Distribution Of Health Resources Research Articles

Ethnic disparities and temporal trends in health resource allocation: a retrospective decadal analysis in Sichuan, a multi-ethnic Province of Southwest China (2009–2019)

BackgroundResearch on health resource allocation trends in ethnic minority and impoverished areas in China is limited since the 2009 Medical Reform. This study aimed to investigate the variations and inequalities in health resource distribution among ethnic minority, poverty-stricken, and non-minority regions in Sichuan Province, a multi-ethnic province in Southwest China, from 2009 to 2019.MethodsThe numbers of beds, doctors and nurses were retrospectively sourced from the Sichuan Health Statistics Yearbook between 2009 and 2019. All the 181 counties in Sichuan Province were categorized into five groups: Yi, Zang, other ethnic minority, poverty-stricken, and non-minority county. The Theil index, adjusted for population size, was used to evaluate health resource allocation inequalities.ResultsFrom 2009 to 2019, the number of beds (Bedp1000), doctors (Docp1000), and nurses (Nurp1000) per 1000 individuals in ethnic minority and poverty-stricken counties consistently remained lower than non-minority counties. The growth rates of Bedp1000 in Yi (140%) and other ethnic minority counties (127%) were higher than in non-minority counties (121%), while the growth rates of Docp1000 in Yi (20%) and Zang (11%) counties were lower than non-minority counties (61%). Docp1000 in 33% and 50% of Yi and Zang ethnic counties decreased, respectively. Nurp1000 in Yi (240%) and other ethnic minority (316%) counties increased faster than non-minority counties (198%). The Theil index for beds and nurses declined, while the index for doctors increased. Key factors driving increases in bed allocation include preferential policies and economic development levels, while health practitioner income, economic development levels and geographical environment significantly influence doctor and nurse allocation.ConclusionsPreferential policies have been successful in increasing the number of beds in health facilities, but not healthcare workers, in ethnic minority regions. The ethnic disparities in doctor allocation increased in Sichuan Province. To increase the number of doctors and nurses in ethnic minority and poverty-stricken regions, particularly in Yi counties, more preferential policies and resources should be introduced.

Investigating the Inequality Trend in Health Resource Distribution in Iran: A Case Study in Bushehr Province

Background: Equity in access to health resources is a fundamental goal of health systems worldwide. Objectives: This study aims to assess the distribution of essential health resources necessary for healthcare provision in Bushehr Province. Methods: This cross-sectional study spans ten years and utilizes several widely recognized indices in health resource distribution equity and equality, including the Gini Coefficient, Concentration Index, Horizontal Inequity, Robin Hood Index, Theil Index, Atkinson Index, and Quantile Ratio. These indices were calculated based on both the population level and the proposed resource allocation model (PRAM) using Excel Software 2018 and Stata version 18. Results: The findings indicate a degree of inequality in the distribution of all health resources examined, with special beds exhibiting much higher levels of inequality than others. The sensitivity of the studied indices varied across the distributed resources. Moreover, the trend of inequality generally decreased for all examined resources. The PRAM results suggest that adopting a different approach to resource distribution can significantly reduce inequality levels. Conclusions: Despite a downward trend in the inequality of health resource distribution, significant disparities persist. Altering the resource distribution system from the conventional geographical division could aid in achieving equity and equality in healthcare. Such changes could also reduce the costs associated with the health system.

Life course socioeconomic status, chronic pain, and the mediating role of allostatic load: findings from the midlife in the United States.

Low socioeconomic status (SES) has been linked to chronic pain (CP); however, the mechanisms by which SES over the life course influences downstream CP outcomes remain unclear. This study utilizes data from the Midlife in the United States (MIDUS) survey, a prospective sample of community-dwelling individuals (N=781), to investigate the chain of risk additive model of SES in relation to CP. Additionally, the study examines the mediating role of allostatic load (AL) in the relationship between life course SES and CP. Confirmatory factor analysis was employed to capture the multidimensionality of life course SES and path analysis was used to examine the direct and indirect effects on CP. AL was computed by quartile-based summation and by latent class analysis. Results indicated lower SES in MIDUS 2 was associated with greater high-interference CP odds in MIDUS 3 (OR=1.069, 95% CI=1.006-1.136, P < 0.05) and no association was found between distal SES and levels of CP interference. Similarly, no significant relationship was observed between SES and the number of CP locations. Additionally, no additive effects of SES were found, and AL did not present mediation effects on the association between life course SES and CP. The present study emphasizes the importance of directly proximal effects of SES on CP, underscoring the need for equitable distribution of health resources and the implementation of policies focused on diminishing socioeconomic inequalities. Further research is needed to examine alternative pathways by which proximal SES impact CP.

