Even though China launched a series of measures to alleviate several financial burdens (including health insurance scheme, increased government investment, and so on), the economic burden of health expenditure has still not been alleviated. Out-of-pocket payments (OPPs) show not only a time correlation but also some degree of spatial correlation. The aims of the current study were thus to identify the spatial cluster of OPPs, to investigate the main factors affecting variation, and to explore the spatial spillover sources of China’s OPP. Global and local spatial autocorrelation tests were validated to identify the spatial cluster of OPPs using the panel data of 31 provinces in China from 2005 to 2016. The Spatial Durbin Model, established in this paper, measured the spatial spillover effect of OPPs and analyzed the possible spillover sources (demand, supply, and socio-economic factors. OPPs were found to have a significant and positive spatial correlation. The results of the Spatial Durbin Model showed the direct and indirect effects of demand, supply, and socio- economic factors on China’s OPPs. Among the demand factors, the direct and indirect correlation (elasticity) coefficients were positive. Among the supply factors, the direct and indirect effects of the share of primary health beds on residents’ OPPs were negative. The ratio of health technicians in hospitals to those in primary health institutions on per capital OPPs had a significant indirect effect. Among the socio-economic factors, the direct effects of GDP, government health expenditure, and urbanization on OPPs were found to be positive. There were no significant indirect effects of socio-economic factors on OPPs. This paper finds that China’s OPPs are not randomly distributed but, overall, present a positive spatial cluster, even though a series of measures have been launched to promote health equity. Socio-economic factors and those associated with demand were found to be the main influences of variation in OPPs, while demand was seen to be the driver of the positive spatial spillover of OPPs, whereby effective supply could inhibit these positive spillover effects.

In designing a clinical trial for comparing two or more treatments with respect to overall survival (OS), a proportional hazards assumption is commonly made. However, in many cancer clinical trials, patients pass through various disease states prior to death and because of this may receive treatments other than originally assigned. For example, patients may crossover from the control treatment to the experimental treatment at progression. Even without crossover, the survival pattern after progression may be very different than the pattern prior to progression. The proportional hazards assumption will not hold in these situations and the design power calculated on this assumption will not be correct. In this article, we describe a simple and intuitive multi-state model allowing for progression, death before progression, post-progression survival, and crossover after progression and apply this model to the design of clinical trials for comparing the OS of two treatments. For given values of the parameters of the multi-state model, we simulate the required number of deaths to achieve a specified power and the distribution of time required to achieve the requisite number of deaths. The results may be quite different from those derived using the usual PH assumption. Supplementary materials for this article are available online.

Objective: This study investigates peer effects on the health behaviors of middle-aged and older adult people in China and examines the moderating role of Internet use.Methods: A total of 16,188 respondents were selected from the China Health and Retirement Longitudinal Study (CHARLS) 2020 data set. Ordinary Least Squares and Quantile Regression were used to validate the peer effect of health behaviors on middle-aged and older adults, and a moderating effects model was used to test the moderating roles of Internet use and Internet proficiency. Finally, the peer effect was analyzed for heterogeneity according to Internet use preferences.Results: The peer effect had a positive influence on the individual health behaviors of middle-aged and older adult people in China (β = 0.5341, p < 0.001). Middle-aged and older adult people were more sensitive to the average health behavior level of the community when they lived in rural communities and/or had a low level of education. Internet use positively moderated the health behavior peer effect in the older adult population (β = 0.0094, p < 0.1), and Internet proficiency negatively moderated the peer effect of the health behaviors of the middle-aged population (β = 0.1589, p < 0.1). According to the magnitude of the influence of peer effect, the Internet preference type can be ranked from social and entertainment (β = 0.6250, p < 0.01), to cultural and entertainment (β = 0.5835, p < 0.01), to comprehensive (β = 0.4622, p < 0.01).Conclusion: There is a peer effect on the health behaviors of middle-aged and old-aged individuals, in which Internet use plays a moderating role. The construction of healthy communities should be promoted, giving full play to the community’s active role in health promotion. Attention should be paid to the health-enabling function of the Internet, encouraging middle-aged and older adult people to use the Internet actively, moderately, and diversely, and making full use of the advantages of short videos for online health education.

Objective: In driving a transition in environmental governance, China’s low-carbon city pilot (LCCP) policy has exerted a dichotomous impact on public health expenditure that is characterized by both a decline in relative proportion and expansion of absolute scale. Research to date is insufficient for understanding the transmission mechanisms and policy coordination pathways underlying this contradiction, which has hindered the sustainable realization of environmental health benefits. This study thus investigates the impact of China’s LCCP policy on public health expenditure and the underlying mechanisms involved.Methods: Based on panel data of 285 Chinese cities at the prefecture level and above from 2003 to 2019, a quasi-natural experiment was conducted using China’s LCCP policy. The time-varying difference-in-differences simulation method and hierarchical regression method were used to analyze the effect and mechanism of the LCCP policy on China’s public health expenditure.Results: The results demonstrate the inherently paradoxical nature of the effects of the LCCP policy on public health expenditure: although the LCCP policy produces a significant relative reduction in public health expenditure (β = −0.331, p < 0.001), it simultaneously produces a pronounced expansion in terms of absolute expenditure (β = 0.409, p < 0.001). These impacts are spatially heterogeneous across regions and exhibit supply–demand divergence in healthcare infrastructure readiness and environmental threshold effects that are contingent upon pollution severity gradients. Further analysis of the underlying mechanism reveals that public low-carbon behaviors serve as dual negative mediators in both expenditure dimensions, whereas household medical burdens exert a significant positive mediating effect on absolute expenditure but a statistically insignificant mediating effect on relative expenditure.Conclusion: This study reveals the complex synergistic mechanisms linking environmental governance to health investment allocation. The internal contradictory effects of the LCCP policy on public health expenditures must be resolved by striking a balance between environmental governance and health investment, implementing regional differentiation strategies, optimizing the structure of preventive expenditures, and guiding the public to collaborative participation. China’s environmental quality and public health should be promoted simultaneously.

Objective To provide references for the management and development of biosimilars. Methods Relevant policy and regulation contents from domestic drug regulatory authorities were retrieved, and the development policies for biosimilars were sorted out. Results The development process of biosimilars can be divided into two themes. China emphasizes Theme 1 ("Research-Based Clinical Benefits and Enrichment"), focusing on research foundations and clinical applications, ultimately enhancing patients' quality of life. Additionally, Theme 2 ("Clinical Research Effectiveness Evaluation") is carried out, which involves the assessment of drugs and therapeutic effects to ensure drugs meet standards and provide precise treatment services. Conclusion In the future, China's biosimilars industry can leverage emerging technologies such as artificial intelligence and big data analytics to enhance regulatory efficiency in research and development, improve regulatory policies, strengthen international cooperation, and promote universal access, thereby fostering healthy development.

This paper explores the mediating role of social support and self-efficacy in the relationship between employment stress and psychological health. A total of 1062 graduates from general colleges and universities in Jilin Province were surveyed using the Employment Stress Scale, the Self-Efficacy Scale, the Social Support Scale and the Mental Health Scale. The results showed that employment stress was significantly and negatively related to mental health, social support and self-efficacy, and social support, self-efficacy and mental health were significantly and positively related to employment stress. Social support and self-efficacy play multiple mediating roles between employment stress and mental health.