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

The analysis of factors influencing patient choice of healthcare providers between tertiary hospitals and community clinics

Background

The uneven distribution of medical resources in China has led to persistently low utilization rates of primary healthcare institutions. The tiered healthcare delivery system aims to optimize resource allocation and strengthen primary care, yet patient preferences for tertiary hospitals hinder its effective implementation. Understanding the factors influencing healthcare-seeking behaviors is crucial for improving policies and promoting system efficiency.

Objective

To analyse the factors influencing patient choices between a tertiary hospital and a community health service center in Chengdu and provide recommendations for advancing the tiered healthcare system.

Methods

A random sampling method was used in August 2023 to survey patients at a tertiary hospital (Group A) and a community health service center (Group B). The survey assessed demographics, health status, factors influencing provider choice, and awareness of the family doctor system. Chi-square, t-tests, or Wilcoxon rank-sum tests were used for group comparisons, while logistic regression identified factors associated with primary care visits.

Results

Among 865 valid responses (Group A: 420; Group B: 445; 92.02% response rate), Group A had significantly higher education levels and household incomes (p < 0.001), while Group B had higher chronic disease prevalence and family doctor contract rates (71.5% vs. 59.3, 44.5% vs. 25.5%; both p < 0.01). Positive factors for choosing community healthcare included better equipment and medication availability (46.9%), lower costs with higher reimbursement (45.0%), and convenient transport (41.2%). Negative factors included distrust in community care quality (39.1%) and limited familiarity with family doctors (32.8%). Logistic regression indicated that being over 60 years old (OR: 1.94, CI: 1.02-3.69) and awareness of the tiered healthcare system (OR: 2.48, CI: 1.56-3.96) were significant factors for seeking primary care.

Conclusion

Patients with higher education and income prefer tertiary hospitals, while chronic disease patients are more likely to utilize community care. Low family doctor contract rates and trust in community healthcare quality remain barriers. Strengthening community resources and promoting the tiered healthcare system could improve patient participation and alleviate pressure on tertiary hospitals.

Equity and efficiency of public health resource allocation in China

OBJECTIVE

To analyze the equity and efficiency of public health resource allocation in China from 2018 to 2022, and to provide a scientific basis for promoting the development of public health resources in China.

METHODS

Data on public health resources of 31 provincial-level administrative regions in mainland China were extracted from 2018 to 2022, and descriptive analysis, Theil index, and health resource agglomeration degree (HRAD) were used to analyze the equity, and data envelopment analysis (DEA) was used to analyze the efficiency.

RESULTS

The Theil index of public health resource allocation by population in China ranges from 0.006 to 0.049, and the Theil index contribution rate of the number of beds, health technicians, licensed (assistant) physicians, and registered nurses within region is less than 28.76%. The Theil index of public health resource allocation by geography in China ranges from 0.274 to 0.624, and the Theil index contribution rate of the number of institutions, the number of beds, health technicians, licensed (assistant) physicians, and registered nurses within region is more than 77.05%. The HRAD of public health resources is more than 2.18 in the eastern and central regions, while the HRAD of public health resources is less than 1 in the northeastern and western regions. The overall HRAD/population agglomeration degree (PAD) is less than 1 in the northeastern and eastern regions, and greater than 1 in the central and western regions overall. The scale efficiency and overall efficiency of public health resource allocation in China are not 1, the returns to scale are decreasing, and the DEA is relatively ineffective from 2019 to 2022.

CONCLUSION

The equity by geography is slightly worse than the equity by population, and the inequity by population mainly comes from between regions, while the inequity by geography mainly comes from within regions. There is a contradiction in the equity by population and by geography allocation in the eastern and western regions, and a congruence in the equity by population and by geography allocation in the northeastern and central regions. The DEA of public health resource allocation in China is relatively ineffective in 2019-2022.

Can the digital economy foster advancements in the healthcare sector? - a case study using interprovincial data from China

BACKGROUND

As China's "Internet + Health" initiative advances, the digital economy significantly influences the quality of medical and health services. However, there is a research gap concerning the digital economy's specific impacts, mechanisms, and marginal effects on these services. This gap impedes a comprehensive understanding of the digital economy's potential in healthcare.

AIMS

This study aims to clarify the digital economy's impact mechanisms on medical and health services levels, offering a scientific foundation for more targeted and effective policy formulation, thereby fostering sustainable digital development in healthcare.

