Health In China Research Articles

Challenges to China's Healthcare System Reform in the Context of Aging and Future Reform Direction

China's healthcare system faces challenges due to economic development and aging. This study focuses on adapting to aging and improving healthcare accessibility for the middle-aged and elderly, crucial for hospital competitiveness and meeting societal needs. The paper proposes measures based on a literature review. As healthcare reform progresses, high hospital costs and imbalanced pricing emerge. To address this, the government should optimize policies to allocate medical resources reasonably and reduce burdens on the middle-aged and elderly by targeting common diseases. Moreover, China lacks geriatric medical institutions and suffers from discipline imbalances. Strengthening geriatric disciplines, training professionals, and investing in grassroots facilities like specialized hospitals and community centers are necessary. Considering external shocks like COVID-19 and an aging population is vital for reform. Optimizing resource allocation, increasing transparency, promoting digitization, and enhancing efficiency and equity of healthcare utilization are essential. These steps will boost hospital competitiveness, foster long-term system development, adapt to aging challenges, and meet national healthcare demands.

The structural characteristics of the lifestyle among older adults and its impact on the health in China.

Enhancing overall health remains a primary global objective, with lifestyle being a crucial factor impacting the health status among older adults. This study focuses on the lifestyle of Chinese older adults, systematically exploring the evolution and characteristics of their lifestyle and investigating its impact on their health. Utilizing panel data from the Chinese Longitudinal Health Longevity Survey (CLHLS) from 2008, 2011, 2014, and 2018, we adopted 15 indicators reflecting older adults' lifestyle. Latent class analysis and ordinary least square regression were used to uncover the structural nuances of the Chinese older adults' lifestyle and its effects on health. The study identifies three distinct lifestyle categories for the older adults: relatively positive, mixed, and relatively negative. It reveals that the Chinese older adults do not predominantly adopt a positive lifestyle, and this trend persisted from 2008 to 2018. Each improvement in lifestyle category significantly boosts the older adults' physical health, mental health, and self-assessed health by 11.2%, 3.6%, and 17.1%, respectively. To attain the strategic aim of healthy aging, efforts should prioritize encouraging the older adults to adopt a positive lifestyle, enhance the geriatric health service system, and promote an intelligent lifestyle management model.

COVID-19 and mental health in China: the effects of personality

BackgroundChina was the first country affected by the COVID-19 virus, and it is a very important case to study the effects of the virus and the consequent restrictions. However, national...

Number of Siblings and Mental Health Among Adolescents: Evidence From the U.S. and China

A growing number of children are being raised with few or no siblings yet the consequences of this seismic demographic shift in family forms are not well understood. We investigate this question in the U.S. and China because previous studies highlight how contextual features can play an important role shaping how siblings matter. Our Chinese analyses draw on more than 9,400 eighth graders from the China Education Panel Study (CEPS). In the U.S., we analyze over 9,100 American eighth graders from the Early Childhood Longitudinal Study—Kindergarten Cohort of 1998 (ECLS-K:98), where our data allow us to consider multiple features of the sibship structure (e.g., size, sex composition, and density). We find that number of siblings is negatively associated with mental health in both China and the U.S., although the details of this pattern (non-linear association, sisters versus brothers, and closely versus widely spaced siblings) vary.

Is the economic uncertainty- human health relationship nonlinear? An empirical analysis for the China.

The health costs of economic uncertainty always remain a major concern among policymakers of China. The theoretical and empirical literature on the economic uncertainty-human health nexus is still in its infancy stage. This study is firmly rooted in the economic uncertainty theory advanced by Baker, Bloom, & Davis. In this study, the primary objective of the analysis is to estimate the asymmetric impact of economic uncertainty on human health in China's economy. In order to evaluate the short and long-run estimates of economic uncertainty on human health across various quantiles, we have employed the linear and nonlinear QARDL models. The linear QARDL model shows that the long-run relationship between economic uncertainty and the infant mortality rate is positive and significant at all quantiles, while the long-run relationship between economic uncertainty and the death rate is positive and significant at higher quantiles. The nonlinear QARDL model reveals that, in the long run, the relationship between the positive shock of economic uncertainty and the infant mortality rate is positive and significant at quantiles 0.30 to 0.95, while the long-run relationship between the positive shock of economic uncertainty and the death rate is positive and significant at higher quantiles. The relationship between the negative shock of economic uncertainty and the infant mortality rate is negative and significant at the highest quantiles, while the relationship between the negative shock of economic uncertainty and death rate is negative and significant at higher quantiles in the long run. The findings indicate a positive relationship between economic uncertainty in China and higher rates of infant mortality and death. Thus, adopting suitable policies for controlling economic uncertainty can help in improving human health in China.

