National Allocation Research Articles

Effect of Out-of-Pocket Health Expenditure on Household Welfare: Evidence from Uganda National Household Survey: 2016–2017

Out-of-Pocket health expenditures (OOP) in Uganda are increasingly rising due to the limited share of the national budget allocation to the health sector. Using Uganda National Household Survey data (UNHS) 2016/17, this study investigates the effect of OOP health expenditures on household welfare in Uganda. Due to the presence of endogeneity, the study employs a robust sampling instrumental variable technique to control for simultaneous causality between household welfare and the OOP health expenditure variable in the model. The findings show that a unit increase in OOP health expenditure reduces household food consumption expenditure by 9% and the household asset base by 2%, respectively. This study thus recommends the effective implementation of the Uganda National Health Insurance Scheme (NHIS), increased investment in preventive care services, and promotion of activities aimed at empowering health beneficiaries in Uganda to improve their household welfare.

Skin conditions among pediatric dermatology outpatients in Botswana

An understanding of the prevalence patterns of skin diseases in children in Botswana is needed to guide national dermatological policy development, training, and resource allocation to improve patient care. To describe local skin disease patterns in children aged 0-18 years presenting for dermatologic care in Botswana. A retrospective review of records from 1st January 2011 to 31st December 2016 was conducted at the outpatient dermatology clinic of Princess Marina Hospital (PMH) in Gaborone, Botswana and outreach clinic sites. There were 4413 pediatric visits constituting 18.6% of all dermatology visits. There was a slight male predominance of 1.2:1. The majority of disorders were noninfectious 80.1% (3537/4413) versus infectious 14.6% (645/4413), with 5.2% (231/4413) unclassified. In the noninfectious category, two-thirds were inflammatory, followed by disorders of nails, skin appendages, and pigmentary disorders. Atopic dermatitis was the most common inflammatory disorder. Over half of infectious skin diseases were viral, followed by fungal and bacterial disorders. In the HIV-related disorders, the majority were verrucae 94% (108/115) followed by Kaposi sarcoma. The nine most common skin diagnoses accounted for close to 70% of all skin diseases seen at the clinic, and these included atopic dermatitis (almost half of all cases), followed by verruca, acne, and vitiligo. There is a high burden of skin disorders in children in Botswana. In our cohort, a small number of skin conditions made up the vast majority of pediatric diagnoses. This information can be used to guide dermatology training and resource allocation to better manage these common diseases.

The Clinical and Economic Benefit of CMV Matching in Kidney Transplant: A Decision Analysis.

The development of cytomegalovirus (CMV) infection after kidney transplant remains a significant cause of posttransplant morbidity, graft loss, and mortality. Despite appropriate antiviral therapy, recipients without previous CMV exposure can currently be allocated a kidney from a donor with previous CMV infection (D+R-) that carries the greatest risk of posttransplant CMV infection and associated complications. Preferential placement of CMV D- organs in negative recipients (R-) has been shown to reduce the risk of viral infection and associated complications. To assess the long-term survival and economic benefits of allocation policy reforms, a decision-analytic model was constructed to compare receipt of CMV D- with CMV D+ organ in CMV R- recipients using data from transplant registry, Medicare claims, and pharmaceutical costs. For CMV R- patients, receipt of a CMV D- organ was associated with greater average survival (14.3 versus 12.6 y), superior quality-adjusted life years (12.6 versus 9.8), and lower costs ($529 512 versus $542 963). One-way sensitivity analysis demonstrated a survival advantage for patients waiting as long as 30 mo for a CMV D- kidney. Altering national allocation policy to preferentially offer CMV D- organs to CMV R- recipients could improve survival and lower costs after transplant if appropriately implemented.

Research on China’s New Energy Cross-Provincial Marketization Mechanism Under the Background of “Double Carbon”

In the past decade, China’s new energy has experienced a prosperous development and has become an important main power supply in China. With the promotion of China’s power market–oriented reform, the market-oriented transaction mechanism will play an essential role for China to achieve a large-scale and efficient national allocation of new energy. This study systematically analyzes and designs the principle of China’s new energy cross-provincial marketization mechanism, including those for a compound system such as an interprovincial medium and long-term transaction and spot transaction. The proposed mechanism is validated by its implemental results on a prototype power system with new energy.

