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Xiong C, Xia Y, Chen H, Cheng J. Regional Inequality and Associated Factors of Emergency Medicine Beds Distribution in China. Int J Public Health 2024; 69:1606812. [PMID: 38651036 PMCID: PMC11033296 DOI: 10.3389/ijph.2024.1606812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/06/2024] [Indexed: 04/25/2024] Open
Abstract
Objective: The regional inequality of emergency medicine beds distribution has a great impact on population health as well as the accessibility of emergency services. This study aimed to explore the regional inequality of emergency medicine bed distribution and its influencing factors. Methods: The Gini coefficient and health resource agglomeration were used to analyze the regional inequality of emergency medicine beds distribution by area from 2012 to 2021 in China. Grey correlation models were used to explore the factors influencing the regional inequality of emergency medicine beds distribution. Results: From 2012 to 2021, Gini coefficients of emergency medicine beds distribution by geographic in China showed a worsening trend, rising from 0.6229 to 0.6636. The average HRAD index was 3.43 in the east and 0.44 in the west. Population structure factors have the greatest influence on the regional inequality of emergency medicine beds distribution. Conclusion: Health resources allocation strategy only according to population size should be changed. In formulating policies for emergency medicine beds allocation should take into account population structure, financial structure of expenditure, the inequality of geographical distribution and so on.
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Affiliation(s)
- Change Xiong
- School of Public Health, Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Ying Xia
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Huihui Chen
- School of Public Health, Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Jing Cheng
- School of Public Health, Wuhan University of Science and Technology, Wuhan, Hubei, China
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Chai Y, Yuan X, Guo L, Chen Z. The Impact of Broadband Infrastructure Construction on Medical Resource Mismatch: Quasi-Natural Experiment From the Broadband China Policy. J Med Internet Res 2024; 26:e53921. [PMID: 38512327 PMCID: PMC10995788 DOI: 10.2196/53921] [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: 10/24/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Whether the construction of broadband infrastructure can alleviate the problem of mismatched medical resources is crucial to the national information strategy, residents' well-being, and social equity. However, the academic community lacks a comprehensive theoretical analysis and rigorous empirical research on this issue. OBJECTIVE This study aims to construct a preliminary theoretical framework to scientifically assess the effects of broadband infrastructure development on the mitigation of health care resource mismatch from both theoretical and empirical perspectives, to explore the potential mechanisms of influence, and ultimately to develop several practical policy recommendations. METHODS We first used a theoretical analysis to propose testable theoretical hypotheses and establish a preliminary theoretical framework. Then, based on balanced panel data from 300 cities from 2010 to 2021, a 2-way fixed effects difference-in-differences model was used for empirical testing. Mechanism tests, robustness analyses, and heterogeneity analyses were further conducted. RESULTS The research findings demonstrate that the Broadband China Policy significantly reduces the degree of mismatch in medical resources by primarily using innovation effects and integration effects, resulting in a reduction of 13.2%. In addition, the heterogeneity analysis reveals that the central and eastern regions, cities with large populations, and areas with a high proportion of young people benefit more significantly. CONCLUSIONS This study fully confirms, both theoretically and empirically, that broadband infrastructure construction can effectively reduce the mismatch of medical resources not only by expanding the existing literature on the impact of broadband on public services but also by providing valuable opportunities for policy makers to optimize the allocation of medical resources.
