Differences in competitors' market influence due to market structure: Evidence from Japanese gambling market

This study investigates how differences in the market structure between the Japanese horse racing and Keirin1 racing markets affects the influence exercised by high-turnover operators (major operators) in both markets on low-turnover operators (minor operators) in those markets.2 In the horse racing market structure, there are few competitors, and the difference in turnover3 between major and minor operators is large. In contrast, in the Keirin racing market structure, there are many competitors, and the difference in turnover between major and minor operators is small. Panel analysis results show that in horse racing, operators with low turnover are significantly affected by those with high turnover, while in Keirin racing, operators with low turnover are less affected by competitors with high turnover. The results not only indicate that firms are affected differently by competitors due to the market structure but also suggest that this has an impact on market segmentation policies and firms' marketing efforts.

Risk management and empirical study of the doctor-patient relationship: based on 1790 litigation cases of medical damage liability disputes in China

BACKGROUND

Compensation for medical damage liability disputes (CMDLD) seriously hinders the healthy development of hospitals and undermines the harmony of the doctor-patient relationships (DPR). Risk management in the DPR has become an urgent issue of the day. The study aims to provide a comprehensive description of CMDLD in China and explore its influencing factors, and make corresponding recommendations for the management of risks in the DPR.

METHODS

This study extracted data from the China Judgment Online - the official judicial search website with the most comprehensive coverage. Statistical analysis of 1,790 litigation cases of medical damage liability disputes (COMDLD) available from 2015 to 2021.

RESULTS

COMDLD generally tended to increase with the year and was unevenly distributed by regions; the compensation rate was 52.46%, the median compensation was 134,900 yuan and the maximum was 2,234,666 yuan; the results of the single factor analysis showed that there were statistically significant differences between the compensation for different years, regions, treatment attributes, and trial procedures (P < 0.05); the correlation analysis showed that types of hospitals were significantly negatively associated with regions (R=-0.082, P < 0.05); trial procedures were significantly negatively correlated with years (R=-0.484, P < 0.001); compensat- ion was significantly positively correlated with years, regions, and treatment attributes (R = 0.098-0.294, P < 0.001) and negatively correlated with trial procedures (R=-0.090, P < 0.01); regression analysis showed that years, treatment attributes, and regions were the main factors affecting the CMDLD (P < 0.05).

CONCLUSIONS

Years, regions, treatment attributes, and trial procedures affect the outcome of CMDLD. This paper further puts forward relevant suggestions and countermeasures for the governance of doctor-patient risks based on the empirical results. Including rational allocation of medical resources to narrow the differences between regions; promoting the expansion and sinking of high-quality resources to improve the level of medical services in hospitals at all levels; and developing a third-party negotiation mechanism for medical disputes to reduce the cost of medical litigation.

Judicial interface with perinatal depression in India: an empirical analysis and thematic review of published judgments

In the absence of health law policies focused on perinatal depression (PND) in India, it has primarily remained a biomedical research matter instead of being understood from the human rights perspective. Also, the interplay between PND and the Indian justice delivery system remains unexplored. Hence, it is imperative to understand the medico-legal milieu of PND through the lens of judicial interface with the facet of PND. Most popular Indian electronic legal databases were used to identify the judgments pronounced by the Indian Courts where the PND quotient was involved. The text of the resultant judgments was individually read to evaluate if if the subject claim were affected by PND quotient to fit the inclusion criteria. Using the inductive and latent thematic approach, the different emergent themes from the subject claims of every single judgment were used for developing codes. Myriad themes emerged out of the analysis, which helped identify how PND vastly impacts the justice delivery system in varied types of cases in India. Obliviousness and lack of awareness in Indian judiciary regarding PND, and its consequences was largely observed. Human rights violations were discerned owing to absence of perinatal mental health (PMH) services. This policy gap, in turn, results in absence of data regarding women affected by PND and about administered treatment (if any) for managing PND, and reduced empathy by the law enforcement agencies. The resultant themes depict the urgent and multidimensional benefits of introducing policies for PMH services, which will help create awareness about the human rights dimension of PND amongst the law enforcement agencies including the Indian judiciary, and police.

