Regional disparities in health care resources in traditional Chinese medicine county hospitals in China
Autoři:
Dawei Zhu aff001; Xuefeng Shi aff002; Stephen Nicholas aff004; Ping He aff001
Působiště autorů:
China Center for Health Development Studies, Peking University, Beijing, China
aff001; School of Management, Beijing University of Chinese Medicine, Beijing, China
aff002; National Institute of Chinese Medicine Development and Strategy, Beijing University of Chinese Medicine, Beijing, China
aff003; Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangdong, China
aff004; School of Economics and School of Management, Tianjin Normal University, Tianjin, China
aff005; TOP Education Institute, Sydney, New South Wales, Australia
aff006; Newcastle Business School, University of Newcastle, Newcastle, New South Wales, Australia
aff007
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0227956
Souhrn
Objective
We aimed to analyze regional disparities of health care resources in traditional Chinese medicine (TCM) county hospitals and their time trends, and to assess the changes of regional disparities before and after 2009 health care reforms.
Methods
We used hospital-based, longitudinal data from all TCM county hospitals in China between 2004 and 2016. To measure the key development features of TCM county hospitals, data were collected on government hospital investment, hospital numbers (the average number of TCM hospitals per county), hospital scale (the number of medical staff and hospital beds) and doctors’ workload (the daily visits and inpatient stays per doctor). We used segmented linear regression to test the time trend for outcome variables. We set a breakpoint at 2011, dividing the pre-reform (2004–2011) and post-reform (2012–2016) periods.
Results
After the 2009 health reforms, TCM hospitals continued to display large disparities in the number, scale, and doctors’ workload across the three regions. In the pre-reform period, yearly government subsidies for TCM hospitals in western area were roughly RMB0.6 million (US$89 thousand) more than those in central and eastern region, which increased under the 2009 reforms to roughly RMB2 million (US$298 thousand) more per yer in post-reform period. These increased subsidies saw an increase in the number of TCM hospitals in the western area, partly addressing regional disparities. But there was no improvement in the regional disparities in terms of scale (number of beds) and the doctors’ workload (daily outpatient visits and inpatients per doctor) increased or remained unchanged between the western and other regions.
Conclusion
Although TCM hospital number, scale, and doctors’ workload increased over the past 13 years, substantial regional disparities remained. The 2009 health reforms did not significantly change the regional disparities in health care resources, especially between the eastern and western regions.
Klíčová slova:
Health economics – Hospitals – China – Chinese people – Inpatients – Medical doctors – Outpatients – Traditional Chinese medicine
Zdroje
1. Fan S, Kanbur R, Zhang X. China’s regional disparities: Experience and policy. Rev Dev Finance. 2011;1: 47–56. doi: 10.1016/j.rdf.2010.10.001
2. Kanbur SR, Lustig N. Why is inequality back on the agenda? Department of Agricultural, Resource, and Managerial Economics, Cornell University; 1999.
3. Fang P, Dong S, Xiao J, Liu C, Feng X, Wang Y. Regional inequality in health and its determinants: Evidence from China. Health Policy. 2010;94: 14–25. doi: 10.1016/j.healthpol.2009.08.002 19735959
4. Murray CJL, Frenk J. A framework for assessing the performance of health systems. Bull World Health Organ. 2000; 15.
5. Horev T, Pesis-Katz I, Mukamel DB. Trends in geographic disparities in allocation of health care resources in the US. Health Policy. 2004;68: 223–232. doi: 10.1016/j.healthpol.2003.09.011 15063021
6. Pan J, Shallcross D. Geographic distribution of hospital beds throughout China: a county-level econometric analysis. Int J Equity Health. 2016;15. doi: 10.1186/s12939-016-0467-9 27821181
7. Zhang T, Xu Y, Ren J, Sun L, Liu C. Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions. Int J Equity Health. 2017;16. doi: 10.1186/s12939-017-0543-9 28253876
8. Liang D, Zhang D, Huang J, Schweitzer S. Does Rapid and Sustained Economic Growth Lead to Convergence in Health Resources: The Case of China From 1980 to 2010. Inq J Health Care Organ Provis Financ. 2016;53: 004695801663169. doi: 10.1177/0046958016631699 26895881
9. China’s state council. Outline of strategic planning for the development of TCM (2016–2030). 2016 [cited 12 Nov 2019]. http://www.gov.cn/xinwen/2016-02/26/content_5046727.htm
10. China’s state council. White paper on the development of traditional Chinese medicine (TCM) in China. 2016 [cited 1 Jul 2019]. https://www.scio.gov.cn/32618/Document/1534638/1534638.htm
11. Lu L, Zeng J. Inequalities in the geographic distribution of hospital beds and doctors in traditional Chinese medicine from 2004 to 2014. Int J Equity Health. 2018;17. doi: 10.1186/s12939-018-0882-1 30419919
12. Wang L, Suo S, Li J, Hu Y, Li P, Wang Y, et al. An investigation Into Traditional Chinese Medicine Hospitals in China: Development Trend and Medical Service Innovation. Int J Health Policy Manag. 2016;6: 19–25. doi: 10.15171/ijhpm.2016.72 28005539
13. Guo S, Zou J. Study on Fiscal Transfer Payment System Reform in China—Based on the Perspective of a New Road to Urbanization. Mod Econ. 2015;06: 871–880. doi: 10.4236/me.2015.68082