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Affiliation(s)
- Yulin Chai
- School of Management, Shandong Second Medical University, Weifang, China
| | - Xiaoping Yuan
- School of Psychology, Shandong Second Medical University, Weifang, China
| | - Lin Guo
- School of Management, Shandong Second Medical University, Weifang, China
| | - Zhongming Chen
- School of Management, Shandong Second Medical University, Weifang, China
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Wang Z, Ye W, Chen X, Li Y, Zhang L, Li F, Yao N, Gao C, Wang P, Yi D, Wu Y. Spatio-temporal pattern, matching level and prediction of ageing and medical resources in China. BMC Public Health 2023; 23:1155. [PMID: 37322467 PMCID: PMC10268402 DOI: 10.1186/s12889-023-15945-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/20/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE Population ageing, as a hot issue in global development, increases the burden of medical resources in society. This study aims to assess the current spatiotemporal evolution and interaction between population ageing and medical resources in mainland China; evaluate the matching level of medical resources to population ageing; and forecast future trends of ageing, medical resources, and the indicator of ageing-resources (IAR). METHODS Data on ageing (EPR) and medical resources (NHI, NBHI, and NHTP) were obtained from China Health Statistics Yearbook and China Statistical Yearbook (2011-2020). We employed spatial autocorrelation to examine the spatial-temporal distribution trends and analyzed the spatio-temporal interaction using a Bayesian spatio-temporal effect model. The IAR, an improved evaluation indicator, was used to measure the matching level of medical resources to population ageing with kernel density analysis for visualization. Finally, an ETS-DNN model was used to forecast the trends in population ageing, medical resources, and their matching level over the next decade. RESULTS The study found that China's ageing population and medical resources are growing annually, yet distribution is uneven across districts. There is a spatio-temporal interaction effect between ageing and medical resources, with higher levels of both in Eastern China and lower levels in Western China. The IAR is relatively high in Northwest, North China, and the Yangtze River Delta, but showed a declining trend in North China and the Yangtze River Delta. The hybrid model (ETS-DNN) gained an R2 of 0.9719, and the predicted median IAR for 2030 (0.99) across 31 regions was higher than the median IAR for 2020 (0.93). CONCLUSION This study analyzes the relationship between population ageing and medical resources, revealing a spatio-temporal interaction between them. The IAR evaluation indicator highlights the need to address ageing population challenges and cultivate a competent health workforce. The ETS-DNN forecasts indicate higher concentrations of both medical resources and ageing populations in eastern China, emphasizing the need for region-specific ageing security systems and health service industries. The findings provide valuable policy insights for addressing a hyper-aged society in the future.
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Affiliation(s)
- Zhenyan Wang
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Wei Ye
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Xicheng Chen
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Yang Li
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Ling Zhang
- Department of Health Education, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Fang Li
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Ning Yao
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Chengcheng Gao
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Pengyu Wang
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Dong Yi
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
| | - Yazhou Wu
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, NO.30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
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Liu Y, Xu Y, Li Y, Wei H. Identifying the Environmental Determinants of Lung Cancer: A Case Study of Henan, China. GEOHEALTH 2023; 7:e2023GH000794. [PMID: 37275567 PMCID: PMC10234758 DOI: 10.1029/2023gh000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/30/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023]
Abstract
Lung cancer has become one of the most prevalent cancers in the last several decades. Studies have documented that most cases of lung cancer are caused by inhaling environmental carcinogens while how external environmental factors lead to individual lung cancer is still an open issue as the pathogenesis may come from the combined action of multiple environmental factors, and such pathogenic mechanism may vary from region to region. Based on the data of lung cancer cases from hospitals at the county level in Henan from 2016 to 2020, we analyzed the response relationship between lung cancer incidence and physical ambient factors (air quality, meteorological conditions, soil vegetation) and socioeconomic factors (occupational environment, medical level, heating mode, smoking behavior). We used a Bayesian spatio-temporal interaction model to evaluate the relative risk of disease in different regions. The results showed that smoking was still the primary determinant of lung cancer, but the influence of air quality was increasing year by year, with meteorological conditions and occupational environment playing a synergistic role in this process. The high-risk areas were concentrated in the plains of East and Central Henan and the basin of South Henan, while the low-risk areas were concentrated in the hilly areas of North and West Henan, which were related to the topography of Henan. Our study provides a better understanding of the environmental determinants of lung cancer which will help refine existing prevention strategies and recognize the areas where actions are required to prevent environment and occupation related lung cancer.
