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Objective: To assess and analyze the operation efficiency of 8 commission general public hospitals managed directly by National Health and Family Planning Commission and 8 municipal general hospitals managed directly by Beijing Municipal Administration of Hospitals in Beijing and to provide suggestions on improving service capacity and designing relevant health policy.Methods: Input and output data of 8 commission hospitals and 8 municipal hospitals were obtained from Beijing Direct-Reported Health Statistics data from 2011 to 2014.Data envelopment analysis was used as the hospital operation efficiency measurement tool.The CCR and BCC models were built to calculate technical efficiency (TE), pure technical efficiency (PTE), scale efficiency (SE) and the status of scale efficiency of 16 hospitals in 2011 and 2014;the Malmquist index model was built to analyze the total factor productivity change (TFPC), technological change (TC), technical efficiency change, pure technical efficiency change and scale efficiency change of the 16 hospitals from 2011 to 2014.Results: In 2011, the TE, PTE and SE of the commission hospitals were higher than those of the municipal hospitals, and the TEs of the commission hospitals and the municipal hospitals were 0.918 and 0.873 respectively.In 2014, the TE, PTE and SE of commission hospitals were lower than those of the municipal hospitals, and the TE of the commission hospitals and the municipal hospitals were 0.906 and 0.951, respectively, which was contrary to the results in 2011.According to the Malmquist index model, the average of TFPC of the municipal hospitals was larger than that of the commission hospitals, the former increased 5.9% and the latter increased 2.8% per year;the average of TC was greater than the one in both the municipal hospitals and the commission hospitals, with a growth of 3.2% and 2.9% per year, respectively;the average growth of PTE in the commission hospitals was lower than that of the municipal hospitals, and the average descent of SE in the commission hospitals was larger than that in the municipal hospitals.Conclusion: There are significant differences in the operation efficiency between different management systems and the main factors associated with operation efficiency are the technological and management level.Given scale efficiency status and macroeconomic medical policies, the commission hospitals and the municipal hospitals require further adjusting the distribution of medical resources, and it is of great significance for all the commission hospitals and the municipal hospitals to improve the management level and resource integration capability.
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Objective:To explore the association between different urbanization levels and non-commu-nicable diseases (NCDs)in China and provide suggestions on designing relevant health policies in the ur-banization process.Methods:We obtained health-related data from China Health and Retirement Longi-tudinal Study (CHARLS)201 1 .This study used multistage sampling in design stage and covered 1 50 districts/counties,representative at the levels of the country.Geo-information system (GIS)method was used to get district areas data,and in combination with the Sixth National Census population data,we computed the population density which was regarded as the proxy variable of urbanization level in every city.The Logistic model was used to explore the effect of urbanization level on hypertension,diabetes, smoking,drinking,overweight and obesity.Results:Compared with other cities in China,Shanghai and Shenzhen,with the population density of more than 3 000 people per km2 ,were the cities with highest urbanization level.From the map of urbanization distribution across China,it was found that the urbani-zation levels of the northwestern districts were lower than those of the southeastern and coastal districts. The hypertension rate increased with the development of urbanization but there was no statistical signifi-cance.The proportion of patients with diabetes went up first and then saw a decrease trend in the process of urbanization.Drinking rate,overweight rate and obesity rate had similar trends,falling to their lowest point when urbanization level equaled 737,1 1 86 and 1 353 people per km2 respectively and then ex-perienced upward trends.By contrast,smoking rate declined first and then went up (the turning point was 1 029 people per km2 ).Conclusion:Different urbanization levels have different effects on NCDs, health-related behavior,overweight and obesity.Low urbanization level may create negative impact on health while high level can pose positive effect and increase people’s health condition possibly due to the improvement of health care accessibility and the quality of living environment.Policy-makers should spe-cially focus on different residents’health problems in different periods of urbanization,such as the impact of environmental pollution,health resources’allocation and accessibility of health services.It is necessa-ry to reduce or avoid the negative effect of urbanization on NCDs during the local development process to face the NCDs’threat.
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Objective:To explore the feasibility of screening for major fetal heart disease by training sonographers in township or county level hospitals .Methods:Training of B ultrasound scan for congeni-tal heart defects was given to the sonographers from one county hospital , and thirteen township hospitals ( or the district hospitals ) , and training of fetal echocardiography was given to sonographers from four city/county hospitals.The trained sonographers who had passed the examinations and had obtained quali-fications after six months of independent practice began to screen fetal congenital heart defects .To evalu-ate the effectiveness , sensitivity and specificity of screening was calculated by using the diagnosis of ex-pert neonatal/fetal echocardiographers as the gold standard .Results: A total of 3 425 fetuses received one fetal B ultrasound screening , one fetal echocardiography and one neonatal echocardiography from April 1, 2004 to December 31, 2005.One hundred and sixty-five B ultrasound screening images (4.9%) from township hospitals and fifty-six fetal echocardiography images (1.7%) from county or city centers couldn ’ t be reviewed because of poor quality .The sensitivity of fetal B ultrasound screening in the township and county hospitals was 30%and 0, and the specificity 93.3%and 99.9%, respectively. Nine fetuses with a major congenital heart disease were eventually found by the trained sonographers , and two cases were misdiagnosed and two unnoticed .The total sensitivity and specificity of fetal echocardio-graphy were 81.8% and 99.9%, respectively.The sensitivity in the county and city hospitals was 66 .7% and 100%, respectively .The specificity in the county and city hospitals was 99 .9%and 100%, respectively .Conclusion: Under the current circumstances , township hospitals are unable to perform effective fetal cardiac screening .Screening on fetal congenital heart disease is suggested to be taken by trained sonographers in county and city level medical centers .