1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Fu R, Huang Z, Lin Y, Tang X, Zheng Z, Hu Z. Temporal-spatial distribution characteristics and associated socioeconomic factors of visiting frequency for rural patients with hypertension in Fujian Province, Southeast China. BMC Public Health 2024; 24:656. [PMID: 38429749 PMCID: PMC10905804 DOI: 10.1186/s12889-024-18113-9] [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: 08/02/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Regular follow-up and medication can effectively reduce the risk of adverse outcomes for patients with hypertension. This study aimed to explore the temporal-spatial distribution characteristics and associated socioeconomic factors of visiting frequency for rural patients with hypertension in Fujian province from 2011 to 2016. METHODS The medical records of patients with hypertension were abstracted from the database of New Rural Cooperative Medical Scheme. Geographically and temporally weighted regression model was used to analyze the associations between percentage of patients whose visiting frequency ≥ 4 times within a year and seven socioeconomic factors at the county level. RESULTS The visiting rate of rural patients with hypertension was 0.79%, 1.27%, 1.87%, 2.29%, 2.78%, 3.43% over the six-year study period, respectively. The percentage of patients whose visiting frequency ≥ 4 times within a year gradually increased over time and the percentage ranged from 61 to 80% in a half of the counties by 2016. In general, there was positive association between Gross Domestic Product per capita and the percentage of patients whose visiting frequency ≥ 4 times within a year. The percentage of female patients, percentage of patients who aged ≥ 60 years, percentage of low-income patients, carbon emission intensity, percentage of savings and number of health technicians per 10,000 persons were negatively correlated with the percentage of patients whose visiting frequency ≥ 4 times within a year in most of counties of Fujian Province. In the sensitivity analysis, the percentage of outpatients whose visiting frequency ≥ 4 times within a year was higher than that of all patients. There was positive association between percentage of outpatients who aged ≥ 60 years and the percentage of outpatients whose visiting frequency ≥ 4 times. CONCLUSIONS The visiting rate and the visiting frequency within a year for rural patients with hypertension in Fujian province need to be improved. Female and elderly patients should be the focus of health management. Effectively implementing the family doctor services, providing several kinds of free antihypertensive drugs, improving energy utilization efficiency and reasonably allocating the health resources may be the effective strategies to improve the follow-up compliance of patients.
Collapse
Affiliation(s)
- Rong Fu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu north Road, Fuzhou, Fujian, 350122, P.R. China
| | - Zhi Huang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu north Road, Fuzhou, Fujian, 350122, P.R. China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu north Road, Fuzhou, Fujian, 350122, P.R. China
| | - Xuwei Tang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu north Road, Fuzhou, Fujian, 350122, P.R. China
| | - Zhenquan Zheng
- School of Health Management, Fujian Medical University, Fuzhou, 350122, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu north Road, Fuzhou, Fujian, 350122, P.R. China.
| |
Collapse
|
3
|
Fu R, Chen Q, Lin Y, Lin Z, Zheng Z, Hu Z. Short-term and long-term effects of Sanming healthcare system reform on drug-related expenditures for rural patients with cancer in public hospitals: an interrupted time series analysis using segmented regression model in China. BMJ Open 2023; 13:e065586. [PMID: 36604122 PMCID: PMC9827248 DOI: 10.1136/bmjopen-2022-065586] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To assess the effects of 'Sanming model' on drug-related expenditures. DESIGN Interrupted time series analysis with two time points was conducted to analyse the effects of 'Sanming model' using segmented regression model. SETTING Two hundred and eighty public hospitals in Fujian province in China. PARTICIPANTS A total of 777 171 inpatients and 792 743 outpatients with cancer who participated in New Rural Cooperative Medical Scheme (NRCMS) were included. INTERVENTIONS 'Sanming model' was issued by Sanming government in February 2013 and spread to other cities in Fujian province in January 2015. PRIMARY OUTCOME MEASURES Four drug-related expenditure variables. RESULTS Among inpatients, total drug expenditures and drug expenditures covered by NRCMS dropped instantly after the reform in all hospitals. Although there was insignificant change during the short-term reform period, the total drug expenditures and drug expenditures covered by NRCMS decreased at the rate of ¥20.3 (p=0.0099) and ¥18.8 (p=0.0341) per capita month-to-month during the long-term reform period in Sanming hospitals, respectively. Among outpatients, total drug expenditures and drug expenditures covered by NRCMS decreased at the rate of ¥20.8 (p=0.0335) and ¥18.4 (p=0.0242) per capita month-to-month during the short-term reform period in Sanming hospitals, respectively. However, the downward trend did not continue into the long term. The significant decreases in trend of drug expenditures uncovered by NRCMS were only observed after the reform in provincial hospitals. The ratio of drug expenditures to inpatient (outpatient) expenditures decreased after the reform in all hospitals. CONCLUSIONS 'Sanming model' had long-term effect in reducing total drug expenditures, drug ratio and drug expenditures covered by NRCMS for rural inpatients with cancer and only short-term positive effect for outpatients. However, there was limited effect of 'Sanming model' on drug expenditures uncovered by NRCMS. 'Sanming model' still needs to accumulate experiences and improves the reform measures dynamically.
