学术发表

• 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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• Rationed Fertility: Treatment Effect Heterogeneity in the Child Quantity–Quality Tradeoff
  Aug 2025
  作者： Junjian Yi, et al.
  摘要： We develop a generalized theory of rationed ferility to analyze treatment effe hetergenily in the child quantity- quality tradeoff. An exogenous increase in ferility can be either desired or undesired. We derive a positive rationing income efect on child quality for desired fertility inereases, but a negative ra- tioning income effect for undesired fertility increases. We propose an econometrie framework to identify treatment ffects of desired and undesired fertility increases, and estimate a stnuctural model to gauge the quantitative importance of the novel rationing income eff Our study highlights the importance of distinguishing between desired and undesired changes when evaluating social programs.
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• Hospital Workload and Adaptation Under Climate Change: Evidence from the People’s Republic of China
  Aug 2025
  作者： Wanrui Wu, et al.
  摘要： Climate change poses significant challenges to healthcare systems. This research estimates temperature impacts on hospital workload, using inpatient records from more than 1,000 emergency departments (EDs) in the People’s Republic of China between 2013 and 2022. We find inpatient admissions in EDs decrease by 12.3% on days with a mean temperature below −6°C, while increasing by 7.7% on days with a mean temperature exceeding 30°C, compared with a temperature reference of 12°C to 15°C. Heterogeneity analysis indicates that specific departments such as internal medicine, surgery, and pediatrics experience more substantial increases in workload during extreme heat. Temperature also reshapes the patient structure: male patients, child patients, and patients with injuries or respiratory diseases take up a larger
  proportion of total admissions on extremely hot days. Considering adaptation methods, we show that hospitals temporarily allocate more junior physicians to EDs when the temperature is hot. Hospitals in cities where people have higher incomes and better-heated homes are less sensitive
  to temperature changes. In terms of monetary burden, we estimate corresponding healthcare expenditures, which suggest that the impact of extreme temperatures is larger on the insured portion of expenditures than it is on out-of-pocket payments. This research highlights the
  relationship between temperature and workload burden faced by the major healthcare facilities, providing suggestions for the healthcare system to increase personnel and adjust resource allocation in response to climate change.
  Keywords: hospital workload, climate change, extreme temperature, healthcare expenditure,
  People’s Republic of China
  JEL codes: I10, I12, I18, Q50, Q51, Q54
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• 基层首诊政策对患者就医选择和医疗费用的影响
  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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• Forging paths together: The history of U.S.-China Track II Health Dialogue and the future of Chinese-American health communication
  Feb 2025
  作者： Yan Q. et al.
  摘要： As two of the largest economies and countries in the world, the People’s Republic of China (China) and the United States of America (U.S.) both have enormous resources and innovative talents in a number of sectors. Cooperation between both sides will be hugely beneficial to the world population, and this is especially the case with healthcare. The U.S.-China Track Ⅱ Dialogue on Healthcare was set up as a forum to discuss and engage ideas on this very topic. In this dialogue, Dr. Qun Yan, head of the hLife Editorial Office engages in a dialogue with Professor Mark McClellan, the Director of the Duke-Margolis Institute for Health Policy at Duke University and U.S. Co-Chair of the Track Ⅱ Dialogue on Healthcare, Professor Gordon G Liu, Professor at Peking University and the Dean of the PKU Institute for Global Health and Development and Co-Organizer of the Track Ⅱ Dialogue, Mr. Stephen Orlins, President of the National Committee on U.S.-China Relations and a Co-Organizer of the Track Ⅱ Dialogue, and Professor George Fu Gao, Academician at the Chinese Academy of Sciences and former Director of the Chinese Center for Disease Control and Prevention. They discuss how and why the Track Ⅱ Dialogue was created, the successes and developments of the dialogues, and what the future of American-Chinese health collaboration looks like.
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• Heterogeneous impacts of and vulnerabilities to the COVID-19 pandemic
  Jan 2025
  作者： Li MY et al.
  摘要： Context
  The COVID-19 pandemic has impacted all sectors of society, with effects that have been acutely experienced at the local, national, regional, and global levels.
  Objectives
  This study examined the heterogeneous impacts of and vulnerability to COVID-19 for promoting urban sustainability and resilience.
  Methods
  We performed a scoping review on the basis of the relevant literature from the Web of Science and PubMed, and a national survey conducted among a total of 5,376 participants in early 2020. The survey adopted a repeated cross-sectional design to study changes in residents’ risk perception of COVID-19 across the three stages (21–23 January, 27–28 February, and 24–27 March), using a snowball sampling method to recruit 2,144, 2,021, and 1,211 participants, respectively.
  Results
  This study revealed that the spatial, social, economic, and health impacts of COVID-19 have not been distributed evenly among populations, with specific individuals and communities more vulnerable than others. Among the determinants of these inequalities are socioeconomic status, housing arrangements, and working requirements, which influence the extent to which people can safely adhere to stay-at-home and social distancing policies and how they perceive risks. Additionally, racial/ethnic minorities face differing risks, in part because of socioeconomic factors but also because some groups experience higher shares of comorbidities. Moreover, overall, these risk factors are the healthcare systems meant to shield individuals and communities from pandemic impacts, which, however, have become increasingly taxed due to the sudden influx of patients and the resultant shortages of resources – including crucial personal protective equipment to minimize interpersonal transmission.
  Conclusions
  Understanding the heterogeneous impacts of and vulnerability to COVID-19 could inform the design of environmentally sustainable and socially resilient cities, making them better equipped to encounter future epidemics. This study would help us identify more effective and equitable solutions to the ongoing challenges of the pandemic, promoting sustainability and resilience at multiple societal levels.
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• Key Issues of Economic Evaluations for Health Technology Assessment in China: A Nationwide Expert Survey
  Nov 2024
  作者： Liu GG. et al.
  摘要： Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.
  