Global Health Management in the Face of Emerging Pandemic Threats: Strategies, Challenges, and Opportunities for International Cooperation

The global Pandemic that has emerged has led to big challenges for the world health system, showing limitations in infrastructure, response, and international coordination. Inequality in the distribution of health resources and access to maintenance, along with obstacles in communication and coordination of inter-country policies, shows the urgent need for evaluating and improving global health management strategies. This condition encourages the need for in-depth analysis of strategies that can be implemented in dealing with pandemics, including strengthening the health system and international cooperation. This study aims to identify and analyze various strategies in global health management to deal with pandemics that emerge, focusing on threats, challenges, and opportunities for international cooperation. This study uses a qualitative approach, relies on data from relevant studies and studies, and is followed by in-depth analysis to integrate findings. The results of this study indicate that the current global health system faces various challenges in dealing with the Pandemic, which include infrastructure readiness, the effectiveness of surveillance systems and early detection, as well as the need for stronger international cooperation. There are also challenges in coordinating between countries, political and economic influences, as well as obstacles in communication and dissemination of information. This study found that international cooperation, especially in research and medical development, sharing resources, and coordination by international organizations, is the key to tackling the Pandemic. Building the capacity of the health system in developing countries is also an important aspect of global strategy.

Measures to Narrow the Gap of Basic Medical and Health Services for Urban and Rural Residents

Health is the foundation of economic and social development, and people's health and longevity is an important symbol of national prosperity and national strength. Since the reform and opening up, our country has made remarkable achievements in the reform and development of health field. A sound medical and health service system is the basis for reducing the occurrence of diseases and ensuring residents' equal access to medical and health services. With the implementation of the "Healthy China 2030" Plan and a series of policies, promoting a healthy lifestyle and improving the level of basic medical and health services have become the fundamental direction of current medical and health development. Under the guidance of this development direction, in view of the inherent problems of basic medical and health services in rural areas of Hebei Province, it is necessary to fully investigate and understand the actual needs of residents in rural areas, increase the supply body of basic medical and health service resources, and solve the problem of insufficient total amount and uneven distribution of basic medical and health resources. Make up for the weak basic medical and health service foundation in rural areas of Hebei Province, strive to build a people-oriented basic medical and health service system that is balanced between urban and rural areas, and consciously transfer human, material and financial resources in urban areas to rural areas, so as to lay a solid foundation for protecting the health level of rural residents.

Sharing peer advice: A case study of Chinese patients’ narratives in an online support group for mental health

Recent health communication studies have begun to look at online illness narratives, showing how narratives are used to report patients’ experience or to offer medical advice in various online contexts. However, few studies have sought to explore the communicative features of these online narratives in the Chinese context. Given the insufficient and uneven distribution of mental health resources and the intense stigma attached, an increasing number of Chinese patients with mental disorders are turning to online support groups (OSGs) for advice. We have limited understanding of Chinese patients’ lived experience or the potential of online illness narratives to be interpersonal tools for sharing advice. Drawing on computer-mediated discourse analysis, this study scrutinises narrative passages from a Chinese OSG to illustrate how individuals with mental illness interact in an online advisory context. The detailed analysis of narrative functions unpacks the potential of OSGs to provide storytelling opportunities for Chinese patients with mental disorders, allowing them to voice their concerns and experiences within the peer-to-peer network of relational understanding and support. This study also identifies a distinct feature of narrative activities in this online advisory context – the illness blog – and illustrates how its occurrence is related to the Chinese sociocultural values. This study can help raise awareness of illness narratives as a communication tool and facilitate culturally sensitive reactions of healthcare professionals towards patients’ narratives.

