The impact of healthcare reform on the dynamic changes in health service utilization and equity: a 10-year follow-up study.

In the past decade, the government of China has implemented healthcare reforms to provide universal access to healthcare by 2020. We aimed to systematically analyse the dynamic changes in health services and equity during the past 10 years to understand the correlation between health services and social-economic status. We performed a longitudinal study in which we extracted aggregated data mainly from a project (2009, 2011, 2012, 2015, 2019). A multi-stage stratified cluster randomized design was used to obtain a representative sample in each county. Concentration indexes were used to analyse the equity of the changes in utilization. We built multivariate random-effects generalized least squares regression models with the panel data to test whether the rate of receiving a medical consultation in the last 2 weeks or the rate of hospital admission or the prevalence of chronic illness was associated with social-economic status including education level and rural disposable income per capita. We found declines in both the rate of not receiving a medical consultation during the last 2 weeks (P < 0.05 intervention group) and the rate of hospital avoidance (P < 0.05) from 2009 to 2019. The equity in residents' health service utilization has improved constantly. We additionally found that rural disposable income per capita is a protective factor for the rate of a receiving a medical consultation during the last 2 weeks and the rate of hospital admission. China's 2009 healthcare reform have positively influenced utilization rates and equity in health service utilization in the past decade, a range of health service-targeted strategies are needed including strengthen the prevention and treatment of chronic diseases, focus attention on the health status of elderly residents and improve social-economic status, especially the level of education.

Spatial assessment of farmland soil pollution and its potential human health risks in China.

Soil pollution severely threatens agro-ecosystem stability. It is important to accurately understand the status of farmland pollution in order to protect national food safety and human health. However, information of the combined pollution level of Chinese farmland soil and associated human health risk at the national scale is relatively lacking. In this study, 5597 samples from 1781 farmland soil sites were obtained from 553 reports and combined into pollution databases of heavy metals, organochlorines, and polycyclic aromatic hydrocarbons. Based on the data obtained, this paper demonstrated the current pollution status of farmland soil, and assessed the subsequent human health risk. Results showed that the combined pollution ratio of Chinese farmland soil was 22.10%, with 1.23% of severe pollution level. Moreover, the total non-carcinogenic hazard quotients of farmland soil pollution were within the safety threshold for adults, but there was a slight non-carcinogenic risk for children. For adults, the ratio of total farmland area to total carcinogenic risk quotients above the safety threshold of 1 × 10-5 was only 1.02%, but for children, the ratio was as high as 20.75%. On the other side, food crop and vegetable plantations were the priority control farmland soil compared to other types. Meanwhile, Yunnan, Hunan, Anhui, Henan, and Liaoning were selected as the priority control provinces due to their severe pollutions and high human health risks. This study has provided a comprehensive pollution and health risk assessment. Furthermore, the spatial distribution might provide as the scientific support for accelerating the mapping of soil pollution in China, as well as developing the policy for the contaminated farmland soil management.