Effects of air environmental audit on reducing air pollutant emissions: evidence from China

In order to mitigate air pollution, governments have implemented various active measures for air pollution prevention and control, among which the air environmental audit is an essential supervision initiative of air environmental regulation policy. This study aims to focus on and investigate the role of air environmental audit in national governance systems by collecting panel data on air environmental audits and air pollutant emissions from 261 prefecture-level cities across China between 2004 and 2018. Using difference-in-differences (DID) models, we empirically analyzed the policy effects of air environmental audits on reducing air pollutant emissions. The results indicate that air environmental audits have a significant impact on reducing air pollutant emissions, which is robust under multiple scenarios, including propensity score matching and placebo tests. The effect of air environmental audits varies significantly among different air pollutants, with the most significant and rapid effect observed on PM2.5 concentration, while industrial sulfur dioxide and industrial smoke (dust) emissions exhibit a time lag. Moreover, the promotion effect of air environmental audits on air pollution control displays strong heterogeneity based on local economic levels, initial environmental quality, and government competition. Therefore, it is of great significance to intensify the implementation of air environmental audits for air pollution control and to promote and improve the audit work according to pollutant classification and local conditions, thereby fully leveraging the audit's role and further improving air quality continuously.

Influence of online E-commerce interaction on consumer satisfaction based on big data algorithm

With the rapid development of the times, people have entered the era of intelligence, and the application of big data algorithms is becoming increasingly widespread. The satisfaction of consumers in online shopping is closely related to communication and interaction during shopping. Based on this, this article studies the impact of online e-commerce interaction on consumer satisfaction based on big data algorithms. This article introduces the mediating variable of consumer satisfaction from the perspective of interaction, constructs a model between interaction and trust, and studies the internal impact mechanism of online interaction on consumer satisfaction in online shopping. This article takes the JD interactive shopping platform as the research object, and analyzes and explores the target consumer satisfaction of the women's clothing interactive shopping platform. Analyzed the impact of interaction on merchant qualifications and service satisfaction evaluations, store size, and logistics of purchased goods. The research results indicate that the normalization coefficients of the H1a and H1b pathways are 0.131 and 0.118, respectively, which are slightly smaller, indicating that the impact of perceived risk on consumer satisfaction is not significant. Meanwhile, the CR in H1 is a positive number and the direction of influence is positive, which is contrary to the assumption. Therefore, it is necessary to calibrate the initial model. After correction, the GFI value is 0.816, AGFI value is 0.825, RMSEA value is 0.042, TFI value is 0.930, CFI value is 0.955, PGFI value is 0.718, and PNFI value is 0.810. The degree is within an acceptable range. Therefore, when implementing interactive shopping, e-commerce companies need to create a good shopping environment for the implementation of interactive activities between sellers and customers. The impact of online e-commerce interaction based on big data algorithms on consumer satisfaction is a hot topic. Personalized recommendations can improve consumer satisfaction and loyalty, but data privacy and security issues are also receiving increasing attention. In addition, it is also necessary to consider the fairness and bias issues of the algorithm, as well as the transparency issues of data analysis and decision-making. On the premise of ensuring data privacy and security, it is necessary to improve the fairness and transparency of algorithms to improve consumer satisfaction and trust, and achieve sustainable development.

Environmental regulations, green development of agriculture, and residents' health-empirical analysis of Yangtze River Economic Belt in China

Environmental pollution and food safety have become key public health issues to be addressed in China. Since they are closely related to the green development of agriculture, it is of great practical significance to elucidate the intrinsic relationships between green development of agriculture, environmental regulation and residents' health. Based on the panel data of the Yangtze River Economic Belt from 2011 to 2020, this study investigates the impacts of environmental regulation and green development of agriculture on residents' health and the influencing mechanism by applying fixed effects method, mediating effectsmethod and the spatial Dubin method. Results show that the use of chemical fertilizers, pesticides and agricultural films is harmful to residents' health; environmental regulation has a negative correlation with the green development of agriculture and affect residents' health through mediating effects; the green development of agriculture has negative spillover effects on residents' health, indicating that purchasing finished products instead of producing locally reduces the input of production factors such as chemical fertilizers and pesticides and transfers health risks associated with agricultural production activities to neighboring areas. Intensifying command-and-control environmental regulation will induce the expansion of hidden economic activities and harm local residents' health, while intensifying market-incentive environmental regulation will lead to the 'Pollution Haven' phenomenon because of the 'race to the bottom', in government and is harmful to the health of residents in neighboring areas. Therefore, it is necessary to formulate reasonable and feasible policies and strengthen the control and prevention of agricultural pollution to enhance green development of agriculture and improve residents' health.

