Regional Maldistribution of China’s Hospitals Based on Their Structural System

Health Shocks and Unbalanced Growth of Medical Resources: Evidence From the SARS Epidemic in China

Since the outbreak of the SARS epidemic in 2003, the Chinese government has increased inputs to bolster the health care system. However, the COVID-19 pandemic has exposed the geographic maldistribution of health resources in China. We examine the spatial and temporal variation of the SARS epidemic using a difference-in-differences strategy. Our empirical results show that, compared with cities without SARS case reports, exogenous health shocks significantly increased the affected cities' medical resources supply. We provide multiple robustness tests to examine the validity of the main findings. Further study shows that the mechanism is because the SARS event increased the financial autonomy of the epidemic-affected cities, thus providing an incentive for local governments to increase health resources. Meanwhile, health shocks have little influence on the regions with only imported cases than the infected area. These findings provide a possible explanation for the inequality in the distribution of health resources.

Internet Influence of Assisted Reproduction Technology Centers in China: Qualitative Study Based on WeChat Official Accounts

BACKGROUND

The prevalence of infertility in China is high, but the advent of assisted reproduction technology (ART) has greatly eased this situation. Social media, such as WeChat official accounts, have become the preferred tool for ART centers to communicate with patients, but their attention and operational status differ, and the Internet influence of WeChat official accounts is insufficient. In addition, questions about whether Internet influence is consistent with academic influence and whether the Internet can influence patients' choice of medical treatment to a certain extent have not been explored.

OBJECTIVE

This study aimed to examine the operational status and Internet influence of WeChat official accounts for ART centers and to explore the degree of Internet influence on patients' choices of medical treatment.

METHODS

We collected information from the WeChat official accounts for ART centers approved by the National Health Commission of the People's Republic of China and used the technique for order of preference by similarity to ideal solution to build an Internet influence model of the ART centers and obtained a Ranking of Internet Influence on Reproductive Centers (RIIRC) for each center.

RESULTS

We found there were 451 ART centers throughout the country by the end of 2016 and 498 by the end of 2018. The number of medical institutions is quite large, but their distribution is uneven, and their level of medical technical ability is very different. Analysis of the text data of posts of WeChat official accounts showed the ART centers have insufficient awareness of network exposure and publicity, and the RIIRC of some medical institutions was inconsistent with their medical level and academic status.

CONCLUSIONS

ART institutions have varying degrees of emphasis and use of WeChat official accounts in China. They fail to realize that the Internet influence of WeChat may bring them potential patient resources and that Internet influence may affect the future market structure of ART and may also potentially affect academic rankings.

Spatial Equilibrium Allocation of Urban Large Public General Hospitals Based on the Welfare Maximization Principle: A Case Study of Nanjing, China

This study aims to utilize the new gravity P-median model to conduct an empirical study for the spatial equilibrium layout of general hospitals in the urban area of Nanjing City, based on multiple requirements for spatial equilibrium, involving spatial equity-efficiency, service utility fairness, and utilization efficiency. The major results are as follows: (1) the new layout can achieve the goal of obtaining a proximate, high-quality medical service in 30 min even for those who reside on the outskirts, which is less than the current 65.6 min. Moreover, the new layout corresponds better to the population distribution and traffic network layout. (2) When compared with several typical characteristics of accessibility to hospitals, including severe gradient variation, five high-value centers, and the efficiency orientation in the current layout, the new demonstrates distinctive ones: comparatively moderate accessibility variation; more relatively high-value areas scattered in different parts of the city; more convenient accessibility on the outskirts; a better balance of the equitable appeal from the inhabitants residing in different areas. (3) The new layout can attain spatial equilibrium at a higher level, the representative indices to measure spatial equity, spatial efficiency, chance fairness, and utilization efficiency have been ameliorated by 54%, 13%, 63%, 14%, respectively. The study reveals that: (1) The new gravity P-median model has the validity and practicability in solving facility location and scale configuration problems with high time complexity, under complicated situations due to multiple targets and multi-agent competition. (2) The model can be applied to decision making related to public infrastructure planning in different types of development areas, by setting concerning parameters or making some minor adjustments to the model in different scenarios. Such research can provide some reference for the location-allocation problem of high-grade facilities in metropolises, and support the decision-making basis for urban infrastructure planning.

Social Media Landscape of the Tertiary Referral Hospitals in China: Observational Descriptive Study

Background

Social media has penetrated all walks of life. Chinese health care institutions are increasingly utilizing social media to connect with their patients for better health service delivery. Current research has focused heavily on the use of social media in developed countries, with few studies exploring its usage in the context of developing countries, such as China. Tertiary hospitals in China are usually located in city centers, and they serve as medical hubs for multiple regions, with comprehensive and specialized medical care being provided. These hospitals are assumed to be the pioneers in creating official social media accounts to connect with their patients due to the fact that they appear to have more resources to support this innovative approach to communication and health care education.

Objective

The objective of our study was to examine China’s best tertiary hospitals, as recognized by The National Health Commission of the People’s Republic of China (NHCPRC), and to map out the landscape of current social media usage by hospitals when engaging with patients.

Methods

We examined the best 705 tertiary hospitals in China by collecting and analyzing data regarding their usage of popular Chinese social media apps Sina Weibo and WeChat. The specific data included (1) hospital characteristics (ie, time since established, number of beds, hospital type, and regions or localities) and (2) status of social media usage regarding two of the most popular local social media platforms in China (ie, time of initiation, number of followers, and number of tweets or posts). We further used a logistic regression model to test the association between hospital characteristics and social media adoption.

Results

Of all, 76.2% (537/705) tertiary referral hospitals have created official accounts on either Sina Weibo or WeChat, with the latter being more popular among the two. In addition, our study suggests that larger and newer hospitals with greater resources are more likely to adopt social media, while hospital type and affiliation with universities are not significant predictors of social media adoption among hospitals.

Conclusions

Our study demonstrated that hospitals are more inclined to use WeChat. The move by hospitals from Sina Weibo to WeChat indicates that patients are not satisfied by mere communication and that they now place more value on health service delivery. Meanwhile, utilizing social media requires comprehensive thinking from the hospital side. Once adopted, hospitals are encouraged to implement specific rules regarding social media usage. In the future, a long journey still lies ahead for hospitals in terms of operating their official social media accounts.