METHODS

Utilizing panel data from China's 31 provinces (2011-2020), this paper employs the Spatial Durbin Model to analyze the spatial and marginal effects of the digital economy on healthcare service levels. To ensure analysis accuracy and robustness, the study refines the spatial weight matrix and addresses model endogeneity using the Generalized Spatial Two-Stage Least Squares method. Additionally, it examines regional disparities in the digital economy's impact through SDM and explores intermediary mechanisms and threshold effects using a mediation effect model and a panel threshold model.

RESULTS

Findings indicate that the digital economy positively affects medical and health services in both local and neighboring regions, with variations across areas. The eastern region particularly benefits from the digital economy's enhancement of service levels, while the central and western regions see less impact. The digital economy enhances services by improving medical resource levels and promoting their coordinated development. However, this positive effect is moderated by the digital economy's and the region's economic development levels, with more pronounced impacts in regions with higher digital and economic development.

CONCLUSIONS

The digital economy plays a crucial role in improving medical and health services, and its full potential is beneficial for the industry's advancement and sustainability. Nonetheless, addressing the uneven digital economy development across regions is essential to ensure equitable benefits for all areas.

Rural patients' satisfaction with humanistic nursing care in Chinese Public Tertiary Hospitals: a national cross-sectional study

Background

The provision of high-quality healthcare services and patient satisfaction are fundamental objectives in modern healthcare. Humanistic nursing care, which emphasizes empathy, respect for individuality, and cultural sensitivity, aims to build trust and improve the overall experience for patients. This approach is especially relevant for rural patients in China, who often face additional challenges in accessing care in large tertiary hospitals.

Methods

A multistage, stratified sampling method was employed to collect data from 8,263 patients aged 18 years or older in large public tertiary hospitals. Humanistic care satisfaction scores were measured using the Nurse Caring Instrument (NCI) questionnaire, a validated tool for assessing patient satisfaction with nursing care.

Results

Satisfaction with nursing humanistic care among rural Chinese patients attending large tertiary public hospitals was low with the overall mean satisfaction score 81.62 ± 16.85. Significant differences in satisfaction were found based on age, marital status, number of children, educational attainment, occupation, monthly household income, department visited, type of medical insurance, and first-time visitor. A multivariate analysis revealed positive correlations with satisfaction for factors such as having children, higher education, higher family monthly income, and first-time visitor, and negative correlations for factors such as older age, being widowed, department visited, and region.

Conclusion

Older adults, widowed individuals, and first-time patients expressed lower levels of satisfaction, highlighting the need for tailored interventions. The findings provide insights into the impact of humanistic nursing care for rural patients and emphasize the importance of culturally sensitive approaches to improve patient satisfaction in rural China. This study has several limitations. The cross-sectional design restricts the ability to establish causal relationships, and there is a potential for selection bias, as participants who completed the survey may have higher educational and economic levels, possibly leading to an overestimation of satisfaction. Lastly, as this study focused on rural patients in large public tertiary hospitals in China, the findings may not be generalizable to other settings or patient groups. Future studies should address these limitations for broader applicability and insight.

Barriers and facilitators for accepting health education of Chinese rural older adults in Henan Province: a qualitative study

BACKGROUND

As global aging continues to intensify, the health status of the older people requires urgent attention, and health education provides a pathway for active aging. However, the current outlook on health education for older people in rural areas of China is not optimistic. This study used Social Ecosystems Theory and explored the deep-rooted influencing factors on the acceptance of health education from the perspective of the rural older people.

METHODS

In this study, a purposive sampling method was adopted, and eligible rural older individuals were selected from Hebi city, Henan Province, China, from March to May 2023 as the research participants. A semistructured interview method was used to explore the factors affecting the acceptance of health education by older people. The interview data were analyzed using the qualitative content analysis method to obtain relevant themes and subthemes.

RESULTS

A total of 14 participants were recruited for the interviews; 8 were male, 6 were female, most had an elementary school education, and most were farmers. The results of the thematic analysis revealed a total of nine facilitators and nine barriers in micro, meso and macro levels. Among the findings, our important and unique finding is that inadequate intergenerational support somewhat hinders older adults' exposure to health education.

