[Advance care planning and use of health resources among COVID-19 nursing home patients in an integrated health care program for frail elders]. / Planificación anticipada de los cuidados y del uso de recursos hospitalarios en pacientes con COVID-19 en un programa de atención integrada para adultos mayores frágiles en residencias.

OBJECTIVES: To estimate the magnitude and importance of a process of stratification and advance care planning and the use of health resources, among patients in an integrated health care program for frail elderls in nursing homes,that were referred to the hospital with COVID-19. MATERIAL AND METHODS: Prospective cohort study of patients >64 years old with COVID-19 infection, in a health care program in nursing homes (from 3/15/2020 to 9/15/2020). The identification of patients with palliative needs, the performing and visible registration in electronic health records of the advance care planning and the use of intensive care were assessed. RESULTS: We included 374 COVID-19 patients. 88% were women, the median age was 88 years old. The 79% were patients with palliative needs, of which 68% had the advance care planning (P<.001) registered in the electronic health record. Only 1% of patients with palliative needs and severity criteria were admitted to the intensive care unit. Overall mortality was 25%. Of those who died, 74% had severity criteria (P<.001) and 90% had palliative needs (P<.001). CONCLUSIONS: Carrying out a care process based on identification of patients with palliative needs and advance care planning and a central and visible registration of advance care planning in health records, could improve the quality and safety of care and optimize the use of intensive care health resources at all times and especially in public health emergencies.

Which Skills Are Key to Public Health Leaders' Success in Crisis Management?

Under-resourced and fragmented public health infrastructure has contributed to a poor pandemic response in the United States. There have been calls to redesign the Centers for Disease Control and Prevention and to increase its budget. Lawmakers also have introduced bills aiming to change public health emergency powers at the local, state, and federal levels. Public health is ripe for reform, but reorganization and enhanced funding will not address an equally pressing problem: chronic failures of judgment in the definition and implementation of legal interventions. Without a more informed and nuanced appreciation for the value and limits of law as an instrument of health promotion, the public will remain at unnecessary risk.

Influencing factors of health resource allocation and utilisation before and after COVID-19 based on RIF-I-OLS decomposition method: a longitudinal retrospective study in Guangdong Province, China.

OBJECTIVES: To explore factors that influenced the health resource allocation and utilisation before and after COVID-19, and subsequently offer sensible recommendations for advancing the scientific distribution of health resources. DESIGN: A longitudinal survey using 2017-2020 data, which were collected for analysis. SETTING: The study was conducted based on data collected from the Health Commission of Guangdong Province's website. OUTCOME MEASURES: Eight health resource indicators and four health resource utilisation indicators were included in the factor analysis. Four indices were calculated to measure the inequality in health resource allocation and utilisation. We analysed factors for the inequality indices using the recentred influence function index ordinary least squares decomposition method. RESULTS: The health resource inequality indices peaked in 2020 (Gini coefficient (Gini): 0.578, Absolute Gini coefficient (AGini): 1.136, Concentration Index (CI): 0.417, Absolute CI (ACI): 0.821), whereas the health resource utilisation inequality indices declined year by year, thus reaching their lowest point in that same year. The majority of inequality indices in the annual change of health resource allocation were at their lowest in 2020 (Gini: -1.672, AGini: 0.046, CI: -0.189, ACI: 0.005), while the use of health resources declined dramatically, showing a negative growth trend. The inequality indices of health resource allocation and utilisation in 2020 were affected by a number of variables, including the COVID-19 level, (p<0.05), while the proportion of expenditure on public health was the most significant one. CONCLUSIONS: Guangdong Province's health resource allocation and utilisation were still concentrated in economically developed regions from 2017 to 2020. The health resource allocation inequality indices increased, especially under COVID-19, but the health resource utilisation inequality indices decreased. Measures should be taken to adjust the health resource allocation scientifically, which will fulfil the changing needs and the use of resources more efficiently. One effective measure is reasonably increasing the proportion of expenditure on public health.

