Efficiency of medical service systems in the rural areas of Mainland China: a comparative study from 2013 to 2017

Spatiotemporal dynamics and determinants of medical service efficiency in China

BACKGROUND

Medical service efficiency is an important indicator for measuring the equity of medical services. Therefore, this study primarily focuses on investigating the spatiotemporal domain to explore both spatial and temporal characteristics, as well as influencing factors that affect medical service efficiency across diverse provinces in China.

METHODS

The super Epsilon-based Measure (EBM) unexpected model has previously been utilized to quantify energy eco-efficiency, carbon emission efficiency, and green development efficiency. However, limited studies have applied this method to assess the efficiency of healthcare services. Therefore, this study investigates the application of the super-EBM-unexpected model in evaluating medical service efficiency, and further integrates spatial econometric models to explore the influencing factors of medical service efficiency and aims to identify potential avenues for improvement.

RESULTS

The average efficiency of medical services in the 31 provinces of China ranges from 0.6 to 0.7, indicating predominantly low efficiency values. However, economically developed coastal areas exhibit relatively high efficiency levels above 1. Conversely, regions with relatively lower levels of economic development demonstrate lower efficiency rates at approximately 0.3. Evidently, substantial regional disparities exist. For the influencing factors, the enhancement of residents' living standards can effectively foster the medical service efficiency, while residential living standards of nearby areas can also exert an impact in this region. The influence of educational attainment on medical service efficiency exhibits a significant inhibitory effect.

CONCLUSIONS

The majority of China's 31 provinces exhibit suboptimal medical service efficiency, with notable regional disparities. Future policy initiatives should be tailored to address the unique challenges faced by regions with lower levels of economic development, prioritizing enhancements in both the efficacy and quality of their healthcare systems.

Technical efficiency and its convergence among village clinics in rural China: evidence from Shanxi Province

Introduction

Village clinics (VCs) are the foundation of the three-tiered health service system in China, delivering basic and routine outpatient services to citizens in rural China. VC technical efficiency and its convergence play a critical role in policy decisions regarding the distribution of health service resources in rural China.

Methods

This study measured VC technical efficiency (using the slacks-based measure model), its convergence (using the convergence model), and the factors that influence the convergence in Shanxi Province, China. Data were obtained from the Shanxi Rural Health Institute 2014-2018 Health Statistics Report, which involved 3,543 VCs.

Results

The results showed that VC technical efficiency was low and differed by region. There was no α convergence in VC technical efficiency, but evidence of β convergence was found in Shanxi. The main factors that influence convergence were the building area of each VC (BA), proportion of government subsidies (PGS), and ratio of total expenditure to total income of each VC (RTETI).

Conclusion

The government should increase investments in VCs and improve VC technical efficiency. Meanwhile, the government should be aware of and take measures to curb the inequity in VC technical efficiency among different regions and take suitable measures to curb this disparity.

A latent class analysis of family resilience and its relationship with fear of recurrence in lung cancer patients: a cross-sectional study

PURPOSE

Family resilience helps cancer-affected families overcome challenges and may influence an individual's fear of cancer recurrence (FCR). Identifying distinct classes of family resilience among lung cancer patients is crucial for tailored interventions. This study aimed to identify latent classes of family resilience in lung cancer patients and explore their relationships with FCR.

METHODS

Three hundred ten lung cancer patients from three hospitals in Fujian were recruited from June to September 2021. Clinical data were extracted from medical records, while sociodemographic details, family resilience, and FCR were self-reported. A latent class analysis was performed to identify family resilience classes.

RESULTS

A 4-class solution showed the best fit. Compared to Class 1, the patients who had no comorbidities (ORs = 3.480-16.005) had an increased likelihood of belonging to Class 2 and 3, while those who were not family breadwinners (ORs = 0.118-0.176) had a decreased likelihood. Further, the patients who (1) did not lack interest/pleasure in doing things during the past 2-week period (OR = 7.057), (2) were never smokers (OR = 6.230), and (3) were urban residents (OR = 8.985) had an increased likelihood of belonging to Class 4, while those who were (1) male (OR = 0.167), (2) not the family breadwinner (OR = 0.152), and (3) had none or only one child (OR = 0.203) had a decreased likelihood of belonging to Class 4. The FCR level differed significantly among these four classes.

