increase in inconsistent and incomplete medical information online will blur the residents' cognitive boundary of common diseases and severe diseases. Exploring the substantive impact of the internet on medical decision making is of great significance for further rational planning and utilization of the internet, in order to guide patients to appropriate medical institution.
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Affiliation(s)
- Qianqian Ma
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Dongxu Sun
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Fangfang Cui
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Yunkai Zhai
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
- School of Management Engineering, Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Zhao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Xianying He
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Jinming Shi
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Jinghong Gao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Mingyuan Li
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Wenjie Zhang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
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Yang Y, Li H, Zhang Z, Liu X. Interval-valued intuitionistic fuzzy analytic network process. Inf Sci (N Y) 2020. [DOI: 10.1016/j.ins.2020.03.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Analysis of the Impact of China’s Hierarchical Medical System and Online Appointment Diagnosis System on the Sustainable Development of Public Health: A Case Study of Shanghai. SUSTAINABILITY 2019. [DOI: 10.3390/su11236564] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the study of the sustainable development of public health in China, academic circles have little to do with the unique hierarchical medical system and online appointment diagnosis system in China’s medical system. Therefore, based on the medical situation in Shanghai, China, in addition to the traditional dimension of medical expenses, this paper fully considers the impact of the current hierarchical medical policy, constructs a selection model for medical treatment behavior under the hierarchical medical system and online appointment diagnosis system, and carries out simulation analysis through the cellular automata grid dynamic model. This paper finds that the time-cost-oriented medical treatment behavior of Chinese patients will have different distribution under the current hierarchical medical system and online appointment diagnosis system. (1) When the medical treatment system neither allows online appointment nor referral, a large number of patients congregated in high-grade hospitals, with the most unreasonable distribution. (2) With the implementation of the system of allowing referral and online appointment, patients are gradually diverted to lower-grade hospitals or off-peak hours, and the distribution is relatively improved. (3) If the medical treatment system allows both referral and online appointment, the distribution of patients is the most reasonable. Therefore, China’s current hierarchical medical system and online appointment diagnosis system will, to a considerable extent, become a policy tool that affects patients’ choice of hospitals and an effective means to achieve the rational allocation of existing medical resources, which will play an important role in the sustainable development of public health in China.
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Gao X, Shi C, Zhai K. An Evaluation of Environmental Governance in Urban China Based on a Hesitant Fuzzy Linguistic Analytic Network Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112456. [PMID: 30400368 PMCID: PMC6266594 DOI: 10.3390/ijerph15112456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/12/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022]
Abstract
The aim of this study is to evaluate the performance of urban environmental governance by developing hesitant fuzzy linguistic analytic network process (HFL-ANP). The study bridges the gaps in current knowledge in the following ways: the study methodically develops the HFL-ANP method to evaluate and pick the optimal environmental governance strategy from alternatives; theoretically, network structure of evaluation indicators system on environmental governance is constructed, and the objective and subjective information in the evaluation process of environmental governance is combined. In detail, based on the environmental Kuznets curve (EKC) and the pollution haven hypothesis, the paper constructs the evaluation indexes system of environmental governance and takes observation time length into consideration. Then, we choose three urban cases of environmental governance by exploring the existing literature. Furthermore, we develop the HFL-ANP method and apply it to the cases. The study calculates the initial weights of all indexes by using multiplicative consistency of the HFL preference relation, and derives the decision matrix through combining objective information with subjective information of environmental governance. Finally, we come to the following conclusions: ANP network stricture is close to real-world practical problems and provides the basis for HFL-ANP method; HFL-ANP is a very suitable method of assessing environmental governance; and based on the urban cases of environmental governance, Shanghai is the optimal alternative. In addition, this indicator system can only be applied to cities in China, and the administrative hierarchy of policies has not been considered by this method. Thus, future studies should expand this method and indicator network to contain different countries and different administrative hierarchy.
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Affiliation(s)
- Xing Gao
- The Bartlett School of Planning, University College London, London WC1E 6BT, UK.
| | - Cheng Shi
- College of Architecture and Urban Planning, Tongji University, Shanghai 200092, China.
| | - Keyu Zhai
- School of Education, University of Glasgow, Glasgow G12 8QQ, UK.
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