1
|
Li KY, Weng JJ, Li HL, Ye HB, Xiang JW, Tian NF. Development of a Deep-Learning Model for Diagnosing Lumbar Spinal Stenosis Based on CT Images. Spine (Phila Pa 1976) 2024; 49:884-891. [PMID: 38112156 DOI: 10.1097/brs.0000000000004903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES This study aimed to develop an initial deep-learning (DL) model based on computerized tomography (CT) scans for diagnosing lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA Magnetic resonance imaging is commonly used for diagnosing lumbar spinal stenosis due to its high soft tissue resolution, but CT is more portable, cost-effective, and has wider regional coverage. Using DL models to improve the accuracy of CT diagnosis can effectively reduce missed diagnoses and misdiagnoses in clinical practice. MATERIALS AND METHODS Axial lumbar spine CT scans obtained between March 2022 and September 2023 were included. The data set was divided into a training set (62.3%), a validation set (22.9%), and a control set (14.8%). All data were labeled by two spine surgeons using the widely accepted grading system for lumbar spinal stenosis. The training and validation sets were used to annotate the regions of interest by the two spine surgeons. First, a region of interest detection model and a convolutional neural network classifier were trained using the training set. After training, the model was preliminarily evaluated using a validation set. Finally, the performance of the DL model was evaluated on the control set, and a comparison was made between the model and the classification performance of specialists with varying levels of experience. RESULTS The central stenosis grading accuracies of DL Model Version 1 and DL Model Version 2 were 88% and 83%, respectively. The lateral recess grading accuracies of DL Model Version 1 and DL Model Version 2 were 75% and 71%, respectively. CONCLUSIONS Our preliminarily developed DL system for assessing the degree of lumbar spinal stenosis in CT, including the central canal and lateral recess, has shown similar accuracy to experienced specialist physicians. This holds great value for further development and clinical application.
Collapse
Affiliation(s)
- Kai-Yu Li
- Department of Spine Surgery, Zhejiang Spine Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | | | | | | | | |
Collapse
|
2
|
Wei H, Jiang K, Zhao Y, Pu C. Equity of health resource allocation in Chongqing, China, in 2021: a cross-sectional study. BMJ Open 2024; 14:e078987. [PMID: 38238051 PMCID: PMC10806633 DOI: 10.1136/bmjopen-2023-078987] [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: 09/07/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Chongqing, the most populous city in Southwest China. This study aims to examine the equity of health resource allocation in Chongqing using the latest statistics, analyse possible shortcomings and propose strategies to address these issues. METHODS This cross-sectional study used healthcare resource, population, area and gross domestic product data from the Seventh National Census Bulletin of Chongqing, the National County Statistical Yearbook, the Chongqing Municipal Bureau of Statistics and the Chongqing Health Statistical Yearbook 2022. We also studied the equity of health resource allocation in Chongqing by using the Gini coefficient, Lorenz curve and Theil index, and used the Analytical Hierarchy Process and Technique for Order of Preference by Similarity to Ideal Solution (AHP-TOPSIS) method to comprehensively evaluate the health resources in the four major regions of Chongqing. RESULTS The Gini coefficient of health resources in Chongqing in 2021 was the highest when allocated according to geographical area, between 0.4285 and 0.6081, both of which exceeded 0.4, and the Gini coefficient of medical equipment was the highest and exceeded 0.6. The inter-regional Theil index of each resource was greater than the intraregional Theil index, and the contribution of inter-regional differences ranged from 64.83% to 80.21%. The results of the AHP-TOPSIS method showed that the relative proximity between health resources and ideal solutions in four regions of Chongqing ranged from 0.0753 to 0.9277. CONCLUSION The allocation of health resources in Chongqing exhibits pronounced inequities, particularly in the distribution of medical equipment according to geographical area. Moreover, there exists a substantial gap in the equity of health resource allocation among the four regions of Chongqing. As such, this study emphasises the need for Chongqing, China, to prioritise the equitable allocation of health resources and increase consideration of geographic factors. Implementing measures to promote equitable allocation of health resources, particularly in geographic terms, is critical.
Collapse
Affiliation(s)
- Hao Wei
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Center for early warning of health-related major social risks Chongqing Medical University sub center, Chongqing, China
| | - Ke Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Yong Zhao
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Pu
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Center for early warning of health-related major social risks Chongqing Medical University sub center, Chongqing, China
| |
Collapse
|
3
|
Nasiri A, Amerzadeh M, Yusefzadeh H, Moosavi S, Kalhor R. Inequality in the distribution of resources in the health sector before and after the Health Transformation Plan in Qazvin, Iran. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:4. [PMID: 38167555 PMCID: PMC10763402 DOI: 10.1186/s41043-023-00495-y] [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: 08/19/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The equitable distribution of healthcare resources represents a paramount objective in the realm of global health systems. Thus, the present study sought to assess the fairness in the allocation of health resources at Qazvin University of Medical Sciences (QUMS), both prior to and subsequent to the implementation of the Health Transformation Plan (HTP) using the Gini coefficient and the Hirschman-Herfindahl index (HHI). METHODS This descriptive-analytical study aimed to investigate the distribution of healthcare resources among general practitioners (GPs), specialists, and subspecialists employed at QUMS between 2011 and 2017. Demographic data pertaining to the cities were obtained from the statistical yearbooks of the Statistical Center of Iran, while information regarding the healthcare workforce was extracted from QUMS records. The analysis utilized two key measures, namely the Gini coefficient and the HHI, to assess the fairness of resource distribution. Data analysis was performed using Microsoft Excel 2016 and the Stata statistical software. RESULTS The highest number of GPs, specialists, and subspecialists was observed in 2014, 2017, and 2017, respectively, while the lowest number was recorded in 2016, 2011, and 2015, respectively. From 2011 to 2017, the Gini coefficient for GPs ranged between 0.61 and 0.63. Among specialists, the lowest Gini coefficient value was observed in 2015 (0.57), while the highest was recorded in 2017 (0.60). The Gini coefficient for subspecialists remained constant at 0.52 from 2011 to 2017. The HHI revealed a high concentration of GPs in the cities of Qazvin province. Although the disparity gradually decreased in the specialties of eye, ear, nose, and throat, and pediatrics, the concentration still persists in Qazvin. In general surgery, the index value is low, indicating some level of inequality. In anesthesia and neurology, the index value decreased after the HTP and reached 5700; however, achieving equality (below 1000) still requires further efforts. No significant change in the index was observed after the HTP in specialties such as neurosurgery, rehabilitation, and nuclear medicine. Subspecialists also exhibited a concentration in the city of Qazvin. CONCLUSION Based on the analysis of the Gini and HHI, it is evident that the distribution of GPs has not undergone significant changes following the implementation of the HTP. The Gini coefficient, which ranges from 0.4 to 0.6, indicates a high to complete level of inequality in the distribution of specialists and subspecialists. Moreover, the HHI exceeds 1000, reflecting a concentration of resources in specific areas. As a result, the HTP has not yet achieved its goal of ensuring a fair distribution of human resources. To address this issue, it is recommended to redesign distribution policies, including the allocation of physical health resources, such as specialized hospitals, beds, and medical equipment. Additionally, increasing student admissions in specialized and subspecialized fields and implementing tariff incentives can contribute to a more equitable distribution of resources. By aligning distribution policies with the principle of fairness, the healthcare system can better address the issue of resource distribution.
Collapse
Affiliation(s)
- Asghar Nasiri
- Student Research Committee, School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hasan Yusefzadeh
- Department of Health Management and Economics, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Saeideh Moosavi
- Student Research Committee, School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
| |
Collapse
|
4
|
Saran M, Teli BD, Rezapour A, Motlagh SN, Behzadifar M, Haghighatfard P, Bragazzi NL, Behzadifar M. The impact of the Iranian health transformation plan policy on equitable access to medical imaging services in West Iran. BMC Res Notes 2023; 16:350. [PMID: 38008715 PMCID: PMC10680178 DOI: 10.1186/s13104-023-06634-2] [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: 08/12/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Equity in the delivery of health services, including diagnostic imaging, is crucial to achieving universal health coverage. The Health Transformation Plan (HTP), launched in 2014, represents a major healthcare policy to improve the quality and accessibility of healthcare services. This study aimed to explore the impact of the HTP on equity in the access to medical imaging in Lorestan province, located in west Iran, from 2014 to 2023. Annual growth rates (AGR) of imaging devices were calculated, whilst equity assessment of medical imaging distribution was carried out by means of the Gini coefficient and the Lorenz curve per 100,000 population. The latter was generated using the cumulative distribution of imaging devices, as well as the cumulative population ratio. RESULTS Between 2014 and 2023, the number of imaging devices has increased threefold. The AGR of installing CT and MRI scanners in Lorestan province increased between 2014 and 2023. The Gini coefficients increased from 0.12 for CT and 0.16 for MRI in 2014 to 0.33 in 2023 for both devices. This indicates a decrease in equity in access to these fundamental health technologies despite the increase in their figures. Policymakers should better allocate medical equipment based on the specific health needs of different regions throughout Iran.
