期刊论文详细信息
International Journal for Equity in Health
Equity in the distribution of CT and MRI in China: a panel analysis
Yingyao Chen2  Hao Yu1  Da He2 
[1] RAND Corporation, Pittsburgh, USA;Department of Hospital Management, School of Public Health, National Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, P. R. China
关键词: Gini coefficients;    Lorenz curve;    Financing;    Distribution;    Equity;    High technology medical equipment;   
Others  :  824798
DOI  :  10.1186/1475-9276-12-39
 received in 2013-03-03, accepted in 2013-05-17,  发布年份 2013
PDF
【 摘 要 】

Introduction

China is facing a daunting challenge to health equity in the context of rapid economic development. This study adds to the literature by examining equity in the distribution of high-technology medical equipment, such as CT and MRI, in China.

Methods

A panel analysis was conducted with information about four study sites in 2006 and 2009. The four provincial-level study sites included Shanghai, Zhejiang, Shaanxi, and Hunan, representing different geographical, economic, and medical technology levels in China. A random sample of 71 hospitals was selected from the four sites. Data were collected through questionnaire surveys. Equity status was assessed in terms of CT and MRI numbers, characteristics of machine, and financing sources. The assessment was conducted at multiple levels, including international, provincial, city, and hospital level. In addition to comparison among the study sites, the sample was compared with OECD countries in CT and MRI distributions.

Results

China had lower numbers of CTs and MRIs per million population in 2009 than most of the selected OECD countries while the increases in its CT and MRI numbers from 2006 to 2009 were higher than most of the OECD countries. The equity status of CT distribution remained at low inequality level in both 2006 and 2009 while the equity status of MRI distribution improved from high inequality in 2006 to moderate inequality in 2009. Despite the equity improvement, the distributions of CTs and MRIs were significantly positively correlated with economic development level across all cities in the four study sites in either 2006 or 2009. Our analysis also revealed that Shanghai, the study site with the highest level of economic development, had more advanced CT and MRI machine, more imported CTs and MRIs, and higher government subsidies on these two types of equipment.

Conclusions

The number of CTs and MRIs increased considerably in China from 2006 to 2009. The equity status of CTs was better than that of MRIs although the equity status in MRI distribution got improved from 2006 to 2009. Still considerable inequality exists in terms of characteristics and financing of CTs and MRIs.

【 授权许可】

   
2013 He et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20140713045633143.pdf 1132KB PDF download
Figure 10. 47KB Image download
Figure 9. 47KB Image download
Figure 8. 50KB Image download
Figure 7. 47KB Image download
Figure 6. 47KB Image download
Figure 5. 45KB Image download
Figure 1. 67KB Image download
Figure 3. 46KB Image download
Figure 2. 53KB Image download
Figure 1. 48KB Image download
【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 1.

Figure 5.

Figure 6.

Figure 7.

Figure 8.

Figure 9.

Figure 10.

