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Zhao J, Luo M, Tan X, Zhu Z, Zhang M, Liu J, Lin W, Yang Y, Li X, Zeng W, Gong D, Rong Z, Huang Z, Zheng W, Guo H, Zeng S, Sun L, Xiao J. Spatial accessibility and inequality analysis of rabies-exposed patients to rabies post-exposure prophylaxis clinics in Guangzhou City, China. Int J Equity Health 2024; 23:122. [PMID: 38877457 PMCID: PMC11179278 DOI: 10.1186/s12939-024-02207-2] [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: 02/07/2024] [Accepted: 05/29/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The incidence of rabies exposure is high and increasing in China, leading to an urgent demand of rabies post-exposure prophylaxis (PEP) clinics for the injured. However, the spatial accessibility and inequality of rabies-exposed patients to rabies PEP clinics is less known in China. METHODS Based on rabies exposure data, PEP clinic data, and resident travel origin-destination (OD) matrix data in Guangzhou City, China, we first described the incidence of rabies exposure in Guangzhou from 2020 to 2022. Then, the Gaussian two-step floating catchment area method (2SFCA) was used to analyze the spatial accessibility of rabies-exposed patients to rabies PEP clinics in Guangzhou, and the Gini coefficient and Moran's I statistics were utilized to evaluate the inequality and clustering of accessibility scores. RESULTS From 2020 to 2022, a total of 524,160 cases of rabies exposure were reported in Guangzhou, and the incidence showed a significant increasing trend, with an average annual incidence of 932.0/100,000. Spatial accessibility analysis revealed that the overall spatial accessibility scores for three scenarios (threshold of driving duration [d0] = 30 min, 45 min, and 60 min) were 0.30 (95% CI: 0.07, 0.87), 0.28 (95% CI: 0.11, 0.53) and 0.28 (95% CI: 0.14, 0.44), respectively. Conghua, Huangpu, Zengcheng and Nansha districts had the higher accessibility scores, while Haizhu, Liwan, and Yuexiu districts exhibited lower spatial accessibility scores. The Gini coefficient and Moran's I statistics showed that there were certain inequality and clustering in the accessibility to rabies PEP clinics in Guangzhou. CONCLUSIONS This study clarifies the heterogeneity of spatial accessibility to rabies PEP clinics, and provide valuable insights for resource allocation to achieve the WHO target of zero human dog-mediated rabies deaths by 2030.
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Affiliation(s)
- Jianguo Zhao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Min Luo
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xiaohua Tan
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zhihua Zhu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Meng Zhang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jun Liu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Wenqing Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Yuwei Yang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Dexin Gong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zitong Huang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wenyuan Zheng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
- Department of Public Health and Preventive Medicine, School of Medicine, Ji'nan University, Guangzhou, 510632, China
| | - Huijie Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Siqing Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Limei Sun
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
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Wang LY, Hu ZY, Chen HX, Zhou CF, Tang ML, Hu XY. Differences in regional distribution and inequality in health workforce allocation in hospitals and primary health centers in China: A longitudinal study. Int J Nurs Stud 2024; 157:104816. [PMID: 38824719 DOI: 10.1016/j.ijnurstu.2024.104816] [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: 02/22/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND In 2009, China launched a new round of healthcare reform to provide households with secure, efficient, convenient, equitable and affordable healthcare services. Healthcare reform is underpinned by three critical pillars: the health workforce, funding, and infrastructure, with reform of the health workforce being particularly significant. OBJECTIVE This study analyses the disparities in regional distribution and the inequity of healthcare workforce allocation across hospitals and primary health centers in China over twelve years. DESIGN Retrospective longitudinal data from the National Health Statistics Yearbook 2011-2022 and National Statistical Yearbook in China from 2011 to 2022 were collected for analysis. PARTICIPANTS The focus was on hospitals and primary health centers, explicitly examining their health technician and nursing workforce. METHODS The research utilized four key indicators of the healthcare workforce to evaluate the distribution of health resources between hospitals and primary health centers. Furthermore, the Gini coefficient and Theil index were employed to assess the inequality in allocating the health workforce. RESULTS Between 2010 and 2021, there was a nationwide increase in the ratio of health workers per 1000 population in hospitals and primary health centers. It is noted that rural districts had higher ratios than urban districts in terms of the number of health technicians and nurses per 1000 population, whether in hospitals or primary health centers; western districts had higher ratios than eastern and central districts did. In the same year, at different levels of medical institutions, the Theil indices of health technicians and nurses in hospitals were lower than those in primary health centers in terms of both demographic and geographical dimensions. Regarding the allocation of the health workforce by population, the Gini coefficient remained below 0.3, while for geographical allocation, it exceeded 0.4. CONCLUSIONS This study analyzed the temporal trends and inequality of health-resource allocation at the hospital and primary health center levels in China, noting trends of improvements in the quantity and inequality in health workforce allocation from 2010 to 2021, suggesting the success of the government's efforts to advance healthcare reform since 2009. The allocation of health workforce based on population exhibits greater fairness compared to geographical distribution.
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Affiliation(s)
- Ling-Ying Wang
- Critical Care Medicine Department, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China; Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Zi-Yi Hu
- Nursing Department, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Hong-Xiu Chen
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Chun-Fen Zhou
- Mental Health Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Meng-Lin Tang
- Critical Care Medicine Department, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Xiu-Ying Hu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, China.