Collapse
Affiliation(s)
- Maryam Saran
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Banafsheh Darvishi Teli
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soraya Nouraei Motlagh
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Payam Haghighatfard
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- Human Nutrition Unit Department of Food and Drugs, University of Parma Medical School, Building C, Via Volturno, 39, Parma, 43125, Italy
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| |
Collapse
|
5
|
Huang X, Wei Y, Sun H, Huang J, Chen Y, Cheng J. Assessment of equity and efficiency of magnetic resonance imaging services in Henan Province, China. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:32. [PMID: 37221536 DOI: 10.1186/s12962-023-00440-0] [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: 01/23/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND By evaluating equity and effectiveness, this study provides evidence-based knowledge for scientific decision-making and the optimization of magnetic resonance imaging (MRI) configuration and utilization at the provincial level. METHODS Using data from 2017, we applied a Gini coefficient to analyze the equity of MRI services in 11 sample cities in Henan province. An agglomeration degree was then applied to measure equity from the perspective of population and geography, and a data envelopment analysis was used to evaluate MRI efficiency. RESULTS The overall Gini coefficient of MRI allocation by population in the 11 sample cities is 0.117; however, equity varies considerably among the sample cities. The sample's comprehensive efficiency is only 0.732, indicating the overall ineffectiveness of provincial MRI utilization. The pure technical and scale efficiencies of four sample cities are below 1, indicating lower MRI effectiveness than the rest. CONCLUSIONS Although the overall equity of configuration at the provincial level is relatively good, equity varies at the municipal level. Our results demonstrate a low MRI utilization efficiency; accordingly, policymakers should dynamically adjust the policy based on equity and efficiency.
Collapse
Affiliation(s)
- Xiaoling Huang
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, P. R. China
| | - Yan Wei
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, P. R. China
| | - Hui Sun
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, P. R. China
| | - Jiaqi Huang
- School of Public Health, Fudan University, Shanghai, China
| | - Yingyao Chen
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, P. R. China.
- School of Public Health, Fudan University, Shanghai, China.
- WHO Collaborating Center for HTA and Management, Shanghai, China.
| | - Jingliang Cheng
- Department of magnetic resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
6
|
Zhang M, Zou K, Liu Z, Liu D, Wang X, Shi Y, Chen Z, Cheng X, Lang B, Li H, Zeng L, Tang Y, Zhao S, Jiang Y, Choonara I, Zhang L. Availability of essential medicines, progress and regional distribution in China: a systematic review and meta-analysis. Front Public Health 2023; 11:1149838. [PMID: 37181691 PMCID: PMC10167309 DOI: 10.3389/fpubh.2023.1149838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Essential medicines are the backbone of healthcare and meet the priority healthcare needs of the population. However, approximately one-third of the global population does not have access to essential medicines. Although China formulated essential medicine policies in 2009, the progress of availability of essential medicines and regional variations remains unknown. Therefore, this study was conducted to evaluate the availability of essential medicines, their progress, and regional distribution in China in the last decade. Methods We searched eight databases from their inception to February 2022, relevant websites, and reference lists of included studies. Two reviewers selected studies, extracted data, and evaluated the risk of bias independently. Meta-analyses were performed to quantify the availability of essential medicines, their progress, and regional distribution. Results Overall 36 cross-sectional studies conducted from 2009 to 2019 were included, with regional data for 14 provinces. The availability of essential medicines in 2015-2019 [28.1%, 95% confidence interval (CI): 26.4-29.9%] was similar to that in 2009-2014 (29.4%, 95% CI: 27.5-31.3%); lower in the Western region (19.8%, 95% CI: 18.1-21.5%) than Eastern (33.8%, 95% CI: 31.6-36.1%) and Central region (34.5%, 95% CI: 30.6-38.5%); very low for 8 Anatomical Therapeutic Chemical (ATC) categories (57.1%), and low for 5 categories (35.7%) among all ATC groups. Conclusion The availability of essential medicines in China is low compared with the World Health Organization goal, has not changed much in the last decade, is unequal across regions, and lacks data for half of provinces. For policy-making, the monitoring system of the availability of essential medicines is to be strengthened to enable long-term surveillance, especially in provinces where the data has been missing. Meanwhile, Joint efforts from all stakeholders are warranted to improve the availability of essential medicines in China toward the universal health coverage target. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=315267, identifier: PROSPERO CRD42022315267.
Collapse
Affiliation(s)
- Miao Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Kun Zou
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zheng Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Dan Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xiuli Wang
- Healthcare Evaluation and Organizational Analysis (HEOA) Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuqing Shi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zhe Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xiao Cheng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Bingchen Lang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yong Tang
- School of Economics, Sichuan University, Chengdu, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, China
| | - Yongmu Jiang
- School of Economics, Sichuan University, Chengdu, China
| | - Imti Choonara
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, United Kingdom
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Su Y, Cui S, Sun Q, Deng J, Cheng J. Analysis of the Status of Radiation-generating Medical Devices in Mainland China. HEALTH PHYSICS 2023; 124:310-315. [PMID: 36649541 DOI: 10.1097/hp.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
ABSTRACT The purpose of this paper is to describe the status of radiation-generating medical devices in mainland China. The number of diagnostic radiology and interventional radiology devices was collected from the national medical radiation protection monitoring information system, while the number of radiation therapy and nuclear medicine devices was from the published articles. Statistical analysis of the correlation was used to assess the relationship between the number of high technology medical devices and GDP per capita. A total of 143,064 radiation-generating medical devices were identified in mainland China, and diagnostic radiology devices accounted for 94% of those. The number of CTs was 14.84 per million, an increase by a factor of 1.45 compared to 2009. But the distribution of CTs was imbalanced among different areas: the highest number of CT per million population was 27.70 in Tibet, and the lowest was 8.55 per million population in Guangxi province. Statistical analysis of the correlation showed that the number of PET scanners per million population was positively correlated with GDP per capita, and similarly for medical accelerators. The number of mammographic devices per million population was much lower than that in other countries. The investment of radiation-generating medical devices in China was far from enough, especially for mammographic devices. More efforts should be taken to bring medical resources to regions with greater population areas in the future.Health Phys. 124(0):000-000; 2023.
Collapse
Affiliation(s)
- Yinping Su
- Key Laboratory of Radiological Protection and Nuclear Emergency, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing 100088, China
| | | | | | | | | |
Collapse
|
8
|
Qin C, Murali S, Lee E, Supramaniam V, Hausenloy DJ, Obungoloch J, Brecher J, Lin R, Ding H, Akudjedu TN, Anazodo UC, Jagannathan NR, Ntusi NAB, Simonetti OP, Campbell-Washburn AE, Niendorf T, Mammen R, Adeleke S. Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems. Eur Heart J Cardiovasc Imaging 2022; 23:e246-e260. [PMID: 35157038 PMCID: PMC9159744 DOI: 10.1093/ehjci/jeab286] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.
Collapse
Affiliation(s)
- Cathy Qin
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjana Murali
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Elsa Lee
- School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Derek J Hausenloy
- Division of Medicine, University College London, London, UK.,Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Hatter Cardiovascular Institue, UCL Institute of Cardiovascular Sciences, University College London, London, UK.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Johnes Obungoloch
- Department of Biomedical Engineering, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rongyu Lin
- School of Medicine, University College London, London, UK
| | - Hao Ding
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Science, Bournemouth University, Poole, UK
| | | | - Naranamangalam R Jagannathan
- Department of Electrical Engineering, Indian Institute of Technology, Chennai, India.,Department of Radiology, Sri Ramachandra University Medical College, Chennai, India.,Department of Radiology, Chettinad Hospital and Research Institute, Kelambakkam, India
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.,Department of Radiology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Centre for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Regina Mammen
- Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Sola Adeleke
- School of Cancer & Pharmaceutical Sciences, King's College London, Queen Square, London WC1N 3BG, UK.,High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| |
Collapse
|
9
|
Wang Y, Chen Y, Liu P, Lv W, Wu J, Wei M, Shi D, Wu X, Liu W, Tao X, Hu H, Ma X, Yang X, Xue H, Jin Z. Clinical effectiveness of contrast medium injection protocols for 80-kV coronary and craniocervical CT angiography-a prospective multicenter observational study. Eur Radiol 2022; 32:3808-3818. [PMID: 35103828 DOI: 10.1007/s00330-021-08505-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/22/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Decreasing X-ray tube voltage is an effective way to reduce radiation and contrast dose, especially in non-obese patients. The current study focuses on CTA in non-obese patients to evaluate image quality and feasibility of 80-kV acquisition protocols with varying iodine delivery rates (IDR) and contrast concentrations in routine clinical practice. METHODS A prospective observational study in patients ≥ 18 years and ≤ 90 kg referred for coronary or craniocervical CTA at 10 centers in China (ClinicalTrials.gov: NCT02840903). Patients were divided into four groups: a standard 100-kV protocol (370 mgI/ml, IDR 1.48 gI/s), and three 80-kV protocols (370 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 0.96gI/s). The primary outcome was contrast opacification of target vascular segments. Secondary outcomes were image quality (contrast-to-noise ratio, signal-to-noise ratio, visual image quality, and diagnostic confidence assessment), radiation, and iodine dose. RESULTS From July 2016 to July 2017, 1213 patients were enrolled: 614 coronary and 599 craniocervical CTA. The mean contrast opacification was ≥ 300 HU for 80-kV 1.2 gI/s IDR scanned segments; IDR 0.96 gI/s led to lower opacification. Image quality and diagnostic confidence were fair to excellent (≥ 98% of images), despite lower contrast-to-noise ratios and signal-to-noise ratios in 80-kV images. Compared to the standard protocol, 80-kV protocols led to 44-52% radiation dose reductions (p < 0.001) and 19% iodine dose reductions (p < 0.001). CONCLUSION Eighty-kilovolt 1.2 gI/s IDR protocols can be recommended for coronary and craniocervical CTA in non-obese patients, reducing radiation and iodine dose without compromising image quality. KEY POINTS • Using low-voltage scanning CTA protocols, in which tube voltage and iodine delivery rate are reduced proportionally (voltage: 80 kV, IDR: 1.2 gI/s), reduces radiation and contrast dose without compromising image quality in routine clinical practice. • Reducing iodine delivery rate beyond direct proportionality to tube voltage is not beneficial.
