Global Health Research and Policy最新文献

{"title":"Establishment of a regional Mpox surveillance network in Central Africa: shared experiences in an endemic region.","authors":"Emmanuel Hasivirwe Vakaniaki, Sydney Merritt, Sylvie Linsuke, Emile Malembi, Francisca Muyembe, Lygie Lunyanga, Andrea Mayuma, Papy Kwete, Thierry Kalonji, Joule Madinga, Matthew LeBreton, Emmanuel Nakoune, Ernest Kalthan, Sevidzem Shang, Julius Nwobegahay, Odianosen Ehiakhamen, Elsa Dibongue, Jean-Médard Kankou, Bernard Erima, Denis K Byarugaba, Paige Rudin Kinzie, Franck Mebwa, Francis Baelongandi, Aimé Kayolo, Pépin Nabugobe, Dieudonné Mwamba, Jean Malekani, Beatrice Nguete, Didine Kaba, Lisa E Hensley, Jason Kindrachuk, Laurens Liesenborghs, Robert Shongo, Jean-Jacques Muyembe-Tamfum, Nicole A Hoff, Anne W Rimoin, Placide Mbala-Kingebeni","doi":"10.1186/s41256-025-00408-y","DOIUrl":"10.1186/s41256-025-00408-y","url":null,"abstract":"<p><p>To address the underreporting of mpox cases in endemic regions, a regional surveillance network, known as the Mpox Threat Reduction Network (MPX-TRN), was established between five neighboring countries in Central and West Africa in 2022. One direct outcome of the MPX-TRN has been the strengthening of regional mpox surveillance. This consortium has facilited open communication channels, detection of cross-border mpox cases, and improvements of the detection and diagnosis of mpox in Central Africa and worldwide. Importantly, the MPX-TRN provides a scalable model for addressing underreporting of diseases, such as mpox.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"14"},"PeriodicalIF":4.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a framework for estimating comorbidity burden of inpatient cancer patients based on a case study in China.","authors":"Jiamin Wang, Wenjing Zhang, Kexin Sun, Mingzhu Su, Yuqing Zhang, Jun Su, Xiaojie Sun","doi":"10.1186/s41256-025-00411-3","DOIUrl":"10.1186/s41256-025-00411-3","url":null,"abstract":"<p><p>Inpatient cancer patients often carry the dual burden of the cancer itself and comorbidities, which were recognized as one of the most urgent global public health issues to be addressed. Based on a case study conducted in a tertiary hospital in Shandong Province, this study developed a framework for the extraction of hospital information system data, identification of basic comorbidity characteristics, estimation of the comorbidity burden, and examination of the associations between comorbidity patterns and outcome measures. In the case study, demographic data, diagnostic data, medication data and cost data were extracted from the hospital information system under a stringent inclusion and exclusion process, and the diagnostic data were coded by trained coders with the 10th revision of the International Classification of Diseases (ICD-10). Comorbidities in this study was assessed using the NCI Comorbidity Index, which identifies multiple comorbidities. Rates, numbers, types and severity of comorbidity for inpatient cancer patients together form the characterization of comorbidities. All prevalent conditions in this cohort were included in the cluster analysis. Patient characteristics of each comorbidity cluster were described. Different comorbidity patterns of inpatient cancer patients were identified, and the associations between comorbidity patterns and outcome measures were examined. This framework can be adopted to guide the patient care, hospital administration and medical resource allocation, and has the potential to be applied in various healthcare settings at local, regional, national, and international levels to foster a healthcare environment that is more responsive to the complexities of cancer and its associated conditions. The application of this framework needs to be optimized to overcome a few limitations in data acquisition, data integration, treatment priorities that vary by stage, and ethics and privacy issues.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"13"},"PeriodicalIF":4.