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Affiliation(s)
- Yan Liu
- School of Remote Sensing and Information EngineeringWuhan UniversityWuhanChina
| | - Yanqing Xu
- School of Remote Sensing and Information EngineeringWuhan UniversityWuhanChina
| | - Yuchen Li
- MRC Epidemiology UnitSchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Haitao Wei
- The School of the Geo‐Science & TechnologyZhengzhou UniversityZhengzhouChina
- Joint Laboratory of Eco‐MeteorologyZhengzhou UniversityZhengzhouChina
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Liang Z, Wu D, Guo C, Gu J. Temporal trend of population structure, burden of diseases, healthcare resources and expenditure in China, 2000-2019. BMJ Open 2023; 13:e062091. [PMID: 36657769 PMCID: PMC9853154 DOI: 10.1136/bmjopen-2022-062091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To explore the evolutionary trend of population structure, disease burden, healthcare resources and expenditure in China, and to identify key domains that are most in need of intervention. DESIGN A cross-sectional and longitudinal analysis. DATA SOURCE Population and healthcare data from China Statistical Yearbook, and disease burden attributable to causes and risk factors from the Global Burden of Diseases between 2000 and 2019. MEASURES AND METHODS We used the Joinpoint Regression Program to measure trends in population composition, population change, dependency ratio, healthcare institution, personnel, expenditure and disease burden from 2000 to 2019. RESULTS Regarding the population in China between 2000 and 2019, a decreasing trend was observed among youth aged 0-14 years (average annual percent change (AAPC): -1.17), a slow rising trend was observed among individuals aged 15-64 years (AAPC: 1.10) and a rapidly increasing trend was observed among individuals older than 65 years (AAPC: 3.67). Astonishing increasing trends in healthcare institutions (AAPC: 3.97), medical personnel (AAPC: 3.26) and healthcare expenditures (AAPC: 15.28) were also observed. Among individuals younger than 70 years, neoplasms (AAPC: 0.54) and cardiovascular diseases (AAPC: 0.67) remained among the top three causes, while tobacco (AAPC: 0.22) remained a top three risk factor. However, while musculoskeletal disorders (AAPC: 1.88) were not a top three cause in 2000, they are a top three cause in 2019. CONCLUSION Comprehensive age/cause/risk factor-specific strategies are key to reconcile the tension among the triad of population ageing, disease burden and healthcare expenditure. The disease burden from cardiometabolic diseases, neoplasms and musculoskeletal disorders was identified as key domains that require intervention to reduce an increasing disease burden among individuals currently older than 70 years, as well as those approaching this age group.
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Affiliation(s)
- Zhenguo Liang
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dongze Wu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Cui Guo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Hong Kong SAR, China
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Liu TY, Qiu DC, Chen T. Effects of Social Participation by Middle-Aged and Elderly Residents on the Utilization of Medical Services: Evidence From China. Front Public Health 2022; 10:824514. [PMID: 35875043 PMCID: PMC9301239 DOI: 10.3389/fpubh.2022.824514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesAim to evaluate the effect of social participation on utilization of medical services among middle-aged and elderly residents in China.MethodsWe used data from the 2018 wave of the China Health and Retirement Longitudinal Study. Social participation is classified into three types. Furthermore, to control for confounding factors, our study computed propensity score matching (PSM) to evaluate the effect of social participation on the utilization of medical services.ResultThe result of PSM indicates that social participation significantly positively affects the utilization of outpatient services, the average treatment effect on the treated (ATT = 0.038***) and the utilization of inpatient services (ATT = 0.015**) by middle-aged and elderly residents. Furthermore, the utilization of outpatient health care services was significantly positively associated with leisure activities (ATT = 0.035***), social activities to help others (ATT = 0.031***), and learning activities to gain new knowledge (ATT = 0.034***) among middle-aged and elderly residents. The utilization of inpatient health care was significantly positively associated with leisure activities (ATT = 0.015***) but had no significant association with social deeds that help others and increased new knowledge among middle-aged and elderly residents.ConclusionThus, social participation significantly positively affects healthcare utilization by middle-aged and elderly residents. Hence, the government and society should provide more conveniences and promote social participation among middle-aged and elderly residents.
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Affiliation(s)
- Tai-Yi Liu
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - De-Chao Qiu
- Jintang First People's Hospital, West China Hospital Sichuan University, Jingtang, China
| | - Ting Chen
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Ting Chen
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Wang MY, Sung HC, Liu JY. Population Aging and Its Impact on Human Wellbeing in China. Front Public Health 2022; 10:883566. [PMID: 35419339 PMCID: PMC8995787 DOI: 10.3389/fpubh.2022.883566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Population aging is getting enlarged in the upcoming decades. Meanwhile, old-aged longevity and dependency are getting large due to improvement in life expectancy. In literature, it is claimed that old-aged dependency affects the wellbeing of society. Thus, the study intends to explore the impact of population aging on human wellbeing. The study adopts the Autoregressive Distributed Lag (ARDL) approach for empirical analysis by using time-series series data from 1990 to 2020. The study findings reveal that an increase in population aging reports a significant and decreasing impact on human wellbeing. However, an increase in health expenditure reports a significant and increasing impact on human wellbeing. Thus, China must pay attention to population aging to improve human health.
