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Zeng Z, Yu X, Tao W, Feng W, Zhang W. Efficiency evaluation and promoter identification of primary health care system in China: an enhanced DEA-Tobit approach. BMC Health Serv Res 2024; 24:777. [PMID: 38961461 PMCID: PMC11223419 DOI: 10.1186/s12913-024-11244-0] [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: 02/29/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND With Primary Health Care (PHC) being a cornerstone of accessible, affordable, and effective healthcare worldwide, its efficiency, especially in developing countries like China, is crucial for achieving Universal Health Coverage (UHC). This study evaluates the efficiency of PHC systems in a southwest China municipality post-healthcare reform, identifying factors influencing efficiency and proposing strategies for improvement. METHODS Utilising a 10-year provincial panel dataset, this study employs an enhanced Data Envelopment Analysis (DEA) model integrating Slack-Based Measure (SBM) and Directional Distance Function (DDF) with the Global Malmquist-Luenberger (GML) index for efficiency evaluation. Tobit regression analysis identifies efficiency determinants within the context of China's healthcare reforms, focusing on horizontal integration, fiscal spending, urbanisation rates, and workforce optimisation. RESULTS The study reveals a slight decline in PHC system efficiency across the municipality from 2009 to 2018. However, the highest-performing county achieved a 2.36% increase in Total Factor Productivity (TFP), demonstrating the potential of horizontal integration reforms and strategic fiscal investments in enhancing PHC efficiency. However, an increase in nurse density per 1,000 population negatively correlated with efficiency, indicating the need for a balanced approach to workforce expansion. CONCLUSIONS Horizontal integration reforms, along with targeted fiscal inputs and urbanisation, are key to improving PHC efficiency in underdeveloped regions. The study underscores the importance of optimising workforce allocation and skillsets over mere expansion, providing valuable insights for policymakers aiming to strengthen PHC systems toward achieving UHC in China and similar contexts.
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Affiliation(s)
- Zhi Zeng
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Office of Policy Research, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China
| | - Xiru Yu
- Institute for Hospital Management, Tsinghua University, Shenzhen, Guangdong, 518055, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wei Feng
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, 610041, China.
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Huang R, Li W, Shi B, Su H, Hao J, Zhao C, Chai J. Evaluating China's primary healthcare services' efficiency and spatial correlation: a three-stage DEA-Malmquist model. Front Public Health 2024; 12:1366327. [PMID: 38962768 PMCID: PMC11220123 DOI: 10.3389/fpubh.2024.1366327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/23/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Enhancing the efficiency of primary healthcare services is essential for a populous and developing nation like China. This study offers a systematic analysis of the efficiency and spatial distribution of primary healthcare services in China. It elucidates the fundamental landscape and regional variances in efficiency, thereby furnishing a scientific foundation for enhancing service efficiency and fostering coordinated regional development. Methods Employs a three-stage DEA-Malmquist model to assess the efficiency of primary healthcare services across 31 provincial units in mainland China from 2012 to 2020. Additionally, it examines the spatial correlation of efficiency distribution using the Moran Index. Results The efficiency of primary healthcare services in China is generally suboptimal with a noticeable declining trend, highlighting significant potential for improvement in both pure technical efficiency and scale efficiency. There is a pronounced efficiency gap among provinces, yet a positive spatial correlation is evident. Regionally, efficiency ranks in the order of East > Central > West. Factors such as GDP per capita and population density positively influence efficiency enhancements, while urbanization levels and government health expenditures appear to have a detrimental impact. Discussion The application of the three-stage DEA-Malmquist model and the Moran Index not only expands the methodological framework for researching primary healthcare service efficiency but also provides scientifically valuable insights for enhancing the efficiency of primary healthcare services in China and other developing nations.
