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Int J Environ Res Public Health. 2019 Aug 7;16(16). pii: E2813. doi: 10.3390/ijerph16162813.

Examining the Multi-Scalar Unevenness of High-Quality Healthcare Resources Distribution in China.

Yu M1,2, He S3,4, Wu D1,2, Zhu H5, Webster C1,2.

Author information

1
Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Pokfulam, Hong Kong, China.
2
Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518057, China.
3
Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Pokfulam, Hong Kong, China. sjhe@hku.hk.
4
Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518057, China. sjhe@hku.hk.
5
Public Policy Research Center, Chinese Academy of Social Sciences, Beijing 100732, China.

Abstract

Healthcare disparity is, to a large extent, ascribable to the uneven distribution of high-quality healthcare resources, which remains insufficiently examined, largely due to data unavailability. To overcome this barrier, we synthesized multiple sources of data, employed integrated methods and made a comprehensive analysis of government administrative structures and the socio-economic environment to build probably the most inclusive dataset of Chinese 3-A hospitals thus far. Calibrated on a sample of 379 hospitals rated by a reputable organization, we developed a realistic and viable evaluation framework for assessing hospital quality in China. We then calculated performance scores for 1246 3-A hospitals, which were aggregated and further analyzed at multiple scales (cities, provinces, regions, and economic zones) using general entropy indexes. This research shows that the fragmented governance and incoordination of "kuai" and "tiao" is rooted deeply in China's legacy of centrally-planned systems, and has had a far-reaching yet partially contradictory influence over the contemporary distribution and performance of healthcare resources. Additionally, the unevenness in the distribution of healthcare resources is related closely to a city's administrative rank and power. This study thus suggests that the policy design of healthcare systems should be coordinated with external socio-economic transformation in a sustainable manner.

KEYWORDS:

3-A hospitals; evaluation framework; general entropy indexes; high-quality healthcare resources; hospital quality; multi-scalar unevenness

PMID:
31394765
PMCID:
PMC6720903
DOI:
10.3390/ijerph16162813
[Indexed for MEDLINE]
Free PMC Article

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