A breath of fresh air: Coal power plant closures and health in China

This study provides the first causal evaluation of the impact of coal power plant closures on health in China using nationally representative survey data. Based on the linkage between the staggered shutdowns of 13 coal power plants between 2000 and 2015 and the China Health and Nutrition Survey (CHNS) data, we adopt the new event study approach by Sun and Abraham (2021) to compare changes in overall health statuses for residents living downwind of coal power plants (treated) with those living upwind (control), before and after plant closures. We find that incidences of sickness are reduced by 7 percentage points or 0.2 standard deviations 5–9 years after the closure. The result is robust to a host of robustness checks. Further analyses reveal that the health benefits are concentrated on older adults, rural areas, and historically low pollution regions. By considering several potential channels, we find that plant shutdowns have decreased incidences of overweight and hypertension, increased physical activity levels, and generated a wealth effect resulting from increased housing prices.

Balancing medical innovation and affordability in the new healthcare ecosystem in China: Review of pharmaceutical pricing and reimbursement policies

AbstractThe China Basic Medical Insurance Program was created in 1999 with three objectives: equal accessibility, affordability, and quality. Today, it has become the biggest medical insurance program in the world, covering 95% of China's population. Since 2015, China's healthcare ecosystem has been reshaped by increasing innovation, which has in turn been driven by regulatory reform, enhancement of research and development capability, and capital market development. There has also been improved regulatory efficiency to reduce lags in launching drugs. In 2022, nearly 20% of novel active substances launched globally were from China. China has also risen to become the second biggest contributor to innovation in terms of pipelines. Using a “fast‐follow” strategy, many locally developed innovative drugs can compete with products from multinational companies in their quality and pricing. However, China's pharmaceutical and biotechnology industry will continue to face challenges in pricing and reimbursement, as well as a shortened product lifecycle with rapid price erosion. The government has already accelerated the timeline for updating the drug reimbursement list and is willing to create a high‐quality medical insurance program. However, some obstacles are hard to overcome, including reimbursement for advanced therapies, limited funding and an increasing burden of disease due to an aging population. This article reviews the trajectory of medical innovation in China, including the challenges. Looking forward, balancing affordability and innovation will be critical for China to continue the trajectory of growth. The article also offers some suggestions for future policy reform, including optimizing reimbursement efficiency with a focus on high‐quality solutions, enhancing the value assessment framework, payer repositioning from “value buyer” to “strategic buyer”, and developing alternative market access pathways for innovative drugs.

Interpretation of the Annual Report on Cardiovascular Health and Diseases in China 2021

Interpretation of the Annual Report on Cardiovascular Health and Diseases in China 2021

Summary of the 2022 Report on Cardiovascular Health and Diseases in China.

