34 research outputs found
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
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.
Réformes économiques et activités des hÎpitaux municipaux en zone rurale : une analyse dans la province de Shandong
Les vastes rĂ©formes entreprises en Chine dans le cadre de ce quâil est convenu dâappeler le Ă« socialisme de marchĂ© Ă» ont eu dâimportantes rĂ©percussions sur le fonctionnement du systĂšme de santĂ©. Cette communication se propose dâen analyser certains effets sur lâactivitĂ© et la performance dâun Ă©chantillon dâhĂŽpitaux municipaux situĂ©s dans une zone rurale de la province de Shandong. Les donnĂ©es de base ont Ă©tĂ© recueillies lors dâune enquĂÂȘte en 2002 et complĂ©tĂ©es par des informations Ă©manant des diffĂ©rents dĂ©partements de lâadministration concernĂ©s. Les dĂ©terminants de lâactivitĂ© des hĂŽpitaux ont Ă©tĂ© analysĂ©s Ă partir dâune analyse de panel sur la pĂ©riode 1986-2000. LâĂ©tude de leur performance a Ă©tĂ© faite en utilisant une analyse non paramĂ©trique (DEA et indice de Malmquist). Les rĂ©sultats obtenus suggĂšrent notamment que la contrainte de revenu de la population est un frein Ă lâaugmentation de la frĂ©quentation des hĂŽpitaux municipaux et que les mĂ©canismes dâassurance ne paraissent pas jouer en lâĂ©tat de rĂŽle significatif. LâactivitĂ© sâavĂšre influencĂ©e par des facteurs reprĂ©sentatifs de lâattractivitĂ© des hĂŽpitaux. Lâintroduction dâun systĂšme de Ă« gestion intĂ©grĂ©e Ă» a permis dâamĂ©liorer la qualitĂ© des soins des structures de santĂ© de village placĂ©s sous la tutelle des hĂŽpitaux municipaux tout en amĂ©liorant dans lâensemble la situation financiĂšre de ces derniers. Dans lâensemble, les hĂŽpitaux municipaux de notre Ă©chantillon ont amĂ©liorĂ© leur efficience durant la pĂ©riode dâĂ©tude sous lâinfluence de facteurs trĂšs variĂ©s selon les hĂŽpitaux. Mais il apparaĂźt que les hĂŽpitaux financiĂšrement contraints ont tendance Ă ĂÂȘtre comparativement plus efficients que les autres.activitĂ© et performance des hopitaux â efficience technique, RĂ©formes Ă©conomiques â dĂ©centralisation
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 hĂŽpitaux municipaux, qui sont un maillon essentiel du systĂšme de santĂ© rural Chinois, ont Ă©tĂ© affectĂ©s par les rĂ©formes Ă©conomiques successives depuis les annĂ©es 1980 et ont ainsi vu leur frĂ©quentation sâaffaiblir. Ă partir dâobservations longitudinales sur neuf annĂ©es (2000-2008) et 24 hĂŽpitaux municipaux sĂ©lectionnĂ©s de façon alĂ©atoire dans la prĂ©fecture de Weifang (Province du Shandong, Chine), cet article analyse les facteurs dâenvironnement et dâoffre qui influencent le volume des activitĂ©s curatives des hĂŽpitaux municipaux, mesurĂ©par le volume de consultations externes et dâhospitalisations. Afin dâestimer lâeffet de variables invariantes dans le temps, deux estimateurs sont utilisĂ©s : Hausman-Taylor et Fixed-Effect Vector Decomposition. Les rĂ©sultats des estimations des deux estimateurs sont similaires. Ils montrent que le systĂšme dâassurance mutualiste graduellement introduit Ă partir de 2003 influence positivement lâactivitĂ© des hĂŽpitaux municipaux, mĂȘme sâil subsiste des barriĂšres financiĂšres Ă lâaccĂšs aux soins de santĂ© coĂ»teux. Lâanalyse souligne aussi queles liens de rĂ©fĂ©rencement entre les diffĂ©rents niveaux de structures de santĂ© devraient ĂȘtre renforcĂ©s et que la taille des hĂŽpitaux municipaux, qui semble surestimĂ©e, doit ĂȘtre adaptĂ©e en fonction des facteurs environnementaux
Evolution de lâactivitĂ© et de la performance dâun Ă©chantillon d'hĂŽpitaux municipaux en Chine
