刘国恩，经济学博士，北京大学国家发展研究院经济学长江学者特聘教授、中国医学科学院 学部委员；北京大学全球健康发展研究院院长、北京大学教育经济研究所学术委员会主任、 北京大学中国卫生经济研究中心主任。《中美健康二轨对话》中方召集人；国务院医改专家 咨询委员会委员；中国药物经济学专业委员会荣誉主任委员。健康经济学国际一流 SCI 期刊 《Health Economics》副主编（2014 –），《Value in Health》副主编（2001-2012）；中文期刊 《中国药物经济学》主编（2006 -至今）；《经济学季刊》副主编（2013-2017）。刘国恩教授 曾全职任教美国南加州大学、北卡大学教堂山分校、北大光华管理学院。他曾担任中国留美 经济学会（CES）2004-2005 届主席、国际药物经济学会（ISPOR）亚太联合会 2004-2006 届 主席。刘国恩教授于 1991 年获得美国纽约市立大学研究院经济学博士学位，师从 Michael Grossman 教授；1994 年完成哈佛大学健康经济学博士后训练，师从 William Hsiao 教授。 刘国恩教授目前在研的重点课题：1）星球健康坐标系统（Planetary Health Axis System – PHAS）; 2）医学机器人队列调查的卫生技术评估（The Survey of Medical Assessment for Robotic Technology - SMART）

【 English Page 】

北大刘国恩观点：人人如何能看得起病？ 2025-09-10

北大刘国恩观点：去留两难的乡村卫生室 2024-08-23

“临湖智库沙龙”第六期举行，刘国恩作“经济增长与星球健康：追寻人类文明的足迹”报告 2025-06-10

北大教授刘国恩：星球健康经济学——全球医疗健康的趋势展望 2024-05-31

北大教授刘国恩：谈一个好价钱的前提是真正有好的药品上市 2024-05-17

北京大学全球健康发展研究院院长刘国恩：运用卫生经济学对生命定价 2024-05-31

北京大学刘国恩：《开讲了》“灵魂砍价”成功背后的秘密 2024-01-13

研究观点 | 刘国恩：挖掘人力资源的潜力成为创新优势 促进良性竞争 2021-08-24

研究观点 | 刘国恩谈疫情对上市公司用工影响：向更高教育程度要求转型 2022-06-11

研究观点 | 刘国恩：希望更多调研数据库能够开放为社会所用 2023-04-07

Liu M. et al. Barriers and Facilitators for Stroke Patients’ Adherence to Rehabilitation in China: A Qualitative Study Based on Medical Experts 2025-08-27

肖楠、刘国恩. 基层首诊政策对患者就医选择和医疗费用的影响 2025-07-31

Li SS. et al. prescription medication expenditures for patients with diabetes in the US: 2012-2021 2025-07-22

Li R. et al.Cost-related non-adherence in US adults with heart failure: a repeated cross-sectional analysis of the medical expenditure panel survey, 2012 to 2021 2025-05-16

Zhou Q.et al.Impact of Urban–Rural Health Insurance Integration on Mental Health Among Rural Adults in China: Evidence From a Quasi-experimental Study 2025-05-12

Li WB. et al. Changing climate and socioeconomic factors contribute to global antimicrobial resistance 2025-04-28

Yao Y. et al. Does the impact of economic inequality on maternal and child health inequality exhibit a threshold effect? Evidence from China 2025-04-09

Li XY. et al.Point-of-care testing reduces antibiotic prescribing in acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis 2025-03-19

He QH. et al.Effects of separating drug sales from treatment on medical disputes 2025-03-14

Yan Q. et al.Forging paths together: The history of U.S.-China Track II Health Dialogue and the future of Chinese-American health communication 2025-02-20