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A strategic framework for managing gestational diabetes in Mexico.","authors":"Luis Alberto Martinez-Juarez, Héctor Gallardo-Rincón, Rodrigo Saucedo-Martínez, Ricardo Mújica-Rosales, Enrique Reyes-Muñoz, Diego-Abelardo Álvarez-Hernández, Roberto Tapia-Conyer","doi":"10.1186/s41256-025-00406-0","DOIUrl":"10.1186/s41256-025-00406-0","url":null,"abstract":"<p><p>Gestational Diabetes (GDM) is a prevalent health challenge in Mexico, affecting 10-14% of pregnancies but detected in only about 5.1% of cases, highlighting a critical gap in the healthcare system. This underdiagnosis poses severe health risks to mothers and children and reflects broader systemic healthcare failures. The disparity in detection rates points to insufficient screening protocols and uneven access to care, particularly affecting rural areas. Additionally, a lack of integrated digital health solutions exacerbates these issues, leading to inconsistent management and follow-up of diagnosed cases. The current reactive healthcare policies fail to prioritize early intervention and comprehensive patient education, crucial for effective GDM management. This paper calls for immediate and coordinated policy action to standardize GDM screening using updated protocols across all healthcare settings, bolster digital health infrastructure for better surveillance and management, and launch an extensive public health campaign focused on GDM awareness and education. These measures should be rigorously evaluated and adapted based on ongoing research and feedback to ensure they meet the needs of all segments of the population. Addressing these challenges head-on will improve health outcomes for mothers and children and reduce long-term healthcare costs associated with GDM complications.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"12"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pooled prevalence and multilevel determinants of stillbirths in sub-Saharan African countries: implications for achieving sustainable development goal.","authors":"Bewuketu Terefe, Mahlet Moges Jembere, Nega Nigussie Abrha, Dejen Kahsay Asgedom, Solomon Keflie Assefa, Nega Tezera Assimamaw","doi":"10.1186/s41256-024-00395-6","DOIUrl":"10.1186/s41256-024-00395-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite being included in the Millennium Development Goals (MDGs) and now the Sustainable Development Goals (SDGs), stillbirths remain overlooked with limited regional research, highlighting an ongoing gap in addressing this issue. However, a staggering 2 million stillbirths occur each year, equivalent to one every 16 s. Furthermore, approximately 98% of these stillbirths take place in developing countries, particularly in sub-Saharan Africa (SSA). In light of these statistics and the need to address the lack of data, methodological approaches, and population gaps, this study aims to assess the prevalence and determinants of stillbirths in SSA from 2016 to 2023, aligning with the SDGs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study used data from the Demographic and Health Survey (DHS) conducted in SSA. The analysis included a weighted sample of 212,194 pregnancies of at least 28 weeks' gestation collected from 2016 to 2023, using R-4.4.0 software. Descriptive data, such as frequencies, were performed. Stillbirth prevalence was visualized using a forest plot. A multilevel modeling analysis was used by considering individual-level factors and community level factors. The multilevel model was employed to account for clustering within countries and allow for the examination of both fixed and random effects that influence stillbirths. For the multivariable analysis, variables with a p value ≤ 0.2 in the bivariate analysis were considered. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and a p value &lt; 0.05 were reported to indicate the statistical significance and the degree of association in the final model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The pooled prevalence of stillbirths was found to be 1.54% per 100 [95% CI 1.19-2.01]. Factors positively associated with stillbirths in SSA included maternal age (25-34 years, 35-49 years), marital status (married, divorced or widowed), antenatal care visits, age at first birth (before age 20), short birth intervals, long birth intervals, birth order (second or third), residence in rural areas, country income level (lower middle income), and low literacy rate. Factors negatively associated with stillbirth mortality included maternal education (primary education, secondary or higher education), wealth index (higher economic status), access to mass media, access to improved drinking water, distance to health facilities, and country income level (upper middle income).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Stillbirth rates fall significantly short of achieving Every Newborn Action Plan target by 2030 in SSA. The analysis of factors that affect stillbirth mortality reveals important connections. It is essential to improve maternal education, economic status, and healthcare infrastructure to decrease stillbirth rates and enhance the health outcomes of mothers and children in the region. To effectively address these risks, efforts should concentrate on increasing access to ant","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"11"},"PeriodicalIF":4.