Recently Published

• Barriers and Facilitators for Stroke Patients’ Adherence to Rehabilitation in China: A Qualitative Study Based on Medical Experts
  Aug 2025
  作者： Liu M. et al.
  摘要： Stroke is a neurological condition characterized by prolonged rehabilitation, requiring long-term patient cooperation for effective recovery. Rehabilitation adherence plays an important role in the prognosis. This study aimed to identify the patient-, doctor-, hospital-, and society-level factors influencing rehabilitation adherence. In this qualitative study, semi-structured interviews were conducted with 25 experts in rehabilitation medicine, cardiovascular medicine, and neurology from six representative cities in China (Beijing, Tianjin, Shanghai, Wuhan, Harbin, and Chengdu) to explore the factors affecting rehabilitation adherence. Transcripts were coded and analyzed using an inductive thematic approach for data analysis. NVivo 14 was used to manage and analyze the textual data. All methods were performed in accordance with relevant guidelines and regulations, specifically the Guidelines for the “Prevention and Treatment of Cerebrovascular Diseases (2024 Edition)” and the “2024 China Stroke Prevention and Treatment Guidelines” issued by the General Office of the National Health Commission of the People’s Republic of China. Regarding in-hospital rehabilitation, medical experts believed that the characteristics of patients who had a stroke directly affected their rehabilitation adherence, including rehabilitation expectations, self-efficacy, economic pressure, family support, and trust in doctors. Additionally, medical experts also believed that various factors at the doctor, hospital, and societal levels influence patient characteristics, such as doctors’ professional skills, collaboration between departments, and social cognition, ultimately affecting rehabilitation adherence. For out-of-hospital rehabilitation, medical experts believed that the key determinants of adherence include accessibility to tele-rehabilitation, tele-medical resources, and active participation of hospital outpatient clinics. Most medical experts believed that it is crucial to focus not only on direct factors, such as rehabilitation expectations and self-efficacy, which influence patients’ subjective intentions, but also on identifying the pathways through which doctors, hospitals, and societal factors impact patient behavior. Attention should be given to in- and out-of-hospital rehabilitation.
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• The Impact of the Primary Care First Consultation Policy on Patients' Healthcare Choices and Medical Expenses
  Jul 2025
  作者： 肖楠、刘国恩
  摘要： 基层首诊是分级诊疗的关键环节,对构建有序就医路径和控制医疗费用具有重要意义。本文使用医保结算数据,采用断点回归-双重差分法研究基层首诊政策对患者就医选择和医疗费用的影响。研究发现,基层首诊政策显著降低了61~64岁参保人首诊选择三级医院的概率和对应的疗程总费用,但没有改变未退休群体的首诊选择。机制分析表明,该政策通过扩大基层首诊与越级首诊间医保待遇差距、增加时间成本影响患者选择。此外,政策实施后61~64岁参保人更多流向二级医院而非基层机构,基层机构服务能力较弱是阻碍患者向下就医的主要原因。本文研究结论表明,基层首诊政策仅能改变部分老年患者,尤其是慢性病患者的首诊选择,没有改变未退休群体向上就医的偏好,仅从需方成本分担角度推进分级诊疗的效果较为有限。
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• prescription medication expenditures for patients with diabetes in the US: 2012-2021
  Jul 2025
  作者： Li SS. et al.
  摘要： Glucose‐lowering medication expenditures per user by different payers among patients with diabetes.
  Keywords: glucose‐lowering drugs, Medicare, medication expenditures, non‐glucose‐lowering drugs, private insurance
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• Cost-related non-adherence in US adults with heart failure: a repeated cross-sectional analysis of the medical expenditure panel survey, 2012 to 2021
  May 2025
  作者： Li R. et al.
  摘要： Objectives: To investigate the prevalence and potential determinants of cost-related non-adherence (CRNA) in US adults with heart failure (HF).
  Design: A serial cross-sectional analysis using nationally representative data from 2012 to 2021 of the US Medical Expenditure Panel Survey.
  Setting: Population-based.
  Participants: Adult participants with HF diagnosis.
  
  Outcome measures: Self-report of never getting or delaying getting prescription medicine because of costs.
  Results: We included 1753 patients with HF (mean age 69.36 [95% CI, 68.23 to 70.48]) years, 47.85% men and 17.09% non-Hispanic Black. The overall weighted prevalence of CRNA was 7.94% (6.40-9.81), increasing from 3.09% (1.29-7.24) in 2012 to 13.69% (8.99-20.32) in 2018 and decreasing to 8.71% (3.82-18.67) in 2021. The prevalence of CRNA was higher among patients <65 years than those ≥65 years (11.78% vs 6.04%), and was more prevalent among patients with lower family income, with no insurance or public insurance, and with a greater comorbidity burden. The highest prevalence of CRNA was found among uninsured patients (18.54 [8.01-37.30]). Among patients <65 years, patients with CRNA had significantly lower utilisation of sodium glucose cotransporter-2 inhibitors and slightly lower use of beta blockers and ACEi/ARBs. The out-of-pocket cost for medication was higher among those with CRNA, especially cost on central nervous system medicines.
  
  Conclusions: CRNA was prevalent among patients with HF, disproportionately affecting those younger than 65 years, with lower socioeconomic status, and higher comorbidity burden. Interventions are needed to reduce financial burden and enhance medication adherence.
  Keywords: Health Equity; Health Services Accessibility; Heart failure; Medication Adherence.
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• Impact of Urban–Rural Health Insurance Integration on Mental Health Among Rural Adults in China: Evidence From a Quasi-experimental Study
  May 2025
  作者： Zhou Q. et al.
  摘要： Introduction
  Like many other countries, China had a fragmented health insurance system; in China's case, there were two separate schemes covering rural and urban residents. This study focused on the policy implications of integrating the schemes, particularly on the psychological effects.
  