Addressing immediate public health needs as part of Afghan evacuees' resettlement to the United States during the COVID-19 pandemic.

OBJECTIVES: Since the removal of US troops from Afghanistan in 2021, the United States welcomed Afghan evacuees through Operation Allies Welcome. Using cell phone accessibility, the CDC Foundation worked with public-private partners to protect evacuees from the spread of COVID-19 and provide accessibility to resources. STUDY DESIGN: This was a mixed methods study. METHODS: The CDC Foundation activated its Emergency Response Fund to accelerate public health components of Operation Allies Welcome, including testing, vaccination, and COVID-19 mitigation and prevention. The CDC Foundation began the provision of cell phones to evacuees to ensure access to public health and resettlement resources. RESULTS: The provision of cell phones provided connections between individuals and access to public health resources. Cell phones provided means to supplement in-person health education sessions, capture and store medical records, maintain official resettlement documents, and assist in registration for state-administered benefits. CONCLUSIONS: Phones provided necessary connectivity to friends and family for displaced Afghan evacuees and higher accessibility to public health and resettlement resources. As many evacuees did not have access to US-based phone services upon entry, provision of cell phones and plans for a fixed amount of service time provided a helpful start in resettlement while also being a mechanism to easily share resources. Such connectivity solutions helped to minimize disparities among Afghan evacuees seeking asylum in the United States. Provision of cell phones by public health or governmental agencies can help to provide equitable resources to evacuees entering the United States for social connection, healthcare resources, and resources to assist in the process of resettlement. Further research is needed to understand the generalizability of these findings to other displaced populations.

Distribution of COVID-19 cases and health resources in Brazil's Amazon region: a spatial analysis. / Distribuição da COVID-19 e dos recursos de saúde na Amazônia Legal: uma análise espacial.

Spatial analysis can help measure the spatial accessibility of health services with a view to improving the allocation of health care resources. The objective of this study was to analyze the spatial distribution of COVID-19 detection rates and health care resources in Brazil's Amazon region. We conducted an ecological study using data on COVID-19 cases and the availability of health care resources in 772 municipalities during two waves of the pandemic. Local and global Bayesian estimation were used to construct choropleth maps. Moran's I was calculated to detect the presence of spatial dependence and Moran maps were used to identify disease clusters. In both periods, Moran's I values indicate the presence of positive spatial autocorrelation in distributions and spatial dependence between municipalities, with only a slight difference between the two estimators. The findings also reveal that case rates were highest in the states of Amapá, Amazonas, and Roraima. The data suggest that health care resources were inefficiently allocated, with higher concentrations of ventilators and ICU beds being found in state capitals.

O método de análise espacial permite mensurar a acessibilidade espacial dos serviços de saúde para alocação dos recursos de forma eficiente e eficaz. Diante disso, o objetivo deste estudo foi analisar a distribuição espacial das taxas de COVID-19 e dos recursos de saúde na Amazônia Legal. Estudo ecológico realizado com casos de COVID-19 e os recursos de saúde nos 772 municípios em dois picos da pandemia. Utilizou-se o método bayesiano global e local para elaboração de mapas coropléticos, com cálculo do índice de Moran para análise da dependência espacial e utilização do Moran map para identificação dos clusters da doença. Os índices de Moran calculados para os dois períodos demonstraram autocorrelação espacial positiva dessa distribuição e dependência espacial entre os municípios nos dois períodos, sem muita diferença entre os dois estimadores. Evidenciaram-se maiores taxas da doença nos estados do Amapá, Amazonas e Roraima. Em relação aos recursos de saúde, observou-se alocação de forma ineficiente, com maior concentração nas capitais.

[Prioritization of health resources in contexts of scarcity. SESPAS Report 2022]. / Priorización de recursos sanitarios en contextos de escasez. Informe SESPAS 2022.

