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Li M, Zhang Y, Wu Z, Jiang Y, Sun R, Yang J, Li J, Lin H, Zhang R, Jiang Q, Wang L, Wu X, Yu F, Yuan J, Yang C, Shen X. Transmission of fluoroquinolones resistance among multidrug-resistant tuberculosis in Shanghai, China: a retrospective population-based genomic epidemiology study. Emerg Microbes Infect 2024; 13:2302837. [PMID: 38205528 PMCID: PMC10810664 DOI: 10.1080/22221751.2024.2302837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
Fluoroquinolones (FQ) are essential for the treatment of multidrug-resistant tuberculosis (MDR-TB). The FQ resistance (FQ-R) rate in MDR-TB in China and its risk factors remain poorly understood. We conducted a retrospective, population-based genomic epidemiology study of MDR-TB patients in Shanghai, China, from 2009 to 2018. A genomic cluster was defined as strains with genetic distances ≤ 12 single nucleotide polymorphisms. The transmitted FQ-R was defined as the same FQ resistance-conferring mutations shared by ≥ 2 strains in a genomic cluster. We used multivariable logistic regression analysis to identify the risk factors for drug resistance. Among the total 850 MDR-TB patients included in the study, 72.8% (619/850) were male, the median age was 39 (interquartile range 28, 55) years, 52.7% (448/850) were migrants, and 34.5% (293/850) were previously treated patients. Most of the MDR-TB strains belong to the Beijing lineage (91.7%, 779/850). Overall, the genotypic resistance rate of FQ was 34.7% (295/850), and 47.1% (139/295) FQ-R patients were in genomic clusters, of which 98 (33.2%, 98/295) were presumed as transmitted FQ-R. Patients with treatment-naïve (aOR = 1.84; 95% CI: 1.09, 3.16), diagnosed in a district-level hospital (aOR = 2.69; 95% CI: 1.56, 4.75), and streptomycin resistance (aOR = 3.69; 95% CI: 1.65, 9.42) were significantly associated with the transmission of FQ-R. In summary, the prevalence of FQ-R among MDR-TB patients was high in Shanghai, and at least one-third were transmitted. Enforced interventions including surveillance of FQ drug susceptibility testing and screening among MDR-TB before initiation of treatment were urgently needed.
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Affiliation(s)
- Minjuan Li
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Guangdong, People’s Republic of China
| | - Yangyi Zhang
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Shanghai Institutes of Preventive Medicine, Shanghai, People’s Republic of China
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, People’s Republic of China
| | - Zheyuan Wu
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Shanghai Institutes of Preventive Medicine, Shanghai, People’s Republic of China
| | - Yuan Jiang
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Shanghai Institutes of Preventive Medicine, Shanghai, People’s Republic of China
| | - Ruoyao Sun
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Guangdong, People’s Republic of China
| | - Jinghui Yang
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Jing Li
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Shanghai Institutes of Preventive Medicine, Shanghai, People’s Republic of China
| | - Honghua Lin
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Guangdong, People’s Republic of China
| | - Rui Zhang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Guangdong, People’s Republic of China
| | - Qi Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, People’s Republic of China
| | - Lili Wang
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Shanghai Institutes of Preventive Medicine, Shanghai, People’s Republic of China
| | - Xiaocui Wu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Fangyou Yu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Jianhui Yuan
- Nanshan District Center for Disease Control and Prevention, Shenzhen, People’s Republic of China
| | - Chongguang Yang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Guangdong, People’s Republic of China
- Nanshan District Center for Disease Control and Prevention, Shenzhen, People’s Republic of China
| | - Xin Shen
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Shanghai Institutes of Preventive Medicine, Shanghai, People’s Republic of China
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Fu L, Han J, Xu K, Pei T, Zhang R. Incentivizing primary care utilization in China: the impact of health insurance coverage on health-seeking behaviour. Health Promot Int 2024; 39:daae115. [PMID: 39243132 DOI: 10.1093/heapro/daae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024] Open
Abstract
China's healthcare system faces significant challenges, notably the underutilization of primary healthcare resources and the inefficient distribution of healthcare services. In response, this article explores the effectiveness of the New Rural Cooperative Medical System (NRCMS) in improving healthcare accessibility and primary care utilization. Employing a multi-period difference-in-differences model and using data from the China Family Panel Studies spanning 2012-20, it aims to empirically examine how health insurance policy incentivizing primary care influences rural residents' health-seeking behaviour and enhances the efficiency of resource utilization. Results indicate that NRCMS significantly improves the probability of rural residents seeking healthcare services at primary healthcare centres (PHCs), especially for outpatient services. This effect can be attributed to the substantially higher outpatient reimbursement rates at PHCs compared to higher-level medical institutions. Conversely, the Urban Resident Basic Medical Insurance fails to increase urban residents' engagement with primary care, reinforcing the role of price sensitivity in healthcare choices among insured lower-income rural population. Furthermore, the study reveals a stronger preference for PHCs among younger, less-educated insured residents and highlights a synergistic effect between the availability of primary healthcare resources and insurance coverage on primary care utilization. These findings offer crucial implications for refining health insurance policies to improve healthcare service accessibility and efficiency.
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Affiliation(s)
- Liping Fu
- Department of Public Administration, College of Management and Economics, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Jiarui Han
- Department of Public Administration, College of Management and Economics, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Kaibo Xu
- Department of Public Administration, School of Public Policy & Management, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China
| | - Tong Pei
- Department of Public Administration, College of Management and Economics, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Ruiyu Zhang
- Department of Public Administration, College of Management and Economics, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
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Pan H, Ding M, Zhu L, Sun X, Liu R, Ai S, Tian L, Wei Q. A national cross-sectional survey on community spinal cord injury individuals profiles, health-related quality of life and support services in China: implications for healthcare and rehabilitation. BMC Musculoskelet Disord 2024; 25:761. [PMID: 39354467 PMCID: PMC11445970 DOI: 10.1186/s12891-024-07877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 09/16/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Spinal cord injury (SCI) results in severe, permanent functional changes and has become a global health priority due to its high incidence, cost, and disability rate. Current national epidemiological data on SCI in China are limited and outdated. This study aimed to provide a comprehensive, national cross-sectional investigation of SCI epidemiology in China. METHODS This cross-sectional study included 3055 SCI participants aged 8 to 78 years, conducted from May to September 2023. Data collected encompassed demographic characteristics, employment status, etiology, years lived with disability (YLD), family structure, caregiving status, income, health insurance, paralysis type, and health-related quality of life (HRQoL). Descriptive statistics analyses were used to assess demographic and injury characteristics. Group differences were assessed using t-tests, one-way ANOVA and Chi-square tests. Significant factors were examined using multivariate regression analysis. RESULTS The majority (88.9%) of respondents were aged 15 to 59 years, with a male-to-female ratio of 2.36:1. Car accidents caused 45.4% of tetraplegia cases, falls caused 35.9% of paraplegia cases, and myelitis was the leading cause of non-traumatic SCI. Among paraplegia participants, 65.5% had complete SCI, while 53.1% of tetraplegia participants had incomplete SCI. Functional improvement was reported by 9.58% of participants. Half (50.3%) of the respondents were unemployed, and 75% had incomes below the national average. HRQoL was significantly lower in the SCI population compared to controls, mainly influenced by injury site, income, age and etiology (p < 0.05). CONCLUSIONS SCI participants in China exhibit low HRQoL and reemployment rates. Accessible community and vocational rehabilitation programs, alongside robust public medical services, are essential for enhancing reemployment and HRQoL among SCI participants, reducing the overall disease burden.
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Affiliation(s)
- Hongxia Pan
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, 610041, Sichuan, PR China
| | - Mingfu Ding
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, 610041, Sichuan, PR China
| | - Liang Zhu
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, 610041, Sichuan, PR China
| | - Xin Sun
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, 610041, Sichuan, PR China
| | - Rui Liu
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, 610041, Sichuan, PR China
| | - Shaolong Ai
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, 610041, Sichuan, PR China
| | - Lu Tian
- China Association of Persons with Physical Disability, Beijing, 100034, China
| | - Quan Wei
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, 610041, Sichuan, PR China.
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Wang L, Liu L, Zhang Z, Li F, Ruan Y, He Y, Huang J, Zheng X. Cost-effectiveness of Sacituzumab Govitecan versus Single-agent Chemotherapy for Patients with Metastatic Triple-Negative Breast Cancer in China. Clin Breast Cancer 2024; 24:e545-e553.e6. [PMID: 38760263 DOI: 10.1016/j.clbc.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Patients with metastatic triple-negative breast cancer (mTNBC) have poor prognosis and survival outcomes. Sacituzumab govitecan was newly approved into Chinese market for mTNBC. However, whether its price matches the survival benefit still needs exploring. Here, this study aimed to evaluate the cost-effectiveness of sacituzumab govitecan versus chemotherapy in patients with mTNBC from the perspective of Chinese healthcare system. METHODS A partitioned survival model consisting of three discrete health states was constructed to assess the cost-effectiveness of sacituzumab govitecan versus single-agent chemotherapy. The key clinical data in the model were from the ASCENT trial. Costs and utility inputs were collected from published literatures. Life-years gained, quality adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits, and incremental net monetary benefits were calculated between 2 treatment strategies. One-way and probabilistic sensitivity analyses were conducted to account for uncertainty and verify model robustness. Subgroup and cost-threshold analysis were also performed. RESULTS Sacituzumab govitecan provided an additional 0.25 QALYs and an incremental cost of $ 81,778.61 compared with chemotherapy, which was associated with an ICER of $ 323,603.84/QALY. One-way sensitivity analysis revealed that the model was most sensitive to the cost of sacituzumab govitecan, weight, and utility of progression-free survival. The probabilistic sensitivity analysis indicated that the probability of sacituzumab govitecan being cost-effective was 0%. Considering a willingness-to-pay (WTP) of 3 times GDP, the maximum cost of sacituzumab govitecan that would make it cost-effective was $155.65 per unit (180 mg). CONCLUSIONS Sacituzumab govitecan was not cost-effective for patients with mTNBC compared with chemotherapy at the commonly adopted WTP threshold of 3 times GDP per capita per QALY in China.
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Affiliation(s)
- Lei Wang
- Pharmacy Department, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Lulu Liu
- Department of Pharmacy, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhe Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Fushu Li
- Pharmacy Department, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Yi Ruan
- Pharmacy Department, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Yao He
- Pharmacy Department, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Jingbin Huang
- Department of Pharmacy, The Second Affiliated Hospital of Army Medical University, Chongqing, China.
| | - Xiaoyuan Zheng
- Pharmacy Department, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China.
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Geng J, Li R, Wang X, Xu R, Liu J, Zhu D, Wang G, Hesketh T. Exploring the lack of continuity of care in older cancer patients under China's 'integrated health system' reform. Age Ageing 2024; 53:afae213. [PMID: 39373574 DOI: 10.1093/ageing/afae213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/08/2024] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND Continuity of care is essential to older patients' health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused. OBJECTIVES To explore the experience and perception of continuity of care in older cancer patients, and to examine how PHCs play a role in the continuity of care within the healthcare system in China. METHODS A qualitative study using semi-structured interviews was conducted in two tertiary hospitals in Nantong city, Jiangsu province, China. A combination of deductive and inductive analysis was conducted thematically. RESULTS Interviews with 29 patients highlighted three key themes: no guidance for patients in connecting with different levels of doctors, unmet patients' needs under specialist-led follow-up care, and poor coordination and communication across healthcare levels. This study clearly illustrated patients' lack of personal awareness and experience of care continuity, a key issue despite China's drive for an integrated healthcare system. CONCLUSION The need for continuity of care at each stage of cancer care is largely unmeasured in the current healthcare system for older patients. PHCs offer benefits which include convenience, less burdened doctors with more time, and lower out-of-pocket payment compared to tertiary hospitals, especially for patients with long-term healthcare needs. However, addressing barriers such as the absence of integrated medical records and unclear roles of PHCs are needed to improve the crucial role of PHCs in continuity of care.
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Affiliation(s)
- Jiawei Geng
- Centre for Global Health, School of Public Health, Zhejiang University, Hangzhou, China
- Institute of Oncology, Affiliated Tumour Hospital of Nantong University, Nantong, China
| | - Ran Li
- Centre for Global Health, School of Public Health, Zhejiang University, Hangzhou, China
- Insititue of Global Health, University College London, London, UK
| | - Xinyu Wang
- School of Public Health, Nantong University, Nantong, China
| | - Rongfang Xu
- Department of Nursing, Affiliated Tumour Hospital of Nantong University, Nantong, China
| | - Jibing Liu
- Institute of Oncology, Affiliated Tumour Hospital of Nantong University, Nantong, China
| | - Dixi Zhu
- Department of Health Management, HanYao Traditional Chinese Medicine Hospital, Nantong, China
| | - Gaoren Wang
- Institute of Oncology, Affiliated Tumour Hospital of Nantong University, Nantong, China
| | - Therese Hesketh
- Centre for Global Health, School of Public Health, Zhejiang University, Hangzhou, China
- Insititue of Global Health, University College London, London, UK
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Wang Y, Li M, Zhang B, Feng Y, Yu Y, Guo L, Du M, Yan W, Liu Q, Qin C, Deng J, Song C, Liu J. Interaction between economic status and healthy lifestyle in long COVID among Chinese older population: a cross-sectional study. BMJ Open 2024; 14:e082314. [PMID: 39327050 PMCID: PMC11429274 DOI: 10.1136/bmjopen-2023-082314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 09/11/2024] [Indexed: 09/28/2024] Open
Abstract
OBJECTIVES To estimate the interaction between economic status (ES) and healthy lifestyle in long COVID among Chinese older people infected with SARS-CoV-2. DESIGN A cross-sectional study based on the Peking University Health Cohort in Anning, Yunnan. SETTING All primary health institutions in Anning, Yunnan Province, China, from April to May 2023. PARTICIPANTS A total of 4804 people aged 60 and older infected with SARS-CoV-2 were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES Long COVID was measured by participants' self-reported symptoms using structured questionnaires. ES was measured by last-month personal income, and participants' ES was defined as low if their income was below the per capita monthly income of local residents. Lifestyle score was equal to the number of healthy behaviours (including smoking, drinking, weight, exercise and diet) and grouped using the median score as the cut-off point. Univariate and multivariate logistic models were employed to estimate the association of ES with long COVID. Interaction between ES and lifestyle in long COVID was assessed by multiplicative interaction term. RESULTS We enrolled a total of 4804 participants infected with SARS-CoV-2, of whom 57.3% (2754 of 4804) had at least one long COVID symptom. Fatigue (1546, 56.1%), cough (1263, 45.9%) and muscle pain (880, 32.0%) were the top three common symptoms. Patients with low ES had a 48% (adjusted OR: 1.48; 95% CI 1.22, 1.82) increased risk of long COVID. A significant interaction was observed between ES and lifestyle (p value for interaction <0.001) in long COVID. CONCLUSION The interaction between ES and healthy lifestyle in long COVID was prominent. Comprehensive strengthened economic support for patients recovering from COVID-19, especially for those with low healthy lifestyle, should be implemented to prevent and manage long COVID symptoms.
