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Li H, Yuan B, Song S, Meng Q, Kawachi I. Trends in resource allocation for primary health care in rural China: Concentration curve and decomposition analysis. Int J Health Plann Manage 2024; 39:1551-1561. [PMID: 39054616 DOI: 10.1002/hpm.3828] [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: 07/24/2020] [Revised: 11/03/2022] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
Since 2009, China has made large investments in strengthening the primary healthcare system. This study aimed to examine the trends in the number and distribution of health resources in rural China following the health system reform and to decompose the sources of inequalities. Data were collected from standardized reports compiled by each county in rural China and compiled by the National Health Commission and Bureau of Statistics. From the findings of this empirical study, resource allocation per capita for primary health care (PHC) improved gradually from 2008 to 2014. The distribution of beds across counties (ranked by level of economic development) was relatively equitable. However, the concentration curve analysis indicated that the distribution of primary care professionals remained skewed in favour of wealthier and more urbanised counties. Economic status was proved to be a major contributor to the inequality of health human resource. China's primary care reforms resulted in simultaneously improved supply of PHC resources as well as pro-rich inequality in distribution of the workforce. To advance equality in health resource allocation, greater attention should be paid to the substantial inequality of economic status within counties.
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Affiliation(s)
- Huiwen Li
- China Population and Development Research Center, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Suhang Song
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Wang T, Zhou T, Zhou L, He Y, Wang J, Wang Y, Huang L. Equity and efficiency of health resource allocation in the Chengdu-Chongqing Economic Circle of China. Front Public Health 2024; 12:1369568. [PMID: 39257950 PMCID: PMC11384592 DOI: 10.3389/fpubh.2024.1369568] [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: 01/17/2024] [Accepted: 07/29/2024] [Indexed: 09/12/2024] Open
Abstract
Objective This study aimed to evaluate the fairness and efficiency of health resource allocation (HRAE) in Chengdu-Chongqing Economic Circle after the new healthcare reform. This study also aimed to identify existing problems, providing empirical evidence for the government to formulate regional health plans scientifically and reasonably. Methods The fairness of health resource allocation was analyzed using the Gini coefficient, Theil index, and agglomeration degree from population and geographical area perspectives. The three-stage data envelopment analysis and the Malmquist productivity index were used to analyze HRAE from static and dynamic perspectives. Results The Gini coefficient for population allocation in Chengdu-Chongqing Economic Circle was 0.066-0.283, and the Gini coefficient for geographical area allocation was 0.297-0.469. The contribution rate within a region was greater than that between regions, and health resources were mainly concentrated in economically developed core areas. The overall fairness of Chengdu Economic Circle was relatively better than that of Chongqing Economic Circle. Moreover, the adjusted mean technical efficiency was 0.806, indicating room for HRAE improvement in Chengdu-Chongqing Economic Circle. Stochastic Frontier Analysis found that different environmental variables have varying degrees of impact on HRAE. The adjusted mean total factor productivity change (Tfpch) was 1.027, indicating an overall upward trend in HRAE since the new healthcare reform. However, scale efficiency change (Sech) (0.997) limited the improvement of Tfpch. Conclusion The fairness of health resources allocated by population was better than that allocated by geographical area. The unfairness of health resources mainly stemmed from intra-regional differences, with considerable health resources concentrated in core areas. Over the past 13 years, HRAE has improved but exhibited spatial heterogeneity and Sech-hindered productivity improvement. The study recommends strengthening regional cooperation and sharing to promote the integrated and high-quality development of the health and well-being in Chengdu-Chongqing Economic Circle.
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Affiliation(s)
- Tianqi Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Ting Zhou
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Leming Zhou
- College of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Yunfei He
- Department of Personnel, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Wang
- Department of Pathophysiology, Chongqing Medical University, Chongqing, China
| | - Yonghong Wang
- Department of Clinical Laboratory, Chongqing Qianjiang Central Hospital, Chongqing, China
| | - Li Huang
- Department of Personnel, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Jieting C, Yan Z, Zhilong S, Siyuan L, Xiangwei W. Research on the coupling measurement of medical education and health resource allocation under the background of healthy China. BMC MEDICAL EDUCATION 2024; 24:863. [PMID: 39135027 PMCID: PMC11318310 DOI: 10.1186/s12909-024-05766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 07/11/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To analyze the coupling and coordination level of medical education and health resource allocation in China, and to provide scientific basis for promoting the high-quality development of medical education and the efficient allocation of health resources. METHODS Based on the panel data from 2011 to 2021, the coupling coordination degree model was used to measure the coupling coordination index of medical education and health resources in China. The spatial auto-correlation model was used to analyze the development status and distribution characteristics of the coupling coordination degree of the two systems. The kernel density estimation method was used to analyze the dynamic evolution trend of the coupling coordination of the two systems. The QR quantile regression model was used to explore the key factors affecting the coupling coordination degree of the two systems. RESULTS During the observation period, the coupling coordination degree of the two systems increased from 0.393 to 0.465, with a growth rate of 18.3%. The coupling coordination degree between regions gradually decreased in the eastern-central and eastern-western regions, and there were still large differences between the central and western regions. The coupling coordination degree of the two systems in the region was significantly different in the eastern and western regions, and the central region was relatively similar. There is a positive spatial correlation between the provinces, and 25.81% of the provinces have transitions. Finally, the number of points in the first and third quadrants is higher than that in the second and fourth quadrants. In the process of dynamic distribution, the degree of polarization of the coupling coordination degree curve of the two systems is gradually weakened. Per capita GDP, residents ' income difference and population size are the positive and significant factors driving the coupling and coordinated development of the two systems. CONCLUSION The coupling and coordination degree of the two systems of medical education and health resource allocation showed a stable upward trend during the observation period, and the global spatial positive correlation also gradually increased, showing the spatial agglomeration characteristics of ' high-high agglomeration ' and ' low-low agglomeration '. The spatial difference of coupling coordination degree shows a shrinking trend and develops towards equalization. The coupling coordination degree of the two systems is affected by social, economic and demographic factors to varying degrees. Therefore, it is necessary to innovate the coordinated development mechanism of the two systems, promote the two-way flow of medical education and health resource allocation in talents, technology and other elements, and then promote the coupling and coordinated development of the two systems.
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Affiliation(s)
- Chen Jieting
- The School of Medicine, Shihezi University, Shihezi, 832003, China
- The School of Medicine, The Academy of Education, Xinjiang Normal University, Urumqi, 830054, China
| | - Zhu Yan
- The School of Medicine, Shihezi University, Shihezi, 832003, China
| | - Song Zhilong
- Shihezi Zhongjiang Huayuan Agricultural Science and Technology Company, Shihezi, 832000, China
| | - Li Siyuan
- The School of Medicine, Shihezi University, Shihezi, 832003, China
| | - Wu Xiangwei
- The School of Medicine, Shihezi University, Shihezi, 832003, China.
- First Affiliated Hospital of Shihezi University/ Central Asia High Incidence Prevention and Control Key Laboratory of National Health Commission, Shihezi, 832008, China.
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Fu M, Gong Z, Zhu Y, Li C, Li H, Shi L, Guan X. Disparity in Guideline-Based Antidiabetic Drugs Prescribing for Type 2 Diabetes Patients in Primary Healthcare Facilities Across China, 2017-2019. Pharmacoepidemiol Drug Saf 2024; 33:e5882. [PMID: 39092465 DOI: 10.1002/pds.5882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/10/2024] [Accepted: 07/13/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The purpose of this study is to evaluate the pattern, appropriateness, and cost of antidiabetic drugs prescribed for patients with Type 2 diabetes at primary healthcare facilities (PHFs) in China. METHODS We collected outpatient-visit prescriptions from 363 PHFs in 31 cities covering eastern, central, and western regions of China. The visits of adult patients with Type 2 diabetes diagnosis were collected and classified the antidiabetic medication pattern of each patient use as recommended or non-recommended according to Chinese guidelines. We then calculated the proportion of guideline-recommended patterns and the average monthly cost for each pattern, overall and by region. RESULTS Of 33 519 prescriptions for Type 2 diabetes, most (73.9%) were for guideline-recommended antidiabetic treatments. The proportion of guideline-recommended prescriptions varied by region (eastern [75.9%], central [87.5%], and western [59.7%]). Metformin monotherapy was the most common guideline-recommended treatment in all three regions (eastern [20.1%], central [28.0%], and western [24.6%]). The most common non-guideline-recommended treatments were monotherapy of insulin (eastern [16.5%], central [5.1%], and western [25.7%]) and traditional Chinese antidiabetic medicines (eastern [5.6%], central [5.7%], and western [11.1%]). The average monthly costs were lower for guideline-recommended treatments compared to non-recommended treatments in all regions (eastern [13.6 ± 15.4 USD vs. 28.1 ± 22.0 USD], central [9.8 ± 10.9 USD vs. 28.7 ± 19.4 USD], and western [17.9 ± 21.4 USD vs. 30.3 ± 23.6 USD]). CONCLUSIONS The majority of patients with Type 2 diabetes received guideline-recommended antidiabetic medications at PHFs in China, with only half of the prescriptions containing guideline-recommended metformin. Utilization of guideline-recommended therapies differed across regions. Tailored interventions to promote evidence-based antidiabetic prescribing are urgently needed, especially in the undeveloped western region.
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Affiliation(s)
- Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Zhiwen Gong
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yuezhen Zhu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Can Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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Wang XY, Zhang BB, Cao YY, Xue Q, Ye Q, Li YS, Wang SY, Ma YW, Sun YQ, Zhang JH. Trends in maternal and child health in China and its urban and rural areas from 1991 to 2020: a joinpoint regression model. Sci Rep 2024; 14:13480. [PMID: 38866837 PMCID: PMC11169526 DOI: 10.1038/s41598-024-63689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 05/31/2024] [Indexed: 06/14/2024] Open
Abstract
The long-term trends in maternal and child health (MCH) in China and the national-level factors that may be associated with these changes have been poorly explored. This study aimed to assess trends in MCH indicators nationally and separately in urban and rural areas and the impact of public policies over a 30‒year period. An ecological study was conducted using data on neonatal mortality rate (NMR), infant mortality rate (IMR), under-five mortality rate (U5MR), and maternal mortality ratio (MMR) nationally and separately in urban and rural areas in China from 1991 to 2020. Joinpoint regression models were used to estimate the annual percentage changes (APC), average annual percentage changes (AAPC) with 95% confidence intervals (CIs), and mortality differences between urban and rural areas. From 1991 to 2020, maternal and child mortalities in China gradually declined (national AAPC [95% CI]: NMRs - 7.7% [- 8.6%, - 6.8%], IMRs - 7.5% [- 8.4%, - 6.6%], U5MRs - 7.5% [- 8.5%, - 6.5%], MMRs - 5.0% [- 5.7%, - 4.4%]). However, the rate of decline nationally in child mortality slowed after 2005, and in maternal mortality after 2013. For all indicators, the decline in mortality was greater in rural areas than in urban areas. The AAPCs in rate differences between rural and urban areas were - 8.5% for NMRs, - 8.6% for IMRs, - 7.7% for U5MRs, and - 9.6% for MMRs. The AAPCs in rate ratios (rural vs. urban) were - 1.2 for NMRs, - 2.1 for IMRs, - 1.7 for U5MRs, and - 1.9 for MMRs. After 2010, urban‒rural disparity in MMR did not diminish and in NMR, IMR, and U5MR, it gradually narrowed but persisted. MCH indicators have declined at the national level as well as separately in urban and rural areas but may have reached a plateau. Urban‒rural disparities in MCH indicators have narrowed but still exist. Regular analyses of temporal trends in MCH are necessary to assess the effectiveness of measures for timely adjustments.