To promote the kidney transplantation of sensitized recipients in China by multilateral cooperation

Sensitized recipients have an increased risk of kidney transplantation due to the immune memory of human leucocyte antigen. They lag on the waiting list and have poorer outcomes of transplantation. The society should give every patient an equal opportunity for treatment. Facing this worldwide problem, Chinese transplant community has some practical difficulties under current status of transplantation development in our country. It requires the cooperation of transplant laboratories, organ procurement organizations, clinicians, and the national organ allocation system to explore a path of solution.

Distortions of National Policies to Renewable Energy Cooperation Mechanisms

The EU endeavors to stimulate the use of renewable energy cooperation mechanisms. These cooperation mechanisms can significantly reduce the policy cost for meeting renewable targets. Several authors, however, have raised concerns that such cooperation mechanisms can be subject to efficiency losses due to different national regulatory conditions, and due to an ill-advised selection of cross-border support instruments. A quantitative evaluation of these effects remains missing. To address this gap, we first introduce a unifying analytical framework to show how optimal cross-border renewable energy trade should be organized and how these mechanisms could be distorted. We then develop a partial equilibrium model, formulated as a large-scale mathematical program with equilibrium constraints, to assess the impact of (i) different national grid cost allocation regimes and (ii) different cross-border feed-in premium implementations. Our results indicate that EU-wide auctions for renewable electricity should (i) not be based on sliding feed-in premiums and should (ii) ideally be discriminatory if national regulatory conditions differ across Member States. We also consider country-level distributional effects and confirm that Member States can lose when engaging in renewable cooperation.

UK National DCD Heart Transplant Program - First Year Experience

Purpose The donation after circulatory death (DCD) pathway is an emerging contributor to heart transplantation. Selected UK centres started their adult programs in 2015, followed by a centrally funded national pilot commencing September 2020. The purpose of this study is to review the activity and outcomes of the UK National DCD heart transplant program during this pilot. Methods Data on DCD heart transplants between September 2020 to August 2021 were extracted from the UK Transplant Registry, held by National Health Service Blood and Transplant. The Registry contains data on all offered organs from potential donors, proceeding donations and organ recipients. Additional data were collected on the DCD Heart travel document. The DCD hearts were procured by 3 specialist retrieval teams, with national organ allocation to all 7 adult and paediatric heart transplant centres. Endpoints The hearts of 143 potential DCD donors were referred for offering during this 12-month period, from all areas of the UK. This resulted in 77 acceptance, 60 retrievals, 33 hearts retrieved and 30 transplants. Direct procurement and machine perfusion was the technique used for all DCD heart retrievals with 2 hearts retrieved during abdominal normothermic regional perfusion. Six procurements were performed by a hybrid team consisting of members from 2 retrieval teams, and 21 were transplanted by a different centre to that of the retrieval team. Median donor and recipient age was 33 (range: 12-50) and 46 (range: 13-62), respectively. Seven recipients were super-urgent and 13 were urgent; with a median wait time of 20 days (range: 1-320). In the same period there were 105 adult and 18 paediatric donation after brain death (DBD) heart transplants; DCDs representing 19% and 22% of the programs, respectively. Two patients died within 30 days, making the 30-day survival rate 93.3% (95% CI: 76-98), similar to the DBD cohort. Extracorporeal membrane oxygenation in the first 30 days was required for 15 out of 30 transplants. Conclusion In the 12-month pilot, DCD heart transplantation was 20% of the total heart transplant activity. This UK wide program was underpinned by unprecedented collaboration between UK cardiothoracic teams, and with abdominal teams, improving communication and shared learning. High volume, specialised procurement teams are key to a successful DCD heart sharing program to overcome challenges from the learning curve. The donation after circulatory death (DCD) pathway is an emerging contributor to heart transplantation. Selected UK centres started their adult programs in 2015, followed by a centrally funded national pilot commencing September 2020. The purpose of this study is to review the activity and outcomes of the UK National DCD heart transplant program during this pilot. Data on DCD heart transplants between September 2020 to August 2021 were extracted from the UK Transplant Registry, held by National Health Service Blood and Transplant. The Registry contains data on all offered organs from potential donors, proceeding donations and organ recipients. Additional data were collected on the DCD Heart travel document. The DCD hearts were procured by 3 specialist retrieval teams, with national organ allocation to all 7 adult and paediatric heart transplant centres. The hearts of 143 potential DCD donors were referred for offering during this 12-month period, from all areas of the UK. This resulted in 77 acceptance, 60 retrievals, 33 hearts retrieved and 30 transplants. Direct procurement and machine perfusion was the technique used for all DCD heart retrievals with 2 hearts retrieved during abdominal normothermic regional perfusion. Six procurements were performed by a hybrid team consisting of members from 2 retrieval teams, and 21 were transplanted by a different centre to that of the retrieval team. Median donor and recipient age was 33 (range: 12-50) and 46 (range: 13-62), respectively. Seven recipients were super-urgent and 13 were urgent; with a median wait time of 20 days (range: 1-320). In the same period there were 105 adult and 18 paediatric donation after brain death (DBD) heart transplants; DCDs representing 19% and 22% of the programs, respectively. Two patients died within 30 days, making the 30-day survival rate 93.3% (95% CI: 76-98), similar to the DBD cohort. Extracorporeal membrane oxygenation in the first 30 days was required for 15 out of 30 transplants. In the 12-month pilot, DCD heart transplantation was 20% of the total heart transplant activity. This UK wide program was underpinned by unprecedented collaboration between UK cardiothoracic teams, and with abdominal teams, improving communication and shared learning. High volume, specialised procurement teams are key to a successful DCD heart sharing program to overcome challenges from the learning curve.