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Liu R, Zhao Q, Dong W, Guo D, Shen Z, Li Y, Zhang W, Zhu D, Zhang J, Bai J, Ren R, Zhen M, Zhang J, Cui J, Li X, Miao Y. Assessing public health service capability of primary healthcare personnel: a large-scale survey in Henan Province, China. BMC Health Serv Res 2024; 24:627. [PMID: 38745226 PMCID: PMC11094852 DOI: 10.1186/s12913-024-11070-4] [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: 12/05/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The public health service capability of primary healthcare personnel directly affects the utilization and delivery of health services, and is influenced by various factors. This study aimed to examine the status, factors, and urban-rural differences of public health service capability among primary healthcare personnel, and provided suggestions for improvement. METHODS We used cluster sampling to survey 11,925 primary healthcare personnel in 18 regions of Henan Province from 20th to March 31, 2023. Data encompassing demographics and public health service capabilities, including health lifestyle guidance, chronic disease management, health management of special populations, and vaccination services. Multivariable regression analysis was employed to investigate influencing factors. Propensity Score Matching (PSM) quantified urban-rural differences. RESULTS The total score of public health service capability was 80.17 points. Chronic disease management capability scored the lowest, only 19.60. Gender, education level, average monthly salary, professional title, health status, employment form, work unit type, category of practicing (assistant) physician significantly influenced the public health service capability (all P < 0.05). PSM analysis revealed rural primary healthcare personnel had higher public health service capability scores than urban ones. CONCLUSIONS The public health service capability of primary healthcare personnel in Henan Province was relatively high, but chronic disease management required improvement. Additionally, implementing effective training methods for different subgroups, and improving the service capability of primary medical and health institutions were positive measures.
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Affiliation(s)
- Rongmei Liu
- Henan Key Laboratory for Health Management of Chronic Diseases, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qiuping Zhao
- Henan Key Laboratory for Health Management of Chronic Diseases, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenyong Dong
- Department of Hypertension, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Dan Guo
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Zhanlei Shen
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Yi Li
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Wanliang Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Dongfang Zhu
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Jingbao Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Junwen Bai
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Ruizhe Ren
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Mingyue Zhen
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Jiajia Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Jinxin Cui
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Xinran Li
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China.
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Deng J, Song Q, Liu H, Jiang Z, Ge C, Li D. The coupling coordination between health service supply and regional economy in China: spatio-temporal evolution and convergence. Front Public Health 2024; 12:1352141. [PMID: 38774045 PMCID: PMC11106377 DOI: 10.3389/fpubh.2024.1352141] [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: 12/12/2023] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
Background The coordination of health service supply and regional economy is an integral path to promote China's prosperity. Methods Based on the coupling mechanism of health service supply and regional economy, we sampled the data from 30 provinces in China from 2009 to 2021 in this study and constructed the evaluation index system. Additionally, we calculated the coupling coordination degree (HED) of the two through the coupling coordination degree model. We further used the kernel density estimation, Moran's I index, and spatial β convergence model to assess the dynamic evolution trends, spatial aggregation effect, and spatial convergence characteristics of coupling coordination. Conclusion (1) HED in China showed a rising trend during the study period but with large regional differences, forming a gradient distribution pattern of "high in the east and low in the west." (2) The results of Kernel density estimation show that HED has formed a gradient differentiation phenomenon within each region in China. (3) HED has modeled spatial clustering characteristics during the study period, with high-value clusters mainly appearing in the eastern region and low-value clusters appearing in the northwestern region. (4) There are absolute β-convergence and conditional β-convergence trends in HED in China and the three major regions during the study period, but there is an obvious regional heterogeneity in the control factors. The research provides a reference for accurately implementing policies according to different levels of health service supply and economic development, in addition to narrowing the regional differences of the coupling coordination between the regional economy and health service supply.
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Affiliation(s)
- Jing Deng
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Data Science and Traditional Chinese Medicine Innovation and Development, Anhui University of Chinese Medicine, Hefei, China
| | - Qianwen Song
- Office of Chengdu Shuangliu District Maternal and Child Health Hospital, Chengdu, China
| | - Huan Liu
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Data Science and Traditional Chinese Medicine Innovation and Development, Anhui University of Chinese Medicine, Hefei, China
| | - Zicheng Jiang
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Data Science and Traditional Chinese Medicine Innovation and Development, Anhui University of Chinese Medicine, Hefei, China
| | - Chengzhi Ge
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Data Science and Traditional Chinese Medicine Innovation and Development, Anhui University of Chinese Medicine, Hefei, China
| | - Dexun Li
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
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Chai Y, Yuan X, Guo L, Chen Z. The Impact of Broadband Infrastructure Construction on Medical Resource Mismatch: Quasi-Natural Experiment From the Broadband China Policy. J Med Internet Res 2024; 26:e53921. [PMID: 38512327 PMCID: PMC10995788 DOI: 10.2196/53921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Whether the construction of broadband infrastructure can alleviate the problem of mismatched medical resources is crucial to the national information strategy, residents' well-being, and social equity. However, the academic community lacks a comprehensive theoretical analysis and rigorous empirical research on this issue. OBJECTIVE This study aims to construct a preliminary theoretical framework to scientifically assess the effects of broadband infrastructure development on the mitigation of health care resource mismatch from both theoretical and empirical perspectives, to explore the potential mechanisms of influence, and ultimately to develop several practical policy recommendations. METHODS We first used a theoretical analysis to propose testable theoretical hypotheses and establish a preliminary theoretical framework. Then, based on balanced panel data from 300 cities from 2010 to 2021, a 2-way fixed effects difference-in-differences model was used for empirical testing. Mechanism tests, robustness analyses, and heterogeneity analyses were further conducted. RESULTS The research findings demonstrate that the Broadband China Policy significantly reduces the degree of mismatch in medical resources by primarily using innovation effects and integration effects, resulting in a reduction of 13.2%. In addition, the heterogeneity analysis reveals that the central and eastern regions, cities with large populations, and areas with a high proportion of young people benefit more significantly. CONCLUSIONS This study fully confirms, both theoretically and empirically, that broadband infrastructure construction can effectively reduce the mismatch of medical resources not only by expanding the existing literature on the impact of broadband on public services but also by providing valuable opportunities for policy makers to optimize the allocation of medical resources.