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Affiliation(s)
- Meng-Yun Wang
- GXNU School of Politics and Public Administration, Guangxi Normal University, Guilin, China
| | - Hsing-Chou Sung
- The Department of Political Science, Tunghai University, Taichung, Taiwan
| | - Jie-Yi Liu
- School of Architecture and Urban Planning, Suzhou University of Science and Technology, Soochow University, Suzhou, China
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Construction of Community Medical Communication Service and Rehabilitation Model for Elderly Patients under the Internet of Things. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9689769. [PMID: 35392145 PMCID: PMC8983247 DOI: 10.1155/2022/9689769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 11/17/2022]
Abstract
The objective of this study was to discuss the health management of elderly patients in the community and the management of community rehabilitation under the support of the new Internet of Things (IoT). The IoT technology was adopted to monitor the wearable devices through mobile medical physiological data. The heart rate, blood pressure, respiratory rate, and other physiological indicators of the elderly were collected in real time. The support vector machine (SVM) algorithm was selected as the core algorithm for the elderly physiological index disease risk assessment, the fuzzy comprehensive evaluation method was adopted as the core method of the elderly disease risk quantitative assessment model to process the physiological indicators, and finally, a reasonable physiological index processing model and quantitative indicators of disease risk were obtained. The data on vascular disease were selected from the MIMIC database. In addition, the advantages and disadvantages of the SVM algorithm and the Backpropagation Neural Network (BPNN) algorithm were compared and analysed. The final verification results showed that the fusion accuracy of the SVM processing MIMIC database and the University of California Irvine (UCI) dataset was 0.8327 and 0.8045, respectively, while the fusion accuracy of the BPNN algorithm in processing the same data was 0.7792 and 0.7288, respectively. It was obvious that the fusion accuracy of the SVM algorithm was higher than that of the BPNN algorithm, and the accuracy difference of the SVM algorithm was lower than that of the BPNN algorithm in different groups of data. In the verification of the elderly disease risk quantitative assessment model, the results were consistent with the selected data, which verified the effectiveness of the design model in this study. Therefore, it can be used as a quantitative assessment model of general elderly physiological indicators of disease risk and can be applied to the community medical communication management system. It proved that the model of medical communication and rehabilitation services for elderly patients in the community constructed in this study can definitely help the development of community service for the elderly.
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Does m-health-based exercise (guidance plus education) improve efficacy in patients with chronic low-back pain? A preliminary report on the intervention's significance. Trials 2022; 23:190. [PMID: 35241140 PMCID: PMC8892411 DOI: 10.1186/s13063-022-06116-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/15/2022] [Indexed: 12/29/2022] Open
Abstract
Background The utilization of mobile health (m-health) has rapidly expanded during the COVID-19 pandemic, and there is still a lack of relevant clinical data pertaining to chronic low-back pain (CLBP) management. This study was designed to compare the effectiveness of m-health-based exercise (via guidance plus education) versus exercise (via guidance) during CLBP management. Methods Participants (n = 40) were randomly assigned to intervention and control groups. The intervention group received m-health-based exercise (via guidance plus education), whereas the control group received m-health-based exercise (via guidance). The exercise prescription video and educational content were sent to participants by the application (app), Ding Talk. Repeated-measures analysis of variance was used to test the baseline’s intervention effects, 6-week follow-up, and 18-week follow-up. We selected function (Roland and Morris Disability Questionnaire) and pain intensity (current, mean, and most severe Numeric Rating Scale in the last 2 weeks) as the primary outcomes, changes of negative emotion (depression, anxious), and quality of life as the secondary outcomes. Results Time’s significant effect was found in pain, function, and health-related quality of life in both groups, but time did not show significant interaction effects. Participants were able to use m-based education with their anxiety and depression after treatment, but the relief only lasted until week 6. No differences were found on the aspect of mental health-related quality of life. Conclusion Preliminary findings suggest that m-health-based exercise (via guidance) may be a convenient and effective method to treat CLBP. However, additional health education didn't help more. More rigorous controlled trials are needed to improve the therapeutic effect in future studies. Trial registration Chinese Clinical Trials Registry Number ChiCTR2000041459. Registered on December 26, 2020.
