ObjectivesThis study explores the mechanisms by which E-health literacy among inpatients in county-level public hospitals influences patient loyalty. It further examines the mediating role of value co-creation and the moderating effect of perceived social support, seeking to provide empirical evidence for the digital transformation of county hospitals and patient relationship management.MethodsA stratified random sampling method was employed to survey 784 inpatients in county-level public hospitals in Shandong Province. E-health literacy, value co-creation, perceived social support, and patient loyalty were assessed using a structured questionnaire. Correlation analysis, regression analysis, and moderated mediation models were applied to examine both the direct and indirect effects of E-health literacy on patient loyalty.ResultsE-health literacy was positively associated with patient loyalty, and value co-creation mediated this relationship. Furthermore, perceived social support was found to moderate the relationship between E-health literacy and patient loyalty, suggesting that elevated perceived social support weakened the positive association between E-health literacy and patient loyalty.ConclusionE-health literacy appears to be an important factor associated with inpatient loyalty in county-level public hospitals. Value co-creation and perceived social support play important mediating and moderating roles, respectively, within this process. By enhancing patients’ E-health literacy, promoting value co-creation behaviors, and leveraging social support resources, it is possible to foster sustained improvements in patient loyalty and advance the quality of smart healthcare services in county-level public hospitals.

BackgroundThe acceleration of population aging, especially in China, has led to a rapid growth in the number of older adults living with disabilities, posing significant challenges to public health and quality of life (QoL). From the perspective of the biopsychosocial framework, the adverse impact of disability (a biological and functional factor) on QoL has been well documented. However, the underlying mechanisms linking disability to QoL within this framework, especially the mediating roles of psychological factors (e.g., depression) and physiological correlates (e.g., sleep quality), remain insufficiently understood. Furthermore, living arrangements, as a key social factor in the biopsychosocial model, may moderate these mediating pathways. Therefore, this study aimed to examine the mediating roles of sleep quality and depression in the association between disability and QoL and to explore whether living arrangements moderate these pathways within the biopsychosocial framework.MethodsA total of 3,855 adults aged ≥60 years were recruited through the Household Health Interview Survey in Taian City, China, using a multi-stage stratified cluster sampling method. Data were collected on disability [measured using the Physical Self-Maintenance Scale (PSMS)], sleep quality [assessed using the Pittsburgh Sleep Quality Index (PSQI)], depression [assessed using the Patient Health Questionnaire-9 (PHQ-9)], living arrangements, QoL (assessed using the EQ-5D-5L), and relevant covariates. Statistical analyses included descriptive analysis, logistic regression, and moderated mediation analysis using the PROCESS macro.ResultsDisability was significantly associated with poorer QoL (OR = 1.816–1.928, P < 0.001), total effect B = 0.767). Sleep quality and depression partially mediated this association via both parallel and serial pathways, with the serial mediation effect through sleep quality and depression being significant (B = 0.046, P < 0.001). The total indirect effect accounted for 17.00% of the total effect. Furthermore, living arrangements significantly moderated the associations of disability with sleep quality and depression, with stronger adverse effects observed among older adults living alone.ConclusionDisability was associated with poorer QoL among older adults, and this relationship was partially explained by sleep quality and depression, with living arrangements further moderating the pathways linking disability to sleep quality and depression. These findings highlight the importance of integrated interventions that address physical, psychological, and social factors to improve QoL among older adults with disabilities. Targeted strategies, including sleep management, depression screening, and enhanced social support, particularly for those living alone, may help improve QoL and promote healthy aging.

Cognitive impairment among older adults is a significant public health concern worldwide. Although previous studies have demonstrated that cognitive impairment impacts the quality of life in these patients, the mechanism between these two variables is still unclear. This study endeavors to investigate the parallel mediating roles of depressive symptoms and frailty on cognitive impairment and quality of life in rural older adults with chronic diseases. This study used data from a cross-sectional study conducted in rural areas of China from October 2024 to January 2025. A total of 2,697 rural older adults With chronic diseases were included. All data were analyzed using SPSS 26.0 software. Spearman correlation analysis Was used to investigate the relationships between variables. Model 4 from the SPSS macro was used to assess the parallel mediating roles of depressive symptoms and frailty in the relationship between cognitive impairment and quality of life among rural older adults with chronic diseases. Cognitive impairment, depressive symptoms, and frailty were significantly associated with quality of life in rural older adults with chronic diseases (p < 0.01). Cognitive impairment was a negative predictor of quality of life (β = -0.2300, p < 0.001). Cognitive impairment was a positive predictor of depressive symptoms (β = 0.2881, p < 0.001) and frailty (β = 0.2275, p < 0.001). Cognitive impairment (β = -0.0964, p < 0.001), depressive symptoms (β = -0.2144, p < 0.001), and frailty (β = -0.3157, p < 0.001) were negative predictors of quality of Life. Cognitive impairment influenced quality of Life through parallel mediating effects of depressive symptoms and frailty, With mediating effects accounting for 26.85