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Affiliation(s)
- Yulin Chai
- School of Management, Shandong Second Medical University, Weifang, China
| | - Xiaoping Yuan
- School of Psychology, Shandong Second Medical University, Weifang, China
| | - Lin Guo
- School of Management, Shandong Second Medical University, Weifang, China
| | - Zhongming Chen
- School of Management, Shandong Second Medical University, Weifang, China
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Zhou M. Equity and efficiency of health resource allocation in township health centers in Sichuan Province, China. PLoS One 2024; 19:e0299988. [PMID: 38442112 PMCID: PMC10914297 DOI: 10.1371/journal.pone.0299988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To analyze the equity and efficiency of health resource allocation in township health centers in Sichuan Province, and to provide a scientific basis for promoting the development of township health centers in Sichuan Province, China. METHODS The Lorenz curve, Gini coefficient and health resource density index were used to analyze the equity of health resource allocation in township health centers in Sichuan Province from 2017 to 2021, and data envelopment analysis(DEA) was used to analyze the efficiency of health resource allocation in township health centers in Sichuan Province from 2017 to 2021. RESULTS The Gini coefficient of health resources of township health centers in Sichuan Province is below 0.2 by population in addition to the number of beds in 2020-2021 and practicing (assistant) physicians in 2021, and the Gini coefficient of health resources of township health centers in Sichuan Province is above 0.6 by geography. The Lorentz curve of health resources of township health centers in Sichuan Province is closer to the equity line by population allocation and further from the equity line by geographical allocation. The average level of township health centers in Sichuan Province is used as the standard to calculate the health resource density standard index(W) of each region, the Ws of Panzhihua, Ganzi, Aba and Liangshan are less than 1, and the Ws of Ziyang, Neijiang, Deyang and Meishan are greater than 1. The overall efficiency of township health centers in Sichuan Province in 2017 and 2021 is 1, and the DEA is relatively effective. The overall efficiency of township health centers in Sichuan Province in 2018 and 2019 is not 1, and the DEA is relatively ineffective. The overall efficiency of all health resources in Mianyang and Ziyang is 1, and the DEA is relatively effective. The overall efficiency of all health resources in Suining, Neijiang, Yibin, Aba and Ganzi is not 1, and the DEA is relatively ineffective. CONCLUSION The equity of health resource allocation by population is better than that by geography in township health centers in Sichuan Province. Combining population and geographical factors, the health resource allocation of Panzhihua, Ganzi, Aba and Liangshan is lower than the average level of Sichuan Province. The efficiency of health resource allocation in township health centers in Sichuan Province is low.
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Affiliation(s)
- Minghua Zhou
- Department of Administration Office, Luzhou People’s Hospital, Luzhou, Sichuan, China
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Wang Y, Yu M, He M, Zhang G, Zhang L, Zhang B. Diagnostic value of a computer-assisted diagnosis system for the ultrasound features in thyroid nodules. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 68:e220501. [PMID: 37948567 PMCID: PMC10916796 DOI: 10.20945/2359-4292-2022-0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/15/2023] [Indexed: 11/12/2023]
Abstract
Objective To explore the diagnostic value of the TUIAS (SW_TH01/II) computer-aided diagnosis (CAD) software system for the ultrasound Thyroid Imaging Reporting and Data System (TI-RADS) features in thyroid nodules. Materials and methods This retrospective study enrolled patients with thyroid nodules in Shanghai East Hospital between January 2017 and October 2021. The novel CAD software (SW_TH01/II) and three sonographers performed a qualitative analysis of the ultrasound TI-RADS features in aspect ratio, margin irregularity, margin smoothness, calcification, and echogenicity of the thyroid nodules. Results A total of 225 patients were enrolled. The accuracy, sensitivity, and specificity of the CAD software in "aspect ratio" were 95.6%, 96.2%, and 95.4%, in "margin irregularity" were 90.7%, 90.5%, and 90.9%, in "margin smoothness" were 85.8%, 88.5%, and 83.0%, in "calcification" were 83.6%, 81.7%, and 82.0%, in "homogeneity" were 88.9%, 90.6%, and 82.2%, in "major echo" were 85.3%, 88.0%, and 85.4%, and in "contains very hypoechoic echo" were 92.0%, 90.0%, and 92.4%. The analysis time of the CAD software was significantly shorter than for the sonographers (2.7 ± 1.6 vs. 29.7 ± 12.7 s, P < 0.001). Conclusion The CAD system achieved high accuracy in describing thyroid nodule features. It might assist in clinical thyroid nodule analysis.
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Affiliation(s)
- Yiwei Wang
- Graduate School of Dalian Medical University, Dalian, Liaoning, China,
| | - Ming Yu
- Tend. AI Medical Technology, China
| | | | | | - Libo Zhang
- Shanghai East Hospital, Department of Ultrasound in Medicine, Shanghai, China
| | - Bo Zhang
- Shanghai East Hospital, Tongji University School of Medicine, Department of Ultrasound in Medicine, Shanghai, China
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Ji H, Yu Y. Examining coordination and equilibrium: an analysis of supply index and spatial evolution characteristics for older adult services in Zhejiang Province. Front Public Health 2023; 11:1222424. [PMID: 37869205 PMCID: PMC10586503 DOI: 10.3389/fpubh.2023.1222424] [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: 05/14/2023] [Accepted: 08/14/2023] [Indexed: 10/24/2023] Open
Abstract
Objective This study aims to analyze the spatial distribution and dynamic evolution of older adult service supply in Zhejiang Province from 2010 to 2019. Additionally, this research seeks to propose an optimized resource allocation strategy for older adult care services, promoting regional fairness and coordinated development. Methods To evaluate the older adult service supply capacity, this research first constructed an evaluation index system based on the Chinese modernization development pattern. Then, an empirical analysis was carried out using a combination of the entropy-TOPSIS method, kernel density estimation, Markov chain analysis, Dagum Gini coefficient, and panel regression model. Results The results show an overall upward trend in the supply and service capacity of older adult care in the whole province. However, the spatial distribution of older adult service supply capacity in Zhejiang Province still exhibits a gradient effect, even in the most recent year of 2019. Furthermore, the supply capacity of older adult services shifted to a higher level in the whole province, and regions with high supply capacity had a positive spillover effect on adjacent regions. The overall difference in the older adult service supply capacity of the province showed a decreasing trend. The level of economic development, urbanization rate, transportation capacity, the level of opening up, and the proportion of employees in the tertiary industry had a significant impact on the supply capacity and spatial difference of older adult services. Conclusion From the findings, this study puts forth countermeasures and suggestions to optimize the spatial distribution of older adult care services. This includes giving full play to the regional spatial linkage effect, promoting new-type urbanization construction, upgrading the transportation network, and expanding the opening up of the industrial structure. By implementing these measures, a more equitable and coordinated older adult services system can be developed in Zhejiang Province.