中国的多层次医学教育体系产生了巨大的医生人力资本异质性。本文试图利用医生人力资本水平的差异，结合我国某省的DRGs数据揭示医院医疗服务错配与医生人力资本、就医可及性之间的关系。研究发现：第一，人力资本水平越高的医院，其医疗服务错配程度越高；第二，医生人力资本与就医可及性存在互补效应，显著提高医疗服务错配程度，该结论在控制内生性和一系列稳健性检验后仍成立。第三，外科的错配效应比内科更显著，相对省属医院，错配效应在县市属医院更强。据此，本文认为患者的“用脚投票”就医行为和中国医生人力资本两级分化带来了大医院医疗服务的错配效应。 Yang LP. et al. Objectives: The COVID-19 pandemic has posed a significant threat to the global healthcare system, presenting a major challenge to antimicrobial stewardship worldwide. This study aimed to provide a comprehensive and up-to-date picture of global antimicrobial resistance (AMR) and antibiotic use in COVID-19 patients.Methods: We conducted a systematic review to determine the prevalence of AMR and antibiotic usage among COVID-19 patients receiving treatment in healthcare facilities. Our search encompassed the PubMed, Web of Science, Embase, and Scopus databases, spanning studies published from December 2019 to May 2023. We utilized random-effects meta-analysis to assess the prevalence of multidrug-resistant organisms (MDROs) and antibiotic use in COVID-19 patients, aligning with both the WHO's priority list of MDROs and the AWaRe list of antibiotic products. Estimates were stratified by region, country, and country income. Meta-regression models were established to identify predictors of MDRO prevalence and antibiotic use in COVID-19 patients. The study protocol was registered with PROSPERO (CRD 42023449396).Results: Among the 11,050 studies screened, 173 were included in the review, encompassing a total of 892,312 COVID-19 patients. MDROs were observed in 42.9% (95% CI 31.1-54.5%, I2 = 99.90%) of COVID-19 patients: 41.0% (95% CI 35.5-46.6%) for carbapenem-resistant organisms (CRO), 19.9% (95% CI 13.4-27.2%) for methicillin-resistant Staphylococcus aureus (MRSA), 24.9% (95% CI 16.7-34.1%) for extended-spectrum beta-lactamase-producing organisms (ESBL), and 22.9% (95% CI 13.0-34.5%) for vancomycin-resistant Enterococcus species (VRE), respectively. Overall, 76.2% (95% CI 69.5-82.9%, I2 = 99.99%) of COVID-19 patients were treated with antibiotics: 29.6% (95% CI 26.0-33.4%) with "Watch" antibiotics, 22.4% (95% CI 18.0-26.7%) with "Reserve" antibiotics, and 16.5% (95% CI 13.3-19.7%) with "Access" antibiotics. The MDRO prevalence and antibiotic use were significantly higher in low- and middle-income countries than in high-income countries, with the lowest proportion of antibiotic use (60.1% (95% CI 52.1-68.0%)) and MDRO prevalence (29.1% (95% CI 21.8-36.4%)) in North America, the highest MDRO prevalence in the Middle East and North Africa (63.9% (95% CI 46.6-81.2%)), and the highest proportion of antibiotic use in South Asia (92.7% (95% CI 90.4-95.0%)). The meta-regression identified antibiotic use and ICU admission as a significant predictor of higher prevalence of MDROs in COVID-19 patients. Zhou Q., Eggleston K., and Liu GG. Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.

Keywords: China; life satisfaction; subjective well-being; universal healthcare coverage; urban–rural health insurance integration. Liu GG. et al. Objective: We study the predetermined characteristics of countries in addition to their government non-pharmaceutical interventions (NPIs) to shed light on the correlates of the variation in COVID-19 infection outcomes across countries.

Methods and analysis: We conduct a systematic investigation of the validity of government responses in 84 countries by gradually adding the predetermined cultural, natural and socioeconomic factors of each country using a fixed-effect model and daily panel data. A relative importance analysis is conducted to isolate the contribution of each variable to the R2 of the model.

Results: Government NPIs are effective in containing the virus spread and explain approximately 9% of the variations in the pandemic outcomes. COVID-19 is more prevalent in countries that are more individual-oriented or with a higher gross domestic product (GDP) per capita, while a country's government expenditure on health as a proportion of GDP and median age are negatively associated with the infection outcome. The SARS-CoV-2 lifecycle and the impacts of other unobserved factors together explain more than half of the variation in the prevalence of COVID-19 across countries. The degree of individualism explains 9.30% of the variation, and the explanatory power of the other socioeconomic factors is less than 4% each.