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Affiliation(s)
- Rui Huang
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Wan Li
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Hao Su
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Jing Hao
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Chuanjun Zhao
- Department of National Security, School of National Security, Minzu University of China, Beijing, China
| | - Juhong Chai
- Department of Management, School of Management, Minzu University of China, Beijing, China
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Su W, Hou Y, Huang M, Xu J, Du Q, Wang P. Evaluating the efficiency of primary health care institutions in China: an improved three-stage data envelopment analysis approach. BMC Health Serv Res 2023; 23:995. [PMID: 37715162 PMCID: PMC10503195 DOI: 10.1186/s12913-023-09979-3] [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: 04/09/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Primary health care (PHC) institutions are key to realizing the main functions of the health care system. Since the new health care reform in 2009, the Chinese government has invested heavily in PHC institutions and launched favorable initiatives to improve the efficiency of such institutions. This study is designed to gauge the efficiency of PHC institutions by using 2012-2020 panel data covering 31 provinces in China. METHODS This study applied an improved three-stage data envelopment analysis (DEA) model to evaluate the efficiency of PHC institutions in China. Unlike the traditional three-stage DEA model, the input-oriented global super-efficiency slack-based measurement (SBM) DEA model is used to calculate the efficiency in the first and third stages of the improved three-stage DEA model, which not only allows the effects of environmental factors and random noise to be taken into account but also deal with the problem of slack, super-efficiency and the comparability of interperiod efficiency values throughout the efficiency measurement. RESULTS The results show that the efficiency of PHC institutions has been overestimated due to the impact of external environmental factors and random noise. From 2012 to 2020, the efficiency of PHC institutions displayed a downward trend. Moreover, there are significant differences in the efficiency of PHC institutions between regions, with the lowest efficiency being found in the northeast region. The efficiency of PHC institutions is significantly affected by residents' annual average income, per capita GDP, population density, the percentage of the population aged 0-14, the percentage of the population aged 65 and older, the number of people with a college education and above per 100,000 residents, and the proportion of the urban population. CONCLUSIONS Substantial investment in PHC institutions has not led to the expected efficiency gains. Therefore, more effective measures should be taken to improve the efficiency of PHC institutions in China based on local conditions. This study provides a new analytical approach to calculating the efficiency of PHC institutions, and this approach can be applied to efficiency evaluation either in other fields or in other countries.
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Affiliation(s)
- Wanmin Su
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, 528244, Guangdong, People's Republic of China
- School of Nursing and Health, Henan University, Kaifeng, 475004, Henan, People's Republic of China
| | - Yatian Hou
- School of Nursing and Health, Henan University, Kaifeng, 475004, Henan, People's Republic of China
| | - Mengge Huang
- School of Nursing and Health, Henan University, Kaifeng, 475004, Henan, People's Republic of China
| | - Jiamian Xu
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, 528244, Guangdong, People's Republic of China
| | - Qingfeng Du
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, 528244, Guangdong, People's Republic of China.
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.
| | - Peixi Wang
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, 528244, Guangdong, People's Republic of China.
- School of Nursing and Health, Henan University, Kaifeng, 475004, Henan, People's Republic of China.
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Sun M, Ye Y, Zhang G, Shang X, Xue Y. Healthcare services efficiency and its intrinsic drivers in China: based on the three-stage super-efficiency SBM model. BMC Health Serv Res 2023; 23:811. [PMID: 37516853 PMCID: PMC10386256 DOI: 10.1186/s12913-023-09820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND The purpose of this study is to examine the development of healthcare services efficiency in China since the reform of the healthcare system. By examining the development environment of healthcare services in China and examining the driving factors affecting the efficiency of healthcare services, we provide a reference for the future high-quality development of healthcare services in China. METHODS A three-stage super-efficient slack-based measure (SBM) model with undesirable outputs was used to measure the efficiency of healthcae services in 31 Chinese provinces from 2009 to 2021, and a global Malmquist-Luenberger (GML) index was used to assess their spatiotemporal evolution characteristics and internal influencing mechanisms of healthcare services efficiency. RESULTS The empirical results showed that the efficiency of China's healthcare services changed significantly from 2009-2014 and then remained stable. During the study period, the efficiency of healthcare services in the eastern region was higher than the national level, while it was lower in the western region. The results of the analysis of environmental factors indicated that an increase in population density reduced the redundancy of healthcare input resources and that economic development as well as an increase in government subsidies, contributed to an increase in the redundancy of healthcare input resources. The main contribution to the growth of healthcare sercices efficiency in China came from the technological innovation effect, and the growth was most significant in the western region. CONCLUSION From 2009 to 2021, the efficiency of national healthcare services generally showed a slow upward trend, and the efficiency of healthcare services varied widely among regions. Under the existing environmental constraints, relevant departments in each region should strengthen technological innovation in healthcare services, completely focus on the regional catch-up effect, and promote the balanced development of regional health.