A Novel National Program to Maximize Utilization of Heart and Lung Allografts from Donors After Brain Death (DBD) and Donors After Circulatory Death (DCD) for Transplantation

<h3>Purpose</h3> Build a national network of dedicated cardiothoracic surgical procurement and Organ Care System (OCS™) ex-vivo perfusion clinical experts to: Maximize cardiothoracic donor organ utilization for transplantation; overcome logistical and infrastructural burden of distant organ procurements and national allocation; standardize clinical quality of care of ex-vivo perfusion management of cardiothoracic allografts; and establish a better work-life balance for transplant teams across the U.S. <h3>Methods</h3> Leveraging the OCS, the only FDA approved portable perfusion technology for heart and lung transplantation, to build a national infrastructure to enable a turn-key service. This program comprehensively covers: donor screening, donor surgical procurement, OCS perfusion management and transportation of allografts from donor hospitals to any transplant program in the U.S. <h3>Results</h3> The National OCS Program (NOP) was initiated in 2021 for lung transplantation using the OCS Lung technology in 9 major regions across the U.S. Early experience is very encouraging and demonstrated the capabilities of NOP to significantly expand thoracic organ retrieval distance. Enabling cross-country thoracic organ sharing to benefit more patients awaiting transplants while unburdening transplant programs resources. The map below demonstrates actual NOP lung transplants. NOP is now expanding to include OCS Heart and provide similar service to heart transplant programs across the U.S. <h3>Conclusion</h3> The process of cardiothoracic donor organ procurement and related logistics are challenging and unscalable to meet the growing national demand for increased donor organ utilization for lung and heart transplantation. NOP was designed to create a collaborative partnership between industry, OPOs and transplant programs to provide solutions to overcome the existing challenges and transform the field of cardiothoracic transplantation in the U.S.

Referral and Evaluation for Kidney Transplantation Following Implementation of the 2014 National Kidney Allocation System

The national kidney allocation system (KAS) implemented in December 2014 in the United States redefined the start of waiting time from the time of waitlisting to the time of kidney failure. Waitlisting has declined post-KAS, but it is unknown if this is due to transplant center practices or changes in dialysis facility referral and evaluation. The purpose of this study was to assess the impact of the 2014 KAS policy change on referral and evaluation for transplantation among a population of incident and prevalent patients with kidney failure. Cohort study. 37,676 incident (2012-2016) patients in Georgia, North Carolina, and South Carolina identified within the US Renal Data System at 9 transplant centers and followed through December 2017. A prevalent population of 6,079 patients from the same centers receiving maintenance dialysis in 2012 but not referred for transplantation in2012. KAS era (pre-KAS vs post-KAS). Referral for transplantation, start of transplant evaluation, and waitlisting. Multivariable time-dependent Cox models for the incident and prevalent population. Among incident patients, KAS was associated with increased referrals (adjusted HR, 1.16 [95% CI, 1.12-1.20]) and evaluation starts among those referred (adjusted HR, 1.16 [95% CI, 1.10-1.21]), decreased overall waitlisting (adjusted HR, 0.70 [95% CI, 0.65-0.76]), and lower rates of active waitlisting among those evaluated compared to the pre-KAS era (adjusted HR, 0.81 [95% CI, 0.74-0.90]). Among the prevalent population, KAS was associated with increases in overall waitlisting (adjusted HR, 1.74 [95% CI, 1.15-2.63]) and active waitlisting among those evaluated (adjusted HR, 2.01 [95% CI, 1.16-3.49]), but had no significant impact on referral or evaluation starts among those referred. Limited to 3 states, residual confounding. In the southeastern United States, the impact of KAS on steps to transplantation was different among incident and prevalent patients with kidney failure. Dialysis facilities referred more incident patients and transplant centers evaluated more incident patients after implementation of KAS, but fewer evaluated patients were placed onto the waitlist. Changes in dialysis facility and transplant center behaviors after KAS implementation may have influenced the observed changes in access to transplantation.