Conclusion: The COVID-19 infection outcomes are correlated with multivariate factors, ranging from state NPIs, culture-influenced human behaviours, geographical conditions and socioeconomic conditions. As expected, the stronger or faster are the government responses, the lower is the level of infections. In the meantime, many other factors underpin a major part of the variation in the control of COVID-19. As such, from a scientific perspective, it is important that country-specific conditions are taken into account when evaluating the impact of NPIs in order to conduct more cost-effective policy interventions. Zhou SD. et al. Objectives
We aimed to investigate the associations of individual and area-level socioeconomic status (SES) with incident cardiovascular diseases (CVD) alone, cancer alone, and comorbid CVD and cancer, and the mediation role of cardiovascular health score in these associations.
Study design
This was a population-based prospective cohort study.
Methods
We used data from the UK Biobank, a population-based prospective cohort study. Latent class analysis was used to create an individual-level SES index based on three indicators (household income, education level, and employment status), and the Townsend Index was defined as the area-level socioeconomic status. We used the American Heart Association's (AHA) Life's Simple 7 (smoking, body weight, physical activity, diet, blood pressure, blood glucose, and total cholesterol) to calculate the cardiovascular health score. We used Cox proportional hazard regression models to estimate the hazard ratio (HR) and 95% confidence interval (CI) adjusted for demographic, environmental, and genetic factors.
Results
Compared with high SES, the HRs in participants with low individual and area-level SES were 1.33 (95% confidence interval [CI] 1.29 to 1.38) and 1.24 (95% CI 1.20 to 1.29) for incident CVD, 0.96 (95% CI 0.93 to 0.99) and 0.95 (95%CI 0.92 to 0.98) for incident cancer, 1.32 (95%CI 1.24 to 1.40) and 1.15 (95%CI 1.08 to 1.22) for incident comorbid CVD and cancer, respectively. Additionally, the mediation proportion of CVD score for individual and area-level SES was 47.93% and 48.87% for incident CVD, 44.83% and 59.93% for incident comorbid CVD and cancer. The interactions between individual-level SES and CVD scores were significant on incident CVD, and comorbid CVD and cancer, and the protective associations were stronger in participants with high individual-level SES.
Conclusions
Life's Simple 7 significantly mediated the associations between SES and comorbid CVD and cancer, while almost half of the associations remained unclear. In China, hospitals are classified into three tiers based on size and quality to triage patients. Among them, tier-2 and tier-3 hospitals provide similar inpatient services, while tier-3s have higher patient cost sharing due to their ability to provide more sophisticated care. In this study, we exploit a plausibly exogenous change in the financial environment facing tier-2 hospitals: reduced cost sharing in tier-3s. We find that patients are diverted from tier-2s after the reform, and in response to income loss, tier-2s increase the surgical probability and total expense per admission. A 1% decrease in the number of admissions increases the surgical probability by 0.25%, which suggests supplier-induced demand. We also find that tier-2 hospitals induce greater demand from patients with less urgent conditions and more elective procedures. Our analysis suggests that benevolent cost sharing reduction may have unintended consequences beyond the targeted group, and policymakers who neglect these effects would underestimate the costs of such reforms. Background: China accounts for 24% of newly diagnosed cancer cases and 30% of cancer-related deaths worldwide. Comprehensive analyses of the economic burden on patients across different cancer treatment phases, based on empirical data, are lacking. This study aims to estimate the financial burden borne by patients and analyze the cost compositions of the leading cancers with the highest number of new cases in China.

Methods: This cross-sectional cost-of-illness study analyzed patients diagnosed with lung, breast, colorectal, esophageal, liver, or gastric cancer, identified through electronic health records (EHRs) from 84 hospitals across 17 provinces in China. Patients completed any one of the initial treatment phase, follow-up phase, and relapse/metastasis phase were recruited by trained attending physicians through a stratified sampling procedure to ensure enough cases for each cancer progression stage and cancer treatment phase. Direct and indirect costs by treatment phase were collected from the EHRs and self-reported surveys. We estimated per case cost for each type of cancer, and employed subgroup analyses and multiple linear regression models to explore cost drivers.