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Affiliation(s)
- Yaping Wang
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Manchang Li
- Anning First People's Hospital, Kunming University of Science and Technology, Kunming, China
| | - Bingkun Zhang
- Anning First People's Hospital, Kunming University of Science and Technology, Kunming, China
| | - Yue Feng
- Anning First People's Hospital, Kunming University of Science and Technology, Kunming, China
| | - Yinghui Yu
- Anning First People's Hospital, Kunming University of Science and Technology, Kunming, China
| | - Ling Guo
- Anning First People's Hospital, Kunming University of Science and Technology, Kunming, China
| | - Min Du
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Wenxin Yan
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Qiao Liu
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Chenyuan Qin
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Jie Deng
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Chao Song
- Anning First People's Hospital, Kunming University of Science and Technology, Kunming, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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Liu X, Zhang L, Fan X, Chen W. Impact of family doctor system on diabetic patients with distinct service utilisation patterns: a difference-in-differences analysis based on group-based trajectory modelling. BMJ Glob Health 2024; 9:e014717. [PMID: 39313253 PMCID: PMC11418535 DOI: 10.1136/bmjgh-2023-014717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 09/06/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION This study examines the impact of China's family doctor system (FDS) on healthcare utilisation and costs among diabetic patients with distinct long-term service utilisation patterns. METHODS Conducted in City A, eastern China, this retrospective cohort study used data from the Health Information System and Health Insurance Claim Databases, covering diabetic patients from 1 January 2014 to 31 December 2019.Patients were categorised into service utilisation trajectories based on quarterly outpatient visits to community health centres (CHCs) and secondary/tertiary hospitals from 2014 to 2017 using group-based trajectory models. Propensity score matching within each trajectory group matched FDS-enrolled patients (intervention) with non-enrolled patients (control). Difference-in-differences analysis compared outcomes between groups, with a SUEST test for cross-model comparison. Outcomes included outpatient visits indicator, costs indicator and out-of-pocket (OOP) expenses. RESULTS Among 17 232 diabetic patients (55.21% female, mean age 62.85 years), 13 094 were enrolled in the FDS (intervention group) and 4138 were not (control group). Patients were classified into four trajectory groups based on service utilisation from 2014 to 2017: (1) low overall outpatient utilisation, (2) high CHC visits, (3) high secondary/tertiary hospital visits and (4) high overall outpatient utilisation. After enrolled in FDS From 2018 to 2019, the group with high secondary/tertiary hospital visits saw a 6.265 increase in CHC visits (225.4% cost increase) and a 3.345 decrease in hospital visits (55.5% cost reduction). The high overall utilisation group experienced a 4.642 increase in CHC visits (109.5% cost increase) and a 1.493 decrease in hospital visits. OOP expenses were significantly reduced across all groups. CONCLUSION The FDS in China significantly increases primary care utilisation and cost, while reducing hospital visits and costs among diabetic patients, particularly among patients with historically high hospital usage. Policymakers should focus on enhancing the FDS to further encourage primary care usage and improve chronic disease management.
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Affiliation(s)
- Xinyi Liu
- School of Public Health, Fudan University, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luying Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Xianqun Fan
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, China
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Dong X, Wang Y. The geography of healthcare: Mapping patient flow and medical resource allocation in China. ECONOMICS AND HUMAN BIOLOGY 2024; 55:101431. [PMID: 39326297 DOI: 10.1016/j.ehb.2024.101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 07/29/2024] [Accepted: 09/02/2024] [Indexed: 09/28/2024]
Abstract
The misallocation of medical resources leads to interregional patient flow in search of better healthcare. Using out-of-pocket medical expenditure data and a delineating method, this paper identifies spatial clusters of medical services in China based on patient flow across cities. Our findings indicate that healthcare resources are more concentrated in northern China, while southern China is divided into several large healthcare clusters at the same threshold. The provincial capital and economically significant cities are more likely to serve as medical cluster centers. We further apply the gravity model to examine the effects of healthcare disparity on cross-city medical expenditure. The results reveal that geographic disparities in high-quality medical resources encourage remote healthcare-seeking behavior, and the shorter the distance between locations, the higher the level of medical consumption. Patients are inclined to seek medical services within their own province and within specific medical clusters identified through delineation methods. This effect is more pronounced among patients from non-central cities. This study highlights healthcare inequality by examining cross-regional medical expenditure, providing valuable insights for future healthcare policy.
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Affiliation(s)
- Xiaofang Dong
- Wang Yanan Institute for Studies in Economics, Xiamen University, China.
| | - Yalin Wang
- Paula and Gregory Chow Institute for Studies in Economic, Xiamen University, China.
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Hou R, Liu X, Zhou J, Zhang T, Wang W, Zhu W. DRG payment for major pancreatic surgery: analysis of resource consumption and suggestions from a tertiary hospital in China. Front Public Health 2024; 12:1437272. [PMID: 39360257 PMCID: PMC11445820 DOI: 10.3389/fpubh.2024.1437272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 09/04/2024] [Indexed: 10/04/2024] Open
Abstract
Aim To investigate the cost homogeneity within the Diagnosis-Related Group (DRG) "major operation of pancreas and liver, with general complications or comorbidities" (HB13), its cost-influencing factors, and to propose suggestions for better grouping efficacy. Methods Medical and insurance settlement data of inpatients covered by the DRG payment system at the author's institution were collected from March 15, 2022 to December 31, 2023. The cost homogeneity of group HB13 was assessed using the coefficient of variation (CV). Clinical factors that may have an impact on hospitalization cost for patients undergoing pancreatic surgery were identified through a semi-structured interview administered to the pancreatic surgeons in author's department, their significance was analyzed using multiple linear regression, along with their impact on the cost of different service categories. A proposal to subdivide HB13 was made and evaluated by CV and t-test. Results The CV of the HB13 group was 0.4. Robotic-assisted surgery and pancreaticoduodenectomy were two independent factors that significantly affected the total cost. Patients undergoing robotic-assisted surgery have an average increase of 41,873 CNY in total cost, primarily derived from operation fee. Patients undergoing pancreaticoduodenectomy have an average increase of 37,487 CNY in total cost, with significant increases across all service categories. HB13 was subdivided based on whether pancreaticoduodenectomy was performed. The newly formed groups exhibited lower CVs than the original HB13. Conclusion The cost homogeneity of HB13 was lower than that of other DRG groups in author's department. It is recommended to introduce a supplementary payment for patients requiring robotic-assisted surgery, to guarantee their access to this advanced technology. It is recommended to establish a new group with higher payment standard for patients undergoing pancreaticoduodenectomy. A tiered CV criterion for the evaluation of grouping efficacy is recommended to increase intra-group homogeneity, facilitating a better allocation of health insurance funds, and the prevention of unintended negative outcomes such as service cuts and cherry-picking.
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Affiliation(s)
- Rui Hou
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaokun Liu
- Department of Medical Insurance Management, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingya Zhou
- Department of Medical Records, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Taiping Zhang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weibin Wang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiguo Zhu
- Department of Medical Insurance Management, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Primary Care and Family Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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10
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Yip W. Improving primary healthcare with generative AI. Nat Med 2024:10.1038/s41591-024-03257-3. [PMID: 39294301 DOI: 10.1038/s41591-024-03257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Affiliation(s)
- Winnie Yip
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
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11
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Wu R, Gesang D, Zhou G, Li Y. Spatial disparities and dynamic evolution of professional public health resource supply level in Beijing, China. BMC Public Health 2024; 24:2524. [PMID: 39289674 PMCID: PMC11406775 DOI: 10.1186/s12889-024-19905-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/27/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND This study aims to explore the development status of the supply level of professional public health resources in Beijing Municipality, analyze the areal differences and spatial distribution characteristics of the supply level in 16 districts, and provide a scientific basis for promoting the balanced development of the supply level of professional public health resources in each district of Beijing Municipality. METHODS Based on panel data from Statistical Yearbook of Health Work in Beijing Municipality and Health and Family Planning Work in Beijing Municipality from 2014 to 2022. Using the entropy method to measure the supply level of professional public health resources in Beijing, employing the Dagum Gini coefficient and Kernel density estimation method to analyze the spatial differentiation characteristics and dynamic evolution process of the supply level, and using heat maps to display the spatial distribution of the supply level in various districts of Beijing. RESULTS The Dagum Gini coefficient of the supply level of professional public health resources in Beijing Municipality decreased continuously from 0.3419 in 2014 to 0.29736 in 2020, then gradually increased, showing a trend of initially decreasing and then increasing overall spatial differences. The spatial differences mainly stem from differences between areas. The kernel density curve shows that the supply level of professional public health resources in Beijing Municipality gradually increased, slightly decreased after 2021, and did not form a situation of two or multi-level differentiation. CONCLUSION From 2014 to 2022, the supply level of professional public health resources in Beijing Municipality showed an overall upward trend, but attention should be paid to the decline after 2021; spatial differences initially decreased and then increased, and the differences between areas is the main source of the overall difference in Beijing. Therefore, the Beijing Municipal Government should focus on narrowing the differences between areas, determine the allocation and management of public health resources based on the actual situation of core areas, promote coordinated development within and outside areas, and thus enhance the supply level of professional public health resources.
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Affiliation(s)
- Rui Wu
- School of Public Health, Capital Medical University, Beijing, China
| | - Danzhen Gesang
- School of Public Health, Capital Medical University, Beijing, China
| | - Guangxin Zhou
- School of Public Health, Capital Medical University, Beijing, China
| | - Ying Li
- School of Public Health, Capital Medical University, Beijing, China.
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12
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Yin S, Chen W, Jia C, Yao Y, Yao L. Effect of long-term care insurance on medical expenditure and health status: National cohort study. Arch Public Health 2024; 82:152. [PMID: 39267147 PMCID: PMC11391772 DOI: 10.1186/s13690-024-01388-0] [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: 05/21/2024] [Accepted: 08/31/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Long-term care insurance (LTCI) was implemented in China to solve the elderly care problems caused by the aging population. It is crucial to evaluate the effectiveness of LTCI implementation from the perspective of value-based healthcare. OBJECTIVE This study aimed to investigate the impact of LTCI on medical care expenditure and health status in China. METHODS We used staggered difference-in-differences (DID) analysis to analyze the effect of LTCI policy on medical expenditure and health status based on China Health and Retirement Longitudinal Study data from 2011 to 2018. RESULTS Our findings confirmed the positive contribution of LTCI policies to medical expenditures and health status. We found that the implementation of LTCI significantly reduced inpatient and outpatient expenditure, scores of self-report of health, and CESD scores by 26.3%, 12.3%, 0.103, and 0.538, respectively. It also decreased ADL scores, but the decrease was not significant. The impact of LTCI on reducing inpatient expenditure was greater for individuals aged between 65 and 80 and those residing in urban areas and eastern cities. In terms of outpatient costs, the effect of LTCI was more pronounced among median and high-income people and people living in central and eastern cities. The impact of LTCI on self-report of health is stronger for rural populations, individuals under 80, and those in central and eastern cities. For ADL scores, LTCI affected those aged 65-80 the most. About the CESD scores, LTCI had a greater impact on rural populations, people aged 45-65, median income groups, and those in eastern cities. CONCLUSIONS Our study underscored LTCI's effectiveness in curbing medical expenditures and enhancing health status, offering valuable insights for future LTCI development in China and beyond. Accelerating the development of LTCI is conducive to improving the quality of life of the disabled elderly, enhancing the well-being of people's livelihoods, and realizing the goal of value-based healthcare.
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Affiliation(s)
- Shanshan Yin
- School of Medicine and Health Management, Tongji Medical College of Huazhong, University of Science and Technology, Wuhan, China
| | - Wen Chen
- School of Medicine and Health Management, Tongji Medical College of Huazhong, University of Science and Technology, Wuhan, China
| | - Changli Jia
- School of Medicine and Health Management, Tongji Medical College of Huazhong, University of Science and Technology, Wuhan, China
| | - Yifan Yao
- School of Medicine and Health Management, Tongji Medical College of Huazhong, University of Science and Technology, Wuhan, China.
| | - Lan Yao
- School of Medicine and Health Management, Tongji Medical College of Huazhong, University of Science and Technology, Wuhan, China.