Investigation and analysis of oral health resources allocation status in Yunnan Province

Objective: To investigate and analyze the allocation status of oral health resources in Yunnan Province at the end of the 13th Five-Year Plan, providing a scientific basis for the rational resource allocation and formulation regional oral health plan for government health administrative departments. Methods: With the method of general survey, a cross-sectional study was conducted to investigate the allocation of material and human resources of all kinds of stomatological medical institutions registered in the health administrative departments in Yunnan before January 1, 2020. The general situation of oral health resources was analyzed by descriptive statistical analysis. Results: There were 2 712 stomatological medical institutions in Yunnan, 634 public and 2 078 non-public included. The largest number was in Kunming (1 167) and the least in Diqing (19). There were 9 018 dental chairs in total, among which 2 584 in public and 6 434 in non-public. Kunming had the largest number of chairs (3 612) and Nujiang had the least (57). There were 702 oral and maxillofacial surgical beds, all of which were distributed in public. There were 15 148 stomatological personnel, including 3 667 in public and 11 481 in non-public. The average ratio of stomatologist to population was 1∶6 615. Dehong (1∶6 620) was close to this average level, while Kunming (1∶2 283) and Yuxi (1∶4 936) were lower than the average and the other 13 states (cities) were higher. The population ratio of licensed stomatologist was only 1∶9 110. The average ratio of stomatologist to nurses was 1∶0.94. Honghe (1∶1.05), Kunming (1∶1.00), Yuxi (1∶1.18) and Qujing (1∶0.94) was better than or reached the average level, while the other 13 states (cities) were lower than this average. And this ratio in public comprehensive medical institutions was only 1∶0.38. Conclusions: The distribution of oral health resources in Yunnan was unbalanced between public and non-public institutions and among states (cities), mainly distributed in economically developed states (cities) and non-public institutions. For the oral health in Yunnan Province, the workforce was insufficient and the structure was unreasonable, and the proportion of nurses was seriously insufficient in public comprehensive medical institutions.

Application and Progress of Intelligent Assistant Diagnosis in Mental Health Assessment System

The establishment of mental health assessment system provides a new way for the early diagnosis of mental health problems, in view of the growing population of mental diseases and problems and the uneven distribution of mental health resources. In the mental health assessment system, intelligent assistant diagnosis can assist or help psychiatrists improve their work efficiency. Intelligent assistant diagnosis provides technical support for predictive screening and auxiliary diagnosis of mental health problems. It is an intelligent diagnosis research based on big data analysis and machine learning in mental health assessment system. This article mainly reviews the application methods, the application progress in the field of mental health, as well as related technical issues and safety issues, and prospects the future research development.

Individual- and institution-level predictors of the turnover intention of medical staff among rural primary medical institutions in Xinjiang Production and Construction Corps, China: a cross-sectional multi-level analysis.

Primary medical staff (PMS) are the guardians of population health. However, their loss further worsens the shortage and uneven distribution of human health resources, which should be addressed immediately. This study aimed to investigate the current status of turnover intention of rural PMS in Xinjiang Production and Construction Corps (XPCC) in China and its influencing factors atthe individual and institutional levels to provide reliable baseline data for intervention strategies to protect valuable rural PMS. Participants were recruited from rural public health institutions of the XPCC using a cross-sectional multistage sampling process. Data on participants' turnover intention and individual- and institution-level indicators were obtained through standardized electronic questionnaires and statistical reports of regional health administrative departments. The key factors influencing PMS turnover intention were identified us ingunivariateandmulti-level logistic regression analysis. Overall, 20.5% (447/2182) of participants reported turnover intention. Univariate analysis showed that the occurrence of turnover intention was significantly influenced by marriage, education, age, year of working, monthly income, human resource management practices (HRMP), job satisfaction, per capita served population (PCSP) and number of beds (p < 0.05). Multi-level logistic regression analysis showed that bachelor's degree or above and intermediate professional title were closely related to the occurrence of turnover intention (p < 0.05), age 41-50 years old and above, high human resource management practice, and high job satisfaction effectively reduced the odds (p < 0.05). The odds of turnover intention increased by 37% (p < 0.10) for PMS in institutions with PCSP more than 250 people. In contrast, the odds of turnover intention decreased to 68% (p < 0.05) for PMS in institutions with more than 50 beds. Government-run primary medical institutions face the risk of PMS turnover intention. From a personal perspective, the high-risk population fortheturnover intention was mainly the PMS with bachelor's degrees or above and intermediate professional titles. The low-risk population was the PMS with aged over 40 years, a higher evaluation of human resource management practice, and job satisfaction. From the perspective of primary medical institutions, larger institutions can reduce the turnover intention of individuals, whereas the size of the service population has the opposite effect.