CONCLUSION

Our study identified four distinct classes of family resilience among Chinese lung cancer patients. FCR severity decreased with increasing levels of family resilience.

Equity and efficiency of health resource allocation in township health centers in Sichuan Province, China

OBJECTIVE

To analyze the equity and efficiency of health resource allocation in township health centers in Sichuan Province, and to provide a scientific basis for promoting the development of township health centers in Sichuan Province, China.

METHODS

The Lorenz curve, Gini coefficient and health resource density index were used to analyze the equity of health resource allocation in township health centers in Sichuan Province from 2017 to 2021, and data envelopment analysis(DEA) was used to analyze the efficiency of health resource allocation in township health centers in Sichuan Province from 2017 to 2021.

RESULTS

The Gini coefficient of health resources of township health centers in Sichuan Province is below 0.2 by population in addition to the number of beds in 2020-2021 and practicing (assistant) physicians in 2021, and the Gini coefficient of health resources of township health centers in Sichuan Province is above 0.6 by geography. The Lorentz curve of health resources of township health centers in Sichuan Province is closer to the equity line by population allocation and further from the equity line by geographical allocation. The average level of township health centers in Sichuan Province is used as the standard to calculate the health resource density standard index(W) of each region, the Ws of Panzhihua, Ganzi, Aba and Liangshan are less than 1, and the Ws of Ziyang, Neijiang, Deyang and Meishan are greater than 1. The overall efficiency of township health centers in Sichuan Province in 2017 and 2021 is 1, and the DEA is relatively effective. The overall efficiency of township health centers in Sichuan Province in 2018 and 2019 is not 1, and the DEA is relatively ineffective. The overall efficiency of all health resources in Mianyang and Ziyang is 1, and the DEA is relatively effective. The overall efficiency of all health resources in Suining, Neijiang, Yibin, Aba and Ganzi is not 1, and the DEA is relatively ineffective.

CONCLUSION

The equity of health resource allocation by population is better than that by geography in township health centers in Sichuan Province. Combining population and geographical factors, the health resource allocation of Panzhihua, Ganzi, Aba and Liangshan is lower than the average level of Sichuan Province. The efficiency of health resource allocation in township health centers in Sichuan Province is low.

Human Resources Allocation of the Centers for Disease Control and Prevention in China

Objective

To analyze the equity of human resources allocation of the Centers for Disease Control and Prevention (CDCs) and to predict the development in the next five years in China, and to provide a scientific basis for promoting the development of human resources.

Methods

The data of the CDCs from 2017 to 2021 were obtained from the "China Health Statistical Yearbook", and descriptive analysis, health resource density index (HRDI), Theil index, and health resource agglomeration degree (HRAD) were used to evaluate the equity, and the grey prediction model GM (1, 1) was used to predict the development from 2022 to 2026.

Results

Measured by the HRDI, the shortage of human resources in the western region was relatively obvious, with a shortage of more than 11,656 health technicians, more than 6418 licensed (assistant) physicians, and more than 693 registered nurses. The Theil index of human resources allocation by population was between 0.016 and 0.071, and the Theil index of human resources allocation by geography was between 0.312 and 0.359. The allocation of human resources by geography was more unequal than those allocated by population. In terms of HRAD, human resources are over-allocated equitably by geography in the eastern and central regions, while they are under-allocated equitably by geography in the western region. In terms of the difference between the HRAD and PAD, the eastern region has a shortage of human resources relative to the concentration population, and the western region has an excess of human resources relative to the concentration population.

