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Access to quality essential healthcare services is a fundamental right for all residents. However, the unequal allocation of healthcare resources affects patients' accessibility to care, thereby influencing their healthcare choices. Utilizing health insurance administrative data and employing a difference-in-differences (DID) model, this study examines the impact of China’s healthcare resource allocation reform on patients’ healthcare choices. The findings reveal that increased investment in rural healthcare resources significantly reduces the proportion of residents seeking medical services outside their counties, alleviates patients’ medical burden, and enhances healthcare quality. Notably, these improvements primarily benefit patients with common diseases, while the impact on those with rare diseases remains less pronounced. These results underscore the importance of strengthening the comprehensive capabilities of county-level hospitals and prioritizing high-quality resource allocation in rural areas as key directions for future reforms in healthcare system.

This work pioneers the novel application of surface friction treatment (SFT) to sintered porous metals to fabricate gradient-structured functional surfaces. The results demonstrate that SFT significantly modifies surface pore architecture, with scanning velocity and normal load critically controlling gradient layer formation. Excessive parameters induce periodic surface cracking due to mechanical overloading. Post-treatment, the porous metal exhibits a 37.5% reduction in maximum pore size (24 μm to 15 μm) and substantially improved surface finish, with arithmetic mean roughness (Ra) decreasing from 23.8 μm to 4.3 μm (82% reduction). These surface enhancements significantly improve filtration functionality while providing a cost-effective alternative to conventional gradient layer fabrication methods.

Background China initiated a reform of the health insurance system in the late 1990s. The new insurance, Urban Employee Basic Medical Insurance (UEBMI), is employment-based, which makes it more difficult than it used to be for those unemployed or informal employed (most of whom are women) to be covered by health insurance. Methods Based on three large sample of micro datasets, we first use statistical methods to identify gender differences in health insurance. Next, we construct a logistic regression model to capture the differences in insurance coverage across age groups using the parameter of interaction terms for gender and age groups. Results Based on data from a demographic survey that covers a large sample, we find that in the below 50 (in 2005) or 60 (in 2015) years age group, the coverage gap of UEBMI between men and women was relatively smaller, while a larger disparity existed in the above 50 (in 2005) or 60 (in 2015) group. Moreover, gender differences in health insurance were more significant in the low-education group, while no gender differences were found in the high-education group. Conclusions This paper explains the gender gap in health insurance and the reason for the wider gap among older people. Our study indicates that because the UEBMI in China mainly covers people with formal jobs, a lower labor participation rate (even much lower in formal jobs) of women has led to their greater difficulty in obtaining health insurance. Since the older women’s greater difficulty in obtaining jobs or susceptibility to lay-offs during the period of the UEBMI’s implementation, the possibility of being covered was even much lower. In fact, it was because of the combined effects of the UEBMI system and the labor market condition at that time that older women had a lower proportion of being covered under the UEBMI.

In China, overcrowding at hospitals increases the workload of medical staff, which may negatively impact the quality of medical services. This study empirically examined the impact of hospital admissions on the quality of healthcare services in Chinese hospitals. Specifically, we estimated the impact of the number of hospital admissions per day on a patient’s length of stay (LOS) and hospital mortality rate using both ordinary least squares (OLS) and instrumental variable (IV) methods. To deal with potential endogeneity problems and accurately identify the impact of medical staff configuration on medical quality, the daily air quality index was selected as the IV. Furthermore, we examined the differential effects of hospital admissions on the quality of care across different hospital tiers. We used the data from a random sample of 10% of inpatients from a city in China, covering the period from January 2014 to June 2019. Our final regression analysis included a sample of 167 disease types (as per the ICD-10 classification list) and 862,722 patient cases from 517 hospitals. According to our results, the LOS decreased and hospital mortality rate increased with an increasing number of admissions. Using the IV method, for every additional hospital admission, there was a 6.22% ( p < 0.01) decrease in LOS and a 1.86% ( p < 0.01) increase in hospital mortality. The impact of healthcare staffing levels on the quality of care varied between different hospital tiers. The quality of care in secondary hospitals was most affected by the number of admissions, with the average decrease of 18.60% ( p < 0.05) in LOS and the increase of 6.05% ( p < 0.01) in hospital mortality for every additional hospital admission in our sample. The findings suggested that the supply of medical services in China should be increased and a hierarchical diagnosis and treatment system should be actively promoted.

In the global context of rural development in developing countries, the integration of digital technology into agriculture has emerged as a pivotal strategy for modernizing rural areas and boosting agricultural productivity. A focal point of policy initiatives, digital village construction aims to harness digital technology to empower rural development. Despite widespread recognition of its potential benefits for agricultural development, empirical evidence on its specific impacts, particularly on farmland scale operation, remains scarce. This study investigates the relationship between digital village construction and farmland scale operation in China, leveraging data from Sichuan Province’s rural revitalization strategy and Peking University’s Digital Village Index. Our analysis reveals a significant enhancement in farmland scale operation, particularly in non-poverty and non-border villages, after addressing potential endogeneity in the estimation. Mechanism analysis demonstrates that digital village construction drives scaled operation and management through improved agricultural production efficiency, the establishment of agricultural industry systems, and the advancement of agricultural engineering projects. However, its impact varies across village types, underscoring potential disparities in rural development. These findings suggest that continued investment in digital village construction is essential to stimulate rural development, focusing on leveraging digital technologies to enhance agricultural productivity and providing targeted support for remote and underserved rural areas to bridge the digital gap and foster inclusive growth.