Collapse
Affiliation(s)
- Yining Wang
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Yu Chen
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Peijun Liu
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Wan Lv
- The First People's Hospital of Yulin, # 495, JiaoYu Central Road, Yulin, 537000, Guangxi, China
| | - Jianlin Wu
- Affiliated Zhongshan Hospital of Dalian University, # 6, Jiefang Road Zhongshan District, Dalian, 116001, Liaoning, China
| | - Mengqi Wei
- The First Affiliated Hospital of Air Force Medical University, # 15 Changle West Road, Xian, 710032, Shanxi, China
| | - Dapeng Shi
- Henan Provincial People's Hospital, # 7, Weiwu Road, Zhengzhou, 450000, Henan, China
| | - Xianheng Wu
- The Second People's Hospital of Shantou, # 28, Waimalu Road, Shantou, 515031, Guangdong, China
| | - Wenya Liu
- The First Affiliated Hospital of Xinjiang Medical University, # 137, Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Xiaofeng Tao
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, # 639, Zaoju Road, Shanghai, 200011, China
| | - Hongjie Hu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun East Road, Hangzhou, 310016, Zhejiang, China
| | - Xiangxing Ma
- Qilu Hospital of Shandong University (Qingdao), North District, # 758, Hefei Road, Qingdao, 266035, Shandong, China
| | - Xiaozheng Yang
- Medical Affairs, Bayer Healthcare Co. Ltd, Dongshanhuan Central Road, Beijing, 100010, China
| | - Huadan Xue
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Zhengyu Jin
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China.
| |
Collapse
|
10
|
Yuan G, Xie H, Wei T, Zhu D, Zhang C, Yang Y. Diagnostic potential of extracellular vesicle-associated microRNA-10b and tumor markers for lung adenocarcinoma. Oncol Lett 2021; 22:614. [PMID: 34257722 PMCID: PMC8243083 DOI: 10.3892/ol.2021.12875] [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: 12/29/2020] [Accepted: 05/21/2021] [Indexed: 11/05/2022] Open
Abstract
MicroRNAs (miRNAs/miRs) in extracellular vesicles (EVs) are potential diagnostic markers. The purpose of the present study was to investigate potential EV miRNA biomarkers for lung adenocarcinoma (LUAD). Potential miRNAs were identified by searching public databases and verified by examining clinical samples. The diagnostic value of EV-associated miR-10b, plasma miR-10b and tumor markers (TMs), including α-fetoprotein (AFP), neuron-specific enolase, carcinoembryonic antigen (CEA), cytokeratin 19 fragment 21-1 (CYFRA211), pro-gastrin-releasing-peptide, carbohydrate antigen (CA)125, CA153, CA199 and CA724, was evaluated via receiver operating characteristic curve analysis. By searching the Gene Expression Omnibus and The Cancer Genome Atlas databases, miR-10b was identified as a potential biomarker. The analysis of clinical samples suggested that EV-associated miR-10b from plasma was significantly differentially expressed between LUAD and control samples. EV-associated miR-10b could function as a diagnostic marker for LUAD, with an AUC of 0.998, which was higher than the AUCs for TMs such as AFP, CEA, CYFRA211, CA125, CA153, CA199, CA724, pro-gastrin-releasing-peptide and neuron-specific enolase. In conclusion, EV-associated miR-10b may be a potential diagnostic biomarker for LUAD that is superior to plasma miR-10b and TMs.
Collapse
Affiliation(s)
- Guangda Yuan
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, P.R. China
| | - Hongya Xie
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, P.R. China
| | - Tengteng Wei
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, P.R. China
| | - Donglin Zhu
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, P.R. China
| | - Chuanyu Zhang
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, P.R. China
| | - Yong Yang
- Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, P.R. China
| |
Collapse
|
11
|
Current status, utilization, and geographic distribution of MRI devices in Jordan. APPLIED NANOSCIENCE 2021. [DOI: 10.1007/s13204-021-01904-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
12
|
Chai P, Wan Q, Kinfu Y. Efficiency and productivity of health systems in prevention and control of non-communicable diseases in China, 2008-2015. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:267-279. [PMID: 33389331 DOI: 10.1007/s10198-020-01251-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
This article examines the health system performance impact of China's new round of healthcare reform adopted in 2009. Specifically, we evaluated productivity and efficiency of health production pre- and post-reform period, compared the effects across all the 31 provinces of mainland China and identified potential determinants. As a major source of disability and premature mortality in China, non-communicable diseases (NCDs) had been the focus of our analysis, and the period during 2008-2015 was considered to allow enough time for the policy to have meaningful impact on the country's health system. Productivity and efficiency performance were analyzed using a bootstrapping data envelopment analysis (DEA) and the Malmquist productivity index (MPI) techniques, while a Tobit regression technique was used to identify determinants of inefficiency. We find that after the reform efficiency and productivity had declined across large number of provinces. Mean overall technical efficiency (OTE) post 2009 was about 30% lower than the potential maximum capacity, while productivity also fell at a rate of 7.57% per annum. Trends in productivity and efficiency performance were largely linked to patterns of scale of technological change observed during the study period. The findings suggest that efficiency and productivity can be improved through enhancing financial security, optimizing health resource allocation, particularly between human resources for health and hospital beds, and expanding cost-effective technology within the health sector. Better urban planning practices and investment in education were also found to contribute to improved efficiency of NCDs services.
Collapse
Affiliation(s)
- Peipei Chai
- Faculty of Health, University of Canberra, Building 22, 11 Kirinari St, Bruce ACT, Canberra, 2617, Australia.
- China National Health Development Research Center, B3 Wudong Building, 9 Chegongzhuang Street, Xicheng District, Beijing, 100044, China.
| | - Quan Wan
- China National Health Development Research Center, B3 Wudong Building, 9 Chegongzhuang Street, Xicheng District, Beijing, 100044, China
| | - Yohannes Kinfu
- Faculty of Health, University of Canberra, Building 22, 11 Kirinari St, Bruce ACT, Canberra, 2617, Australia
- College of Medicine, Qatar University, P. O. Box 2713, Doha, Qatar
| |
Collapse
|
13
|
Tian F, Pan J. Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016. Int J Equity Health 2021; 20:51. [PMID: 33516208 PMCID: PMC7846917 DOI: 10.1186/s12939-021-01391-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Driven by the government's firm commitment to promoting maternal health, maternal mortality ratio (MMR) in China has achieved a remarkable reduction over the past 25 years. Paralleled with the decline of MMR has been the expansion of hospital bed supply as well as substantial reduction in hospital bed distribution inequalities, which were thought to be significant contributors to the reduction in MMR. However, evidences on the impact of hospital bed supply as well as how its distribution inequality has affected MMR remains scarce in China. Addressing this uncertainty is essential to understand whether efforts made on the expansion of healthcare resource supply as well as on improving its distribution inequality from a geographical perspective has the potential to produce measurable population health improvements. METHODS Panel data of 31 provinces in China between 2004 and 2016 were extracted from the national statistical data, including China Statistical Yearbooks, China Health Statistical Yearbooks and other national publications. We firstly described the changes in hospital bed density as well as its distribution inequality from a geographical perspective. Then, a linear mixed model was employed to evaluate the impact of hospital bed supply as well as its distribution inequality on MMR at the provincial level. RESULTS The MMR decreased substantially from 48.3 to 19.9 deaths per 100,000 live births between 2004 and 2016. The average hospital bed density increased from 2.28 per 1000 population in 2004 to 4.54 per 1000 population in 2016, with the average Gini coefficient reducing from 0.32 to 0.25. As indicated by the adjusted mixed-effects regressions, hospital bed density had a negative association with MMR (β = - 0.112, 95% CI: - 0.210--0.013) while every 0.1-unit reduction of Gini coefficient suggested 14.50% decline in MMR on average (β = 1.354, 95% CI: 0.123-2.584). Based on the mediation analysis, the association between hospital bed density or Gini coefficient with MMR was found to be significantly mediated by facility birth rate, especially during the period from 2004 to 2009. CONCLUSIONS This study provided empirical evidences on China's impressive success in the aspect of reducing MMR which could be attributed to the expansion of hospital beds as well as the improvement in its distribution inequality from a geographical perspective. Such findings were expected to provide evidence-based implications for long-term policy-making procedures in order to achieve rational healthcare resource allocations as well as promoting the equity and accessibility to obtaining health care from a holistic perspective. Constant efforts should be made on improving the equity in healthcare resource allocations in order to achieve the penetration of universal healthcare coverage.
Collapse
Affiliation(s)
- Fan Tian
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China.