The COVID-19 pandemic has been a clinical challenge, but also a legal and bioethical one. These three fundamental pillars are developed in the approach to prioritizing health resources in pandemic, clinical criteria, corresponding legal framework and applicable ethical principles. Initially, clinical criteria were applied to identify patients with the best survival prognosis, combining a clinical evaluation and the use of short-term and long-term prognostic variables. But the decision to prioritize the care of one patient over another has a legal-political burden, which poses a risk of falling into discrimination since fundamental rights are at stake. The prioritization criteria must be based on principles that reflect as a vehicle philosophy that which we have constitutionally assumed as a social and democratic State of Law, which did not respond to utilitarianism but to personalism. Any philosophy of resource distribution must bear in mind the scientific and constitutional perspective and, with them, those of fundamental rights and bioethical principles. In the prioritization of resources, ethical principles must be consolidated such as respect for the human dignity, the principle of necessity (equal need, equal access to the resource), the principle of equity (which advises prioritizing the most vulnerable population groups), transparency (fundamental in society's trust) and the principle of reciprocity (which requires protecting the sectors of the population that take more risks), among others.

Trends in the disparities and equity of the distribution of traditional Chinese medicine health resources in China from 2010 to 2020.

BACKGROUND: At present, improving the accessibility to traditional Chinese medicine (TCM) health resources is an important component of China's health policy. This study evaluated the trends in the disparities and equity of TCM health resource allocation from 2010 to 2020 to inform optimal future local health planning and policy. METHOD: The data for this study were extracted from the China Health Statistical Yearbook (2011-2021) and China Urban Statistical Yearbook (2020). The equity and rationality of the allocation of TCM health resources at the national and provincial levels were evaluated using the Gini coefficient and the health resource aggregation degree, respectively. RESULT: The number of TCM-related institutions, beds, health staff, outpatients and admissions increased by 1.97, 2.61, 2.35, 1.72 and 2.41 times, respectively, between 2010 and 2020. The population-based Gini coefficients for health staff, beds and institutions were 0.12, 0.23 and 0.13, respectively, indicating acceptable equity, while the geographical area-based Gini index for health staff, beds and institutions were 0.65, 0.62 and 0.62, respectively, indicating serious inequity. The agglomeration degree as a function of geographical area was as follows: eastern region > central region > western region. Moreover, the institutional and health staff gaps between the geographical areas increased from 2012 to 2020. In addition, there was a relatively balanced agglomeration degree based on the population in these three regions and an increasingly equitable allocation of institutions and health staff. CONCLUSION: In recent years, China's TCM health resources and services have increased rapidly, but their proportions within the overall health system remain low. The equity and rationality of TCM health allocated by the population was better than that by the geographic area. Regional differences and inequalities, especially for institutions, still exist. A series of policies to promote the balanced development of TCM need to be implemented.

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity.

BACKGROUND: The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries. METHODS: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria. RESULTS: A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)). CONCLUSION: Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities.

Mind the gap: Inequalities in mental health care and lack of social support in Parkinson disease.

Inequalities in mental healthcare and lack of social support during the COVID-19 pandemic have lowered quality of life and increased overall burden of disease in people with Parkinson's (PWP). Although the pandemic has brought attention to these inequalities, they are long standing and will persist unless addressed. Lack of awareness of mental health issues is a major barrier and even when recognized disparities based on race, gender, and socioeconomic factors limit access to already scarce resources. Stigma regarding mental illness is highly prevalent and is a major barrier even when adequate care exists. Limited access to mental healthcare during the pandemic and in general increases the burden on caregivers and families. Historically, initiatives to improve mental healthcare for PWP focused on interventions designed for specialty and academic centers generally located in large metropolitan areas, which has created unintended geographic disparities in access. In order to address these issues this point of view suggests a community-based wellness model to extend the reach of mental healthcare resources for PWP.

Research on the Equity and Optimal Allocation of Basic Medical Services in Guangzhou in the Context of COVID-19.