A Historical Perspective to Inform Strategic Planning for 2020 End-of-Year Wildland Fire Response Efforts

A severe outbreak of wildfire across the US Pacific Coast during August 2020 led to persistent fire activity through the end of summer. In late September, Fire Weather Outlooks predicted higher than usual fire activity into the winter in parts of California, with concomitant elevated fire danger in the Southeastern US. To help inform the regional and national allocation of firefighting personnel and equipment, we developed visualizations of resource use during recent late season, high-demand analogs. Our visualizations provided an overview of the crew, engine, dozer, aerial resource, and incident management team usage by geographic area. While these visualizations afforded information that managers needed to support their decisions regarding resource allocation, they also revealed a potentially significant gap between resource demand and late-season availability that is only likely to increase over time due to lengthening fire seasons. This gap highlights the need for the increased assessment of suppression resource acquisition and allocation systems that, to date, have been poorly studied.

Managing the Development of Motor Transport Infrastructure with the Help of State-Private Partnership Tools

The world rating of the ratio of automobile roads of the highest technical category and the total length of roads places Russia at the end of the first hundred. State began paying attention to the problem of developing the road-transport infrastructure only about 5 years ago, including elaboration and implementation of national and federal projects and allocation of great amounts of money for them. In conditions of finance shortage, especially on the regional level, the necessity to raise private capital to the road-transport industry becomes more and more acute. It could help build more projects, get more benefits and repay investment. The article explains the state interest in using the state-private partnership for founding and developing the road-transport infrastructure. The author identifies tools of state participation, which are used now in road-transport industry in the Russian Federation and proposes the lines of stimulating the state-private partnership development in road-transport industry. Special attention is paid to such key trends of extending forms of interaction between state and business in this sphere as setting up channels of continuous provision of information to concerned people that deals with new technologies and projects, upgrading regional legislation, elaborating programs supporting research and development in road construction, training highly-qualified personnel, etc. The development of road-transport infrastructure can improve accessibility of territories and provide access to global markets, which could foster economic and social effects.

Study protocol for a population-based observational surveillance study of culture-confirmed neonatal bloodstream infections and meningitis in South Africa: Baby GERMS-SA

IntroductionWorldwide, neonatal mortality remains high accounting for 47% of childhood deaths in 2019 and including an estimated 500 000 deaths from neonatal infections. While 42% of global neonatal deaths occur...

ABOi - A2 to O Liver Transplantation in a High MELD ESLD Patient: A Case Report

Introduction: Many ESLD patients die while on the waitlist due to limited donor pool. The inclusion of ABO incompatible donors to the pool has increased the number of transplants and expanded the donor pool. Case History: 43 year old male with ESLD secondary to PSC was listed for transplant with MELD of 40. He got A2 primary liver offer and underwent OLT in a bi-caval fashion. He required a hepaticojejunostomy due to PSC. On POD 5 he underwent a trans-jugular liver biopsy for rise in bilirubin and it was suggestive of AMR. His Anti A titers peaked at 1:1024 and Anti A2 at 1:256. He was treated with methylprednisolone and for rising antibody titers he required 6 sessions of PLEX/IVIG. His Anti A and Anti A2 titers were down to 1:256 and 1:32 respectively. Patient’s bilirubin and liver enzymes normalized and patient was discharged home. Discussion: ABOi liver transplant has been debatable due to higher incidence of early graft loss, acute and chronic rejection, vascular and biliary complications. With the advent of pre and post-transplant treatment modalities, the success rate of ABOi transplants match those of ABOc transplants. It becomes really important to break the barriers and transplant the incompatible livers as it needs to be increasingly utilized in the national liver allocation system so that better organ utilization and lower waitlist mortalities can be achieved. Hence, a non-identical liver transplant can be life-saving for a high MELD patient who would otherwise die awaiting an identical blood type offer.