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
14
|
Chai P, Zhang Y, Zhou M, Liu S, Kinfu Y. Health system productivity in China: a comparison of pre- and post-2009 healthcare reform. Health Policy Plan 2020; 35:257-266. [PMID: 31828335 DOI: 10.1093/heapol/czz157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 11/13/2022] Open
Abstract
In 2009, China launched an ambitious health system reform that combined extending social health insurance scheme with improving efficiency, access and quality of care in the country. To assess the impact of the policy on efficiency and productivity change, we investigated the country's health system performance at provincial levels during pre- and post-reform period. Outputs were measured using multiple health outcomes (namely, non-communicable diseases free healthy life years and infant and maternal survival rates), while health expenditure, number of medical personnel and hospital beds per 1000 residents were used as proxy measures for health inputs. Changes in productivity were quantified using a bootstrap Malmquist productivity index (MPI). The analysis focused on the period between 2004 and 2015. This was to capture pre- and post-policy implementation experience and to ensure that enough time was allowed for the policy to work through. Finally, a bootstrap Tobit regression model for panel data was applied to examine the potential effects of contextual factors on productivity change. The result showed that the reform has had negative effects on productivity. Only scale efficiency had improved steadily, but the decline in the scale of technological change observed during the same period meant that the progress in scale efficiency had been masked. Better economic performance (as measured by per capita Gross Domestic Product (GDP)) and higher human resource to capital investment ratio (as measured by density of medical staff per hospital beds) tended to boost productivity growth, while population aging, low educational attainment and higher percentage of out-of-pocket (OOP) payments had adverse effects. Improving health system productivity in China requires improving financial risk protection and maintaining proper balance between human and capital investment in the country.
Collapse
Affiliation(s)
- Peipei Chai
- Faculty of Health, University of Canberra, Building 22, 11 Kirinari Street, Bruce, ACT 2617, Australia.,Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, B3 Wudong Building, 9 Chegongzhuang Street, Xicheng District, Beijing 100044, China
| | - Yuhui Zhang
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, B3 Wudong Building, 9 Chegongzhuang Street, Xicheng District, Beijing 100044, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China
| | - Shiwei Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China
| | - Yohannes Kinfu
- Faculty of Health, University of Canberra, Building 22, 11 Kirinari Street, Bruce, ACT 2617, Australia
| |
Collapse
|
15
|
Yang C, Hu S, Ye D, Jiang M, Babar ZUD, Fang Y. Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study. Front Pharmacol 2020; 11:602421. [PMID: 33381042 PMCID: PMC7768899 DOI: 10.3389/fphar.2020.602421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/12/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives: To evaluate the price and availability of medicines in China. Methods: A standard methodology developed by WHO and Health Action International was used to collect medicine price and availability data. We obtained cross-sectional data for 48 medicines from 519 facilities (280 public hospitals and 239 private retail pharmacies) in five provinces in China in 2018. We also collected longitudinal data for 31 medicines in Shaanxi Province in 2010, 2012, 2014, and 2018. Medicine price was compared with the international reference price to obtain a median price ratio (MPR). The availability and price in five provinces were compared in matched sets. We used general estimating equations to calculate differences in availability and median prices from 2010 to 2018. Findings: Mean availability of surveyed medicines in five provinces was low in both public (4.29–32.87%) and private sectors (13.50–43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80–3.02) and for originator brands (OBs) was much higher (9.14–12.65). The variation was significant for both availability and price of medicines across provinces. In Shaanxi Province, the availability of medicines decreased between 2010 and 2018, but this was not significant in the public or private sector. Compared with 2010, the median adjusted patient price was significantly lower in 2018 for nine OBs (difference −22.4%; p = 0.005) and 20 LPGs (−20.5%; p = 0.046) in the public sector and 10 OBs (−10.2%; p = 0.047) in the private sector. Conclusion: Access to medicines was found to be poor and unequal across China in 2018. Future interventions are needed, and possible strategies include effective and efficient procurement, promoting the development of retail pharmacies and increasing medicine price transparency.
Collapse
Affiliation(s)
- Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
| | - Dan Ye
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Department of Pharmacy, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
| | - Zaheer-Ud-Din Babar
- Center for Pharmaceutical Policy and Practice Research, Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
16
|
Khaing M, Saw YM, Than TM, Mon AM, Cho SM, Saw TN, Kariya T, Yamamoto E, Hamajima N. Geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. BMC Health Serv Res 2020; 20:742. [PMID: 32787832 PMCID: PMC7424658 DOI: 10.1186/s12913-020-05610-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) is important for patient care. However, the geographic distribution and utilisation of these machines in countries with limited resources, such as Myanmar, have not been sufficiently studied. Therefore, this study aims to identify the geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. METHODS This nationwide, cross-sectional study was conducted at 43 public hospitals in Myanmar. Data were collected retrospectively using a prepared form from 1st January 2015 to 31st December 2017 at public hospitals in Myanmar. A descriptive analysis was performed to calculate the number of CT and MRI units per million population in each state and region of Myanmar. The distribution of CT and MRI units was assessed using the Lorenz curve and Gini coefficient, which are indicators of inequality in distribution. RESULTS In total, 45 CT and 14 MRI units had been installed in public hospitals in Myanmar by 2017. In total, 205,570 CT examinations and 18,981 MRI examinations have been performed within the study period. CT units per million population in 2017 varied from 0.30 in Rakhine State to 3.22 in Kayah State. However, MRI units were available only in public hospitals in five states/regions. The Gini coefficient for CT and MRI was 0.35 and 0.69, respectively. An upward trend in the utilisation rate of CT and MRI was also observed during the study period, especially among patients aged between 36 and 65 years. CONCLUSIONS Throughout Myanmar, CT units were more equally distributed than MRI units. CT and MRI units were mostly concentrated in the Yangon and Mandalay Regions, where the population density is higher. The geographic distribution and utilisation rate of CT and MRI units varied among states, regions, and patients' age group. However, the utilisation rates of CT and MRI increased annually in all states and regions during the review period. The Ministry of Health and Sports in Myanmar should consider the utilisation and population coverage of CT and MRI as an important factor when there will be procurement of those medical equipment in the future.
Collapse
Affiliation(s)
- Moe Khaing
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Medical Care Division, Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan.
| | - Thet Mon Than
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Medical Care Division, Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aye Myat Mon
- Medical Care Division, Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Su Myat Cho
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Thu Nandar Saw
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
17
|
Zhu Z, Li Y, Meng X, Han J, Li Y, Liu K, Shen J, Qin Y, Zhang H. New warfarin anticoagulation management model after heart valve surgery: rationale and design of a prospective, multicentre, randomised trial to compare an internet-based warfarin anticoagulation management model with the traditional warfarin management model. BMJ Open 2019; 9:e032949. [PMID: 31811010 PMCID: PMC6924837 DOI: 10.1136/bmjopen-2019-032949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Warfarin is an effective anticoagulant and the only oral anticoagulant available for patients with mechanical heart valves. The prothrombin time and the associated international normalised ratio (INR) are routinely tested to monitor the response to anticoagulation therapy in patients. Patients who undergo mechanical heart valve replacement need lifelong anticoagulation therapy, and their INR is regularly measured to adjust the anticoagulation strength and the dose of anticoagulation drugs. Appropriate warfarin anticoagulation management can reduce patient complications, such as bleeding and thrombosis, and improve the long-term survival rate. We propose modern internet technology as a platform to build a warfarin anticoagulation follow-up system after valve replacement surgery. This system will provide doctors and patients with more standardised and safer follow-up methods as well as a method to further reduce the risk of warfarin anticoagulation-related complications and improve its therapeutic effects. METHODS AND ANALYSIS A prospective, multicentre, randomised, controlled trial will be conducted. A total of 700 patients who require long-term warfarin anticoagulation monitoring after heart valve replacement will be enrolled and randomly divided at a 1:1 ratio into a traditional outpatient anticoagulation management group and a group undergoing a new method of management based on the internet technology with follow-up for 1 year. Differences in the percentage of time in the therapeutic range (TTR), drug dose adjustments, bleeding/thrombosis and other related complications will be observed. The primary endpoint is the difference in the TTR between the two groups. The purpose of this study is to explore a safer and more effective mode of doctor-patient interaction and communication in the internet era. As of 13 July 2019, 534 patients had been enrolled. ETHICS AND DISSEMINATION This study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. The results will be published in a peer-reviewed medical journal. TRIAL REGISTRATION NUMBER ChiCTR1800016204.
Collapse
Affiliation(s)
- Zhihui Zhu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuehuan Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kun Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinglun Shen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Qin
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
18
|
Yu HY, Chen JJ, Wang JN, Chiu YL, Qiu H, Wang LY. Identification of the Differential Effect of City-Level on the Gini Coefficient of Health Service Delivery in Online Health Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132314. [PMID: 31261952 PMCID: PMC6651774 DOI: 10.3390/ijerph16132314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022]
Abstract
Inequality of health services for different specialty categories not only occurs in different areas in the world, but also happens in the online service platform. In the online health community (OHC), health services often display inequality for different specialty categories, including both online views and medical consultations for offline registered services. Moreover, how the city-level factors impact the inequality of health services in OHC is still unknown. We designed a causal inference study with data on distributions of serviced patients and online views in over 100 distinct specialty categories on one of the largest OHCs in China. To derive the causal effect of the city-levels (two levels inducing 1 and 0) on the Gini coefficient, we matched the focus cases in cities with rich healthcare resources with the potential control cities. For each of the specialty categories, we first estimated the average treatment effect of the specialty category’s Gini coefficient (SCGini) with the balanced covariates. For the Gini coefficient of online views, the average treatment effect of level-1 cities is 0.573, which is 0.016 higher than that of the matched group. Similarly, for the Gini coefficient of serviced patients, the average treatment effect of level-1 cities is 0.470, which is 0.029 higher than that of the matched group. The results support the argument that the total Gini coefficient of the doctors in OHCs shows that the inequality in health services is still very serious. This study contributes to the development of a theoretically grounded understanding of the causal effect of city-level factors on the inequality of health services in an online to offline health service setting. In the future, heterogeneous results should be considered for distinct groups of doctors who provide different combinations of online contributions and online attendance.
