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Zhou M. Equity and efficiency of health resource allocation in township health centers in Sichuan Province, China. PLoS One 2024; 19:e0299988. [PMID: 38442112 PMCID: PMC10914297 DOI: 10.1371/journal.pone.0299988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To analyze the equity and efficiency of health resource allocation in township health centers in Sichuan Province, and to provide a scientific basis for promoting the development of township health centers in Sichuan Province, China. METHODS The Lorenz curve, Gini coefficient and health resource density index were used to analyze the equity of health resource allocation in township health centers in Sichuan Province from 2017 to 2021, and data envelopment analysis(DEA) was used to analyze the efficiency of health resource allocation in township health centers in Sichuan Province from 2017 to 2021. RESULTS The Gini coefficient of health resources of township health centers in Sichuan Province is below 0.2 by population in addition to the number of beds in 2020-2021 and practicing (assistant) physicians in 2021, and the Gini coefficient of health resources of township health centers in Sichuan Province is above 0.6 by geography. The Lorentz curve of health resources of township health centers in Sichuan Province is closer to the equity line by population allocation and further from the equity line by geographical allocation. The average level of township health centers in Sichuan Province is used as the standard to calculate the health resource density standard index(W) of each region, the Ws of Panzhihua, Ganzi, Aba and Liangshan are less than 1, and the Ws of Ziyang, Neijiang, Deyang and Meishan are greater than 1. The overall efficiency of township health centers in Sichuan Province in 2017 and 2021 is 1, and the DEA is relatively effective. The overall efficiency of township health centers in Sichuan Province in 2018 and 2019 is not 1, and the DEA is relatively ineffective. The overall efficiency of all health resources in Mianyang and Ziyang is 1, and the DEA is relatively effective. The overall efficiency of all health resources in Suining, Neijiang, Yibin, Aba and Ganzi is not 1, and the DEA is relatively ineffective. CONCLUSION The equity of health resource allocation by population is better than that by geography in township health centers in Sichuan Province. Combining population and geographical factors, the health resource allocation of Panzhihua, Ganzi, Aba and Liangshan is lower than the average level of Sichuan Province. The efficiency of health resource allocation in township health centers in Sichuan Province is low.
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Affiliation(s)
- Minghua Zhou
- Department of Administration Office, Luzhou People’s Hospital, Luzhou, Sichuan, China
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Wang Z, Lin T, Xing X, Cai B, Chen Y. Dynamic distribution, regional differences and convergence of health workforce allocation in township health centers in China. Heliyon 2024; 10:e23857. [PMID: 38192759 PMCID: PMC10772724 DOI: 10.1016/j.heliyon.2023.e23857] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
This study evaluated the dynamic distribution, regional differences, and convergence of health workforce allocation in Township Health Centers in China during 2011-2020 using data obtained from the China Health Statistics Yearbook (2012-2021). The Gini coefficient and kernel density estimation were chosen to examine the dynamic distribution and regional differences in health workforce allocation in Township Health Centers in China and their components. σ convergence and β convergence were used to investigate the change trend of health workforce allocation in Township Health Centers. The results show that between 2011 and 2020, the number of licensed doctors and registered nurses per thousand population in Township Health Centers both increased largely and regional disparities still exist. In 2020, the largest differences in the density of licensed doctors and registered nurses were found in the eastern and central regions, respectively, and the intensity of trans-variation contributed the most to the overall disparities. The allocation of licensed doctors and registered nurses both exhibited σ convergence, absolute and conditional β convergence, indicating that the regional differences in health workforce in THCs among provinces will decrease. The growth of healthcare workforce was positively impacted by the urbanization rate, growth rate of government health expenditures and growth domestic product per capita, but negatively impacted by population density in rural areas and fiscal self-sufficiency.
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Affiliation(s)
- Zuobao Wang
- School of Humanities and Law, Northeastern University, Shenyang, 110169, China
| | - Tianrun Lin
- School of Humanities and Law, Northeastern University, Shenyang, 110169, China
| | - Xinyi Xing
- School of Humanities and Law, Northeastern University, Shenyang, 110169, China
| | - Bingshu Cai
- School of Humanities and Law, Northeastern University, Shenyang, 110169, China
| | - Yao Chen
- School of Management, Shenyang Urban Construction University, Shenyang, 110167, China
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Cai C, Xiong S, Millett C, Xu J, Tian M, Hone T. Health and health system impacts of China's comprehensive primary healthcare reforms: a systematic review. Health Policy Plan 2023; 38:1064-1078. [PMID: 37506039 PMCID: PMC10566320 DOI: 10.1093/heapol/czad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
China's comprehensive primary healthcare (PHC) reforms since 2009 aimed to deliver accessible, efficient, equitable and high-quality healthcare services. However, knowledge on the system-wide effectiveness of these reforms is limited. This systematic review synthesizes evidence on the reforms' health and health system impacts. In 13 August 2022, international databases and three Chinese databases were searched for randomized controlled trials, quasi-experimental studies and controlled before-after studies. Included studies assessed large-scale PHC policies since 2009; had a temporal comparator and a control group and assessed impacts on expenditures, utilization, care quality and health outcomes. Study quality was assessed using Risk of Bias In Non-randomized Studies of Interventions, and results were synthesized narratively. From 49 174 identified records, 42 studies were included-all with quasi-experimental designs, except for one randomized control trial. Nine studies were assessed as at low risk of bias. Only five low- to moderate-quality studies assessed the comprehensive reforms as a whole and found associated increases in health service utilization, whilst the other 37 studies examined single-component policies. The National Essential Medicine Policy (N = 15) and financing reforms (N = 11) were the most studied policies, whilst policies on primary care provision (i.e. family physician policy and the National Essential Public Health Services) were poorly evaluated. The PHC reforms were associated with increased primary care utilization (N = 17) and improved health outcomes in people with non-communicable diseases (N = 8). Evidence on healthcare costs was unclear, and impacts on patients' financial burden and care quality were understudied. Some studies showed disadvantaged regions and groups that accrued greater benefits (N = 8). China's comprehensive PHC reforms have made some progress in achieving their policy objectives including increasing primary care utilization, improving some health outcomes and reducing health inequalities. However, China's health system remains largely hospital-centric and further PHC strengthening is needed to advance universal health coverage.
