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Huang R, Li W, Shi B, Su H, Hao J, Zhao C, Chai J. Evaluating China's primary healthcare services' efficiency and spatial correlation: a three-stage DEA-Malmquist model. Front Public Health 2024; 12:1366327. [PMID: 38962768 PMCID: PMC11220123 DOI: 10.3389/fpubh.2024.1366327] [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: 01/06/2024] [Accepted: 04/23/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Enhancing the efficiency of primary healthcare services is essential for a populous and developing nation like China. This study offers a systematic analysis of the efficiency and spatial distribution of primary healthcare services in China. It elucidates the fundamental landscape and regional variances in efficiency, thereby furnishing a scientific foundation for enhancing service efficiency and fostering coordinated regional development. Methods Employs a three-stage DEA-Malmquist model to assess the efficiency of primary healthcare services across 31 provincial units in mainland China from 2012 to 2020. Additionally, it examines the spatial correlation of efficiency distribution using the Moran Index. Results The efficiency of primary healthcare services in China is generally suboptimal with a noticeable declining trend, highlighting significant potential for improvement in both pure technical efficiency and scale efficiency. There is a pronounced efficiency gap among provinces, yet a positive spatial correlation is evident. Regionally, efficiency ranks in the order of East > Central > West. Factors such as GDP per capita and population density positively influence efficiency enhancements, while urbanization levels and government health expenditures appear to have a detrimental impact. Discussion The application of the three-stage DEA-Malmquist model and the Moran Index not only expands the methodological framework for researching primary healthcare service efficiency but also provides scientifically valuable insights for enhancing the efficiency of primary healthcare services in China and other developing nations.
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Affiliation(s)
- Rui Huang
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Wan Li
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Hao Su
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Jing Hao
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Chuanjun Zhao
- Department of National Security, School of National Security, Minzu University of China, Beijing, China
| | - Juhong Chai
- Department of Management, School of Management, Minzu University of China, Beijing, China
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Sapbamrer R, Sittitoon N, Thongtip S, Chaipin E, Sutalangka C, La-up A, Thirarattanasunthon P, Thammachai A, Suwannakul B, Sangkarit N, Kitro A, Panumasvivat J, Srisookkum T. Socio-demographic, agricultural, and personal protective factors in relation to health literacy among farmers from all regions of Thailand. Front Public Health 2024; 12:1364296. [PMID: 38590809 PMCID: PMC10999635 DOI: 10.3389/fpubh.2024.1364296] [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: 01/02/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Farmers are vulnerable to adverse health effects from pesticide exposure due to their health literacy (HL). Therefore, this study aims to investigate HL among farmers in four main regions of Thailand, investigating socio-demographics, agricultural, and personal protective factors to their HL. Methods This cross-sectional design study was conducted on 4,035 farmers from January to July 2023. The European Health Literacy Survey Questionnaire-47 items were used to measure HL. Results Thai farmers had a mean HL score of 34.7 ± 8.7, and the farmers in the North region of Thailand had the highest frequency of limited HL (75.8%). Socio-demographic factors that were associated with HL included gender, region of living, marital status, education level, co-morbidity, and number of family members. Agricultural factors associated with HL included planting status, working hours on farm, spraying pesticides, harvesting crops, pesticide use of >1 type, access information from government officers, access information from posters/brochures, information from online multimedia, and access information from neighbors. Personal protective factors that were associated with HL included wearing a hat, goggles, a rubber apron, and a long-sleeved shirt. Discussion Our study recommends that strategies and interventions to enhance the HL of farmers should be focused on the target populations, which include men, widows, or divorced, those with low levels of education, those who have co-morbidities, and those who applied pesticides of more than 1 type and improper personal protective equipment (PPE) use. The primary emphasis needs to be on the North region of Thailand, making that the target area to improve health equity in Thailand. These efforts would enhance the HL of farmers and sustainably improve pesticide safety behavior. Additionally, there is an urgent need for supportive measures aimed at altering on-farm practices and promoting education on alternative pest management strategies, particularly non-chemical crop protection, to ensure sustainable agriculture.