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global dominance of non-institutional delivery and the risky impact on maternal mortality spike in 25 Sub-Saharan African Countries.","authors":"Oyewole K Oyedele, Temitayo V Lawal","doi":"10.1186/s41256-025-00409-x","DOIUrl":"10.1186/s41256-025-00409-x","url":null,"abstract":"<p><strong>Background: </strong>Despite 70% of global maternal death occurring in Sub-Saharan Africa (SSA) and the high rate of non-institutional delivery (NID), studies that inspect the connections are needed but lacking. Thus, we investigated the urban-rural burden and risk factors of NID and the correlate with maternal mortality to extend strategies for sinking the mortality spike towards sustainable development goal (SDG-3.1) in SSA.</p><p><strong>Methods: </strong>Secondary analysis of recent (2014-2021) cross-sectional demographic-health-survey (DHS) were conducted across 25-countries in SSA. Primary outcome was institutional versus non-institutional delivery and secondary outcome was maternal-mortality-ratio (MMR) per 100,000 livebirths and the lifetime risk (LTR), while predictors were grouped by socio-economic, obstetrics and country-level factors. Data were weighted to adjust for heterogeneity and descriptive analysis was performed. Pearson chi-square, correlation, and simple linear regression anlyses were performed to assess relationships. Multivariable logistic regression further evaluated the predictor likelihood and significance at alpha = 5% (95% confidence-interval 'CI').</p><p><strong>Results: </strong>Prevalence of NID was highest in Chad (78.6%), Madagascar (60.6%), then Nigeria (60.4%) and Angola (54.3%), with rural SSA dominating NID rate by about 85%. Odds of NID were significantly lower by 60% and 98% among women who had at least four antenatal care (ANC) visits (aOR = 0.40, 95%CI = 0.38-0.41) and utilized skilled birth attendants (SBA) at delivery (aOR = 0.02, 95%CI = 0.01-0.02), respectively. The odds of NID reduces by women age, educational-level, and wealth-quintiles. Positive and significant linear relationship exist between NID and MMR (ρ = 0.5453), and NID and LTR (ρ = 0.6136). Consequently, 1% increase in NID will lead to about 248/100000 and 8.2/1000 increase in MMR and LTR in SSA respectively.</p><p><strong>Conclusions: </strong>Only South Africa, Rwanda and Malawi had achieved the WHO 90% coverage for healthcare delivery. ANC and SBA use reduced NID likelihood but, MMR is significantly influenced by NID. Hence, strategic decline in NID will proportionately influence the sinking of MMR spike to attain SDG-3.1 in SSA.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"10"},"PeriodicalIF":4.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health system reform in the context of COVID-19: a policy brief outlining lessons from Ireland's journey towards the goal of universal healthcare.","authors":"Sarah Parker, Katharine Schulmann, Carlos Bruen, Sara Burke","doi":"10.1186/s41256-025-00407-z","DOIUrl":"10.1186/s41256-025-00407-z","url":null,"abstract":"<p><p>The COVID-19 pandemic has presented unique challenges and opportunities for health system reform globally. In Ireland, this period coincided with the early stages of the Sláintecare reform plan, a core goal of which is to establish universal healthcare. This policy brief synthesises key research findings from 13 studies carried out under the Foundations research programme to harness key learnings from the pandemic response for health system change. The analysis reveals how the COVID-19 crisis accelerated health system reforms in Ireland, breaking from a history of incremental change to implement rapid innovations towards universal healthcare. While a 'new normal' has emerged, the challenge remains to integrate these rapid developments into enduring health system improvements under evolving governance and leadership in the COVID-19 context. Three significant implications for health systems research and policy are identified: 1) Political consensus is essential for sustained health system reform, particularly during crises; 2) Adaptive health systems that can transform challenges into reform opportunities are crucial; and 3) Co-production in research enhances policy acceptability and implementation by aligning it with real-world complexities. Leveraging these pandemic-driven insights will be key to ensuring that the swift adaptations and lessons learned will transition into lasting elements of Ireland's health system.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"9"},"PeriodicalIF":4.