Herpes zoster (HZ), affecting 14.9 million people aged ≥ 50 globally in 2020, imposes a growing burden in aging populations due to its association with chronic pain, psychological distress, and socioeconomic disparities. This study aimed to evaluate health-related quality of life (HRQoL) among people with HZ and explore its socioeconomic and clinical determinants in China. We conducted a cross-sectional survey to investigate the HRQoL of 2,566 herpes zoster patients across seven Chinese cities using the EQ-5D-5 L and VAS-100 instruments. Multivariate linear regression models quantified the association of age, income, insurance type, herpes zoster related pain, complications, and comorbidities with HRQoL. The average EQ-5D score was 0.83, and the average VAS score was 71.49 among herpes zoster patients in China. Patients aged ≥ 70 years exhibited the most severe decline in both EQ-5D (β = −0.110, p < 0.01) and VAS-100 scores (β = −8.811, p < 0.01), with mobility limitations (OR = 3.696, p < 0.01) and self-care deficits (OR = 2.295, p < 0.01) disproportionately affecting this group. Herpes zoster related pain was associated with lower HRQoL (EQ-5D:β = -0.126, p < 0.01). Patients with comorbidities faced significant HRQoL reductions (VAS: β = -4.014, p < 0.01). Our study found that Chinese herpes zoster patients exhibited higher HRQoL scores compared to those reported in most of other studies. Advanced age, lower education levels, inadequate insurance coverage, and pain occurrence were all significantly associated with diminished HRQoL. The observed disparities in HRQoL reductions among patient subgroups highlight the need to address health equity through curative interventions and preventive strategies.

Chronic diseases and depression pose significant health challenges among older adults, but their dynamic relationship is not fully understood. This study explores how chronic diseases affect depressive trajectories in older adults using a comprehensive health ecology model. We conducted a longitudinal analysis using data from 21,541 adults aged 60 + from the China Family Panel Studies (CFPS). The baseline sample (2012) included 3709 older adults, with an average age of 65.88 years, and 1912 (51.45

This study aimed to determine the relationship among socioeconomic status, social support and frailty, and its gender difference. Education and income were combined to indicate the socioeconomic status. The Social Support Rating Scale (SSRS) was used to measure the level of social support. Frailty was measured by the FRAIL Scale. Mediation effects were analyzed using the PROCESS 4.1 macro in SPSS version 26.0. Among the 936 participants, socioeconomic status had a direct effect on frailty (effect = − 0.088, 95

背景 儿童作为特殊群体受到公众的关注，虽然近年来发布了一系列政策保障儿童用药安全，但仍存在药物适宜品种少、不合理用药等问题，亟需科学合理的儿童用药政策推动其发展。目的 对我国儿童用药政策文本进行量化评价，为未来的儿童用药政策的制订和完善提供参考，从而推动儿童用药事业的高质量发展。方法 基于文本挖掘法对2014—2023年国家层面出台的23份儿童用药政策文件进行处理，构建儿童用药政策的政策建模一致性（PMC）指数模型，通过10个一级变量和41个二级变量对我国23项儿童用药政策进行量化评价分析。结果 23项儿童用药政策的PMC指数均值为5.65,PMC凹陷指数均值为4.35，包括1项优秀级政策、17项良好级政策和5项合格级政策，无完美级政策和不良政策；23项儿童用药政策在政策工具和政策受体上得分较高，在发布机构和政策时效上得分较低。结论 我国儿童用药政策总体上处于良好水平，可从政策时效、发布机构和政策内容方面进一步完善。