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Affiliation(s)
- Xin-Yue Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People's Republic of China
| | - Bei-Bei Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People's Republic of China
| | - Yuan-Yi Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People's Republic of China
| | - Qian Xue
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People's Republic of China
| | - Qin Ye
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People's Republic of China
| | - Yuan-Sheng Li
- School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China
| | - Shu-Yuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People's Republic of China
| | - Yuan-Wei Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People's Republic of China
| | - Yan-Que Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People's Republic of China
| | - Jun-Hui Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People's Republic of China.
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Wei D, Wong LP, He X, Loganathan T. Healthcare utilisation and economic burden of migraines among bank employees in China: a probabilistic modelling study. J Headache Pain 2024; 25:60. [PMID: 38641794 PMCID: PMC11027248 DOI: 10.1186/s10194-024-01763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Despite the recognised high prevalence of migraines among bank employees, yet their healthcare utilisation patterns and the economic burden of migraines remain underexplored. AIM To examine migraine-related healthcare utilisation among bank employees in China, and to estimate the economic burden of migraines. METHODS A cross-sectional survey was conducted in Guizhou province, China between May and October 2022. The HARDSHIP questionnaire was used to identify migraine-positive individuals and enquire about their healthcare utilisation and productivity losses. A probabilistic decision-analytic model with a micro-costing approach was used to estimate the economic burden from the perspectives of the healthcare system, employers, and society. All costs were expressed in 2022 United States dollars. One-way and probabilistic sensitivity analyses were performed. RESULTS Nearly half of individuals with migraines reported not seeking medical care. Only 21.8% reported seeking outpatient consultations, 52.5% reported taking medicines, and 27.1% reported using complementary therapies. Chronic migraine patients had significantly higher healthcare utilisation than episodic migraine patients. Among individuals with a monthly migraine frequency of 15 days or more, 63.6% took inappropriate treatments by excessively using acute medications. Migraines in the banking sector in Guizhou cost the healthcare system a median of $7,578.0 thousand (25th to 75th percentile $4,509.2-$16,434.9 thousand) per year, employers $89,750.3 thousand (25th to 75th percentile $53,211.6-$151,162.2 thousand), and society $108,850.3 thousand (25th to 75th percentile $67,370.1-$181,048.6 thousand). The median societal cost per patient-year is $3,078.1. Migraine prevalence and productivity losses were identified as key cost drivers. CONCLUSIONS The study points to the need to raise awareness of migraines across all stakeholders and to improve the organisation of the migraine care system. A substantial economic burden of migraines on the healthcare system, employers, and society at large was highlighted. These cost estimates offer evidence-based benchmarks for assessing economic savings from improved migraine management, and can also draw the attention of Chinese policymakers to prioritise migraine policies within the banking and other office-based occupations.
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Affiliation(s)
- Du Wei
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
| | - Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Xun He
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China.
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China.
| | - Tharani Loganathan
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Su Q, Hu D, Lin X, Zhao T. Preparing future general practitioners: the effects of individual, familial, and institutional characteristics. BMC MEDICAL EDUCATION 2023; 23:850. [PMID: 37946150 PMCID: PMC10636867 DOI: 10.1186/s12909-023-04857-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND There is a substantially increasing need for general practitioners (GPs) for future unpredictable pandemic crises, especially at the community-based health services (CBHS) level to protect the vast and varied grassroot-level population in China. Thus, it is crucial to understand the factors that affect Chinese medical students' GP career choices and commitments to CBHS. METHODS Leveraging the self-administered data collected across the country, this study conducted logistic regressions with 3,438 medical students. First, descriptive statistics of outcome variables and independent variables were provided. Then, stepwise logistic regression models were built, starting from adding individual characteristics, and then familial and institutional characteristics. Last, post-estimation was conducted to further assess whether there were significant marginal effects. RESULTS Results showed that women students were 24% less likely to choose GP careers but were 1.25 times more likely to commit to CBHS than their men peers, holding other individual, familial, and institutional characteristics constant. In addition, students who major in GP-orientated were more likely to choose GP careers and commit to CBHS, respectively, than those who major in clinical medicine. Furthermore, familial characteristics like annual income and mother's educational level only significantly predicted commitments to CBHS. Notably, sex-related differences in GP career choices and commitments to CBHS - by different regions - were observed. CONCLUSIONS Understanding the factors that affect medical students' GP career choices sheds light on how medical education stakeholders can make informed decisions on attracting more medical students to GP-orientated majors, which in turn cultivates more GP professionals to meet the nation's demand for GPs. In addition, by understanding the factors that influence medical students' commitment to CBHS, policymakers could make beneficial policies to increase medical students' motivations to the grassroot-level health institutions, and devote to CBHS as gatekeepers for a large population of residents' health.
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Affiliation(s)
- Qiang Su
- Zhejiang Academy of Higher Education, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Dan Hu
- China Center for Health Development Studies, Peking University, Beijing, 100083, China
| | - Xiaoru Lin
- School of Marxism, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Teng Zhao
- Zhejiang Academy of Higher Education, Hangzhou Dianzi University, Hangzhou, 310018, China.
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Wu L, Qian L, Li Y, Huang Z, Guan W. Spatial coupling relationship between older adults and elderly care resources in the Yangtze River Delta. PLoS One 2023; 18:e0293985. [PMID: 37934772 PMCID: PMC10629642 DOI: 10.1371/journal.pone.0293985] [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: 07/25/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023] Open
Abstract
The imbalance between supply and demand of elderly care resources in the Yangtze River Delta is increasing. By the older adult agglomeration, spatial cluster analysis, hotspot analysis, and coupling coordination model, this study explores the spatial coupling relationship between older adults and elderly care resources in the Yangtze River Delta in 2020 from the perspective of a supply-and-demand balance. The results demonstrate that: (1) population aging is mainly in the moderate aging stage, followed by the primary aging stage; (2) there are significant spatial differences in elderly care resources on the urban scale in the Yangtze River Delta; and (3) elderly care resources and the older adults in the Yangtze River Delta are mostly highly coupled. However, Nantong, with the highest degree of aging, has a serious mismatch in life service resources and ecological environment resources. The social security resources and medical resources of provincial capital cities with low aging are mismatched. Medical and health resources in underdeveloped areas are seriously mismatched. The social security resources are barely matched in Shanghai. A path for optimizing the spatial allocation of elderly care resources is proposed. This research offers a decision-making reference for coordinating elderly care resources distribution.
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Affiliation(s)
- Lianxia Wu
- Population Research Institute, School of Social Development, East China Normal University, Shanghai, China
- Aging Research Base of China National Committee on Aging (East China Normal University), Shanghai, China
| | - Linyi Qian
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science-MOE, School of Statistics, East China Normal University, Shanghai, China
| | - Yinhuan Li
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science-MOE, School of Statistics, East China Normal University, Shanghai, China
| | - Zuyu Huang
- School of Public Administration, Hunan University, Changsha, Hunan, China
| | - Weihua Guan
- School of Geography, Nanjing Normal University, Nanjing, China
- Collaborative Innovation Center for Development and Utilization of Geographic Information Resources in Jiangsu Province, Nanjing, China
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Yi Z, Xu T, Yang J, Yu S, Zhou M, Li H, Guo J, Qian J, Dong W. Comprehensive assessment of resources for prevention and control of chronic and non-communicable diseases in China: a cross-sectional study. BMJ Open 2023; 13:e071407. [PMID: 37474175 PMCID: PMC10360424 DOI: 10.1136/bmjopen-2022-071407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study aims to comprehensively evaluate the resources for prevention and control of chronic and non-communicable diseases (NCDs) in China to provide a reference basis for optimising the resource allocation for prevention and control of NCDs. METHODS China Chronic Disease and Risk Factor Surveillance sites and National Demonstration Areas for Integrated Chronic and Non-communicable Disease Prevention and Control (NCDDA) were selected as investigation objects. In December 2021, the district (or county) resource allocation for NCD prevention and control was investigated through the NCDDA management information system. According to the index system of NCD prevention and control, 31 indicators of 6 dimensions were collected, and the weighted technique for order preference by similarity to an ideal solution, weighted rank-sum ratio and fuzzy comprehensive evaluation methods were used for comprehensive evaluation of resources for prevention and control of NCDs. RESULTS The 653 districts (or counties) in this study cover 22.96% of China's districts (or counties). The top three weights were full-time staff for NCD prevention and control (0.1066), the amount of funds for NCD prevention and control (0.0967), and the coverage rate of districts (or counties) establishing chronic obstructive pulmonary disease surveillance information system (0.0886). The comprehensive evaluation results for the resources for prevention and control of NCDs by the three methods were basically the same. The results of fuzzy comprehensive evaluation showed that the resource allocation in urban areas (0.9268) was better than that in rural areas (0.3257), the one in eastern region (0.9016) was better than that in central (0.3844) and western regions (0.3868), and the one in NCDDA (0.9625) was better than that in non-NCDDA (0.2901). CONCLUSION The resources in China for NCD prevention and control differ among different regions, which should be taken into account in future policymaking and resource allocation.
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Affiliation(s)
- Zhun Yi
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tingling Xu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Yang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shicheng Yu
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Han Li
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiahuan Guo
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Qian
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Health Management, China Medical University, Shenyang, China
| | - Wenlan Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Lobanov-Rostovsky S, He Q, Chen Y, Liu Y, Wu Y, Liu Y, Venkatraman T, French E, Curry N, Hemmings N, Bandosz P, Chan WK, Liao J, Brunner EJ. Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people. BMC Public Health 2023; 23:1272. [PMID: 37391766 PMCID: PMC10311713 DOI: 10.1186/s12889-023-15583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/01/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND From 2020 to 2050, China's population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer's disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country. METHODS Using official and population-level statistics, we summarise China's demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China's improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: 'what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?'. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China's second long-term care insurance pilot phase in 2020. RESULTS Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home. CONCLUSIONS China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.
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Affiliation(s)
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yuntao Chen
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Yuyang Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Yanjuan Wu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yixuan Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Tishya Venkatraman
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Eric French
- Faculty of Economics, University of Cambridge, CB3 9DD Cambridge, UK
- Institute for Fiscal Studies, University of Cambridge, London, WC1E 7AE UK
| | - Natasha Curry
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Nina Hemmings
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Piotr Bandosz
- Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, 80-210 Poland
| | - Wing Kit Chan
- School of Government, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Eric John Brunner
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
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11
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Feng QQ, Ao YB, Chen SZ, Martek I. Evaluation of the allocation efficiency of medical and health resources in China's rural three-tier healthcare system. Public Health 2023; 218:39-44. [PMID: 36965462 DOI: 10.1016/j.puhe.2023.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES Evaluating the efficiency of health resource allocations is critical to improving China's rural three-level health service network. STUDY DESIGN This was a prospective panel data study. METHODS Based on panel data of the medical and health resources of 31 provinces within rural China, collected from 2003 to 2020, this study uses a three-stage Data Envelopment Analysis-Malmquist index to analyze the evolution of efficiency and productivity. RESULTS The efficiency and productivity of county and county-level medical and health institutions rank highest, followed by township hospitals, whereas village clinics are shown to be in great need of improvement. A decline in technical advancement appears as a crucial factor exacerbating loss of factor productivity. CONCLUSIONS Policy makers should further optimize the efficiency of medical resource allocation and promote the coordinated development of rural health in China.