- HUST Base of National Institute of Healthcare Security, Huazhong University of Science and Technology, Wuhan, China.
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Xu Zheng E, Zhu X, Zhu Y, Qin Z, Zhang J, Huang Y. Impact of Insurance on Readmission Rates, Healthcare Expenditures, and Length of Hospital Stay among Patients with Chronic Ambulatory Care Sensitive Conditions in China. Healthcare (Basel) 2024; 12:1798. [PMID: 39273822 PMCID: PMC11395110 DOI: 10.3390/healthcare12171798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/31/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024] Open
Abstract
Background: The disparities in healthcare access due to varying insurance coverage significantly impact hospital outcomes, yet what is unclear is the role of insurance in providing care once the patient is in the hospital for a preventable admission, particularly in a weak gatekeeping environment. This study aimed to investigate the association between insurance types and readmission rates, healthcare expenditures, and length of hospital stay among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Methods: This retrospective observational study utilized hospitalization data collected from the Nanhai District, Foshan City, between 2016 and 2020. Generalized linear models (GLMs) were employed to analyze the relationship between medical insurance types and readmission rates, lengths of hospital stay, total medical expenses, out-of-pocket expenses, and insurance-covered expenses. Results: A total of 185,384 records were included. Among these, the participants covered by urban employee basic medical insurance (UEBMI) with 44,415 records and urban and rural resident basic medical insurance (URRBMI) with 80,752 records generally experienced more favorable outcomes compared to self-pay patients. Specifically, they had lower readmission rates (OR = 0.57, 95% CI: 0.36 to 0.90; OR = 0.59, 95% CI: 0.42 to 0.84) and reduced out-of-pocket expenses (β = -0.54, 95% CI: -0.94 to -0.14; β = -0.41, 95% CI: -0.78 to -0.05). However, they also experienced slightly longer lengths of hospital stay (IRR = 1.08, 95% CI: 1.03 to 1.14; IRR = 1.11, 95% CI: 1.04 to 1.18) and higher total medical expenses (β = 0.26, 95% CI: 0.09 to 0.44; β = 0.25, 95% CI: 0.10 to 0.40). Conclusions: This study found that different types of health insurance were associated with varying clinical outcomes among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Since the hospitalization of these patients was initially avoidable, disparities in readmission rates, lengths of hospital stay, and medical expenses among avoidable inpatient cases exacerbated the health gap between different insurance types. Addressing the disparities among different types of insurance can help reduce unplanned hospitalizations and promote health equity.
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Affiliation(s)
- Esthefany Xu Zheng
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Xiaodi Zhu
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Yi Zhu
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Zhenhua Qin
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Jiachi Zhang
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Yixiang Huang
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
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14
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Zhou MC, Fei YT, Lai XZ, Lan J, Liu B, Wang ZW, Fang H, Liu JP, Rong HG. Progress and challenges in integrated traditional Chinese and western medicine in China from 2002 to 2021. Front Pharmacol 2024; 15:1425940. [PMID: 39309004 PMCID: PMC11412861 DOI: 10.3389/fphar.2024.1425940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024] Open
Abstract
Objective The World Health Organization advocated for enhanced integration of traditional medicine and complementary medicine into national healthcare systems across all countries. This study aims to explore the progress and challenges in integrated traditional Chinese and western medicine (ITCWM) in China over 20 years using nationwide data. Methods This cross-sectional study examined various facets of ITCWM in China in terms of policies, resources, services, and funding. National policy documents from 2009 onwards were retrieved from official websites of the Chinese government. Data on ITCWM resources, services and subsidies from 2002 to 2021 were extracted from the China Statistical Yearbooks of Chinese Medicine and China Health Statistical Yearbooks. Research fund projects with the ITCWM discipline were collected from the database of National Natural Science Foundation of China. A mixed method of both quantitative and qualitative approaches was employed to present a comprehensive overview of the collected data. Results This study presented five key findings. First, despite the issuance of 17 national policies by the Chinese government since 2009 to promote the development of traditional Chinese medicine (TCM), only three of them were specifically tailored for ITCWM. Second, although the average annual growth rates of ITCWM institutions, beds, and practitioners reached 0.35%, 10.56%, and 10.88% from 2002 to 2021, with more equitable allocation of ITCWM resources, the overall proportion of ITCWM remained below 5% in 2021. Third, progress has been made in ITCWM practices, yet service efficiency requires further enhancement. In 2021, ITCWM hospitals accounted for 2% of outpatient and emergency visits and 1.57% of hospital admissions among all hospitals, and 9.82% of delivered services were preventive healthcare services. Fourth, ITCWM served a crucial role in primary healthcare services, but its service capabilities need improvement. From 2007 to 2021, the average growth rates of ITCWM clinics, outpatient departments, and practitioners in outpatient departments were 13.30%, 2.57%, and 12.14%, respectively, while the proportion within TCM hospitals dropped. Lastly, despite the Chinese government's emphasis on financial investment and related project funding for ITCWM, it remained lower than that allocated to TCM and western medicine. Conclusion ITCWM played a pivotal role in China's healthcare system to advance individuals' health and well-being across the lifespan. In the future, China will provide further support to enhance ITCWM health resources and improve service capability, and the strategic integration of ITCWM into the broader healthcare system will play a crucial role in achieving universal health coverage and the Sustainable Development Goals.
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Affiliation(s)
- Man-Ci Zhou
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Tong Fei
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- School of Traditional Chinese Medicine, University of Chinese Medicine, Beijing, China
| | - Xiao-Zhen Lai
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jian Lan
- School of Traditional Chinese Medicine, University of Chinese Medicine, Beijing, China
| | - Bo Liu
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi-Wei Wang
- National Institute of Chinese Medicine Development and Strategy, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jian-Ping Liu
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-Guo Rong
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- School of Traditional Chinese Medicine, University of Chinese Medicine, Beijing, China
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Guan X, Xu J, Huang X. Digital economy and the medical and health service supply in China. Front Public Health 2024; 12:1441513. [PMID: 39296853 PMCID: PMC11409523 DOI: 10.3389/fpubh.2024.1441513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/19/2024] [Indexed: 09/21/2024] Open
Abstract
The impact of the digital economy on the healthcare sector is becoming increasingly profound. This article focuses on the relationship between the development of China's digital economy and medical and health services supply. Based on panel data from 30 provinces in China from 2012 to 2021, the CRITIC weight method was applied to measure the supply capacity of medical and health services and the level of digital economy development, and the kernel density estimation method and Dagum Gini coefficient method was used to characterize the evolutionary trends and regional differences. Additionally, a two-way fixed-effects model is adopted to investigate the impact of digital economy development on medical and health services supply. The results show that both the supply capacity of healthcare services and the level of digital economy development have been increasing continuously in terms of evolutionary trends. From the perspective of regional differences, compared to the supply level of healthcare services, the regional differences in digital economy development are more significant. The intra-regional differences in medical and health services supply are greater than the inter-regional differences, while the development of the digital economy exhibits the opposite trend. The findings of this paper provide supports for China to enhance the development level of digital economy and improve supply of medical and health service.
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Affiliation(s)
- Xueling Guan
- School of Management, Xuzhou Medical University, Xuzhou, China
- Research Institute Chinese-Style Modernization in Healthcare, Xuzhou Medical University, Xuzhou, China
| | - Jiayue Xu
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Xinru Huang
- School of Management, Xuzhou Medical University, Xuzhou, China
- Research Institute Chinese-Style Modernization in Healthcare, Xuzhou Medical University, Xuzhou, China
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16
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Guo Y, Yang L, Wang L, Li H, Ge Q. Assessment of ecological civilization construction from the perspective of environment and health in China. ECO-ENVIRONMENT & HEALTH 2024; 3:281-289. [PMID: 39252857 PMCID: PMC11381979 DOI: 10.1016/j.eehl.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/04/2024] [Accepted: 02/24/2024] [Indexed: 09/11/2024]
Abstract
This study innovatively evaluated ecological civilization in China from the perspective of environment and health. A Composite Environmental Health Index (CEHI) was constructed based on the Driving force-Pressure-State-Impact-Response (DPSIR) and Coupling Coordination Degree (CCD) models. Results showed that significant and sustained improvements were observed in the ecological environment after ecological civilization, while economic development continued to progress at a steady pace. However, the advancement in population health (impact subsystem), exhibited comparatively modest progress, potentially linked to issues such as demographic aging and the enduring consequences of past exposure to environmental pollutants. At the provincial level, the regional development was uneven. The CEHI performance was highest in the eastern regions, followed by the central regions, with the western regions showing the least progress. Beijing, Guangdong, Jiangsu, Shanghai, and Zhejiang emerged as top performers with higher CEHI scores, which can be attributed to their favorable geographical positioning and the response subsystem. Conversely, northeastern regions (Heilongjiang, Jilin, and Liaoning) and northwestern regions (Shanxi, Gansu, Ningxia, and Qinghai) experienced limited advancements in post-ecological civilization implementation. For these underperforming regions, there is a pressing need to intensify efforts aimed at enhancing their response subsystems. In summary, China's pursuit of ecological civilization has yielded significant successes, potentially offering valuable insights for other nations striving for sustainable development. The ecological civilization model's integration of ecological environmental protection into economic, political, cultural, and social constructs may serve as a meaningful reference for the sustainable development of other countries.
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Affiliation(s)
- Ya'nan Guo
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Linsheng Yang
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Li Wang
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Hairong Li
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Quansheng Ge
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
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17
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Hao Z, Zhang X, Wang Y. Assessing the accuracy of self-reported health expenditure data: Evidence from two public surveys in China. Soc Sci Med 2024; 356:117155. [PMID: 39088928 DOI: 10.1016/j.socscimed.2024.117155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 06/30/2024] [Accepted: 07/18/2024] [Indexed: 08/03/2024]
Abstract
This paper utilizes Benford's law, the distribution that the first significant digit of numbers in certain datasets should follow, to assess the accuracy of self-reported health expenditure data known for measurement errors. We provide both simulation and real data evidence supporting the validity assumption that genuine health expenditure data conform to Benford's law. We then conduct a Benford analysis of health expenditure variables from two widely utilized public datasets, the China Health and Nutrition Survey and the China Family Panel Studies. Our findings show that health expenditure data in both datasets exhibit inconsistencies with Benford's law, with the former dataset tending to be less prone to reporting errors. These results remain robust while accounting for variations in survey design, recall periods, and sample sizes. Moreover, we demonstrate that data accuracy improves with a shorter time interval between hospitalization and interviews, when the data is self-reported as opposed to proxy responses, and at the household level. We find no compelling evidence that enumerators' assessments of respondents' credibility or urgency to end interviews are indicative of data accuracy. This paper contributes to literature by introducing an easy-to-implement analytical framework for scrutinizing and comparing the reporting accuracy of health expenditure data.
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Affiliation(s)
- Zhuang Hao
- College of Economics and Management, Huazhong Agricultural University, Wuhan, 430070, China.
| | - Xudong Zhang
- College of Economics and Management, Huazhong Agricultural University, Wuhan, 430070, China.
| | - Yuze Wang
- College of Economics and Management, Huazhong Agricultural University, Wuhan, 430070, China.
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18
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Peng X, Huang M, Li X, Zhou T, Lin G, Wang X. Patient regional index: a new way to rank clinical specialties based on outpatient clinics big data. BMC Med Res Methodol 2024; 24:192. [PMID: 39217327 PMCID: PMC11365139 DOI: 10.1186/s12874-024-02309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Many existing healthcare ranking systems are notably intricate. The standards for peer review and evaluation often differ across specialties, leading to contradictory results among various ranking systems. There is a significant need for a comprehensible and consistent mode of specialty assessment. METHODS This quantitative study aimed to assess the influence of clinical specialties on the regional distribution of patient origins based on 10,097,795 outpatient records of a large comprehensive hospital in South China. We proposed the patient regional index (PRI), a novel metric to quantify the regional influence of hospital specialties, using the principle of representative points of a statistical distribution. Additionally, a two-dimensional measure was constructed to gauge the significance of hospital specialties by integrating the PRI and outpatient volume. RESULTS We calculated the PRI for each of the 16 specialties of interest over eight consecutive years. The longitudinal changes in the PRI accurately captured the impact of the 2017 Chinese healthcare reforms and the 2020 COVID-19 pandemic on hospital specialties. At last, the two-dimensional assessment model we devised effectively illustrates the distinct characteristics across hospital specialties. CONCLUSION We propose a novel, straightforward, and interpretable index for quantifying the influence of hospital specialties. This index, built on outpatient data, requires only the patients' origin, thereby facilitating its widespread adoption and comparison across specialties of varying backgrounds. This data-driven method offers a patient-centric view of specialty influence, diverging from the traditional reliance on expert opinions. As such, it serves as a valuable augmentation to existing ranking systems.
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Affiliation(s)
- Xiaoling Peng
- Guangdong Provincial Key Laboratory of Interdisciplinary Research and Application for Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Moyuan Huang
- Guangdong Provincial Key Laboratory of Interdisciplinary Research and Application for Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Xinyang Li
- Guangdong Provincial Key Laboratory of Interdisciplinary Research and Application for Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Tianyi Zhou
- Guangdong Provincial Key Laboratory of Interdisciplinary Research and Application for Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Guiping Lin
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, China
| | - Xiaoguang Wang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, China.