Background: Understanding patients' medication experience is crucial for improving adherence, health outcomes, and medical safety. Currently, there is a lack of measurement tools for the medication experience of patients with chronic diseases in primary care facilities in China, which seriously restricts the research and practice of pharmaceutical service and management in primary care facilities. Objective: This study aims to develop the Medication Experience Scale For Patients with Chronic Disease in Primary Care Facilities tailored to China's chronic disease management practices. The scale is intended to support research and practice in medication management for chronic disease patients. Methods: A preliminary item pool for the scale was constructed through literature review, semi-structured interviews, and focus group discussions. The Delphi Method was employed to consult experts and refine the scale. A pilot survey was conducted with 313 chronic disease patients from primary care facilities, selected via random sampling. The reliability and validity of the scale were tested, and iterative adjustments were made to optimize its content. Results: The finalized scale consists of 3 primary dimensions, 7 secondary dimensions, and 28 measurement items. Item analysis yielded P-values < 0.05. The Cronbach's α coefficients for the overall scale and all dimensions exceeded 0.8, with split-half reliabilities above 0.7 and intra-class correlation coefficients above 0.8, indicating high reliability. Post-rotation factor loadings for all items exceeded 0.5. The confirmatory factor analysis demonstrated excellent model fit: CMIN/DF = 1.485, GFI = 0.902, RMSEA = 0.039, RMR = 0.03, CFI = 0.981, NFI = 0.945, IFI = 0.981. Composite reliability values were above 0.7, and average variance extracted values exceeded 0.5, demonstrating strong validity. Conclusion: The Medication Experience Scale For Patients with Chronic Disease in Primary Care Facilities developed in this study exhibits better reliability and validity. Its adaptability to local contexts make it a suitable tool for investigating the medication experiences of chronic disease patients in primary care facilities.

Background With the accelerated population aging,the number of elderly patients with chronic diseases is growingly elevated.Adherence to medication regimens is pivotal for the health outcomes of chronic diseases.Existing research mainly analyzed influencing factors for medication adherence and the outcome of medication adherence by interventions.A single analysis of medication adherence from the aspect of medication experience is one-sided.Objective To understand the current situations of medication experience and medication adherence in elderly patients with chronic diseases,and to explore the influence of medication experience at multiple dimensions on medication adherence,thus proposing countermeasures to improve medication adherence in elderly patients with chronic diseases.Methods From September 2023 to December 2023,a total of 2 432 residents of three cities in Shandong Province were selected by stratified random sampling according to the economic level and social development.Elderly patients(>60 years of age)with chronic diseases and long-term medications were screened according to the inclusion and exclusion criteria.A self-designed Medication Experience Scale,consisting of 7 dimensions and 28 items was used to investigate the medication experience.A Chinese version of 4-item Medication Adherence Scale was used to investigate the medication adherence.Current status of patients'medication experience and medication adherence were described.Multiple linear regression was performed to analyze the dimensions of medication experience that greatly influenced medication adherence.Results A total of 2 432 questionnaires were distributed in this survey,and 2 415 were retrieved.After excluding samples with missing data on the main variables,a total of 1 544 samples were included in this study.The mean score of medication experience of elderly patients with chronic diseases was(4.31±0.39)point,with the highest score in the dimension of life influenced by medication(4.72±0.58)points,and lowest in the dimension of convenience(3.86±0.49)points.The mean score of medication adherence in elderly patients with chronic diseases was(3.48±0.62)points.A total of 698(45.2%)patients were identified as a poor adherence.The most common cause for non-adherence was'forgetting to take medication'(77.1%,538/698).Medication adherence scores were significantly lower in female elderly,or elderly patients with two or more chronic diseases than those of counterparts(P<0.05).The results of multivariate linear regression showed that medication adherence was worse in female elderly patients(β=-0.056)and elderly patients with two or more chronic diseases(β=-0.053)(P<0.05).Among the dimensions of the Medication Experience Scale,the dimensions of effectiveness(β=0.083),and affordability(β=0.135)positively predicted patients'medication adherence(P<0.05).Conclusion The proportion of elderly patients with poor medication adherence to chronic diseases in Shandong Province is 45.2%,among whom,female patients and elderly patients with two or more chronic diseases have a worse medication adherence.The effectiveness and affordability dimensions of the medication experience are positive predictors of medication adherence.Relevant departments should focus on continuously reducing the price of chronic disease medicines,and doctors should strengthen the pharmacy guidance service provided to female patients and elderly patients with two or more chronic diseases.