Research on Global Fairness Coefficient Based on AHM-CRITIC-TOPSIS Algorithm

With the signing of treaties for the exploration and utilization of outer space by most countries, mankind has begun to advance the exploitation of asteroid resources. However, due to the large number of countries involved and the limited space and resources of the planets, the issue of fairness in resource exploitation is gradually emerging. Asteroid mining is a typical example. To define global fairness, analyze the national allocation of asteroid mining, with the impact of mining sector changes, and propose mining fairness policies, we construct one model to measure global equity. in order to construct a Global Fairness Coefficient (GFC) and allocate mining resources and space, we collect data of 14 indicators from 5 dimensions of 266 countries, measure the global fairness coefficient of each country based on the AHM-CRITIC-TOPSIS coupled evaluation model, and rank countries by this coefficient. Finally, countries are divided into three categories using hierarchical clustering, and mineral resources are allocated to countries by category. Among them, the United States (0.482), China (0. 452), and Japan (0.414) are the top three countries in the ranking. In conclusion, the global equity coefficient model, linear regression model of planetary mining task allocation, sectoral change impact regression model, and global mining hierarchy analysis model constructed in this paper can provide a better assessment of global equity and provide relevant policy recommendations and decision options.

Renal cancer: First look at a potential South African urological cancer registry

Purpose: The National Cancer Registry (NCR) of South Africa is the largest repository of cancer data in South Africa. While the NCR collects essential demographic data, vital clinical and tumour data are not captured. For these reasons, the authors propose the establishment of a prospective South African urological cancer registry. To spark interest in this proposal, we retrospectively analysed renal cancer histopathology reports submitted to the NCR. Materials and methods: This was a retrospective audit of all renal cancer histopathological reports submitted to the NCR over two years. Descriptive statistics were explored and are presented as means and standard deviations for continuous variables and proportions for categorical variables. Results: Eight hundred and one reports were submitted to the NCR from 22 laboratories. The mean age of the sample was 59 (± 4 years). Males accounted for 60% and females 40%. The population group for the majority of patients (50%) were classified as White, 28% were Black Africans, 14% were Coloured, and 6% were Asian/Indian. Clear cell renal cell carcinoma (ccRCC) accounted for the majority of cases (79%). Papillary RCC and chromophobe RCC accounted for 18% and 1.6%, respectively. American Joint Committee on Cancer pathological tumour staging showed more localised pT1 and pT2 tumours, 38.5% and 27.9%, respectively. Locally advanced, i.e. pT3 and pT4, formed 22.8% and 3.7% of all cases, respectively. Histological proof of metastatic disease was present in 7.1% of patients. World Health Organization/ International Society of Urological Pathology histological tumour grading for clear cell RCC showed 16.8%, 43.4%, 28.7% and 11.1% for grades 1, 2, 3 and 4, respectively. Conclusion: Urological cancers may be well underdiagnosed and misrepresented by the statistics published by the NCR. Establishing a prospective South African urological cancer registry will help qualify the burden of urological cancers more accurately and improve national resource allocation.

How and why do countries make Universal Health Care policies? Interplay of country and global factors.

BackgroundAn examination of country policy making tends to reveal more complex processes that reflect domestic as well as external pressures and influences. The paper examines the interplay of external and internal, as well as other, factors in universal health care (UHC) decision-making for a select number of countries spanning the income range from low to high income.MethodsAfter developing a conceptual framework to help identify variables to explore in answering our study questions, we reviewed literature on health policies and policy making, especially around the time of the adoption of relevant policies for a number of UHC reform countries, followed by a narrative review of countries for more in-depth study. For more quantitative data, we consulted databases maintained by international institutions.ResultsWe found that, for low-income countries (LICs)/lower-middle-income countries (LMICs), the external environment helps set the policy agenda that drives national priorities and resource allocation decisions, while national actors take the actual decisions consistent with the interests of their constituencies and their goals. The upper-middle-income countries (UMICs) and high-income countries (HICs) in the study were less influenced by externally driven agendas and more by their own internal dynamics. For LICs/LMICs, a country’s income level as well as growth record did not appear to play any overt role at the start of the reform, whereas the UMIC/HIC countries were generally at a higher economic stage with steady growth when they initiated the reforms. The use of technical analysis and evidence to guide the UHC reform decisions was much more pronounced in the UMICs/HIC. The findings on alignment of the UHC program to national health priorities were more mixed. On sustainability, the UMICs/HIC were much more likely than LICs/LMICs to phase in their reforms, whether in terms of the geographical extension of coverage, the population groups to be covered or the expansion of the benefit package in the course of time.ConclusionsThe near-systematic use of scientific evidence by the UMICs/HIC to inform decisions on the path to UHC in contrast to the LICs/LMICs leads to the conclusion that some LICs/LMICs may have made less than optimal resource allocation decisions based on scanty evidence and factors not conducive to sustainability of their UHC efforts.