Conclusion

The human resources allocation of the CDCs in China was uneven. The human resources of the CDCs were allocated more equitably by population than by geography. There was a situation where the equity of human resource allocation of the CDCs was contrary to the actual demand for medical care.

Can Comprehensive Medical Reform Improve the Efficiency of Medical Resource Allocation? Evidence From China

Objectives: To evaluate the impact of comprehensive medical reform on the efficiency of medical resource allocation in China. Methods: This study employs the Slacks-Based Measure- Directional Distance Function (SBM-DDF) to estimate the efficiency of medical resource allocation (MRAE) in China, using panel data from 30 provinces during 2009-2021. Moreover, a multi-period Difference in differences (DID) model is developed to explore the effect of the comprehensive medical reform pilot (CMRP) strategy on efficiency of medical resource allocation in China. Results: The results show that the average value of China's medical resources allocation efficiency is 0.861 during the sample period. Coastal area has a higher MRAE than that in the inland area. The DID results show that the comprehensive medical reform pilot strategy has a good, long-lasting impact on the efficiency of medical resource allocation. And the results remain valid after a series of robustness analysis. Additionally, the comprehensive medical reform policy has heterogeneous impact on efficiency of medical resource allocation. The promotion effect is only statistically significant in the eastern and central regions, the groups of higher MRAE and larger population size. Conclusion: China's comprehensive medical reform policy can effectively promote the improvement of regional efficiency of medical resource allocation.

Measurement and characteristics of the temporal-spatial evolution of China's healthcare services efficiency

BACKGROUND

Healthcare services efficiency (HSE) is directly related to the healthcare demands of the general public and also plays an essential role in the country's coordinated economic and social development.

METHODS

In this study, the stochastic frontier approach (SFA)-Malmquist model was applied to measure the HSE of 31 Chinese provinces based on panel data from 2010-2020. Then, kernel density estimation, Markov chain, and exploratory spatial data analysis were adopted to study the temporal-spatial dynamic evolution characteristics of the HSE.

RESULTS

The study found that China's HSE showed an average value of approximately 0.841, indicating room for improvement. The HSE varied significantly across regions, presenting an "East > Central > West" distribution layout. The TFP of healthcare services in China grew by 1.6% per year, driven mainly by technological progress of 1.8% per year. The trend of the HSE shifting to a high level in China was significant, but its evolution exhibited stability of maintaining the original state, and it was harder to achieve leapfrog transfer. The temporal-spatial evolution of the HSE was also significantly affected by geospatial factors, with a clear spatial spillover effect and spatial agglomeration characteristics. Provinces with high-level HSE exhibited positive spatial spillover effects, while provinces with low-level HSE had negative spatial spillover effects. Thus, the "club convergence" phenomenon of "high efficiency concentration, low efficiency agglomeration, high levels of radiation, and low levels of suppression" was formed in the spatial distribution.

CONCLUSIONS

The results indicate that countermeasures should be taken to improve the HSE in China. Theoretical support for the improvement of HSE is provided in this paper.

Efficiency and productivity analysis of maternal and infant healthcare services in Sub-Saharan Africa

The paper examines the efficiency and productivity of Sub-Saharan African (SSA) countries towards maternal and infant healthcare services between 2015 and 2019. Data envelopment analysis is utilised to evaluate efficiency, and Malmquist-Luenberger's (ML) productivity estimation is employed for productivity analysis. The results indicate inefficiency in SSA maternal and infant healthcare services. Average efficiency is pegged at 85%, and 60% of the countries evaluated had below-average efficiency. Effects of socioeconomic dynamics of countries were analysed. Preliminary estimations on the impact of Gross domestic product (GDP), education, urban population, and total population on efficiency are not significant. Although GDP and education sometimes show that they influence efficiency positively. Sensitivity analysis indicates efficiency to be more responsive to health expenditure, as well as to nurses and midwives. ML Productivity decomposition into technical efficiency change and technological change indicates improvement in technical efficiency as the principal driver of efficiency and productivity. Policy recommendations are made in line with the findings, requirements, and constraints of SSA countries.