14. Wagstaff A, Lindelow M, Wang S, Zhang S. Reforming China’s Rural Health System. The World Bank; 2009.
15. Bank TW. Deepening health reform in China : building high-quality and value-based service delivery—policy summary. The World Bank; 2016 Jul pp. 1–202. Report No.: 107176. http://documents.worldbank.org/curated/en/800911469159433307/Deepening-health-reform-in-China-building-high-quality-and-value-based-service-delivery-policy-summary
16. Yip WC-M, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. The Lancet. 2012;379: 833–842.
17. WPRO. Health sector reform in China. In: Health sector reform in China [Internet]. 2011 [cited 12 Dec 2018]. http://www.wpro.who.int/china/mediacentre/factsheets/health_sector_reform/en/
18. CPC Central Committee and the State. Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform. 2009. http://www.gov.cn/jrzg/2009-04/06/content_1278721.htm
19. China’s state council. Implementation Plan for the Recent Priorities of the Health Care System Reform (2009–2011) (Guo Fa [2009] NO.12). 2009 [cited 7 Jan 2019]. http://www.gov.cn/zwgk/2009-04/07/content_1279256.htm
20. Han B. Analysis the development of county-level publich traditional Chinese medicine hospital from 2006 to 2011. Master, Beijing University of Chinese Medicine. 2013.
21. China’s state council. Opinions of the State Council on supporting and promoting the development of TCM (Guo Fa [2009] NO.22). [cited 7 Jan 2019]. http://www.gov.cn/zwgk/2009-05/07/content_1307145.htm
22. Jin J, Wang J, Ma X, Wang Y, Li R. Equality of Medical Health Resource Allocation in China Based on the Gini Coefficient Method. Iran J Public Health. 2015;44: 13.
23. Zhou K, Zhang X, Ding Y, Wang D, Lu Z, Yu M. Inequality trends of health workforce in different stages of medical system reform (1985–2011) in China. Hum Resour Health. 2015;13. doi: 10.1186/s12960-015-0089-0 26645960
24. Wang S, Xu J, Jiang X, Li C, Li H, Song S, et al. Trends in health resource disparities in primary health care institutions in Liaoning Province in Northeast China. Int J Equity Health. 2018;17. doi: 10.1186/s12939-018-0896-8 30514300
25. He C, Liu L, Chu Y, Perin J, Dai L, Li X, et al. National and subnational all-cause and cause-specific child mortality in China, 1996–2015: a systematic analysis with implications for the Sustainable Development Goals. Lancet Glob Health. 2017;5: e186–e197. doi: 10.1016/S2214-109X(16)30334-5 28007477
26. Zhou M, Wang H, Zhu J, Chen W, Wang L, Liu S, et al. Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. The Lancet. 2016;387: 251–272. doi: 10.1016/S0140-6736(15)00551-6
27. Division of the Eastern, Central and Western China. China Popul Today. 2000; 3.
28. Keppel K, Pamuk E, Lynch J, Carter-Pokras O, Kim I. Methodological Issues in Measuring Health Disparities. Vital Health Stat. 2013; 34.
29. Barr B, Higgerson J, Whitehead M. Investigating the impact of the English health inequalities strategy: time trend analysis. BMJ. 2017; j3310. doi: 10.1136/bmj.j3310 28747304
30. National Health and Family Planning Commission. China Health and family planning Yearbook. China union medical university press; 2016.
31. Wu Q, Ma X, Chen L, Yang Y. SWOT Analysis of Personnel Filing System in Public Hospitals. Chin Hosp Manag. 2016;36: 11–13.
32. Chen L, Ma X, Huang Y. Historical Evolution of Public Hospital Establishment System Reform from Institutional Change Angle. Chin Hosp Manag. 2016;36: 1–3.
33. Jiang S, Min R, Fang P. The impact of healthcare reform on the efficiency of public county hospitals in China. BMC Health Serv Res. 2017;17. doi: 10.1186/s12913-017-2780-4 29262816
34. Chen T, Wang Y, Luo X, Rao Y, Hua L. Inter-provincial inequality of public health services in China: the perspective of local officials’ behavior. Int J Equity Health. 2018;17. doi: 10.1186/s12939-018-0827-8 30064429
35. Li H, Zhou L-A. Political turnover and economic performance: the incentive role of personnel control in China. J Public Econ. 2005;89: 1743–1762. doi: 10.1016/j.jpubeco.2004.06.009
36. Liu D, Tsegai D, Litaker D, von Braun J. Under regional characteristics of rural China: a clearer view on the performance of the New Rural Cooperative Medical Scheme. Int J Health Econ Manag. 2015;15: 407–431. doi: 10.1007/s10754-015-9175-z 27878696
Článek vyšel v časopise
PLOS One
2020 Číslo 1
- S diagnostikou Parkinsonovy nemoci může nově pomoci AI nástroj pro hodnocení mrkacího reflexu
- Proč při poslechu některé muziky prostě musíme tančit?
- Je libo čepici místo mozkového implantátu?
- Chůze do schodů pomáhá prodloužit život a vyhnout se srdečním chorobám
- Pomůže v budoucnu s triáží na pohotovostech umělá inteligence?
Nejčtenější v tomto čísle
- Severity of misophonia symptoms is associated with worse cognitive control when exposed to misophonia trigger sounds
- Chemical analysis of snus products from the United States and northern Europe
- Calcium dobesilate reduces VEGF signaling by interfering with heparan sulfate binding site and protects from vascular complications in diabetic mice
- Effect of Lactobacillus acidophilus D2/CSL (CECT 4529) supplementation in drinking water on chicken crop and caeca microbiome
Zvyšte si kvalifikaci online z pohodlí domova
Všechny kurzy