COVID-19 pandemic, port congestion, and air quality: Evidence from China

The emergency of COVID-19 leads to almost all unnecessary activities being banned because of city lockdowns, which results in the economy and human mobility being strictly restricted. While affecting economic development, it has brought some environmental benefits. As a critical link to collection and distribution, ports have been deeply impacted by COVID-19, including quarantine time and operational efficiency, and even cause unexpected port congestion. This study empirically examines the relationship between the COVID-19 pandemic, port congestion and air quality in Chinese port cities using classical and system panel models. We find that the COVID-19 pandemic and port congestion significantly influence air quality in port cities. Managerial implications include the ensuring of port workers' shifts, the unblocking of port logistics, and the cooperation between transportation, customs, and quarantine departments, which can reduce the time of ships at berths and improve the air quality in port cities.

Capital stock, energy, and innovation-related aspects as drivers of environmental quality in high-tech investing economies

By looking at the technological advancement and climate change mitigation plan of the advanced economies, the current study examines the role of sustainable development aspects such as innovations, high technology export, labor productivity, capital stock, research and development (R&D), information and communication technology (ICT), capital stock, and energy use in mitigating environmental degradation for the selected panel of countries with the most investment in technology (China, Denmark, Finland, France, Israel, Korea, Hong Kong, Germany, Japan, Netherlands, Singapore, Sweden, United Kingdom, and United States) over the period 2000-2018. Foremost, the pooled ordinary least square (POLS) and random-effects (RE) generalized least squares (GLS) approaches provided additional interesting inferences. As such, the POLS result revealed that only capital stock in the panel countries shows a desirable environmental effect. At the same time, labor productivity, innovation, R&D, ICT, and energy further hamper ecological quality in the examined panel countries. Similarly, the GLS result largely affirms the POLS results, with only the capital stock among the explanatory variables showing evidence of emission mitigation effect in the panel. Additionally, the panel Granger causality result illustrates evidence of unidirectional causality only innovation, ICT, and capital stock to environmental degradation.

Intervention factors associated with environmental stressors resulting from cross-provincial transfers by coal resource-based enterprises

The environmental stressors associated with the cross-provincial transfer of coal resource-based enterprises (CREs) have become a critical concern for the green, sustainable, and high-quality development of resource-rich areas in central and western regions. This study referred to socioeconomic statistics and carried out an interview survey, literature review, and systematic analysis to clarify the mechanism underlying environmental stressors arising from the cross-provincial transfer of CREs. The intervention factors associated with such environmental stressors were identified, and the study conducted an empirical analysis of relevant data related to the coal-resources industry in three central and western provinces in China for the period 1997-2016. Research findings: (1) The intensity ranking of the influencing factors associated with environmental stressors caused by cross-provincial transfers of CREs has certain rules. The 'level of the enterprise's investment in environmental protection' is the weakest, the 'enterprise's development mode level' is slightly stronger, the 'enterprise scale' is stronger, and 'environmental regulation' is the strongest. (2) Stricter endogenous and exogenous policy regulations for environmental governance in rich coal resource-based regions are associated with weaker negative externalities in respect of resource development and the intensity of stressors. (3) Larger CREs are associated with a better green mining capacity, environmental repair cost advantages, social constraints, self-discipline, and thus, a weaker stress effect. (4) CREs that adopt more superior modes of development that focus on the utilization of the 'three wastes' are associated with a weaker stress effect. (5) The higher the level of investment by CREs in environmental protection technology, facilities, and equipment, the weaker the stress effect. The conclusions of the study can provide a theoretical basis to assist the Chinese government to develop relevant regulations to control inter-provincial transfers by CREs and to thereby diminish environmental stressor effects.

