Submit to IJERPH Review for IJERPH Propose a Special Issue

Journal Menu

Journal Browser

Recent Advances in Healthcare Services in China

Special Issue Editors
Special Issue Information
Keywords
Published Papers

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 March 2020) | Viewed by 20863

Share This Special Issue

Special Issue Editors

Dr. Lei Gao

E-Mail Website
Guest Editor

Commonwealth Scientific and Industrial Research Organization (CSIRO), Glen Osmond, SA 5064, Australia
Interests: complex environmental system modelling; environmental policy assessment; sustainable development goals and health; decision-making and risk analysis
Special Issues, Collections and Topics in MDPI journals

Prof. Zhaoxia Guo

E-Mail Website
Guest Editor

Business School, Sichuan University, Chengdu 610065, China
Interests: operations management; healthcare management; intelligent and data-driven decision-making

Prof. Feng Lin

E-Mail Website
Guest Editor

West China School of Medicine, Sichuan University, Chengdu 610041, China
Interests: human health risk assessment; environmental health; meta-analysis; diagnosis and treatment of lung cancer

Special Issue Information

Dear Colleagues,

China’s economic and social reforms over the past 40 years have achieved tremendous success. With rapid social development and huge healthcare demands, the Chinese healthcare market is booming. It is currently the world’s second-largest market, and continues to develop at double-digit rates. However, compared to developed countries such as the US, Japan, and Europe, the healthcare expenditures in China are relatively low. The Chinese healthcare sector is still immature and has more opportunities for future development.

There is an unprecedentedly large number of healthcare service needs in China. However, the Chinese healthcare system cannot satisfy these needs well due to the lack of appropriate primary care facilities. The public does not trust in community clinics to address primary medical needs. As a result, around 90% of inpatient and outpatient care is addressed through large public hospitals. Taking the West China Hospital of Sichuan University as an example, this largest single-site hospital in the world receives over 15,000 patients on average per day with only about 4300 beds and 10,000 doctors available. This indicates the large discrepancy between supply and demand in Chinese healthcare services. The inability of urban public hospitals to satisfy the public’s fast-growing demands is one of the most severe challenges faced by the Chinese healthcare system. Increasing environmental pollution and an aging population further exacerbate these challenges.

The Chinese healthcare sector has pressing needs to address these challenges—improving the healthcare services and alleviating this discrepancy between supply and demand of healthcare services from various perspectives. The main purpose of this Special Issue is to share ideas and applicable solutions to meet these challenges.

Researchers and practitioners all over the world from both academia and healthcare sectors, working in the areas of empirical studies and solution-based approaches that address significant issues for Chinese healthcare services, are invited to discuss state-of-the-art solutions, newly emerged issues, recent developments, applications, methodologies, and techniques. Review papers are also welcomed if they provide new insights into the practice of Chinese healthcare services.

We look forward to your contributions.

Prof. Lei Gao
Prof. Zhaoxia Guo
Prof. Feng Lin
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

environmental influences on public health and diseases
environmental influences on postoperative rehabilitation
healthcare operation management
healthcare quality management
healthcare decision making
hierarchical medical system
unbalanced medical resources
medical resources gap narrowed
multi-disciplinary treatment team
patient satisfaction in healthcare
sustainable development goals and healthcare

Published Papers (7 papers)

Download All Papers

Research

Jump to: Review

18 pages, 1928 KiB

Open AccessArticle

Evolution of the Output–Workforce Relationship in Primary Care Facilities in China from 2009 to 2017

by Shan Lu, Liang Zhang, Niek Klazinga and Dionne Kringos

Int. J. Environ. Res. Public Health 2020, 17(9), 3043; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17093043 - 27 Apr 2020