Impact of MELD 30-allocation policy on liver transplant outcomes in Italy

In Italy, since August 2014, liver transplant (LT) candidates with model for end-stage liver disease (MELD) scores ≥30 receive national allocation priority. This multicenter cohort study aims to evaluate time on the waiting list, dropout rate, and graft survival before and after introducing the macro-area sharing policy. A total of 4,238 patients registered from 2010 to 2018 were enrolled and categorized into an ERA-1 Group (n= 2,013; before August 2014) and an ERA-2 Group (n= 2,225; during and after August 2014). A Cox proportional hazards model was used to estimate the hazard ratio (HR) of receiving a LT or death between the two eras. The Fine-Gray model was used to estimate the HR for dropout from the waiting list and graft loss, considering death as a competing risk event. A Fine-Gray model was also used to estimate risk factors of graft loss. Patients with MELD ≥30 had a lower median time on the waiting list (4 vs.12 days, p <0.001) and a higher probability of being transplanted (HR 2.27; 95% CI 1.78-2.90; p= 0.001) in ERA-2 compared to ERA-1. The subgroup analysis on 3,515 LTs confirmed ERA-2 (odds ratio 0.56; 95% CI 0.46-0.68; p= 0.001) as a protective factor for better graft survival rate. The protective variables for lower dropouts on the waiting list were: ERA-2, high-volume centers, no competition centers, male recipients, and hepatocellular carcinoma. The protective variables for graft loss were high-volume center and ERA-2, while MELD ≥30 remained related to a higher risk of graft loss. The national MELD ≥30 priority allocation was associated with improved patient outcomes, although MELD ≥30 was associated with a higher risk of graft loss. Transplant center volumes and competition among centers may have a role in recipient prioritization and outcomes. NCT04530240 LAY SUMMARY: Italy introduced a new policy in 2014 to give national allocation priority to patients with a model for end-stage liver disease (MELD) score ≥30 (i.e. very sick patients). This policy has led to more liver transplants, fewer dropouts, and shorter waiting times for patients with MELD ≥30. However, a higher risk of graft loss still burdens these cases. Transplant center volumes and competition among centers may have a role in recipient prioritization and outcomes.

Analysis of the impact of electric vehicle policy on supply and demand of U.S. states bioethanol market

This study aims to construct a quantitative model of the dynamic influence of electric vehicle sales in the United States on bioethanol consumption and bioethanol production. The final research results have shown that there is a long-term equilibrium relationship in our multivariate vector autoregression (VAR) model between bioethanol consumption and bioethanol production, gasoline price, corn price, and electric vehicle sales. It can be seen from the impulse response analysis that ethanol demand will strongly respond to one standard deviation of electric vehicle sales, and our new model fits the real data of ethanol supply and demand deviation well. Based on this newly long-term equilibrium relationship, we have constructed a policy simulation model to describe the quantitative relationship between the changes in the electric vehicle policy of each state and the temporal and spatial pattern of the national bioethanol resource allocation among US states. It can help and serve as a reference tool for policy makers to conduct quantitative policy evaluation.

Kidney Allocation: The Path Forward.

Kidney Allocation: The Path Forward.

Analysis and Evaluation of Comprehensive Competitiveness of China’s Main Coastal Ports

As the center of national resource strategy and global resource allocation, the port is of great significance in economic development and foreign trade. The implementation of “The Belt and Road” initiative makes China’s ports play a more prominent role in foreign trade than before. As the dominant node of the maritime route of the Silk Road, China’s ports are facing great opportunities and challenges. With the increasing economic pressure in the world, the competition of ports is increasingly fierce, and the ports are facing a severe challenge. This paper analyzes the basic problems and explores how to develop further in China’s coastal major ports along “The Belt and Road”. The evaluation factors of port comprehensive competitiveness are selected to establish the evaluation index system. The factors of 13 ports are defined by SPSS software to obtain the ranking of comprehensive competitiveness of the ports through the ladder comparison with cluster analysis. Based on the result, the appropriate policy is suggested.