Background:Traditional Chinese medicine plays a unique role and has proven efficacy in preventing and treating common and chronic diseases. Moxibustion, as a type of traditional Chinese medicine healthcare therapy, has a broad mass, social, and cultural foundation in China. This study analyzes the pathways and influencing factors of residents' acceptance of moxibustion. Methods:Data were collected from 808 residents in 18 cities or districts using whole cluster stratified random sampling. Take the expanded Unified Theory of Acceptance and Use of Technology model scale as the research tool. Data were analyzed by SPSS 25.0 and AMOS 24.0, including descriptive statistics, one-way analysis of variance, structural equation model analysis, and multi-group model analysis. Results:Structural equation modeling showed that performance expectancy (β = 0.603, p < 0.001), effort expectancy (β = 0.260, p < 0.001), social influence (β = 0.373, p < 0.001), and perceived risk (β = -0.162, p < 0.001) significantly predicted behavioral intention. Facilitating conditions (β = 0.186, p < 0.01) and behavioral intention (β = 0.708, p < 0.001) directly affect usage behavior. The multiple-group analysis found that experiential and chronic disease status played a moderating role in the structural pathways. Conclusions:The study confirmed that the constructed resident moxibustion technology model can serve as a suitable framework for predicting the factors that influence residents' intention to use moxibustion and their behaviors. Increasing residents' performance expectations and effort expectations, creating a positive social environment, and reducing perceived risk are key factors in enhancing residents' behavior and willingness to use moxibustion.

BackgroundDepression is a widespread mental health issue affecting older adults globally, with substantial implications for their well-being. Although digital interventions have proven effective in high-income countries, research on the potential of internet usage to alleviate depression among older adults in high-income countries remains limited. ObjectiveThis study aimed to examine the impact of internet usage on depression among older adults in high-income countries by developing a comprehensive theoretical framework and testing key hypotheses. MethodsUsing data from the China Health and Retirement Longitudinal Study (CHARLS), a 2-stage instrumental variable approach was applied to address endogeneity and estimate causal relationships between internet usage and depression. ResultsThe findings indicate that internet usage results in a 1.41% reduction in depression levels among older adults. This effect is mediated by four primary mechanisms: (1) enhanced social interaction, (2) increased physical activity, (3) improved intergenerational contact, and (4) expanded access to educational opportunities. A heterogeneity analysis revealed that these effects are more pronounced in urban areas, eastern regions, and regions with superior internet infrastructure. ConclusionsInternet usage plays a crucial role in alleviating depression among older adults in high-income countries, with regional variations. The findings highlight the need for targeted policy interventions to improve internet access and digital literacy, which can mitigate depression and enhance the mental health of older adults.

Background:Arthritis is the most disabling disease worldwide, and the presence of the disease usually greatly threatens the patient's activities of daily living (ADL). Currently, there are a few studies that are related to exploring factors associated with impaired ADL in middle-aged and older adult arthritis patients. This study aimed to explore the factors associated with impaired ADL in Chinese middle-aged and older adult patients through logistic regression and decision tree models. Methods:The method of univariate analysis was the chi-square test. Variables with significant differences in univariate analysis were included in binary logistic regression model and decision tree model based on the E-CHAID algorithm to explore the factors associated with impaired ADL in middle-aged and older adult arthritis patients in China. Results:The results of the logistic regression model indicated that sex, place of residence, age, education level, falls, Internet usage, depressive symptoms, pain, self-rated health, and number of comorbid chronic diseases were the influencing factors for impaired ADL. The decision tree results showed that pain was the most important variable predicting impaired ADL in middle-aged and older adult arthritis patients. The area under the curve of the logistic regression model and the decision tree model were 0.792 (95%CI: 0.780-0.804) and 0.767 (95%CI: 0.754-0.780), respectively. Conclusion:The results of the study suggest that pain, self-rated health, Internet usage, age, and depressive symptoms are significant correlates of impaired ADL. Primary care providers need to provide intervention strategies that are individualized to the middle-aged and older adults with arthritis themselves.