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The EU global health strategy: from policy to implementation.","authors":"Jolene Skordis, Guenter Froeschl, Sante Leandro Baldi, Astrid Berner-Rodoreda, Nuria Casamitjana, Frank Cobelens, Kerstin Klipstein-Grobusch, Mario Raviglione, Alberto Rocamora, Anne-Mieke Vandamme, Antoni Plasència","doi":"10.1186/s41256-025-00410-4","DOIUrl":"10.1186/s41256-025-00410-4","url":null,"abstract":"<p><p>In November 2022, a draft of the next EU Global Health Strategy was published. The European Global Health Research Institutes Network (EGHRIN) of 22 leading European Universities has analysed the Strategy. In this commentary, EGHRIN notes the Strategy's positive commitments to life-course wellbeing, strengthening health systems and combating health threats in an equitable and collaborative manner. We find the strategy is compatible with the sustainable development goals and addresses social, political and environmental determinants of health. However, our analyses also highlight a lack of critical assessment of the private sector's role within health systems, insufficient attention to syndemics, and little emphasis on transdisciplinary education and the ethical training of a global health workforce. We conclude that, while its commitments are commendable, the greatest challenge for the next EU Strategy will be in its implementation. The trategy currently lacks a fully-resourced and clearly hypothecated funding mechanism and there is little evidence to date of the stated commitment that Global Health will be considered in all EU policy areas. In the present geopolitical climate, a speedy acceptance of both the policy and an implementation plan is needed more than ever.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"8"},"PeriodicalIF":4.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11854385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulatory efforts to address the access gap for foreign new drugs in China: the priority review program and related policies.","authors":"Xingyue Zhu, Jinsui Zhang","doi":"10.1186/s41256-024-00396-5","DOIUrl":"10.1186/s41256-024-00396-5","url":null,"abstract":"<p><strong>Background: </strong>China has implemented the priority review (PR) program and flexible registration requirements for new drugs with significant clinical value since 2016 to accelerate drug access. We aim to explore the impact of the reform efforts on the drug access gap between China and the US.</p><p><strong>Methods: </strong>We collected data on the imported new drug approvals that were licensed in China between 2007 and 2023, and measured their launch delays as compared to the US. Difference-in-difference models were used to compare the launch delays of PR approvals and non-PR approvals before and after the implementation of the PR. Propensity score matching was used to construct the imputed PR and non-PR approvals in the pre-PR period.</p><p><strong>Results: </strong>A total of 410 imported approvals were licensed in China in 2007-2023. Most approvals (316[77.1%]) were licensed after the PR was implemented, of which 189[59.8%] received the PR designation. The difference-in-difference models found that the PR program reduced drug launch delay by 1157.0 days (robust standard error, 571.0; P<0.05) and reduced drug submission delay by 1037.3 days (robust standard error, 520.8; P<0.05). The PR identified drugs with high clinical value and informed flexible registration requirements for them, which accelerated drug submission and market entry.</p><p><strong>Conclusions: </strong>Our findings proved the importance of value-based prioritization of new drugs and flexibility in the statutory evidentiary standard in the drug approval process. Further efforts from the drug agency are needed to leverage the regulatory flexibility to provide fast market entry of new drugs without compromising their quality.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"7"},"PeriodicalIF":4.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative content analysis of national health policies, strategies and plans before and after COVID-19 among OECD and BRICS countries.","authors":"Jialu Song, Ziqi Zhu, Qi Li, Ying Chen, Zhebin Wang, Shuduo Zhou, Ming Xu, Zhi-Jie Zheng","doi":"10.1186/s41256-024-00400-y","DOIUrl":"10.1186/s41256-024-00400-y","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic exposed significant limitations in health systems worldwide and emphasized the need for updated National Health Policies, Strategies, and Plans (NHPSPs). This study aimed to evaluate the NHPSPs of Organization for Economic Cooperation and Development (OECD) and BRICS (Brazil, Russia, India, China, and South Africa) countries before and after the COVID-19 pandemic. Specifically, it explored each country's commitment to strengthening health systems to address health threats and analyzed the specific changes made.