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Xiong Y, Qin J, Zhou L, Huang Z, Wu C, Liu L. The working experience of medical staff in the hospital-wide bed-sharing mode: A qualitative study. Nurs Open 2023; 10:6885-6895. [PMID: 37469117 PMCID: PMC10495703 DOI: 10.1002/nop2.1940] [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: 11/18/2022] [Revised: 06/14/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
AIM The purpose of this study was to provide a comprehensive understanding of the attitudes and experiences of the medical staff regarding the hospital bed-sharing model. DESIGN The present research was a qualitative study. METHODS This qualitative study used in-depth individual interviews with 7 doctors, 10 clinical nurses and 3 head nurses, which were then transcribed and analysed thematically. RESULTS The study identified six overall themes. Issues were raised about the efficient utilization of hospital bed resources, greater challenges for nursing work, adjustment of doctors' work modes, barriers to communication between doctors, nurses, and patients, potential medical risks, and differentiation of patients' medical experience. IMPLICATIONS FOR NURSING MANAGEMENT Hospital administrators and nurse managers should work together to solve the challenges that medical staff face, including strengthening nursing training, improving medical-nursing collaboration models, standardizing and effective communication strategies, and improving patient experiences.
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Affiliation(s)
- Ying Xiong
- Department of Vascular SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of HematologyChongqing General HospitalChongqingChina
| | - Juan Qin
- Department of HematologyChongqing General HospitalChongqingChina
| | - Li‐li Zhou
- Nursing DepartmentChongqing General HospitalChongqingChina
| | - Zhi‐feng Huang
- Nursing DepartmentChongqing General HospitalChongqingChina
| | - Cai‐e Wu
- Nursing DepartmentChongqing General HospitalChongqingChina
| | - Li‐ping Liu
- Department of Vascular SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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Zhou M. Equity and prediction of health resource allocation of traditional Chinese medicine in China. PLoS One 2023; 18:e0290440. [PMID: 37616267 PMCID: PMC10449139 DOI: 10.1371/journal.pone.0290440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 07/08/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To analyze the equity of health resource allocation of Traditional Chinese Medicine(TCM) and predict its development during the 14th Five-Year Plan period, and to provide a scientific basis for promoting the improvement of TCM service capacity. METHODS The Chinese Mainland (excluding Hong Kong, Macao and Taiwan) was divided into the Northeast, Eastern, Central and Western regions, and the number of TCM medical institutions, the number of TCM beds, practitioners (assistants) of TCM and Chinese pharmacists from 2016 to 2020 were selected as evaluation indicators, and the equity of health resource allocation of TCM was evaluated by Concentration index(CI), Theil index(T) and Health resource agglomeration degree (HRAD), and the development of health resource of TCM during the 14th Five-Year Plan period was predicted by grey prediction model GM (1,1). RESULTS The Concentration index of the number of TCM medical institutions and TCM beds is negative, and the allocation tends to the regions with low economic development level. The Concentration index of practitioners (assistants) of TCM and Chinese pharmacists is positive, and the allocation tends to the regions with higher economic development level. The number of TCM medical institutions, TCM beds, practitioners (assistants) of TCM and Chinese pharmacists' Theil index allocated by geography is larger than that allocated by population, which indicates that the equity of TCM health resources allocated by population is better than that allocated by geography. The number of TCM medical institutions, practitioners (assistants) of TCM and Chinese pharmacists in between regions by population contributed more than 72% to the Theil index, indicating that the inequity mainly comes from between regions. The number of TCM medical institutions, TCM beds, practitioners (assistants) of TCM and Chinese pharmacists in within regions by geography contributed more than 80% to the Theil index, indicating that the inequity mainly comes from within regions. The HRAD in the Eastern and Central regions is greater than 1, indicating that the equity is better by geography. The HRAD in the Western region is less than 1, indicating insufficient equity by geography. The HRAD/PAD of the Central region (except for the number of TCM beds in 2020) is less than 1, indicating that it cannot meet the medical needs of the agglomerated population. The HRAD/PAD of the Western region (excluding for the Chinese pharmacists) is greater than 1, indicating that the equity is better than that of the agglomeration population. CONCLUSION The number of TCM medical institutions and TCM beds tends to regions with low economic development levels, while the number of practitioners (assistants) of TCM and Chinese pharmacists tends to regions with high economic development levels. The equity of the allocation of TCM health resources by population is better than that by geography, and the inequity of the allocation by geography mainly comes from within region. The allocation of health resources of TCM in the four regions is different, and there is a contradiction between equity and actual medical needs.
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Affiliation(s)
- Minghua Zhou
- Department of administration office, Luzhou People’s Hospital, Luzhou, Sichuan, 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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Al-Sheddi A, Kamel S, Almeshal AS, Assiri AM. Distribution of Primary Healthcare Centers Between 2017 and 2021 Across Saudi Arabia. Cureus 2023; 15:e41932. [PMID: 37583734 PMCID: PMC10425129 DOI: 10.7759/cureus.41932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND AND AIM Access to adequate healthcare systems is seen as a fundamental human right. Therefore, healthcare services must be distributed and accessible in the most efficient way possible to those who need them the most. Primary healthcare centers are the backbone of any healthcare system as they provide essential healthcare services to the general population. Inequalities in the distribution of primary healthcare centers can lead to disparities in healthcare access and outcomes. This study aimed to assess the equity of primary healthcare centers distribution, we analyzed and evaluated the allocation of primary healthcare centers in Saudi Arabia from 2017 to 2021. METHOD This cross-sectional study utilized data from the Health Statistical Yearbook published by the Ministry of Health, Saudi Arabia, during the period of 2017-2021. The number of primary healthcare centers per 10,000 population was calculated for the 20 health regions. We used the Gini index to measure inequality in the distribution of primary healthcare centers. The Pearson coefficient was calculated to assess the correlation between the number of primary healthcare centers and the population in each health region. RESULT The overall ratio of primary healthcare centers to population decreased from 0.72 to 0.62 between 2017 and 2021. The Gini index showed relative equality in the distribution of primary healthcare centers from 2017 to 2021 with values between 0.2 and 0.3. There was a positive correlation between the population and the primary healthcare centers in Jeddah, Tabouk, and the Northern Region. However, in Riyadh, Makkah, Taif, Madinah, Qaseem, Eastern Region, Al-Ahsa, Aseer, Hail, Jazan, Najran, Al-Baha, and Al-Jouf, the correlation was found to be negative. CONCLUSION From 2017 to 2021, primary healthcare facilities are distributed fairly throughout 20 health regions of Saudi Arabia. However, there are still some disparities between provinces, and efforts must be made to ensure that primary healthcare centers are distributed equitably across the country to improve healthcare access and outcomes for all.
