Research Institute of Health Development Strategies, Fudan University, Shanghai, China.
Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
Front Public Health. 2022 Mar 4;10:826800. doi: 10.3389/fpubh.2022.826800. eCollection 2022.
The World Health Organization has proposed an initiative to "end tuberculosis (TB)." Unfortunately, TB continues to endanger the health of people worldwide. We investigated the impact of public health services (PHS) in China on TB incidence. In this way, we provided policy ideas for preventing the TB epidemic.
We used the "New Public Management Theory" to develop two indicators to quantify policy documents: multisector participation (MP) and the Assessable Public Health Service Coverage Rate (ASCR). The panel data from 31 provinces in Chinese mainland were collected from 2005 to 2019 based on 1,129 policy documents and the China Statistical Yearbook. A fixed-effect model was used to determine the impact of MP and the ASCR on TB incidence.
From 2005 to 2019, the average MP increased from 89.25 to 97.70%, and the average ASCR increased from 53.97 to 78.40% in Chinese mainland. However, the development of ASCR between regions was not balanced, and the average level in the western region was lower than that in the eastern coastal provinces. With an increase in MP and the ASCR, the TB incidence had been decreasing gradually in recent years. The panel analysis results showed that MP (β = -0.76, < 0.05). and ASCR (β = -0.40, < 0.01) had a negative effect on TB incidence, respectively. Even if the control variables were added, the negative effects of MP (β = -0.86, < 0.05) and ASCR (β = -0.35, < 0.01) were still statistically significant.
Promoting the participation of multiple departments, as well as emphasizing the quality of PHS delivery, are important ways to alleviate the TB epidemic. The settings of evaluation indices for PHS provision should be strengthened in the future.
世界卫生组织提出了一项“终结结核病（TB）”的倡议。然而，结核病仍然在威胁着全球人民的健康。本研究旨在探究中国公共卫生服务（PHS）对结核病发病率的影响，以期为防控结核病流行提供政策思路。
本研究采用“新公共管理理论”构建了多部门参与（MP）和可评估的公共卫生服务覆盖率（ASCR）两个政策量化指标。利用中国大陆 31 个省份 2005—2019 年 1129 项政策文件和《中国统计年鉴》的数据，采用固定效应模型，实证检验了 MP 和 ASCR 对结核病发病率的影响。
2005—2019 年，中国 MP 从 89.25%提升至 97.70%，ASCR 从 53.97%提升至 78.40%。但各省 ASCR 发展并不均衡，西部地区平均水平明显低于东部沿海省份。MP 和 ASCR 的提高，使近年来结核病发病率呈下降趋势。面板数据分析结果显示，MP（β=-0.76， < 0.05）和 ASCR（β=-0.40， < 0.01）均对结核病发病率具有负向影响，且加入控制变量后，MP（β=-0.86， < 0.05）和 ASCR（β=-0.35， < 0.01）的负向影响仍然显著。
促进多部门参与，强调公共卫生服务供给质量，是缓解结核病流行的重要途径。未来应加强公共卫生服务供给评价指标的设定。