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Affiliation(s)
- Mengya Sun
- College of Science, Zhejiang University of Science and Technology, Hangzhou, China
| | - Yaojun Ye
- College of Science, Zhejiang University of Science and Technology, Hangzhou, China.
| | - Guangdi Zhang
- College of Science, Zhejiang University of Science and Technology, Hangzhou, China
| | - Xiuling Shang
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China.
| | - Yuan Xue
- Operation and Management Office, Fujian Provincial Hospital, Fuzhou, China.
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Zhang W, He X, Liu Z. Factors and Mechanism Influencing Client Experience of Residential Integrated Health and Social Care for Older People: A Qualitative Model in Chinese Institutional Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4638. [PMID: 36901645 PMCID: PMC10002276 DOI: 10.3390/ijerph20054638] [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: 01/19/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND An emerging service delivery model of integrating health and social care for older people has been actively promoted by the Chinese government since 2016, but the client experience and influencing mechanism still remain unclear. METHODS this study adopts a qualitative methodology to delve deeper into the factors and mechanism shaping the client experience of residential integrated health and social care for older people in the Chinese context, so as to understand the experiences of older residents during the whole process of receiving integrated care services, and on this basis, put forward suggestions for the improvement of a high-quality aged care service system. We coded and analyzed the in-depth interview data of twenty older adults and six staff members from June 2019 to February 2020, recruited from six institutions in Changsha, one of the ninety pilot cities for integrated health and social care in China. RESULTS the findings showed that the client experience of older adults is mainly affected by factors in three dimensions (scene construction, individual minds, and interaction and communication), which are comprised of six sub-categories (social foundation, institutional functions, perception and emotion, cognition and understanding, intimacy and trust, and participation). Based on the factors and mechanism (consisting of six influencing paths), we constructed a model of the client experience of integrated health and social care for older people in the Chinese population. CONCLUSIONS the factors and mechanism influencing the client experience of integrated health and social care for older people are complex and multifaceted. Attention should be paid to the direct effects of perception and emotion, institutional functions, intimacy and trust in the client experience, and the indirect effects of social foundation and participation on the client experience.
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Affiliation(s)
- Wenya Zhang
- Center for Social Security Studies, Wuhan University, Wuhan 430072, China
- School of Public Administration, Central South University, Changsha 410075, China
| | - Xiaojiao He
- School of Public Administration, Central South University, Changsha 410075, China
| | - Zhihan Liu
- School of Public Administration, Central South University, Changsha 410075, China
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Zhou J, Peng R, Chang Y, Liu Z, Gao S, Zhao C, Li Y, Feng Q, Qin X. Analyzing the efficiency of Chinese primary healthcare institutions using the Malmquist-DEA approach: Evidence from urban and rural areas. Front Public Health 2023; 11:1073552. [PMID: 36817900 PMCID: PMC9931751 DOI: 10.3389/fpubh.2023.1073552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background China has been increasing the investment in Primary Health Care Institutions (PHCIs) since the launch of the New Health Care System Reform in 2009. It is a crucial concern whether the PHCIs can meet residents' need both in urban and rural with the limited government finance, especially encountering the challenge of the COVID-19. This study aimed to reveal the trend of the primary health service efficiency in the past decade, compare the urban-rural differences, and explore relevant factors. Methods DEA and Malmquist models were applied to calculate the health service efficiency of PHCIs among 28 provinces in China, with the input variables including the number of institutions, number of beds, number of health technicians, and the outputs variables including the number of outpatients and emergency visits, number of discharged patients. And the Tobit model was used to analyze the factors on the efficiency in urban and rural. A sensitivity analysis for model validations was also carried out. Results The average technical efficiency (TE) of urban PHCIs fluctuated from 63.3% to 67.1%, which was lower than that in rural (75.8-82.2%) from 2009 to 2019. In terms of dynamic efficiency, the urban PHCIs performed better than the rural, and the trends in the total factor productivity change were associated with favorable technology advancement. The population density and dependency ratio were the key factors on TE in both of the urban and rural PHCIs, and these two factors were positively correlated to TE. In terms of TE, it was negatively correlated with the proportion of total health expenditure as a percentage of GDP in urban PHCIs, while in rural it was positively correlated with the urbanization rate and negatively correlated with GDP per capita. Besides, the tests of Mann-Whitney U, and Kruskal-Wallis H indicated the internal validity and robustness of the chosen DEA and Malmquist models. Conclusions It needs to reduce the health resource wastes and increase service provision in urban PHCIs. Meanwhile, it is necessary to strengthen medical technology and gaining greater efficiency in rural PHCIs by technology renovation.
