The evolution of mental health related policies in China: A bibliometric analysis, 1987-2020.

Background: Since 1987, the Chinese government has promoted public mental health by continuously implementing mental health related policies. This research attempts to reveal the distribution and characteristics of mental health related policies. In addition, it can help stakeholders evaluate whether the environment for policy implementation has improved and identify key points in the development of the overall mental health system. Methods: We used a bibliometric approach to analyze the evolution of mental health related policies in China from 1987 to 2020. A total of 239 mental health related policies were collected from Beida Fabao and official Internet websites of governmental departments. Co-wording, social networks, and citation analysis were applied to explore the evolutionary features of such policies. Results: The evolution of policy development showed that the number of mental health related policies in China has been increasing and their content has been enriched. Over time, mental health related policies not only gradually expanded its focus on common mental disorders, but also included an increasing number of keywords related to service provision, organization and administration. However, most policies were implemented independently by separate agencies and the number of policies jointly implemented by different agencies only accounted for 32.64% of all the policies implemented. The Ministry of Health (MOH) is at the core of the collaborative network associated with implementing mental health related policies in China. Conclusion: The environment associated with the implementation of mental health related policies in China is gradually improving. However, cross-sector collaboration among different agencies needs to be strengthened and financial support for related resources needs more attention. A clear division of responsibilities among various agencies and a sustainable financing mechanism are essential to the development and implementation of mental health related policies.

Impact of new health care reform on enabling environment for children's health in China: An interrupted time-series study.

Background: Creating an enabling environment (EE) can help foster the development and health of children. The Chinese government implemented a new health care reform (NHR) in 2009 in a move to promote an EE for health. The purpose of this study was to evaluate the impact of the NHR on EE for children's health. Methods: An interrupted time-series analysis was used to evaluate the changes in the EE before and after 2009 in China. This study analysed the EE through five quantitative indicators, including policy element coverage rate (PECR), service meeting with children's needs rate (SMCNR), multisector participation rate (MPR), and accountability mechanism clarity rate (AMCR), based on the content analysis of available public policy documents (updated as of 2019) from 31 provinces in mainland China, and the number of health care personnel of maternity and child care centres per 10 000 population (HP per 10 000 population), based on the 2002-2019 China Health Statistical Yearbook and China Statistical Yearbook. Results: The average values of PECR, SMCNR, and MPR increased rapidly to 90.96%, 82.46%, and 81.31%, respectively, in 2019, representing a higher value compared to the AMCR (7.38%). The NHR promoted the EE, in which HP per 10 000 population showed the fastest increase (ß1 = 0.03, P < 0.01; ß3 = 0.10, P < 0.01), followed by SMCNR (ß1 = 0.94, P < 0.01; ß3 = 1.83, P < 0.01), AMCR (ß1 = 0.13, P < 0.01; ß3 = 0.24, P = 0.14), MPR (ß1 = 1.35, P < 0.01; ß3 = 2.47, P < 0.01) and PECR (ß1 = 1.43, P < 0.01; ß3 = 1.47, P < 0.01). Conclusions: The NHR has a positive impact on the EE, especially on the human resources and service provision for children. Efforts should be intensified to improve the clarity of the accountability mechanism of the health-related sectors.

Influence of Public Health Services on the Goal of Ending Tuberculosis: Evidence From Panel Data in China.

Background: The World Health Organization has proposed an initiative to "end tuberculosis (TB)." Unfortunately, TB continues to endanger the health of people worldwide. We investigated the impact of public health services (PHS) in China on TB incidence. In this way, we provided policy ideas for preventing the TB epidemic. Methods: We used the "New Public Management Theory" to develop two indicators to quantify policy documents: multisector participation (MP) and the Assessable Public Health Service Coverage Rate (ASCR). The panel data from 31 provinces in Chinese mainland were collected from 2005 to 2019 based on 1,129 policy documents and the China Statistical Yearbook. A fixed-effect model was used to determine the impact of MP and the ASCR on TB incidence. Results: From 2005 to 2019, the average MP increased from 89.25 to 97.70%, and the average ASCR increased from 53.97 to 78.40% in Chinese mainland. However, the development of ASCR between regions was not balanced, and the average level in the western region was lower than that in the eastern coastal provinces. With an increase in MP and the ASCR, the TB incidence had been decreasing gradually in recent years. The panel analysis results showed that MP (ß = -0.76, p < 0.05). and ASCR (ß = -0.40, p < 0.01) had a negative effect on TB incidence, respectively. Even if the control variables were added, the negative effects of MP (ß = -0.86, p < 0.05) and ASCR (ß = -0.35, p < 0.01) were still statistically significant. Conclusions: Promoting the participation of multiple departments, as well as emphasizing the quality of PHS delivery, are important ways to alleviate the TB epidemic. The settings of evaluation indices for PHS provision should be strengthened in the future.