  
  
  Methods
  The study used four waves of data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2011, 2013, 2015, and 2018, adopting a time-varying DID approach to capture the effect of integration on depressive symptoms among rural residents.
  
  
  
  Results
  The average CES-D score of rural adults decreased by 0.424, and the likelihood of depressive symptoms decreased by 3.5% after the implementation of the urban–rural health insurance integration policy. The positive effects may be due to the reduced cost-sharing rates as well as improvements in health satisfaction, social interactions, and physical activity. The integration reform had a limited impact on improving the mental health of those with the lowest economic status, the worst health status, and those aged 40–49 or over 70
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• Changing climate and socioeconomic factors contribute to global antimicrobial resistance
  Apr 2025
  作者： Li WB. et al.
  摘要： Climate change poses substantial challenges in containing antimicrobial resistance (AMR) from a One Health perspective. Using 4,502 AMR surveillance records involving 32 million tested isolates from 101 countries (1999–2022), we analyzed the impact of socioeconomic and environmental factors on AMR. We also established forecast models based on several scenarios, considering antimicrobial consumption reduction, sustainable development initiatives and different shared socioeconomic pathways under climate change. Our findings reveal growing AMR disparities between high-income countries and low- and middle-income countries under different shared socioeconomic pathway scenarios. By 2050, compared with the baseline, sustainable development efforts showed the most prominent effect by reducing AMR prevalence by 5.1% (95% confidence interval (CI): 0.0–26.6%), surpassing the effect of antimicrobial consumption reduction. Key contributors include reducing out-of-pocket health expenses (3.6% (95% CI: −0.5 to 21.4%)); comprehensive immunization coverage (1.2% (95% CI: −0.1% to 8.2%)); adequate health investments (0.2% (95% CI: 0.0–2.4%)) and universal access to water, sanitation and hygiene services (0.1% (95% CI: 0.0–0.4%)). These findings highlight the importance of sustainable development strategies as the most effective approach to help low- and middle-income countries address the dual challenges of climate change and AMR.
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• Does the impact of economic inequality on maternal and child health inequality exhibit a threshold effect? Evidence from China
  Apr 2025
  作者： Yao Y. et al.
  摘要： When the economy (economic inequality) develops to a certain level, does the impact of economic inequality on health inequality change? Through threshold regression, this study analyses the impact of city-level economic inequality on the absolute and economic-related inequality in under-5 child mortality rate (U5MR) (2001-2012) and maternal mortality rate (MMR) (2001-2015), along with the threshold values for economic development stages and economic inequality. Findings show: For the relationship between economic inequality and absolute inequality in U5MR, as well as economic-related inequality, there exists an economic development threshold effect. For the relationship between economic inequality and absolute inequality in MMR, an economic inequality threshold effect is illustrated. The improvement of economic conditions contributes to alleviating inequality in U5MR. Economic development inequality has a significant impact on the equality of maternal health development, but for enhancing the equality of women's health, health promotion policies may be more feasible.
  
  Keywords: I10; I19; Threshold effect; good health and well-being; inequality in health and economic status; maternal and child health; reduced inequality.
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• Point-of-care testing reduces antibiotic prescribing in acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis
  Mar 2025
  作者： Li XY. et al.
  摘要： Background: Challenges in identifying the causes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to overuse of antibiotics. The advantages of point-of-care testing (POCT) may help to identify pathogens and use antibiotics more appropriately.
  Methods: We conducted a systematic review to evaluate the effect of POCT to guide antibiotic prescriptions for AECOPD. Adhering to a protocol (CRD42024555847), we searched eligible studies. The outcomes included antibiotic-related and clinical outcomes. We evaluated the risk of bias and performed meta-analyses with subgroup based on the type and testing timing of POCT.
  
  Results: A total of 18 studies evaluating 4346 AECOPD patients were included. Overall, POCT significantly reduced the number of AECOPD patients given antibiotic prescriptions by 16% (P < 0.001). Additionally, antibiotic treatment was reduced by 1.19 days (P = 0.04). There was no detrimental impact on clinical outcomes, such as the length of hospital stay (P = 0.19). Our results proved robust to sensitivity analyses.
  Conclusion: We offered reasonable evidence for using POCT to reduce antibiotic exposure for AECOPD without adversely affecting clinical outcomes. As diagnostic techniques become increasingly important in combating antimicrobial resistance, the use of POCT should be encouraged.
  Keywords: Acute exacerbations of COPD; Antibiotics; C-reactive protein; Point-of-care testing; Procalcitonin.
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• Effects of separating drug sales from treatment on medical disputes
  Mar 2025
  作者： He QH. et al.
  摘要： For decades, the patient-physician conflict has been a persistent issue globally, particularly in China, where the situation has been deteriorating. To curb the inappropriate financial incentives of physicians, eliminate the practice of over-prescription, and improve the strained patient-physician relationship, the Chinese government has been implementing Separating Drug Sales from Treatment (SDST) in public hospitals since 2012. In this paper, we exploit the staggered difference-in-differences method and event study approach to examine the effects of SDST on medical disputes, based on administrative hospital-level annual data from 2011 to 2018 in G province. We find that SDST significantly decreases the number of total medical disputes by 10.0%, through reducing the over-prescription and medical malpractice, and improving hospital management practices and operational efficiency. This paper argues that removing the link between drug prescription and hospital revenue contributes to realigning physicians' financial incentives and thus building a healthy patient-physician relationship.
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