Unmet healthcare needs, health outcomes, and health inequalities among older people in China

Objective

This study examines whether the experience of unmet healthcare needs in a large sample of Chinese adults aged 60 and over is associated with adverse health outcomes, and how this association varied across needs related to health conditions.

Study design

The 2013 wave of the China Health and Retirement Longitudinal Study is examined. We adopted latent class analysis to identify groups based on health conditions. Then in each identified group, we examined the extent to which unmet needs were associated with self-rated health and depression. To understand the channels through which unmet needs adversely affected health outcomes, we examined the impact of unmet needs attributed to various factors.

Results

Compared to the mean, experiencing unmet outpatient needs is associated with a 3.4% decrease in self-rated health, and people are twice as likely to have depression symptoms (OR = 2.06). Health problems are even more severe when inpatient needs are not met. The frailest people are most affected by affordability-related unmet needs, while healthy people are most affected by unmet needs attributable to availability.

Conclusion

To tackle unmet needs, direct measures for particular populations will be required in the future.

Evaluation of the allocation efficiency of medical and health resources in China's rural three-tier healthcare system

OBJECTIVES

Evaluating the efficiency of health resource allocations is critical to improving China's rural three-level health service network.

STUDY DESIGN

This was a prospective panel data study.

METHODS

Based on panel data of the medical and health resources of 31 provinces within rural China, collected from 2003 to 2020, this study uses a three-stage Data Envelopment Analysis-Malmquist index to analyze the evolution of efficiency and productivity.

RESULTS

The efficiency and productivity of county and county-level medical and health institutions rank highest, followed by township hospitals, whereas village clinics are shown to be in great need of improvement. A decline in technical advancement appears as a crucial factor exacerbating loss of factor productivity.

CONCLUSIONS

Policy makers should further optimize the efficiency of medical resource allocation and promote the coordinated development of rural health in China.

A study of primary health care service efficiency and its spatial correlation in China

BACKGROUND

China's primary health care system has undergone major changes since the new round of medical reform in 2009, but the current status of primary health care institution service efficiency is still unsatisfactory. The purpose of this study is to compare and evaluate the China's primary health care institution service efficiency and provide a reference for improving the efficiency and promoting the development of primary health care institution.

METHODS

Based on panel data of 31 provinces (municipalities directly under the central government and autonomous regions) in mainland China from 2011 to 2020, using the super efficiency slack-based measure-data envelopment analysis model, to analyze the data from a static perspective, and the changes in the efficiency of primary health care services were analyzed from a dynamic perspective by using the Malmquist index method. Spatial autocorrelation analysis method was used to verify the spatial correlation of primary health care service efficiency among various regions.

RESULTS

The number of Primary health care institutions increased from 918,000 in 2011 to 970,000 in 2020. The average primary health care institution service efficiency in the northeastern region including Jilin (0.324), Heilongjiang (0.460), Liaoning (0.453) and northern regions such as Shaanxi (0.344) and Neimenggu (0.403) was at a low level, while the eastern coastal regions such as Guangdong (1.116), Zhejiang (1.211), Shanghai (1.402) have higher average service efficiency levels. The global Moran's I showed the existence of spatial autocorrelation, and the local Moran's I index suggested that the problem of uneven regional development was prominent, showing a contiguous regional distribution pattern. Among them, H-H (high-efficiency regions) were mainly concentrated in Jiangsu, Anhui and Shanghai, and L-L regions (low-efficiency regions) were mostly in northern and northeastern China.

CONCLUSION

The service efficiency of primary health care institution in China showed a rising trend in general, but the overall average efficiency was still at a low level, and there were significant geographical differences, which showed a spatial distribution of "high in the east and low in the west, high in the south and low in the north". The northwestern region, after receiving relevant support, has seen a rapid development of primary health care, and its efficiency was steadily improving and gradually reaching a high level. The average primary health care institution service efficiency in the northeastern region including the northern region of China was at a low level, while the average efficiency in the eastern coastal region and some economically developed regions was high, which also verifies the dependence and high symbiosis of primary health care institution service efficiency on regional economy.