Understanding the Association Between Sensory Impairment and Dementia: Toward Informing Future Research and Health Policy

Recent epidemiological research has linked decline in multiple sensory functions with an increased risk of dementia. However, the pathways linking such factors with neurodegenerative disorders remain unclear. Studies that assess this are crucial for guiding the distribution of public health resources and the development of clinical trials aiming to delay or prevent dementia. This commentary examines the contribution of a study by Dintica and colleagues to the field of sensory-cognitive research.

Inequity in the global distribution of monkeypox vaccines.

Monkeypox (mpox) has been a public health emergency of international concern that emerged in mid-2022 and has spread to 110 countries. The clinical findings of the disease vary according to the seriousness of the cases. Although its case fatality risk has not been high, a significant percentage of patients require hospitalization. In this context, local initiatives were taken to extend the limited supply of vaccines against the disease; however, such measures have not been sufficient to contain the spread of cases and ensure an equitable distribution of health resources. As a result, endemic regions of low-income countries continue to have insufficient access to mpox vaccination. Despite this and considering the global scope of the disease, there is still little discussion in the literature about the difficulties in achieving adequate vaccination coverage rates for the target population of interest. In this article, we briefly discussed general aspects of the disease, including its surveillance, the current global context of challenges for mpox vaccination, and issues on global allocation of health resources as well as proposed related recommendations.

The Possibilities, Limits, and Complexities of Triage in COVID-19 Regime

The new and prevailing Corona virus (COVID-19) pandemic is an extremely contagious virus. Scientific research has gone far in the study and treatment of the virus. One of the things known about it at present is that its spread depends on social contact. In this paper, I consider the challenge that allocation of scarce medical resources poses in the fight against COVID-19. Millions have been infected, just as the number of diseased also runs in thousands. The allocation of scarce medical resources during the COVID-19 pandemic regime poses a challenge to healthcare providers. In attempting to save the lives of COVID-19 patients, how should we allocate ventilators or vaccines? Since ventilators, or as at present vaccines, are scarce compared to the number of patients that need it for survival, who should get one? To address this challenge, healthcare providers often resort to triage, especially in Emergency Departments (EDs) and intensive care units (ICUs). In this paper, I discuss the possibilities, limits, and complexities associated with the principle of triage in the distribution of scarce medical resources in the treatment and attempt to save the lives of COVID-19 patients. I contend that triage as a principle of distribution of scarce health resources fails in the distribution of scarce life-saving resources to COVID-19 patients. I aim to show that the triage protocol approach fails in terms of clinical and non-clinical evidence as well as regarding procedural issues associated with its application.

Transitional Care for Young People with Movement Disorders: Consensus-Based Recommendations from the MDS Task Force on Pediatrics.

The International Parkinson and Movement Disorders Society (MDS) set up a working group on pediatric movement disorders (MDS Task Force on Pediatrics) to generate recommendations to guide the transition process from pediatrics to adult health care systems in patients with childhood-onset movement disorders. To develop recommendations for transitional care for childhood onset movement disorders, we used a formal consensus development process, using a multi-round, web-based Delphi survey. The Delphi survey was based on the results of the scoping review of the literature and the results of a survey of MDS members on transition practices. Through iterative discussions, we generated the recommendations included in the survey. The MDS Task Force on Pediatrics were the voting members for the Delphi survey. The task force members comprise 23 child and adult neurologists with expertise in the field of movement disorders and from all regions of the world. Fifteen recommendations divided across four different areas were made pertaining to: (1) team composition and structure, (2) planning and readiness, (3) goals of care, and (4) administration and research. All recommendations achieved consensus with a median score of 7 or greater. Recommendations on providing transitional care for patients with childhood onset movement disorders are provided. Nevertheless several challenges remain in the implementation of these recommendations, related to health infrastructure and the distribution of health resources, and the availability of knowledgeable and interested practitioners. Research on the influence of transitional care programs on outcomes in childhood onset movement disorders is much needed.