The Impacts of Regional Regulatory Policies on the Prevention and Control of Chronic Diseases in China: A Mediation Analysis.

Regional regulatory policies (RPs) are a major factor in the prevention and control of chronic diseases (PCCDs) through the implementation of various measures. This study aimed to explore the impacts of RPs on PCCDs, with a focus on the mediating roles of community service. The soundness of the regulatory mechanism (SORM) was used to measure the soundness of RPs based on 1095 policy documents (updated as of 2015). Coverage provided by community service institutions (CSIs) and community health centres (CHCs) was used to represent community service coverage derived from the China Statistical Yearbook (2015), while the number of chronic diseases (NCDs) was used to measure the effects of PCCDs based on data taken from the 2015 China Health and Retirement Longitudinal Study survey. To assess the relationship between SORM, NCDs and community service, a negative binomial regression model and mediation analysis with bootstrapping were conducted. Results revealed that there was a negative correlation between SORM and NCDs. CSIs had a major effect on the relationship between RPs and PCCDs, while CHCs had a partial mediating effect. RPs can effectively prevent and control chronic diseases. Increased effort should also be aimed at strengthening the roles of CSIs and CHCs.

Are Essential Women's Healthcare Services Fully Covered? A Comparative Analysis of Policy Documents in Shanghai and New York City from 1978-2017.

This study aimed to analyze the changes in the 10 major categories of women's healthcare services (WHSs) in Shanghai (SH) and New York City (NYC) from 1978 to 2017, and examine the relationship between these changes and maternal mortality ratio (MMR). Content analysis of available public policy documents concerning women's health was conducted. Two indicators were designed to represent the delivery of WHSs: The essential women's healthcare service coverage rate (ESCR) and the assessable essential healthcare service coverage rate (AESCR). Spearman correlation was used to analyze the relationship between the two indicators and MMR. In SH, the ESCR increased from 10% to 90%, AESCR increased from 0% to 90%, and MMR decreased from 24.0/100,000 to 1.01/100,000. In NYC, the ESCR increased from 0% to 80%, the AESCR increased from 0% to 60%, and the MMR decreased from 24.7/100,000 to 21.4/100,000. The MMR significantly decreased as both indicators increased (p < 0.01). Major advances have been made in women's healthcare in both cities, with SH having a better improvement effect. A common shortcoming for both was the lack of menopausal health service provision. The promotion of women's health still needs to receive continuous attention from governments of SH and NYC. The experiences of the two cities showed that placing WHSs among policy priorities is effective in improving service status.

The public health emergency management system in China: trends from 2002 to 2012.

BACKGROUND: Public health emergencies have challenged the public health emergency management systems (PHEMSs) of many countries critically and frequently since this century. As the world's most populated country and the second biggest economy in the world, China used to have a fragile PHEMS; however, the government took forceful actions to build PHEMS after the 2003 SARS outbreak. After more than one decade's efforts, we tried to assess the improvements and problems of China's PHEMS between 2002 and 2012. METHODS: We conducted two rounds of national surveys and collected the data of the year 2002 and 2012, including all 32 provincial, 139 municipal, and 489 county CDCs. The municipal and county CDCs were selected by systematic random sampling. Twenty-one indicators of four stages (preparation, readiness, response and recovery) from the National Assessment Criteria for CDC Performance were chosen to assess the ten-year trends. RESULTS: At the preparation stage, organization, mechanisms, workforce, and stockpile across all levels and regions were significantly improved after one decade's efforts. At the readiness stage, the capability for formulating an emergency plan was also significantly improved during the same period. At the response stage, internet-based direct reporting was 98.8%, and coping scores were nearly full points of ten in 2012. At the recovery stage, the capabilities were generally lower than expected. CONCLUSIONS: Due to forceful leadership, sounder regulations, and intensive resources, China's PHEMS has been improved at the preparation, readiness, and response stages; however, the recovery stage was still weak and could not meet the requirements of crisis management and preventive governance. In addition, CDCs in the Western region and counties lagged behind in performance on most indicators. Future priorities should include developing the recovery stage, establishing a closed feedback loop, and strengthening the capabilities of CDCs in Western region and counties.