Collapse
Affiliation(s)
- Hai-Yan Yu
- School of Economics and Management, Chongqing University of Posts and Telecommunications, Chongqing 400065, China.
- Department of Statistics, Eberly College of Science, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Jing-Jing Chen
- School of Economics and Management, Chongqing University of Posts and Telecommunications, Chongqing 400065, China
| | - Jying-Nan Wang
- College of International Finance and Trade, Zhejiang Yuexiu University of Foreign Languages, Shaoxing 312000, China
| | - Ya-Ling Chiu
- College of International Business, Zhejiang Yuexiu University of Foreign Languages, Shaoxing 312000, China
| | - Hang Qiu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Li-Ya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu 611731, China
| |
Collapse
|
19
|
Alzheimer Disease-associated Cortical Atrophy Does not Differ Between Chinese and Whites. Alzheimer Dis Assoc Disord 2019; 33:186-193. [PMID: 31094707 DOI: 10.1097/wad.0000000000000315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess whether there are differences in Alzheimer disease (AD)-associated atrophy regions in Chinese and white patients with AD versus cognitively normal older adults, and to test whether associations between clinical severity and gray matter volume are similar or different across these ethnic groups in a cross-sectional analysis. MATERIALS AND METHODS Chinese and white patients with AD, individuals with mild cognitive impairment, and cognitively normal controls (46 white and 48 Chinese) were clinically evaluated at an academic center within 1 year of magnetic resonance imaging acquisition. Clinical severity was assessed using the Clinical Dementia Rating Sum of Boxes and cortical atrophy was measured using voxel-based morphometry as well as Freesurfer. Chinese and white cohorts were demographically matched for age, sex, and education. RESULTS Clinical severity by diagnosis was similar across ethnicities. Chinese and white patient groups showed similar amounts of atrophy in the regions most affected in AD after accounting for demographic variables and head size. There was no significant difference between ethnic groups when compared by atrophy and clinical severity. CONCLUSIONS Our study suggests that Chinese and white patients with AD, when matched demographically, are clinically and neuroanatomically similar on normalized measures of cortical atrophy and clinical severity.
Collapse
|
20
|
Qian J, Jingwei He A, Dean-Chen Yin J. The medical arms race and its impact in Chinese hospitals: implications for health regulation and planning. Health Policy Plan 2019; 34:37-46. [DOI: 10.1093/heapol/czz001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Jiwei Qian
- East Asian Institute, National University of Singapore, Singapore
| | - Alex Jingwei He
- Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong
| | - Jason Dean-Chen Yin
- Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong
| |
Collapse
|
21
|
Guan X, Hu H, Man C, Shi L. A survey of availability, price and affordability of essential medicines from 2011 to 2016 in Chinese secondary and tertiary hospitals. Int J Equity Health 2018; 17:158. [PMID: 30340587 PMCID: PMC6194621 DOI: 10.1186/s12939-018-0870-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/07/2018] [Indexed: 12/22/2022] Open
Abstract
Background Essential medicines are those drugs that satisfy the priority health care needs of the population and help with functioning healthcare systems. Although many countries have formulated an essential medicine list, almost half of the global population still lack regular access to essential medicines. Research about the initiation of National Essential Medicines Policy in Chinese secondary and tertiary hospitals is inadequate, and the long-term effect on access after the reform is still unknown. This study’s objective was to investigate the access to essential medicines in mainland China’s secondary and tertiary hospitals. Methods Data on the access to 30 essential medicines from China’s National Essential Medicine List were obtained from China Medicine Economic Information database covering 396 secondary hospitals and 763 tertiary hospitals. We improved the standard methodology developed by the World Health Organization and the Health Action International to measure the availability, median price ratio (MPR) and the incidence of catastrophic drug expenditure (CDE). Results Five essential medicines had > 50% availability and the nationwide availability kept steady; availability of drugs in eastern regions of China was significantly higher than the central and western regions. The median MPR of 30 drugs nationwide kept steady approximately 5; MPR of drugs in the eastern regions was significantly higher than the central and western regions and the ratio of MPR of innovator brands to generics increased from 3.66 to 6.32 during the study period. The incidence of CDE caused by essential medicines decreased from 2011 to 2014; brand name medicines were more likely to cause CDE than generics and rural patients have a greater tendency to fall into CDE. Conclusions After the implementation of National Essential Medicines Policy, the MPR of essential medicines was well controlled and became more affordable in the context of steady availability. This has highlighted the problems associated with region disparity and inequity between rural and urban areas in the delivery of essential medicines and sustainable mechanisms are needed to deepen the National Essential Medicines Policy in mainland China. Electronic supplementary material The online version of this article (10.1186/s12939-018-0870-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China.,International Research Center for Medicinal Administration, Peking University, Beijing, 100191, China
| | - Huajie Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Chunxia Man
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China. .,International Research Center for Medicinal Administration, Peking University, Beijing, 100191, China.
| |
Collapse
|
22
|
He L, Yu H, Shi L, He Y, Geng J, Wei Y, Sun H, Chen Y. Equity assessment of the distribution of CT and MRI scanners in China: a panel data analysis. Int J Equity Health 2018; 17:157. [PMID: 30290807 PMCID: PMC6173854 DOI: 10.1186/s12939-018-0869-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/25/2018] [Indexed: 12/03/2022] Open
Abstract
Background Distribution equity assessment of computed tomography (CT) and magnetic resonance imaging (MRI) scanners is an important dimension of access to health technology. However, limited studies on the subject have been done in China. This study aims to reveal the distribution status of CT and MRI scanners and assess their distribution equity of them in China. Methods Five provinces with 66 cities from China were selected as the study sites. Descriptive analysis was used for the absolute number and number per million population of CT and MRI scanners in the study sites. Fixed effect model was used to examine the health service factors that were associated with the allocation of CT and MRI scanners. The Gini coefficient and concentration index was used to evaluate the distribution equity of CT and MRI scanners. Results The absolute number and number per million population of CT and MRI scanners in five provinces were lower than those of Organization for Economic Co-operation and Development (OECD) countries, but annual growth rates were relatively higher from 2005 or 2006 to 2013. Population, GDP, number of hospitals, number of health professionals, number of hospital beds, number of outpatient visits, and number of inpatient visits all had a positive correlation with the allocation number of CT and MRI scanners. Moreover, the number of health professionals and the number of beds had a much closer correlation than other variables. All the Gini coefficients of CT and MRI had decreased overall. The concentration indices of CT and MRI were all positive and no more than 0.30. Conclusions Large gaps in the number of CT and MRI scanners per million population between China and OECD countries emerge, although the growth rate is higher in China. The distribution equity of CT and MRI scanners in China was relatively good from 2005 or 2006 to 2013. The overall distribution equity of CT and MRI scanners also improved during the period. However, consideration attention should be given to the area with large economic disparities.
Collapse
Affiliation(s)
- Luyang He
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hao Yu
- RAND Corporation, Pittsburgh, USA
| | - Lizheng Shi
- School of Public Health, Tulane University, New Orleans, USA
| | - Yao He
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jingsong Geng
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yan Wei
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hui Sun
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yingyao Chen
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China.
| |
Collapse
|
23
|
Schlemmer HP, Bittencourt LK, D’Anastasi M, Domingues R, Khong PL, Lockhat Z, Muellner A, Reiser MF, Schilsky RL, Hricak H. Global Challenges for Cancer Imaging. J Glob Oncol 2018; 4:1-10. [PMID: 30241164 PMCID: PMC6180759 DOI: 10.1200/jgo.17.00036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Imaging plays many essential roles in nearly all aspects of high-quality cancer care. However, challenges to the delivery of optimal cancer imaging in both developing and advanced countries are manifold. Developing countries typically face dramatic shortages of both imaging equipment and general radiologists, and efforts to improve cancer imaging in these countries are often complicated by poor infrastructure, cultural barriers, and other obstacles. In advanced countries, on the other hand, although imaging equipment and general radiologists are typically accessible, the complexity of oncologic imaging and the need for subspecialists in the field are largely unrecognized; as a result, training opportunities are lacking, and there is a shortage of radiologists with the necessary subspecialty expertise to provide optimal cancer care and participate in advanced clinical research. This article is intended to raise awareness of these challenges and catalyze further efforts to address them. Some promising strategies and ongoing efforts are reviewed, and some specific actions are proposed.
Collapse
Affiliation(s)
- Heinz-Peter Schlemmer
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Leonardo K. Bittencourt
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Melvin D’Anastasi
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Romeu Domingues
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Pek-Lan Khong
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Zarina Lockhat
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Ada Muellner
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Maximilian F. Reiser
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Richard L. Schilsky
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| | - Hedvig Hricak
- Heinz-Peter Schlemmer, German Cancer Research Center,
Heidelberg; Melvin D’Anastasi and Maximilian F.