Results: We recruited a total of 13,745 cancer patients across three treatment phases. The relapse/metastasis phase incurred the highest per case costs, varying from $8,890 to $14,572, while the follow-up phase was the least costly, ranging from $1,840 to $4,431. Being in the relapse/metastasis phase and having an advanced clinical stage of cancer at diagnosis were associated with significantly higher cost, while patients with low socioeconomic status borne lower costs.
Conclusions: There were substantial financial burden on patients with six leading cancers in China. Health policymakers should emphasize comprehensive healthcare coverage for marginalized populations such as the uninsured, less educated, and those living in underdeveloped regions.
Keywords: Cancer costs; China; Cost-of-illness; Treatment phases. In Global Health 2050, the Lancet Commission on Investing in Health concludes that dramatic improvements in human welfare are achievable by mid-century with focused health investments. By 2050, countries that choose to do so could reduce by 50% the probability of premature death in their populations—ie, the probability of dying before age 70 years—from the levels in 2019. We call this goal 50 by 50. The interventions that enable achieving the goal of 50 by 50 should also reduce morbidity and disability at all ages. Xiao N. et al. Introduction With a precarious economic outlook and increasing income volatility in current times, understanding the association between negative income shock and health is crucial. However, few studies have examined such associations in developing countries. Using data from China, this study aimed to examine associations of both serial absolute income drops and relative income trajectory and mortality.

Methods We included 4757 participants from the China Health and Nutrition Survey, a large prospective cohort study. Data between 1989 and 1997 were used to define income drops and relative income trajectories. We defined income drop as a decrease of ≥50% between two consecutive interviews and defined relative income trajectory using a latent class model. All-cause mortality between 2000 and 2015 was ascertained by participants’ family members.

Results A total of 2066 (43.43%) experienced 1 income drop and 477 (10.03%) experienced ≥2 income drops. A total of 535 deaths occurred (incidence rate 8.88 per 1000 person-years). Income drops were associated with a greater risk of mortality after adjusting for baseline income, comorbidities, sociodemographic and behavioural factors (HR 1.42 (95% CI 1.04 to 1.93) for ≥2 income drops vs no income drop). The downshift in relative income was also associated with increased mortality risk (HR 3.61 (95% CI 1.45 to 8.96) for always low; HR 3.36 (95% CI 1.36 to 8.32) for decreasing; HR 2.92 (95% CI 1.14 to 7.51) for increasing vs always high relative income). The associations between income drops and mortality were observed only among individuals with low wealth and low household income.

Conclusion In a large sample of the Chinese population with repeated income measurement and over 14 years of follow-up, both serial absolute income drops and a downward relative income trajectory were associated with higher risks of mortality in China. Priority should be given to policies aimed at enhancing resilience against serial income shocks and financial burdens. Liu GG. et al. Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.

Keywords: China; life satisfaction; subjective well-being; universal healthcare coverage; urban–rural health insurance integration. Context
The COVID-19 pandemic has impacted all sectors of society, with effects that have been acutely experienced at the local, national, regional, and global levels.
Objectives
This study examined the heterogeneous impacts of and vulnerability to COVID-19 for promoting urban sustainability and resilience.
Methods
We performed a scoping review on the basis of the relevant literature from the Web of Science and PubMed, and a national survey conducted among a total of 5,376 participants in early 2020. The survey adopted a repeated cross-sectional design to study changes in residents’ risk perception of COVID-19 across the three stages (21–23 January, 27–28 February, and 24–27 March), using a snowball sampling method to recruit 2,144, 2,021, and 1,211 participants, respectively.
Results
This study revealed that the spatial, social, economic, and health impacts of COVID-19 have not been distributed evenly among populations, with specific individuals and communities more vulnerable than others. Among the determinants of these inequalities are socioeconomic status, housing arrangements, and working requirements, which influence the extent to which people can safely adhere to stay-at-home and social distancing policies and how they perceive risks. Additionally, racial/ethnic minorities face differing risks, in part because of socioeconomic factors but also because some groups experience higher shares of comorbidities. Moreover, overall, these risk factors are the healthcare systems meant to shield individuals and communities from pandemic impacts, which, however, have become increasingly taxed due to the sudden influx of patients and the resultant shortages of resources – including crucial personal protective equipment to minimize interpersonal transmission.
Conclusions
Understanding the heterogeneous impacts of and vulnerability to COVID-19 could inform the design of environmentally sustainable and socially resilient cities, making them better equipped to encounter future epidemics. This study would help us identify more effective and equitable solutions to the ongoing challenges of the pandemic, promoting sustainability and resilience at multiple societal levels. Yan Q. et al. As two of the largest economies and countries in the world, the People’s Republic of China (China) and the United States of America (U.S.) both have enormous resources and innovative talents in a number of sectors. Cooperation between both sides will be hugely beneficial to the world population, and this is especially the case with healthcare. The U.S.-China Track Ⅱ Dialogue on Healthcare was set up as a forum to discuss and engage ideas on this very topic. In this dialogue, Dr. Qun Yan, head of the hLife Editorial Office engages in a dialogue with Professor Mark McClellan, the Director of the Duke-Margolis Institute for Health Policy at Duke University and U.S. Co-Chair of the Track Ⅱ Dialogue on Healthcare, Professor Gordon G Liu, Professor at Peking University and the Dean of the PKU Institute for Global Health and Development and Co-Organizer of the Track Ⅱ Dialogue, Mr. Stephen Orlins, President of the National Committee on U.S.-China Relations and a Co-Organizer of the Track Ⅱ Dialogue, and Professor George Fu Gao, Academician at the Chinese Academy of Sciences and former Director of the Chinese Center for Disease Control and Prevention. They discuss how and why the Track Ⅱ Dialogue was created, the successes and developments of the dialogues, and what the future of American-Chinese health collaboration looks like. For decades, the patient-physician conflict has been a persistent issue globally, particularly in China, where the situation has been deteriorating. To curb the inappropriate financial incentives of physicians, eliminate the practice of over-prescription, and improve the strained patient-physician relationship, the Chinese government has been implementing Separating Drug Sales from Treatment (SDST) in public hospitals since 2012. In this paper, we exploit the staggered difference-in-differences method and event study approach to examine the effects of SDST on medical disputes, based on administrative hospital-level annual data from 2011 to 2018 in G province. We find that SDST significantly decreases the number of total medical disputes by 10.0%, through reducing the over-prescription and medical malpractice, and improving hospital management practices and operational efficiency. This paper argues that removing the link between drug prescription and hospital revenue contributes to realigning physicians' financial incentives and thus building a healthy patient-physician relationship. Li XY. et al. Background: Challenges in identifying the causes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to overuse of antibiotics. The advantages of point-of-care testing (POCT) may help to identify pathogens and use antibiotics more appropriately.
Methods: We conducted a systematic review to evaluate the effect of POCT to guide antibiotic prescriptions for AECOPD. Adhering to a protocol (CRD42024555847), we searched eligible studies. The outcomes included antibiotic-related and clinical outcomes. We evaluated the risk of bias and performed meta-analyses with subgroup based on the type and testing timing of POCT.