Collapse
Affiliation(s)
- Rong Fu
- The School of Public Health, Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China
| | - Qidong Chen
- The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Yulan Lin
- The School of Public Health, Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China
| | - Zheng Lin
- The School of Public Health, Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China
| | - Zhenquan Zheng
- The School of Health Management, Fujian Medical University, Fuzhou, China
| | - Zhijian Hu
- The School of Public Health, Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China
| |
Collapse
|
4
|
Hu L, Fu M, Wushouer H, Ni B, Li H, Guan X, Shi L. The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China. Front Public Health 2022; 10:936719. [PMID: 35832279 PMCID: PMC9271699 DOI: 10.3389/fpubh.2022.936719] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background The excessive use of resources and poor quality of care are great concerns worldwide, particularly in China. In 2013, a model of systematic reforms was developed in Sanming to address the inefficiency and waste in public hospitals. However, limited empirical studies have evaluated the effect of Sanming healthcare reform on antibiotic appropriate use. This study aims to evaluate the impact of the healthcare reform on the appropriate use of antibiotics in county-level public hospitals in Sanming, China. Methods We conducted a retrospective observational study exploring trends in antibiotic use with an interrupted time series design. We selected three county-level hospitals in Sanming and extracted outpatient prescriptions of the Departments of Internal Medicine and the Department of Pediatrics between January 2011 and December 2017. Acute Upper Respiratory Tract Infection (AURI), Acute Bronchitis (AB) and Community Acquired Pneumonia (CAP) were selected as the sample diseases for our analysis. The primary outcome was the percentage of prescriptions conformed with standard treatment guidelines (STGs). Results A total of 142,180 prescriptions were included in the analysis. During the study period, the percentage of antibiotics prescriptions conformed with STGs boosted from 32.4% in 2011 to 82.3% in 2017. Moreover, after the reform, the rate of prescriptions that conformed with STGs showed significant increasing trends in children with AURI (β = 1.624, p < 0.001), children with AB (β = 3.123, p < 0.001), adult with AB (β = 1.665, p < 0.001), children with CAP (β = 3.123, p < 0.001), adult with CAP (β = 4.385, p < 0.001), but not in adult patients with AURI (β = −0.360, p = 0.022). Conclusion Our study confirmed that the Sanming healthcare reform helped to promote the appropriate use of antibiotics in county-level hospitals. This systematic approach to healthcare reform, characterized by an effective governance structure, dynamic financial compensation mechanisms, and specialized drug stewardship, is promising for future public hospital reforms.