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Affiliation(s)
- Junxu Zhou
- School of Public Policy and Management, Guangxi University, Nanning, China
| | - Rong Peng
- School of Public Policy and Management, Guangxi University, Nanning, China
- Health Policy Research Center, Guangxi Medical University, Nanning, China
| | - Yajun Chang
- School of Public Policy and Management, Guangxi University, Nanning, China
| | - Zijun Liu
- School of Public Policy and Administration, Chongqing University, Chongqing, China
| | - Songhui Gao
- School of Public Policy and Management, Guangxi University, Nanning, China
| | - Chuanjun Zhao
- School of Public Policy and Management, Guangxi University, Nanning, China
| | - Yixin Li
- School of Public Policy and Management, Guangxi University, Nanning, China
| | - Qiming Feng
- Health Policy Research Center, Guangxi Medical University, Nanning, China
| | - Xianjing Qin
- Health Policy Research Center, Guangxi Medical University, Nanning, China
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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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Ye Y, Evans R, Jing L, Rizwan M, Xuan Y, Lu W. The Impact of County Medical Community Reform on the Medical Service Efficiency of County-Level Public General Hospitals in China: A Case Study of Shanxi Province. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13827. [PMID: 36360707 PMCID: PMC9656417 DOI: 10.3390/ijerph192113827] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
China introduced the county medical community (CMC) reform, aimed to provide high-quality medical resources to rural citizens, in 2017. This study examines the impact of the reform on the medical service efficiency of county-level public general hospitals in Shanxi Province, China. In total, 92 county-level public general hospitals from Shanxi Province were taken as the research objective, and the super-efficiency SBM-DEA model was applied to measure medical service efficiency. Further, a two-way fixed-effect model was used to evaluate the impact of CMC reform on the medical service efficiency of county-level public general hospitals by using health statistics data from 2014 to 2018. The study reveals that the CMC reform improved the medical service efficiency of county-level public general hospitals by 15.6%. Moreover, the CMC reform had regional heterogeneity in its impact on the medical service efficiency of county-level public general hospitals. The CMC reform improved the medical service efficiency of hospitals in the southern region more than in the northern region of the province. The medical service efficiency of hospitals in the central region was also improved by CMC reform, but the causal relationship was not found significant. Further, hospital-level factors (e.g., fixed assets, hospital stay, and regional health center) and environmental factors (e.g., GDP, population, urbanization rate, and government subsidies) affected the medical service efficiency of county-level public hospitals during the process of promoting the CMC reform.