Assessment of the distribution of human and material resources for eye health in the public sector in Nampula, Mozambique

BackgroundThe unavailability of human and material resources can affect access to eye health services, constituting an obstacle in the fight against avoidable visual impairment. This study aimed to assess the availability and distribution of human and material resources for eye health in the public sector in Nampula province.MethodsA mixed method approach was used, which included document reviews (to extract information regarding the number of professionals and inhabitants in each district) and application of a questionnaire to heads of the ophthalmology department in each health facility (to obtain the list of available equipment). The ratios of eye health professionals per population in Nampula province and each of its districts were calculated and evaluated taking into account the recommendations of the World Health Organization (WHO). Based on the level of care of each health facility, the availability of equipment was evaluated.ResultsNampula Province has not reached the recommended ratio of eye health professionals per population in the different categories (ophthalmic technicians with 0.8 per 100 thousand inhabitants; optometrists and ophthalmologists with 0.4 and 0.2 per 250 thousand inhabitants, respectively). Most districts of Nampula did not reach the recommended ratio in the three categories of professionals, except Nampula City (provincial capital). However, there was a greater concentration of professionals and facilities with eye health services in the provincial capital. Primary and secondary level health facilities lacked some equipment to provide eye health services within their scope.ConclusionsThere is an unequal distribution of the workforce in Nampula and the centralization of surgical services at the Central Hospital of Nampula level. Therefore, there is a need to review resource distribution strategies and decentralization policy of eye health services in Nampula.

Generating data to facilitate more equitable distribution of health resources: an illustration of how local health surveys can identify probable need in mixed socio-economic regions

ObjectivesThis study aimed to (1) encourage allocation of governmental and grant funds to the administration of local area health surveys and (2) illustrate the predictive impact of socio-economic resources on adult health status at the local area level to provide an example of how health surveys can identify residents with the greatest health needs. Study designRandomly sampled and weight-adjusted regional household health survey (7501 respondents) analyzed with categorical bivariate and multivariate statistics, combined with Census data. Survey sample consists of the lowest, highest, and near highest ranked counties in the County Health Rankings and Roadmaps for Pennsylvania. MethodsSocio-economic status (SES) is measured regionally with Census data consisting of seven indicators and individually with Health Survey data consisting of five indicators based on poverty level, overall household income, and education. Both of these composite measures are examined jointly for their predictive effects on a validated health status measure using binary logistic regression. ResultsOnce county-level measures of SES and health status are broken down into smaller areas, better identification of pockets of health need is possible. This was most strongly revealed in an urban county, Philadelphia, which is ranked lowest of 67 counties on health measures in the state of Pennsylvania, yet when broken down into ‘neighborhood clusters’ contained both the highest- and lowest-ranked local area in a five-county region. Overall, regardless of the SES level of the County subdivision one lives in, a low-SES adult has close to six times greater odds of reporting ‘fair or poor health status’ than does a high-SES adult. ConclusionLocal health survey analysis can lead to a more precise identification of health needs than surveys attempting to cover broad areas. Low-SES communities within counties, and low-SES individuals, regardless of the community they live in, are substantially more likely to experience fair to poor health. This adds urgency to the need to implement and investigate socio-economic interventions, which can hopefully improve health and save healthcare costs. Novel local area research can identify the impact of intervening variables such as race in addition to SES to add more specificity in identifying populations with the greatest health needs.

Skin cancer mortality in Spain: adjusted mortality rates by province and related risk factors.

Ultraviolet radiation is the main environmental risk factor responsible for the development of skin cancer. Other occupational, socioeconomic, and environmental factors appear to be related to the risk of skin cancer. Furthermore, the factors appear to differ for melanoma and non-melanoma skin cancer (NMSC). The purpose of this study is to analyze mortality rates of skin cancer in the different provinces of Spain and to determine the influence of socioeconomic conditions and other environmental and demographic factors in rates. Deaths from melanoma and NMSC in the period 2000-2019 were obtained as well as socioeconomic and environmental variables. Annual standardized mortality rates (SMR) were calculated for all Spanish provinces. The Pearson correlation coefficient was calculated. The SMR of melanoma was 2.10/100,000 inhabitants, while that of NMSC was 1.28/100,000. At the provincial level, a great variability is confirmed. Gross domestic product showed a positive correlation with melanoma mortality but a negative correlation with NMSC. Other environmental and socioeconomic variables also showed correlation, as a positive correlation between tobacco sales and melanoma and between agricultural development and the NMSC. There are still important differences between each province that must be taken into account when planning health care and resource distribution. This ecological and province-wise study helps to elucidate the relationship between social and ambient exposure determinants and skin cancer mortality in Spain.