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Affiliation(s)
- Ratana Sapbamrer
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Environmental and Occupational Medicine Excellence Center (EnOMEC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nalin Sittitoon
- School of Environmental Health, Institute of Public Health, Suranaree University of Technology, Nakhon Ratchasima, Thailand
| | - Sakesun Thongtip
- Department of Environmental Health, School of Public Health, University of Phayao, Phayao, Thailand
| | - Eakasit Chaipin
- Department of Public Health, Faculty of Science, Rajabhat Lampang University, Lampang, Thailand
| | - Chatchada Sutalangka
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Aroon La-up
- Nakhonsawan Campus, Mahidol University, Nakhonsawan, Thailand
| | | | - Ajchamon Thammachai
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Boonsita Suwannakul
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Noppharath Sangkarit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Amornphat Kitro
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Environmental and Occupational Medicine Excellence Center (EnOMEC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jinjuta Panumasvivat
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Environmental and Occupational Medicine Excellence Center (EnOMEC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Taweewun Srisookkum
- Department of Community Health, School of Public Health, University of Phayao, Phayao, Thailand
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Tian Y, Peng J, Liu Y, Huang J. Efficiency trends of essential public health services and possible influencing factors since the new round health reform in China: a case study from Hainan Province. Front Public Health 2023; 11:1269473. [PMID: 38026396 PMCID: PMC10657853 DOI: 10.3389/fpubh.2023.1269473] [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: 07/30/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This article aimed to evaluate the efficiency trends and influencing factors of essential public health services in Hainan Province after the healthcare reform launched in 2009 in China. Methods The efficiency of essential public health services (EPHS) at primary health institutions was assessed using data envelopment analysis (DEA), and the efficiency change was analyzed by employing the Malmquist productivity index (MPI). We used Tobit regression to identify the influence of environmental factors on the efficiency of public health services. The bootstrap method was adopted to reduce the impact of random errors on the result. Results The bootstrapping bias-corrected efficiency revealed that the average values of technical efficiency, pure technical efficiency, and scale efficiency were 0.7582, 0.8439, and 0.8997, respectively, which meant that the EPHS in Hainan Province were not at the most effective state. The average bias-corrected MPI was 1.0407 between 2010 and 2011 and 1.7404 between 2011 and 2012. MPIs were less than 1.0000 during other periods investigated, ranging from 0.8948 to 0.9714, indicating that the efficiency of EPHS has been decreasing since 2013. The Tobit regression showed that the regression coefficients of per capita GDP, population density, the proportion of older people aged over 65, and the proportion of ethnic minority population were 0.0286, -0.0003, -0.0316, and - 0.0041 respectively, which were statistically significant (p < 0.05). Conclusion There was a short-term improvement in the efficiency of EPHS in Hainan after the launch of the new round of health reform. However, this trend has not been sustained after 2013. In particular, equalized financial investment in essential public health could not fulfill the needs of poor counties. This has resulted in the inability to improve scale efficiency in some counties, which in turn has affected the improvement of overall EPHS efficiency. Therefore, to promote EPHS efficiency sustainably, it is suggested that under this model of provincial control of counties, the equity of resource allocation should be effectively improved while further advancing the technology of service delivery.
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Affiliation(s)
- Ye Tian
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Jia Peng
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Yumei Liu
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Jiayan Huang
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
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Gao Y, Zhu L, Mao ZJ. Correction: How to improve public health literacy based on polycentric public goods theory: preferences of the Chinese general population. BMC Public Health 2022; 22:1222. [PMID: 35725442 PMCID: PMC9208190 DOI: 10.1186/s12889-022-13417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yaxin Gao
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Ave, Wuhan, No. 1095, China.,College of Public Administration, Huazhong University of Science and Technology, No 1037 Luau Road, Hongshan District, Wuhan, 430074, China.,Non-traditional Security Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Li Zhu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Ave, Wuhan, No. 1095, China
| | - Zi Jun Mao
- College of Public Administration, Huazhong University of Science and Technology, No 1037 Luau Road, Hongshan District, Wuhan, 430074, China. .,Non-traditional Security Institute, Huazhong University of Science and Technology, Wuhan, 430074, China.
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