  Keywords: China; life satisfaction; subjective well-being; universal healthcare coverage; urban–rural health insurance integration.
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• Associations of serial negative income shock and all-cause mortality: a longitudinal study in China
  Oct 2024
  作者： Xiao N. et al.
  摘要： Introduction With a precarious economic outlook and increasing income volatility in current times, understanding the association between negative income shock and health is crucial. However, few studies have examined such associations in developing countries. Using data from China, this study aimed to examine associations of both serial absolute income drops and relative income trajectory and mortality.
  
  Methods We included 4757 participants from the China Health and Nutrition Survey, a large prospective cohort study. Data between 1989 and 1997 were used to define income drops and relative income trajectories. We defined income drop as a decrease of ≥50% between two consecutive interviews and defined relative income trajectory using a latent class model. All-cause mortality between 2000 and 2015 was ascertained by participants’ family members.
  
  Results A total of 2066 (43.43%) experienced 1 income drop and 477 (10.03%) experienced ≥2 income drops. A total of 535 deaths occurred (incidence rate 8.88 per 1000 person-years). Income drops were associated with a greater risk of mortality after adjusting for baseline income, comorbidities, sociodemographic and behavioural factors (HR 1.42 (95% CI 1.04 to 1.93) for ≥2 income drops vs no income drop). The downshift in relative income was also associated with increased mortality risk (HR 3.61 (95% CI 1.45 to 8.96) for always low; HR 3.36 (95% CI 1.36 to 8.32) for decreasing; HR 2.92 (95% CI 1.14 to 7.51) for increasing vs always high relative income). The associations between income drops and mortality were observed only among individuals with low wealth and low household income.
  
  Conclusion In a large sample of the Chinese population with repeated income measurement and over 14 years of follow-up, both serial absolute income drops and a downward relative income trajectory were associated with higher risks of mortality in China. Priority should be given to policies aimed at enhancing resilience against serial income shocks and financial burdens.
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