Relationship between subjective socioeconomic status and sense of gain of health-care reform and the mediating role of self-rated health: A cross- sectional study in China

Background: The sense of gain has gradually become the main evaluation index for the effectiveness of China’s deepening reform and is affected by many factors. However, there is no relevant research on the sense of gain of health-care reform (SGHR) and its influencing factors. The purpose of this study was to explore the influence of subjective socioeconomic status (SSS) on SGHR and the mediating role of self-rated health (SRH) between them.Methods: Data (27,437 samples total) from China Family Panel Studies (CFPS) in 2018 were included in the analysis. A nonparametric test was used to explore the differences in demographic characteristics of SGHR, and a correlation analysis and mediating effect model were used to explore the influence of SSS on SGHR and the mediating effect of SRH.Results: Demographic characteristics such as age, urban and rural areas, educational background, marriage and choice of medical treatment had significant differences in the distribution of perceived acquisition of medical reform. SSS, SHR and SGHR are positively correlated with each other. SSS not only directly affects SGHR positively but also indirectly affects SGHR through SRH.Conclusions: SSS is an important predictor of SGHR, and SHR plays a partially mediating role in SGHR.

The efficiency of provincial government health care expenditure after China’s new health care reform

Objective We aim to estimate the total factor productivity and analyze factors related to the Chinese government’s health care expenditure in each of its provinces after its implementation of new health care reform in the period after 2009. Materials and methods We use the Malmquist DEA model to measure efficiency and apply the Tobit regression to explore factors that influence the efficiency of government health care expenditure. Data are taken from the China statistics yearbook (2004–2020). Results We find that the average TFP of China’s 31 provincial health care expenditure was lower than 1 in the period 2009–2019. We note that the average TFP was much higher after new health care reform was implemented, and note this in the eastern, central and western regions. But per capita GDP, population density and new health care reform implementation are found to have a statistically significant impact on the technical efficiency of the provincial government’s health care expenditure (P<0.05); meanwhile, region, education, urbanization and per capita provincial government health care expenditure are not found to have a statistically significant impact. Conclusion Although the implementation of the new medical reform has improved the efficiency of the government’s health expenditure, it is remains low in 31 provinces in China. In addition, the government should consider per capita GDP, population density and other factors when coordinating the allocation of health care input. Significance This study systematically analyzes the efficiency and influencing factors of the Chinese government’s health expenditure after it introduced new health care reforms. The results show that China’s new medical reform will help to improve the government’s health expenditure. The Chinese government can continue to adhere to the new medical reform policy, and should pay attention to demographic and economic factors when implementing the policy.