Réformes économiques et activités des hôpitaux municipaux en zone rurale : une analyse dans la province de Shandong

Les vastes réformes entreprises en Chine dans le cadre de ce qu’il est convenu d’appeler le « socialisme de marché » ont eu d’importantes répercussions sur le fonctionnement du système de santé. Cette communication se propose d’en analyser certains effets sur l’activité et la performance d’un échantillon d’hôpitaux municipaux situés dans une zone rurale de la province de Shandong. Les données de base ont été recueillies lors d’une enquête en 2002 et complétées par des informations émanant des différents départements de l’administration concernés. Les déterminants de l’activité des hôpitaux ont été analysés à partir d’une analyse de panel sur la période 1986-2000. L’étude de leur performance a été faite en utilisant une analyse non paramétrique (DEA et indice de Malmquist). Les résultats obtenus suggèrent notamment que la contrainte de revenu de la population est un frein à l’augmentation de la fréquentation des hôpitaux municipaux et que les mécanismes d’assurance ne paraissent pas jouer en l’état de rôle significatif. L’activité s’avère influencée par des facteurs représentatifs de l’attractivité des hôpitaux. L’introduction d’un système de « gestion intégrée » a permis d’améliorer la qualité des soins des structures de santé de village placés sous la tutelle des hôpitaux municipaux tout en améliorant dans l’ensemble la situation financière de ces derniers. Dans l’ensemble, les hôpitaux municipaux de notre échantillon ont amélioré leur efficience durant la période d’étude sous l’influence de facteurs très variés selon les hôpitaux. Mais il apparaît que les hôpitaux financièrement contraints ont tendance à être comparativement plus efficients que les autres.activité et performance des hopitaux – efficience technique, Réformes économiques – décentralisation

Evolution de l’activité et de la performance d’un échantillon d'hôpitaux municipaux en Chine

La décentralisation en Chine a placé les hôpitaux municipaux (HM) au cœur du système sanitaire en zone rurale. Nous avons utilisé les informations collectées dans un échantillon de 21 HM de la province de Shandong et dans les administrations concernées pour analyser par des méthodes quantitatives les déterminants de leur activité, mesurer leur efficience et en rechercher les facteurs explicatifs pour la période 1986-2000. Nos résultats suggèrent entre autres que le revenu per capita de la zone de desserte des HM ainsi que leur attractivité perçue ont un effet positif sur leur activité, que les tarifs pratiqués en sont un frein et que les dispositifs de couverture maladie n’ont pas d’impact significatif sur leur fréquentation. L’intégration verticale partielle des HM avec les centres de santé villageois a freiné l’activité de ces hôpitaux. Leur efficience s’est globalement améliorée durant la période étudiée, mais selon une dynamique relativement hétérogène,. Cette évolution s’est faite en partie sous l’influence de facteurs institutionnels qui tiennent à des modalités de régulation sectorielle et à des questions de gouvernance liées aux relations entre les HM et la tutelle.

The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China

Since 2003, the New Rural Cooperative Medical Scheme is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.China;New Rural Cooperative Medical Scheme;Impact analysis;Township Hospitals.

The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China

Since 2003, the New Rural Cooperative Medical Scheme is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.China;New Rural Cooperative Medical Scheme;Impact analysis;Township Hospitals.

Curative Activities of Township Hospitals in Weifang Prefecture, China: An Analysis of Environmental and Supply-Side Determinants

Township hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized.Health insurance, China, Healthcare services, Hausman-Taylor, Fixed-effects vector decomposition

Social prediction: a new research paradigm based on machine learning

Sociology is a science concerned with both the interpretive understanding of social action and the corresponding causal explanation, process, and result. A causal explanation should be the foundation of prediction. For many years, due to data and computing power constraints, quantitative research in social science has primarily focused on statistical tests to analyze correlations and causality, leaving predictions largely ignored. By sorting out the historical context of "social prediction," this article redefines this concept by introducing why and how machine learning can help prediction in a scientific way. Furthermore, this article summarizes the academic value and governance value of social prediction and suggests that it is a potential breakthrough in the contemporary social research paradigm. We believe that through machine learning, we can witness the advent of an era of a paradigm shift from correlation and causality to social prediction. This shift will provide a rare opportunity for sociology in China to become the international frontier of computational social sciences and accelerate the construction of philosophy and social science with Chinese characteristics

Congenital cystic adenomatoid malformation of lung in adults: 2 rare cases report and review of the literature

Congenital cystic adenomatoid malformation (CCAM), also named congenital pulmonary airway malformation (CPAM), is a congenital abnormality of lung which is uncommon in adults. Here we present 2 adult cases of CCAM with unusual clinical and pathologic findings. One case was complicated with aspergillosis which was seldom reported. The other case was suffered bilateral lesions and the patient's mother had been previously radiographically discovered bilateral cystic lesions that CCAM could not be ruled out. A review of currently published related literatures has also been provided

Curative Activities of Township Hospitals in Weifang Prefecture, China: An Analysis of Environmental and Supply-Side Determinants

International audienceTownship hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized.Les hôpitaux municipaux, qui sont un maillon essentiel du système de santé rural Chinois, ont été affectés par les réformes économiques successives depuis les années 1980 et ont ainsi vu leur fréquentation s’affaiblir. À partir d’observations longitudinales sur neuf années (2000-2008) et 24 hôpitaux municipaux sélectionnés de façon aléatoire dans la préfecture de Weifang (Province du Shandong, Chine), cet article analyse les facteurs d’environnement et d’offre qui influencent le volume des activités curatives des hôpitaux municipaux, mesurépar le volume de consultations externes et d’hospitalisations. Afin d’estimer l’effet de variables invariantes dans le temps, deux estimateurs sont utilisés : Hausman-Taylor et Fixed-Effect Vector Decomposition. Les résultats des estimations des deux estimateurs sont similaires. Ils montrent que le système d’assurance mutualiste graduellement introduit à partir de 2003 influence positivement l’activité des hôpitaux municipaux, même s’il subsiste des barrières financières à l’accès aux soins de santé coûteux. L’analyse souligne aussi queles liens de référencement entre les différents niveaux de structures de santé devraient être renforcés et que la taille des hôpitaux municipaux, qui semble surestimée, doit être adaptée en fonction des facteurs environnementaux

InterFace:Adjustable Angular Margin Inter-class Loss for Deep Face Recognition

In the field of face recognition, it is always a hot research topic to improve the loss solution to make the face features extracted by the network have greater discriminative power. Research works in recent years has improved the discriminative power of the face model by normalizing softmax to the cosine space step by step and then adding a fixed penalty margin to reduce the intra-class distance to increase the inter-class distance. Although a great deal of previous work has been done to optimize the boundary penalty to improve the discriminative power of the model, adding a fixed margin penalty to the depth feature and the corresponding weight is not consistent with the pattern of data in the real scenario. To address this issue, in this paper, we propose a novel loss function, InterFace, releasing the constraint of adding a margin penalty only between the depth feature and the corresponding weight to push the separability of classes by adding corresponding margin penalties between the depth features and all weights. To illustrate the advantages of InterFace over a fixed penalty margin, we explained geometrically and comparisons on a set of mainstream benchmarks. From a wider perspective, our InterFace has advanced the state-of-the-art face recognition performance on five out of thirteen mainstream benchmarks. All training codes, pre-trained models, and training logs, are publicly released \footnote{$https://github.com/iamsangmeng/InterFace$}.Comment: arXiv admin note: text overlap with arXiv:2109.09416 by other author