Reiser, Ludwig-Maximilians-University Hospital, Munich, Germany;
Leonardo K. Bittencourt, Fluminense Federal University,
Niterói; Leonardo K. Bittencourt and Romeu
Domingues, Clínica de Diagnóstico por Imagem
(CDPI/Dasa), Rio de Janeiro, Brazil; Pek-Lan Khong, University of
Hong Kong, Queen Mary Hospital, Hong Kong, China; Zarina Lockhat,
University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa;
Ada Muellner and Hedvig Hricak, Memorial Sloan
Kettering Cancer Center, New York, NY; and Richard L. Schilsky,
American Society of Clinical Oncology, Alexandria, VA
| |
Collapse
|
24
|
Innovative technologies and social inequalities in health: A scoping review of the literature. PLoS One 2018; 13:e0195447. [PMID: 29614114 PMCID: PMC5882163 DOI: 10.1371/journal.pone.0195447] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/22/2018] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to systematically review the range, nature, and extent of current research activity exploring the influence of innovative health-related technologies on social inequalities in health, with specific focus on a deeper understanding of the variables used to measure this connection and the pathways leading to the (re)production of inequalities. A review process was conducted, based on scoping review techniques, searching literature published from January 1, 1996 to November 25, 2016 using MEDLINE, Scopus, and ISI web of science. Search, sorting, and data extraction processes were conducted by a team of researchers and experts using a dynamic, reflexive examination process. Of 4139 studies collected from the search process, a total of 33 were included in the final analysis. Results of this study include the classification of technologies based on how these technologies are accessed and used by end users. In addition to the factors and mechanisms that influence unequal access to technologies, the results of this study highlight the importance of variations in use that importantly shape social inequalities in health. Additionally, focus on health care services technologies must be accompanied by investigating emerging technologies influencing healthy lifestyle, genomics, and personalized devices in health. Findings also suggest that choosing one measure of social position over another has important implications for the interpretation of research results. Furthermore, understanding the pathways through which various innovative health technologies reduce or (re)produce social inequalities in health is context dependent. In order to better understand social inequalities in health, these contextual variations draw attention to the need for critical distinctions between technologies based on how these various technologies are accessed and used. The results of this study provide a comprehensive starting point for future research to further investigate how innovative technologies may influence the unequal distribution of health as a human right.
Collapse
|
25
|
Ren Z, Song P, Chang X, Wang J, An L. Inequality of obstetric and gynaecological workforce distribution in China. Int J Equity Health 2018; 17:3. [PMID: 29304827 PMCID: PMC5756396 DOI: 10.1186/s12939-017-0716-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/27/2017] [Indexed: 11/30/2022] Open
Abstract
Background Women’s health is defined as a continuum throughout their whole lives. In China, women receive life-round preventative and curative health care from the health system, although the universal access to reproductive health has already been basically achieved in China, the situation of women’s access to curative health care is still unknown. Methods Data from the national maternal and child health human resource investigation were analysed. Lorenz curves, Gini coefficients, and Theil L indexes were drawn and calculated to reflect the inequality. Demographically, we found that the Obstetric and gynaecological (OB/GYN) workforce was the least equitable regarding the distribution of live births. Results Demographically, we found that the OB/GYN workforce was the least equitable regarding the distribution of live births. The geographic distribution of the OB/GYN workforce was found to be severely inequitable, especially in the West region. Most of the inequality was found to come from inner-regions. Conclusion For the first time, the distribution inequality of OB/GYN workforce in China was analysed. The findings in this study can be adopted in making national or regional OB/GYN workforce allocation policies, but further studies are still needed to reveal the detailed sources of inequality and to provide evidence for local policy-making. Electronic supplementary material The online version of this article (10.1186/s12939-017-0716-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Zhenghong Ren
- Department of Maternal and Child Health, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Peige Song
- Department of Maternal and Child Health, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China.,Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Xinlei Chang
- Department of Maternal and Child Health, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Jiawen Wang
- Institute of Medical Humanities, Peking University, Beijing, 100191, China
| | - Lin An
- Department of Maternal and Child Health, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China.
| |
Collapse
|
26
|
Changing of China׳s health policy and Doctor–Patient relationship: 1949–2016. HEALTH POLICY AND TECHNOLOGY 2017. [DOI: 10.1016/j.hlpt.2017.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
27
|
Sun J, Luo H. Evaluation on equality and efficiency of health resources allocation and health services utilization in China. Int J Equity Health 2017; 16:127. [PMID: 28709422 PMCID: PMC5513103 DOI: 10.1186/s12939-017-0614-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/26/2017] [Indexed: 11/29/2022] Open
Abstract
Background China is faced with a daunting challenge to equality and efficiency in health resources allocation and health services utilization in the context of rapid economic growth. This study sought to evaluate the equality and efficiency of health resources allocation and health services utilization in China. Methods Demographic, economic, and geographic area data was sourced from China Statistical Yearbook 2012–2016. Data related to health resources and health services was obtained from China Health Statistics Yearbook 2012–2016. Furthermore, we evaluated the equality of health resources allocation based on Gini coefficient. Concentration index was used to measure the equality in utilization of health services. Data envelopment analysis (DEA) was employed to assess the efficiency of health resources allocation. Results From 2011 to 2015, the Gini coefficients for health resources by population ranged between 0.0644 and 0.1879, while the Gini coefficients for the resources by geographic area ranged from 0.6136 to 0.6568. Meanwhile, the concentration index values for health services utilization ranged from −0.0392 to 0.2110. Moreover, in 2015, 10 provinces (32.26%) were relatively efficient in terms of health resources allocation, while 7 provinces (22.58%) and 14 provinces (45.16%) were weakly efficient and inefficient, respectively. Conclusions There exist distinct regional disparities in the distribution of health resources in China, which are mainly reflected in the geographic distribution of health resources. Furthermore, the people living in the eastern developed areas are more likely to use outpatient care, while the people living in western underdeveloped areas are more likely to use inpatient care. Moreover, the efficiency of health resources allocation in 21 provinces (67.74%) of China was low and needs to be improved. Thus, the government should pay more attention to the equality based on geographic area, guide patients to choose medical treatment rationally, and optimize the resource investments for different provinces.
Collapse
Affiliation(s)
- Jian Sun
- School of Humanities and Social Science, Guangxi Medical University, 22 Shuang Yong Road, Qing Xiu District, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Hongye Luo
- School of Information and Management, Guangxi Medical University, 22 Shuang Yong Road, Qing Xiu District, Nanning, Guangxi Zhuang Autonomous Region, 530021, China.
| |
Collapse
|
28
|
Kuwawenaruwa A, Borghi J, Remme M, Mtei G. An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania. Int J Equity Health 2017; 16:124. [PMID: 28697732 PMCID: PMC5505032 DOI: 10.1186/s12939-017-0620-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 07/04/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. METHODS This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. RESULTS We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately proportional (non dominance), whereas the distribution of oxytocics, anti-retroviral therapy (ART) and anti-hypertensive drugs was pro-rich, with the 45 degree line dominating the concentration curve for ART. CONCLUSION This study has shown there are inequities in the distribution of health care inputs across public primary care facilities. This highlights the need to ensure a better coordinated and equitable distribution of inputs through regular monitoring of the availability of health care inputs and strengthening of reporting systems.
Collapse
Affiliation(s)
- August Kuwawenaruwa
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania
| | - Josephine Borghi
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Michelle Remme
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Gemini Mtei
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania
| |
Collapse
|
29
|
Regional Maldistribution of China’s Hospitals Based on Their Structural System. SUSTAINABILITY 2017. [DOI: 10.3390/su9061046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
30
|
Shi L, Mao Y, Tang M, Liu W, Guo Z, He L, Chen Y. Health technology assessment in China: challenges and opportunities. GLOBAL HEALTH JOURNAL 2017. [DOI: 10.1016/s2414-6447(19)30058-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
31
|
Sun J, Gu H, Wen Q, Luo H. Assessing equity in the distribution of high-technology medical equipment in Guangxi: evidence from an ethnic minority region in Southern China. Int J Equity Health 2017; 16:81. [PMID: 28511714 PMCID: PMC5434632 DOI: 10.1186/s12939-017-0568-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 04/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background High-technology medical equipment (HTME) are important health resources. However, there is unequal distribution of these equipment in favor of metropolis and well equipped health facilities. This study sought to examine the equity gaps in the distribution of HTME in Guangxi. The results of this study could shed light on the future HTME allocation in Guangxi Zhuang Autonomous Region. Methods Data related to HTME was sourced from a general investigation of all the hospitals of Guangxi. Concentration index was used to assess the equity status of HTME in Guangxi. Results Over all, the total amount of HTME in Guangxi had been increasing from 2011 to 2015, and the per million population HTME of five kinds were all increased at the same time. Meanwhile, the concentration indices ranged between 0.1020 and 0.4617. The five medical equipment were all concentrated among the rich. Conclusions The possession of SPECT per million population in Guangxi is lower than the national average level while it is superior to the national average level for CT, MRI, DSA and LA. The equity status in the distribution of the five medical equipment has deteriorated since 2011. In 2015, the equity status of CT was the best, while the equity status of MRI was the worst. Meanwhile, 45.1% of HTME were concentrated in Nanning, Guilin, and Liuzhou.