Efficiency Measurement Using Data Envelopment Analysis (DEA) in Public Healthcare: Research Trends from 2017 to 2022

With the shifting healthcare environment, the importance of public healthcare systems is being emphasized, and the efficiency of public healthcare systems has become a critical research agenda. We reviewed recent research on the efficiency of public healthcare systems using DEA, which is one of the leading methods for efficiency analysis. Through a systematic review, we investigated research trends in terms of research purposes, specific DEA techniques, input/output factors used for models, etc. Based on the review results, future research directions are suggested. The results of this paper provide valuable information and guidelines for future DEA research on public healthcare systems.

Using Shannon Entropy to Improve the Identification of MP-SBM Models with Undesirable Output

In the context of the COVID-19 global epidemic, it is particularly important to use limited medical resources to improve the systemic control of infectious diseases. There is a situation where a shortage of medical resources and an uneven distribution of resources in China exist. Therefore, it is important to have an accurate understanding of the current status of the healthcare system in China and to improve the efficiency of their infectious disease control methods. In this study, the MP-SBM-Shannon entropy model (modified panel slacks-based measure Shannon entropy model) was proposed and applied to measure the disposal efficiency of the medical institutions responding to public health emergencies (disposal efficiency) in China from 2012 to 2018. First, a P-SBM (panel slacks-based measure) model, with undesirable outputs based on panel data, is given in this paper. This model measures the efficiency of all DMUs based on the same technical frontier and can be used for the dynamic efficiency analysis of panel data. Then, the MP-SBM model is applied to solve the specific efficiency paradox of the P-SBM model caused by the objective data structure. Finally, based on the MP-SBM model, undesirable outputs are considered in the original efficiency matrix alignment combination for the deficiencies of the existing Shannon entropy-DEA model. The comparative analysis shows that the MP-SBM-Shannon model not only solves the problem of the efficiency paradox of the P-SBM model but also improves the MP-SBM model identification ability and provides a complete ranking with certain advantages. The results of the study show that the disposal efficiency of the medical institutions responding to public health emergencies in China shows an upward trend, but the average combined efficiency is less than 0.47. Therefore, there is still much room for improvement in the efficiency of infectious disease prevention and control in China. It is found that the staffing problem within the Center for Disease Control and the health supervision office are two stumbling blocks.

The Impact of County Medical Community Reform on the Medical Service Efficiency of County-Level Public General Hospitals in China: A Case Study of Shanxi Province

China introduced the county medical community (CMC) reform, aimed to provide high-quality medical resources to rural citizens, in 2017. This study examines the impact of the reform on the medical service efficiency of county-level public general hospitals in Shanxi Province, China. In total, 92 county-level public general hospitals from Shanxi Province were taken as the research objective, and the super-efficiency SBM-DEA model was applied to measure medical service efficiency. Further, a two-way fixed-effect model was used to evaluate the impact of CMC reform on the medical service efficiency of county-level public general hospitals by using health statistics data from 2014 to 2018. The study reveals that the CMC reform improved the medical service efficiency of county-level public general hospitals by 15.6%. Moreover, the CMC reform had regional heterogeneity in its impact on the medical service efficiency of county-level public general hospitals. The CMC reform improved the medical service efficiency of hospitals in the southern region more than in the northern region of the province. The medical service efficiency of hospitals in the central region was also improved by CMC reform, but the causal relationship was not found significant. Further, hospital-level factors (e.g., fixed assets, hospital stay, and regional health center) and environmental factors (e.g., GDP, population, urbanization rate, and government subsidies) affected the medical service efficiency of county-level public hospitals during the process of promoting the CMC reform.