【 参考文献 】
  • [1]Tang S, Meng Q, Chen L, Bekedam H, Evans T, Whitehead M: Tackling the challenges to health equity in China. Lancet 2008, 372:1493-1501.
  • [2]Ma J, Lu M, Quan H: From a national, centrally planned health system to a system based on the market: lessons from China. Health Aff (Millwood) 2008, 27:937-948.
  • [3]Sen A: Why health equity? Heal Econ 2002, 11:659-666.
  • [4]Zhang X, Kanbur R: Spatial inequality in education and health care in China. China Econ Rev 2005, 16:189-204.
  • [5]Ministry of Health: Analysis report of national health services survey in 2003. 2004, 180-184. [Book analysis report of national health services survey in 2003]
  • [6]Xu L, Wang Y, Collins C, Tang S: Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003. BMC Heal Serv Res 2007, 7:37. BioMed Central Full Text
  • [7]Anand S, Fan VY, Zhang J, Zhang L, Ke Y, Dong Z, Chen LC: China’s human resources for health: quantity, quality, and distribution. Lancet 2008, 372:1774-1781.
  • [8]Zhao GY, Li JW, Liu JX: Brife introduction of allocation state and method of utilization assessment of China. Chinese Med Equip J 2003, 12:41-43.
  • [9]Kang GJ: Equity study of major medical equipment in China. Hosp Dir Forum 2007, 4:59-62.
  • [10]Hou SL, Li JL, Bi XL, Li SY, Tang QQ: Diffusion of major medical equipment of Tangshan city. Med Equip J 2003, 1:31-33.
  • [11]Li J, Wang B, Tian ZF, Yang JS, Guo NL, Wang J, Lin YJ, Qiu TL: Equity research of major medical devices in Dongying city. Health Econ Res 2003, 10:23-24.
  • [12]Liu S: Equity evaluation on the distribution of large medical equipment. Inf Med Equip 2007, 22:50-53.
  • [13]Deng LJ, Wang GJ, Yin TP, Qin JM, Liao PH, Tang JX, Mao L, Zhang YH, Zhang JY, Zhang JL: Study on allocation and equity of medical equipment type 2 in Xinjiang Production and Construction Corps. Chin Health Resour 2009, 39:225-227.
  • [14]Miao CX, Guo CJ, Zhuo L, Gu YM: The allocation of large medical equipment in Xuzhou. Mod Prev Med 2007, 34:3110-3111.
  • [15]Wang JP, He SY, Li XR, Yi F: Allocation and equity status of CT machines in Sichuan province. Chin Health Qual Manag 2010, 17:105-107.
  • [16]Tan L, He SY, Li XR, Zheng ZR, Yi Y: Status quo of disposition of MRI and its justice in Sichuan Province. China Med Equip 2010, 2:1-5.
  • [17]Banta HD, Luce BR: Health care technology and its assessment: an international perspective. Oxford: Oxford University Press; 1993.
  • [18]Fisher ES, Bynum JP, Skinner JS: Slowing the growth of health care costs—lessons from regional variation. N Engl J Med 2009, 360:849-852.
  • [19]Pope B, Johnson A: Scope. Nonparametric Assessment, Policy Insights and Functional Estimation.: Properties; 2011.
  • [20]Hurst J, Jee-Hughes M: Performance measurement and performance management in OECD health systems. In Book Performance measurement and performance management in OECD health systems. Edited by Editor ed.^eds. City: OECD Publishing; 2001.
  • [21]Evans DB, Tandon A, Murray CJ, Lauer JA: The comparative efficiency of national health systems in producing health: an analysis of 191 countries. Geneva: World Health Organization; 2001.
  • [22]World Health Organization: The world health report 2000: health systems: improving performance. Geneva; 2000. Available from URL: http://www.who.int/whr/2000/en/ webcite
  • [23]Szczepura A, Clark M: Creating a strategic management plan for magnetic resonance imaging (MRI) provision. Health policy 2000, 53:91-104.
  • [24]Hillman AL, Schwartz JS: The adoption and diffusion of CT and MRI in the United States: a comparative analysis. Medical care 1985, 23:1283.
  • [25]Baker LC: Managed care and technology adoption in health care: evidence from magnetic resonance imaging. J Heal Econ 2001, 20:395-421.
  • [26]Oh E-H, Imanaka Y, Evans E: Determinants of the diffusion of computed tomography and magnetic resonance imaging. Int J Technol Assess Health Care 2005, 21:73-80.
  • [27]Loureiro S, Simões B, Aragão E, Mota F, Moura H, Damasceno L: Diffusion of medical technology and equity in health in brazil: an exploratory analysis. Eur J Dev Res 2007, 19:66-80.
  • [28]Hsiao WCL: The Chinese health care system: lessons for other nations. Soc Sci Med 1995, 41:1047-1055.
  • [29]Magnetic resonance imaging. Wikipedia 2012 http://www.en.wikipedia.org/wiki/Magnetic_resonance_imaging webcite
  • [30]X-ray computed tomography. Wikipedia 2012 http://en.wikipedia.org/wiki/X-ray_computed_tomography webcite
  • [31]Ministry of Health, National Development and Reform Commission and Ministry of Finance: Regulation on large medical equipment allocation and utilization. 2004. Available from URL: http://www.moh.gov.cn/mohghcws/s3585/200905/40572.shtml webcite
  • [32]Health policies and data http://www.oecd.org/els/health-systems/oecdhealthdata2012-frequentlyrequesteddata.htm webcite
  • [33]Kakwani N, Wagstaff A, Van Doorslaer E: Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econometrics 1997, 77:87-103.
  • [34]O'Donnell O, Van Doorsslaer E, Wagstaff A, Lindelöw M: Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington D.C: World Bank Publications; 2008.
  • [35]Wagstaff A, Van Doorslaer E, Watanabe N: On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econometrics 2003, 112:207-223.
  • [36]Doorslaer E, Koolman X: Explaining the differences in income‒related health inequalities across European countries. Health Econ 2004, 13:609-628.
  • [37]Harper S, Lynch J: Commentary: using innovative inequality measures in epidemiology. Int J Epidemiol 2007, 36:926-928.
  • [38]Wolfson M, Rowe G: On measuring inequalities in health. Bull World Health Organ 2001, 79:553-560.
  • [39]Horev T, Pesis-Katz I, Mukamel DB: Trends in geographic disparities in allocation of health care resources in the US. Health policy 2004, 68:223-232.
  • [40]McGrail KM, van Doorslaer E, Ross NA, Sanmartin C: Income-related health inequalities in Canada and the United States: a decomposition analysis. Am J Public Health 1856, 2009:99.
  • [41]Ameryoun A, Meskarpour-Amiri M, Dezfuli-Nejad ML, Khoddami-Vishteh H, Tofighi S: The assessment of inequality on geographical distribution of Non-cardiac intensive care beds in Iran. Iranian J Public Health 2011, 40:25-33.
  • [42]Luebker M: Inequality, income shares and poverty: the practical meaning of Gini coefficients. Geneva, Switzerland: International Labour Office, Travail Policy Brief No 3; 2010:8.
  • [43]Schuetz GM, Zacharopoulou NM, Schlattmann P, Dewey M: Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging. Ann Intern Med 2010, 152:167.
  • [44]Zhang YJ, Shi YX, Zhang ZY: Comparison of Image Quality between Hitachi 0.3 T MR Domestic Machine and Imported One. Chin Med Equip J 2011, 5:028.
  • [45]Li XTYRNP: Trends of domestic medical image processing. J University of Electronic Sci Technol China 2002, 5:014.
  • [46]Ma ZS, Zhang HJ, Lei W, Xiong LZ: Musculoskeletal trauma services in china. Clin Orthop Relat Res 2008, 466:2329-2336.
  • [47]Otsubo T, Imanaka Y, Lee J, Hayashida K: Evaluation of resource allocation and supply–demand balance in clinical practice with high-cost technologies. J Eval Clin Pract 2011, 17:1114-1121.
  • [48]Azari R, Xue L: Variations in the utilisation of medical technology as influenced by socio-economic factors in the case of magnetic resonance imaging (MRI). Int J Healthc Technol Manage 2000, 2:337-357.
  • [49]Ministry of Health, China: Instruction of trial reform of public hospitals. 2010. http://www.sda.gov.cn/WS01/CL0611/49458.html webcite
  文献评价指标  
  下载次数:102次 浏览次数:50次