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Affiliation(s)
- Q Q Feng
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Y B Ao
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China.
| | - S Z Chen
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - I Martek
- School of Architecture and Built Environment, Deakin University, Geelong 3220, Australia
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12
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Wu F, Gu M, Zhu C, Qu Y. Temporal-Spatial Evolution and Trend Prediction of the Supply Efficiency of Primary Medical Health Service-An Empirical Study Based on Central and Western Regions of China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1664. [PMID: 36767031 PMCID: PMC9914151 DOI: 10.3390/ijerph20031664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
China has established a comprehensive primary medical health service system, but the development of primary medical health services in the central and western regions is still unbalanced and insufficient. Based on data from 2010 to 2019, this paper constructs a super efficiency Slack-Based Measure model to calculate the supply efficiency of primary medical health services in 20 provinces and cities in central and western China. Using Kernel density estimation and Markov chain analysis, this paper further analyzes the spatial-temporal evolution of the supply efficiency of primary medical health services in central and western China, and also predicts the future development distribution through the limiting distribution of Markov chain to provide a theoretical basis for promoting the sinking of high-quality medical resources to the primary level. The results show that firstly, during the observation period, the center of the Kernel density curve moves to the left, and the main peak value decreases continuously. The main diagonal elements of the traditional Markov transition probability matrix are 0.7872, 0.5172, 0.8353, and 0.7368 respectively, which are significantly larger than other elements. Secondly, when adjacent to low state and high state, it will develop into convergence distributions of 0.7251 and 0.8243. The supply efficiency of primary medical health services in central and western China has the characteristics of high (Ningxia) and low (Shaanxi) aggregation respectively, but the aggregation trend is weakened. Thirdly, the supply efficiency of health services has the stability of keeping its own state unchanged, but the transition of state can still occur. The long-term development of the current trend cannot break the distribution characteristics of the high and low clusters, the efficiency will show a downward trend in the next 10-20 years, and still the problem of uneven long-term development emerges.
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Affiliation(s)
- Fang Wu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, China
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13
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Zhao N, Chen K. Equity and efficiency of medical and health service system in China. BMC Health Serv Res 2023; 23:33. [PMID: 36641525 PMCID: PMC9840836 DOI: 10.1186/s12913-023-09025-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Equity and efficiency are basic value dimensions to evaluate the effectiveness of China's medical and health service system (MHS) reform and development. Coordinated development of equity and efficiency is necessary to realize high-quality development of medical and health services. This study aims to evaluate the equity, efficiency, and combined efforts in coordinating the MHS during 1991-2020 reform. METHODS Data on China's MHS were obtained from the China Statistical Yearbook 1992-2021. Ratios of urban to rural residents' medical expenditure and number of medical professionals per 10,000 people were employed to evaluate MHS's equity. The data envelopment analysis-Malmquist model was employed to evaluate MHS's efficiency. We constructed a combined-efforts-in-coordination model to examine the coordination degree between equity and efficiency. RESULTS Equity of medical expenditure burden significantly improved from during 1991-2007. Urban residents' 1991 medical expenditure burden was 87.8% of that of rural residents, which increased to 100.1% in 2007. Urban areas' mean medical expenditure burden was 105.94% of that in rural areas during 1991-2007. The gap in equity of medical expenditure burden between urban and rural areas slowly widened after 2007, with urban areas' mean burden being 68.52% of that in rural areas during 2007-2020. Medical and health resources allocation shows an alarming inequity during this period, with mean number of medical professionals per 10,000 people in urban areas being 238.30% of that in rural areas. Efficiency experienced several fluctuations before 2008. Since 2008, efficiency was high (0.915) and remained stable, except in 2020. The combined-efforts-in-coordination score for medical expenditure burden was less than 0.2 for 80% of the years, while that for in medical and health resources was more than 0.5 for 99.67% of the years. CONCLUSIONS MHS inequity remains between urban and rural China, primarily because of disproportionate allocation of medical and health resources. The government should enhance rural medical professionals' salary and welfare and provide medical subsidies for rural residents to adjust resource allocation levels in urban and rural areas, control differences in medical expenditure burden between urban and rural residents to a reasonable range, and continuously improve urban and rural residents' equity level.
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Affiliation(s)
- Na Zhao
- Party School of Liaoning Provincial Committee of C.P.C, Shenyang, Liaoning, 110004 China
| | - Kai Chen
- grid.412252.20000 0004 0368 6968School of Business Administration, Northeastern University, Shenyang, Liaoning, 110819 China
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14
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You Y, Xie A, Cleland J. Medical students' rural practice intention: Academic performance matters. MEDICAL EDUCATION 2022; 56:1203-1213. [PMID: 35953464 DOI: 10.1111/medu.14918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Many countries are driving forward policies and practices to train medical students for later rural practice. Previous research has investigated individual (e.g., rural upbringing) and structural factors (e.g., curricular exposure) associated with rural practice intention. However, the relationship between academic performance in medical school and rural practice intention has been neglected, although optimisation theory suggests there may be a relationship. To address this gap, our aim was to identify the relationship between academic performance and rural practice intention. METHODS Data were collected via a cross-sectional (self-report) survey in 2021. Participants were students from 60 of the 96 rural order directed (RODs) medical programmes across China. We asked students their rural practice intention. We conducted univariate analyses to test for associations between rural practice intention and independent variables, including socio-demographics, ROD location, grade year and academic performance measures. We used multilevel logistic regression models to test whether students' academic performance in medical school could be used to predict rural practice intention, holding the other factors constant. RESULTS There were 13 123 respondents, representing roughly 77.6% of the student population from the 60 schools. There was a statistically significant relationship between student (self)-reported academic performance in medical school and rural practice intention. Higher performers had a lower likelihood (ORs: 0.65-0.78) of rural practice intention. This held across all performance measures (GPA rank, academic awards and student leadership) and for the sub-group with rural upbringing (ORs: 0.68-0.78). DISCUSSION This is the first study to identify a relationship between medical school performance and rural practice intention. The findings suggest that students maximise their utility when choosing career options, with higher performers having lower rural practice intention. These data provide insight into the complexity of medical career decision making and can be used by medical school and workforce planners to inform rural training, recruitment and retention strategies.
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Affiliation(s)
- You You
- Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Beijing, China
- Institute of Economics of Education, Peking University, Beijing, China
| | - Ana Xie
- Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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15
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Zheng D, Gong J. Impacts of comprehensive reform on the efficiency of Guangdong's County public hospitals in 2014–2019, China. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Li L, Zhu L, Zhou X, Zeng G, Huang H, Gan Y, Lu Z, Wang X, Chen Z, Sun K, Yang D, Zhang Q, Wu C. Patients’ trust and associated factors among primary care institutions in China: a cross-sectional study. BMC PRIMARY CARE 2022; 23:109. [PMID: 35524197 PMCID: PMC9075926 DOI: 10.1186/s12875-022-01709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Empirical evidence on patients’ trust and the factors among primary care institutions (PCIs) in China is limited. This study aimed to investigate patients’ trust and explore some associated factors among PCIs in the central region of China.
Methods
The data was collected through a multistage stratified sampling method with a structured self-administered questionnaire, which was distributed from January to March 2021 among 2,287 Chinese patients ever involved in seeking healthcare among PCIs. Patients’ trust was measured with the Chinese version of the Wake Forest Physician Trust Scale (C-WFPTS). Differences in C-WFPTS scores among groups were estimated by t-tests or ANOVA analyses. Multiple linear regression analysis was used to analyze influencing factors for patients’ trust in primary care physicians.
Results
Based on the C-WFPTS with a full score of 50, the average score of patients’ trust was 34.19 (SD = 5.83). Multiple linear analyses indicated that the patients who were older aged, married, with education of higher level, living in urban regions, under better health status and with a family doctor contract reported a higher level of patients’ trust.
Conclusion
Patients’ trust in primary care physicians was at a medium but slightly improved level in the central region of China. Age, marital status, education, residential area, health status, and a family doctor contract were significant predictors of patients’ trust.
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Ma Z, Yin J, Yang L, Li Y, Zhang L, Lv H. Using Shannon Entropy to Improve the Identification of MP-SBM Models with Undesirable Output. ENTROPY (BASEL, SWITZERLAND) 2022; 24:1608. [PMID: 36359698 PMCID: PMC9689818 DOI: 10.3390/e24111608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
In the context of the COVID-19 global epidemic, it is particularly important to use limited medical resources to improve the systemic control of infectious diseases. There is a situation where a shortage of medical resources and an uneven distribution of resources in China exist. Therefore, it is important to have an accurate understanding of the current status of the healthcare system in China and to improve the efficiency of their infectious disease control methods. In this study, the MP-SBM-Shannon entropy model (modified panel slacks-based measure Shannon entropy model) was proposed and applied to measure the disposal efficiency of the medical institutions responding to public health emergencies (disposal efficiency) in China from 2012 to 2018. First, a P-SBM (panel slacks-based measure) model, with undesirable outputs based on panel data, is given in this paper. This model measures the efficiency of all DMUs based on the same technical frontier and can be used for the dynamic efficiency analysis of panel data. Then, the MP-SBM model is applied to solve the specific efficiency paradox of the P-SBM model caused by the objective data structure. Finally, based on the MP-SBM model, undesirable outputs are considered in the original efficiency matrix alignment combination for the deficiencies of the existing Shannon entropy-DEA model. The comparative analysis shows that the MP-SBM-Shannon model not only solves the problem of the efficiency paradox of the P-SBM model but also improves the MP-SBM model identification ability and provides a complete ranking with certain advantages. The results of the study show that the disposal efficiency of the medical institutions responding to public health emergencies in China shows an upward trend, but the average combined efficiency is less than 0.47. Therefore, there is still much room for improvement in the efficiency of infectious disease prevention and control in China. It is found that the staffing problem within the Center for Disease Control and the health supervision office are two stumbling blocks.
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Affiliation(s)
- Zhanxin Ma
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Jie Yin
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Lin Yang
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Yiming Li
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Lei Zhang
- School of Economics and Management, Inner Mongolia University, Hohhot 010021, China
| | - Haodong Lv
- School of Environment, Tsinghua University, Beijing 100084, China
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18
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Research on the equity of health resource allocation in TCM hospitals in China based on the Gini coefficient and agglomeration degree: 2009-2018. Int J Equity Health 2022; 21:145. [PMID: 36199086 PMCID: PMC9534739 DOI: 10.1186/s12939-022-01749-7] [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: 03/27/2022] [Accepted: 09/09/2022] [Indexed: 11/11/2022] Open
Abstract
Background The demographical and geographical distributions of health resources are important aspects of healthcare access. Few studies have been published on health resource allocation in TCM hospitals in China despite public equity concerns. Methods This article uses the Gini coefficient and agglomeration degree to analyze the health resources of TCM hospitals in China according to demographic and geographic configuration conditions in order to study the equity of the health resources of TCM from 2009 to 2018. Results From 2009 to 2018, all regions of the TCM health resources per ten thousand people and per ten thousand square kilometers showed overall upward trends. The overall equity of the health resource allocations of TCM hospitals in China tended to improve year by year. However, there were still great differences among regions. Generally, the equity of physical resource allocation was better than the equity of human resource allocation. Additionally, the equity of health resources in TCM hospitals allocated by population was better than it was by geographic region. Conclusions It is necessary to further optimize the structure of TCM resource allocation, and enhance the equity of resource allocation among different regions.