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Xiong X, Huo Z, Zhou S, Bai G, He S, Zhou Y, Jia J, Quan J, Luo L. Short- and long-term impacts of the National Essential Medicines Policy on drug availability, price, and usage in a deprived rural county in southwestern China: an interrupted time series analysis across 8 years. Front Public Health 2024; 12:1355239. [PMID: 39267638 PMCID: PMC11390679 DOI: 10.3389/fpubh.2024.1355239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 08/15/2024] [Indexed: 09/15/2024] Open
Abstract
Background China's National Essential Medicines Policy (NEMP) has been implemented for over 15 years; yet empirical evidence on its long-term impacts is lacking, particularly in remote and rural regions. This study aims to assess the short-and long-term effects of NEMP on the drug availability, price, and usage in a deprived rural county in southwestern China. Methods A quasi-experimental design was employed, featuring a single-group pre-and-post comparison. We gathered 74,436 procurement records spanning from 2009 to 2016 from the drug warehouses of local medical institutions. Pharmaceutical data were analyzed quarterly, considering various policy and therapeutic attributes. Fisher's Drug Price Index (DPI-F) was calibrated for the retail and wholesale prices of a consistent collection of 405 medications. We conducted interrupted time-series analysis to examine the immediate and enduring impacts of NEMP's initial (commencing in January 2011) and second (starting from December 2015) stages. Results After initiation of NEMP, the number of available essential medicines surged by 115 but subsequently faced a steady quarterly decline (-9.1) in township healthcare centers (THCs, primary care). Conversely, county hospitals (secondary care) initially saw a reduction of 40 in drug availability but later exhibited a steady increase (+4.2 per quarter) up to the second-stage NEMP. Regarding price, THCs encountered abrupt (-26.1%/-15.9% in retail/wholesale price) and sustained (-0.2%/-0.3% per quarter) price drops after NEMP. The immediate price change after NEMP in county hospitals were milder but significant in non-essential medicines, and long-term declines were also observed in all drugs. As for total sales, a significant long-term disparity emerged between THCs (+0.9% per quarter) and county hospitals (+3.3% per quarter). Following the second-stage NEMP, retail prices in county hospitals further decreased, although wholesale prices did not; however, following price upward trends were observed in both THCs and county hospitals. Lastly, the influences of NEMP varied across different therapeutical categories of medicines. Conclusion NEMP has successfully regulated drug prices in primary and secondary healthcare facilities in remote and rural areas, both short-term and long-term. However, a remarkable disparity in medicine availability and utilization was observed between different levels of facilities over time. Continuous monitoring is essential, with increased attention needed on the uneven impacts of the policy on diverse drugs, facilities, regions, and demographics.
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Affiliation(s)
- Xuechen Xiong
- School of Public Health, Fudan University, Shanghai, China
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zhaohua Huo
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shuai Zhou
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ge Bai
- School of Public Health, Fudan University, Shanghai, China
| | - Shiying He
- School of Public Health, Fudan University, Shanghai, China
| | - Yinan Zhou
- School of Public Health, Fudan University, Shanghai, China
| | - Jing Jia
- JC School of Public Health, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jianchao Quan
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Li Luo
- School of Public Health, Fudan University, Shanghai, China
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20
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Liu D, Chu Y. Impact of Urban-Rural Resident Basic Medical Insurance integration on individual social fairness perceptions: evidence from rural China. Front Public Health 2024; 12:1408146. [PMID: 39267656 PMCID: PMC11390400 DOI: 10.3389/fpubh.2024.1408146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/05/2024] [Indexed: 09/15/2024] Open
Abstract
Background Achieving universal health insurance coverage has become a fundamental policy for improving the accessibility and equity of healthcare services. China's Urban-Rural Resident Basic Medical Insurance (URRBMI) is a crucial component of the social security system, aimed at promoting social equity and enhancing public welfare. However, the effectiveness of this policy in improving rural residents' social fairness perceptions (SFP) remains to be tested. Objective To examine the impact of the urban-rural resident basic medical insurance (URRBMI) on rural residents' social fairness perception (SFP) in China. Methods and samples The study utilizes city-level and national micro-survey (CGSS) datasets, applying a time-varying difference-in-difference (DID) approach to analyze the equity effects of URRBMI. Excluding urban samples, the final dataset consists of 20,800 rural respondents from 2010, 2011, 2013, and 2015, covering 89 cities. Results Key findings reveal that URRBMI has a significant negative effect on SFP. The impact varies depending on the integration model and intensifies over time. Additionally, the negative effect shows heterogeneity based on income, age, health, and region. Conclusion This study highlights the complexities and impacts of integrating China's urban and rural healthcare systems. It provides a detailed understanding of the role of URRBMI in rural China, emphasizing the need for targeted approaches to improve rural residents' perceptions of social fairness. The research offers specific policy recommendations, such as establishing differentiated contribution standards, implementing welfare policies favoring rural residents, and adopting varied reimbursement rates for different diseases.
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Affiliation(s)
- Dandan Liu
- Institute of Finance and Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Yifei Chu
- Institute of Agricultural Science and Technology Information, Shanghai Academy of Agricultural Sciences, Shanghai, China
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Gong F, Zhou Y, Luo J, Hu G, Lin H. Health resource allocation within the close-knit medical consortium after the Luohu healthcare reform in China: efficiency, productivity, and influencing factors. Front Public Health 2024; 12:1395633. [PMID: 39267642 PMCID: PMC11390686 DOI: 10.3389/fpubh.2024.1395633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/19/2024] [Indexed: 09/15/2024] Open
Abstract
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.
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Affiliation(s)
- Fangfang Gong
- Department of Hospital Group Office, Shenzhen Luohu Hospital Group Luohu People's Hospital, (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
| | - Ying Zhou
- Department of Hospital Group Office, Shenzhen Luohu Hospital Group Luohu People's Hospital, (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
| | - Junxia Luo
- Department of Hospital Group Office, Shenzhen Luohu Hospital Group Luohu People's Hospital, (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
| | - Guangyu Hu
- Institute of Medical Information, Center for Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanqun Lin
- Department of Hospital Group Office, Shenzhen Luohu Hospital Group Luohu People's Hospital, (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
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Wang T, Zhou T, Zhou L, He Y, Wang J, Wang Y, Huang L. Equity and efficiency of health resource allocation in the Chengdu-Chongqing Economic Circle of China. Front Public Health 2024; 12:1369568. [PMID: 39257950 PMCID: PMC11384592 DOI: 10.3389/fpubh.2024.1369568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/29/2024] [Indexed: 09/12/2024] Open
Abstract
Objective This study aimed to evaluate the fairness and efficiency of health resource allocation (HRAE) in Chengdu-Chongqing Economic Circle after the new healthcare reform. This study also aimed to identify existing problems, providing empirical evidence for the government to formulate regional health plans scientifically and reasonably. Methods The fairness of health resource allocation was analyzed using the Gini coefficient, Theil index, and agglomeration degree from population and geographical area perspectives. The three-stage data envelopment analysis and the Malmquist productivity index were used to analyze HRAE from static and dynamic perspectives. Results The Gini coefficient for population allocation in Chengdu-Chongqing Economic Circle was 0.066-0.283, and the Gini coefficient for geographical area allocation was 0.297-0.469. The contribution rate within a region was greater than that between regions, and health resources were mainly concentrated in economically developed core areas. The overall fairness of Chengdu Economic Circle was relatively better than that of Chongqing Economic Circle. Moreover, the adjusted mean technical efficiency was 0.806, indicating room for HRAE improvement in Chengdu-Chongqing Economic Circle. Stochastic Frontier Analysis found that different environmental variables have varying degrees of impact on HRAE. The adjusted mean total factor productivity change (Tfpch) was 1.027, indicating an overall upward trend in HRAE since the new healthcare reform. However, scale efficiency change (Sech) (0.997) limited the improvement of Tfpch. Conclusion The fairness of health resources allocated by population was better than that allocated by geographical area. The unfairness of health resources mainly stemmed from intra-regional differences, with considerable health resources concentrated in core areas. Over the past 13 years, HRAE has improved but exhibited spatial heterogeneity and Sech-hindered productivity improvement. The study recommends strengthening regional cooperation and sharing to promote the integrated and high-quality development of the health and well-being in Chengdu-Chongqing Economic Circle.
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Affiliation(s)
- Tianqi Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Ting Zhou
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Leming Zhou
- College of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Yunfei He
- Department of Personnel, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Wang
- Department of Pathophysiology, Chongqing Medical University, Chongqing, China
| | - Yonghong Wang
- Department of Clinical Laboratory, Chongqing Qianjiang Central Hospital, Chongqing, China
| | - Li Huang
- Department of Personnel, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tan H, Zhang X, Peng X, Guo D, Chen Y. Does vertical integration increase the costs for primary care inpatients? Evidence from a national pilot programme in China. Arch Public Health 2024; 82:136. [PMID: 39187907 PMCID: PMC11346275 DOI: 10.1186/s13690-024-01378-2] [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: 05/15/2024] [Accepted: 08/18/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE To assess the impact of vertical integration (VI) within County-Level Integrated Health Organisations (CIHOs) on the costs of primary care inpatients. METHODS This study assessed Xishui, a national pilot county for CIHOs, using inpatient claims data. The treatment group comprised 10,118 inpatients from 5 vertically integrated township health centres (THCs), while the control group consisted of 21,165 inpatients from 19 non-vertically integrated THCs. The periods from July 2020 to December 2021 and January 2022 to December 2022 were defined as pre- and post-policy intervention, respectively. The primary outcome variables were total health expenditures (THS), out-of-pocket (OOP) expenditures, and the proportion of OOP expenditures. Propensity score matching was employed to align inpatient demographics and disease characteristics between the groups, followed by a difference-in-differences analysis to evaluate the outcomes. FINDINGS VI significantly increased THS (β = 0.1337, p < 0.01) and OOP expenditures per case (β = 0.1661, p < 0.001), but the increase in the proportion of OOP expenditures per case was not significant (β = 0.0029, p > 0.05). For the basic medical insurance for urban and rural residents, THS per case (β = 0.1343, p < 0.01) and OOP expenditures (β = 0.1714, p < 0.001) significantly increased. For the basic medical insurance system for employees, THS per case also increased significantly (β = 0.1238, p < 0.01), but the change in OOP expenditure proportion per case was not significant (β = 0.1020, p > 0.05). The THS per case led by Xishui County People's Hospital, the leading county medical sub-centre (CMSC), significantly increased (β = 0.1753, p < 0.01), whereas the increase led by Xishui County Traditional Chinese Medicine Hospital was not significant (β = 0.0742, p > 0.05). Increases in OOP expenditures per case were significant in CMSCs led by the People's Hospital and the Traditional Chinese Medicine Hospital (β = 0.1782, p < 0.01 and β = 0.0757, p < 0.05, respectively). CONCLUSION VI significantly increased THS and OOP expenditures for primary care inpatients. However, VI could exacerbate economic disparities in disease burden across different insurance categories.
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Affiliation(s)
- Huawei Tan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xueyu Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xinyi Peng
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dandan Guo
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yingchun Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Xu X, Yasmeen R, Shah WUH. Efficiency evaluation, regional technological heterogeneity and determinant of total factor productivity change in China's healthcare system. Sci Rep 2024; 14:19606. [PMID: 39179793 PMCID: PMC11343758 DOI: 10.1038/s41598-024-70736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/20/2024] [Indexed: 08/26/2024] Open
Abstract
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.
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Affiliation(s)
- Xiaowei Xu
- Physical, Aesthetic, and Labor Education Centre, Zhejiang Shuren University, Hangzhou, China
| | - Rizwana Yasmeen
- School of Economics and Management, Panzhihua University, Panzhihua, 617000, Sichuan, China.
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Xu W, Zheng Y, Suo Z, Yang Y, Yang J, Wang Q, Zhou B, Ni C. Potential vicious cycle between postoperative pain and sleep disorders: A bibliometric analysis. Heliyon 2024; 10:e35185. [PMID: 39170563 PMCID: PMC11336490 DOI: 10.1016/j.heliyon.2024.e35185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024] Open
Abstract
Background Surgical pain affects postoperative sleep quality, and they jointly form a vicious cycle of mutual influence. The cycle of postoperative pain and sleep disorders could lead to delirium, cardiovascular disease, and hyperalgesia, which significantly affect patients' postoperative recovery. Thus, exploring this phenomenon is of great importance for surgical patients, and warrants further investigation. Objective By employing bibliometric methods, this study systematically analyzes the publications on postoperative pain-sleep disorders, identifies research trends and field dynamics, and ultimately provides insights for further progress in this research area. Methods In this study, we searched the Web of Science database for studies on postoperative pain and sleep disorders from 2013 to 2023, and analyzed the number of publications, journals, authors, institutions, country regions, and keywords by utilizing CiteSpace, VOSviewer, and Bibliometrix. Results The 1894 retrieved publications showed a trend of increasing number of publications and correlations between postoperative pain and sleep disorders from 2013 to 2023. The top countries for publications included the USA, China, etc., establishing a global collaborative network centered around the USA, China, and Europe. The top institutions for publications included University of California System, Harvard University, etc. The top authors include Christine Miaskowski, Steven M. Paul, Qiuling Shi, etc. These publications involved multiple disciplines including surgery, neurology, and anesthesiology, and various research funds including NIH, HHS, NSFC, etc. The top journals for publications included the European Archives of Oto-Rhino-Laryngology, etc. Keywords that appear most frequently in this field include "pain", "surgery", "quality of life", "sleep", "depression", and "outcomes". The thematic map indicated that the hot topics in this area include obstructive sleep apnea, tonsillectomy, children, pain, quality of life, and sleep. The undeveloped topics with research potential included postoperative pain, analgesia and dexmedetomidine, breast cancer, fatigue, and lung cancer. Conclusion The increased number of publications and correlations between postoperative pain and sleep disorders, and the collaborative network across the USA, China, and Europe indicate a growing global interest in this area. This study also provides valuable insights into the trend of hot topics and frontiers and shows that this is an evolving and dynamic research area.