The Centers for Disease Control and Prevention System in China: Trends From 2002-2012.

OBJECTIVES: To assess the improvements of the Chinese Centers for Disease Control and Prevention (CDCs) system between 2002 and 2012, and problems the system has encountered. METHODS: We obtained data from 2 national cross-sectional surveys in 2006 and 2013, including 32 provincial, 139 municipal, and 489 county-level CDCs throughout China. We performed a pre-post comparative analysis to determine trends in resource allocation and service delivery. RESULTS: The overall completeness of public health services significantly increased from 47.4% to 76.6%. Furthermore, the proportion of CDC staff with bachelor's or higher degrees increased from 14.6% to 32.6%, and governmental funding per CDC increased 5.3-fold (1.283-8.098 million yuan). The working area per CDC staff increased from 37.9 square meters to 63.3 square meters, and configuration rate of type A devices increased from 28.1% to 65.0%. Remaining problems included an 11.9% reduction in staff and the fact that financial investments covered only 71.1% of actual expenditures. CONCLUSIONS: China's CDC system has progressed remarkably, enabling quicker responses to emergent epidemics. Future challenges include establishing a sustainable financing mechanism and retaining a well-educated, adequately sized public health workforce.

[Study on manpower allocation criteria of center of disease prevention and control in the context of province level, city level and county level].

OBJECTIVE: To set the manpower allocation criteria of center of disease prevention and control. METHODS: Expected allocation manpower criteria was obtained through adjusting the current manpower allocation of disease prevention and control centers. The principle was to fulfill public function and promote professional efficiency. RESULTS: Based on function requirement, in 3 - 5 years, the manpower allocation criteria of center of disease prevention and control at provincial-level is 336 persons, at city-level is 102 persons, and at county-level is 33 persons, that means in whole country 140016 persons should be needed. In 10 years, the manpower allocation criteria of center of disease prevention and control at provincial-level is 386 persons, at city-level is 112 persons, and at county-level is 38 persons, that means in whole country 159086 persons should be needed. CONCLUSION: The manpower allocation criteria advanced in the study indicated that current manpower quantity should be greatly reduced. It is an inevitable trend that disease prevention and control centers reduce the staff quantity and promote their quality.

[Implementation analysis of public functions of 161 centers of disease prevention and control in 7 provinces].

OBJECTIVE: To evaluate the implementation of public function and items of the centers of disease prevention and control (CDC). METHODS: 161 centers of disease prevention and control have been investigated by two-stage stratified sampling. The implementation analysis of public function and items of CDC is measured by multiplying average operational proportion and average operational degree. RESULTS: (1) For investigated centers, the average rate of function implementation is 42.9%, with 56.0% at provincial level and 43.7% at city level, 41.3% for the county level, while 49.3% in east areas, 45.4% in middle areas and 35.3% in west areas. (2) Among all 7 functional items, the implemented rate of disease prevention and control is 54.3%, 65.8% for emergency treatment, 35.0% for epidemic situation report and information management of health relative factors, 31.3% for inspection and control of health risk factors, 39.1% for the laboratory examination and evaluation, 36.4% for health education and health promotion, and 56.7% for technological guidance and application study. CONCLUSION: The implemented degree of public function of CDC was generally lower, varied with regions and levels. Among 7 public functional items, the emergency treatment function had the highest implementation, with the lowest for the inspection and control of health relative factors.

[Human resources allocation in centers of disease prevention and control in China].

OBJECTIVE: To compare the human resources allocation of CDC in different areas and different levels. METHODS: By stratified cluster sampling we get 70 CDC's manpower data, which come from different areas(east, middle part, west)and different levels (province, city, county). RESULTS: (1) The average number of CDC's staff is 62. (2)CDC of province level are understaffed by 15%, while CDC of county level are overstaffed by 3%, and CDC of county level are overstaffed by 12%. (3) Structure of age: The average age of CDC's staff is 62, people under 35 years old in CDC is 39.4%, people above 55 years old is 3.5% (4) Structure of education: People with graduate degree are only 0.8%, and people come from technicalsecondary school are 57.0%. (5) Structure of specialty: A majority of people's majors are clinical medicine, and the percent of people having a non-medical-major are 36.6%. (6) Area distributing. Distribution of average quality score of staff are imbalance in different areas, the average quality score of staff in east area are 1.07 times than that in middle area, and 1.12 times than that in west area.