Cognitive impairment is a common health problem among older adults. Previous studies have proven the association between sleep quality and cognitive impairment, but the specific underlying mechanisms need to be further explored. This study aimed to examine the relationship between sleep quality and cognitive impairment and the mediating effect of frailty in this relationship among the rural older adults. Data from a cross-sectional study conducted in rural areas of Shandong Province from September to December in 2023. A total of 695 rural older adults were included. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. Frailty was defined using the FRAIL scale. We assessed cognitive impairment using the Dementia Screening Interview (AD8). Logistic regression analyse was used to assess the relationship between sleep quality and cognitive impairment. And the Karlson-Holm-Breen (KHB) method was performed to test the mediating role of frailty in this relationship. After adjusting for all covariates, sleep quality was significantly associated with cognitive impairment (OR = 1.047, 95

BACKGROUND:Depression, a prevalent mental illness among older people, is associated with some adverse health problems and lower quality of life. Against the backdrop of a growing aging population, coping with late-life depression has become an important public health priority. Emerging evidence suggests that short video addiction tendency may be a new risk factor for depression. However, there has been limited discussion on the potential association between short video addiction tendency and depression among older adults. OBJECTIVE:We aimed to investigate the relationship between short video addiction tendency and depression in a sample of rural older adults. In addition, we aimed to examine the mediating roles of asthenopia and sleep efficiency in the relationship between short video addiction tendency and depression. METHODS:A face-to-face interview design was used to collect valid data from 872 rural older adults aged ≥60 years from October 2024 to January 2025 in 2 provinces of China. Participants were requested to complete self-report measures on short video addiction tendency (Short Video Addiction Scale), asthenopia (11-item Asthenopia Survey Questionnaire), sleep efficiency (actual sleep time and time in bed at night), and depression (Center for Epidemiologic Studies Depression Scale). Linear regression analyses were performed using model 6 of the PROCESS 4.1 macro in SPSS 26.0 to assess the relationship between short video addiction tendency and depression and to examine the mediating roles of asthenopia and sleep efficiency in this relationship, adjusting for sex, age, education, and marital status. RESULTS:We observed that the prevalence of depression was 27.8% (242/872) in this study. There was a significant positive relationship between short video addiction tendency and depression (β=.263; P<.001). Short video addiction tendency affected depression through 3 different pathways: the mediating role of asthenopia (β=.084, 95% CI .059-.114); the mediating role of sleep efficiency (β=.021, 95% CI .001-.043); and the chain mediating role of asthenopia and sleep efficiency (β=.017, 95% CI .010-.026). The effect values of the 3 pathways accounted for 31.94%, 7.99%, and 6.46% of the total effect, respectively. CONCLUSIONS:We highlighted a direct and statistically substantial relationship between short video addiction tendency and depression, with asthenopia and sleep efficiency serving as potential mediating factors. Our findings predicted that guiding and assisting rural older adults to use short video apps appropriately, addressing asthenopia, and enhancing sleep efficiency may be a valuable approach to improve their mental health, preventing and delaying the occurrence and development of depression.

A significant correlation has been discovered between illness perception and quality of life, but the relationships among illness perception, medication experience, and quality of life remain to be confirmed. Therefore, this study aims to identify the relationship between illness perception and quality of life among Chinese rural elderly patients with hypertension and to analyse the possible mediating role of medication experience between these two aspects. From September to December 2023, a cross-sectional study was conducted to select rural elderly patients with hypertension by multi-stage stratified random sampling. Data was collected using the brief illness perception questionnaire, the grassroots medication experience scale for patients with chronic diseases and the quality of life scale. Multiple linear regression and Bootstrap method were used to explore the mediating role of medication experience between illness perception and quality of life. A total of 846 patients met the inclusion criteria. The mean scores of illness perception, medication experience and quality of life at baseline were 4.85 ± 1.04, 4.13 ± 0.52, 4.37 ± 0.37, respectively. The result of Spearman correlation analysis showed that the illness perception was negatively correlated with medication experience (r = -0. 359, P < 0.01) and quality of life (r = -0. 317, P < 0.01), and medication experience was positively correlated with quality of life (r = 0. 511, P < 0.01). The results of mediating effect test indicate that medication experience had a partial mediating effect on the relationship between illness perception and quality of life among rural elderly hypertensive patients, and the mediating effect accounted for 54.21