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Shao Q, Tao R, Luca MM. The Effect of Urbanization on Health Care Expenditure: Evidence From China. Front Public Health 2022; 10:850872. [PMID: 35242736 PMCID: PMC8885621 DOI: 10.3389/fpubh.2022.850872] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
This paper investigates the impact and non-linear effects of urbanization on health care expenditure in China. The results indicate that urbanization in both Eastern and Central regions can significantly increase health care expenditure. But the impact of urbanization is not significant, which is related to the backward economic development level and low urbanization rate in the Western region. Taking population aging into consideration, the results of the panel threshold regression model imply that the positive relationship between urbanization and health care expenditure becomes greater when the level of population aging exceeds 10.72% in the Eastern region and 7.00% in the Western region. Therefore, in the urbanization process, the government should pay attention to the positive effect of urbanization on health care expenditure, provide more financial support for the construction of medical facilities, and expand the coverage of medical services and security for residents, especially for elderly people.
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Affiliation(s)
- Qi Shao
- China Center for Human Capital and Labor Market Research, Central University of Finance and Economics, Beijing, China
| | - Ran Tao
- Qingdao Municipal Center for Disease Control & Prevention, Qingdao, China
| | - Magda Mihaela Luca
- Department of Dentistry, Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
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Zhu Z, Kong W, Wang H, Xiao Y, Shi Y, Gan L, Sun Y, Tang H, Xia Z. Clinical status of hospitalized keloid cases from 2013 to 2018. Burns 2021; 48:1874-1884. [PMID: 34980519 DOI: 10.1016/j.burns.2021.12.007] [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: 09/21/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTS Keloids are intractable scar diseases and sometimes undergo hospitalization. This study aims to represent current status of keloid management in a national sample of hospitalized scar cases. METHODS Data of scar-diagnosed cases admitted in 1064 China's tertiary hospitals between 2013 and 2018, were obtained from the Hospital Quality Monitoring System (HQMS) database. Variables analyzed include sex, age, nationality, occupation, hospital department, accompanied symptoms at admission, surgical treatment, length of stay (LOS), and hospitalization cost. The potential risk factors of keloid diagnosis among scar cases were preliminarily identified through the Cochran-Mantel-Haenszel tests and univariate regression analyses. RESULTS This study identified 177,586 scar cases including 21,777 keloid cases and 155,809 non-keloid scar cases. The prevalence of scars in the HQMS database was gradually decreased from 0.123% in 2013 to 0.075% in 2018. We found a preponderances of males (54.32%), adults (61.52%), Han nationality (93.38%), and students (17.35%) in scar cases, among whom keloid cases accounted for growing proportions increasing from 9.2% in 2013 to 15.1% in 2018. Comparing non-keloid scar cases, keloid cases consisted of more women (59.1% VS 43.8%), office staffs (13.08% VS 6.75%) and retirees (5.16% VS 2.65%), and less Zhuang (0.79% VS 1.40%) and Hui nationalities (0.76% VS 1.00%), and showed lower incidence of accompanied symptoms (4.51% VS 47.96%) and higher rate of receiving operations (57.96% VS 50.28%, P < 0.001). Both the LOS and cost per hospitalization were lower in keloid cases. Furthermore, the adult and older women, Han and Uyghur nationalities, office staffs and retirees, and admitted in otolaryngology and dermatology departments, were potential predictors of keloid diagnosis among hospitalized scar cases. CONCLUSION When viewed at the national level, keloid occupies an important part in scar management in Chinese tertiary hospitals. Demographic and clinical differences between keloids and other scars facilitate understanding and promoting of individualized anti-scar therapeutic strategies.
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Affiliation(s)
- Zhe Zhu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Weishi Kong
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Haibo Wang
- Clinical Trial Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Centre for Data Science in Health and Medicine, Peking University, Beijing, China
| | - Yongqiang Xiao
- Department of Burn and Plastic Surgery, The 970th Hospital of PLA, Yantai, Shandong, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen, China
| | - Lanxia Gan
- China Standard Medical Information Research Center, Shenzhen, China
| | - Yu Sun
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Hongtai Tang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Zhaofan Xia
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China.