Collapse
Affiliation(s)
- Jian Sun
- School of Humanities and Social Science, Guangxi Medical University, 22 Shuang Yong Road, Qing Xiu District, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Hai Gu
- Research Center of Health Policy and Management, Nanjing University, 163 Xian Lin Avenue, Qi Xia District, Nanjing, 210023, Jiangsu Province, China
| | - Qiulin Wen
- School of Pharmacy, Guangxi Medical University, 22 Shuang Yong Road, Qing Xiu District, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Hongye Luo
- School of Information and Management, Guangxi Medical University, 22 Shuang Yong Road, Qing Xiu District, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
| |
Collapse
|
32
|
Haghi M. The neglected value of health information technologies in universal health coverage in developing countries. Technol Health Care 2017; 25:167-169. [DOI: 10.3233/thc-161291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
33
|
Pan J, Shallcross D. Geographic distribution of hospital beds throughout China: a county-level econometric analysis. Int J Equity Health 2016; 15:179. [PMID: 27821181 PMCID: PMC5100192 DOI: 10.1186/s12939-016-0467-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/27/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Geographical distribution of healthcare resources is an important dimension of healthcare access. Little work has been published on healthcare resource allocation patterns in China, despite public equity concerns. METHODS Using national data from 2043 counties, this paper investigates the geographic distribution of hospital beds at the county level in China. We performed Gini coefficient analysis to measure inequalities and ordinary least squares regression with fixed provincial effects and additional spatial specifications to assess key determinants. RESULTS We found that provinces in west China have the least equitable resource distribution. We also found that the distribution of hospital beds is highly spatially clustered. Finally, we found that both county-level savings and government revenue show a strong positive relationship with county level hospital bed density. CONCLUSIONS We argue for more widespread use of disaggregated, geographical data in health policy-making in China to support the rational allocation of healthcare resources, thus promoting efficiency and equity.
Collapse
Affiliation(s)
- Jay Pan
- Health Economics, West China School of Public Health, Sichuan University, Chengdu, China
- West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - David Shallcross
- Public Health in Developing Countries, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| |
Collapse
|
34
|
Song P, Ren Z, Chang X, Liu X, An L. Inequality of Paediatric Workforce Distribution in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E703. [PMID: 27420083 PMCID: PMC4962244 DOI: 10.3390/ijerph13070703] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/09/2016] [Accepted: 07/07/2016] [Indexed: 11/17/2022]
Abstract
Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of paediatric nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation.
Collapse
Affiliation(s)
- Peige Song
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Zhenghong Ren
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Xinlei Chang
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Xuebei Liu
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Lin An
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100191, China.
| |
Collapse
|
35
|
Is the pro-competition policy an effective solution for China's public hospital reform? HEALTH ECONOMICS POLICY AND LAW 2016; 11:337-57. [PMID: 27346712 DOI: 10.1017/s1744133116000220] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The new round of health care reforms in China achieved significant initial results. New and emerging problems coinciding with the deepening of the reforms, however, require further institutional changes to strengthen the competition mechanism and promote public hospital efficiency. This paper provides a conceptual framework and preliminary assessment of public hospital competition in China. Specifically, we distinguish between two closely related concepts - competition and privatization, and identify several critical conditions under which hospital competition can be used as a policy instrument to improve health care delivery in China. We also investigate the current performance and identify several unintended consequences of public hospital competition - mainly, medical arms race, drug over-prescription and the erosion of a trusting relationship between patients and physicians. Finally, we discuss the policy options for enhancing the internal competition in China's hospital market, and conclude that public investment on information provision is key to reaping the positive outcomes of pro-competition policies.
Collapse
|
36
|
Zhu LM, Tang L, Qiao XW, Wolin E, Nissen NN, Dhall D, Chen J, Shen L, Chi Y, Yuan YZ, Ben QW, Lv B, Zhou YR, Bai CM, Chen J, Song YL, Song TT, Lu CM, Yu R, Chen YJ. Differences and Similarities in the Clinicopathological Features of Pancreatic Neuroendocrine Tumors in China and the United States: A Multicenter Study. Medicine (Baltimore) 2016; 95:e2836. [PMID: 26886644 PMCID: PMC4998644 DOI: 10.1097/md.0000000000002836] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The presentation, pathology, and prognosis of pancreatic neuroendocrine tumors (PNETs) in Asian patients have not been studied in large cohorts. We hypothesized that the clinicopathological features of PNETs of Chinese patients might be different from those of US patients. The objectives of this study were to address whether PNETs in Chinese patients exhibit unique clinicopathological features and natural history, and can be graded and staged using the WHO/ENETS criteria. This is a retrospective review of medical records of patients with PNETs in multiple academic medical centers in China (7) and the United States (2). Tumor grading and staging were based on WHO/ENETS criteria. The clinicopathological features of PNETs of Chinese and US patients were compared. Univariate and multivariate analyses were performed to find associations between survival and patient demographics, tumor grade and stage, and other clinicopathological characteristics. A total of 977 (527 Chinese and 450 US) patients with PNETs were studied. In general, Chinese patients were younger than US patients (median age 46 vs 56 years). In Chinese patients, insulinomas were the most common (52.2%), followed by nonfunctional tumors (39.7%), whereas the order was reversed in US patients. Tumor grade distribution was similar in the 2 countries (G1: 57.5% vs 55.0%; G2: 38.5% vs 41.3%; and G3: 4.0% vs 3.7%). However, age, primary tumor size, primary tumor location, grade, and stage of subtypes of PNETs were significantly different between the 2 countries. The Chinese nonfunctional tumors were significantly larger than US ones (median size 4 vs 3 cm) and more frequently located in the head/neck region (54.9% vs 34.8%). The Chinese and US insulinomas were similar in size (median 1.5 cm) but the Chinese insulinomas relatively more frequently located in the head/neck region (48.3% vs 26.1%). Higher grade, advanced stage, metastasis, and larger primary tumor size were significantly associated with unfavorable survival in both countries. Several clinicopathological differences are found between Chinese and US PNETs but the PNETs of both countries follow a similar natural history. The WHO tumor grading and ENETS staging criteria are applicable to both Chinese and US patients.
Collapse
Affiliation(s)
- Li-Ming Zhu
- From the Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (L-MZ, X-WQ, Y-LS, T-TS, C-ML, Y-JC); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (LT); Markey Cancer Center, University of Kentucky, Lexington, KY (EW); Department of Surgery (NNN); Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA (DD); Department of Gastroenterology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou (JC); Department of Gastrointestinal Medical Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute (LS); Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (YC); Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai (Y-ZY, Q-WB); Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou (BL); Department of Endocrinology, the Third Hospital of Hebei Medical University, Shijiazhuang (Y-RZ); Department of Oncology (C-MB); Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (JC); and Division of Endocrinology and Carcinoid and Neuroendocrine Tumor Center, Cedars-Sinai Medical Center, University of California Los Angeles, Los Angeles, CA (RY)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
The effect of concentrating obstetrics services in fewer hospitals on patient access: a simulation. Int J Health Geogr 2016; 15:4. [PMID: 26800889 PMCID: PMC4724143 DOI: 10.1186/s12942-016-0035-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background In Japan, the number of obstetrics facilities has steadily decreased and the selection and concentration of obstetrics facilities is progressing rapidly. Obstetrics services should be concentrated in fewer hospitals to improve quality of care and reduce the workload of obstetricians. However, the impact of this intensification of services on access to obstetrics hospitals is not known. We undertook a simulation to examine how the intensification of obstetrics services would affect access to hospitals based on a variety of scenarios, and the implications for health policy. Methods The female population aged between 15 and 49 living within a 30-min drive of an obstetrics hospital was calculated using a Geographic Information System for three possible intensification scenarios: Scenario 1 retained facilities with a higher volume of deliveries without considering the geographic boundaries of Medical Service Areas (MSAs, zones of healthcare administration and management); Scenario 2 prioritized retaining at least one hospital in each MSA and then retained higher delivery volume institutions, while Scenario 3 retained facilities to maximize population coverage using location-allocation modeling. We also assessed the impact of concentrating services in academic hospitals and specialist perinatal medical centers (PMCs) alone. Results In 2011, 95.0 % of women aged 15–49 years lived within a 30-min drive of one of 1075 obstetrics hospitals. This would fall to 82.7 % if obstetrics services were intensified into academic hospitals and general and regional PMCs. If 55.0 % of institutions provided obstetrics services, the coverage would be 87.6 % in Scenario 1, whereas intensification based on access would achieve over 90.5 % coverage in Scenario 2 and 93.9 % in Scenario 3. Conclusions Intensification of obstetrics facilities impairs access, but a greater caseload and better staffing have the potential advantages of better clinical outcomes and reduced costs. It is essential to consult residents of hospital catchment areas when reorganizing clinical services; a simulation is a useful means of informing these important discussions.
Collapse
|
38
|
Liu K, Hsieh C, Zhuang N, Gao Y, Li Z, Ren X, Yang L, Zhang J, Budoff MJ, Lu B. Current utilization of cardiac computed tomography in mainland China: A national survey. J Cardiovasc Comput Tomogr 2015; 10:76-81. [PMID: 26699712 DOI: 10.1016/j.jcct.2015.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/09/2015] [Accepted: 11/24/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surveys that describe the utilization of cardiac CT are available for the United States, Germany, and Taiwan, but not mainland China. OBJECTIVES To analyze the clinical utilization of cardiac CT in mainland China. METHODS A 25-item questionnaire was created and 240 tertiary hospitals were randomly selected to participate. Survey data were collected and confirmed by email as well as phone interviews. RESULTS In total, 237 (99%) hospitals consented to this survey, but 85 were excluded because of lack of cardiac CT patient volume or advanced technology. Finally, 152 (64%) questionnaires were available for analysis. Median patient volume was 1,037 patients (range: 150-8,072) annually. The most common clinical indications for coronary CT angiography were exclusion of coronary artery disease in patients with low to intermediate pretest likelihood, asymptomatic individuals with cardiovascular risk factors, and follow-up after coronary bypass grafting. The median heart rate threshold for beta blocker administration was >70 beats/min; most centers (86%) used sublingual nitroglycerin. Prospectively ECG triggered acquisition was the predominant technique in 44% of hospitals. Most (59%) providers adjusted the tube current to the body mass, but few (16%) adjusted the contrast injection rate. Per case, the mean examination duration was 14.2 min; post-processing time 13.6 min; and reporting time 18.0 min. CONCLUSIONS Cardiac CT is widely established in clinical practice in mainland China but there is a need for more uniform standards regarding performance and clinical utilization.