In light of the ERI exacerbated by health emergencies, stabilizing the working conditions of primary healthcare professionals and ensuring the consistent operation of the public health system has become a focal point of research. This study was designed to investigate the mechanisms by which ERI affects job performance among primary healthcare professionals in the context of health emergencies, as well as the mediating role of perceived social support and resilience. Participants were recruited from 54 primary healthcare institutions, with a total of 1,050 primary healthcare professionals included in the study. Data were collected using the Effort-Reward Imbalance Scale, Perceived Social Support Scale, Individual Resilience Scale, and Job Performance Scale to assess key variables. Hayes' serial mediation model was applied to examine the interrelationships between these variables. The effects of the Effort-Reward-Imbalance and Job Performance were negatively correlated (P < 0.01). ERI influences job performance through three pathways: the mediating role of perceived social support, the mediating role of individual resilience, and the chain mediating role of both perceived social support and individual resilience. Perceived social support and individual resilience moderates the association between Effort-Reward-Imbalance and job performance among primary healthcare professionals.

Introduction:Chronic pain (CP) is a prevalent comorbidity in patients with chronic diseases, yet the relationship between CP and health-related quality of life (HRQoL) remain unclear, particularly through the mediating roles of frailty and depression. Methods:We conducted a cross-sectional survey in two provinces (eastern and central China) from October 2024 to January 2025, enrolling 3,094 patients with chronic diseases. HRQoL was assessed using the EQ-5D scale, while CP status was determined through structured logic-based questions. Frailty was evaluated using the FRAIL scale, and depressive symptoms were measured with the CES-D10. Spearman's correlation analysis was performed to assess associations among CP, frailty, depression, and HRQoL. A chain mediation model (PROCESS 4.1, Model 6) was constructed, and mediation effects were tested using a bootstrap approach with 5,000 resamples. Results:Frailty and depression exhibited significant mediating effects in the relationship between CP and HRQoL. The indirect effects of frailty and depression on HRQoL were -0.0747 (95% CI: -0.0881, -0.0618) and -0.0211 (95% CI: -0.0297, -0.0135). Additionally, a significant chain mediation effect was observed (-0.0192, 95% CI: -0.0242, -0.0145). The indirect effect of frailty and depression accounted for 34.09% of the association between CP and HRQoL (total effect: -0.1150, 95% CI: -0.1305, -0.0999). Conclusion:The study findings demonstrated that frailty and depression serve as significant chain mediators in the relationship between CP and diminished HRQoL. Measures should be taken to reduce the incidence and severity of CP in patients with chronic diseases, improve frailty and depression, and thus improve HRQoL.

Chronic noncommunicable diseases, which can be referred to as chronic diseases, have become a significant challenge to global public health. Various studies have shown that traditional Chinese medicine (TCM) therapies are effective means of preventing and treating chronic diseases. The purpose of our study was to analyze the present circumstances of the use of TCM therapies among Chinese patients who have chronic diseases and explore the related influencing factors. Using datasets from the 2021 China General Social Survey (CGSS), we collected basic information, health status, and lifestyle data from 1,023 residents who suffered from at least one chronic disease. We analyzed the distribution characteristics of different indicators among patients using TCM therapies through the χ2 test and determined the main factors influencing the use of TCM therapies through binary logistic regression analysis. Among the 1,023 patients with chronic diseases, 502 (49.07%) used TCM therapies. The five types of TCM therapies were used in the following order of frequency: Chinese herbal medicine (73.11%), cupping (37.45%), acupressure or massage (31.27%), acupuncture (30.48%), and moxibustion (23.11%). Age, self-rated health status, frequency of drinking, frequency of medical visits in the past year, media information sources, types of chronic diseases, and comorbidities significantly affected the use of TCM therapies (P < 0.05). Compared with the population aged over 81 years, patients aged 41-60 years (OR: 1.978, 95% CI: 1.069-3.663) had a higher rate of TCM therapy use. Compared with patients who never drank, those who drank several times a year or less (OR: 1.628, 95% CI: 1.031-2.569) had a higher rate of TCM therapy use. Compared with patients who had never visited a doctor in the past year, those who had visited a doctor several times a week (OR: 2.888, 95% CI: 1.047-7.966), approximately once a week (OR: 3.101, 95% CI: 1.369-7.023), approximately once a month (OR: 1.988, 95% CI: 1.239-3.190), or several times a year (OR: 1.734, 95% CI: 1.202-2.502) had a greater rate of TCM therapy use. Compared with patients whose self-rated health status was poor, those whose self-rated health status was normal (OR: 0.709, 95% CI: 0.504-0.996) had a lower rate of TCM therapy use. Compared with patients who obtained media information through more than three sources, those who obtained it only through television (OR: 0.624, 95% CI: 0.410-0.948) had a lower rate of TCM therapy use. Compared with patients who suffered from three or more chronic diseases simultaneously, those who suffered from hypertension (OR: 0.260, 95% CI: 0.134 ~ 0.507) alone, diabetes (OR: 0.359, 95% CI: 0.149 ~ 0.864) alone, musculoskeletal diseases (OR: 0.466, 95% CI: 0.237 ~ 0.917) alone, other types of chronic diseases (OR: 0.367, 95% CI: 0.191 ~ 0.706) alone, and two (OR: 0.394, 95% CI: 0.212 ~ 0.732) or three (OR: 0.375, 95% CI: 0.186 ~ 0.755) kinds of chronic diseases simultaneously had a lower rate of TCM therapy use. Many factors affect the use of TCM therapies in patients with chronic diseases. The government and relevant departments should understand the trend in the use of TCM therapies in chronic disease management, accurately identify the characteristics of the population that has chronic diseases, optimize publicity channels, enhance the accessibility and acceptance of TCM therapies in global chronic disease health management, and provide practical references for enriching the methods available for preventing and treating chronic diseases.