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Affiliation(s)
- Ahmed Al-Sheddi
- Field Epidemiology Training Program (FETP), Ministry of Health, Riyadh, SAU
| | - Shady Kamel
- Field Epidemiology Training Program (FETP), Ministry of Health, Riyadh, SAU
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Sanhueza A, Mujica OJ, Soliz PN, Cox AL, de Mucio B. Scenarios of maternal mortality reduction by 2030 in the Americas: insights from its tempo. Int J Equity Health 2023; 22:121. [PMID: 37381010 PMCID: PMC10303897 DOI: 10.1186/s12939-023-01938-y] [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: 12/24/2022] [Accepted: 06/18/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND The enduring threat of maternal mortality to health worldwide and in the Americas has been recognized in the global and regional agendas and their targets to 2030. To inform the direction and amount of effort needed to meet those targets, a set of equity-sensitive regional scenarios of maternal mortality ratio (MMR) reduction based on its tempo or speed of change from baseline year 2015 was developed. METHODS Regional scenarios by 2030 were defined according to: i) the MMR average annual rate of reduction (AARR) needed to meet the global (70 per 100,000) or regional (30 per 100,000) targets and, ii) the horizontal (proportional) or vertical (progressive) equity criterion applied to the cross-country AARR distribution (i.e., same speed to all countries or faster for those with higher baseline MMR). MMR average and inequality gaps -absolute (AIG), and relative (RIG)- were scenario outcomes. RESULTS At baseline, MMR was 59.2 per 100,000; AIG was 313.4 per 100,000 and RIG was 19.0 between countries with baseline MMR over twice the global target and those below the regional target. The AARR needed to meet the global and regional targets were -7.60% and -4.54%, respectively; baseline AARR was -1.55%. In the regional MMR target attainment scenario, applying horizontal equity would decrease AIG to 158.7 per 100,000 and RIG will remain invariant; applying vertical equity would decrease AIG to 130.9 per 100,000 and RIG would decrease to 13.5 by 2030. CONCLUSION The dual challenge of reducing maternal mortality and abating its inequalities will demand hefty efforts from countries of the Americas. This remains true to their collective 2030 MMR target while leaving no one behind. These efforts should be mainly directed towards significantly speeding up the tempo of the MMR reduction and applying sensible progressivity, targeting on groups and territories with higher MMR and greater social vulnerabilities, especially in a post-pandemic regional context.
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Affiliation(s)
- Antonio Sanhueza
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC USA
| | - Oscar J. Mujica
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC USA
| | - Patricia N. Soliz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC USA
| | - Adrienne L. Cox
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC USA
| | - Bremen de Mucio
- Latin American Center for Perinatology, Women’s Health, and Reproductive Health (CLAP/WR), Pan American Health Organization, PAHO/WHO, Montevideo, Uruguay
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Ya-qing L, Hao-ran N, Xiang-yang T, Mei-cheng Z, Feng J, Yu-tong Q, Jian-bo C. Research on equity of medical resource allocation in Yangtze River Economic Belt under healthy China strategy. Front Public Health 2023; 11:1175276. [PMID: 37435525 PMCID: PMC10332165 DOI: 10.3389/fpubh.2023.1175276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Objective This study aimed to assess the fairness of medical resource allocation in the Yangtze River Economic Belt, based on the Healthy China strategy. It aimed to identify the issues with resource allocation fairness and provide optimization suggestions. Methods To assess the allocation fairness from a geographical population perspective, the study used the Health Resource Concentration and Entropy Weight TOPSIS methods. Additionally, the study analyzed the allocation fairness from an economic level angle, using the Concentration Curve and Concentration Index. Results The study found that the downstream area had higher resource allocation fairness than the midstream and upstream areas. The middle reaches had more resources than the upper and lower reaches, based on population concentration. The Entropy Weight TOPSIS method found that Shanghai, Zhejiang, Chongqing, and Jiangsu had the highest comprehensive score index of agglomeration. Furthermore, from 2013 to 2019, the fairness of medical resource distribution gradually improved for different economic levels. Government health expenditure and medical beds were distributed more equitably, while general practitioners had the highest level of unfairness. However, except for medical and health institutions, traditional Chinese medicine institutions, and primary health institutions, other medical resources were mostly distributed to areas with better economic conditions. Conclusion The study found that the fairness of medical resource allocation in the Yangtze River Economic Belt varied greatly based on geographical population distribution, with inadequate spatial accessibility and service accessibility. Although the fairness of distribution based on economic levels improved over time, medical resources were still concentrated in better economic areas. The study recommends improving regional coordinated development to enhance the fairness of medical resource allocation in the Yangtze River Economic Belt.
