An integrative method for analyzing spatial accessibility in the hierarchical diagnosis and treatment system in China

Yang, Nian‐Yun; Shen, Liyin; Shu, Tianheng; Liao, Shiju; Peng, Yi; Wang, Jinhuan

doi:10.1016/j.socscimed.2020.113656

Cited by 35 publications

(28 citation statements)

References 30 publications

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“…Existing studies have made efforts to decipher the inter-level differences in accessibility to hierarchical healthcare facilities [30,31]. Some studies have also examined the impacts of referrals between facilities at different levels on healthcare accessibility [13,32,33]. However, little attention has been paid to the impacts of the insufficient utilization of lower-level facilities on healthcare accessibility.…”

Section: Discussionmentioning

confidence: 99%

“…Some consensuses have been reached among these exploratory studies on the heterogeneity in catchment area sizes, distance friction effects and transport modes among different levels [12,15,30,31]. Meanwhile, some studies are focused on the impacts of the referrals between facilities at different levels on healthcare accessibility [13,32,33]. Furthermore, the establishment of a hierarchical medical system would also influence the health seeking behaviors of patients [16].…”

Section: Introductionmentioning

confidence: 99%

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Assessing the Impacts of Hierarchical Healthcare System on the Accessibility and Spatial Equality of Healthcare Services in Shenzhen, China

Tao

Han

2021

IJGI

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The hierarchical healthcare system is widely considered to be a desirable mode of the delivery of healthcare services. It is expected that the establishment of a hierarchical healthcare system can help provide better and more equal healthcare accessibility. However, limited evidence has been provided on the impacts of a hierarchical healthcare system on healthcare accessibility. This study develops an improved Hierarchical two-step floating catchment area (2SFCA) method, which incorporates variable catchment area sizes, distance friction effects and utilization efficiency for facilities at different levels. Leveraging the Hierarchical 2SFCA method, various scenarios are set up to assess the accessibility impacts of a hierarchical healthcare system. The methods are applied in a case study of Shenzhen. The results reveal significant disparity and inequality in healthcare accessibility and also differences between various facility levels in Shenzhen. The overall healthcare accessibility and its equality can be significantly improved by fully utilizing existing facilities. It is also demonstrated that allocating additional supply to lower-level facilities can generate larger accessibility gains. Furthermore, allocating new supply to primary facilities would mitigate the inequality in healthcare accessibility, whereas inequality tends to be aggravated with new supply allocated to tertiary facilities. These impacts cannot be captured by traditional accessibility measures. This study demonstrates the pivotal role of primary facilities in the hierarchical healthcare system. It can contribute to the literature by providing transferable methods and procedures for measuring hierarchical healthcare accessibility and assessing accessibility impacts of a hierarchical healthcare system in developing countries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessing the Impacts of Hierarchical Healthcare System on the Accessibility and Spatial Equality of Healthcare Services in Shenzhen, China

Tao

Han

2021

IJGI

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“…This may be because the new policy changes the examination from twice a year to once a year and if examinees fail the examination they will not be able to obtain their degree within a year, which will affect their employment and application for a PhD, so examinees who resit the examination may be more nervous and anxious. Examinees from primary health care institutions were less likely to pass the practical skills examination than those from the tertiary hospitals, which may be partly due to the fact that advanced medical equipment and skilled doctors were mainly concentrated in tertiary hospitals [21][22][23] , and partly because most examinees from primary health care institutions were assistant general practitioners with only two years of training, resulting in insu cient exercise of clinical practice skills. Examinees from colleges and universities had a higher pass rate in written examination compared to those from tertiary hospitals, mainly because most of the examinees from colleges and universities were graduating full-time postgraduate students whose theoretical knowledge had been consolidated and strengthened by three years of study.…”

Section: Discussionmentioning

confidence: 99%

Performance of Graduation Examination of Standardized Residency Training in Zhejiang Province, China

