Background: Third-grade hospitals in Beijing have been rapidly developing in capacity and scale for many years. These hospitals receive a large number of patients, and ensuring their efficient operation is crucial in meeting people’s healthcare needs. In this context, a study of their relative efficiency and productivity would be helpful to identify the driving factors and further improve their performance.Methods: After a review of literature, the current numbers of open beds and employees were selected as input variables. The number of outpatient and emergency visits and the number of discharged patients were selected as output variables. A total of 12 third-grade Class A general public hospitals in Beijing were selected for a preliminary study. The panel data from 2006–2009 were collected by the National Institute of Hospital Administration, Ministry of Health of P.R. China. Descriptive analysis and data envelopment analysis were used to analyze the data using Stata 10.0 and DEAP(V2.1) software.Results: In the 2006–2009 period, descriptive results show that sample hospitals continuously expanded their capacity and scale, with growth rate of total revenue being the highest among all variables. The DEA results show that the average annual growth rate of productivity was 26.7%, and the rates were 47.3%, 21.3% and 13.8% respectively for two consecutive years. The average annual growth rate of technological change was 28.3%, and the rates were 49.4%, 21.5% and 16.4% respectively for two consecutive years. The average annual growth rate of technical efficiency change was -1.3%, and the rates were -1.4%, -0.02% and -2.2% respectively for two consecutive years.Conclusions: The sample hospitals in Beijing experienced substantial productivity growth, but annual growth rates were declining. Substantial technological change was the main contributor to the growth. Although some hospitals exhibited improvements in technical efficiency, there was a slight decline in general. To improve overall efficiency and productivity, both government and hospitals need to further drive positive technological change, technical change, and allocative efficiency of public hospitals. More empirical studies are needed to include more hospitals of all three grades at a larger scale.

China has long been stuck in applying traditional data envelopment analysis (DEA) models to measure technical efficiency of public hospitals without bias correction of efficiency scores. In this article, we have introduced the Bootstrap-DEA approach from the international literature to analyze the technical efficiency of public hospitals in Tianjin (China) and tried to improve the application of this method for benchmarking and inter-organizational learning. It is found that the bias corrected efficiency scores of Bootstrap-DEA differ significantly from those of the traditional Banker, Charnes, and Cooper (BCC) model, which means that Chinese researchers need to update their DEA models for more scientific calculation of hospital efficiency scores. Our research has helped shorten the gap between China and the international world in relative efficiency measurement and improvement of hospitals. It is suggested that Bootstrap-DEA be widely applied into afterward research to measure relative efficiency and productivity of Chinese hospitals so as to better serve for efficiency improvement and related decision making.

Diagnosis-related group (DRG) payment methods are increasingly being used to decrease the costs of healthcare worldwide. However, the effectiveness of cost controls varies from region to region. This study aimed to analyze the impacts of DRG payments on medical costs in China and provide theoretical support for the promotion of DRG payments in other countries. Patients from City Wuxi in China was selected, which underwent a reform from fee-for-service (FFS) payment to DRG payment during the study period. Ordinary least regression analysis (OLS) and propensity-score-matching (PSM) were used to analyze the effects of DRG, Causal Forest (CF) of machine learning algorithm was used to analyze the underlying reasons for the results. The OLS model revealed that personal total medical costs decreased by 28.3% after the DRG reform and the total personal out-of-pocket payment (OPP) decreased by 21.3% after the DRG reform, but the personal out-of-pocket ratio increased by 15% after the DRG reform. The PSM-OLS model regression and the DRG reform results indicated decreases of 29.4% and 24.2% in personal total cost and OPP costs, respectively. The proportion of OPP costs increased by 9%. The causal forest model suggested that age and the number of surgeries played a significant role in the impact of DRG reform on patients' medical burden (total medical expenses, OPP costs, and OPP Ratio). Results indicate that the impacts of the DRG reform was associated with a 27% reduction in patients' medical burden (SE = 0.007), a 19.4% reduction in out-of-pocket expenses (SE = 0.012), and a 1.4% increase in utilization costs (SE = 0.002). DRG payment can control the growth of medical expenses and ease the burden on the medical insurance fund. However, the current rules may increase the OPP ratio and the economic burden on patients. A regulatory model in line with China's national conditions still must be explored.

Objective: To evaluate the efficacy, immunogenicity and safety of HPV vaccination in Chinese population.Methods: PubMed, Embase, Web of Science and Cochrane Library from inception to November 2022 were searched to collect information on clinical trials of HPV vaccines. Database search strategy used a combination of subject terms and free terms. Studies were first identified by two authors through reading the title, abstract and full texts and, subsequently, based on the inclusion criteria: Chinese population, with at least one of the following outcomes (efficacy, immunogenicity, and safety), and HPV vaccine RCT, those eligible were included in this paper. Efficacy, immunogenicity and safety data, pooled by random effects models, are presented as risk ratios [95% confidence intervals (CI)].Results: Eleven RCTs and four follow-up studies were included. Meta-analysis showed that HPV vaccine had good profile of efficacy and immunogenicity. The seroconversion rates were significantly higher among the vaccinated, uninfected (initial negative serum antibody) population than the placebo population for both HPV-16 (RR 29.10; 95% CI: 8.40–100.82) and HPV-18 (RR 24.15; 95% CI: 3.82–152.84), respectively. A significant reduction of the incidence of cervical intraepithelial neoplasia grade 1 (CIN1+) (RR 0.05; 95% CI: 0.01–0.23) and CIN2+ (RR 0.09; 95% CI: 0.02–0.40) was also measured. Risk for serious adverse events after HPV vaccination indicated comparable outcomes between vaccination and placebo.Conclusions: For Chinese populations, HPV vaccines enhance the level of HPV16- and HPV18-specific antibodies and reduce the incidence of CIN1+ and CIN2+ in uninfected population. Also, the risk of serious adverse events in both groups are almost equivalent. More data are needed to establish vaccine efficacy with cervical cancer.

Objective: With the demand for rehabilitation has been increasing faster for the aging of China's population, the equity of rehabilitation resource has aroused great concern. This study aimed to analyze the spatial distribution and evolution of the human resources of rehabilitation institutions and propose targeted countermeasures and suggestions to promote optimal allocation.Methods: A total of 31 provinces in China Mainland were identified and geocoded. The spatial weight matrix was introduced to analyze the spatial correlation. Spatial autocorrelation analysis and tests were used to analyze the spatial distribution and evolution characteristics of rehabilitation institutions' human resources in China from 2016 to 2019.Results: The average density of rehabilitation staff from 2016 to 2019 has been rising yearly (From 1.60 to 1.88). From 2018 to 2019, the proportion of rehabilitation professionals was higher than 75% in only 5 provinces, and no provinces met 75% from 2016 to 2017. Global Moran's I index from 2016 to 2019 showed no apparent aggregation phenomenon in the allocation of management personnel resources (P > 0.05). Three provinces in western China belonged to the Low-Low area and a province in northeastern China fitted to the Low–High area, with statistically significant differences. In addition, the changes in the spatial distribution and evolution trend of the human resources of rehabilitation institutions in different periods were affected by health policies.Conclusions: Although the overall spatial distribution gap of human resource allocation of rehabilitation institutions is shrinking, there are still internal structural defects and a maldistribution at the provincial level. It is necessary to improve the overall number of staff in rehabilitation institutions and to ameliorate the proportion of different types of staffing.