In crisis, we pray: Religiosity and the COVID-19 pandemic

In times of crisis, humans have a tendency to turn to religion for comfort and explanation. The COVID-19 pandemic is no exception. Using daily and weekly data on Google searches for 107 countries, this research demonstrates that the COVID-19 crisis resulted in a massive rise in the intensity of prayer. During the early months of the pandemic, Google searches for prayer relative to all Google searches rose by 30%, reaching the highest level ever recorded. A back-of-the-envelope calculation shows that by April 1, 2020, more than half of the world population had prayed to end the coronavirus. Prayer searches remained 10% higher than previously throughout 2020, particularly so in Europe and the Americas. Prayer searches rose more among the more religious, rose on all continents, at all levels of income, inequality, and insecurity, and for all types of religion, except Buddhism. The increase is not merely a substitute for services in the physical churches that closed down to limit the spread of the virus. Instead, the rise is due to an intensified demand for religion: People pray to cope with adversity. The results thus reveal that religiosity has risen globally due to the pandemic with potential direct long-term consequences for various socio-economic outcomes.

Estimating the effect of COVID-19 epidemic on shipping trade: An empirical analysis using panel data

The unexpected outbreak of COVID-19 epidemic is an unpredictable event in shipping trade. In this paper, we mainly investigate the gaps that occur in the shipping trade between China and different regions during the period February-October 2020 and to provide useful information for operation management of shipping industry. The data include a panel obtained from the National Statistics Institute to analyze the gap where a selected group of shipping trade in three regions are considered: European Union, North America, and Southeast Asia. On this basis, a dynamic panel data model is proposed to estimate the trend. We observe that government prevention and control measures have a negative impact on export trade, while import trade increases accordingly.

Risk assessment model and application of COVID-19 virus transmission in closed environments at sea

This paper focuses on the risk assessment methods of novel coronavirus pneumonia virus (COVID-19) pneumonia virus spreading in closed marine environment. Firstly, the possibility of the spread of new coronavirus in closed environments at sea and the consequences of the harm caused by the epidemic are classified into five levels, and the corresponding risk assessment framework is constructed, and the risk assessment model of the spread of COVID-19 pneumonia virus in closed environment at sea is established taking the Japanese "Diamond Princess" as an example, the model is applied and its output is analysed. Finally, the proportion of the cumulative confirmed cases on the Diamond Princess is calculated, and the possibility of viral infection of Diamond Princess passengers in this COVID-19 pneumonia epidemic in four different risk transmission stages are assessed, and the corresponding risk assessment is undertaken. Through the calculation of risk assessment value, the five stages of the epidemic are established to assess the risk of the "Diamond Princess" outbreak. The research method in the present work helps to provide a risk assessment and analysis idea for the risk of spread of the COVID-19 epidemic in a closed environment at sea.

Performance evaluation of surrogate measures of safety with naturalistic driving data

Surrogate measures of safety (SMoS) play an important role in detecting traffic conflicts and in traffic safety assessment. However, the underlying assumptions of SMoS are different and a certain SMoS may be adequate/inadequate for different applications. A comprehensive approach to evaluate the validity and applicability of SMoS is lacking in the literature. This study proposes such a framework that supports evaluating SMoS in multiple dimensions. We apply the framework to gain insights into the characteristics of six widely-used SMoS for longitudinal maneuvers, i.e., Time to Collision (TTC), single-step Probabilistic Driving Risk Field (S-PDRF), Deceleration Rate to Avoid a Crash (DRAC), Potential Index for Collision with Urgent Deceleration (PICUD), Proactive Fuzzy Surrogate Safety Metric (PFS), and the Critical Fuzzy Surrogate Safety Metric (CFS). To ensure comparability, all measures are calibrated with the same risk detection criterion. Four performance indicators, i.e., Prediction Accuracy, Timeliness, Robustness, and Efficiency are computed for all six SMoS and validated using naturalistic driving data. The strengths and weaknesses of all six measures are compared and analyzed elaborately. A key result is that not a single SMoS performs well in all performance dimensions. S-PDRF performs best in terms of Robustness but consumes the most time for computation. TTC is the most efficient but performs poorly in terms of Timeliness and Robustness. The proposed evaluation approach and the derived insights can support SMoS selection in active vehicle safety system design and traffic safety assessment.