Optimizing the allocation of basic medical services and ensuring their equity are necessary to improve the ability to respond to public health emergencies and promote health equity in the context of COVID-19. This study aims to analyze the equity of Guangzhou's basic medical service and identify areas where health resources are relatively scarce. The spatial distribution and patterns of basic medical services were analyzed using kernel density analysis and standard deviation ellipse. The equity was analyzed using the Gini coefficient and Lorenz curve in terms of population and geographical area, respectively. Considering the medical demand and supply sides, the Gaussian two-step floating catchment area method was used to analyze the accessibility to different levels of medical institutions. The kernel density analysis and standard deviation ellipse showed that the spatial distribution of medical and health resources in Guangzhou is unevenly distributed, and high-level hospitals and medical resources are mainly concentrated in the centrum. From the perspective of population, Guangzhou's medical equity is generally reasonable. The accessibility of medical institutions differs with different levels, and the tertiary medical institutions have the best accessibility, while the unclassified, primary, and secondary medical institutions generally have lower accessibility. The accessibility of districts in Guangzhou varies greatly. Areas in the center are most accessible to basic medical services, while accessibility in outskirt areas has gradually decreased. Conclusion: The quantity of per capita medical and health resources in Guangzhou, as evidenced by basic medical services, is sufficient, but the spatial distribution is unequal. The developed city center enjoys more adequate healthcare resources than the distant suburbs. Primary healthcare should be built, especially in distant suburbs, to strengthen basic medical service equity in Guangzhou.

A Survey of COVID-19 Preparedness Among Hospitals in Idaho.

BACKGROUND: SARS-CoV-2 has been implicated in the largest recorded coronavirus outbreak to date. Initially, most COVID-19 cases were in China, but the virus has spread to more than 184 countries worldwide, and the United States currently has more cases than any other country. OBJECTIVE: With person-to-person spread expanding in the United States, we describe hospital preparedness for managing suspected and confirmed COVID-19 patients. DESIGN: Cross-sectional survey focused on various elements of respiratory disease preparedness. SETTING: Critical access hospitals (CAHs) and acute-care hospitals (ACHs) in Idaho. METHODS: The electronic survey was sent to infection preventionists (IPs) and nurse administrators in 44 hospitals in Idaho. RESULTS: Overall, 32 (73%) hospitals responded to the survey. Participating facilities reported their preparedness with respect to existing, formalized structures for managing infectious disease incidents-specifically COVID-19-as well as availability of resources, such as isolation rooms and personal protective equipment, for safely managing suspected and confirmed COVID-19 cases. CONCLUSIONS: Hospitals covered by the survey had varying levels of preparedness for managing COVID-19 cases, with differences across the various categories of interest in this study. Although the study reveals strengths, including in application of emergency management and infection control frameworks, it also suggests that other areas, such as consistent implementation of federal guidelines and requirements for infection prevention, are potential areas for strengthening preparedness for SARS-CoV-2 and other respiratory pathogens with pandemic potential.

White House Advisor Nahid Bhadelia, MD, MALD, on COVID-19 in Resource-Limited Nations-Undercounted Deaths, Vaccine Inequity, and More.

This Medical News article is an interview with Nahid Bhadelia, MD, MALD, the White House COVID-19 Response Team's senior policy advisor for Global COVID Response.

Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) epidemic has spread from China to 25 countries. Local cycles of transmission have already occurred in 12 countries after case importation. In Africa, Egypt has so far confirmed one case. The management and control of COVID-19 importations heavily rely on a country's health capacity. Here we evaluate the preparedness and vulnerability of African countries against their risk of importation of COVID-19. METHODS: We used data on the volume of air travel departing from airports in the infected provinces in China and directed to Africa to estimate the risk of importation per country. We determined the country's capacity to detect and respond to cases with two indicators: preparedness, using the WHO International Health Regulations Monitoring and Evaluation Framework; and vulnerability, using the Infectious Disease Vulnerability Index. Countries were clustered according to the Chinese regions contributing most to their risk. FINDINGS: Countries with the highest importation risk (ie, Egypt, Algeria, and South Africa) have moderate to high capacity to respond to outbreaks. Countries at moderate risk (ie, Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya) have variable capacity and high vulnerability. We identified three clusters of countries that share the same exposure to the risk originating from the provinces of Guangdong, Fujian, and the city of Beijing, respectively. INTERPRETATION: Many countries in Africa are stepping up their preparedness to detect and cope with COVID-19 importations. Resources, intensified surveillance, and capacity building should be urgently prioritised in countries with moderate risk that might be ill-prepared to detect imported cases and to limit onward transmission. FUNDING: EU Framework Programme for Research and Innovation Horizon 2020, Agence Nationale de la Recherche.

A nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil. / Estudo nacional sobre recursos da saúde e práticas clínicas durante o início da pandemia da COVID-19 no Brasil.

OBJECTIVE: To evaluate clinical practices and hospital resource organization during the early COVID-19 pandemic in Brazil. METHODS: This was a multicenter, cross-sectional survey. An electronic questionnaire was provided to emergency department and intensive care unit physicians attending COVID-19 patients. The survey comprised four domains: characteristics of the participants, clinical practices, COVID-19 treatment protocols and hospital resource organization. RESULTS: Between May and June 2020, 284 participants [median (interquartile ranges) age 39 (33 - 47) years, 56.3% men] responded to the survey; 33% were intensivists, and 9% were emergency medicine specialists. Half of the respondents worked in public hospitals. Noninvasive ventilation (89% versus 73%; p = 0.001) and highflow nasal cannula (49% versus 32%; p = 0.005) were reported to be more commonly available in private hospitals than in public hospitals. Mechanical ventilation was more commonly used in public hospitals than private hospitals (70% versus 50%; p = 0,024). In the Emergency Departments, positive endexpiratory pressure was most commonly adjusted according to SpO2, while in the intensive care units, positive end-expiratory pressure was adjusted according to the best lung compliance. In the Emergency Departments, 25% of the respondents did not know how to set positive end-expiratory pressure. Compared to private hospitals, public hospitals had a lower availability of protocols for personal protection equipment during tracheal intubation (82% versus 94%; p = 0.005), managing mechanical ventilation [64% versus 75%; p = 0.006] and weaning patients from mechanical ventilation [34% versus 54%; p = 0.002]. Finally, patients spent less time in the emergency department before being transferred to the intensive care unit in private hospitals than in public hospitals [2 (1 - 3) versus 5 (2 - 24) hours; p < 0.001]. CONCLUSION: This survey revealed significant heterogeneity in the organization of hospital resources, clinical practices and treatments among physicians during the early COVID-19 pandemic in Brazil.