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Li J, Wu Y, Lu Y. Analysis of medical resources for allocation equity using traditional Chinese medicine resource as a model. Int J Health Plann Manage 2022; 37:3205-3217. [PMID: 35983688 DOI: 10.1002/hpm.3549] [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: 09/02/2020] [Revised: 04/07/2022] [Accepted: 07/11/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES This study is designed to analyse current allocation equity of medical resources in China for a better distribution of medical resources. METHODS Descriptive statistical methods were used to analyse the overall allocation of Traditional Chinese medicine (TCM) resources between 2012 and 2018. Lorentz curve and Gini coefficient were used to quantitatively analyse the fairness of the allocation from the population and geography two dimensions. RESULTS This study revealed an increase of TCM resources for the 6-year period, but the fair allocation of these resources was subjected to the methods used. The Gini coefficients were <0.3 based on population distribution but >0.5 basing on the geography allocation. CONCLUSION Population based analysis for the equity of the TCM resource allocation is superior, more attention for health resource planning is needed to focus on geographical fairness in the future, especially for the less populated rural regions.
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Affiliation(s)
- Junshan Li
- School of Economics and Management of Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Yilin Wu
- School of Economics and Management of Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China.,Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Yuanan Lu
- Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, Hawaii, USA
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20
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Evaluating the Inequality of Medical Resource Allocation Based on Spatial and Non-Spatial Accessibility: A Case Study of Wenzhou, China. SUSTAINABILITY 2022. [DOI: 10.3390/su14148331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Environmental and social factors influencing resource allocation in rural, developing regions are critical social determinants of health that necessitate cross-sector collaboration to improve health opportunities. Thus, we sought to evaluate the spatial distribution and accessibility of medical resources to assess existing disparities, identify best practices for resource allocation, and inform regional health planning policies. In this study, inequality in the frequency distribution of medical resources in Wenzhou, China, was measured using the Gini coefficient and agglomeration degree. We evaluated the spatial accessibility of medical institutions throughout the city using the modified hierarchical two-step floating catchment area (H2SFCA) method. Using the Spearman correlation analysis, we investigated the factors influencing accessibility differences. The results indicate that Wenzhou’s spatial distribution of medical resources is unbalanced and unequal. According to the population and geographic distribution, the distribution of medical resources in Wenzhou is unequal. Wenzhou’s overall spatial accessibility is poor. The east region is more accessible than the west region, and the accessibility of medical institutions at different levels varies greatly. The correlation between accessibility and the number of institutions, doctors, population density, road density, and GDP is positive. There is a need for policies and initiatives to enhance the geographical distribution of resources, construct interconnected road networks, and improve residents’ access to medical resources.
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The Balanced Allocation of Medical and Health Resources in Urban Areas of China from the Perspective of Sustainable Development: A Case Study of Nanjing. SUSTAINABILITY 2022. [DOI: 10.3390/su14116707] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The balanced allocation of medical and health resources is an important basis for the sustainable development of health undertakings. In recent years, China has made remarkable achievements in the medical and health services, but there is still a phenomenon of unbalanced allocation of medical and health resources among different regions, which has become an urgent problem to be solved in deepening the reform of the medical and health system during the 14th Five-Year Plan period. From the perspective of people’s needs for health, this study analyzed the equity and efficiency of urban medical and health resources allocation in China by using the Theil index method and DEA method. Meanwhile, the authors used the coupling coordination degree model to construct a balanced development model with equity and efficiency as subsystems, taking the city of Nanjing as an example to analyze its balanced allocation of medical and health resources from 2008 to 2019. In general, taking Nanjing as an example, it shows that the balanced allocation of medical and health resources in Chinese cities is good, but in geographical dimension, the level of balanced allocation is low, and there are still significant differences in the equity and efficiency of allocation among regions. In the future, the government can strengthen the rationality of regional planning, appropriately increasing health investment and medical supply, considering both equity and efficiency to further realize the balanced allocation of medical and health resources and improve the sustainability of urban medical service system. The main contribution of this paper lies in that, from the perspective of sustainable development, the evaluation system is integrated to measure the equity and efficiency respectively, and the balanced development model is used to investigate the allocation of urban medical and health resources. The research results can provide reference for optimizing resources allocation and promoting the sustainable development of medical and health undertakings.
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22
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Bai Q, Man X, Hong B, Li B, Shi X, Bian Y. Do China rural traditional Chinese medicine hospitals provide efficient healthcare to the people? Empirical study from 2013 to 2018 using data envelopment analysis. PLoS One 2022; 17:e0267490. [PMID: 35452498 PMCID: PMC9032415 DOI: 10.1371/journal.pone.0267490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/31/2022] [Indexed: 11/26/2022] Open
Abstract
Rural traditional Chinese medicine hospitals bear responsibilities of providing efficient medical services for rural residents. Efficiency assessments have previously been conducted in single province. This study aimed to investigate the technical efficiency of rural traditional Chinese medicine hospitals across China from 2013 to 2018, with the application of super slack-based measure data envelopment analysis. In total, 1219 hospitals covering 28 provinces were included as sample hospitals. Overall, hospitals performed technically less efficiently but presented with an increasing trend. Redundancy and insufficiency existed in health input and output variables, respectively. Notably, optimizing input variables was found to make more substantial improvement in hospital efficiency. Provincial and regional disparities were also observed in hospital efficiency. In conclusion, rural traditional Chinese medicine hospitals have experienced slight improvement in efficiency during the study period, however, their efficiency was still in a relatively low level with ample room for improvement. Meanwhile, regional coordinated development should also be noticed in this process.
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Affiliation(s)
- Qian Bai
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Xiaowei Man
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Baolin Hong
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Bo Li
- Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
- * E-mail: (YB); (XS)
| | - Ying Bian
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
- * E-mail: (YB); (XS)
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Yu X, He C, Wang Y, Kang L, Miao L, Chen J, Zhao Q, Huang X, Zhu J, Liang J, Li Q, Wang M, Liu H. Preterm neonatal mortality in China during 2009-2018: A retrospective study. PLoS One 2021; 16:e0260611. [PMID: 34879099 PMCID: PMC8654200 DOI: 10.1371/journal.pone.0260611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/14/2021] [Indexed: 01/09/2023] Open
Abstract
In this retrospective analysis, we aimed to analyze the epidemic characteristics of neonatal mortality due to preterm birth at 28-36 weeks gestation in different regions from 2009 to 2018. Data were obtained from China's Under-5 Child Mortality Surveillance System (U5CMSS). The χ2 trend test, Poisson regression and the Cochran-Mantel-Haenszel method were used in this study. We found that 51.3%, 42.0% and 44.5% of neonate deaths were preterm infants, and immaturity was mainly attributed to 60.1%, 64.1% and 69.5% of these deaths, in the eastern, central and western regions, respectively. The preterm neonatal mortality rate due to immaturity dropped from 149.2, 216.5 and 339.5 in 2009 to 47.4, 83.8 and 170.1 per 100 000 live births in 2018, giving an average annual decline rate of 12.1%, 11.6% and 6.3% in the eastern, central and western regions, respectively, during the studying period. The relative risk of preterm neonatal mortality due to immaturity were 1.3 and 2.3 for the central regions and western regions in 2009-2010, ascending to 2.2 and 3.9 in 2017-2018. The proportion of preterm neonatal deaths with a gestational age <32 weeks was highest among the eastern region. There were significantly more preterm neonatal infants who were not delivered at medical institutions in the western region than in the eastern and central regions. The preterm infant, especially with gestational age <32 weeks, should receive the most attention through enhanced policies and programs to improve child survival. Priority interventions should be region-specific, depending on the availability of economic and healthcare resources.
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Affiliation(s)
- Xue Yu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunhua He
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Leni Kang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Miao
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian Chen
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qihui Zhao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaona Huang
- Department of Pediatrics, Meishan Maternal and Child Care Hospital, Chengdu, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Pediatrics, Pidu Maternal and Child Care Hospital, Chengdu, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meixian Wang
- Department of Pediatrics, Pidu Maternal and Child Care Hospital, Chengdu, China
| | - Hanmin Liu
- Department of Pediatrics, Pidu Maternal and Child Care Hospital, Chengdu, China
- Health, Nutrition and Water, Sanitation & Hygiene, UNICEF China, Beijing, China
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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.
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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
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25
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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.
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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.
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26
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Li Z, Zhang W, Kong A, Ding Z, Wei H, Guo Y. Configuration Analysis of Influencing Factors of Technical Efficiency Based on DEA and fsQCA: Evidence from China's Medical and Health Institutions. Risk Manag Healthc Policy 2021; 14:49-65. [PMID: 33447109 PMCID: PMC7802899 DOI: 10.2147/rmhp.s282178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/03/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose This paper aims to measure the technical efficiency of China’s medical and health institutions from 2012 to 2017 and outline the path to achieve high-quality development. Methods The DEA-Malmquist was used to evaluate the total factor productivity of medical and health institutions in 31 provinces. A fuzzy set Qualitative Comparative Analysis (fsQCA) was used for configuration analysis of determinants affecting technical efficiency. Results The average total factor productivity (TFP) of those institutions was 0.965, namely TFP declined averagely by 3.5% annually. The efficiency change and the technical change were 0.998 and 0.967, respectively. The realization paths of high technical efficiency are composed of high fatality rate and high financial allocation-led, high population density and high GDP-led. Low dependency ratio and low financial allocation-led, low fatality rate and low financial allocation-led are the main reasons for low technical efficiency. Conclusion Due to advanced medical technology and economic development, major cities like Beijing, Shanghai, and Guangdong have attracted a large number of high-level health personnel, achieving long-term and stable health business growth. Hubei, Anhui, and Sichuan also have made rapid development of health care through appropriate financial subsidies and policy supports. The technical changes in Qinghai, Yunnan, and Inner Mongolia are higher than the national average, but the operation and management level of the medical and health institutions is relatively weak. Henan, Jiangxi, and Heilongjiang have a prominent performance in the efficiency change, but the technical change is weaker than the national average.