Recent decades have seen the remarkable development of China in medical accessibility and quality index, and the application of a number of new advanced cardiovascular technologies benefits more patients. However, according to the Annual Report on Cardiovascular Health and Diseases in China published in this article, which was organized and summarized by National Center for Cardiovascular Diseases, there is still a huge population living with risk factors of cardiovascular diseases (CVD), and the morbidity and mortality of CVD are increasing. It is estimated that there are around 330 million patients suffering from CVD currently, including 245 million of hypertension, 13 million of stroke, 45.3 million of peripheral artery disease, 11.39 million of coronary heart disease (CHD), 8.9 million of heart failure, 5 million of pulmonary heart disease, 4.87 million of atrial fibrillation, 2.5 million of rheumatic heart disease, and 2 million of congenital heart disease. Tobacco use, diet and nutrition factors, physical activity, overweight and obesity, and psychological factors are what affect cardiovascular health, while hypertension, dyslipidemia, diabetes, chronic kidney disease, metabolic syndrome, and air pollution are the risk factors for CVD. In this article, in addition to risk factors for CVD, we also report the epidemiological trends of CVD, including CHD, cerebrovascular disease, arrhythmias, valvular heart disease, congenital heart disease, cardiomyopathy, heart failure, pulmonary vascular disease and venous thromboembolism, and aortic and peripheral artery diseases, as well as the basic research and medical device development in CVD. In a word, China has entered a new stage of transforming from high-speed development focusing on scale growth to high-quality development emphasizing on strategic and key technological development to curb the trend of increasing incidence and mortality of CVD.

Increased Impact of Aviation on Air Quality and Human Health in China.

China's civil aviation market has rapidly expanded, becoming the world's second-largest. However, the air quality and health impacts caused by its aircraft emissions have been inadequately assessed. Here, we leverage an updated emission inventory of air pollutants with improved temporal and spatial resolution based on hundreds of thousands of flight trajectories and simulate aviation-attributable contributions to ground-level air pollution in China. We find that in 2017, the annual-average aviation-attributed PM2.5 and O3 concentrations were 0.4-1.5 and 10.6-14.5 μg·m-3, respectively, suggesting that aviation emissions have become an increasingly important source of ambient air pollution. The contributions attributable to high-altitude emissions (climb/cruise/descent) were comparable to those at low altitudes (landing and takeoff). Aviation-attributed ambient PM2.5 and O3 exposures are estimated to have caused about 67,000 deaths in China in 2017, with populous coastal regions in Eastern China suffering the most due to the dense aviation activity. We recommend that industrial and policy stakeholders expedite an agenda of regulating air pollutants harmonized with decarbonization efforts for a more sustainable aviation future.

Job preference of preventive medicine students during the COVID-19 pandemic: a discrete choice experiment survey in Shandong Province, China

BackgroundPublic health workers are a crucial part of the health workforce, particularly during the coronavirus disease (COVID-19) pandemic. They play an important role in achieving universal health coverage and sustainable development goals. Human resources in public health in China are in short supply, their distribution is unequal, and their turnover rate is high. A discrete choice experiment (DCE) was applied to investigate preventive medicine students’ preferred job choice criteria and trends in trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of jobs primarily selected by preventive medicine students and estimated the monetary value of each attribute.MethodsBased on discussions and in-depth interviews with preventive medicine students and a literature review, we developed a DCE that assessed how students’ stated preferences for a certain choice were influenced by several job attributes, including location, salary, bianzhi, career development opportunities, working environment, and workload. We applied this DCE to preventive medicine students in Shandong Province, China, using a brief, structured questionnaire. Conditional logit models were used to estimate the utility of each job’s attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative value of the cost attribute.ResultsA total of 307 respondents completed the questionnaire, and 261 passed the internal consistency test. All the attributes were statistically significant. Career development opportunities and work locations were the most important factors for the respondents. Preference heterogeneity existed among respondents, e.g., 3-year medical education college students placed a higher value on jobs with bianzhi compared to 5-year medical education college students. Furthermore, rural students’ WTP for a job located in the county or city is much lower than that of urban students.ConclusionsThe heterogeneity of attributes indicates the complexity of job preferences. Monetary and nonmonetary job characteristics significantly influenced the job preferences of preventive medicine students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both job incentives and the backgrounds of preventive medicine graduates.

Spatial and temporal analysis of China's healthcare resource allocation measurements based on provincial data: 2010-2021.