OBJETIVO: Avaliar as práticas clínicas e a organização dos recursos hospitalares durante o início da pandemia da COVID-19 no Brasil. METÓDOS: Foi realizado um estudo transversal multicêntrico. Um questionário on-line foi disponibilizado a médicos dos serviços de emergência e das unidades de terapia intensiva que atendiam pacientes com COVID-19. O questionário contemplava quatro aspectos: perfil dos participantes, práticas clínicas, protocolos de tratamento da COVID-19 e organização dos recursos hospitalares. RESULTADOS: Entre maio e junho de 2020, 284 participantes (56,3% homens), com idade mediana de 39 (intervalo interquartil de 33 - 47), responderam ao questionário; 33% eram intensivistas e 9% eram especialistas em medicina de emergência. Metade dos respondentes trabalhava em hospitais públicos. Verificou-se que a ventilação não invasiva (89% versus 73%; p = 0,001) e a cânula nasal de alto fluxo (49% versus 32%; p = 0,005) encontravam-se mais frequentemente disponíveis em hospitais privados do que nos públicos. A ventilação mecânica foi mais frequentemente utilizada em hospitais públicos do que em privados (70% versus 50%; p = 0,024). Nos serviços de emergência, a pressão positiva expiratória final foi mais frequentemente ajustada de acordo com a saturação de oxigênio, enquanto nas unidades de terapia intensiva, a pressão positiva expiratória final foi ajustada de acordo com a melhor complacência pulmonar. Nos serviços de emergência, 25% dos respondentes não sabiam como ajustar a pressão positiva expiratória final. Comparativamente aos hospitais privados, os hospitais públicos tiveram menor disponibilidade de protocolos para Equipamentos de Proteção Individual durante a intubação traqueal (82% versus 94%; p = 0,005), o manejo da ventilação mecânica (64% versus 75%; p = 0,006) e o desmame dos pacientes da ventilação mecânica (34% versus 54%; p = 0,002). Finalmente, os pacientes passaram menos tempo no serviço de emergência antes de serem transferidos à unidade de terapia intensiva em hospitais privados do que em hospitais públicos (idade mediana de 2 (1 - 3) versus idade mediana de 5 (2 - 24) horas; p < 0,001). CONCLUSÃO: Este estudo revelou heterogeneidade considerável entre os médicos em termos de organização dos recursos hospitalares, práticas clínicas e tratamentos durante o início da pandemia da COVID-19 no Brasil.

How is the medical service efficiency in China? An empirical analysis using stochastic frontier approach and gravity models.

The COVID-19 has heightened the focus of medical services. Scientifically evaluating the efficiency of medical services and defining their spatial transmission relationship is crucial for the rational allocation of health resources and the accomplishment of balanced regional medical service growth. We used a Stochastic Frontier Model to calculate medical service performance in Chinese provinces and the Gravity Model to study the spatial relationship of medical service performance across provinces using data from 2009 to 2018. We discover that: (1) population density and proportion of technical personnel are significantly positively correlated with the efficiency of regional medical services, whereas health institution density has a significantly negative influence. Their respective influence coefficients were 1.717, 0.647, and 0.407. (2) In China, the regional development of medical service efficiency is unbalanced. The east, middle, and west multi-year average medical service efficiency were 0.65, 0.46, and 0.53, respectively, and their gaps were narrowing; the south and north average efficiency were 0.591, 0.516, respectively, and their gaps were widening. (3) Our medical efficiency network is not yet widespread in the country. Hubei, Henan, Shandong, Jiangsu, Zhejiang, and Beijing were at the centre of the medical efficiency network, driving and connecting the nation's medical service. Our findings offer specific recommendations for better understanding and improving the efficiency of medical services.

Resource Allocation Equity in the China's Rural Three-Tier Healthcare System.

The rural three-tier healthcare system is an essential part of the Chinese healthcare service system. To ensure rural residents' equal access to such healthcare services, it is necessary to examine the current status of the healthcare system in rural China and formulate corresponding improvement suggestions. This study therefore collects the data from the China Health Statistics Yearbook, the China Health Yearbook and the China Statistical Yearbook between the years 2004 and 2021 to calculate the Gini coefficient (G), health resource density index (HRDI) and Theil index (T) first, and then perform the Mann-Kendall test afterwards to evaluate the equity of healthcare resource allocation comprehensively. This series of analysis helps in drawing the following conclusions: (1) county and county-level city medical and health institutions (CMHIs) show a higher development trend in comparison with township hospitals (THs) and village clinics (VCs); (2) VCs have higher institutional fairness, while for beds and personnel, CMHIs and THs are more fairly positioned; (3) more specifically for CMHIs and THs, personnel allocation is more fair than beds and institution allocations; (4) the density of healthcare resources in the eastern and central regions is higher than that in the western part, while the intra-regional distribution of beds and personnel in the west and central regions is better than that in the eastern region; (5) intra-regional differences are more significant than inter-regional differences and the fairness according to population distribution is higher than that of geographical area allocation. The results of this study provide theoretical basis for further optimizing the allocation of healthcare resources and improving the fairness of healthcare resources allocation from a macro perspective.