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Affiliation(s)
- Zhiguang Li
- School of Economics and Management, Anhui University of Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Wanying Zhang
- School of Economics and Management, Anhui University of Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Aijie Kong
- School of Economics and Management, Anhui University of Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Zhiyuan Ding
- School of Economics and Management, Anhui University of Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Hua Wei
- School of Economics and Management, Anhui University of Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Yige Guo
- King's Business School, King's College London, London, UK
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27
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Li C, Tang C, Wang H. Investigating the association of health system characteristics and health care utilization: a multilevel model in China's ageing population. J Glob Health 2020; 10:020802. [PMID: 33312509 PMCID: PMC7719298 DOI: 10.7189/jogh.10.020802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background To achieve universal health coverage in China, it is necessary to identify access barriers to health care. This study examined the association between health system characteristics and health care utilization in China and identified factors associated with accessing health care among the mid-aged and elderly. Methods Data were obtained from the 2015 China Health and Retirement Longitudinal Study, and 17 370 respondents aged 45 and above were included in the analysis. The dependent variables were the use of outpatient and inpatient care among respondents. Health system characteristics at the provincial level were measured using the density of doctors and ward beds, health expenditure per visit/admission and health financing. A two-level logistic regression model was constructed to examine association between health care utilization and health system characteristics, controlling for predisposing, enabling and need variables. Results Of the 17 370 respondents, 18.3% had utilized outpatient care and 13.7% had utilized inpatient care in 2015. Increases in the share of out-of-pocket (OOP) payments as total health spending at the provincial-level was less likely to be associated with outpatient care utilization (odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.93-0.98) among the mid-age and elderly population. Increases in the share of OOP payments (OR = 0.98, 95% CI = 0.97-1.00) and health expenditure per admission (OR = 0.20, 95% CI = 0.04-0.88) were less likely to be associated with inpatient care utilization, while increases in the density of beds (OR = 1.26, 95% CI = 1.10-1.43) was more likely to be associated with inpatient care utilization. gross domestic product (GDP) per capita at the provincial level and types of health insurance owned by respondents were significantly related to both inpatient and outpatient care utilization. Conclusions Low affordability of the mid-aged and elderly population is the main barrier to utilizing health care in China. In order to improve access to health care, the government should make more efforts, such as improving health insurance reimbursement rates and implementing prospective provider payment methods, to decrease OOP payment for the ageing population.
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Affiliation(s)
- Chaofan Li
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong, China
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, Guangdong, China
| | - Haipeng Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
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28
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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.
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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
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29
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Li Q, Wei J, Jiang F, Zhou G, Jiang R, Chen M, Zhang X, Hu W. Equity and efficiency of health care resource allocation in Jiangsu Province, China. Int J Equity Health 2020; 19:211. [PMID: 33246458 PMCID: PMC7694921 DOI: 10.1186/s12939-020-01320-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Jiangsu was one of the first four pilot provinces to engage in comprehensive health care reform in China, which has been on-going for the past 5 years. This study aims to evaluate the equity, efficiency and productivity of health care resource allocation in Jiangsu Province using the most recent data, analyse the causes of deficiencies, and discuss measures to solve these problems. Methods Data were extracted from the Jiangsu Health/Family Planning Statistical Yearbook (2015–2019) and Jiangsu Statistical Yearbook (2015–2019). The Gini coefficient (G), Theil index (T) and health resource density index (HRDI) were chosen to study the fairness of health resource allocation in Jiangsu Province. Data envelopment analysis (DEA) and the Malmquist productivity index (MPI) were used to analyse the efficiency and productivity of this allocation. Results From 2014 to 2018, the total amount of health resources in Jiangsu Province increased. The G of primary resource allocation by population remained below 0.15, and that by geographical area was between 0.14 and 0.28; additionally, the G of health financial resources was below 0.26, and that by geographical area was above 0.39. T was consistent with the results for G and Lorenz curves. The HRDI shows that the allocated amounts of health care resources were the highest in southern Jiangsu, except for the number of health institutions. The average value of TE was above 0.93, and the DEA results were invalid for only two cities. From 2014 to 2018, the mean TFPC in Jiangsu was less than 1, and the values exceeded 1 for only five cities. Conclusion The equity of basic medical resources was better than that of financial resources, and the equity of geographical allocation was better than that of population allocation. The overall efficiency of health care resource allocation was high; however, the total factor productivity of the whole province has declined due to technological regression. Jiangsu Province needs to further optimize the allocation and increase the utilization efficiency of health care resources. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01320-2.
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Affiliation(s)
- Qian Li
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, P.R. China.,Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 200040, Shanghai, P.R. China
| | - Jianjun Wei
- Department of Construction Management of Real Estate, School of Economics and Management, Tongji University, Shanghai, 200092, P.R. China.,Shanghai Shenkang Hospital Development Centre, Shanghai, 200092, P.R. China
| | - Fengchang Jiang
- Taizhou Polytechnic College, Taizhou, 225300, Jiangsu, P.R. China
| | - Guixiang Zhou
- Taizhou Polytechnic College, Taizhou, 225300, Jiangsu, P.R. China
| | - Rilei Jiang
- School of Basic Medicine Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, P.R. China
| | - Meijuan Chen
- School of Medicine & Holistic Integrative medicine, Nanjing University of Chinese Medicine, Jiangsu, Nanjing, 210023, P.R. China
| | - Xu Zhang
- School of Medicine & Holistic Integrative medicine, Nanjing University of Chinese Medicine, Jiangsu, Nanjing, 210023, P.R. China.
| | - Wanjin Hu
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, P.R. China. .,Nanjing Municipal Government, Jiangsu, Nanjing, 210008, P.R. China.
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30
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Bai L, Xu Z, Huang C, Sui Y, Guan X, Shi L. Psychotropic medication utilisation in adult cancer patients in China: A cross-sectional study based on national health insurance database. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 5:100060. [PMID: 34327398 PMCID: PMC8315446 DOI: 10.1016/j.lanwpc.2020.100060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 01/06/2023]
Abstract
Background Psychotropic medications are useful to treat psychiatric disorders which are frequently underdiagnosed and undertreated in cancer patients. Evidence on utilisation of psychotropic medications in cancer patients was absent in China. This study aimed to analyse the prevalence and the potential predictors of psychotropic medication use in adult cancer patients in China. Methods We analysed cross-sectional data from the China Health Insurance Association database in 2015-2017, which contained health care utilisation information for a national representative sample of basic medical insurance beneficiaries. Cancer patients aged above 18 were identified by International Classification of Disease 10th revision code C00-C97. Psychotropic medications were defined following the Anatomical Therapeutic Chemical codes: antipsychotics (N05A), anxiolytics (N05B), hypnotics and sedatives (N05C), and antidepressants (N06A, N06CA). We calculated the prevalence of psychotropic medication use in cancer patients, and applied multivariable logistic regression to identify its potential predictors. Findings A total of 260,364 adults with cancer were identified in the database, of which 48,111 (18•5%) were prescribed at least one psychotropic medication comprising antipsychotics (3763, 1•4%), anxiolytics (15,902, 6•1%), hypnotics and sedatives (37,040, 14•2%), and antidepressants (2379, 0•9%). Patients with solid tumours had higher prevalence of psychotropic medication use than patients with lymphoid and hematopoietic malignancies (e.g. female genital organs, adjusted odds ratio (OR)=2•25, 95%CI=2•09-2•44). The prevalence of psychotropic medication use in cancer patients in the Eastern region was significantly higher than those of cancer patients in the Western regions (OR=2•33, 95%CI=2•27-2•40). Compared with the Urban Rural Resident Basic Medical Insurance beneficiaries, cancer patients covered by the Urban Employee Basic Medical Insurance were more likely to use psychotropic medications (OR=1•18, 95%CI=1•15-1•20). Midazolam was the most frequently used psychotropic (21,728, 45•2%), and flupentixol-melitracen was the most commonly used antidepressant (1176, 2•4%) among all psychotropic medication users in the sample. Interpretation The prevalence of psychotropic medication use in Chinese adult cancer patients was inequitable. Further attention will be needed to be paid to the mental health of cancer patients in China. Funding No funding.
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Affiliation(s)
- Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Ziyue Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Cong Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Yunchuan Sui
- Department of Psychiatry, No. 904th Hospital of the PLA Joint Logistics Support Force, Changzhou 213000, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.,International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.,International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
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31
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Dong Y, Hu P, Song Y, Dong B, Zou Z, Wang Z, Xu R, Luo D, Gao D, Wen B, Ma Y, Ma J, Tian X, Huang X, Narayan A, Patton GC. National and Subnational Trends in Mortality and Causes of Death in Chinese Children and Adolescents Aged 5-19 Years From 1953 to 2016. J Adolesc Health 2020; 67:S3-S13. [PMID: 32665069 DOI: 10.1016/j.jadohealth.2020.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/31/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE We aimed to analyze the recent trends of mortality and rankings of causes of death in Chinese children and adolescents from 1953 to 2016. METHODS Data on mortality and causes of death in Chinese children and adolescents aged 5-19 years were extracted from the China Health Statistics Yearbook and the Global Burden of Disease Study from 1953 to 2016. Mortality variations were analyzed by year, age, sex, province, and causes of death. RESULTS The mortality of Chinese children and adolescents aged 5-19 years declined steadily from 1953 (366.03/100,000) to 2016 (27.21), with the largest reduction in adolescents aged 15-19 years and the smallest reduction in those aged 10-14 years. Large subnational disparities for all-cause mortality existed in national 31 provinces with higher mortality in western regions compared with eastern regions, but with narrowing disparities between 1981 and 2010. Injuries dominated the causes of death compared with noncommunicable diseases and communicable, maternal and neonatal, and nutritional diseases from 1990 (58.13/100,000 vs. 32.10 and 14.31) to 2016 (22.65 vs. 13.00 and 2.93). In 2016, the leading three causes of death were road injuries (8.30/100,000), drowning (7.25), and leukemia (2.60). Drowning was the leading cause of death for 5- to 14-year-olds, but road injuries have been the leading cause for 15- to 19-year-olds of both sexes since 2010. CONCLUSIONS Although mortality in Chinese adolescents now stands at just 7% of rates in the 1950s, there is a need to address continuing inequalities across sex, economic status, and region.
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Affiliation(s)
- Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Peijin Hu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Zhenghe Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Rongbin Xu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dongmei Luo
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Disi Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Bo Wen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China.
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China.
| | - Xiaobo Tian
- Health, Nutrition & WASH Section of UNICEF China Office, Beijing, China
| | - Xiaona Huang
- Health, Nutrition & WASH Section of UNICEF China Office, Beijing, China
| | - Anuradha Narayan
- Health, Nutrition & WASH Section of UNICEF China Office, Beijing, China
| | - George C Patton
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia
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Wang Y, Jing Z, Ding L, Tang X, Feng Y, Li J, Chen Z, Zhou C. Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China. BMC Health Serv Res 2020; 20:984. [PMID: 33109188 PMCID: PMC7590715 DOI: 10.1186/s12913-020-05843-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China. METHODS The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level. RESULTS Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p < 0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p = 0.017) and 2.04 (95% CI 1.45, 2.88, p = 0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p = 0.044) and 1.37 (95% CI 1.02, 1.83, p = 0.035), respectively. CONCLUSION This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.
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Affiliation(s)
- Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Zhengyue Jing
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Lulu Ding
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Xue Tang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Yuejing Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Zhuo Chen
- College of Public Health, University of Georgia, Athens, GA, 30606, USA.,School of Economics, University of Nottingham, Ningbo, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
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Chen D, Lang Y. The cream-skimming effect in China's health care services: A mixed methods study. Int J Health Plann Manage 2020; 36:113-133. [PMID: 32914460 DOI: 10.1002/hpm.3071] [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: 08/20/2019] [Revised: 06/28/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE One of the greatest inequities in China's health care service is that between senior cadres, high-level bureaucrats, and the general public in terms of hospital access and payment. We aim to demonstrate this inequity and to explore its connection with the regional inequity of different levels of health care facilities. METHODS In a content analysis of official websites of provincial health bureaus and national top hospitals, we determine whether senior cadres enjoy priority in health services with fewer payments. Then, we employ multiple regression analyses to explore the correlation of the local economy, the local population as well as the regional power and different levels of health care facilities. RESULTS The content analysis suggests that senior cadres indeed enjoy priority in health care services. According to the regression results, the local population has a positive correlation with every level of health care facilities except the highest one, which is responsive only to the local power index. CONCLUSION We demonstrate a demand-side cream-skimming effect in China's health care service. Senior cadres have taken the 'cream', the best services, and the individual inequity between senior cadres and the general public is related to the regional inequity of different-level health care facilities.