With the development of society, industrialization, urbanization, aging, lifestyle and social transformation, environmental degradation, global warming and other factors have had a great impact on the health of the population, and there is an urgent need to take a series of practical actions to promote the improvement of national health. Among them, healthcare resource allocation plays a key role in advancing the level of national health, treatment of chronic diseases, and leisure and healthcare. This article collected panel data on healthcare resource allocation in all provinces of China from 2010 to 2021, and comprehensively applied Analytic Hierarchy Process, comprehensive scoring method, regional difference analysis and spatial autocorrelation analysis to reveal regional differences, spatial-temporal patterns and development characteristics of healthcare resource allocation in China. In terms of regional differences, intra-regional differences in healthcare resource allocation tend to narrow and inter-regional differences tend to widen. In terms of spatial pattern, the western provinces on the left side of the Hu Huanyong line generally have higher scores, while the central and eastern provinces on the right side of the Hu Huanyong line have lower scores, and healthcare resource allocation in the provinces on the left side of the Hu Huanyong line, such as Tibet, Xinjiang, Qinghai, Ningxia, Gansu, Inner Mongolia, Sichuan, have the spatial characteristics of HH clusters in terms of geographic location, while the southeast coastal provinces, such as Zhejiang, Fujian, Guangdong, Hainan, have the spatial characteristics of LL clusters in terms of geographic location. From the quadrant analysis, the 2010-2021 healthcare resource allocation in the first quadrant concentrates most of the provinces in the western and northeastern regions, while the third quadrant concentrates most of the provinces in the eastern region. The allocation of healthcare resources in China's four major zones has undergone a process of change from "unbalanced quantity to relatively balanced quantity," but high-quality healthcare resources are highly concentrated in the eastern part of the country, and the problem of contradiction between people and doctors is prominent. It is recommended that Internet plus healthcare technology be used to reshape the regional allocation of high-quality healthcare resources.

The effect of housing tenure on health status of migrant populations in China: are health service utilization and social integration mediating factors?

BackgroundCurrent research suggests that there is an association between housing tenure and the health status of migrant populations, but the potential mediators of this association remain to be explored. We aimed to examine the effect of housing tenure on migrant populations’ health in China and how this effect is mediated by health service utilization and social integration.MethodsData from the 2017 China Migrants Dynamic Survey of 47,459 participants was used. Logistic regression models were used to explore the effects of housing tenure, health service utilization, and social integration on the health status of migrant populations. Mediated effects models were used to explore the association among them. This study used the bootstrap method and KHB method to test the mediating effect of health service utilization and social integration.ResultsCompared to private renters, owners with mortgages (OR: 0.828, 95% CI: 0.765–0.896) were significantly associated with a higher risk of poor health. Compared with private renters, outright owners were associated with a lower risk of poor health (OR: 1.016, 95% CI: 0.935, 1.104), but the association was not statistically significant (p > 0.05). Moreover, health service utilization (OR: 1.422, 95% CI: 1.268, 1.594) and social integration (OR: 4.357, 95% CI: 3.555, 5.341) were both significantly associated with a higher probability of good health (p < 0.001).ConclusionAmong migrant populations, homeowners with mortgages had a lower likelihood of good health than private renters, while there was no significant difference in the health status between outright owners and private renters. Moreover, health service utilization and social integration mediate the effect of housing tenure on the health status of migrant populations. Policies and interventions can be designed to improve the health service utilization and social inclusion of migrant populations to reduce health disparities across housing tenure types.

Evaluating and optimizing the ecosystem health of China’s Yellow River Basin based on emergy analysis and multi-objective decision method

Evaluating and optimizing the ecosystem health of China’s Yellow River Basin based on emergy analysis and multi-objective decision method

Impact of vertical integration in a referral-based healthcare system

Vertical integration has been growing steadily in healthcare and several studies have explored the impact of this phenomenon on prices, consumers, etc. In this work, motivated by changes in healthcare systems in China, we provide an operational perspective by investigating how vertical integration influences the referral behavior in primary care and the corresponding service provision at hospitals or specialists. We present an optimization model to explore the effect of different levels of vertical integration on generalists and specialists. We find that the healthcare system efficiency can indeed be improved with a moderate level of integration. However, when the level of integration increases beyond a certain threshold, healthcare costs may actually increase with more integration especially when generalists or primary care providers are inadequately trained and specialists are highly utilized. We find that full integration is not optimal. Moreover, aiming for a moderate level of integration is especially appropriate if the generalist’s ability to treat complex patients is limited and/or timely access to treatment is important. Our work also shows that physicians get higher payment without necessarily improving service quality when the integration level is higher. We discuss the implications of our results in the context of the Chinese healthcare system, although some insights may apply more broadly.