Collapse
Affiliation(s)
- Kun Liu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China
| | - Christopher Hsieh
- Olin Business School, Washington University in St. Louis, 1 Brookings Drive, St. Louis 63130, MO, United States
| | - Nan Zhuang
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, 5 Dongdansantiao Street, Beijing 100005, China
| | - Yang Gao
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China
| | - Zhennan Li
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China
| | - Xinshuang Ren
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China
| | - Li Yang
- Department of Radiology, PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Matthew Jay Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 West Carson Street, Torrance 90502, CA, United States
| | - Bin Lu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center of Cardiovascular Diseases, 167 Beilishi Road, Beijing 100037, China.
| |
Collapse
|
39
|
Matsumoto M, Koike S, Kashima S, Awai K. Geographic Distribution of Radiologists and Utilization of Teleradiology in Japan: A Longitudinal Analysis Based on National Census Data. PLoS One 2015; 10:e0139723. [PMID: 26421721 PMCID: PMC4589480 DOI: 10.1371/journal.pone.0139723] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/16/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Japan has the most CT and MRI scanners per unit population in the world, and as these technologies spread, their geographic distribution is becoming equalized. In contrast, the number of radiologists per unit population in Japan is the lowest among OECD countries and their geographic distribution is unknown. Likewise, little is known about the use of teleradiology, which can compensate for the uneven distribution of radiologists. METHODS Based on the Survey of Physicians, Dentists and Pharmacists and the Static Survey of Medical Institutions by the Ministry of Health, Labour and Welfare, a dataset of radiologists and CT and MRI utilizations in each of Japan's 1811 municipalities was created. The inter-municipality equity of the number of radiologists was evaluated using Gini coefficient. Logistic regression analysis, based on Static Survey data, was performed to evaluate the association between hospital location and teleradiology use. RESULTS Between 2006 and 2012 the number of radiologists increased by 21.7%, but the Gini coefficient remained unchanged. The number of radiologists per 1,000 CT (MRI) utilizations decreased by 17.9% (1.0%); the number was highest in metropolis and lowest in town/village and the disparity has widened from 1.9 to 2.2 (1.6 to 2.0) times. The number of hospitals and clinics using teleradiology has increased (by 69.6% and 18.1%, respectively). Hospitals located in towns/villages (odds ratio 1.61; 95% confidence interval 1.26-2.07) were more likely to use teleradiology than those in metropolises. CONCLUSIONS Contrary to the CT and MRI distributions, radiologist distribution has not been evened out by the increase in their number; in other words, the distribution of radiologists was not affected by market-derived spatial competition force. As a consequence, the gap of the radiologist shortage between urban and rural areas is increasing. Teleradiology, which is one way to ameliorate this gap, should be encouraged.
Collapse
Affiliation(s)
- Masatoshi Matsumoto
- Department of Community-Based Medical System, Faculty of Medicine, Hiroshima University, Hiroshima, Japan
- * E-mail:
| | - Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Saori Kashima
- Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
40
|
AKBARI SARI A, REZAEI S, HOMAIE RAD E, DEHGHANIAN N, CHAVEHPOUR Y. Regional Disparity in Physical Resources in the Health Sector in Iran: A Comparison of Two Time Periods. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:848-54. [PMID: 26258098 PMCID: PMC4524310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 04/15/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND One of the major health policy issues, in the both developed and developing countries, is the equality in the distribution of health resources. The aim of this study was to investigate the disparity in the distribution of health physical resources across the provinces of Iran in 2001 and 2011. METHODS This was a cross-sectional retrospective study which investigated inequality in the distribution of health physical resources by three indexes of Gini Coefficient, Gaswirth index and Index of Dissimilarity. The data on provinces were obtained from the yearbook statistics and Ministry of Health, and Medical Education. The Excel software was used to calculated indexes. RESULTS The finding showed the mean Gini Coefficient for all variables was 0.178 in 2001 and 0.158 in 2011. Besides, the mean Gaswirth index and index of dissimilarity were 11.5 and 1.5% in 2001 and 11 and 1.4% in 2011, respectively. CONCLUSION There was slightly inequality in distribution of physical health resources in Iran. According to the results of three indexes, this study showed when Tehran province excluding from total sample, the inequality was decreased.
Collapse
Affiliation(s)
- Ali AKBARI SARI
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Satar REZAEI
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran,Corresponding Author: Tel: +98-8338262005
| | - Enayatollah HOMAIE RAD
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim DEHGHANIAN
- Dept. of Healthcare Management, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran
| | - Yousef CHAVEHPOUR
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
41
|
Matsumoto M, Koike S, Kashima S, Awai K. Geographic Distribution of CT, MRI and PET Devices in Japan: A Longitudinal Analysis Based on National Census Data. PLoS One 2015; 10:e0126036. [PMID: 25946125 PMCID: PMC4422695 DOI: 10.1371/journal.pone.0126036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background Japan has the most CT and MRI scanners per unit population in the world; however, the geographic distribution of these technologies is currently unknown. Moreover, nothing is known of the cause-effect relationship between the number of diagnostic imaging devices and their geographic distribution. Methods Data on the number of CT, MRI and PET devices and that of their utilizations in all 1829 municipalities of Japan was generated, based on the Static Survey of Medical Institutions conducted by the government. The inter-municipality equity of the number of devices or utilizations was evaluated with Gini coefficient. Results Between 2005 and 2011, the number of CT, MRI and PET devices in Japan increased by 47% (8789 to 12945), 19% (5034 to 5990) and 70% (274 to 466), respectively. Gini coefficient of the number of devices was largest for PET and smallest for CT (p for PET-MRI difference <0.001; MRI-CT difference <0.001). For all three modalities, Gini coefficient steadily decreased (p for 2011-2005 difference: <0.001 for CT; 0.003 for MRI; and <0.001 for PET). The number of devices in old models (single-detector CT, MRI<1.5 tesla, and conventional PET) decreased, while that in new models (multi-detector CT, MRI≥1.5 tesla, and PET-CT) increased. Gini coefficient of the old models increased or remained unchanged (increase rate of 9%, 3%, and -1%; p for 2011-2008 difference <0.001, 0.072, and 0.562, respectively), while Gini coefficient of the new models decreased (-10%, -9%, and -10%; p for 2011-2008 difference <0.001, <0.001, and <0.001 respectively). Similar results were observed in terms of utilizations. Conclusions The more abundant a modality, the more equal the modality’s distribution. Any increase in the modality made its distribution more equal. The geographic distribution of the diagnostic imaging technology in Japan appears to be affected by spatial competition derived from a market force.
Collapse
Affiliation(s)
- Masatoshi Matsumoto
- Department of Community-Based Medical System, Faculty of Medicine, Hiroshima University, Hiroshima, Japan
- * E-mail:
| | - Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Saori Kashima
- Department of Public Health and Health Policy, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
42
|
Abstract
Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals.
Collapse
Affiliation(s)
- Winnie Yip
- Blavatnik School of Government, University of Oxford, Oxford, UK.
| | | |
Collapse
|
43
|
Meskarpour-Amiri M, Mehdizadeh P, Barouni M, Dopeykar N, Ramezanian M. Assessment the trend of inequality in the distribution of intensive care beds in Iran: using GINI index. Glob J Health Sci 2014; 6:28-36. [PMID: 25363104 PMCID: PMC4825512 DOI: 10.5539/gjhs.v6n6p28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 05/14/2014] [Indexed: 11/21/2022] Open
Abstract
Background and Aim: While most of the published researches have reported the amount of inequity in geographical distribution of important health resources, only a small number of studies have focused on the trend of inequality in the distribution of these resources. The purpose of this study was to determine the trend of inequality in the distribution of intensive care beds in Iran during 2010 to 2012 by using the Gini coefficient. Methods: This is a cross-sectional research conducted in 2013. The changes over three years (2010 to 2012) were calculated by Gini coefficient to investigate the trend of inequality in geographical distribution of intensive care beds (CCU, ICU and NICU). Results: The Gini coefficient for CCU beds was calculated as 0.02, 0.04 and 0.06 in 2010, 2011 and 2012, respectively. The Gini coefficient for ICU beds was calculated as 0.03, 0.05 and 0.05 in 2010, 2011 and 2012, respectively. Also, the Gini coefficient for NICU bed was calculated as 0.02, 0.03 and 0.04 in 2010, 2011 and 2012, respectively. Conclusion: Regarding to Gini coefficient, the trend of inequality was increased in the distribution of intensive care beds in Iran. Particularly, the inequalities in distribution of CCU beds were significantly increased during past years. In fact, if this trend of inequality continues, the distribution of intensive care beds will be extremely unequal in the next five years in Iran.
Collapse
|