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Affiliation(s)
- Wenjie Xu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuxiang Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zizheng Suo
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yafan Yang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jing Yang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China
| | - Qing Wang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bowen Zhou
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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Li HM, Liu Y, Hao MD, Liang XQ, Yuan DJ, Huang WB, Li WJ, Ding L. Research status and hotspots of tight junctions and colorectal cancer: A bibliometric and visualization analysis. World J Gastrointest Oncol 2024; 16:3705-3715. [PMID: 39171170 PMCID: PMC11334041 DOI: 10.4251/wjgo.v16.i8.3705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related death. Over the past two decades, numerous researchers have provided important evidence regarding the role of tight junction (TJ) proteins in the occurrence and progression of CRC. The causal relationship between the presence of specific TJ proteins and the development of CRC has also been confirmed. Despite the large number of publications in this field, a bibliometric study to review the current state of research and highlight the research trends and hotspots in this field has not yet been performed. AIM To analyze research on TJs and CRC, summarize the field's history and current status, and predict future research directions. METHODS We searched the Science Citation Index Expanded database for all literature on CRC and TJs from 2001-2023. We used bibliometrics to analyze the data of these papers, such as the authors, countries, institutions, and references. Co-authorship, co-citation, and co-occurrence analyses were the main methods of analysis. CiteSpace and VOSviewer were used to visualize the results. RESULTS A total of 205 studies were ultimately identified. The number of publications on this topic has steadily increased since 2007. China and the United States have made the largest contributions to this field. Anticancer Research was the most prolific journal, publishing 8 articles, while the journal Oncogene had the highest average citation rate (68.33). Professor Dhawan P was the most prolific and cited author in this field. Co-occurrence analysis of keywords revealed that "tight junction protein expression", "colorectal cancer", "intestinal microbiota", and "inflammatory bowel disease" had the highest frequency of occurrence, revealing the research hotspots and trends in this field. CONCLUSION This bibliometric analysis evaluated the scope and trends of TJ proteins in CRC, providing valuable research perspectives and future directions for studying the connection between the two. It is recommended to focus on emerging research hotspots, such as the correlations among intestinal microbiota, inflammatory bowel disease, TJ protein expression, and CRC.
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Affiliation(s)
- Hui-Min Li
- Department of Gastrointestinal Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yin Liu
- Department of Gastrointestinal Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Meng-Di Hao
- Department of Gastrointestinal Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Xiao-Qing Liang
- Department of Gastrointestinal Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Da-Jin Yuan
- Department of Gastrointestinal Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Wen-Bin Huang
- Department of Gastrointestinal Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Wen-Jie Li
- Department of Gastrointestinal Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Lei Ding
- Department of Gastrointestinal Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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Wang X, Zhang T, Gong H, Li J, Wu B, Chen B, Zhao S. Game-theoretic analysis of governance and corruption in China's pharmaceutical industry. Front Med (Lausanne) 2024; 11:1439864. [PMID: 39206179 PMCID: PMC11349649 DOI: 10.3389/fmed.2024.1439864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction With the rapid development of China's pharmaceutical industry, issues of corruption and regulatory effectiveness have become increasingly prominent, posing critical challenges to public health safety and the industry's sustainable development. Methods This paper adopts a bounded rationality perspective and employs a game-theoretic evolutionary approach to establish a tripartite evolutionary game model involving pharmaceutical companies, third-party auditing organizations, and health insurance regulatory agencies. It analyzes the stable strategies of the parties involved and the sensitivity of key parameters within this tripartite game system. Results The study reveals that adherence to health insurance regulations by pharmaceutical companies, refusal of bribes by third-party auditing organizations, and the implementation of lenient regulations by health insurance agencies can form an effective governance equilibrium. This equilibrium state contributes to reducing corruption in the pharmaceutical industry, balancing the interests of all parties, and promoting healthy industry development. Discussion Pharmaceutical companies must balance compliance costs against the risks of non-compliance benefits while maximizing profits; third-party auditing organizations need to choose between fulfilling their duties and accepting bribes, considering their economic benefits and professional reputation; health insurance regulatory agencies adjust their strategies between strict and lenient regulation to maximize social welfare. The paper suggests enhancing policy support, strengthening compliance supervision, improving audit independence, and adjusting regulatory strategies to optimize governance in the pharmaceutical industry. Additionally, the research highlights the role of collaborative efforts among the three parties in achieving sustainable governance. Furthermore, the study conducts a numerical simulation analysis to demonstrate the impact of various parameters on the evolutionary stability of the system, providing practical insights into the implementation of regulatory policies. This research offers new insights for policy formulation and governance in China's pharmaceutical sector, providing significant reference value for guiding the industry's sustainable development.
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Affiliation(s)
- Xi Wang
- Faculty of Humanities and Social Sciences, Macau Polytechnic University, Macau, Macau SAR, China
| | - Tao Zhang
- Faculty of Humanities and Social Sciences, Macau Polytechnic University, Macau, Macau SAR, China
| | - Hanxiang Gong
- The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinghua Li
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Baoling Wu
- Faculty of Humanities and Social Sciences, Macau Polytechnic University, Macau, Macau SAR, China
| | - Baoxin Chen
- Pingshan Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Shufang Zhao
- Faculty of Humanities and Social Sciences, Macau Polytechnic University, Macau, Macau SAR, China
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Wang W, Zhao R, Zhang J, Xu T, Lu J, Nicholas S, Wei X, Liu X, Yang H, Matiland E. Public expectations of good primary health care in China: a national qualitative study. Fam Pract 2024; 41:564-570. [PMID: 36573339 DOI: 10.1093/fampra/cmac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND China is currently making efforts to transform the current hospital-centric service delivery system to people-centred primary health care (PHC)-based delivery system, with service delivery organized around the health needs and expectations of people. To help direct China's PHC reform efforts, a profile of high-quality PHC from the public's perspective is required. OBJECTIVES To profile high-quality PHC from the perspective of the Chinese public. METHODS Semistructured interviews were conducted in 6 provinces (Henan, Shandong, Zhejiang, Shaanxi, Shanxi, and Heilongjiang) in China. In total, 58 interviewees completed the recorded interview. For transcription, trained research assistant listened to the recording of the interviews, summarizing each 30-s segment in English. Next, thematic analysis was performed on the narrative summaries to identify thematic families. RESULTS Seven themes and 16 subthemes were generated from the analysis of our interview data. In order of their frequency, the interviewees expressed a high expectation for interpersonal communication and technical quality; followed by access, comprehensive care, cost, continuity, and coordination. CONCLUSIONS Using qualitative data from 6 provinces in China, knowledge was generated to reveal the public's views and expectations for high-quality PHC. Our results confirm the urgent need for quality improvement efforts to improve patient experience and technical quality. The government also needs to further improve the delivery system and medical training programme to better meet public expectation in these areas, especially in establishing an innovative integrated primary care model, and strengthening interpersonal and clinical competency training for family doctors.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Ruixue Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Tiange Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, Australia
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, PR China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, PR China
- Newcastle Business School, University of Newcastle, Newcastle, Australia
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Xiaoyun Liu
- China Centre for Health Development Studies, Peking University, Beijing, PR China
| | - Huiyun Yang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Elizabeth Matiland
- School of Management, University of Liverpool, Liverpool, United Kingdom
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Lin K, Yao Y, Xiong Y, Xiang L. The effect of an innovative payment method on inpatient volume and bed resources and their regional distribution: the case of a central province in China. Int J Equity Health 2024; 23:159. [PMID: 39138482 PMCID: PMC11320847 DOI: 10.1186/s12939-024-02243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Since 2020, China has piloted an innovative payment method known as the Diagnosis-Intervention Packet (DIP). This study aimed to assess the impact of the DIP on inpatient volume and bed allocation and their regional distribution. This study investigated whether the DIP affects the efficiency of regional health resource utilization and contributes to disparities in health equity among regions. METHODS We collected data from a central province in China from 2019 to 2022. The treatment group included 508 hospitals in the pilot area (Region A, where the DIP was implemented in 2021), whereas the control group consisted of 3,728 hospitals from non-pilot areas within the same province. We employed the difference-in-differences method to analyze inpatient volume and bed resources. Additionally, we conducted a stratified analysis to examine whether the effects of DIP implementation varied across urban and rural areas or hospitals of different levels. RESULTS Compared with the non-pilot regions, Region A experienced a statistically significant reduction in inpatient volume of 14.3% (95% CI 0.061-0.224) and a notable decrease of 9.1% in actual available bed days (95% CI 0.041-0.141) after DIP implementation. The study revealed no evidence of patient consultations shifting from inpatient to outpatient services due to the reduction in hospital admissions in Region A after DIP implementation. Stratified analysis revealed that inpatient volume decreased by 12.4% (95% CI 0.006-0.243) in the urban areas and 14.7% in the rural areas of Region A (95% CI 0.051-0.243). At the hospital level, primary hospitals experienced the greatest impact, with a 19.0% (95% CI 0.093-0.287) decline in inpatient volume. Furthermore, primary and tertiary hospitals experienced significant reductions of 11.0% (95% CI 0.052-0.169) and 8.2% (95% CI 0.002-0.161), respectively, in actual available bed days. CONCLUSIONS Despite efforts to curb excessive medical service expansion in the region following DIP implementation, large hospitals continue to attract a large number of patients from primary hospitals. This weakening of primary hospitals and the subsequent influx of patients to urban areas may further limit rural patients' access to medical services. The implementation of the DIP may raise concerns about its impact on health care equality and accessibility, particularly for underserved rural populations.
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Affiliation(s)
- Kunhe Lin
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yifan Yao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingbei Xiong
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Xiang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- HUST Base of the National Institute of Healthcare Security, Wuhan, China.
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Shen C, Deng Q, Lai S, Yang L, Zhao D, Zhao Y, Zhou Z. New evidence on supplier-induced demand in China's public tertiary hospitals: is the cost of hospitalization higher in the off-season? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:951-962. [PMID: 37922094 DOI: 10.1007/s10198-023-01638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/02/2023] [Indexed: 11/05/2023]
Abstract
Supplier-induced demand (SID) is a long-standing concern in health economics and health system studies; however, empirical evidence on SID-critical to the development of health policy-is difficult to obtain, especially from China. This study, therefore, aims to add new evidence on SID in China's public tertiary hospitals and facilitates the development of evidence-based health policies in China and other countries with similar healthcare systems. For this study, we used patient-level electronic medical records (EMRs) collected from the information systems of tertiary hospitals in a western province in China. From 11 tertiary hospitals, we collected 274,811 hospitalization records dated between 15 February and 30 November 2019. Total expenditure on hospitalization and length of admission of each patient were the primary metrics for measuring SID. We constructed a character indicator to measure the high-season or off-season status of hospitals, and log-linear estimations were applied to estimate the "off-season effect" on hospitalized expenditures and length of admission. We find that the cost of hospitalization is indeed higher in the off-season in China's public tertiary hospitals; specifically, expenditures for patients admitted in the off-season increased by an average of 5.3-7.9% compared to patients admitted in the peak season, while the length of admission in the hospital increased by an average of 6.8% to 10.2%. We also checked the robustness of our findings by performing subgroup analyses of EMRs in the city-level hospitals and surgical group. We name this phenomenon the "hospital off-season effect" and suggest that the main reason for it is inappropriate financial incentives combined with a Fee-For-Services payment method. We suggest that China should work to reform inappropriate financial incentives in public hospitals to eliminate SID by changing its payment and financing compensation system.
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Affiliation(s)
- Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Qiwei Deng
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Liu Yang
- Center of Health Information of Shaanxi Province, Xi'an, 710003, China
| | - Dantong Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.
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Gu Y, Liu M, Wang A, He D, Sun H, Cui X, Tian W, Zhang Y, Jin C, Wang H. Analysis of Factors Influencing Hospitalization Expenses of Patients with Gastric Cancer in Shanghai, 2014-2021: Based on Grey Relational Analysis and Structural Equation Modeling. Value Health Reg Issues 2024; 44:101029. [PMID: 39094426 DOI: 10.1016/j.vhri.2024.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/06/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES This study analyzed the basic condition and the influencing factors of hospitalization costs of patients with gastric cancer in Shanghai from 2014 to 2021, so as to provide a scientific reference for promoting the reform of the medical and healthcare system. METHODS The study data were obtained from the electronic medical record system of Shanghai Hospital. The grey relational analysis was applied to analyze the correlation strength of various expenses with hospitalization costs. The structural equation modeling was constructed to analyze the influences of factors on the hospitalization expenses, as well as the relationship between each factor. RESULTS A total of 23 335 study subjects were included. The results of grey relational analysis showed that the total cost of drugs had the strongest correlation with hospitalization expenses, followed by material expenses and surgery cost, whereas those of others were lower. The results of the structural equation modeling showed that age had the greatest influence on hospitalization expenses with a path coefficient of 0.618. Other influencing factors included surgery history, length of stay, hospital level, gender, and medical insurance. CONCLUSIONS The total cost of drugs had the strongest correlation with hospitalization expenses. Factors such as gender, age, and hospital level all affect the hospitalization expenses. In the future, it is necessary to take further measures to control the cost of drugs and constantly optimize the structure of hospitalization costs. Meanwhile, the reform of the medical and healthcare system should be deepened to reasonably regulate the medical behaviors and reduce the financial burden of patients.