CONCLUSION

There are numerous and complex facilitators of and barriers to accessing health education for rural older adults; of these, a lack of intergenerational support is particularly important. In the future, health education needs to be centered on the families of older people with the assistance of village committees so that older people and their children can learn and communicate together.

Health resource allocation within the close-knit medical consortium after the Luohu healthcare reform in China: efficiency, productivity, and influencing factors

Objective

This study aims to assess the efficiency and productivity of the Luohu Hospital Group after the reform and to identify factors influencing the efficiency to support the future development of medical consortia.

Methods

Data on health resources from Shenzhen and the Luohu Hospital Group for the years 2015 to 2021 were analyzed using the super-efficiency slack-based measure data envelopment analysis (SE-SBM-DEA) model, Malmquist productivity index (MPI), and Tobit regression to evaluate changes in efficiency and productivity and to identify determinants of efficiency post-reform.

Results

After the reform, the efficiency of health resource allocation within the Luohu Hospital Group improved by 33.87%. Community health centers (CHCs) within the group had an average efficiency score of 1.046. Moreover, the Luohu Hospital Group's average total factor productivity change (TFPCH) increased by 2.5%, primarily due to gains in technical efficiency change (EFFCH), which offset declines in technical progress change (TECHCH). The efficiency scores of CHCs were notably affected by the ratio of general practitioners (GPs) to health technicians and the availability of home hospital beds.

Conclusion

The reform in the Luohu healthcare system has shown preliminary success, but continuous monitoring is necessary. Future strategies should focus on strengthening technological innovation, training GPs, and implementing the home hospital bed policy. These efforts will optimize the efficiency of health resource allocation and support the integration and development of resources within the medical consortium.

Efficiency evaluation, regional technological heterogeneity and determinant of total factor productivity change in China's healthcare system

Enhancing efficiency and productivity in countries' healthcare systems is a global challenge. The Chinese government invested huge resources to improve the efficiency and productivity of the healthcare system across the country. To assess the success of the mission above, this research utilized DEA-SBM Meta frontier analysis alongside the Malmquist Productivity Index. These methodologies were employed to gauge Efficiency, production technology heterogeneity, and productivity of healthcare systems change across 31 mainland Chinese provinces and four distinct geographical regions throughout the study period spanning from 1997 to 2022. Results revealed that the mean efficiency score of China's healthcare system is 0.7672. It indicates a growth potential of 23.28 percent in the operational efficiency of healthcare systems. The eastern region's efficiency level (0.86917) is higher among all four regions. Zhejiang, Shandong, and Guangdong are the top three healthcare-efficiency performers. The technology gap ratio indicates that eastern regions witnessed a high TGR (0.9909), showing the country's attainment of superior healthcare technologies. Beijing, Guangdong, Shanghai, Tianjin, and Zhejiang witnessed higher TGR values among all 31 mainland Chinese provinces. The total factor productivity index of the healthcare system witnessed a slight growth of 0.33%, with an average MI score of 1.0033. Efficiency change (EC) was found to be the main determinant of TFPC as technology change TC is less than EC. Moreover, the MI score of the Western region (1.033) is higher than the corresponding Eastern, northeastern, and central regions. Guizhou, Anhui, and Yunnan were found to be the top three performers in TFPC growth. Finally, the Kruskal-Wallis test confirmed the statistically significant difference among 4 Chinese regions for the healthcare system's efficiency, TFPC, and TGR.

Spatial effects of township health centers' health resource allocation efficiency in China

Introduction

China is a large agricultural nation with the majority of the population residing in rural areas. The allocation of health resources in rural areas significantly affects the basic rights to life and health for rural residents. Despite the progress made by the Chinese government in improving rural healthcare, there is still room for improvement. This study aims to assess the spatial spillover effects of rural health resource allocation efficiency in China, particularly focusing on township health centers (THCs), and examine the factors influencing this efficiency to provide recommendations to optimize the allocation of health resources in rural China.

Methods

This study analyzed health resource allocation efficiency in Chinese rural areas from 2012 to 2021 by using the super-efficiency SBM model and the global Malmquist model. Additionally, the spatial auto-correlation of THC health resource allocation efficiency was verified through Moran test, and three spatial econometric models were constructed to further analyze the factors influencing efficiency.