Collapse
Affiliation(s)
- Lin Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Bingyu Ni
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- *Correspondence: Xiaodong Guan
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Luwen Shi
| |
Collapse
|
5
|
Tu WJ, Zeng X, Liu Q. Aging tsunami coming: the main finding from China's seventh national population census. Aging Clin Exp Res 2022; 34:1159-1163. [PMID: 34727357 DOI: 10.1007/s40520-021-02017-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 11/24/2022]
Abstract
China is undergoing great social changes, and its demographic makeup is shifting every year along with those changes. China released key indicators from the seventh national population census on 12 May 2021. The total population of China's mainland increased to 1.41178 billion in 2020 from 1.33972 billion in 2010 (sixth national population census) with an average annual growth rate of 0.53%. In the past 10 years, the share of the population aged above 60 and 65 years increased by 5.44% (from 13.26% in 2010 to 18.70% in 2020) and 4.6% (from 8.9 to 13.5%), respectively. The share of the population with a college education or above rose from 8.93% in 2010 to 15.47% in 2020, and the illiteracy rate dropped from 4.08% in 2010 to 2.67% in 2020. In the next decade, China is likely to face many changes, including the increasing proportion of older adults in the population, declining births, and economic transformation. In an effort to respond to the changed demographic landscape, the authorities should adopt new laws and strategies to improve government services for older adults and consider ways to support women and families and make childbearing more attractive to and feasible for women.
Collapse
Affiliation(s)
- Wen-Jun Tu
- Chinese Academy of Medical Science, Peking Union Medical College Institute of Radiation Medicine, No.238, Baiti Road, Tianjin, 300192, People's Republic of China
| | - Xianwei Zeng
- Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Qiang Liu
- Chinese Academy of Medical Science, Peking Union Medical College Institute of Radiation Medicine, No.238, Baiti Road, Tianjin, 300192, People's Republic of China.
| |
Collapse
|
6
|
Meng Z, Zou K, Song S, Wu H, Han Y. Associations of Chinese diagnosis-related group systems with inpatient expenditures for older people with hip fracture. BMC Geriatr 2022; 22:169. [PMID: 35232376 PMCID: PMC8887083 DOI: 10.1186/s12877-022-02865-3] [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: 07/07/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Hip fracture is frequent in older people and represents a major public health issue worldwide. The increasing incidence of hip fracture and the associated hospitalization costs place a significant economic burden on older patients and their families. On January 1, 2018, the Chinese diagnosis-related group (C-DRG) payment system, which aims to reduce financial barriers, was implemented in Sanming City, southern China. This study aimed to evaluate the associations of C-DRG system with inpatient expenditures for older people with hip fracture. Methods An uncontrolled before-and-after study employed data of all the patients with hip fracture aged 60 years or older from all the public hospitals enrolled in the Sanming Basic Health Insurance Scheme from January 1, 2016 to December 31, 2018. The ‘pre C-DRG sample’ included patients from January 1, 2016 to December 31, 2017. The ‘post C-DRG sample’ included patients from January 1, 2018 to December 31, 2018. A propensity score matching analysis was used to adjust the difference in baseline characteristic parameters between the pre and post samples. Data were analyzed using generalized linear models adjusted for the demographic, clinical, and institutional factors. Robust tests were performed by accounting for time trend, the fixed effects of the year and hospitals, and clustering effect within hospitals. Results After propensity score matching, we obtained two homogeneous groups of 1123 patients each, and the characteristic variables of the two matched groups were similar. We found that C-DRG reform was associated with a 19.51% decrease in out-of-pocket (OOP) payments (p < 0.001) and a 99.93% decrease in OOP payments as a share of total inpatient expenditure (p < 0.001); whereas total inpatient expenditure was not significantly associated with the C-DRG reform. All the sensitivity analyses did not change the results significantly. Conclusion The implementation of C-DRG payment system reduced both the absolute amount of OOP payments and OOP payments as a share of total inpatient expenditure for older patients with hip fracture, without affecting total inpatient expenditure. These results may provide significant insights for policymakers in reducing the financial burden on older patients with hip fracture in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02865-3.
Collapse
Affiliation(s)
- Zhaolin Meng
- School of Nursing, Capital Medical University, Beijing, China
| | - Kun Zou
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Suhang Song
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Huazhang Wu
- Department of Health Service Management, China Medical University, Shenyang, Liaoning, China
| | - Youli Han
- Department of Health Management and Policy, School of Public Health, Capital Medical University, NO 10, Xi Toutiao Rd Youanmenwai District, Beijing, 100069, China.
| |
Collapse
|