Study of dynamic behaviour of psychological stress during COVID-19 in India: A mathematical approach

In this study, a new attempt has been made using mathematical modelling to study dynamic behaviour and estimate the final size of spread of the psychological stress arising due to sudden outbreak of COVID-19 in India. The proposed mathematical model examines and includes different behaviours of transition from one process to another in current situation and study their propagation mode. We propose a mathematical model, where two different type of psychological stresses occur due to COVID-19 situation and its impact on people's life such as their mental well being and happiness. We present some sufficient conditions for the vanishing or spreading of the psychological stress through qualitative and quantitative analysis. The basic reproduction number ( R 0 ) of the model is computed and the local and the global stabilities of different equilibria are studied. Moreover, to better understand the level of psychological stress and decreasing mental well-being during the COVID-19 outbreak in India, we also conducted an online survey. Our findings establish several factors associated with level of psychological impact and mental health status. Based on the empirical analysis, we found that psychological stress has a significant negative influence on mental well being. Further, this study confirms that coping strategies with stress have significantly contributed towards the betterment in the mental well-being of the people. Numerical simulations are also given to illustrate the theoretical results. The results of the present study can be generalized to the society, Government, and others that they can adopt different strategies to avoid stressful situations during COVID-19 outbreak. The findings suggest that policy-makers, Government officials should focus on coping strategies to combat with pandemic disease.

Economic disasters and aggregate investment

The 2007-2008 global financial crisis has spurred an increasing interest for investigating the financial and macroeconomic effects of the rare but extremely large economic crises, the so-called economic disasters. Current literature on the topic shows that probability of economic disasters plays an important role in the long-run effect of output volatility on investment. This paper investigates the long-run relationship between economic disasters and aggregate investment. We analyze the data for a large number of developing and developed countries after the World War II. The conducted panel data analysis indicates a negative effect of the probability of economic disasters on aggregate investment. Our results contribute to the recent literature on economic disasters by providing empirical support for the hypothesis that probability of infrequent but extremely large economic crises has a negative long-run effect on investment. We also find that the effect of 'normal' output volatility on aggregate investment is relatively small.

Epistemological Equation for Analysing Uncontrollable States in Complex Systems: Quantifying Cyber Risks from the Internet of Things

The Internet-of-Things (IoT) triggers data protection questions and new types of cyber risks. Cyber risk regulations for the IoT, however, are still in their infancy. This is concerning, because companies integrating IoT devices and services need to perform a self-assessment of its IoT cyber security posture. At present, there are no self-assessment methods for quantifying IoT cyber risk posture. It is considered that IoT represent a complex system with too many uncontrollable risk states for quantitative risk assessment. To enable quantitative risk assessment of uncontrollable risk states in complex and coupled IoT systems, a new epistemological equation is designed and tested though comparative and empirical analysis. The comparative analysis is conducted on national digital strategies, followed by an empirical analysis of cyber risk assessment approaches. The results from the analysis present the current and a target state for IoT systems, followed by a transformation roadmap, describing how IoT systems can achieve the target state with a new epistemological analysis model. The new epistemological analysis approach enables the assessment of uncontrollable risk states in complex IoT systems—which begin to resemble artificial intelligence—and can be used for a quantitative self-assessment of IoT cyber risk posture.