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Affiliation(s)
- Dongjin Chen
- Centre for Social Governance and Communication, Communication University of Zhejiang, Hangzhou, Zhejiang, China
| | - Youxing Lang
- Department of Political Science, School of Public Affairs, Zhejiang University, Hangzhou, Zhejiang, China
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Spatial and Temporal Impacts of Socioeconomic and Environmental Factors on Healthcare Resources: A County-Level Bayesian Local Spatiotemporal Regression Modeling Study of Hospital Beds in Southwest China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165890. [PMID: 32823743 PMCID: PMC7460194 DOI: 10.3390/ijerph17165890] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 12/28/2022]
Abstract
Comprehensive investigation on understanding geographical inequalities of healthcare resources and their influencing factors in China remains scarce. This study aimed to explore both spatial and temporal heterogeneous impacts of various socioeconomic and environmental factors on healthcare resource inequalities at a fine-scale administrative county level. We collected data on county-level hospital beds per ten thousand people to represent healthcare resources, as well as data on 32 candidate socioeconomic and environmental covariates in southwest China from 2002 to 2011. We innovatively employed a cutting-edge local spatiotemporal regression, namely, a Bayesian spatiotemporally varying coefficients (STVC) model, to simultaneously detect spatial and temporal autocorrelated nonstationarity in healthcare-covariate relationships via estimating posterior space-coefficients (SC) within each county, as well as time-coefficients (TC) over ten years. Our findings reported that in addition to socioeconomic factors, environmental factors also had significant impacts on healthcare resources inequalities at both global and local space–time scales. Globally, the personal economy was identified as the most significant explanatory factor. However, the temporal impacts of personal economy demonstrated a gradual decline, while the impacts of the regional economy and government investment showed a constant growth from 2002 to 2011. Spatially, geographical clustered regions for both hospital bed distributions and various hospital bed-covariates relationships were detected. Finally, the first spatiotemporal series of complete county-level hospital bed inequality maps in southwest China was produced. This work is expected to provide evidence-based implications for future policy making procedures to improve healthcare equalities from a spatiotemporal perspective. The employed Bayesian STVC model provides frontier insights into investigating spatiotemporal heterogeneous variables relationships embedded in broader areas such as public health, environment, and earth sciences.
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Bai L, Wushouer H, Huang C, Luo Z, Guan X, Shi L. Health Care Utilization and Costs of Patients With Prostate Cancer in China Based on National Health Insurance Database From 2015 to 2017. Front Pharmacol 2020; 11:719. [PMID: 32587512 PMCID: PMC7299164 DOI: 10.3389/fphar.2020.00719] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In terms of medical costs, prostate cancer is on the increase as one of the most costly cancers, posing a tremendous economic burden, but evidence on the health care utilization and medical expenditure of prostate cancer has been absent in China. OBJECTIVE This study aimed to analyze health care utilization and direct medical costs of patients with prostate cancer in China. METHODS Health care service data with a national representative sample of basic medical insurance beneficiaries between 2015 and 2017 were obtained from the China Health Insurance Association database. We conducted descriptive and statistical analyses of health care utilization, annual direct medical costs, and composition based on cancer-related medical records. Health care utilization was measured by the number of hospital visits and the length of stay. RESULTS A total of 3,936 patients with prostate cancer and 24,686 cancer-related visits between 2015 and 2017 were identified in the database. The number of annual outpatient and inpatient visits per patient differed significantly from 2015 to 2017. There was no obvious change in length of stay and annual direct medical costs from 2015 to 2017. The number of annual visits per patient (outpatient: 3.0 vs. 4.0, P < 0.01; inpatient: 1.5 vs. 2.0, P < 0.001) and the annual medical direct costs per patient (US$2,300.1 vs. US$3,543.3, P < 0.001) of patients covered by the Urban Rural Resident Basic Medical Insurance (URRBMI) were both lower than those of patients covered by the Urban Employee Basic Medical Insurance (UEBMI), and the median out-of-pocket expense of URRBMI was higher than that of UEBMI (US$926.6 vs. US$594.0, P < 0.001). The annual direct medical costs of patients with prostate cancer in Western regions were significantly lower than those of patients in Eastern and Central regions (East: US$4011.9; Central: US$3458.6; West: US$2115.5) (P < 0.001). CONCLUSIONS There was an imbalanced distribution of health care utilization among regions in China. The direct medical costs of Chinese patients with prostate cancer remained stable, but the gap in health care utilization and medical costs between two different insurance schemes and among regions still needed to be further addressed.
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Affiliation(s)
- Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Center for Strategic Studies, Chinese Academy of Engineering, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Cong Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zhenhuan Luo
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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Huang M, Luo D, Wang Z, Cao Y, Wang H, Bi F, Huang Y, Yi L. Equity and efficiency of maternal and child health resources allocation in Hunan Province, China. BMC Health Serv Res 2020; 20:300. [PMID: 32293425 PMCID: PMC7158093 DOI: 10.1186/s12913-020-05185-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A reasonable allocation of health resources is often characterized by equity and high efficiency. This study aims to evaluate the equity and efficiency of maternal and child health (MCH) resources allocation in Hunan Province, China. METHODS Data related to MCH resources and services was obtained from the Hunan maternal and child health information reporting and management system. The Gini coefficient and data envelopment analysis (DEA) were employed to evaluate the equity and efficiency of MCH resources allocation, respectively. RESULTS The MCH resources allocation in terms of demographic dimension were in a preferred equity status with the Gini values all less than 0.3, and the Gini values for each MCH resources' allocation in terms of the geographical dimension ranged from 0.1298 to 0.4256, with the highest values in the number of midwives and medical equipment (≥ CNY 10,000), which exceeds 0.4, indicating an alert of inequity. More than 40% regions in Hunan were found to be relatively inefficient with decreased return to scale in the allocation of MCH resources, indicating those inefficient regions were using more inputs than needed to obtain the current output levels. CONCLUSIONS The equity of MCH resources by population size is superior by geographic area and the disproportionate distribution of the number of medical equipment (≥ CNY 10,000) and midwives between different regions was the main source of inequity. Policy-makers need to consider the geographical accessibility of health resources among different regions to ensure people in different regions could get access to available health services. More than 40% of regions in Hunan were found to be inefficient, with using more health resources than needed to produce the current amount of health services. Further investigations on factors affecting the efficiency of MCH resources allocation is still needed to guide regional health plans-making and resource allocation.
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Affiliation(s)
- Minyuan Huang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078, People's Republic of China
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078, People's Republic of China.
| | - Zhanghua Wang
- Health Commission of Hunan Province, Changsha, 410008, People's Republic of China
| | - Yongmei Cao
- Health Commission of Hunan Province, Changsha, 410008, People's Republic of China
| | - Hua Wang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, People's Republic of China
| | - Fengying Bi
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078, People's Republic of China
| | - Yunxiang Huang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078, People's Republic of China
| | - Luxi Yi
- Health Commission of Hunan Province, Changsha, 410008, People's Republic of China
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Zhong K, Chen L, Cheng S, Chen H, Long F. The Efficiency of Primary Health Care Institutions in the Counties of Hunan Province, China: Data from 2009 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051781. [PMID: 32182945 PMCID: PMC7084797 DOI: 10.3390/ijerph17051781] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to estimate the efficiency and its influencing factors of Primary Health Care Institutions (PHCIs) in counties in Hunan Province, China, and put forward feasible suggestions for improving the efficiency of PHCIs in Hunan Province. We applied the Input-Oriented Data Envelopment Analysis (DEA) method and the Malmquist Index Model to estimate the efficiency of PHCIs in 86 counties in Hunan Province from 2009 to 2017. Then, the Tobit model was used to estimate the factors that influence the efficiency of PHCIs. Since the implementation of the new health-care reform in 2009, the number of health resources in PHCIs in Hunan Province has increased significantly, but most counties’ PHCIs remain inefficient. The efficiency of PHCIs is mainly affected by the total population, city level, the proportion of health technicians and the proportion of beds, but the changes in per capita GDP have not yet played a significant role in influencing efficiency. In the future, the efficiency of PHCIs should be improved by increasing medical technology skills and enthusiasm of health technicians and by improving the payment policies of medical insurance funds.
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Affiliation(s)
- Kaili Zhong
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410078, China; (K.Z.); (S.C.)
| | - Lv Chen
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410078, China; (K.Z.); (S.C.)
- Correspondence:
| | - Sixiang Cheng
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410078, China; (K.Z.); (S.C.)
| | - Hongjun Chen
- Department of Primary Health Care, Health Commission of Hunan Province, Changsha 410078, China; (H.C.); (F.L.)
| | - Fei Long
- Department of Primary Health Care, Health Commission of Hunan Province, Changsha 410078, China; (H.C.); (F.L.)
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Ke L, Chen J, Jia J, Ke P, Chen X, Mao Z, Liu B. Outpatients' Satisfaction in the Context of 10 Years of Health-Care Reform: A Cross-Sectional Study of Tertiary Hospitals in Shiyan, China. Patient Prefer Adherence 2020; 14:191-202. [PMID: 32099337 PMCID: PMC6996206 DOI: 10.2147/ppa.s233472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study aimed to evaluate outpatient satisfaction in tertiary hospitals in Shiyan, China, to predict which items had highest priorities for outpatient satisfaction, and to identify population groups on which the medical institutions should focus. PATIENTS AND METHODS A cross-sectional survey was conducted at three tertiary hospitals in Shiyan city of China, from March to June 2018. An 18-item outpatient satisfaction questionnaire was applied. We conducted matrix analysis to describe the distribution of satisfaction score and the degree of influence of the items. Outpatient satisfaction was classified into the lowest and highest groups according to the 80/20 rule. Logistic regression model was used to identify demographic factors which might influence outpatient satisfaction. RESULTS A total of 2109 valid questionnaires were completed. The "waiting time", "diagnosis and treatment time" and "medical charges" items showed relatively higher degrees of influence but earned lower levels of satisfaction. Outpatients with a college level or above educational background (AOR=1.36, 95% CI=1.03-1.79) and with a family per-capita monthly income (FPMI)>7000 CNY (AOR=3.30, 95% CI=1.60-6.81) were more prevalent in the lowest satisfaction group. Outpatients with college level or above education background (COR=0.77, 95% CI=0.60-0.99), FPMI of 3001-5000 CNY (AOR=0.76, 95% CI=0.60-0.96), non-local residents (AOR=1.48, 95% CI=1.07-2.04), and urban workers with medical insurance (AOR=1.74, 95% CI=1.27-2.39) were more prevalent in the highest satisfaction group. CONCLUSION The survey indicated that "long time to wait for treatment", "short treatment time", and "medical charges too expensive" were the top three aspects that need to be improved with priority by medical institutions. Education level, income level, residence and type of health insurance were the sociodemographic characteristics that significantly affect the outpatient satisfaction in tertiary hospitals. These factors need to be paid more attention by healthcare professionals to improve the patients' satisfaction.