Results: A total of 18 studies evaluating 4346 AECOPD patients were included. Overall, POCT significantly reduced the number of AECOPD patients given antibiotic prescriptions by 16% (P < 0.001). Additionally, antibiotic treatment was reduced by 1.19 days (P = 0.04). There was no detrimental impact on clinical outcomes, such as the length of hospital stay (P = 0.19). Our results proved robust to sensitivity analyses.
Conclusion: We offered reasonable evidence for using POCT to reduce antibiotic exposure for AECOPD without adversely affecting clinical outcomes. As diagnostic techniques become increasingly important in combating antimicrobial resistance, the use of POCT should be encouraged.
Keywords: Acute exacerbations of COPD; Antibiotics; C-reactive protein; Point-of-care testing; Procalcitonin. Yao Y. et al. When the economy (economic inequality) develops to a certain level, does the impact of economic inequality on health inequality change? Through threshold regression, this study analyses the impact of city-level economic inequality on the absolute and economic-related inequality in under-5 child mortality rate (U5MR) (2001-2012) and maternal mortality rate (MMR) (2001-2015), along with the threshold values for economic development stages and economic inequality. Findings show: For the relationship between economic inequality and absolute inequality in U5MR, as well as economic-related inequality, there exists an economic development threshold effect. For the relationship between economic inequality and absolute inequality in MMR, an economic inequality threshold effect is illustrated. The improvement of economic conditions contributes to alleviating inequality in U5MR. Economic development inequality has a significant impact on the equality of maternal health development, but for enhancing the equality of women's health, health promotion policies may be more feasible.