Interannual variation and exposure risk assessment of lead in brick tea in Hubei, China

Lead (Pb) exposure may cause severe health outcomes such as decreased fertility, joint pain and neurological disorders. It is important to know the Pb exposure level in tea and the risk assessment for local residents who drink brick tea daily. This study detected sixteen brick tea samples over 26 years and fifteen green tea samples in 2011 in a southeast city of Hubei province. The Pb content in brick tea was found to increase rapidly with the fast development of industrial activities represented by car sales from 1985 to 2011, which was less susceptible to gasoline. The concentrations of Pb in 16 brick tea were in the range of 1.77-17.8 mg/kg with a mean value of 11.1 mg/kg. Their percentiles P₅₀, P₉₀, and P₉₅ were 13.22, 16.95, and 17.21 mg/kg. A regressional model was built, suggesting strong correlation between the Pb content in brick tea and the car sales. The concentrations of Pb in 15 green tea samples were between 0.36-1.30 mg/kg with a mean value of 0.66 mg/kg and the percentiles P₅₀, P₉₀, and P₉₅ were 0.62, 1.05, and 1.23 mg/kg. The MOE values of brick tea and green tea were all greater than 1 just considering tea consumption which displayed low Pb exposure risk. By adding the Pb exposure by food, the MOE values for green tea were still greater than 1 while the MOE values of brick tea were less than 1 suggesting a potential risk of Pb exposure to the people drinking brick tea daily, who should pay more attention.

Dynamic real-time risk analytics of uncontrollable states in complex internet of things systems: cyber risk at the edge

The Internet of Things (IoT) triggers new types of cyber risks. Therefore, the integration of new IoT devices and services requires a self-assessment of IoT cyber security posture. By security posture this article refers to the cybersecurity strength of an organisation to predict, prevent and respond to cyberthreats. At present, there is a gap in the state of the art, because there are no self-assessment methods for quantifying IoT cyber risk posture. To address this gap, an empirical analysis is performed of 12 cyber risk assessment approaches. The results and the main findings from the analysis is presented as the current and a target risk state for IoT systems, followed by conclusions and recommendations on a transformation roadmap, describing how IoT systems can achieve the target state with a new goal-oriented dependency model. By target state, we refer to the cyber security target that matches the generic security requirements of an organisation. The research paper studies and adapts four alternatives for IoT risk assessment and identifies the goal-oriented dependency modelling as a dominant approach among the risk assessment models studied. The new goal-oriented dependency model in this article enables the assessment of uncontrollable risk states in complex IoT systems and can be used for a quantitative self-assessment of IoT cyber risk posture.

How participation influences the perception of fairness, efficiency and effectiveness in environmental governance: An empirical analysis

Participation processes can improve environmental decision-making. However, proving the impact of participation processes - i.e. decision-making involving diverse actors from civil society, business, state, and administration - is challenging. This paper therefore examines participation processes by applying proxy measures that are assumed to strongly correlate with improved environmental decision-making. Such indicators include the perception of the process as being fair and legitimate, the final outcomes being considered effective and efficient, satisfaction with one's own engagement and the development of trust, and conflict resolution. Participation process characteristics such as participation format and facilitation are assumed to have an impact on these indicators. This study examined participation processes in relation to the German energy transformation (Energiewende), asking respondents about their experience of participation, their perception of the process, and also about intermediate outcomes such as trust building and conflict resolution. An online survey was conducted, resulting in 516 valid responses. The results show that participation processes related to the Energiewende are often perceived as fair and legitimate. Moreover, the findings provide a better understanding of the relationships between participation process characteristics and desirable intermediate outcomes, such as trust and conflict resolution, as well as normative process factors. The intensity of a participation process - i.e. whether it is dialogic or a written consultation process - had no significant influence either on normative process factors, such as procedural fairness, or on trust or conflict resolution. Instead, a trustworthy moderator and the integration of all affected interests are important participation process characteristics that could determine the success of the decision-making process.

Factors that influence hospital inpatients' exercise constraints

The purpose of this study is to present ways to provide more precise patient-oriented services by presenting implications and promoting a better understanding of exercise constraints. This study used questionnaire survey as measurement tool for 196 hospital inpatients in 5 general hospitals in the metropolitan area (Seoul, Gyeonggi, and Incheon). The collected data were analyzed using frequency analysis, exploratory factor analysis, reliability analysis, correlation analysis, and hierarchical regression analysis using IBM SPSS Statistics ver. 23.0. The following results were obtained. First, physical activity level and health condition on their physical constraints showed that their health condition factors such as pain/discomfort and anxiety/depression had greater effects on physical constraints than other factors. Second, physical activity level, and health condition on their psychological constraints showed that health condition factors had major effects on patients’ psychological constraints. Thirdly, physical activity level, and health condition on their sociocultural constraints found that anxiety/depression appeared as the key influence factor in physical and psychological constraints.