Background Price regulation is a common constraint in Chinese hospitals. Based on a policy experiment conducted in China on the price deregulation of private nonprofit hospitals, this study empirically examines the impact of medical service price regulation on the pricing of medical services by hospitals. Methods Using the claim data of insured inpatients residing in a major Chinese city for the period 2010–2015, this study constructs a DID (difference-in-differences) model to compare the impact of price deregulation on medical expenditure and expenditure structure between public and private nonprofit hospitals. Results The empirical results based on micro data reveal that, price deregulated significantly increased the total expenditure per inpatient visit by 10.5%. In the itemized expenditure, the diagnostic test and drug expenditure per inpatient visit of private nonprofit hospitals decreased significantly, whereas the physician service expenditure per inpatient visit increased significantly. For expenditure structure, the proportions of drug expenditure and diagnostic test expenditure per inpatient visit significantly decreased by 5.7 and 3.1%, respectively. Furthermore, this paper also found that hospitals had larger price changes for dominant diseases than for non-dominant diseases. Conclusions Under price regulation, medical service prices generally become lower than their costs. Therefore, after price deregulation, private nonprofit hospitals increase medical service prices above their cost and achieve the service premium increasing physician medical services. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well.

The class III PI3-kinase (PIK3C3) is an enzyme responsible for the generation of phosphatidylinositol 3-phosphate (PI3P), a critical component of vesicular membrane. Here, we report that PIK3C3 deficiency in zebrafish results in intestinal injury and inflammation. In pik3c3 mutants, gut tube forms but fails to be maintained. Gene expression analysis reveals that barrier-function-related inflammatory bowel disease (IBD) susceptibility genes ( e-cadherin , hnf4a , ttc7a ) are suppressed, while inflammatory response genes are stimulated in the mutants. Histological analysis shows neutrophil infiltration into mutant intestinal epithelium and the clearance of gut microbiota. Yet, gut microorganisms appear dispensable as mutants cultured under germ-free condition have similar intestinal defects. Mechanistically, we show that PIK3C3 deficiency suppresses the formation of PI3P and disrupts the polarized distribution of cell-junction proteins in intestinal epithelial cells. These results not only reveal a role of PIK3C3 in gut homeostasis, but also provide a zebrafish IBD model. The functions of the class III PI3-kinase (PIK3C3) in gut homeostasis and innate immunity are poorly understood. Here the authors show that PIK3C3-deficient zebrafishes develop intestinal injury and inflammation due to mislocalization of cell junction proteins.

Reducing farmland abandonment is crucial for food security. While the association between e-commerce proliferation and farmland abandonment at the village level has been discussed, the correlation at the farming household level remains unexplored. Utilizing 2020 survey data from 3831 rural households across 10 Chinese provinces, this study develops an “e-commerce–household–farmland abandonment” framework to explore the co-occurrence of e-commerce engagement with farmland abandonment, using econometric models. The findings reveal that e-commerce engagement significantly increases farmland abandonment, with implicit and explicit rates rising by 10.3% and 28.5%, respectively. It also shifts household incomes from planting to forestry, animal husbandry, and fisheries, leading households to reallocate labor away from agriculture, thereby intensifying abandonment. However, land transfer can alleviate this co-occurrence. This study also explores the variation in the association between e-commerce participation and farmland abandonment in relation to agricultural subsidies, economic development, and the presence of family farms. By elucidating the dynamics at the household level, this research offers fresh perspectives for developing countries to safeguard food security by curbing farmland abandonment.

Background Access to essential medicines is a vital component of universal health coverage. The low availability of essential medicines for children (EMC) has led the World Health Organization (WHO) to issue a number of resolutions calling on member states on its improvement. But its global progress has been unclear. We aimed to systematically evaluate the progress of availability of EMC over the past decade across economic regions and countries. Methods We searched eight databases from inception to December 2021 and reference lists to identify included studies. Two reviewers independently conducted literature screening, data extraction and quality evaluation. This study was registered with PROSPERO, CRD42022314003. Results Overall, 22 cross-sectional studies covering 17 countries, 4 income groups were included. Globally, the average availability rates of EMC were 39.0% (95%CI: 35.5-42.5%) in 2009–2015 and 43.1% (95%CI: 40.1-46.2%) in 2016–2020. Based on the World Bank classification of economic regions, income was not proportional to availability. Nationally, the availability rate of EMC was reasonable and high (> 50%) in only 4 countries, and low or very low for the rest 13 countries. The availability rates of EMC in primary healthcare centers had increased, while that for other levels of hospitals slightly declined. The availability of original medicines decreased while that of generic medicines was stable. All drug categories had not achieved the high availability rate. Conclusion The availability rate of EMC was low globally, with slight increase in the last decade. Continuous monitoring and timely reporting of the availability of EMC are also needed to facilitate targets setting and inform relevant policy making.

The government continues to face multiple challenges in increasing female labor force participation (FLFP) among ethnic minorities. While culture is considered a key factor, distinguishing it from other factors like institutions remains difficult. This study uses a spatial regression discontinuity design to address this challenge and analyze the differential impact of culture on FLFP on both sides of the ethnic boundary. The results reveal that the probability of FLFP among ethnic minority women is 33.4 percentage points lower than that of Han women on both sides of the ethnic boundary. This finding remains robust across different bandwidths and model specifications, ruling out the influence of factors such as institutional differences, non-random migration, and “sorting behavior”. Mechanism analysis suggests that culture exerts its effect on both sides of the ethnic Boundary through both labor demand and supply dimensions. The impact is particularly pronounced among women aged 18–29 or over 40, those who are unmarried or married with a spouse, and those in families with two or fewer children. This study holds significant theoretical and practical implications for optimizing employment policies for women in ethnic minority regions from a cultural perspective.