Cited by 7 | Viewed by 1967

Abstract

This study evaluates trends in workforce supply compared with those in the volume of service delivery (output) for basic clinical care (CC) and public health (PH) services from 2009 to 2017 in China. A cross-sectional survey (2018) was combined with retrospective data (2009–2017) from 785 primary care (PC) facilities in six provinces. Measures for the output of clinical care and of public health services were aggregated into a single (weighted) index for both service profiles. The output–workforce relationship was measured by its ratio. Latent class growth analysis and logistic regression analysis were applied to classify trajectories and determine associations with facility-level, geographic, and economic characteristics. From 2009 to 2017, the proportion of PC to overall healthcare workforce decreased from 24.25% to 18.57%; the proportion of PH to PC providers at PC facilities increased from 23.6% to 29.5%, while the proportion of PH output increased from 44.3% to 65.9%. Four trajectories of the output–workforce relationship were identified for CC, and five trajectories for PH services of which 85.3% of the facilities showed initially increasing and then slightly decreasing trends. Geographic characteristics impacted different trajectories. The PC workforce falls behind hospital workforce. The expansion in workload of PH services is unbalanced with that of workforce. Full article

(This article belongs to the Special Issue Recent Advances in Healthcare Services in China)

► Show Figures

Figure 1

13 pages, 314 KiB

Open AccessArticle

The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China

by Xiang Jing, Lingzhong Xu, Wenzhe Qin, Jiao Zhang, Lu Lu, Yali Wang, Yu Xia, An’an Jiao and Yaozu Li

Int. J. Environ. Res. Public Health 2020, 17(1), 369; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17010369 - 06 Jan 2020

Cited by 6 | Viewed by 2754

Abstract

Objectives: The aim of this study was to understand the willingness for downward referral among older adults who were hospitalized in the year before the survey and to explore its influencing factors. Methods: The sample was randomly selected by the multi-stage sampling method. A structural questionnaire was used to collect data from participants age 60 and above in Shandong, China, during August 2017. Data were analyzed by using descriptive statistics, one-way ANOVA, chi-square test, and multinomial logistic regression. Results: Of 1198 participants who were hospitalized in the year before the survey, 28.7% self-initiated downward referral, and 33.9% were willing to accept downward referral after a doctor’s advice. Multinomial logistic regression results showed that self-rated health, treatment effect in primary medical institutions, preference for outpatient service, choice of inpatient service, general understanding of essential medicines, the cost of essential medicines after zero-markup policy, and satisfaction with essential medicines’ reimbursement policy significantly correlated with older adults’ willingness for downward referral. Conclusions: The proportion of older adults who self-initiated downward referral was less than one-third. Doctors’ advice plays an important role in willingness for downward referral. More attention should be paid to improving the treatment effect of primary medical institutions, increasing the benefits of zero-markup policy, and ensuring a high reimbursement for the downward referral to work alongside doctors’ advice. Full article

(This article belongs to the Special Issue Recent Advances in Healthcare Services in China)

14 pages, 2523 KiB

Open AccessArticle

The Effect of the Full Coverage of Essential Medicines Policy on Utilization and Accessibility of Primary Healthcare Service for Rural Seniors: A Time Series Study in Qidong, China

by Ying Wang, Yulei Zhu, Hang Shi, Xiaoluan Sun, Na Chen and Xin Li

Int. J. Environ. Res. Public Health 2019, 16(22), 4316; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16224316 - 06 Nov 2019

Cited by 20 | Viewed by 2522

Abstract

Background: Since 2015, in order to handle the increasing prevalence of age-related diseases and escalating health expenditures arising from the aging population, the full coverage of essential medicines (FCEMs) policy for rural seniors has been implemented in primary healthcare institutions of Qidong County of Jiangsu, China. The purpose of this study is to examine the long-term effects of the introduction of FCEMs’ policy on the utilization and accessibility of primary healthcare service for elderly beneficiaries. Methods: The retrospective study was conducted in Qidong County in the Jiangsu province, China. A 47-month longitudinal dataset involving 91,444 health insurance claims records of inpatients aged 70 and older in primary healthcare institutions was analyzed. Changes in health service utilization (average length of stay), patient copayments (out-of-pocket expenses), New Rural Cooperative Medical System (NRCMS) reimbursement rate and daily hospitalization costs per patient were analyzed using interrupted time series analysis. Augment Dicky-Fuller unit root method was used to test the stationarity of the series alongside the Durbin Watson method to test autocorrelation. Results: Average length of stay increased at 0.372 bed-days per month before the implementation of FCEMs policy, whereas the increasing trend was slowed down at 0.003 bed-days per month after the implementation of FCEMs policy (p < 0.001). The average out-of-pocket expenses increased by 38.035 RMB monthly in pre-implementation of the policy period, but it decreased at the rate of 5.180 RMB per month after the implementation of the FCEMs policy (p = 0.006). The NRCMS reimbursement rate increased at 0.066% per month in pre-implementation of policy and the increasing trend was sharper at 0.349% in post-implementation of policy (p = 0.135). The daily hospitalization costs per patient decreased by 6.263 RMB (p = 0.030) per month, whereas it increased at the rate of 3.119 RMB (p = 0.002) per month afterwards. Conclusions: Based on interrupted time series analyses, we concluded that FCEMs policy was associated with positive changes of average LOS and average OOP expenses. The FCEMs policy has alleviated the financial burden of the rural seniors and slightly improved the efficiency of primary health service utilization. However, it had no positive effect on daily hospitalization costs. Therefore, in the general framework of FCEMs policy, the Chinese health policy-maker should take necessary supporting measures to curb climbing hospitalization expenditures and promote the rational drug use in primary healthcare institutions. Full article