La dĂ©centralisation en Chine a placĂ© les hĂŽpitaux municipaux (HM) au cĆur du systĂšme sanitaire en zone rurale. Nous avons utilisĂ© les informations collectĂ©es dans un Ă©chantillon de 21 HM de la province de Shandong et dans les administrations concernĂ©es pour analyser par des mĂ©thodes quantitatives les dĂ©terminants de leur activitĂ©, mesurer leur efficience et en rechercher les facteurs explicatifs pour la pĂ©riode 1986-2000. Nos rĂ©sultats suggĂšrent entre autres que le revenu per capita de la zone de desserte des HM ainsi que leur attractivitĂ© perçue ont un effet positif sur leur activitĂ©, que les tarifs pratiquĂ©s en sont un frein et que les dispositifs de couverture maladie nâont pas dâimpact significatif sur leur frĂ©quentation. LâintĂ©gration verticale partielle des HM avec les centres de santĂ© villageois a freinĂ© lâactivitĂ© de ces hĂŽpitaux. Leur efficience sâest globalement amĂ©liorĂ©e durant la pĂ©riode Ă©tudiĂ©e, mais selon une dynamique relativement hĂ©tĂ©rogĂšne,. Cette Ă©volution sâest faite en partie sous lâinfluence de facteurs institutionnels qui tiennent Ă des modalitĂ©s de rĂ©gulation sectorielle et Ă des questions de gouvernance liĂ©es aux relations entre les HM et la tutelle.
High-throughput functional analysis of autism genes in zebrafish identifies convergence in dopaminergic and neuroimmune pathways
Advancing from gene discovery in autism spectrum disorders (ASDs) to the identification of biologically relevant mechanisms remains a central challenge. Here, we perform parallel in vivo functional analysis of 10 ASD genes at the behavioral, structural, and circuit levels in zebrafish mutants, revealing both unique and overlapping effects of gene loss of function. Whole-brain mapping identifies the forebrain and cerebellum as the most significant contributors to brain size differences, while regions involved in sensory-motor control, particularly dopaminergic regions, are associated with altered baseline brain activity. Finally, we show a global increase in microglia resulting from ASD gene loss of function in select mutants, implicating neuroimmune dysfunction as a key pathway relevant to ASD biology
Single-cell multi-omics reveals dyssynchrony of the innate and adaptive immune system in progressive COVID-19.
Dysregulated immune responses against the SARS-CoV-2 virus are instrumental in severe COVID-19. However, the immune signatures associated with immunopathology are poorly understood. Here we use multi-omics single-cell analysis to probe the dynamic immune responses in hospitalized patients with stable or progressive course of COVID-19, explore V(D)J repertoires, and assess the cellular effects of tocilizumab. Coordinated profiling of gene expression and cell lineage protein markers shows that S100
ActivitĂ© et performance des hĂŽpitaux municipaux en Chine rurale. Une analyse sur donnĂ©es d'enquĂȘtes dans la province de Shandong
La dĂ©centralisation en Chine a placĂ© les hĂŽpitaux municipaux (HM) au cĆur du systĂšme sanitaire en zone rurale. Nous avons collectĂ© des informations dans un Ă©chantillon de 21 HM de la province de Shandong et dans les administrations concernĂ©es pour analyser par des mĂ©thodes quantitatives les dĂ©terminants de leur activitĂ©, mesurer leur efficience et en rechercher les facteurs explicatifs pour la pĂ©riode 1986-2000. Nos rĂ©sultats suggĂšrent entre autres que le revenu per capita de la zone de desserte des HM et leur attractivitĂ© perçue ont un effet positif sur leur activitĂ©, que les tarifs pratiquĂ©s en sont un frein et que les dispositifs de couverture maladie n'ont pas d'impact significatif sur leur frĂ©quentation. L'intĂ©gration verticale partielle des HM avec les centres de santĂ© villageois a relativement freinĂ© l'activitĂ© de ces hĂŽpitaux. Leur efficience s'est globalement amĂ©liorĂ©e, selon une dynamique relativement hĂ©tĂ©rogĂšne, durant la pĂ©riode Ă©tudiĂ©e, mais on observe une certaine convergence des performances. Cette Ă©volution s'est faite en partie sous l'influence de facteurs institutionnels qui tiennent Ă des modalitĂ©s de rĂ©gulation sectorielle et Ă des questions de gouvernance liĂ©es aux relations entre les HM et la tutelle