Keywords: I10; I19; Threshold effect; good health and well-being; inequality in health and economic status; maternal and child health; reduced inequality. Li WB. et al. Climate change poses substantial challenges in containing antimicrobial resistance (AMR) from a One Health perspective. Using 4,502 AMR surveillance records involving 32 million tested isolates from 101 countries (1999–2022), we analyzed the impact of socioeconomic and environmental factors on AMR. We also established forecast models based on several scenarios, considering antimicrobial consumption reduction, sustainable development initiatives and different shared socioeconomic pathways under climate change. Our findings reveal growing AMR disparities between high-income countries and low- and middle-income countries under different shared socioeconomic pathway scenarios. By 2050, compared with the baseline, sustainable development efforts showed the most prominent effect by reducing AMR prevalence by 5.1% (95% confidence interval (CI): 0.0–26.6%), surpassing the effect of antimicrobial consumption reduction. Key contributors include reducing out-of-pocket health expenses (3.6% (95% CI: −0.5 to 21.4%)); comprehensive immunization coverage (1.2% (95% CI: −0.1% to 8.2%)); adequate health investments (0.2% (95% CI: 0.0–2.4%)) and universal access to water, sanitation and hygiene services (0.1% (95% CI: 0.0–0.4%)). These findings highlight the importance of sustainable development strategies as the most effective approach to help low- and middle-income countries address the dual challenges of climate change and AMR. Zhou Q. et al. Introduction
Like many other countries, China had a fragmented health insurance system; in China's case, there were two separate schemes covering rural and urban residents. This study focused on the policy implications of integrating the schemes, particularly on the psychological effects.



Methods
The study used four waves of data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2011, 2013, 2015, and 2018, adopting a time-varying DID approach to capture the effect of integration on depressive symptoms among rural residents.



Results
The average CES-D score of rural adults decreased by 0.424, and the likelihood of depressive symptoms decreased by 3.5% after the implementation of the urban–rural health insurance integration policy. The positive effects may be due to the reduced cost-sharing rates as well as improvements in health satisfaction, social interactions, and physical activity. The integration reform had a limited impact on improving the mental health of those with the lowest economic status, the worst health status, and those aged 40–49 or over 70 Li R. et al. Objectives: To investigate the prevalence and potential determinants of cost-related non-adherence (CRNA) in US adults with heart failure (HF).
Design: A serial cross-sectional analysis using nationally representative data from 2012 to 2021 of the US Medical Expenditure Panel Survey.
Setting: Population-based.
Participants: Adult participants with HF diagnosis.

Outcome measures: Self-report of never getting or delaying getting prescription medicine because of costs.
Results: We included 1753 patients with HF (mean age 69.36 [95% CI, 68.23 to 70.48]) years, 47.85% men and 17.09% non-Hispanic Black. The overall weighted prevalence of CRNA was 7.94% (6.40-9.81), increasing from 3.09% (1.29-7.24) in 2012 to 13.69% (8.99-20.32) in 2018 and decreasing to 8.71% (3.82-18.67) in 2021. The prevalence of CRNA was higher among patients <65 years than those ≥65 years (11.78% vs 6.04%), and was more prevalent among patients with lower family income, with no insurance or public insurance, and with a greater comorbidity burden. The highest prevalence of CRNA was found among uninsured patients (18.54 [8.01-37.30]). Among patients <65 years, patients with CRNA had significantly lower utilisation of sodium glucose cotransporter-2 inhibitors and slightly lower use of beta blockers and ACEi/ARBs. The out-of-pocket cost for medication was higher among those with CRNA, especially cost on central nervous system medicines.