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Affiliation(s)
- Yichun Gu
- Shanghai Health Development Research Center, Shanghai, China
| | - Mengying Liu
- School of Pharmacy, Anhui Xinhua University, Hefei, Anhui, China
| | - Anqi Wang
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Da He
- Shanghai Health Development Research Center, Shanghai, China
| | - Hui Sun
- Shanghai Health Development Research Center, Shanghai, China
| | - Xin Cui
- Shanghai Health Statistics Center, Shanghai, China
| | - Wenqi Tian
- Shanghai Health Statistics Center, Shanghai, China
| | - Yulin Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai, China.
| | - Haiyin Wang
- Shanghai Health Development Research Center, Shanghai, China.
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Yi L, Zeng X, Zhou Z, Liu Q. Comparison Between Sotorasib with Docetaxel for the Treatment of Chinese Patients with Previously Treated NSCLC with KRASG12C Mutation: A Cost-Effectiveness Analysis to Inform Drug Pricing. Adv Ther 2024; 41:3159-3172. [PMID: 38888881 DOI: 10.1007/s12325-024-02908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION This study sought to investigate the affordable price of sotorasib among patients with previously treated advanced KRASG12C-mutant non-small cell lung cancer (NSCLC) through a cost-effectiveness analysis from the perspectives of both the Chinese healthcare system and the patients. METHODS We developed a Markov model spanning a 20-year time horizon with a cycle length of 21 days. Our data were derived from the CodeBreaK 200 clinical trial, supplemented with published literature, publicly available national databases, and local hospitals. The primary outcomes were the affordable prices of sotorasib which would result in the incremental cost-effectiveness ratios (ICERs) of sotorasib relative to docetaxel below the preset willing-to-pay (WTP) threshold. Sensitivity analyses were performed to evaluate the model's robustness. RESULTS At the national level, from the perspective of the Chinese healthcare system and patients, the price of sotorasib should be lower than US$0.04673 and $0.03231, respectively, to make it affordable, which is equivalent to $1346 and $931 per box (120 mg × 240 pieces). At the provincial level, the price ceiling of sotorasib/mg fluctuated between $0.04084 to $0.08061 from the Chinese healthcare system's perspective and between $0.02642 to $0.06620 from the patients' perspective. Probabilistic sensitivity analyses revealed that, as the price of sotorasib decreased, its likelihood of being cost-effective increased. CONCLUSION Sotorasib might be a cost-effective therapy in China. The pharmaco-economic evidence generated from this study has significant implications not only for guiding the drug pricing of the upcoming sotorasib but also for determining the reimbursement ratio for its potential inclusion in the National Reimbursement Drugs List in the future.
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Affiliation(s)
- Lidan Yi
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Xiaohui Zeng
- PET-CT Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Qiao Liu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.
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Zhang J, Hu M, Jia Y, Gu Y, Chen W. How should regulatory schemes be optimized to enhance deterrence against medical insurance fraud by enrollees? Evidence from a discrete choice experiment in China. Soc Sci Med 2024; 354:117059. [PMID: 38968901 DOI: 10.1016/j.socscimed.2024.117059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/10/2024] [Accepted: 06/16/2024] [Indexed: 07/07/2024]
Abstract
Medical insurance fraud (MIF) poses a substantial global financial challenge, necessitating effective regulatory strategies, especially in China, where such measures are in a critical developmental phase. This study investigates the effectiveness of various regulatory components in deterring MIF among enrollees and explores preference heterogeneity among individuals with different characteristics, utilizing a discrete choice experiment survey. Grounded in deterrence theory, our conceptual framework incorporates five attributes: intensity of economic penalties, restrictions on medical insurance benefits, deterioration of social reputation, and certainty and celerity of penalties. Employing a D-efficiency design, 24 choice sets were generated and blocked into three versions. A multistage stratified sampling method was adopted to collect data from the basic medical insurance enrollees in Shanghai. The survey was conducted from September to October 2022. The sample representativeness was further improved via the entropy balancing approach. Data from the final sample of 1034 respondents were analyzed using mixed logit models (MIXLs), incorporating interactions with individual characteristics to assess preference heterogeneity. Results reveal that escalating economic penalties, suspending insurance benefits, listing individuals as unfaithful parties, ensuring penalty certainty, and expediting enforcement significantly enhance the deterrent effect. We observed preference heterogeneity across different demographics, including age, gender, education, health status, and employment status. The study underscores the pivotal role of economic penalties in deterring MIF, while also acknowledging the significance of non-economic measures such as enforcement efficiency and social sanctions. These findings offer valuable insights for policymakers to tailor and strengthen regulatory schemes against MIF, contributing to the advancement of more effective and precise healthcare policies.
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Affiliation(s)
- Jinsui Zhang
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China.
| | - Min Hu
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China.
| | - Yusheng Jia
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China; Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, Rochester, NY, 14642, USA.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Australian Institute of Health Innovation & Macquarie Business School, Level 5, 75 Talavera Road, Macquarie University, NSW, 2109, Australia.
| | - Wen Chen
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China.
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Liu S, Kazonda P, Leyna GH, Rohr JK, Fawzi WW, Shinde S, Abioye AI, Francis JM, Probst C, Sando D, Mwanyka-Sando M, Killewo J, Bärnighausen T. Emotional and cognitive influences on alcohol consumption in middle-aged and elderly Tanzanians: a population-based study. Sci Rep 2024; 14:17520. [PMID: 39079984 PMCID: PMC11289436 DOI: 10.1038/s41598-024-64694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/12/2024] [Indexed: 08/02/2024] Open
Abstract
Alcohol consumption in Tanzania exceeds the global average. While sociodemographic difference in alcohol consumption in Tanzania have been studied, the relationship between psycho-cognitive phenomena and alcohol consumption has garnered little attention. Our study examines how depressive symptoms and cognitive performance affect alcohol consumption, considering sociodemographic variations. We interviewed 2299 Tanzanian adults, with an average age of 53 years, to assess their alcohol consumption, depressive symptoms, cognitive performance, and sociodemographic characteristics using a zero-inflated negative binomial regression model. The logistic portion of our model revealed that the likelihood alcohol consumption increased by 8.4% (95% confidence interval [CI] 3.6%, 13.1%, p < 0.001) as depressive symptom severity increased. Conversely, the count portion of the model indicated that with each one-unit increase in the severity of depressive symptoms, the estimated number of drinks decreased by 2.3% (95% CI [0.4%, 4.0%], p = .016). Additionally, the number of drinks consumed decreased by 4.7% (95% CI [1.2%, 8.1%], p = .010) for each increased cognitive score. Men exhibited higher alcohol consumption than women, and Christians tended to consume more than Muslims. These findings suggest that middle-aged and elderly adults in Tanzania tend to consume alcohol when they feel depressed but moderate their drinking habits by leveraging their cognitive abilities.
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Affiliation(s)
- Shuyan Liu
- Department of Psychiatry and Psychotherapy (Campus Charité Mitte), Charité - Universitätsmedizin Berlin, Berlin, Germany.
- German Center for Mental Health (DZPG), Berlin and Heidelberg, Germany.
| | | | - Germana H Leyna
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Julia K Rohr
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sachin Shinde
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ajibola Ibraheem Abioye
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joel M Francis
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charlotte Probst
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David Sando
- Management and Development for Health, Dar Es Salaam, Tanzania
| | | | - Japhet Killewo
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Till Bärnighausen
- German Center for Mental Health (DZPG), Berlin and Heidelberg, Germany.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany.
- Africa Health Research Institute, Somkhele and Durban, South Africa.
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Lin K, Xiang L. The Effects of the Multi-Hospital Global Budget Payment on Medical Expenditure and Service Volume: The Evidence from Dangyang County, China. Risk Manag Healthc Policy 2024; 17:1875-1887. [PMID: 39100547 PMCID: PMC11297547 DOI: 10.2147/rmhp.s471212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/23/2024] [Indexed: 08/06/2024] Open
Abstract
Background Global budget payment is currently the prevailing payment strategy internationally. In China, the concept of multi-hospital global budget payment has been proposed with the aims of achieving cost control effects while also encouraging hospital collaboration and optimising allocation of healthcare resources. This study seeks to analyse the impact of multi-hospital global budget payment in China on healthcare expenditure and service volume. Materials and Methods A retrospective comparative study was carried out in Dangyang County, China. The exposure cases were migrants who were not locally registered in the residence registration system. The study period encompassed January 1, 2017, to December 31, 2019. Including 3,246,164 outpatient medical records and 242,685 inpatient medical records. The key variables are medical expenditure and service volume indicators. Continuous variables were reported as mean and tested by t-test. We used interrupted time series analysis models to estimate the changes in the level and trend of each outcome measure after the policy. Results After the outpatient global budget payment reform, the monthly medical expenditure of the hospital alliance has transitioned from a discernible upward trajectory to a deceleration in the rate of growth. The outpatient volume in public and private high-level hospitals decreased at a rate of -419.26 person/month and -137.04 person/month, respectively. In terms of inpatient service volume, only private high-level hospitals reported a decrease, with a reduction rate of -15.38 individuals per month. Conclusion This study presents new evidence demonstrating that the multi-hospital global budget payment can effectively control costs and promote resource reallocation when implemented jointly with hospital alliance policies. However, overly lenient budget caps risk counterproductive effects.
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Affiliation(s)
- Kunhe Lin
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Li Xiang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- HUST Base of National Institute of Healthcare Security, Wuhan, People’s Republic of China
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Lan Y, Lin X, Chen Q, Wang L, Sun L, Huang Z. Drug supply and assurance: a cross-sectional study of drug shortage monitoring varieties in China. BMC Public Health 2024; 24:2048. [PMID: 39080661 PMCID: PMC11289944 DOI: 10.1186/s12889-024-19361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Drug shortage is a worldwide problem that seriously threatens public health. China released the most comprehensive list of key drug shortage monitoring varieties ever in 2022. We aim to analyze the attributes and characteristics of the medicines within the list to provide a reference for improving China's supply security of shortage drugs. METHODS We used public data to extract information on drug types, dosage forms, indications, classification of clinical uses, whether they were included in medical catalogs such as the National Essential Drugs, and the number of drug and active pharmaceutical ingredient (API) manufacturers. A descriptive statistical analysis was used. RESULTS Of the 980 drugs on the list, 99.59% were chemicals and 92.65% were injectables. Drugs for blood and hematopoietic organs, the cardiovascular system, and the digestive tract and metabolism ranked among the top three shortages. Verification of the medical catalogs showed that 90.41% of the drugs belonged to the national essential drugs, 95.10% were medicare drugs, 2.55% were volume-based procurement drugs, and 14.70% were for rare diseases, and 42.04% were for children. In terms of drug supply capacity, 21.33% of drug approvals are less than 10, and there were even 26 drugs for exclusive production, close to 90% of manufacturers need to purchase APIs from outside. Among the 256 APIs included in the list, 152 APIs had less than 10 manufacturers, and there were even 5 APIs produced by only one enterprise nationwide. CONCLUSIONS The situation of drug shortages in China was severe and complex, with serious shortages of medicines adapted to basic medical and healthcare needs and clinically necessary medicines, and a need to improve the production capacity of drugs and the ability to supply APIs. We recommend strengthening drug monitoring and stockpiling and accelerating the approval of shortage drugs to improve drug supply security.
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Affiliation(s)
- Yipeng Lan
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Xiaofeng Lin
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Qiannan Chen
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Li Wang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Lihua Sun
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China.
- Institute of Drug Regulatory Science, Shenyang Pharmaceutical University, Shenyang, China.
| | - Zhe Huang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China.
- Institute of Drug Regulatory Science, Shenyang Pharmaceutical University, Shenyang, China.
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He S, Bian Y. Older adults 's hospitalizational costs and burden study in China--analysis from CHARLS data 2018. Front Public Health 2024; 12:1418179. [PMID: 39118974 PMCID: PMC11306026 DOI: 10.3389/fpubh.2024.1418179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/19/2024] [Indexed: 08/10/2024] Open
Abstract
Objective The aging Chinese population is driving up health care costs, with hospitalizational accounting for a large portion of total health care costs. By 2012, hospitalization costs for people over 60 years of age exceeded outpatient costs, marking a change in the allocation of medical resources. Further research is needed on the factors influencing changes in hospitalizational costs and burden. This paper examines the costs and burden of hospitalization for older adults from a micro perspective, providing new evidence to explain how social, medical, family, personal, and geographic factors affect them. Methods Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a linear regression model was constructed to investigate the impact of various factors on the hospitalization costs and burden among the older adult in China. To ensure the heterogeneity of the results, the sample was divided into subgroups based on different regions for comparative analysis. Additionally, collinearity among the variables was examined. Results The average hospitalization costs for the older adult are $1,199.24, with a burden score of 0.5. Residence, type of chronic diseases, region, family size, type of health service facility, received distance, smoke and alcoholic significantly affect the out-of-pocket expenses for older adult hospitalizations. In terms of the burden of hospitalization for the older adult, Residence, health insurance, education, type of chronic diseases, region, family size, ethnic, type of health service facility, received distance, smoke, alcoholic and pension significantly impact the hospitalization burden for the older adult. Conclusion This paper provides a new perspective to explain the factors influencing hospitalizational costs and burden in China. The policy recommendations include expanding health insurance coverage and promoting commercial insurance to enhance the accessibility and financial security of healthcare services. Strengthening primary care is suggested to reduce the burden on hospitals and lower the overall cost of hospitalization. Policies aimed at addressing regional healthcare disparities are proposed, along with targeted support for vulnerable groups, including subsidies and culturally sensitive services.