Public Health Services, Health Human Capital, and Relative Poverty of Rural Families

With the successful completion of the battle against poverty, after 2020, the focus and difficulty of China's poverty governance will change from solving absolute poverty to alleviating relative poverty. Analyzing and studying the alleviation of relative poverty from the perspective of public health services is in line with the current needs of consolidating and expanding poverty alleviation in China, and it is also of great significance to building a long-term solution mechanism for relative poverty. In this study, basic panel data were constructed by using the data of five CFPS surveys in 2010, 2012, 2014, 2016, and 2018 and matched with the macro data. The correlation between public health services and rural households' relative poverty was also analyzed by using logit regression analysis and the KHB mediation effect decomposition method. The results show that (1) public health services play a significant role in promoting the accumulation of health human capital, improving individual feasible ability, and alleviating the relative poverty of rural families; (2) the improvement of public health services is conducive to the alleviation of the relative poverty of rural families; (3) we should continue to increase investment in public health care in underdeveloped areas and strive to promote the balanced development of public health services, so as to further consolidate and expand the achievements of poverty eradication.

Grandchild care, inadequate medical insurance protection, and inequalities in socioeconomic factors exacerbate childhood obesity in China

This study examines the influences of grandchild care and medical insurance on childhood obesity. Nationally representative longitudinal data-from the China Family Panel Studies 2010-2020-of 26,902 school-age children and adolescents aged 6-16 years and China's new reference standard ("WS/T586-2018") are used to identify a child's obesity status. Using binary mixed-effects logistic regression models and the Blinder-Oaxaca decomposition method, this study explores the roots of obesity inequalities and finds that at least 15% of Chinese children aged 6-16 were obese in the 2010s. The logistic regression analysis results indicate that grandchild care, public medical insurance, and commercial medical insurance are key risk factors of child obesity. However, the influences are heterogeneous in different groups: Grandchild care and public medical insurance increase urban-rural obesity inequalities because of a distribution effect, and grandchild care may also exacerbate children obesity inequalities between left-behind and non-left-behind children owing to the event shock of parental absence. Inequalities in socioeconomic status (SES) factors such as income, education, and region also cause obesity inequalities. These results indicate that child obesity and its inequalities are rooted in multidimensional environmental inequalities, including medical protection policies and its benefit incidence; intergenerational behavior and family SES factors; and urban-rural and left-behind risk shocks. This study provides new evidence for the development of population-based interventions and equitable medical insurance policies to prevent the deterioration of child obesity among Chinese school-age children and adolescents.

The Core of Healthcare Efficiency: A Comprehensive Bibliometric Review on Frontier Analysis of Hospitals

Parametric and non-parametric frontier applications are typical for measuring the efficiency and productivity of many healthcare units. Due to the current COVID-19 pandemic, hospital efficiency is the center of academic discussions and the most desired target for many public authorities under limited resources. Investigating the state of the art of such applications and methodologies in the healthcare sector, besides uncovering strategical managerial prospects, can expand the scientific knowledge on the fundamental differences among efficiency models, variables and applications, drag research attention to the most attractive and recurrent concepts, and broaden a discussion on the specific theoretical and empirical gaps still to be addressed in future research agendas. This work offers a systematic bibliometric review to explore this complex panorama. Hospital efficiency applications from 1996 to 2022 were investigated from the Web of Science base. We selected 65 from the 203 most prominent works based on the Core Publication methodology. We provide core and general classifications according to the clinical outcome, bibliographic coupling of concepts and keywords highlighting the most relevant perspectives and literature gaps, and a comprehensive discussion of the most attractive literature and insights for building a research agenda in the field.