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Affiliation(s)
- Yun Ye
- School of Management, Hainan Medical University, 3 Xueyuan Road, Longhua District, Haikou 571199, China
| | - Richard Evans
- Faculty of Computer Science, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Li Jing
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Muhammad Rizwan
- School of Economics and Management, Yangtze University, Jingzhou 434023, China
| | - Yan Xuan
- Hainan Women and Children’s Medical Center, Haikou 570312, China
| | - Wei Lu
- School of Management, Hainan Medical University, 3 Xueyuan Road, Longhua District, Haikou 571199, China
- Hainan Women and Children’s Medical Center, Haikou 570312, China
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Hou Y, Tao W, Hou S, Li W. Levels, trends, and determinants of effectiveness on the hierarchical medical system in China: Data envelopment analysis and bootstrapping truncated regression analysis. Front Public Health 2022; 10:921303. [PMID: 36203685 PMCID: PMC9530448 DOI: 10.3389/fpubh.2022.921303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/19/2022] [Indexed: 01/22/2023] Open
Abstract
Background The hierarchical medical system (HMS) refers to the classification of treatment according to disease priorities based on severity and difficulty to promote the fairness of medical services for residents, which is regarded as the key to the success of medical reform in China. Methods In the past decade of "New Medical Reform," the efficiency of HMS, including secondary and tertiary hospitals and primary healthcare centers (PHCs), was measured horizontally and vertically by employing the combination of an output-oriented superefficiency slack-based model-data envelopment analysis (SE-SBM-DEA) model with the Malmquist total factor productivity index (MTFP). In the second stage, the overall technical efficiency (OTE) scores were regressed against a set of environmental characteristics and several managerial factors through bootstrapping truncated regression. Results On average, the OTE score in tertiary hospitals was 0.93, which was higher than that in secondary hospitals and PHCs (0.9 and 0.92, respectively). In terms of trend, the OTE of tertiary hospitals declined at first and then increased. The opposite was true of secondary hospitals, in which the APC of the OTE was 10.82 and -3.11% in early and late 2012, respectively. The PHCs generally showed a fluctuating downward trend. In the aspects of productivity, all institutions showed a downturn by an annual average rate of 2.73, 0.51, and 2.70%, respectively. There was a significant negative relationship between the ratio of outpatients to inpatients and tertiary hospitals. Additionally, the medical technical personnel per 1,000 population negatively affected PHCs. In contrast, the GDP per capita had a significantly positive effect on tertiary hospitals, and the number of beds per 1,000 population positively influenced PHCs. Conclusion The efficiency of medical institutions at various levels in HMS was unbalanced and took the form of an "inverted pyramid." Multilateral factors influence the efficiency of HMS, and to address it, multi-intervention packages focusing on sinking high-quality medical resources and improving healthcare capacity, and guiding hierarchical medical practice should be adopted.
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Affiliation(s)
- Yuanxin Hou
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Shufen Hou
- Department of Critical Care Medicine, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Weimin Li
- President's Office, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Weimin Li
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Chen K, Li Z, Liu R, Zhu Y, Yan W, Pui NAP, Chen Z. Distribution of health problems at the general outpatients' clinic of the University of Hong Kong-Shenzhen Hospital: A cross-sectional study. Front Public Health 2022; 10:889819. [PMID: 36003636 PMCID: PMC9393786 DOI: 10.3389/fpubh.2022.889819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe study aimed to understand the distribution of health problems of a general practice clinic to provide guidance on how to develop primary care in Shenzhen, China.Study designThis is a cross-sectional study.MethodsPatients' sociodemographic data and diagnoses were recorded from the electronic medical record system of the University of Hong Kong-Shenzhen Hospital from Jan 2014 to Dec 2020 and coded using the International Classification of Primary Care-2. Descriptive statistics were used to describe the distribution of health problems.ResultsA total of 368,167 health problems were recorded. Respiratory, digestive, musculoskeletal, general, and cardiovascular were the top five categories, which accounted for 67.71% of the total in this study. Acute upper respiratory tract infection (AURTI) was the most common health problem (6.67%). Chronic diseases, including hypertension and diabetes mellitus, accounted for about 7% of all health problems. The proportion of cardiovascular problems increased significantly with age (r = 0.96, P < 0.05). The proportion of consultations for mental health problems was low in all age groups.ConclusionsThe results represent an understanding of the common health problems of patients in Shenzhen city, which can provide a reference for preventing diseases and developing primary care.
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Affiliation(s)
- Kai Chen
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Zhuo Li
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
- *Correspondence: Zhuo Li
| | - Ruihong Liu
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Yanyan Zhu
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Weihui Yan
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Ng Amy Pui Pui
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Shenzhen, China
| | - Zhiyuan Chen
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
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