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Affiliation(s)
- Liu Ya-qing
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Niu Hao-ran
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tian Xiang-yang
- China State Construction Northwestern Regional Headquarters, China State Construction Silkroad Construction Investment Group co., LTD, Xian, Shanxi, China
| | - Zhang Mei-cheng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiang Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Yu-tong
- School of Marxism, Party School of CPC Hubei Provincial Committee, Wuhan, Hubei, China
| | - Cao Jian-bo
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Wang L, Liu J, Wu L, Zhang J, Fang H. Caregiving experiences of stroke caregivers: A systematic review and meta-synthesis of qualitative studies. Medicine (Baltimore) 2023; 102:e33392. [PMID: 37000103 PMCID: PMC10063269 DOI: 10.1097/md.0000000000033392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Caregivers of stroke patients have demanding caregiving tasks and roles, and they face multiple challenges and a variety of needs in their caregiving process. This study aimed to systematically integrate and evaluate qualitative research data to understand the care experiences of caregivers of stroke patients and to provide them with targeted assistance. METHODS We critically assessed the study using the Joanna Briggs Institute Critical Assessment Checklist for Qualitative Research. Extraction, summarization and meta-synthesis of qualitative data. Qualitative studies related to this study were searched in PubMed, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, China Biomedical Literature Database, and Wanfang Database by computer from the establishment of the database to February 2022. The method of tracing citations was used to find other articles that might be included to ensure the comprehensiveness of the search articles. RESULTS A total of 11 studies, including 167 participants, were included, and 40 research results were extracted, summarized into 8 new categories, and formed 2 meta-themes. Meta-theme 1: Caregivers had emotional struggles during caregiving but were still able to provide compassion and care for patients through positive coping. Meta-theme 2: caregivers faced many difficulties in the care process and were eager for support. CONCLUSIONS Caregiving is a long and heavy process. Society, medical institutions, and families should pay full attention to the feelings and needs of stroke caregivers in the care process and provide appropriate support for them.
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Affiliation(s)
- Lingyu Wang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Jingyu Liu
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Lingsha Wu
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Jing Zhang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Haiyan Fang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
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Meyers CCA, Mann MJ, Thorisdottir IE, Ros Garcia P, Sigfusson J, Sigfusdottir ID, Kristjansson AL. Preliminary impact of the adoption of the Icelandic Prevention Model in Tarragona City, 2015–2019: A repeated cross-sectional study. Front Public Health 2023; 11:1117857. [PMID: 37006583 PMCID: PMC10061134 DOI: 10.3389/fpubh.2023.1117857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundThere is a great need for effective primary prevention intervention strategies to reduce and delay onset of adolescent substance use. The Icelandic Prevention Model (IPM) showed great success in Iceland over the past twenty plus years, however, evidence for the transferability of model is still somewhat limited. Using data collected in Tarragona during regional efforts to begin adoption of the IPM in Catalonia, this study tested the transferability and stability of the core risk and protective factor assumptions of the IPM overtime and examined trends of lifetime smoking, e-cigarette-use, alcohol-use, intoxication, and cannabis-use within the same time period.MethodsThis study includes responses from 15- to 16-years-olds from two region-wide samples taken in 2015 and 2019 in Tarragona (N = 2,867). Survey questions assessed frequency of lifetime: smoking, e-cigarette-use, alcohol-use, intoxication, and cannabis-use, and the core model assumptions. Demographic data were also collected. Logistic regression models of main effects with and without time interaction were used to test assumptions and their stability across time. Chi-square tests and Wilcoxon–Mann–Whitney U tests were used to compare prevalence of substance use and mean scores of primary prevention variables respectively.ResultsLifetime: smoking (−7%, p < 0.001) and cannabis-use (−4%, p < 0.001) decreased, and e-cigarette-use increased (+33%, p < 0.001) in Tarragona. Lifetime intoxication (−7%, p < 0.001) decreased in a single zone exclusively. Most core model assumptions held in their hypothesised direction across time. The strongest positive association was observed between time spent with parents during weekends and reduced odds of lifetime smoking (OR: 0.62, 95%CI: 0.57–0.67) and the strongest negative association was observed between being outside after midnight and increased odds of lifetime intoxication (OR: 1.41, 95%CI: 1.32–1.51). Mean scores of primary prevention variables also changed disproportionately in Tarragona.ConclusionThis study confirms that the core IPM assumptions are similar in Tarragona as in Iceland and other contexts previously examined. They also indicate that prevalence of lifetime smoking, intoxication, and cannabis-use decreased disproportionately in Tarragona between 2015 and 2019 during the first phase of regional adoption of the model. Thus, targeting model assumptions represents a viable primary prevention strategy for communities that hope to reduce smoking, alcohol-use, intoxication, and cannabis-use among adolescents.
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Affiliation(s)
- Caine C. A. Meyers
- Planet Youth Ltd., Reykjavik, Iceland
- *Correspondence: Caine C. A. Meyers
| | - Michael J. Mann
- Department of Community and Environmental Health, School of Allied Health Sciences, Boise State University, Boise, ID, United States
| | | | | | | | - Inga Dora Sigfusdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Icelandic Centre for Social Research and Analysis (ICSRA), Reykjavik, Iceland
| | - Alfgeir L. Kristjansson
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV, United States
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Yuan L, Cao J, Wang D, Yu D, Liu G, Qian Z. Regional disparities and influencing factors of high quality medical resources distribution in China. Int J Equity Health 2023; 22:8. [PMID: 36627636 PMCID: PMC9832614 DOI: 10.1186/s12939-023-01825-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND With the gradual increase of residents' income and the continuous improvement of medical security system, people's demand for pursuing higher quality and better medical and health services has been released. However, so far little research has been published on China's high quality medical resources (HQMR). This study aims to understand the spatiotemporal variation trend of HQMR from 2006 to 2020, analyze regional disparity of HQMR in 2020, and further explore the main factors influencing the distribution of HQMR in China. METHODS The study selected Class III level A hospitals (the highest level medical institutions in China) to represent HQMR. Descriptive statistical methods were used to address the changes in the distribution of HQMR from 2006 to 2020. Lorentz curve, Gini coefficient (G), Theil index (T) and High-quality health resource density index (HHRDI) were used to calculate the degree of inequity. The geographical detector method was used to reveal the key factors influencing the distribution of HQMR. RESULTS The total amount of HQMR in China had increased year by year, from 647 Class III level A hospitals in 2006 to 1580 in 2020. In 2020, G for HQMR by population was 0.166, while by geographic area was 0.614. T was consistent with the results for G, and intra-regional contribution rates were higher than inter-regional contribution rates. HHRDI showed that Beijing, Shanghai, and Tianjin had the highest allocated amounts of HQMR. The results of the geographical detector showed that total health costs, government health expenditure, size of resident populations, GDP, number of medical colleges had a significant impact on the spatial distribution of HQMR and the q values were 0.813, 0.781, 0.719, 0.661, 0.492 respectively. There was an interaction between the influencing factors. CONCLUSIONS China's total HQMR is growing rapidly but is relatively inadequate. The distribution of HQMR by population is better than by geography, and the distribution by geography is less equitable. Population size and geographical area both need to be taken into account when formulating policies, rather than simply increasing the number of HQMR.