</p><p><strong>Methods: </strong>NHPSP documents from the WHO document repository and official governmental websites were systematically searched. Data were extracted using a standardized template. A coding framework was inductively developed to sort qualitative texts into categories, with frequencies calculated and weighting evaluated, followed by organizing underlying content into subthemes.</p><p><strong>Results: </strong>Out of 154 documents initially identified, 36 met the screening criteria, covering 14 OECD and 3 BRICS countries. The most predominant theme was prevention (88.9% pre-pandemic, 99.4% post-pandemic), which was addressed as a primary theme in 26 included NHPSPs. After the COVID-19 pandemic, 6 out of 14 analyzed themes saw higher occurrences, among which infection prevention and control (22.2-50.0%) and resilience to health crisis (22.2-44.4%) increased most significantly. Themes mainstreamed in post-pandemic NHPSPs included prevention (94.4%), health research and technology (61.1%), and One Health (66.7%). Primary healthcare emerged as the most concerned subtheme under prevention. Notably, OECD countries displayed more increased occurrences of themes (13 out of 14) or increased emphasis on themes with similar occurrences before and after COVID-19, while BRICS countries only differed in infection control. Additionally, OECD and BRICS countries varied in their subthemes and specific actions under similar primary themes.</p><p><strong>Conclusions: </strong>COVID-19 exposed vulnerabilities in many countries' health systems, highlighting the need to build resilient health infrastructures through the optimization of NHPSPs. However, only about half of the OECD and BRICS countries have implemented new NHPSPs since the pandemic. Our findings highlight the critical need for global health system reforms and offer actionable recommendations for other countries in formulating their NHPSPs.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"6"},"PeriodicalIF":4.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the hierarchical medical system on the perceived quality of primary care in China: a quasi-experimental study.","authors":"Yaxin Zhao, Xiaohui Zhai, Zhongliang Zhou, Zixuan Peng, Chi Shen, Xiaojing Fan, Sha Lai, Peter C Coyte","doi":"10.1186/s41256-024-00398-3","DOIUrl":"10.1186/s41256-024-00398-3","url":null,"abstract":"<p><strong>Background: </strong>Although the implementation of a hierarchical medical system (HMS) has been shown to improve the allocation of medical resources and patient health-seeking behaviour, its role in patient's perceived quality of primary care remains unexplored. This study aimed to assess the impact of HMS implementation on rural and urban residents' perceived quality of primary care.</p><p><strong>Methods: </strong>Data were obtained from the China Family Panel Study for 2012, 2014, 2016, and 2018. A total of 40,011 rural and 22,482 urban residents were included in the research participants for analysis. This study adopted a quasi-natural experimental design, and the multiple-period difference-in-differences method was used to capture changes in patient's perceived quality of primary care before and after the introduction of HMS.</p><p><strong>Results: </strong>We found that HMS implementation declined the perceived quality of primary care by an average of 18% among rural residents (OR: 0.82, 95% CI 0.68-0.99), while there was no significant change among urban residents (OR: 1.13, 95% CI 0.87-1.46). There was a 24% reduction in the perceived quality of primary care (OR: 0.76, 95% CI 0.61-0.96) one year after HMS among rural residents, and there was no statistically significant difference two years after HMS. After HMS implementation, the level of perceived quality of primary care by rural patients with chronic diseases decreased by 72% (OR: 0.28, 95% CI 0.11-0.78).</p><p><strong>Conclusions: </strong>HMS has a limited effect on improving residents' perceived quality of primary care, especially for those living in rural areas. Policymakers are suggested to establish a quality monitoring system that incorporates patient experience as an essential standard to systematically evaluate the impacts of the HMS, with more efforts being put into helping vulnerable groups such as residents under 60 years old and patients with chronic diseases.</p>","PeriodicalId":52405,"journal":{"name":"Global Health Research and Policy","volume":"10 1","pages":"5"},"PeriodicalIF":4.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}