Jiang¹,

Xia

et al. 2021

Preprint

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Background Standardized residency training is an important part of post-graduation medical education for medical students in China, and the graduation examination is a necessary part to test the effect of residency training and an important measure to guarantee the quality of residency training. This study analyzed the graduation examination results of standardized residency training in Zhejiang Province in 2020. Methods This study calculated the pass rates for the practical skills examination and written examination for 5555 examinees and analyzed the relationship between examinees' demographic characteristics and pass rates. Results The pass rates for practical skills examination and written examination were 91.8% and 96.5%, respectively. Gender, age, education, and type of organizations were significantly associated with the pass rates. Examinees who retook the examination were less likely to pass the practical skills examination (AOR = 0.266, 95% CI = 0.189-0.377) and the written examination (AOR = 0.043, 95% CI = 0.025-0.074) than examinees who took the examination for the first time. If an examinee did not pass the practical skills examination initially, he or she was less likely to pass the written examination (AOR = 0.172, 95% CI = 0.120-0.249) Conclusion The pass rate of graduation examination of standardized residency training was not only influenced by the individual characteristics of the examinees but also related to the level of training hospitals and lead teachers. Therefore, it is necessary to take comprehensive measures to further improve the system of standardized residency training.

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“…Consequently, tertiary hospitals are often overcrowded and Chinese patients increasingly experience difficulties in and high costs of obtaining medical services. To address this, in 2015, China’s administration established the Tiered-network Healthcare Delivery System (THDS) [ 6 ]. In adopting THDS, patients are encouraged to go to primary hospitals first, where those with severe disease will be referred to secondary or tertiary hospitals, and they will return to primary hospitals for rehabilitation when they are in stable condition [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Relationship between outpatients’ sociodemographic and belief characteristics and their healthcare-seeking behavioral decision-making: Evidence from Jiaxing city, China

Yu¹,

Yang²,

Cheng³

et al. 2022

PLoS ONE

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Background China established the Tiered-network Healthcare Delivery System (THDS) in 2015 to address the disproportionate number of patients attending tertiary hospitals relative to primary- or secondary-care institutions. Although the reported number of outpatients visiting tertiary hospitals is slowly decreasing, numerous patients choose to visit them regardless of their disease’s severity. To effectively implement the THDS, this article explored the relationship between patients’ sociodemographic and belief characteristics and their healthcare-seeking behavioral decision-making in China. Methods Data obtained through questionnaires were analyzed using decision tree and logistic regression models to explore outpatients’ characteristics and medical decision-making using comprehensive feature data. Moreover, further statistical analyses were conducted on the outpatient data obtained from the regional population health platform in Jiaxing, China. Results The decision tree model revealed that whether outpatients have medical insurance is the primary factor guiding their healthcare-seeking behaviors, with those without medical insurance more likely to choose primary or secondary hospitals to treat minor diseases. For those with medical insurance, profession is the main factor, with industrial workers more inclined to choose primary or secondary hospitals for minor diseases. The logistic regression analyses revealed that outpatients without insurance and who were not freelancers or individual owners were more likely to choose primary or secondary hospitals for minor diseases. Further statistical analysis of the data from the Jiaxing population health platform showed that, for minor or general diseases, outpatients without medical insurance and employed as farmers tended to choose primary and secondary hospitals over tertiary hospitals. Conclusion The three analyses yielded consistent results: in China, medical insurance and patients’ profession are the most important factors guiding outpatients’ healthcare-seeking behaviors. Accordingly, we propose that the government should focus on economic reforms to increase outpatients’ visits to primary and secondary hospitals and diagnosis-related groups’ payment of medical insurance to decrease the admittance of patients with minor diseases in large tertiary hospitals. Meanwhile, the government should correct patients’ belief prejudice about selecting hospitals through corresponding publicity.

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An integrative method for analyzing spatial accessibility in the hierarchical diagnosis and treatment system in China

Cited by 35 publications

References 30 publications

Assessing the Impacts of Hierarchical Healthcare System on the Accessibility and Spatial Equality of Healthcare Services in Shenzhen, China

Assessing the Impacts of Hierarchical Healthcare System on the Accessibility and Spatial Equality of Healthcare Services in Shenzhen, China

Performance of Graduation Examination of Standardized Residency Training in Zhejiang Province, China

Relationship between outpatients’ sociodemographic and belief characteristics and their healthcare-seeking behavioral decision-making: Evidence from Jiaxing city, China

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