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Chen J, Lin Z, Li LA, Li J, Wang Y, Pan Y, Yang J, Xu C, Zeng X, Xie X, Xiao L. Ten years of China's new healthcare reform: a longitudinal study on changes in health resources. BMC Public Health 2021; 21:2272. [PMID: 34903184 PMCID: PMC8670033 DOI: 10.1186/s12889-021-12248-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China launched a new round of healthcare-system reform in 2009 and proposed the goal of equal and guaranteed essential medical and health services for all by 2020. We aimed to investigate the changes in China's health resources over the past ten years after the healthcare reform. METHODS Data were collected from the China Statistical Yearbook and China Health Statistics Yearbook from 2009 to 2018. Four categories and ten indicators of health resources were analyzed. A descriptive analysis was used to present the overall condition. The Health Resource Density Index was applied to showcase health-resource distribution in demographic and geographic dimensions. The global and local Moran's I were used to assess the spatial autocorrelation of health resources. Concentration Index (CI) was used to quantify the equity of health-resource distribution. A Geo-Detector model and Geographic Weighted Regression (GWR) were applied to assess the association between gross domestic product (GDP) per capita and health resources. RESULTS Health resources have increased over the past ten years. The global and local Moran's I suggested spatial aggregation in the distribution of health resources. Hospital beds were concentrated in wealthier areas, but this inequity decreased yearly (from CI=0.0587 in 2009 to CI=0.0021 in 2018). Primary medical and health institutions (PMHI) and their beds were concentrated in poorer areas (CI remained negative). Healthcare employees were concentrated in wealthier areas (CI remained positive). In 2017, the q-statistics indicated that the explanatory power of GDP per capita to beds, health personnel, and health expenditure was 40.7%, 50.3%, and 42.5%, respectively. The coefficients of GWR remained positive with statistical significance, indicating the positive association between GDP per capita and health resources. CONCLUSIONS From 2009 to 2018, the total amount of health resources in China has increased substantially. Spatial aggregation existed in the health-resources distribution. Health resources tended to be concentrated in wealthier areas. When allocating health resources, the governments should take economic factors into account.
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Affiliation(s)
- Jiang Chen
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuochen Lin
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-An Li
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuyao Wang
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Pan
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Yang
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuncong Xu
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaojing Zeng
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxu Xie
- School of Public Health, Fujian Medical University, Fuzhou, China.
| | - Liangcheng Xiao
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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13
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Ren W, Tarimo CS, Sun L, Mu Z, Ma Q, Wu J, Miao Y. The degree of equity and coupling coordination of staff in primary medical and health care institutions in China 2013-2019. Int J Equity Health 2021; 20:236. [PMID: 34717630 PMCID: PMC8557061 DOI: 10.1186/s12939-021-01572-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Primary medical and health care facilities are the first lines of defense for the health of population. This study aims to evaluate the current state and trend of equity and coupling coordination degree (CCD) of staff in primary medical and health care institutions (SPMHCI) based on the quantity and living standards of citizens in China 2013–2019. The research findings are expected to serve as a guideline for the allocation of SPMHCI. Methods The data used in this study including the quantity and living standards of citizens, as well as the number of SPMHCI in 31 provincial administrative regions of China, were obtained from the China Statistical Yearbook and the China Health Statistics Yearbook. The equity and CCD for SPMHCI were analyzed by using the Gini coefficient and the CCD model, and the Grey forecasting model GM (1, 1) (GM) was used to predict the equity and CCD from 2020 to 2022. Results Between 2013 and 2019, the number of SPMHCI increased from 3.17 million to 3.50 million, and the population-based Gini coefficient declined from 0.0704 to 0.0513. In urban and rural areas, the Gini coefficients decreased from 0.1185 and 0.0737 to 0.1025 and 0.0611, respectively. The CCD between SPMHCI and citizens’ living standards (CLS) changed from 0.5691, 0.5813, 0.5818 to 0.5650, 0.5634, 0.6088 at national, urban, and rural levels, respectively. The forecasting results of GM revealed that at the national, urban and rural levels from 2020 to 2022, the Gini coefficient would rise at a rate of − 13.53, − 5.77%, and − 6.10%, respectively, while the CCD would grow at a rate of - 0.89, 1.06, and 0.87%, respectively. Conclusions In China, the number of SPMHCI has increased significantly, with an equitable allocation based on the population. The interaction between SPMHCI and CLS is sufficient, but the degree of mutual promotion is moderate. The government could optimize SPMHCI and improve the chronic disease management services to improve CLS and to ensure the continued operation of primary medical and health care institutions in urban areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01572-6.