Impact of the new rural social pension insurance on the health of the rural older adult population: based on the China health and retirement longitudinal study.

The health issues of China's older adult population in rural areas have been receiving increasing attention with the continuous expansion of the nation's ageing population and the continuous promotion of urban-rural integration. The impact of the new rural social pension insurance (NRSPI) on the health of the rural older adult population, the mechanism of its action and how old-age service can be improved and optimised according to the health needs of the rural older adult population are urgent and realistic challenges. Based on survey data from the China Health and Retirement Longitudinal Study in 2015 and 2018, this study applies a multivariate ordered logistic regression model to explore the impact mechanism and effect of the NRSPI on the older adult population health in rural China while controlling for endogeneity. The results show that participation in the NRSPI can significantly improve the health of the rural older adult population at a 1% level. The results of the heterogeneity test reveal that the NRSPI has a significant impact on the self-reported health of the rural older adult at a 1% level, with a significantly positive impact on the mental and physical health of rural female older adult, whereas the impact on male older adult is not significant. The mediating effect test results show that medical services, food access and entertainment activities have a mediating effect on the new rural social endowment insurance. The results of the moderating effect test indicate that the NRSPI regulates 7.8% of the effect of physical health on mental health and 10.7% of the effect of mental health on physical health. Based on these findings, this study proposes to strengthen the construction of healthy lifestyle guidance and emotional support systems while improving the NRSPI's participation rate and treatment level to meet the diverse health service needs of different older adult groups.

Socioeconomic, meteorological factors and spatiotemporal distribution of human brucellosis in China between 2004 and 2019-A study based on spatial panel model.

Human brucellosis continues to be a great threat to human health in China. The present study aimed to investigate the spatiotemporal distribution of human brucellosis in China from 2004 to 2019, to analyze the socioeconomic factors, meteorological factors and seasonal effect affecting human brucellosis incidence in different geographical regions with the help of spatial panel model, and to provide a scientific basis for local health authorities to improve the prevention of human brucellosis. The monthly reported number and incidence of human brucellosis in China from January 2004 to December 2019 were obtained from the Data Center for China Public Health Science. Monthly average air temperature and monthly average relative humidity of 31 provincial-level administrative units (22 provinces, 5 autonomous regions and 4 municipalities directly under the central government) in China from October 2003 to December 2019 were obtained from the National Meteorological Science Data Centre. The inventory of cattle, the inventory of sheep, beef yield, mutton yield, wool yield, milk yield and gross pastoral product of 31 provincial-level administrative units in China from 2004 to 2019 were obtained from the National Bureau of Statistics of China. The temporal and geographical distribution of human brucellosis was displayed with Microsoft Excel and ArcMap software. The spatial autocorrelation and hotspot analysis was used to describe the association among different areas. Spatial panel model was constructed to explore the combined effects on the incidence of human brucellosis in China. A total of 569,016 cases of human brucellosis were reported in the 31 provincial-level administrative units in China from January 2004 to December 2019. Human brucellosis cases were concentrated between March and July, with a peak in May, showing a clear seasonal increase. The incidence of human brucellosis in China from 2004 to 2019 showed significant spatial correlations, and hotspot analysis indicated that the high incidence of human brucellosis was mainly in the northern China, particularly in Inner Mongolia, Shanxi, and Heilongjiang. The results from spatial panel model suggested that the inventory of cattle, the inventory of sheep, beef yield, mutton yield, wool yield, milk yield, gross pastoral product, average air temperature (the same month, 2-month lagged and 3-month lagged), average relative humidity (the same month) and season variability were significantly associated with human brucellosis incidence in China. The epidemic area of human brucellosis in China has been expanding and the spatial clustering has been observed. Inner Mongolia and adjacent provinces or autonomous regions are the high-risk areas of human brucellosis. The inventory of cattle and sheep, beef yield, mutton yield, wool yield, milk yield, gross pastoral product, average air temperature, average relative humidity and season variability played a significant role in the progression of human brucellosis. The present study strengthens the understanding of the relationship between socioeconomic, meteorological factors and the spatial heterogeneity of human brucellosis in China, through which 'One Health'-based strategies and countermeasures can be provided for the government to tackle the brucellosis menace.