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Affiliation(s)
- Chang Cai
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
| | - Shangzhi Xiong
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney 2042, Australia
- Global Health Research Centre, Duke Kunshan University, Academic Building 3038, No. 8 Duke Avenue, Kunshan, Jiangsu 215316, China
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
- Public Health Research Centre and Comprehensive Health Research Centre, NOVA National School of Public Health, NOVA University Lisbon, Avenida Padre Cruz, Lisbon 1600-560, Portugal
| | - Jin Xu
- China Center for Health Development Studies, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Maoyi Tian
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Level 5, 1 King Street Newtown, Sydney 2042, Australia
- School of Public Health, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin 150081, China
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
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Feng J, Gong Y, Li H, Wu J, Lu Z, Zhang G, Zhou X, Yin X. Development trend of primary healthcare after health reform in China: a longitudinal observational study. BMJ Open 2022; 12:e052239. [PMID: 35676005 PMCID: PMC9185408 DOI: 10.1136/bmjopen-2021-052239] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Reconstructing the primary healthcare system is the focus of the new round of Chinese health reform. Nevertheless, there have been few studies focusing on the strengthening of primary healthcare in Chinese health system. DESIGN This study was a longitudinal observational study. PRIMARY AND SECONDARY OUTCOME MEASURES The data of this study came from China Health Statistical Yearbook (2009-2018). We evaluated the development of primary healthcare based on the absolute values of health resources allocation and health service provision and evaluated the status of primary healthcare throughout the health system based on the composition ratios of the indicators across the health system. The Cochran-Armitage trend test and linear trend test were used to identify the indicators' trends over time. RESULTS From 2009 to 2018, the amounts of health resources allocation and health service provision of Chinese primary healthcare institutions showed a significant upward trend (p<0.001). However, compared with the indicators in 2009, excepting that the proportion of grants from the government in the whole health system has an upward trend, the proportions of other indicators had an escalating trend in 2018 by 3.66% for practicing (assistant) physicians, by 2.69% for nurses, by 3.99% for total revenues, by 5.87% for beds, by 8.39% for outpatient visits. CONCLUSION The primary healthcare system has developed rapidly, but its development speed lagged behind the entire health system, resulting in the weakening of its actual functions, which is not in line with the goal of health reform. The government should be more aware of the importance of primary healthcare at all levels of local governments and ensure adequate financial input.
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Affiliation(s)
- Jie Feng
- Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hui Li
- Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianxiong Wu
- Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guopeng Zhang
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuan Zhou
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Jiang Q, Yu T, Huang K, Huang X, Zhang Q, Hu S. The impact of medical insurance reimbursement on postoperative inflammation reaction in distinct cardiac surgery from a single center. BMC Health Serv Res 2022; 22:494. [PMID: 35418067 PMCID: PMC9008956 DOI: 10.1186/s12913-022-07920-8] [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: 12/20/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Evidences shows that socioeconomic status is reversely associated with the risk of morbidity and mortality for people with cardiovascular disease via pro-inflammation mechanism, but the population profile is not deeply defined on. We aimed to investigate the impact of medical insurance coverage on postoperative systemic inflammatory reaction in two kinds of disease populations undergoing distinct cardiac procedures. Methods A total of 515 patients receiving open mitral valve procedure with high-total expense from May 2013 through May 2021 in Sichuan Provincial People’s Hospital were retrospectively collected and stratified according to medical insurance reimbursement: low coverage with high out-pocket (< 30%), medium coverage (≤ 60%, but ≥ 30%), and high coverage (> 60%). Another 118 cases undergoing atrium septum defect (ASD) or patent foramen ovale (PFO) occlusion and taking on consistent low-total expense and low-coverage (< 30%) were also classified according to their insured conditions. The postoperative systemic inflammatory response indexes were high sensitivity C-reactive protein (hs-CRP) and the neutrophil–lymphocyte ratio (NLR). Results Low insurance reimbursement population undergoing open mitral valve procedure had a higher level of hs-CRP and NLR but not troponin I protein or lactate within 48 h postoperatively, and higher thoracic drainage, longer ventilation use and stay in intensive care unit. No significant difference in inflammatory indexes existed among diverse medical insurance coverage in population undergoing ASD/PFO occlusion. Conclusions Higher inflammatory reaction and weaker clinical recovery was associated with lower insurance coverage population undergoing open mitral valve procedure but not ASD/PFO interventional occlusion procedure. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07920-8.
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Affiliation(s)
- Qin Jiang
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, No.32, West Second Section First Ring Road, Chengdu, 610072, China.
| | - Tao Yu
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, No.32, West Second Section First Ring Road, Chengdu, 610072, China
| | - Keli Huang
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, No.32, West Second Section First Ring Road, Chengdu, 610072, China
| | - Xiaobo Huang
- Department of Surgical Intensive Care Unit, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China
| | - Qingfeng Zhang
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China
| | - Shengshou Hu
- Department of Cardiac Surgery, Fuwai Hospital, National, Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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