Comprehensive investigation on understanding geographical inequalities of healthcare resources and their influencing factors in China remains scarce. This study aimed to explore both spatial and temporal heterogeneous impacts of various socioeconomic and environmental factors on healthcare resource inequalities at a fine-scale administrative county level. We collected data on county-level hospital beds per ten thousand people to represent healthcare resources, as well as data on 32 candidate socioeconomic and environmental covariates in southwest China from 2002 to 2011. We innovatively employed a cutting-edge local spatiotemporal regression, namely, a Bayesian spatiotemporally varying coefficients (STVC) model, to simultaneously detect spatial and temporal autocorrelated nonstationarity in healthcare-covariate relationships via estimating posterior space-coefficients (SC) within each county, as well as time-coefficients (TC) over ten years. Our findings reported that in addition to socioeconomic factors, environmental factors also had significant impacts on healthcare resources inequalities at both global and local space–time scales. Globally, the personal economy was identified as the most significant explanatory factor. However, the temporal impacts of personal economy demonstrated a gradual decline, while the impacts of the regional economy and government investment showed a constant growth from 2002 to 2011. Spatially, geographical clustered regions for both hospital bed distributions and various hospital bed-covariates relationships were detected. Finally, the first spatiotemporal series of complete county-level hospital bed inequality maps in southwest China was produced. This work is expected to provide evidence-based implications for future policy making procedures to improve healthcare equalities from a spatiotemporal perspective. The employed Bayesian STVC model provides frontier insights into investigating spatiotemporal heterogeneous variables relationships embedded in broader areas such as public health, environment, and earth sciences.

Hospital infrastructure has been addressed as the prerequisite of healthcare delivery which intensively affects medical quality. Over the past decade, China has proposed a series of investment plans for hospital infrastructure in order to promote healthcare development in underdeveloped regions. Focusing on the construction of hospital buildings as the key component of hospital infrastructure, this study aims to examine whether the investment efficiency is lower where a government prioritizes equity and to explore what kind of geographical predispositions should be embedded in governmental investment plans for hospital infrastructures from the perspectives of both investment equity and efficiency. Relevant data from 330 governmental-invested hospital building construction projects in Sichuan province, China, from 2009 to 2018 were collected. Concentration index was used to evaluate the equity in the distribution of the investments. Tobit model was employed to explore the relationship between regional economic development and investment efficiency measured by an integrated approach of principal component analysis and data envelopment analysis. The results demonstrated a slight concentration of governmental investments in economically developed regions, while a negative association with regional economic development was identified with investment efficiency. Our study illustrated the investment efficiency was higher where a government prioritized equity and provided empirical evidences on switching governmental investment predisposition in the aspect of healthcare infrastructure construction toward less developed regions in China from the perspectives of both investment allocation equity and efficiency, which would further assist in the formulation of region-specific policies and strategies for underdeveloped regions.

Background Although studies have provided the estimates of floods-diarrhoea associations, little is known about the lag effect, effect modification, and attributable risk. Based on Sichuan, China, an uneven socio-economic development province with plateau, basin, and mountain terrains spanning different climatic zones, we aimed to systematically examine the impacts of floods on diarrheal morbidity. Methods We retrieved information on daily diarrheal cases, floods, meteorological variables, and annual socio-economic characteristics for 21 cities in Sichuan from January 1, 2017 to December 31, 2019. We fitted time-series Poisson models to estimate the city-specific floods-diarrhoea relation over the lags of 0-14 days, and then pooled them using meta-analysis for cumulative and lag effects. We further employed meta-regression to explore potential effect modifiers and identify effect modification. We calculated the attributable diarrheal cases and fraction of attributable morbidity within the framework of the distributed lag model. Results Floods had a significant cumulative association with diarrhoea at the provincial level, but varied by regions and cities. The effects of the floods appeared on the second day after the floods and lasted for 5 days. Floods-diarrhoea relations were modified by three effect modifiers, with stronger flood effects on diarrhoea found in areas with higher air pressure, lower diurnal temperature range, or warmer temperature. Floods were responsible for advancing a fraction of diarrhoea, corresponding to 0.25% within the study period and 0.48% within the flood season. Conclusions The impacts imposed by floods were mainly distributed within the first week. The floods-diarrhoea relations varied by geographic and climatic conditions. The diarrheal burden attributable to floods is currently low in Sichuan, but this figure could increase with the exposure more intensive and the effect modifiers more detrimental in the future. Our findings are expected to provide evidence for the formulation of temporal- and spatial-specific strategies to reduce potential risks of flood-related diarrhoea.

Medical service pricing reform was considered as one of the focuses of China's remarkable health reform. This paper preliminarily assessed the roles of medical service pricing in the context of China's healthcare system. Specifically, we described the potential roles of medical service pricing in China and pointed out relevant challenges that emerged in practice as the result of reform-related activities. Multiple constraint factors that might have induced undesired outcomes were then recognized, including the excessive diversity and specialization of medical services, the price inelasticity of patients' demand, and the inadequate capability of both medical institutions and administrations. Finally, we provided policy recommendations to inform the ongoing medical service pricing reform in China from a long-term perspective.

Over the past decades, constantly increasing morbidity of diabetes has been addressed as a critical issue worldwide, with its global prevalence reaching approximately 8.5% among adults aged over 18 in 2014 (Gojka, 2016