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Affiliation(s)
- Li Ke
- School of Nursing, Hubei University of Medicine, Shiyan, People’s Republic of China
- Global Health Institute, Wuhan University, Wuhan, People’s Republic of China
| | - Jingshu Chen
- School of Public Health and Management, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Jia Jia
- School of Nursing, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Pan Ke
- Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Xueqin Chen
- Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Zongfu Mao
- Global Health Institute, Wuhan University, Wuhan, People’s Republic of China
| | - Bing Liu
- School of Public Health and Management, Hubei University of Medicine, Shiyan, People’s Republic of China
- Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, People’s Republic of China
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Yitbarek K, Abraham G, Adamu A, Tsega G, Berhane M, Hurlburt S, Mann C, Woldie M. Technical efficiency of neonatal health services in primary health care facilities of Southwest Ethiopia: a two-stage data envelopment analysis. HEALTH ECONOMICS REVIEW 2019; 9:27. [PMID: 31656977 PMCID: PMC6815357 DOI: 10.1186/s13561-019-0245-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Disparity in resource allocation is an issue among various health delivery units in Ethiopia. To sufficiently address this problem decision-makers require evidence on efficient allocation of resources. Therefore, the purpose of this study was to assess the technical efficiency of primary health care units providing neonatal health services in Southwest Ethiopia. METHODS Two-stage data envelopment analysis was conducted based on one-year (2016/17) data from 68 health posts and 23 health centers in Southwest Ethiopia. Primary data were collected from each of the facility, respective district health offices and finance and economic cooperation offices. Technical efficiency scores were calculated using data envelopment analysis software version 2.1. Tobit regression was then applied to identify determinants of technical efficiency. STATA version 14 was used in the regression model and for descriptive statistics. RESULTS By utilizing the best combination of inputs, eight health posts (11.76%) and eight health centers (34.78%) were found to be technically efficient in delivering neonatal health services. Compared with others included in the analysis, inefficient health delivery units were using more human and non-salary recurrent resources. The regression model indicated that there was a positive association between efficiency and the health center head's years of experience and the facility's catchment population. Waiting time at the health posts was found to negatively affect efficiency. CONCLUSIONS Most of health posts and the majority of health centers were found to be technically inefficient in delivering neonatal health services. This indicates issues with the performance of these facilities with regards to the utilization of inputs to produce the current outputs. The existing resources could be used to serve additional neonates in the facilities.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Gelila Abraham
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ayinengida Adamu
- Department of Public health, Bahirdar University, Bahirdar, Ethiopia
| | - Gebeyehu Tsega
- Department of Public health, Bahirdar University, Bahirdar, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and child health, Institute of health, Jimma University, Jimma, Ethiopia
| | - Sarah Hurlburt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Carlyn Mann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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In Favour of Regional Diabetes Day Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132293. [PMID: 31261638 PMCID: PMC6650929 DOI: 10.3390/ijerph16132293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/14/2019] [Accepted: 06/25/2019] [Indexed: 01/12/2023]
Abstract
Diabetes mellitus is considered a public health issue worldwide, with a high prevalence. It is a direct cause of death, disability, and high health costs. In addition, it generates a series of complications of variable types and degrees that have frequent negative effects on the quality of life of the people who suffer from it. Efficiency in public health implies a reduction in costs and improvements in citizens' quality of life. With the twofold aim of rationalizing costs and promoting an improvement in the care of people with diabetes, we propose a project: a Diabetes Day Hospital (DDH) in Extremadura (Spain). This involves a new organizational model which has already been implemented in other European regions, generating satisfactory results. This study includes details on the structure and operation of the DDH, as well as the expected costs. The DDH allows for a proper coordination among the parties involved in the monitoring and treatment of the disease, and reduces the costs derived from unnecessary admissions and chronic complications. Results show that efficiency in the regional health system could be improved and a significant amount of money could be saved.
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Efficiency of medical service systems in the rural areas of Mainland China: a comparative study from 2013 to 2017. Public Health 2019; 171:139-147. [PMID: 31132517 DOI: 10.1016/j.puhe.2019.04.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Inefficient rural medical service systems are one of major obstacles to the Deepening Healthcare Reform. The objectives of this work are to analyze the efficiency of China's rural medical service systems and explore the key related factors. STUDY DESIGN Two-stage study including measuring efficiency and identifying factors. METHODS An output-oriented slacks-based data envelopment analysis model was used to measure the efficiency, and a Spearman rank correlation analysis and a multiple linear regression model were used to explore the factors. RESULTS For the village-level medical service system, 20 out of 27 provinces were inefficient in 2013-2017, 12 out of 27 provinces had the efficiency lower than the average scores in 2013-2017 (0.633, 0.659, 0.638, 0.603, and 0.589), Guangdong had the highest scores of 1 in 2014-2017, whereas Tibet had the lowest scores (0.064-0.083) in 2013-2017, and the west region performed worst. For the township-level medical service system, 11 out of 27 provinces were inefficient in 2013-2017, 10 out of 27 provinces had the efficiency lower than the average scores in 2013-2017 (0.819, 0.791, 0.757, 0.787, and 0.811), Ningxia had the highest efficiency of 1 in 2013-2017, whereas Jilin had the lowest efficiency (0.313-0.370), and the central region performed worst. Additionally, rural residents' income was positively associated with the efficiency of village-level medical services, while the proportion of the vulnerable population was positively associated with the efficiency of township-level medical services. CONCLUSIONS Most provinces had inefficient rural medical service systems in 2013-2017. The efficiency scores varied greatly across provinces, and most scores changed a little over time. Imbalances in the development of rural medical service systems existed across regions, and the efficiency of village-level medical services and township-level medical services was associated with different factors.
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Zhang T, Liu C, Liu L, Gan Y, Lu W, Tao H. General practice for the poor and specialist services for the rich: inequality evidence from a cross-sectional survey on Hangzhou residents, China. Int J Equity Health 2019; 18:69. [PMID: 31088453 PMCID: PMC6518799 DOI: 10.1186/s12939-019-0966-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/22/2019] [Indexed: 12/03/2022] Open
Abstract
Background Inequalities in health care services are becoming an increasing concern in the world including in China. This study measured the income-related inequalities of residents in Hangzhou of China in access to general practice and specialist care and identified socioeconomic factors associated with such inequalities. Methods A cross-sectional questionnaire survey was conducted on 1048 residents in ten urban communities in Hangzhou, China. The percentage and frequency of respondents visiting general practice (GP) and hospital specialist clinics over the past four weeks prior to the survey were estimated. Income-related inequalities in access to these services were measured by the concentration index. Logistic regression and Poisson regression models were established to decompose the contributions of socioeconomic factors (residency, income, education, marital status, and social health insurance) to the inequalities in the probability and frequency of accessing these services, respectively, after adjustment for the needs factors (age, sex and illness conditions). Results The GP services were in favor of the poor, with a concentration index of − 0.0464 and − 0.1346 for the probability and frequency of GP visits, respectively. In contrast, the specialist services were in favor of the rich, with a concentration index of 0.1258 and 0.1279 for the probability and frequency of specialist visits, respectively. Income is the biggest contributor to the inequalities, except for the frequency of visits to specialists in which education played the greatest role. Conclusions Income-related inequalities in GP and specialist care are evident in China. Policy interventions should pay increasing attention to the emergence of a two-tier system, potentially enlarging socioeconomic disparities in health care services. Electronic supplementary material The online version of this article (10.1186/s12939-019-0966-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13, Aviation Road, Qiaokou District, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Lingrui Liu
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.,Global Health Leadership Initiative, Yale University, New Haven, CT, USA
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wei Lu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13, Aviation Road, Qiaokou District, Wuhan, Hubei, China
| | - Hongbing Tao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13, Aviation Road, Qiaokou District, Wuhan, Hubei, China.
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Zhu B, Fu Y, Liu J, He R, Zhang N, Mao Y. Detecting the priority areas for health workforce allocation with LISA functions: an empirical analysis for China. BMC Health Serv Res 2018; 18:957. [PMID: 30541543 PMCID: PMC6292090 DOI: 10.1186/s12913-018-3737-y] [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: 06/07/2018] [Accepted: 11/19/2018] [Indexed: 01/21/2023] Open
Abstract
Background Health workforce misdistribution leads to severe inequity and low-efficiency in health services in the developing countries. Targeting at China, this research aims to reveal, visualize and compare the geographical distribution patterns of different subtypes of urban and rural health workforce and identify the priority regions for health workforce planning and allocation policies designing. Methods The health workforce density (workforce-to-population ratio) is adopted to represent the accessibility to health workforce in each geographical unit. Besides a descriptive geography of health workforce as a whole, the local indicators of spatial association (LISA) are used to explore the spatial clusters of different subtypes of health workforce, which are visualized by geographical tools. Results Results reveal that regional disparities and spatial clusters exist in China’s health workforce distribution, with different types of workforce exhibiting relatively different spatial distribution characteristics. Besides, huge urban-rural disparities are found in the distribution of health workforce in China. Unexpectedly but intriguingly, most of the high-high and high-low cluster area of urban health workforce are concentrated in the western China (Xinjiang, Xizang etc.), indicating the relative abundant stock of urban health workforce in these units, while the low-low and low-high cluster area of different types of urban health workforce are mainly distributed in middle China. Regarding the rural health workforce, there is an obvious and similar low-low and low-high clustering pattern in western provinces (Sichuan, Yunnan) for the licensed doctors, pharmacists, technologists, which play a critical role in health services delivery. Conclusions Different types of health workforce displayed distinct spatial distribution patterns, while the misdistribution of rural health workforce imposed more challenges to the Chinese health sector due to its poorer stock and more disadvantaged positions of backward regions (i.e., low-low and low-high cluster area). Subtype-specific and region-oriented health workforce planning and allocation policies are suggested to be made, aiming at the urban and rural health workforce respectively, by prioritizing the identified low-low and low-high cluster areas. Electronic supplementary material The online version of this article (10.1186/s12913-018-3737-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bin Zhu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.,Department of Public Policy, City University of Hong Kong, Hong Kong, 999077, China
| | - Yang Fu
- College of Management, Shenzhen University, Nanhai Ave 3688, Shenzhen, Guangdong, China
| | - Jinlin Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Rongxin He
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Ning Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Ying Mao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.
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Lu L, Zeng J. Inequalities in the geographic distribution of hospital beds and doctors in traditional Chinese medicine from 2004 to 2014. Int J Equity Health 2018; 17:165. [PMID: 30419919 PMCID: PMC6233493 DOI: 10.1186/s12939-018-0882-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/28/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives This study identifies inequities in the provincial-level geographical distribution of traditional Chinese Medicine (TCM) hospital beds and doctors in China from 2004 to 2014. This provides policy implications of the optimal allocation of TCM health care resources. Methods Our study used province level data on TCM hospital beds and doctors from 2004 to 2014. These data were obtained from the China TCM Yearbook 2004–2014 and the China Statistical Yearbook 2004–2014.Global and local spatial autocorrelation was performed by using Moran’s index and the local Moran’s index to describe the spatial distribution of TCM hospital beds (doctors) as well as their density. A Gini coefficient was used to estimate inequalities in the geographic distribution of TCM hospital beds (doctors) based on their density. Correlations of the Gini coefficients between TCM hospital beds and doctors were calculated by Pearson correlation analysis. Results All indicators of TCM hospital beds and doctor density have increased over the past 11 years. The number of TCM hospital beds per 10,000 populations increased the fastest. Geographical clustering was not obvious in the density distribution of TCM hospital beds or doctors, as no significant spatial autocorrelation was found. Gini coefficients showed that from 2004 to 2014 the distribution of TCM hospital beds per 10,000 population and doctors per 10,000 populations were equitable between different regions. A large gap existed in the distribution inequality of TCM hospital beds (doctors) per square kilometer among different regions. Conclusion Targeted health policy with equitable distribution of TCM hospital beds (doctors) per square kilometer and the balance and coordination of related resources should be a priority in shaping China’s healthcare system reform.