Whose public, whose goods? Generations of patients and visions of fairness in Ghanaian health.

Since Ghana's independence in 1957, the country has seen an ebb and flow of reforms intended to expand and fund state healthcare, informed by diverse notions of affordability and adequate provision. Cycles of attempted health reforms have emerged from disparate political and economic ideologies, themselves a product of broader global histories and specific national experiences. Based on group interviews with people across most administrative regions of Ghana, this paper examines how the formative historical experiences of different generations gives rise to a multiplicity of understandings of what constitutes a 'fair' distribution of national health resources. It discusses the forms and contents of arguments that people of different ages raised in both rural and urban settings in the course of the study - with particular reference to the operation of Ghana's current National Health Insurance Scheme, and in light of their perceptions of the justice or injustice of present day healthcare in relation to earlier periods.

The Application of Artificial Intelligence in Health Care Resource Allocation Before and During the COVID-19 Pandemic: Scoping Review

Background Imbalanced health care resource distribution has been central to unequal health outcomes and political tension around the world. Artificial intelligence (AI) has emerged as a promising tool for facilitating resource distribution, especially during emergencies. However, no comprehensive review exists on the use and ethics of AI in health care resource distribution. Objective This study aims to conduct a scoping review of the application of AI in health care resource distribution, and explore the ethical and political issues in such situations. Methods A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A comprehensive search of relevant literature was conducted in MEDLINE (Ovid), PubMed, Web of Science, and Embase from inception to February 2022. The review included qualitative and quantitative studies investigating the application of AI in health care resource allocation. Results The review involved 22 articles, including 9 on model development and 13 on theoretical discussions, qualitative studies, or review studies. Of the 9 on model development and validation, 5 were conducted in emerging economies, 3 in developed countries, and 1 in a global context. In terms of content, 4 focused on resource distribution at the health system level and 5 focused on resource allocation at the hospital level. Of the 13 qualitative studies, 8 were discussions on the COVID-19 pandemic and the rest were on hospital resources, outbreaks, screening, human resources, and digitalization. Conclusions This scoping review synthesized evidence on AI in health resource distribution, focusing on the COVID-19 pandemic. The results suggest that the application of AI has the potential to improve efficacy in resource distribution, especially during emergencies. Efficient data sharing and collecting structures are needed to make reliable and evidence-based decisions. Health inequality, distributive justice, and transparency must be considered when deploying AI models in real-world situations.

Developing a Capsule Clinic—A 24-Hour Institution for Improving Primary Health Care Accessibility: Evidence From China

Telehealth is an effective combination of medical service and intelligent technology. It can improve the problem of remote access to medical care. However, an imbalance in the allocation of health resources still occurs. People spend more time and money to access higher-quality services, which results in inequitable access to primary health care (PHC). At the same time, patients' usage of telehealth services is limited by the equipment and their own knowledge, and the PHC service suffers from low usage efficiency and lack of service supply. Therefore, improving PHC accessibility is crucial to narrowing the global health care coverage gap and maintaining health equity. In recent years, China has explored several new approaches to improve PHC accessibility. One such approach is the capsule clinic, an emerging institution that represents an upgraded version of the internet hospital. In coordination with the United Nations, the Yinzhou district of Ningbo city in Zhejiang, China, has been testing this new model since 2020. As of October 2022, the number of applications in Ningbo was 15, and the number of users reached 12,219. Unlike internet hospitals, the entire process-from diagnosis to prescription services-can be completed at the capsule clinic. The 24-hour telehealth service could also solve transportation problems and save time for users. Big data analysis can accurately identify regional populations' PHC service needs and improve efficiency in health resource allocation. The user-friendly, low-cost, and easily accessible telehealth model is of great significance. Installation of capsule clinics would improve PHC accessibility and resolve the uneven distribution of health resources to promote health equity.

Incidence of thymic malignancies in China: A longitudinal study based on a national commercial claims database from 2007 to 2016.

Incidence of thymic malignancies in China: A longitudinal study based on a national commercial claims database from 2007 to 2016.