[Implementation analysis of public functions of centers of disease prevention and control of China].

OBJECTIVE: To evaluate the implementation of public function and items of the centers of disease prevention and control(CDC). METHODS: 161 centers of disease prevention and control have been investigated by two-stage stratified sampling. The implementation analysis of public function and items of CDC is measured by multiplying average operational proportion and average operational degree. RESULTS: 1. For investigated centers, the average rate of function implementation is 42.9% ,with 56.0% at provincial level and 43.7% at city level, 41.3% for the county level; while 49.3% in east areas, 45.4% in middle areas and 35.3% in west areas. 2. Among all 7 functional items, the implemented rate of disease prevention and control is 54.3%, 65.8% for emergency treatment, 35.0% for epidemic situation report and information management of health relative factors, 31.3% for inspection and control of health risk factors, 39.1% for the laboratory examination and evaluation, 36.4% for health education and health promotion, and 56.7% for technological guidance and application study. CONCLUSION: The implemented degree of public function of CDC was generally lower, varied with regions and levels. Among 7 public functional items, the emergency treatment function had the highest implementation, with the lowest for the inspection and control of health relative factors.

[Operational proportion of the public function and items of 161 centers of disease prevention and control in 7 provinces].

OBJECTIVE: To explicate the operational proportion of public function and items of the centers of disease prevention and control (CDC). METHODS: 161 CDC have been investigated by two-stage stratified sampling to provide the information about the operation of the public function and items of CDC. RESULTS: (1) The average operational proportion investigated CDC is 71.7%, the province level 92.0%, the city level 73.7%, the county level 68.5%. East areas 76.5%, middle areas 71.5%, west areas 68.1%. (2) The operational proportion of disease prevention and control function and emergency treatment function were higher, but that of epidemic situation report and information management of health relative factor, inspection and control of health relative factor, and the laboratory examination and evaluation were lower. CONCLUSION: Public function and items were rather poorly carried out by the centers of prevention and control in China, especially those in middle and west areas, and those in counties.

[Reform steps of reestablishing disease prevention and control system of China].

OBJECTIVE: To develop and demonstrate the reform steps of reestablishing disease prevention and control system of China. METHODS: A model named "strategies of fulfilling public functions of disease prevention and control system of China" has been employed to develop reform steps. 154 centers for disease prevention and control (CDC) have been sampled to consult the opinions about the reform steps developed by research team. RESULTS: To reestablish the disease prevention and control system of China, the following reform steps should be kept to: (1) increase government's attention to disease prevention and control, (2) insure feasible government investment to disease prevention and control, (3) increase the stability and efficiency of government financing, (4) reform management system to enhance the operation efficiency of the CDC, (5) revise labor regulation to attract and stabilize specialists, (6) be carefully to dispose the non-public-service now delivered by the CDC. The consent percent of all sampling CDC was 98.7%.

[A study on the cause of public health service delivery insufficiency of disease prevention and control system of China].

OBJECTIVE: To demonstrate the cause of public health service delivery insufficiency of disease prevention and control system of China. METHODS: 205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various causes of public health service delivery insufficiency of disease prevention and control system of China. RESULTS: Literatures review demonstrated that the financing from government to disease prevention and control system of China was insufficiency and show lower efficiency, which has been agreed by 99.3% of CDC. Literatures review demonstrated that the financing administration idea of permitting charging service caused the fee-for-service played a key role in the economic reimbursement of various levels of CDC, which has been agreed by 96.0% of CDC. CONCLUSION: The causes of public health service delivery insufficiency of disease prevention and control system of China were the government financing insufficiency and the defective administration strategies.

[Fundamental strategies to address the problem of public health service delivery insufficiency of disease prevention and control system of China].

OBJECTIVE: To develop and demonstrate the strategies to solve the problem of public health service delivery insufficiency of disease prevention and control system of China. METHODS: 205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various reform strategies. Based on the causes and mechanism of public health service delivery insufficiency of disease prevention and control system, the logic analysis has been employed to develop fundamental strategies, which has been demonstrated by 154 CDC using intention questionnaires. RESULTS: There are fundamental strategies to which the agreeing rate for sampling CDC was over 95%: to make sure government should afford the financing function of disease prevention and control and secure the feasible investment for centers of disease prevention and control. Meanwhile, the working efficiency of CDC should be improved through strengthening management and reforming government investing manner.