Determining Factors Affecting the Users' Participation of Online Health Communities: An Integrated Framework of Social Capital and Social Support

As the national awareness of health keeps deepening, online health communities (OHCs) have achieved rapid development. Users' participation is critically important to the sustainable development of OHCs. Nevertheless, users usually lack the motive for participation. Based on the social capital theory, this research examines factors influencing users' participation in OHCs. The purpose of this research is to find out decisive factors that influence users' participation in OHCs, enrich the understanding of users' participation in OHCs, and help OHCs address the issue of sustainable development. The research model was empirically tested using 1277 responses from an online survey conducted in China. Data was analyzed using the structural equation modeling (SEM). We found informational support and emotional support to have significant direct effects over the structural capital, relational capital and cognitive capital of OHCs. Meanwhile, it is observed that relational capital and cognitive capital degree have a significant influence on knowledge acquisition and knowledge contribution of OHCs. For researchers this study provides a basis for further refinement of individual models of users' participation. For practitioners, understanding the social capital is crucial to users' knowledge acquisition and knowledge contribution that achieve high participation in OHCs.

The Association of Residence Permits on Utilization of Health Care Services by Migrant Workers in China

Due to the limitations in the verifiability of individual identity, migrant workers have encountered some obstacles in access to public health care services. Residence permits issued by the Chinese government are a solution to address the health care access inequality faced by migrant workers. In principle, migrant workers with residence permits have similar rights as urban locals. However, the validity of residence permits is still controversial. This study aimed to examine the impact of residence permits on public health care services. Data were taken from the China Migrants Dynamic Survey (CMDS). Our results showed that the utilization of health care services of migrant workers with residence permits was significantly better than others. However, although statistically significant, the substantive significance is modest. In addition, megacities had significant negative moderating effects between residence permits and health care services utilization. Our research results emphasized that reforms of the household registration system, taking the residence permit system as a breakthrough, cannot wholly address the health care access inequality in China. For developing countries with uneven regional development, the health care access inequality faced by migrant workers is a structural issue.

Research on Urban Medical and Health Services Efficiency and Its Spatial Correlation in China: Based on Panel Data of 13 Cities in Jiangsu Province

The improvement of the efficiency of medical and health services is of great significance for improving the high-quality and efficient medical and health services system and meeting the increasingly diverse health needs of residents. Based on the panel data of 13 cities in Jiangsu Province, this research analyzed the relative effectiveness of medical and health services from 2015 to 2019 using the super efficiency slack-based measure-data envelopment analysis model, and the Malmquist index method was used to explore the changes in the efficiency of medical and health services from a dynamic perspective. Furthermore, the spatial autocorrelation analysis method was used to verify the spatial correlation of medical and health services efficiency. In general, there is room for improvement in the efficiency of medical and health services in 13 cities in Jiangsu Province. There are obvious differences in regional efficiency, and there is a certain spatial correlation. In the future, the medical and health services efficiency of China’s cities should be improved by increasing the investment in high-quality medical and health resources, optimizing their layout and making full use of the spatial spillover effects between neighboring cities to strengthen inter-regional cooperation and exchanges.

WITHDRAWN: The health management status of medical and health service institutions and its correlation with residents' health risk

Ahead of Print article withdrawn by publisher.

Do Age-Friendly Rural Communities Affect Quality of Life? A Comparison of Perceptions from Middle-Aged and Older Adults in China

The aging population in rural areas of China faces serious challenges due to urban–rural disparities. In order to improve the active aging of rural older adults, the establishment of age-friendly communities is encouraged. However, globally, the focus is on age-friendly communities in urban areas, not reflecting rural communities. Hence, we addressed the importance of age-friendly rural communities (AFRCs) and aimed to investigate their impact on the quality of life (QoL) of older adults. We examined different perceptions of AFRCs among older adults (aged over 60) and middle-aged people (45–60) in rural communities with questionnaire surveys (n = 470 and 393, respectively). Several statistical methods, such as Chi-squared test, t-test, reliability test, and multiple regression, were adopted to investigate and compare the perceptions of these two. The results indicated that (1) middle-aged people were more satisfied with AFRC components and had a higher QoL than older adults; (2) the QoL of middle-aged people was predicted by housing, accessibility, and outdoor spaces; (3) the QoL of older adults was affected by housing, outdoor spaces, social participation, and public transportation. These findings aid in our understanding of rural communities and the QoL of rural residents. They are helpful for urban planners and policymakers to improve the planning of AFRCs and supplement research on age-friendly communities in rural areas. Practical implementations are proposed for the planning of AFRCs, such as the passive design of residential housing, grouping of community facilities together, and improvement in the hygiene of outdoor spaces in rural areas.