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Affiliation(s)
- Lei Yuan
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan China
| | - Jing Cao
- grid.431010.7Department of Cardiovascular Medicine, Third Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Dong Wang
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Dan Yu
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan China
| | - Ge Liu
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Zhaoxin Qian
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan China
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Hu B, Jiang G, Yao X, Chen W, Yue T, Zhao Q, Wen Z. Allocation of emergency medical resources for epidemic diseases considering the heterogeneity of epidemic areas. Front Public Health 2023; 11:992197. [PMID: 36908482 PMCID: PMC9998515 DOI: 10.3389/fpubh.2023.992197] [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: 07/12/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
Background The resources available to fight an epidemic are typically limited, and the time and effort required to control it grow as the start date of the containment effort are delayed. When the population is afflicted in various regions, scheduling a fair and acceptable distribution of limited available resources stored in multiple emergency resource centers to each epidemic area has become a serious problem that requires immediate resolution. Methods This study presents an emergency medical logistics model for rapid response to public health emergencies. The proposed methodology consists of two recursive mechanisms: (1) time-varying forecasting of medical resources and (2) emergency medical resource allocation. Considering the epidemic's features and the heterogeneity of existing medical treatment capabilities in different epidemic areas, we provide the modified susceptible-exposed-infected-recovered (SEIR) model to predict the early stage emergency medical resource demand for epidemics. Then we define emergency indicators for each epidemic area based on this. By maximizing the weighted demand satisfaction rate and minimizing the total vehicle travel distance, we develop a bi-objective optimization model to determine the optimal medical resource allocation plan. Results Decision-makers should assign appropriate values to parameters at various stages of the emergency process based on the actual situation, to ensure that the results obtained are feasible and effective. It is necessary to set up an appropriate number of supply points in the epidemic emergency medical logistics supply to effectively reduce rescue costs and improve the level of emergency services. Conclusions Overall, this work provides managerial insights to improve decisions made on medical distribution as per demand forecasting for quick response to public health emergencies.
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Affiliation(s)
- Bin Hu
- School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Guanhua Jiang
- School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xinyi Yao
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Wei Chen
- School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Tingyu Yue
- School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Qitong Zhao
- Department of Logistics and Supply Chain Management School of Business, Singapore University of Social Science, Singapore, Singapore
| | - Zongliang Wen
- School of Management, Xuzhou Medical University, Xuzhou, China.,Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Luo J, Gama Z, Gesang D, Liu Q, Zhu Y, Yang L, Bai D, Xiao M. Real-life experience of accepting assistive device services for Tibetans with dysfunction: A qualitative study. Int J Nurs Sci 2022; 10:104-110. [PMID: 36860713 PMCID: PMC9969061 DOI: 10.1016/j.ijnss.2022.12.005] [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: 10/02/2022] [Revised: 11/17/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to understand the real-life experiences of Tibetans in China with dysfunction in the process of accepting assistive device services and to provide a reference for service quality improvement and policy formulation. Methods Semi-structured personal interviews were used to collect data. Ten Tibetans with dysfunction representing three categories of different economic level areas in Lhasa, Tibet were selected to participate in the study by purposive sampling method from September to December 2021. The data were analyzed using Colaizzi's seven-step method. Results The results present three themes and seven sub-themes: identification of tangible benefits from assistive devices (enhancing self-care ability for persons with dysfunction, assisting family members with caregiving and promoting harmonious family relationships), problems and burdens (difficulty in accessing professional services and cumbersome processes, not knowing how to use it correctly, psychological burden: fear of falling and stigmatization), and needs and expectations (providing social support to reduce the cost of use, enhancing the accessibility of barrier-free facilities at the grassroots level and improving the environment for the use of assistive devices). Conclusion A proper understanding of the problems and challenges faced by Tibetans with dysfunction in the process of accepting assistive device services, focusing on the real-life experiences of people with functional impairment, and proposing targeted suggestions for improving and optimizing the user experience can provide reference and basis for future intervention studies and related policy formulation.
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Affiliation(s)
- Jun Luo
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhujizhaba Gama
- Department of Rehabilitation Medicine, Tibet Autonomous Region People’s Hospital, Tibet, China
| | - Deji Gesang
- Department of Rehabilitation Medicine, Tibet Autonomous Region People’s Hospital, Tibet, China
| | - Qing Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Zhu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lining Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dingqun Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Corresponding author.