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Affiliation(s)
- Shanheng He
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Ying Bian
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
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Gao Y, Yang Y, Wang S, Zhang W, Lu J. Has China's hierarchical medical system improved doctor-patient relationships? HEALTH ECONOMICS REVIEW 2024; 14:54. [PMID: 39023676 PMCID: PMC11256484 DOI: 10.1186/s13561-024-00520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 06/14/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND AND OBJECTIVE Developing harmonious doctor-patient relationships is a powerful way to promote the construction of a new pattern of medical reform in developing countries. We aim to analyze the effects of China's hierarchical medical system on doctor-patient relationships, thus contributing to China's medical and health system reform. METHODS With panel data on prefectural-level cities in China from 2012 to 2019, we used a time-varying difference-in-differences model to evaluate the effect of hierarchical medical treatment policy. RESULTS Hierarchical medical treatment policies can significantly improve doctor-patient relationships, and this conclusion is supported by various robustness tests. And improving doctor-patient relationships can be indirectly realized by the optimization of resource allocation and saving of medical costs. In addition, the marginal effect of the pilot policy on doctor-patient relationships decreased with age within the city population. In focal cities and cities with high levels of fiscal spending on health care, the effect of the pilot policy on doctor-patient relationships was stronger. CONCLUSION While reinforcing the literature on the doctor-patient relationship, this study also provides a reference for further exploration of the pilot policy of hierarchical medical treatment and the development of new medical and health system reform in developing countries.
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Affiliation(s)
- Yang Gao
- School of Economics and Management, Northwest University, Xi'an, Shaanxi, China
- School of Economics, Qufu Normal University, Rizhao, Shandong, China
| | - Yang Yang
- School of Economics, Qufu Normal University, Rizhao, Shandong, China
| | - Shoupeng Wang
- School of Economics and Management, Northwest University, Xi'an, Shaanxi, China
| | - Wenqian Zhang
- School of Economics, Qufu Normal University, Rizhao, Shandong, China
| | - Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xianning West Road 28#, Xi'an, 710049, Shaanxi, China.
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He G, Ren J, Chen X, Pan Q, Pan T. GP's GP, general practitioner's health and willingness to contract family doctors in China: a national cross-sectional study. BMC PRIMARY CARE 2024; 25:253. [PMID: 38997659 PMCID: PMC11245823 DOI: 10.1186/s12875-024-02492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/26/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES General practitioners are trained to care for patients with a high level of responsibility and professional competency. However, there are few reports on the physical and mental health status of general practitioners (GPs) in China, particularly regarding help seeking and self-treatment. The primary aims of this study were to explore GPs' expectations of their own family doctors and their reflection on role positioning, and to explore the objective factors that hinder the system of family doctors. STUDY DESIGN Cross-sectional study. METHODS We conducted an online survey of Chinese GPs. Descriptive statistics were used to summarize the findings. RESULTS More than half of the participants (57.20%) reported that their health was normal over the past year. A total of 420 participants (23.35%) reported having chronic diseases. For sleep duration, 1205 participants (66.98%) reported sleeping 6-8 h per day; 473 participants (26.29%) reported chronic insomnia. Two hundred thirty-one participants (12.84%) had possible depression. A total of 595 (33.07%) participants reported that they had contracted a fixed family doctor. In terms of preventing themselves from contracting for a family doctor, the following factors were identified: lack of sufficient time (54.81%), could solve obstacles themselves (50.97%), and embarrassment (24.24%). The proportion of the contract group (12.44%) taking personal relationship as a consideration was higher than that of the non-contract group (7.64%) (χ2 = 10.934 P = 0.01). Most participants (79.90%) in the non-signed group reported never having seen a family doctor. In terms of obstacles, more than half of the signed group thought that they could solve obstacles themselves, while the non-signed group (39.20%) was less confident in the ability of family doctors than the signed group (29.75%) (χ2 = 15.436, P < 0.01). CONCLUSIONS GPs work under great pressure and lack of self-care awareness, resulting in an increased prevalence of health conditions. Most GPs did not have a regular family doctor. Having a family doctor with a fixed contract is more conducive to the scientific management of their health and provides a reasonable solution to health problems. The main factors hindering GPs from choosing a family doctor were time consumption, abilities to solve obstacles themselves, and trust in the abilities of GPs. Therefore, simplifying the process of family doctor visits, Changing the GPs' medical cognition, and strengthening the policy of GP training would be conducive to promoting a family doctor system that enhances hierarchical diagnosis and treatment. International collaboration could integrate GP health support into global healthcare system.
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Affiliation(s)
- Guoshu He
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
| | - Jingjing Ren
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China.
| | - Xiaoyang Chen
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
| | - Qi Pan
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
| | - Tianyuan Pan
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
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Cao Z, Wang L, Ma R, Hu Y, Bao B, Liu X, Li M, Wang X, Liu P, Li X. Access to essential and innovative anti-cancer medicines: a longitudinal study in Nanjing, China. BMC Health Serv Res 2024; 24:802. [PMID: 38992687 PMCID: PMC11242009 DOI: 10.1186/s12913-024-11285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 07/08/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE To evaluate the availability, cost, affordability of anti-cancer medicines in Nanjing, Jiangsu. METHODS A longitudinal tracking investigation study was performed to collect information about 24 essential anti-cancer medicines (EAMs) and 17 innovative anti-cancer medicines (IAMs) in 26 healthcare institutions in Nanjing from 2016 to 2020. The availability, cost, drug utilization and affordability of EAMs and IAMs were investigated. RESULTS The availability of EAMs showed no significant changes in Nanjing, but the availability of IAMs showed a significant increase in 2018 and 2019 and tended to stabilize in 2020. For EAMs, the DDDc(Defined Daily Dose cost) of LPGs (Lowest-Priced Generics) showed no significant changes, and the DDDc of OBs (Originator Brands) and IAMs significantly decreased. The DDDs(Defined Daily Doses) of EAMs (LPGs) showed a decreasing trend since 2016 and rose again in 2019. Overall, the DDDs of EAMs (LPGs) decreased by 25.18% between 2016 and 2020, but the proportion selected for clinical treatment remained at 67.35% in 2020. The DDDs of EAMs (OBs) and IAMs both showed an increasing trend year by year, with a proportional increase of 207.72% and 652.68%, respectively; but the proportion selected for clinical treatment was only 16.09% and 16.56% respectively in 2020. EAMs (LPGs) had good affordability for urban residents but poor affordability for rural residents; the affordability of EAMs (OBs) and IAMs was poor for both urban and rural residents. CONCLUSIONS There were no significant changes in the availability and cost of EAMs (LPGs), whose lower prices showed better affordability. Although their relative change in drug utilization showed a decreasing trend, they still dominated clinical treatment. Driven by the national drug price negotiation (NDPN) policy, the availability of IAMs was on the rise. It is necessary to further develop and strengthen policies for essential medicines procurement assessment to improve the accessibility of EAMs.
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Affiliation(s)
- Zhaoliu Cao
- School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
- Nanjing City Qixia District Hospital, Nanjing, Jiangsu, 210046, China
| | - Lili Wang
- Nanjing City Qixia District Hospital, Nanjing, Jiangsu, 210046, China
| | - Rui Ma
- School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - Yun Hu
- Essential Medicine Division of Qixia District Health Commission of Nanjing City, Nanjing, Jiangsu, 210046, China
| | - Baiyi Bao
- School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - Xiaohua Liu
- Department of Pharmacy, Jiangsu Province Hospital, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Mengyuan Li
- Department of Pharmacy, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210011, China
| | - Xiao Wang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - Pingyu Liu
- Department of Pharmacy, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210011, China.
| | - Xin Li
- School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
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Chen M, Zhang H, He X, Lin Y. Cost-effectiveness of utidelone and capecitabine versus monotherapy in anthracycline- and taxane-refractory metastatic breast cancer. Front Pharmacol 2024; 15:1303808. [PMID: 39055495 PMCID: PMC11269192 DOI: 10.3389/fphar.2024.1303808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Background This study aimed to assess the cost-effectiveness of combining utidelone with capecitabine, compared to capecitabine monotherapy, for the treatment of anthracycline- and taxane-refractory metastatic breast cancer within the Chinese healthcare system. Methods A partitioned survival model was formulated based on patient characteristics from the NCT02253459 trial. Efficacy, safety, and health economics data were sourced from the trial and real-world clinical practices. We derived estimates for costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) for the two treatment strategies. Sensitivity and subgroup analyses were conducted to rigorously evaluate uncertainties' impact. Results Over a 5-year span, the combination therapy manifested substantially higher costs than capecitabine monotherapy, with a differential of US$ 26,370.63. This combined approach conferred an additional 0.49 QALYs, resulting in an ICER of US$ 53,874.17/QALY. Utilizing the established willingness-to-pay threshold, the combination might not consistently be deemed cost-effective when juxtaposed against monotherapy. However, at an ICER of US$ 53,874.4/QALY, the probability of the combination being cost-effective increased to 48.97%. Subgroup analysis revealed that the combination was more cost-effective than capecitabine alone in specific patient groups, including those <60 years, patients with more than two chemotherapy rounds, patients lacking certain metastases, patients having limited metastatic sites, patients with an Eastern Cooperative Oncology Group status of 0, and patients with particular hormone receptor profiles. Conclusion Although the combination of utidelone and capecitabine may not be an economically viable universal choice for anthracycline- and taxane-refractory metastatic breast cancer, it could be more cost-effective in specific patient subgroups than capecitabine monotherapy.
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Affiliation(s)
- Mulan Chen
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Heng Zhang
- Clinical Medical Research Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Xiaoyan He
- Department of Endocrinology, Fuqing City Hospital of Fujian, Fuqing City Hospital Affiliated to Fujian Medical University, Fuqing, China
| | - Yingtao Lin
- Clinical Medical Research Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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Teng X, Sun Y, Zhao L, Kang Y. Study on the management effect of chronic disease intelligent information management platform in post percutaneous coronary intervention patients. Technol Health Care 2024:THC240621. [PMID: 39031412 DOI: 10.3233/thc-240621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
BACKGROUND In 2019, approximately 330 million individuals in China were affected by cardiovascular diseases, with 11.4 million cases specifically attributed to coronary artery disease (CAD). A national public health report indicated that the mortality rate for CAD ranged from 121.59 to 130.14 per 100,000 individuals in 2019. The treatments for CAD include lifestyle changes, medications, percutaneous coronary intervention (PCI) and coronary artery bypass grafting. OBJECTIVE To investigate the management effect of a digital health program in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). METHODS This retrospective study compares blood pressure, blood glucose, low-density lipoprotein cholesterol (LDL-C), medication adherence, lifestyle modification, and readmission rate between digital health users and traditional follow-up in post-PCI CAD patients. RESULTS In this study of 698 CAD patients, the 6-month readmission rate of all patients was 27.4%, with digital health users showing lower rates than those in traditional follow-up (22.6% vs. 32.1%, p= 0.005). Digital health users had significantly higher target achievements rates in blood pressure (79.7% vs. 54.7%, p< 0.001), blood glucose (98.9% vs. 82.5%, p< 0.001) and LDL-C level (71.3% vs. 52.7%, p< 0.001) at 6-month post-PCI. The digital health group had more patients adopting lifestyle changes, including quitting smoking, maintaining a healthy diet, and exercising regularly. In risk factor analysis, digital health utilization (OR = 0.60, 95%CI: 0.40-0.90, p= 0.014) and multivessel disease (double: OR = 1.72, 95%CI: 1.09-2.72, p= 0.02; triple: OR = 2.59, 95%CI: 1.61-4.17, p< 0.001) were independent predictors of CAD-related cardiovascular readmissions. CONCLUSIONS Post-PCI patients using digital health platforms exhibited improved blood pressure, glucose, and LDL-C control, greater treatment adherence, enhanced lifestyle changes, and reduced six-month readmission rates versus those with traditional follow-up.
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Affiliation(s)
- Xiaohuan Teng
- Department of Cardiology, Central Hospital of Qinghe County, Xingtai, Hebei, China
| | - Yanrong Sun
- Department of Cardiology, Central Hospital of Qinghe County, Xingtai, Hebei, China
| | - Landi Zhao
- Department of Cardiology, Central Hospital of Qinghe County, Xingtai, Hebei, China
| | - Yingxian Kang
- Department of Medical Education, Central Hospital of Qinghe County, Xingtai, Hebei, China
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Zeng Z, Yu X, Tao W, Feng W, Zhang W. Efficiency evaluation and promoter identification of primary health care system in China: an enhanced DEA-Tobit approach. BMC Health Serv Res 2024; 24:777. [PMID: 38961461 PMCID: PMC11223419 DOI: 10.1186/s12913-024-11244-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND With Primary Health Care (PHC) being a cornerstone of accessible, affordable, and effective healthcare worldwide, its efficiency, especially in developing countries like China, is crucial for achieving Universal Health Coverage (UHC). This study evaluates the efficiency of PHC systems in a southwest China municipality post-healthcare reform, identifying factors influencing efficiency and proposing strategies for improvement. METHODS Utilising a 10-year provincial panel dataset, this study employs an enhanced Data Envelopment Analysis (DEA) model integrating Slack-Based Measure (SBM) and Directional Distance Function (DDF) with the Global Malmquist-Luenberger (GML) index for efficiency evaluation. Tobit regression analysis identifies efficiency determinants within the context of China's healthcare reforms, focusing on horizontal integration, fiscal spending, urbanisation rates, and workforce optimisation. RESULTS The study reveals a slight decline in PHC system efficiency across the municipality from 2009 to 2018. However, the highest-performing county achieved a 2.36% increase in Total Factor Productivity (TFP), demonstrating the potential of horizontal integration reforms and strategic fiscal investments in enhancing PHC efficiency. However, an increase in nurse density per 1,000 population negatively correlated with efficiency, indicating the need for a balanced approach to workforce expansion. CONCLUSIONS Horizontal integration reforms, along with targeted fiscal inputs and urbanisation, are key to improving PHC efficiency in underdeveloped regions. The study underscores the importance of optimising workforce allocation and skillsets over mere expansion, providing valuable insights for policymakers aiming to strengthen PHC systems toward achieving UHC in China and similar contexts.