Impact of Home-based Care and Institutionbased Care on Older Adults’ Health in China: A Comparative Analysis

Objective: This study compares between two types of care for older adults′ health, viz., home -based care and. Institution-based care in the context of China, and further explored the impact of each care type on their health. Methods: A fully aligned polygonal graphical indexing method, t-tests, logistic binary regression analysis were performed using SPSS for data analysis. Results: In both care types, females had higher incidence of one or more chronic disease than males, as well as anxiety. However, hypertension was the chronic disease with the highest incidence, higher in males than females. Care types had significant impact on variables like self-reported health (OR=0.329, [CI95%=0.107-1.010], p&lt;0.05) and mental health (OR=0.567, [CI95%=0.364-0.881], p&lt;0.05), but had no significant impact on the objective physical health (OR=1.010, [CI95%=0.577-1.767], p&gt;0.05). Conclusion: Both the types of care of older adults showed a significant impact on the self-reported and mental health, but only a significant difference was made on their mental health. Information exchange and emotional communication through smart facilities and the Internet useability, such as eHealth training, intelligent old-age care may be good interventions to improve older adults′ health.

A Meta-analysis of the Effect of COVID-19 on Mental Health in China

This article focuses on the effects of COVID-19 and policies in China. In December 2019, an unexpected epidemic emerged. As of April 2021, there were 2.89 million deaths from COVID and 133 million cases of SARS-CoV-2 infection, the virus that causes COVID (Mathieu et al., 2021). The mental health impact of this epidemic cannot be underestimated; it has brought stress, anxiety and depression to medical staff, infected patients, and uninfected people. Much of this stress led to suicide.

Study on a job competence evaluation system for resident physicians (including integrated postgraduates) receiving standardized training

BackgroundStandardized training for resident physicians is the primary form of postgraduate medical education, and it plays a pivotal role in healthcare safety and industry stability. Currently, it has garnered significant attention from healthcare institutions.MethodsBy conducting a comprehensive literature review and a Delphi consultation in June 2022 for which 40 experts in clinical medicine, public health, and other related fields in China were invited. The indicators were adjusted according to the results of the consultation, and the final indicator weights were determined through an analytic hierarchy process.ResultsThe response rate was 100%, and the expert authority coefficient was 0.879. The consistency among the experts on the tertiary indicators, as measured by Kendall’s W, was 0.675 (χ2 = 42.516, p < 0.001). Based on the results of the expert consultation, a job competence evaluation system for resident physicians (including integrated postgraduates) receiving standardized training was established, which included 6 primary indicators, 18 secondary indicators, and 116 tertiary indicators. The weights for the primary indicators, namely professional quality, skills and knowledge, patient care, communication and collaboration, teaching skills, and lifelong learning, were 0.313, 0.248, 0.181, 0.083, 0.066, and 0.110, respectively. The top three secondary indicators in terms of combined weights were clinical skills (0.122), professional ethics (0.120), and professional dedication (0.109). The three tertiary indicators with the highest scores were “maintains collaboration with peers and colleagues in patient treatment,” “has clinical thinking skills, makes diagnosis and treatment decisions based on analysis of evidence, and has the ability to administer suitable treatments,” and “abides by laws and discipline and refuses to seek personal gains in medical practice”; their combined weights were 0.035, 0.028, and 0.027, respectively.ConclusionThis study has established a concrete, objective, and quantifiable competency assessment index system for standardized training of clinical resident physicians (including integrated postgraduates). This system provides a foundation for the quantitative evaluation of the competency of clinical resident physicians (including integrated postgraduates) undergoing standardized training.