The Mixed Effect of China's New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach

In 2009, China launched a new health care reform as it endeavoured to develop a tiered system of disease diagnosis and treatment to promote the integration of medical resources. This was important for improving service capacity and building medical alliances that would eventually lead to improved health service utilisation efficiency. However, while the 2009 reform aimed to provide universal health insurance coverage to all citizens, its overall effect on health service utilisation efficiency remains unclear. We aimed to examine the new health care reform's mixed effect by applying a longitudinal study using China Health and Nutrition Survey (CHNS) data and the difference-in-difference (DID) method to estimate the health reform's impact on health insurance coverage rate. Then, we studied whether the increase in health insurance coverage rate affected health service utilisation efficiency in China. Our results showed that the increase in insurance coverage rate has indeed made expensive medical services available to low-income individuals. However, it also increased the likelihood of use of hospitals rather than primary care facilities, since there is more insurance cover for outpatient visits, which has led to an increased demand for quality services. This effect has generated a negative impact on health care utilisation which directly pertains to systemic inefficiency. This study thus indicates that China's latest health reform requires further policies to improve its overall efficiency.

The Efficiency of Primary Health Care Institutions in the Counties of Hunan Province, China: Data from 2009 to 2017

This study aimed to estimate the efficiency and its influencing factors of Primary Health Care Institutions (PHCIs) in counties in Hunan Province, China, and put forward feasible suggestions for improving the efficiency of PHCIs in Hunan Province. We applied the Input-Oriented Data Envelopment Analysis (DEA) method and the Malmquist Index Model to estimate the efficiency of PHCIs in 86 counties in Hunan Province from 2009 to 2017. Then, the Tobit model was used to estimate the factors that influence the efficiency of PHCIs. Since the implementation of the new health-care reform in 2009, the number of health resources in PHCIs in Hunan Province has increased significantly, but most counties’ PHCIs remain inefficient. The efficiency of PHCIs is mainly affected by the total population, city level, the proportion of health technicians and the proportion of beds, but the changes in per capita GDP have not yet played a significant role in influencing efficiency. In the future, the efficiency of PHCIs should be improved by increasing medical technology skills and enthusiasm of health technicians and by improving the payment policies of medical insurance funds.

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

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.

Cardiovascular surgery experience does not significantly improve patients' response to stroke

OBJECTIVES

Patients with a history of cardiovascular surgery are at risk of stroke, and immediately calling emergency medical services (EMS) after stroke onset is crucial to receiving effective reperfusion therapy. We aimed to determine the effect of a history of cardiovascular surgery on patients' ability to recognize stroke and intent to call EMS.

METHODS

We performed a cross-sectional community-based study from January 2017 to May 2017. A total population of 186,167 individuals, recruited from 69 administrative areas across China, was analyzed. Different multivariable logistic regression models were performed to identify the associations between cardiovascular surgical history and stroke recognition or intent to call EMS, respectively.

RESULTS

0.1% of the total population had a history of cardiovascular surgery. In the surgery group, the estimated stroke recognition rate (SRR) and correct action rate (CAR) were 84.9% and 74.7%, respectively. The prevalence of cardiovascular risk factors was significantly higher in the surgery group. Cardiovascular surgical history was not associated with recognition of stroke across different models. The surgery group was more likely to call EMS, but the difference was not significant after full adjustment (OR: 1.40, 95% CI: 0.99-1.98, p = .0572).

CONCLUSIONS

Cardiovascular surgical history does not influence patients' likelihood of calling EMS more often at stroke onset. Patients receiving cardiovascular surgeries should be counseled regarding stroke recognition, proper response to stroke, and the importance of controlling risk factors.