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Affiliation(s)
- Weicun Ren
- College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, 450001, Henan, China.,Department of Health Management, Sanquan College of Xinxiang Medical University, Xinxiang, 453000, Henan, China
| | - Clifford Silver Tarimo
- College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, 450001, Henan, China.,Dares Salaam Institute of Technology, Department of Science and Laboratory Technology, P.O. Box 2958, Dar es Salaam, Tanzania
| | - Lei Sun
- Department of Health Management, Sanquan College of Xinxiang Medical University, Xinxiang, 453000, Henan, China
| | - Zihan Mu
- College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, 450001, Henan, China
| | - Qian Ma
- Department of Health Management, Sanquan College of Xinxiang Medical University, Xinxiang, 453000, Henan, China
| | - Jian Wu
- College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, 450001, Henan, China
| | - Yudong Miao
- College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, 450001, Henan, China.
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14
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Jia H, Cao P, Yu J, Zhang J, Jiang H, Zhao Q, Yu X. A New Perspective for Improving the Human Resource Development of Primary Medical and Health Care Institutions: A Structural Equation Model Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2560. [PMID: 33806526 PMCID: PMC7967509 DOI: 10.3390/ijerph18052560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
In some countries, including China, primary health care is rarely utilized because of medical personnel shortages at primary medical and health care institutions (PMHCIs). Several studies suggest that the most effective solution is to guide qualified doctors and medical graduates to work in PMHCIs, but the studies and measures have been formulated only from the perspective of the government and PMHCIs; few have considered the subjective willingness of medical personnel. Therefore, it is necessary to explore the measures to develop human resources of PMHCIs from the guiding object. This research was divided into two parts based on implicit theory and a lexical approach. The first part collected the factors affecting their choosing PMHCIs for employment, and the second part used exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM) to explore the dimensions and paths of the influencing factors. At last, seven factors were obtained from the EFA, and the SEM hypothesis fit the data well. Internal Organization Development, Patient Factor, Remuneration and Development, and Family Support had a significantly positive effect on the Sense of Gain of medical personnel seeking employment at PMHCIs, whereas both Job Responsibilities and Condition of the City Where the PMHCI Is Located had no significant effect. In addition, the indirect effects of Internal Organization Development and Condition of the City Where the PMHCI Is Located on the Sense of Gain were significant. The Patient Factor, Family Support, and Remuneration and Development significantly mediated the relationship between the internal and external environment of the institution and the Sense of Gain, whereas the mediating effect of Job Responsibilities was not significant. The improvement of family support, remuneration and development, and patient factors increase the willingness of medical personnel to seek employment at PMHCIs. In addition, the internal and external environments of a PMHCI play a vital role in guiding medical personnel to PMHCIs for employment. This research provides theoretical support for improving the development of human resources, guiding medical personnel to work in PMHCIs, and promoting the use of primary care services.
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Affiliation(s)
- Huanhuan Jia
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Peng Cao
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Jianxing Yu
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Jingru Zhang
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Hairui Jiang
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
| | - Qize Zhao
- Jilin Province Healthcare Security Administration Management Center, Changchun 130000, China;
| | - Xihe Yu
- School of Public Health, Jilin University, Changchun 130000, China; (H.J.); (P.C.); (J.Y.); (J.Z.); (H.J.)
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15
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Total Health Expenditure and Its Driving Factors in China: A Gray Theory Analysis. Healthcare (Basel) 2021; 9:healthcare9020207. [PMID: 33673001 PMCID: PMC7918561 DOI: 10.3390/healthcare9020207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022] Open
Abstract
The continuous growth in total health expenditure (THE) has become a social issue of common concern in most countries. In China, the total health expenditure (THE) is maintaining a rapid growth trend that is higher than that of the economy, which has become increasingly obvious in the 21st century and has brought a heavy burden to the government and residents. To analyze the main driving factors of THE in China in the 21st century and establish a predictive model, gray system theory was employed to explore the correlation degree between THE and nine hot topics in the areas of the economy, population, health service utilization, and policy using national data from 2000 to 2018. Additionally, a New Structure of the Multivariate Gray Prediction Model of THE was established and compared with the traditional grey model and widely used BP neural network to evaluate the prediction effectiveness of the model. We concluded that the Chinese government and society have played a crucial role in reducing residents’ medical burden. Besides this, the improved economy and aging population have increased the demand for health services, leading to the continual increase in THE. Lastly, the improved NSGM(1,N) model achieved good prediction accuracy and has unique advantages in simulating and predicting THE, which can provide a basis for policy formulation.
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