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Affiliation(s)
- Liming Lu
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
| | - Jingchun Zeng
- Department of Acupuncture, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
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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.
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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.
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Guo L, Bao Y, Li S, Ma J, Sun W. Quality analysis and policy recommendations on the utilization of community basic public health services in urban and suburban Shanghai from 2009 to 2014. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:28206-28215. [PMID: 30073596 DOI: 10.1007/s11356-018-2811-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
Disparities in quality of basic public health services exist between urban and rural populations, but there is no data about these disparities between urban and suburban populations in Shanghai. The study aims to analyze and compare the quality of basic public health service utilization of community health service centers in Shanghai urban and suburban areas between 2009 and 2014. This was a cross-sectional study. Using a two-stage random sampling method, 80 community health service centers were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistical analysis, principal component analysis, and forecast analysis were used to compare and analyze basic health services utilization quality between urban and suburban centers. During the 6 years, there has been an increasing trend of the basic public health service effectiveness of prevention services, health care services, rehabilitation services, health education services, and health indexes in Shanghai urban and suburban areas. Prevention services, health care services, health education services, and population health index indicators of urban areas were better than those of the suburbs, while effectiveness indicators of rehabilitation services were lower than that of the suburbs. The urban areas had four principal component scores lower than the suburbs (P < 0.001, P = 0.006, P < 0.001, and P = 0.015). During the 6 years, with the strengthening of national support, basic public health service utilization has increased rapidly, and effectiveness of services has improved obviously. Nevertheless, there is an imbalance of basic public health service utilization between urban and suburban areas.
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Affiliation(s)
- Lijun Guo
- Shanghai University of Medicine & Health Sciences, College of Health Information Technology and Management, Shanghai, 201318, China
| | - Yong Bao
- Shanghai Jiao Tong University School of Public Health, No. 227 Chongqing South Road, Shanghai, 200025, China.
- Hongqiao International Institute of Medicine, Shanghai Jiao Tong University School of Medicine, No. 1111 XianXia Road, Changning District, Shanghai, 200336, China.
| | - Shujun Li
- Zhengzhou Fifteenth People's Hospital, Zhengzhou, 450041, Henan, China
| | - Jun Ma
- Shanghai Tongren Hospital, Shanghai, 200336, China
| | - Wei Sun
- Shanghai Jiao Tong University School of Public Health, No. 227 Chongqing South Road, Shanghai, 200025, China
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Si G, Liu X, Xu N, Yu M, Liu X. A 14-year literature survey on spine-related clinical research output by orthopedic surgeons from mainland China. Medicine (Baltimore) 2018; 97:e11959. [PMID: 30142820 PMCID: PMC6112939 DOI: 10.1097/md.0000000000011959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In recent years, China is increasingly playing an active role in various fields of biomedical research. Many bibliometric studies have provided valuable insights to different fields of clinical studies. However, similar evaluation on spine surgery-related clinical research is still limited. We herein aimed to examine the scientific publications by orthopedic spine surgeons from mainland China within a 14-year period. METHODS Articles were identified in PubMed using predetermined query terms. Descriptive statistics were calculated, and T tests, Chi-squared tests, and regression analysis were conducted on the number of publications, impact factors (IFs), citations, region of the study, and associated medical subject headings (MeSHs). RESULTS A total of 1498 articles were identified and the annual number of publications, citations, and IFs all increased exponentially. The average IF was significantly higher in 2007 to 2013 than 2000 to 2006. Most publications were from Shanghai and Beijing and the 5 most productive administrative regions generated 70% of all publications. Analysis of associated MeSHs suggested research topics became more heterogeneous over the study period. CONCLUSION This was the first comprehensive evaluation on the clinical research output by orthopedic spine surgeons from mainland China. The annual number of publications and citations both increased significantly; however, research was highly concentrated in a handful of administrative regions.
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Affiliation(s)
- Gao Si
- Orthopaedic Department, Peking University Third Hospital
- Peking University Health Science Center, Haidian District, Beijing, China
| | - Xiao Liu
- Orthopaedic Department, Peking University Third Hospital
| | - Nanfang Xu
- Orthopaedic Department, Peking University Third Hospital
| | - Miao Yu
- Orthopaedic Department, Peking University Third Hospital
| | - Xiaoguang Liu
- Orthopaedic Department, Peking University Third Hospital
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Liu X, Hou Z, Towne SD, He M, Tan A, Jiang D, Mohammed ASH, Mao Z. Knowledge, attitudes, and practices related to the establishment of the National Hierarchical Medical System (NHMS) among outpatients in Chinese tertiary hospitals. Medicine (Baltimore) 2018; 97:e11836. [PMID: 30170374 PMCID: PMC6393072 DOI: 10.1097/md.0000000000011836] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study sought to assess the status of, and factors associated with, knowledge, attitudes, and practices (KAP) related to the establishment of the National Hierarchical Medical System (NHMS) among outpatients receiving care in tertiary hospitals in China.A cross-sectional study surveying tertiary outpatients was conducted. This study investigated KAP concerning the establishment of the NHMS among outpatients from tertiary hospitals, who could have sought medical care from a general practitioner in surrounding primary care medical institutions. Several factors associated with outpatients' knowledge were identified and included in fully adjusted analyses using logistic regression.Survey questionnaires were completed by 565 outpatients in 4 tertiary hospitals. Approximately half (51.86%) of the sample was aware of the NHMS. In multivariable analysis sex, age, education level, and place of residence were associated (P < .05) with knowledge of NHMS. Overall 74.69% of respondents expressed positive attitudes toward the establishment of the NHMS. However, a much lower proportion, 21.95%, was willing to choose nearby grassroots sub-unit hospitals as their first choice when seeking health care.The present study revealed outpatients in China may lack knowledge of the NHMS, yet most have a positive attitude toward the establishment of the NHMS. Even so, there was hesitation in terms of seeking care from the NHMS, indicating the need for policy makers to take action to increase public awareness surrounding NHMS-related information to improve the public's KAP on the establishment of the NHMS. This study highlights information useful for policy makers in China and other countries planning or evaluating related policies.
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Affiliation(s)
- Xiaojun Liu
- School of Health Sciences
- Global Health Institute, Wuhan University, Wuhan, China
| | | | - Samuel D. Towne
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL
- School of Public Health, Texas A&M University, College Station, TX
| | | | | | | | | | - Zongfu Mao
- School of Health Sciences
- Global Health Institute, Wuhan University, Wuhan, China
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Incorporating Spatial Statistics into Examining Equity in Health Workforce Distribution: An Empirical Analysis in the Chinese Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071309. [PMID: 29932139 PMCID: PMC6068954 DOI: 10.3390/ijerph15071309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/06/2018] [Accepted: 06/20/2018] [Indexed: 12/30/2022]
Abstract
Existing measures of health equity bear limitations due to the shortcomings of traditional economic methods (i.e., the spatial location information is overlooked). To fill the void, this study investigates the equity in health workforce distribution in China by incorporating spatial statistics (spatial autocorrelation analysis) and traditional economic methods (Theil index). The results reveal that the total health workforce in China experienced rapid growth from 2004 to 2014. Meanwhile, the Theil indexes for China and its three regions (Western, Central and Eastern China) decreased continually during this period. The spatial autocorrelation analysis shows that the overall agglomeration level (measured by Global Moran’s I) of doctors and nurses dropped rapidly before and after the New Medical Reform, with the value for nurses turning negative. Additionally, the spatial clustering analysis (measured by Local Moran’s I) shows that the low–low cluster areas of doctors and nurses gradually reduced, with the former disappearing from north to south and the latter from east to west. On the basis of these analyses, this study suggests that strategies to promote an equitable distribution of the health workforce should focus on certain geographical areas (low–low and low–high cluster areas).
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Guo L, Bao Y, Ma J, Li S, Cai Y, Sun W, Liu Q. Quality of community basic medical service utilization in urban and suburban areas in Shanghai from 2009 to 2014. PLoS One 2018; 13:e0195987. [PMID: 29791470 PMCID: PMC5965823 DOI: 10.1371/journal.pone.0195987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/20/2018] [Indexed: 11/18/2022] Open
Abstract
Urban areas usually display better health care services than rural areas, but data about suburban areas in China are lacking. Hence, this cross-sectional study compared the utilization of community basic medical services in Shanghai urban and suburban areas between 2009 and 2014. These data were used to improve the efficiency of community health service utilization and to provide a reference for solving the main health problems of the residents in urban and suburban areas of Shanghai. Using a two-stage random sampling method, questionnaires were completed by 73 community health service centers that were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistics, principal component analysis, and forecast analysis were used to complete a gap analysis of basic health services utilization quality between urban and suburban areas. During the 6-year study period, there was an increasing trend toward greater efficiency of basic medical service provision, benefits of basic medical service provision, effectiveness of common chronic disease management, overall satisfaction of community residents, and two-way referral effects. In addition to the implementation effect of hypertension management and two-way referral, the remaining indicators showed a superior effect in urban areas compared with the suburbs (P<0.001). In addition, among the seven principal components, four principal component scores were better in urban areas than in suburban areas (P = <0.001, 0.004, 0.036, and 0.022). The urban comprehensive score also exceeded that of the suburbs (P<0.001). In summary, over the 6-year period, there was a rapidly increasing trend in basic medical service utilization. Comprehensive satisfaction clearly improved as well. Nevertheless, there was an imbalance in health service utilization between urban and suburban areas. There is a need for the health administrative department to address this imbalance between urban and suburban institutions and to provide the required support to underdeveloped areas to improve resident satisfaction.
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Affiliation(s)
- Lijun Guo
- Shanghai University of Medicine & Health Sciences, College of Health Information Technology and Management, Pudong New District, Shanghai, China
| | - Yong Bao
- Shanghai Jiao Tong University School of Public Health, Shanghai, China
- Hongqiao International Institute of Medicine, Shanghai Jiao Tong University School of Medicine, Changning District, Shanghai, China
- * E-mail:
| | - Jun Ma
- Shanghai Tongren Hospital, Changning District, Shanghai, China
| | - Shujun Li
- Zhengzhou Fifteenth People’s Hospital, Shangjie District, Zhengzhou City, Henan Province, China
| | - Yuyang Cai
- Shanghai Jiao Tong University School of Public Health, Shanghai, China
| | - Wei Sun
- Shanghai Jiao Tong University School of Public Health, Shanghai, China
| | - Qiaohong Liu
- Shanghai University of Medicine & Health Sciences, College of Health Information Technology and Management, Pudong New District, Shanghai, China
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