Conclusions: CRNA was prevalent among patients with HF, disproportionately affecting those younger than 65 years, with lower socioeconomic status, and higher comorbidity burden. Interventions are needed to reduce financial burden and enhance medication adherence.
Keywords: Health Equity; Health Services Accessibility; Heart failure; Medication Adherence. Glucose‐lowering medication expenditures per user by different payers among patients with diabetes.
Keywords: glucose‐lowering drugs, Medicare, medication expenditures, non‐glucose‐lowering drugs, private insurance 基层首诊是分级诊疗的关键环节,对构建有序就医路径和控制医疗费用具有重要意义。本文使用医保结算数据,采用断点回归-双重差分法研究基层首诊政策对患者就医选择和医疗费用的影响。研究发现,基层首诊政策显著降低了61~64岁参保人首诊选择三级医院的概率和对应的疗程总费用,但没有改变未退休群体的首诊选择。机制分析表明,该政策通过扩大基层首诊与越级首诊间医保待遇差距、增加时间成本影响患者选择。此外,政策实施后61~64岁参保人更多流向二级医院而非基层机构,基层机构服务能力较弱是阻碍患者向下就医的主要原因。本文研究结论表明,基层首诊政策仅能改变部分老年患者,尤其是慢性病患者的首诊选择,没有改变未退休群体向上就医的偏好,仅从需方成本分担角度推进分级诊疗的效果较为有限。 Liu M. et al. Stroke is a neurological condition characterized by prolonged rehabilitation, requiring long-term patient cooperation for effective recovery. Rehabilitation adherence plays an important role in the prognosis. This study aimed to identify the patient-, doctor-, hospital-, and society-level factors influencing rehabilitation adherence. In this qualitative study, semi-structured interviews were conducted with 25 experts in rehabilitation medicine, cardiovascular medicine, and neurology from six representative cities in China (Beijing, Tianjin, Shanghai, Wuhan, Harbin, and Chengdu) to explore the factors affecting rehabilitation adherence. Transcripts were coded and analyzed using an inductive thematic approach for data analysis. NVivo 14 was used to manage and analyze the textual data. All methods were performed in accordance with relevant guidelines and regulations, specifically the Guidelines for the “Prevention and Treatment of Cerebrovascular Diseases (2024 Edition)” and the “2024 China Stroke Prevention and Treatment Guidelines” issued by the General Office of the National Health Commission of the People’s Republic of China. Regarding in-hospital rehabilitation, medical experts believed that the characteristics of patients who had a stroke directly affected their rehabilitation adherence, including rehabilitation expectations, self-efficacy, economic pressure, family support, and trust in doctors. Additionally, medical experts also believed that various factors at the doctor, hospital, and societal levels influence patient characteristics, such as doctors’ professional skills, collaboration between departments, and social cognition, ultimately affecting rehabilitation adherence. For out-of-hospital rehabilitation, medical experts believed that the key determinants of adherence include accessibility to tele-rehabilitation, tele-medical resources, and active participation of hospital outpatient clinics. Most medical experts believed that it is crucial to focus not only on direct factors, such as rehabilitation expectations and self-efficacy, which influence patients’ subjective intentions, but also on identifying the pathways through which doctors, hospitals, and societal factors impact patient behavior. Attention should be given to in- and out-of-hospital rehabilitation. Gordon G. Liu, et al. Background
In China, dementia poses a significant public health challenge, exacerbated by an ageing population and lifestyle changes. This study assesses the temporal trends and disparities in the population-attributable fractions (PAFs) of modifiable risk factors (MRFs) for new-onset dementia from 2011 to 2018.

Methods
We used data from the China Health and Retirement Longitudinal Study (CHARLS), covering 75,214 person-waves. We calculated PAFs for 12 MRFs identified by the Lancet Commission (including six early-to mid-life factors and six late-life factors). We also determined the individual weighted PAFs (IW-PAFs) for each risk factor. Subgroup analyses were conducted by sex, socio-economic status (SES), and geographic location.

Findings
The overall PAF for dementia MRFs had a slight increase from 45.36% in 2011 to 52.46% in 2018, yet this change wasn’t statistically significant. During 2011–2018, the most contributing modifiable risk was low education (average IW-PAF 11.3%), followed by depression, hypertension, smoking, and physical inactivity. Over the eight-year period, IW-PAFs for risk factors like low education, hypertension, hearing loss, smoking, and air pollution showed decreasing trends, while others increased, but none of these changes were statistically significant. Sex-specific analysis revealed higher IW-PAFs for traumatic brain injury (TBI), social isolation, and depression in women, and for alcohol and smoking in men. The decline in IW-PAF for men’s hearing loss were significant. Lower-income individuals had higher overall MRF PAFs, largely due to later-life factors like depression. Early-life factors, such as TBI and low education, also contributed to SES disparities. Rural areas reported higher overall MRF PAFs, driven by factors like depression, low education, and hearing loss. The study also found that the gap in MRF PAFs across different SES groups or regions either remained constant or increased over the study period.

Interpretation
The study reveals a slight but non-significant increase in dementia’s MRF PAF in China, underscoring the persistent relevance of these risk factors. The findings highlight the need for targeted public health strategies, considering the demographic and regional differences, to effectively tackle and reduce dementia risk in China’s diverse population.

Funding
This work was supported by the PKU Young Scholarship in Global Health and Development. This paper assesses mental health responses to information on environmental risks. We exploit the progressive implementation of a national program in China that This paper assesses mental health responses to information on environmental risks. We exploit the progressive implementation of a national program in China thatThis paper assesses mental health responses to information on environmental risks. We exploit the progressive implementation of a national program in China that This paper assesses mental health responses to information on environmental risks. We exploit the progressive implementation of a national program in China that