Patent information retrieval: approaching a method and analysing nanotechnology patent collaborations

Many challenges still remain in the processing of explicit technological knowledge documents such as patents. Given the limitations and drawbacks of the existing approaches, this research sets out to develop an improved method for searching patent databases and extracting patent information to increase the efficiency and reliability of nanotechnology patent information retrieval process and to empirically analyse patent collaboration. A tech-mining method was applied and the subsequent analysis was performed using Thomson data analyser software. The findings show that nations such as Korea and Japan are highly collaborative in sharing technological knowledge across academic and corporate organisations within their national boundaries, and China presents, in some cases, a great illustration of effective patent collaboration and co-inventorship. This study also analyses key patent strengths by country, organisation and technology.

Expanding public health in China: an empirical analysis of healthcare inputs and outputs

OBJECTIVES

The Chinese Government claims that China's health policy is primarily focused on prevention. However, this does not appear to be the case. Researchers with an interest in China's health policy may be aware that the Chinese Government launched a health reform in 2009 to improve the health status of the entire population by 2020.¹ This health reform has been in place for 7 years, and only 4 years now remain to achieve the overall objectives by 2020. This study analyzed the main inputs and outputs of China's health reform in order to identify the main problems and highlight the major challenges. It is hoped that this study will provide some reference for health reform in China and other developing countries.

STUDY DESIGN

This study focused on health, with human resources and healthcare costs as the main input indicators, and 2-week prevalence of illness and prevalence of non-communicable diseases as the main output indicators. By longitudinal comparison of real data from 2009 to 2014, the effects of China's health reform were analyzed to identify the main challenges, enabling suggestions to be made for future reference.

METHODS

This was a retrospective analysis of empirical data. Data were collected between 2009 and 2014 as follows: (1) data on the distribution of healthcare professionals were collected from the Statistical Bulletin of China's Health Development, issued by the National Health and Family Planning Commission every year between 2009 and 2014; (2) data on government health expenditure were obtained from the Annual National Public Fiscal Expenditure Data, released by the Financial Ministry of the People's Republic of China from 2009 to 2014; (3) data on the prevalence of chronic diseases, 2-week prevalence of illness, residents' medical service demands, and utilization of health services were obtained from the Fourth and Fifth National Health Care Surveys in 2008 and 2013; and (4) data on total healthcare expenditure, medical expenditure and out-of-pocket payments were obtained from the 2015 China Statistical Yearbook.

RESULTS

From 2009 to 2014, China's healthcare human resources were distributed primarily in hospitals that focus on providing treatment. By 2014, 62.5% of the health professionals and technical personnel were distributed in hospitals. From 2009, the Chinese Government spent more money on health care than previously, with approximately 67% spent on disease treatment and 14.19% spent on disease prevention. However, the 2-week prevalence of illness increased by 5.2 percentage points, and the prevalence of chronic diseases increased by 9 percentage points. Meanwhile, residents' out-of-pocket payments for health care were as high as 50.61% of the total healthcare expenditure and were particularly high in rural areas.

CONCLUSION

China should adjust the direction of its health reform as soon as possible to focus on improving health status rather than treatment of disease. In the future, as China's population ageing trend intensifies, China must take effective measures or the country's non-communicable disease rates will continue to increase. To meet this challenge, China's health reform should take effective measures to control the rising trend of the incidence of non-communicable diseases. First, China should focus on the core goal of its health reform policy, which is disease prevention. Second, China should focus on strengthening public health systems to effectively prevent and control key epidemic diseases. Third, China should increase the number of public health personnel, improve the level of education and training of public health personnel and increase the input of funds into the field of public health as soon as possible.