(This article belongs to the Special Issue Recent Advances in Healthcare Services in China)

► Show Figures

Figure 1

12 pages, 819 KiB

Open AccessArticle

Effect of an Integrated Payment System on the Direct Economic Burden and Readmission of Rural Cerebral Infarction Inpatients: Evidence from Anhui, China

by Haomiao Li, Yingchun Chen, Hongxia Gao, Jingjing Chang, Dai Su, Shihan Lei, Di Jiang, Xiaomei Hu, Min Tan and Zhifang Chen

Int. J. Environ. Res. Public Health 2019, 16(9), 1554; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16091554 - 03 May 2019

Cited by 7 | Viewed by 2483

Abstract

Rural China is piloting an integrated payment system, which prepays a budget to a medical alliance rather than a single hospital. This study aims to evaluate the effect of this reform on the direct economic burden and readmission rates of cerebral infarction inpatients. The settlement records of 78,494 cerebral infarction inpatients were obtained from the New Rural Cooperative Medical Scheme (NRCMS) database in Dingyuan and Funan Counties in the Anhui Province. The direct economic burden was estimated by total costs, out-of-pocket expenditures, the out-of-pocket ratio, and the compensation ratio of the NRCMS. Generalized additive models and multivariable linear/logistic regression were applied to measure the changes of the dependent variables along with the year. Within the county, the total costs positively correlated to the year (β = 313.10 in 2015; 163.06 in 2016). The out-of-pocket expenditures, out-of-pocket ratios, and the length-of-stay positively correlated to the year in 2015 (β = 105.10, 0.01, and 0.18 respectively), and negatively correlated to the year in 2016 (β = −58.40, −0.03, and −0.30, respectively). The odds ratios of the readmission rates were less than one within the county (0.70 in 2015; 0.53 in 2016). The integrated payment system in the Anhui Province has considerably reduced the direct economic burden for the rural cerebral infarction inpatients, and the readmission rate has decreased within the county. Inpatients’ health outcomes should be given further attention, and the long-term effect of this reform model awaits further evaluation. Full article

(This article belongs to the Special Issue Recent Advances in Healthcare Services in China)

► Show Figures

Figure 1

9 pages, 683 KiB

Open AccessArticle

Can Primary Medical Institutions Lead to Worse Health Status for Patients with Noncommunicable Diseases Compared with High-Level Hospitals? A Follow-Up Observation Study in China

by Yadong Niu, Ting Ye, Yan Zhang and Liang Zhang

Int. J. Environ. Res. Public Health 2019, 16(8), 1336; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16081336 - 14 Apr 2019