BackgroundThe global misallocation of healthcare resources has emerged as a critical impediment to public health. In China, healthcare resources are predominantly concentrated in major cities and high-tier hospitals, while primary care facilities suffer from inadequate capacity, contributing to issues such as “difficult and expensive access to healthcare.” Despite numerous healthcare reforms, significant disparities in resource distribution persist.ObjectiveThis study seeks to elucidate the causal effects of healthcare system reform on the misallocation of medical resources and to investigate the underlying mechanisms. Focusing on the healthcare reform implemented in Sanming in 2012 as a quasi-natural experiment, the research employs the synthetic control method (SCM) to assess the policy’s impact on resource misallocation.MethodsThe synthetic control method is applied to estimate the causal impact of the Sanming Medical Reform on the misallocation of healthcare resources. By constructing a weighted control group that replicates Sanming’s counterfactual resource allocation trajectory in the absence of the reform, the model controls for covariates such as industrial structure, GDP, and human resources to ensure precise estimation of the policy effect. Data were obtained from the National Bureau of Statistics, local health commissions, and other sources, forming a balanced panel dataset of 203 cities spanning 2007 to 2022.ResultsThe analysis reveals that the Sanming Medical Reform markedly reduced the misallocation of healthcare resources. Following the 2012 intervention, Sanming exhibited a substantial decline in misallocation, with the misallocation index decreasing by an average of 0.1412 between 2013 and 2017. Both city-level and time placebo tests confirm that the observed policy effect is statistically significant and not attributable to random variation. Mechanism analysis further indicates that the reform achieved its outcomes by increasing government expenditure on health and refining the structure of health insurance.ConclusionThe empirical evidence demonstrates that the Sanming Medical Reform effectively alleviated the misallocation of healthcare resources and bolstered primary care capacity through enhanced government spending and optimized health insurance payment structures. These findings offer valuable insights and empirical support for healthcare reforms in China and other countries, paving the way for more equitable and efficient resource allocation.

BACKGROUND:Establishing an efficient health insurance payment mechanism is a core objective of China's healthcare reform. The Chinese government has introduced numerous policy documents to refine the health insurance payment system. However, research on these new payment methods primarily relies on economic analysis such as cost-effectiveness and econometric studies, and has not systematically assessed the internal design and consistency of policy texts. METHODS:This study uses text mining methods and the Policy Modeling Consistency (PMC) Index model to construct a policy evaluation framework, which includes 9 primary variables and 39 secondary variables. The framework is used to conduct a quantitative evaluation of China's new health insurance payment policies. RESULTS:The themes of China's new Health insurance payment policies are focused and continuously refined. Quantitative results from the PMC Index model show that the overall policy design is reasonable, although significant differences exist among them. Of the 9 policies, 1 is rated excellent, 4 are rated good, and 4 are rated acceptable. CONCLUSIONS:The overall evaluation of health insurance payment policies is positive, though there is room for optimization between individual policies. Strengthening top-level design, improving policy effectiveness, timeliness, and the use of policy tools, as well as promoting localized and standardized reforms, are crucial to fostering high-quality development in healthcare.