Results

The key findings are: firstly, the average efficiency of health resource allocation in THCs was 0.676, suggesting a generally inefficient allocation of health resources over the decade. Secondly, the average Malmquist productivity index of THCs was 0.968, indicating a downward trend in efficiency with both non-scale and non-technical efficient features. Thirdly, Moran's Index analysis revealed that efficiency has a significant spatial auto-correlation and most provinces' values are located in the spatial agglomeration quadrant. Fourthly, the SDM model identified several factors that impact THC health resource allocation efficiency to varying degrees, including the efficiency of total health resource allocation, population density, PGDP, urban unemployment rate, per capita disposable income, per capita healthcare expenditure ratio, public health budget, and passenger traffic volume.

Discussion

To enhance the efficiency of THC healthcare resource allocation in China, the government should not only manage the investment of health resources to align with the actual demand for health services but also make use of the spatial spillover effect of efficiency. This involves focusing on factors such as total healthcare resource allocation efficiency, population density, etc. to effectively enhance the efficiency of health resource allocation and ensure the health of rural residents.

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.

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.

Research on the Operational Efficiency of Basic Medical Insurance for Urban Employees in China-Based on Three-Stage DEA Model

Purpose

To conduct a three-stage data envelopment analysis (DEA) of the operational efficiency of urban employee basic medical insurance (UEBMI) across 31 provinces in China from 2012 to 2021.

Methods

Utilized a three-stage DEA model, this study measured and evaluated the operational efficiency of urban employee basic medical insurance within China's 31 provinces.

Results

The operational efficiency of urban employee basic medical insurance in China was notably low, displaying significant disparities across different regions and periods. Substantial room for improvement exists. Environmental factors, including urbanization level and unemployment rate, wielded a pronounced influence on the operational efficiency of China's employee medical insurance. Conversely, the fiscal revenue and expenditure ratio hindered the enhancement of employee medical insurance efficiency.

Conclusion

This study held valuable insights for enhancing the operational efficiency of China's urban employee basic medical insurance. To effectively improve insurance efficiency, the following recommendations are put forth: firstly, relevant departments should escalate resource investments and optimize resource utilization based on rational allocation; secondly, enhance legislation and regulations, fortify fund oversight, and ensure equitable and judicious utilization of the medical insurance fund; finally, leveraging modern high-tech advancements can comprehensively elevate the operational efficiency of the employee medical insurance fund. Ultimately, with the advent of cutting-edge technology, the operational efficiency of employee medical insurance fund can be comprehensively elevated.

Resource allocation of rural institutional elderly care in China's new era: spatial-temporal differences and adaptation development

OBJECTIVES

In the new era of China, to ensure that rural residents can get the corresponding institutional elderly services equally, it is necessary to investigate the current situation of resource allocation of rural institutional elderly care and make corresponding adaptation suggestions.

STUDY DESIGN

This research discusses the characteristics and evolution pattern of rural aging, the resource allocation of rural elderly care institutions, and the adaptation degree of rural institutional elderly care resource and aging.

METHODS

The research methodology consists of the following stages: entropy-based Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS), kernel density estimation, coupling coordination, spatial autocorrelation, and Theil index decomposition.

RESULTS

The degree of aging in rural areas of China is rising, and the whole population has entered a moderate aging society, showing the spatial characteristics of 'high in the east and low in the west'. The resource allocation of rural institutional elderly care in China is at a low level, and the absolute differences among provinces tend to reduce over time, and the overall resource allocation level tends to decline. The provinces that were in the mismatched adaptation relationship in the early stage have improved; however, the number of provinces with mismatched adaptability has continued to increase. The local spatial autocorrelation of resource adaptation verifies that the middle and lower reaches of the Yangtze River as the core form a hot spot, and during the observation period, the spatial agglomeration effect of the core is strengthened. The Theil index decomposition of resource adaptation indicates that the within-group differences between the eastern and western regions is significantly higher than that between the northeastern and central regions.

CONCLUSIONS

First, special attention should be paid to preventing the resource allocation of rural institutional elderly care in the eastern and western regions from falling again. Second, to avoid more and more low-adapted provinces falling into the 'mismatch dilemma' with the deepening of the aging degree. Third, strengthen cooperation among regions and promote the coordinated development of resource allocation of institutional elderly care in various regions. Fourth, the priority of institutional elderly care balanced development should be given to the eastern region and western region, thus weakening the overall difference.