Cited by 6 | Viewed by 2482

Abstract

The weak primary healthcare system in China brings challenges to the national strategy of primary medical institutions providing general health needs for patients with non-communicable diseases (NCDs). It is necessary to explore the potential discrepancies in health status for patients with NCDs if they go to primary medical institutions rather than high-level hospitals. Data was obtained from Surveillance of Health-seeking Behavior in Hubei Province. Respondents were investigated six times to collect information on health service utilization and health-related quality of life (HRQoL). Ninety-two hypertension patients who went to medical institutions of the same level were included. HRQoL was measured by the Chinese version of EQ-5D-3L. A multilevel growth curve model was applied to analyze whether provider level could influence HRQoL. The utility score and visual analogue scale (VAS) of patients varied insignificantly over six months (p > 0.05). A growth curve model showed that comorbidity was the only factor significantly influencing utility score (p = 0.019). Time and comorbidity were the only influencing factors of VAS (p < 0.05). Our findings indicated that the level of healthcare provider had no significant impact on the health status of patients with NCDs. As such, this study concludes that the primary healthcare system in China is qualified to be the health gatekeeper for NCDs patients. Full article

(This article belongs to the Special Issue Recent Advances in Healthcare Services in China)

► Show Figures

Figure 1

19 pages, 607 KiB

Open AccessArticle

The Relationship between Socioeconomic Status, Mental Health, and Need for Long-Term Services and Supports among the Chinese Elderly in Shandong Province—A Cross-Sectional Study

by Fanlei Kong, Lingzhong Xu, Mei Kong, Shixue Li, Chengchao Zhou, Jiajia Li, Long Sun and Wenzhe Qin

Int. J. Environ. Res. Public Health 2019, 16(4), 526; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16040526 - 13 Feb 2019

Cited by 22 | Viewed by 4597

Abstract

This study aims to clarify the association between socioeconomic status (SES), mental health, and the need for long-term services and support (NLTSS) of the Chinese elderly, and further, to provide evidence-based suggestions for the development of the long-term services and support (LTSS) system in China. A cross-sectional survey using a multi-stage random sampling method was conducted in Shandong Province, China, in 2017. Data were collected from seniors aged over 60 years old through questionnaires by face-to face interviews. A total of 7070 subjects were included in the final database (40.3% male and 59.7% female). A chi-square test analysis and structural equation modeling (SEM) were employed to explore the relationship between SES, mental health, and NLTSS for both male and female elderly people. The SEM analysis showed that mental health was significantly and negatively associated with NLTSS for both male elderly and female elderly, and it was slightly stronger among the male elderly. A significant and negative relationship was observed between SES and NLTSS for both genders, and the association was stronger among the female elderly. SES exerted a positive effect on mental health for both male and female elderly people, and a slightly stronger effect was found among the male elderly. Advice for the development of a LTSS system in China was given based on the above results. Full article

(This article belongs to the Special Issue Recent Advances in Healthcare Services in China)

► Show Figures

Figure 1

Review

Jump to: Research

14 pages, 308 KiB

Open AccessReview

Evaluating Primary Health Care Performance from User Perspective in China: Review of Survey Instruments and Implementation Issues

by Wenhua Wang, Jeannie Haggerty, Ekaterina (Katya) Loban and Xiaoyun Liu

Int. J. Environ. Res. Public Health 2019, 16(6), 926; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16060926 - 14 Mar 2019

Cited by 9 | Viewed by 3500

Abstract

This review aims to summarize the progress of patient evaluation studies focusing on primary health care (PHC) in China, specifically in relation to survey instruments and implementation issues. Eligible studies published in English or Chinese were obtained through online searches of PubMed and China National Knowledge Infrastructure. A descriptive reporting approach was used due to variations in the measurements and administration methods between studies. A total of 471 articles were identified and of these articles; of those 91 full-text articles were included in the final analysis. Most studies used author-developed measurements with five-point Likert response scales and many used the Chinese translations of validated tools from other countries. Most instruments assessed the physical environment, medical equipment, clinical competency and convenience aspects of PHC using a satisfaction rating instead of care experience reporting. Many studies did not report the sampling approach, patient recruitment procedures and survey administration modes. The patient exit survey was the most commonly used survey implementation method. The focus on the structural dimensions of PHC, inconsistent wording, categories of response options that use satisfaction rating, and unclear survey implementation processes are common problems in patient evaluation studies of PHC in China. Further studies are necessary to identify population preferences of PHC in China in order to move towards developing Chinese value-based patient experience measurements. Full article

(This article belongs to the Special Issue Recent Advances in Healthcare Services in China)

Journal Menu

Journal Browser

Recent Advances in Healthcare Services in China

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Published Papers (7 papers)

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI