Can the allocation of primary health care system resources affect efficiency? A spatial Dubin model study in China.

BACKGROUND: The primary health care (PHC) system plays an important role in China's health care system, but there are challenges such as irrational allocation of health resources and inefficient operation, which need to be improved. The purpose of this study was to explore the impact of resource allocation on the efficiency of the PHC system in China. METHODS: The data in 31 provinces were collected from the China Statistical Yearbook 2017-2021 and the China Health Statistical Yearbook 2017-2021. The comprehensive health resource density index (CHRDI) was constructed based on the entropy method and the health resource density index (HRDI), which was used to analyze the allocation of primary health resources in each province. The adjusted efficiency of the PHC system in each province was calculated by the bootstrap data envelopment analysis (DEA). Finally, the spatial Dubin model was used to explore the effect of the CHRDI on efficiency. RESULTS: From 2016 to 2020, the allocation of primary health resources in 31 provinces showed an increasing trend, and the average efficiency after correction showed a decreasing state year by year. The spatial direct effect and spatial spillover effect coefficients of CHRDI were 0.820 and 1.471, which positively affect the efficiency. Per capita Gross Domestic Product (GDP), urbanization rate, and the proportion of the elderly were the factors affecting the efficiency of the PHC system. CONCLUSIONS: The allocation of primary health resources in all provinces in China has improved each year, but there are still great differences, and efficiency must be further improved. Pay attention to the spatial spillover effect of the level of resource allocation and formulate differentiated measures for different regions. Attention should also be paid to the impact of population aging and economic development on the utilization of primary health resources by increasing health needs and choices.

What factors affect Beijing residents' contracts with family doctors? A comparative study of Beijing's urban and suburban areas.

Objective: To improve the health of residents and promote hierarchical diagnosis and treatment to achieve an orderly pattern of medical treatment, Beijing implemented family doctor contract services (FDCSs) in 2011. The aims of this study were to analyze the current status of Beijing residents' contracts with family doctors (FDs), compare the differences in contracting between urban and suburban residents, and explore the factors that affect residents' contract behavior. Methods: From August 2020 to October 2020, a stratified sampling method was adopted to select residents from community health centers (CHCs) in districts D (urban area) and S (suburb) of Beijing to conduct a questionnaire survey. Chi-square tests, rank sum tests and logistic regression analyzes were used to analyze the current status and influencing factors of residents' contracting with FDs. Results: A total of 4,113 valid questionnaires were included in the final analysis. District D was rich in medical resources, and the FD contract rate of residents there (93.09%) was significantly higher than that of residents in district S (78.06%; p < 0.05). Residents' district (OR = 1.55, 95% CI = 1.18-2.05), understanding of FDCS policies (OR = 4.13, 95% CI = 3.63-4.69), preferred medical institutions (OR = 0.58, 95% CI = 0.42-0.79 for tertiary hospitals in the district; OR = 0.36, 95% CI = 0.22-0.59 for urban medical institutions in Beijing), age, education level, average annual medical expenses and medical insurance type were factors that influenced residents' contracts with FDs (p < 0.05). Conclusion: This study shows that residents who are located in districts with rich medical resources, prefer CHCs as their first choice, have a better understanding of FDCS policies, and are more inclined to contract with FDs than other residents. It is recommended that the number and quality of FDs in suburban areas be increased and that medical staff strengthen publicity about FDCSs and actively encourage residents to contract with FDs.

Identifying organisational capability of hospitals amid the new healthcare reform in China: a Delphi study.

OBJECTIVE: Since China launched its nationwide systemic healthcare reform in 2009, policies such as the elimination of drug markups and the reform of medical insurance payments have forced some hospitals into a crisis threatening their survival. Both public and private hospitals have been building and strengthening their capacity to achieve sustainable development. However, the existing research has not provided a comprehensive evaluation tool required to support this effort. Therefore, this study develops an organisational capability evaluation index system to help public and private hospitals assess their current conditions. DESIGN: The Delphi method was used to construct a hospital organisational capability evaluation index system in conjunction with the boundary value method and an analytic hierarchical process. Then, a questionnaire survey was administered in 55 hospitals (32 non-profit and 23 for-profit hospitals), and Cronbach's α and a factor analysis were used to verify the index system's reliability and validity. SETTING AND PARTICIPANTS: A literature review and semistructured interviews with 23 hospital managers and scholars clarified the definition of hospital organisational capability and formed an indicator pool. Additionally, 20 hospital directors were selected from public and private hospitals to participate in two rounds of the Delphi consultation. RESULTS: The Delphi consultation resulted in an index system including 12 primary and 40 secondary indicators demonstrated to be reliable and valid. The three indicators with the largest weights were 'regulation capability' (0.251), 'decision-making capability' (0.121) and 'executive capability' (0.105). CONCLUSION: This study constructed an index system based on theoretical and practical considerations, and is expected to be applied to quantitatively evaluate the organisational capability of both public and private hospitals in China, and support their adaptation to external environmental changes.

One-Step Synthesis of N-Doped Carbon and Its Application as a Cost-Efficient Catalyst for the Oxygen Reduction Reaction in Microbial Fuel Cells.

Nitrogen-doped carbon with a high surface area was prepared by the one-step pyrolysis of cellulose paper under NH3 gas, and has been developed as an alternative to Pt/C for the oxygen reduction reaction in microbial fuel cells (MFCs).The electrochemical tests showed that the catalytic performance of N-doped carbon in neutral media was significantly better than that of undoped carbon, with an onset of 0.21 V. The maximum power density of MFCs with the N-doped carbon catalyst (1041±90 mW m-2 ) was much higher than that of Pt/C-based MFC (584±10 mW m-2 ), while the cost was significantly lower. These results demonstrated that such N-doped carbon has the advantages of low cost and high efficiency, and can be a promising alternative to Pt/C in large-scale applications of MFCs.

[Changes of crop yield and soil fertility under long-term application of fertilizer and recycled nutrients in manure on a black soil III. Soil nutrient budget].

The nutrient budget of fertilization models under different treatments was calculated using data from a field experiment over the period of 1985-1999. The results indicated that application of nitrogen fertilizer accelerated a large deficit of soil phosphorus, and the use of nitrogen and phosphorus accelerated the deficit of potassium. The experimental data demonstrated the appearance of a large area of soil deficit of phosphorus from 1970s and of potassium from 1980s in China. Nutrient recycled in farming system improved soil nutrient budget, but could not meet the nutrient requirements from high-yield crops. The use of recycled nutrients with an appropriate use of fertilizers according to the soil fertility could produce higher crop yields, balance soil nutrient budget, and not cause surplus nutrients to emit into environment.