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Affiliation(s)
- Zhi Zeng
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Office of Policy Research, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China
| | - Xiru Yu
- Institute for Hospital Management, Tsinghua University, Shenzhen, Guangdong, 518055, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wei Feng
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, 610041, China.
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Zhao Z, Li H, Xing X, Sun W, Ma X, Zhu H. Temporal trends and correlates in multiple hospitalizations among older adults: findings from a nationally representative sample in China. Geriatr Nurs 2024; 58:336-343. [PMID: 38875760 DOI: 10.1016/j.gerinurse.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE This study aims to examine the trends and correlates in multiple hospitalizations among older adults in China. METHODS The data were from the China Health and Retirement Longitudinal Study (CHARLS), and generalized ordered logit model (GOLM) was used to identify the correlates of multiple hospitalizations among older adults aged≥60 years old. RESULTS Between 2011 and 2018, the proportion of older adults having multiple hospitalizations in the past year showed an increasing trend in the total sample (p value for trend = 0.014). Being older, male, illiterate, living in the middle/western region, having higher annual per capita household expenditure, health insurance, multimorbidity, and being depressed were associated with increased odds of multiple hospitalizations. CONCLUSIONS Our findings indicated that older adults with multiple hospitalizations may expect an increasing burden on healthcare system. More efforts are needed to improve health insurance and primary healthcare to reduce avoidable hospitalizations.
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Affiliation(s)
- Ziyin Zhao
- School of Public Health, Peking University, Beijing 100191, China
| | - Huining Li
- School of Public Health, Peking University, Beijing 100191, China
| | - Xing Xing
- School of Public Health, Peking University, Beijing 100191, China
| | - Wenjun Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing 100191, China
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
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Wu M, Yang Y, Chen Y. Evaluation of treatment information quality on hypertension and diabetes on WeChat and TikTok: A cross-sectional content analysis. Health Informatics J 2024; 30:14604582241275824. [PMID: 39137943 DOI: 10.1177/14604582241275824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Objective: This study aimed to assess the quality of the information in WeChat and TikTok videos related to hypertension and diabetes treatment. Methods: A sample of 120 Chinese videos was collected based on specific inclusion and exclusion criteria. The quality was evaluated using DISCERN, JAMA and the latest edition of Chinese guidelines for hypertension and diabetes prevention and treatment, and two observers independently scored each video using the three assessment tools. Results: Among all 120 videos, only 10 scored above 38 points in DISCERN, with 45 videos rated as "very poor". None of the video met all JAMA criteria simultaneously, and there were gaps in accuracy and completeness compared to the two guidelines. Furthermore, there was no significant correlation between information quality and the number of likes and comments. Conclusion: The current quality of information on the treatment of hypertension and diabetes on WeChat and TikTok was unsatisfactory. Consequently, the government should strengthen oversight of information quality, and social media platforms should actively review health-related content to prevent inaccurate information dissemination. Individuals should enhance their digital and health literacy.
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Affiliation(s)
- Minxia Wu
- School of Medical Humanities and Management, Wenzhou Medical University, Wenzhou, China
| | - Yongmei Yang
- School of Medical Humanities and Management, Wenzhou Medical University, Wenzhou, China
| | - Yanxing Chen
- School of Medical Humanities and Management, Wenzhou Medical University, Wenzhou, China
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Wang Y, Wang R, Jiang M, Ying X. Provincial inequality of China's progress towards universal health coverage: An empirical analysis in 2016-21. J Glob Health 2024; 14:04122. [PMID: 38939928 PMCID: PMC11211969 DOI: 10.7189/jogh.14.04122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the regional economy and resource allocation, subnational evidence in China is urgently needed. This study aimed to monitor provincial progress from 2016 to 2021, thereby informing the development of region-specific strategies. Methods Based on the UHC monitoring framework proposed by the World Health Organization, a UHC index was constructed comprising the service coverage dimension (16 indicators) and financial protection dimension (four indicators). In this observational study, routinely collected health data from 25 provinces (autonomous regions and municipalities) in mainland China were obtained from statistical yearbooks, relevant literature, and nationally representative surveys. The indices were calculated using geometric means. Socioeconomic inequalities among provinces were quantified using the slope index of inequality (SII) and relative index of inequality (RII). Results From 2016 to 2021, China made laudable progress towards achieving UHC, with the index rising from 56.94 in 2016 to 63.03 in 2021. Most provinces demonstrated better performance in service coverage. Western provinces generally presented faster rates of progress, which were attributed to more substantial increases in financial protection. Despite significant disparities, with the UHC index ranging from 77.94 in Shanghai to 54.61 in Fujian in 2021, the overall equity of UHC has improved across the 25 provinces. SII decreased from 17.78 (95% confidence interval (CI) = 11.64, 23.93) to 12.25 (95% CI = 5.86, 18.63) and RII from 1.38 (95% CI = 1.29, 1.46) to 1.22 (95% CI = 1.16, 1.29). However, the non-communicable disease (NCD) domain experienced a drop in both index score and equity, underscoring the need for prioritised attention. Conclusions In the context of SDGs and the 'Healthy China 2030' initiative, China has made commendable progress towards UHC, and inter-provincial equity has improved. However, substantial differences persisted. The equitable realisation of UHC necessitates prioritising the enhancement of service capacity and financial protection in less developed regions, particularly by addressing shortages in the general practitioner workforce and mitigating catastrophic payments. Developed regions should focus on preventing NCDs through effective interventions targeting key risk factors. This study provides insights for other countries to adopt comprehensive monitoring frameworks, identify subnational disparities, and introduce targeted policy initiatives.
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Affiliation(s)
- Yining Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Ruixin Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Mingzhu Jiang
- School of Public Health, Fudan University, Shanghai, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China
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Zhao J, Wang BL, Qin X, Liu Y, Liu T. Core elements of excellent hospital leadership: lessons from the five top-performing hospitals in China. Int J Qual Health Care 2024; 36:mzae046. [PMID: 38804900 PMCID: PMC11168336 DOI: 10.1093/intqhc/mzae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/22/2024] [Accepted: 05/27/2024] [Indexed: 05/29/2024] Open
Abstract
Substantial evidence indicates that leadership plays a critical role in an organization's success. Our study aims to conduct case studies on leadership attributes among China's five top-performing hospitals, examining their common practices. A semi-structured interview was conducted with 8 leaders, 39 managers, 19 doctors, and 16 nurses from the five sample hospitals in China. We collected information from these hospitals on the role of senior leadership, organizational governance, and social responsibility, aligning with the leadership assessment guidelines in the Baldrige Excellence Framework. Qualitative data underwent interpretation through content analysis, thematic analysis, and comparative analysis. This study adhered to the consolidated criteria for reporting qualitative research guidelines for reporting qualitative research. Our study revealed that the leaders of the five top-performing hospitals in China consistently established "Patient Needs First" as the core element of the hospital culture. Striving to build world-renowned hospitals with Chinese characteristics, the interviewees all believed strongly in scientific vigor, professionalism, and cooperative culture. The leaders adhered to a staff-centered approach, placing special emphasis on talent recruitment and development, creating a compensation system, and fostering a supportive environment conducive to enhancing medical knowledge, skills, and professional ethics. In terms of organizational governance, they continuously enhanced the communication between various departments and levels of staff, improved the quality and safety of medical care, and focused on innovative medical and scientific research, thereby establishing evidence-based, standardized hospital management with a feedback loop. Meanwhile, regarding social responsibility, they prioritized improvements in the quality of healthcare by providing international and domestic medical assistance, community outreach, and other programs. To a large extent, the excellent leadership of China's top-performing hospitals can be attributed to their commitment to a "Two-Pillared Hospital Culture," which prioritizes putting patient needs first and adopting a staff-centered approach. Furthermore, the leaders of these hospitals emphasize hospital performance, operations management, and social responsibility.
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Affiliation(s)
- Jinhong Zhao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
| | - Bing-Long Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
| | - Xiaoping Qin
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
| | - Tingfang Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
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Zhang C, Liu W, Wang L, Wang F, Li J, Liu Z, Zhao Y, Zhou M, Yin P, Hao J. Prevalence and Burden of Multiple Sclerosis in China, 1990-2019: Findings From the Global Burden of Disease Study 2019. Neurology 2024; 102:e209351. [PMID: 38759127 PMCID: PMC11175640 DOI: 10.1212/wnl.0000000000209351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/15/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) is the leading cause of neurologic disability in young adults, but the burden caused by MS in China is lacking. We aimed to comprehensively describe the prevalence and health loss due to MS by demographic and geographical variables from 1990 to 2019 across China. METHODS Data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). We used GBD methodology to systematically analyze the prevalence, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) due to MS by age, sex, and location from 1990 to 2019 in mainland China and its provinces. We also compared the MS burden in China with the world and other Group of 20 (G20) countries. RESULTS In 2019, 42,571 (95% uncertainty interval [UI] 33,001-53,329) individuals in China had MS, which doubled from 1990. The age-standardized prevalence rate of MS was 2.32 per 100,000 (95% UI 1.78-2.91), which increased by 23.31% (95% UI 20.50-25.89) from 1990, with most of the growth occurring after 2010. There was a positive latitudinal gradient with the increasing prevalence from south to north across China. The total DALYs caused by MS were 71,439 (95% UI 58,360-92,254) in 2019, ranking China third among G20 countries. Most of the MS burden in China derived from premature mortality, with the higher fraction of YLLs than that at the global level and most other G20 countries. From 1990 to 2019, the age-standardized DALY and YLL rate had nonsignificant changes; however, the age-standardized YLD rate substantially increased by 23.33% (95% UI 20.50-25.89). The geographic distribution of MS burden varied at the provincial level in China, with a slight downward trend in the age-standardized DALY rates along with increasing Socio-Demographic Index over the study period. DISCUSSION Although China has a low risk of MS, the substantial and increasing prevalent cases should not be underestimated. The high burden due to premature death and geographic disparity of MS burden reveals insufficient management of MS in China, highlighting the needs for increased awareness and effective intervention.
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Affiliation(s)
- Chen Zhang
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Wei Liu
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Lijun Wang
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Fei Wang
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Jiao Li
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Zheng Liu
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Yinan Zhao
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Maigeng Zhou
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Peng Yin
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Junwei Hao
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
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Zhang Z. Survey and analysis on the resource situation of primary health care institutions in rural China. Front Public Health 2024; 12:1394527. [PMID: 38919917 PMCID: PMC11196621 DOI: 10.3389/fpubh.2024.1394527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Background China's rural population is immense, and to ensure the well-being of rural residents through healthcare services, it is essential to analyze the resources of rural grassroots healthcare institutions in China. The objective is to examine the discrepancies and deficiencies in resources between rural grassroots healthcare institutions and the national average, providing a basis for future improvements and supplementation of rural healthcare resources. Methodology The study analyzed data from 2020 to 2022 on the number of healthcare establishments, the capacity of hospital beds, the number of healthcare professionals, and the number of physicians in both rural and national settings. Additionally, it examined the medical service conditions and ratios of township health centers in rural areas to assess the resource gap between rural areas and the national average. Results Healthcare establishments: On average, there were 2.2 fewer healthcare institutions per 10,000 persons in rural areas compared to the national average over three years. Hospital beds: On average, there were approximately 36 fewer hospital beds per 10,000 persons in rural areas compared to the national average over three years. Healthcare professionals and physicians: On average, there were about 48 fewer healthcare technical personnel and 10 fewer practicing (including assistant) physicians per 10,000 persons in rural areas compared to the national average over three years. Conclusion Compared to the national average, there are significant discrepancies and deficiencies in grassroots healthcare resources in rural China. This underscores the necessity of increasing funding to progressively enhance the number of healthcare institutions in rural areas, expand the number of healthcare personnel, and elevate medical standards to better align with national benchmarks. Improving rural healthcare resources will strategically equip these institutions to cater to rural communities and effectively handle public health emergencies. Ensuring that the rural population in China has equal access to healthcare services as the rest of the country is crucial for promoting the well-being of rural residents and achieving health equity.
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Affiliation(s)
- Zhaoting Zhang
- School of Public Policy and Management, China University of Mining and Technology, Xuzhou, China
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50
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Chen D, Han W, Yang Y, Pan J. Doctors' Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study. JMIR Mhealth Uhealth 2024; 12:e49040. [PMID: 38857491 PMCID: PMC11196915 DOI: 10.2196/49040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/26/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients' mobile app adoption behavior; however, they offer limited insights into doctors' personal preferences among a variety of choices of mobile apps. OBJECTIVE This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps? METHODS We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals. RESULTS In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees' perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors' affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues. CONCLUSIONS Our findings contribute to a nuanced understanding of doctors' adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns.
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Affiliation(s)
- Dongjin Chen
- Institute for Social Governance and Communication Innovation of Zhejiang, Communication University of Zhejiang, Hangzhou, China
| | - Wenchao Han
- Center for Asia-Europe Study, Xi'an Jiaotong University, Xi'an, China
| | - Yili Yang
- HEOA Group, Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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