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20
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Li N, Zeller MP, Shih AW, Heddle NM, St John M, Bégin P, Callum J, Arnold DM, Akbari-Moghaddam M, Down DG, Jamula E, Devine DV, Tinmouth A. A data-informed system to manage scarce blood product allocation in a randomized controlled trial of convalescent plasma. Transfusion 2022; 62:2525-2538. [PMID: 36285763 DOI: 10.1111/trf.17151] [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: 07/28/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Equitable allocation of scarce blood products needed for a randomized controlled trial (RCT) is a complex decision-making process within the blood supply chain. Strategies to improve resource allocation in this setting are lacking. METHODS We designed a custom-made, computerized system to manage the inventory and allocation of COVID-19 convalescent plasma (CCP) in a multi-site RCT, CONCOR-1. A hub-and-spoke distribution model enabled real-time inventory monitoring and assignment for randomization. A live CCP inventory system using REDCap was programmed for spoke sites to reserve, assign, and order CCP from hospital hubs. A data-driven mixed-integer programming model with supply and demand forecasting was developed to guide the equitable allocation of CCP at hubs across Canada (excluding Québec). RESULTS 18/38 hospital study sites were hubs with a median of 2 spoke sites per hub. A total of 394.5 500-ml doses of CCP were distributed; 349.5 (88.6%) doses were transfused; 9.5 (2.4%) were wasted due to mechanical damage sustained to the blood bags; 35.5 (9.0%) were unused at the end of the trial. Due to supply shortages, 53/394.5 (13.4%) doses were imported from Héma-Québec to Canadian Blood Services (CBS), and 125 (31.7%) were transferred between CBS regional distribution centers to meet demand. 137/349.5 (39.2%) and 212.5 (60.8%) doses were transfused at hubs and spoke sites, respectively. The mean percentages of total unmet demand were similar across the hubs, indicating equitable allocation, using our model. CONCLUSION Computerized tools can provide efficient and immediate solutions for equitable allocation decisions of scarce blood products in RCTs.
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Affiliation(s)
- Na Li
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Michelle P Zeller
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Canadian Blood Services, Ottawa, Ontario, Canada
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy M Heddle
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Canadian Blood Services, Ottawa, Ontario, Canada
| | - Melanie St John
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Philippe Bégin
- Section of Allergy, Immunology and Rheumatology, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada.,Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Canadian Blood Services, Ottawa, Ontario, Canada
| | - Maryam Akbari-Moghaddam
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Douglas G Down
- Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Erin Jamula
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dana V Devine
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Alan Tinmouth
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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21
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Fan X, Zhang W, Guo Y, Cai J, Xie B. Equity assessment of the distribution of mental health beds in China: based on longitudinal data from 2011 to 2020. BMC Health Serv Res 2022; 22:1453. [PMID: 36451145 PMCID: PMC9709752 DOI: 10.1186/s12913-022-08658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mental health problems have become a public health problem that needs to be solved in China. However, medical resources for mental healthcare remain insufficient and unevenly distributed. The Chinese central government has taken many measures to address this issue over the last decade. This study aimed to evaluate the changes in equity in mental health bed allocation from 2011 to 2020. METHODS The data of this study came from the China Health Statistical Yearbook (2012-2021) and the China National Administrative Division Information Platform. The annual growth rate was used to evaluate the time trends of mental health beds. The Lorenz curve, Gini coefficient and Theil index were used to assess equity in the demographic and geographical dimensions. The distribution of mental health beds was visualized on a map using geographic information system (GIS) software. RESULTS The total number of mental health beds in China increased steadily from 2011 to 2020. At the national level, the Gini coefficient and Theil index all exhibited downward trends over time. The mental health bed allocation in terms of the demographic dimension was relatively equitable, with Gini values all less than 0.3; however, the Gini coefficients by geographical area were all more than 0.6, indicating inequity. Intraregional contribution rates were higher than interregional contribution rates, which were all above 60%. CONCLUSION The overall distribution equity of mental health beds improved from 2011 to 2020. The equity of mental health beds in terms of population size is superior to that in terms of geographical area. Intraregional differences are the main source of inequity. In particular, differences within the western region need to be given attention. Thus, the findings from this study emphasize that the demographic and geographical distributions and all influencing factors should be considered when the government makes mental health resource allocation policies.
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Affiliation(s)
- Xin Fan
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, China ,Shanghai Center for Mental Disease Control and Prevention, 200030 Shanghai, China
| | - Weibo Zhang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, China ,grid.16821.3c0000 0004 0368 8293Center for Mental Health Management, China Hospital Development Institute, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Yanping Guo
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, China ,Shanghai Center for Mental Disease Control and Prevention, 200030 Shanghai, China
| | - Jun Cai
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, China
| | - Bin Xie
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, China
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22
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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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23
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Equity and efficiency of public hospitals' health resource allocation in Guangdong Province, China. Int J Equity Health 2022; 21:138. [PMID: 36138478 PMCID: PMC9493174 DOI: 10.1186/s12939-022-01741-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background To better meet people’s growing demand for medical and health services, 21 cities in Guangdong Province were involved in the reform of public hospitals in 2017. This paper evaluates the equity and efficiency of public hospitals’ health resource allocation in Guangdong Province and explores ways to change the current situation. Methods Data were collected from the Guangdong Health Statistical Yearbook 2016–2020 and Guangdong Statistical Yearbook 2017–2021. The Gini coefficient (G), Theil index (T), and health resource density index (HRDI) were used to measure the equity of health resource allocation. An improved three-stage DEA method was applied in efficiency evaluation. The entropy weight method was employed to calculate the weight of different indicators to obtain a comprehensive indicator representing the overall volume of health resources in each city. A two-dimensional matrix was drawn between the HRDI of the comprehensive indicator and efficiency and the per capita government financial subsidies and efficiency to observe the coordination of equity and efficiency across regions. Results From 2016 to 2020, the G of public hospital, bed, and health technician allocation by population remained below 0.2, while that by geographical area ranged from 0.4 to 0.6; the G of government financial subsidies by population was above 0.4, while that by geographical area was greater than 0.7. The results for T showed that inequality mainly comes from intraregional differences, and the Pearl River Delta contributes most to the overall differences. Although the HRDI of the Pearl River Delta is far greater than that of other regions, obvious differences exist across cities in the region. Only 38.1% of cities were found to be efficient in 2020. The Pearl River Delta was in the first quadrant, and the other three regions were in the third quadrant, accounting for a large proportion. Conclusion The equity of government financial subsidies allocation was the worst, and there were distinct regional differences in the geographical distribution of health resources. The development of healthcare within the Pearl River Delta was highly unbalanced. The development of healthcare was uneven between the Pearl River Delta, eastern, western, and mountainous regions. In addition, most cities in the eastern, western, and mountainous regions bore the dual pressures of relatively insufficient health resources and inefficiency. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01741-1.
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