Huang Guowu, Wu Wanying, Wen Qiaoxi, Lu Liyong, Pan Jay
School of Public Administration, Sichuan University, Chengdu, China.
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhua Xi Road 44, Jinan, Shandong Province, 250012, People's Republic of China.
Health Econ Rev. 2025 Apr 5;15(1):30. doi: 10.1186/s13561-025-00616-9.
Universal Health Coverage (UHC) is a central component of the Sustainable Development Goals, and integrated healthcare is recognized as a key pathway to achieving UHC. China's healthcare reform, aimed at realizing the "Healthy China 2035" goal, faces challenges in ensuring the coordinated development of disease prevention, medical services, and healthcare financing. However, empirical research assessing the integration of these three systems in China is scarce.
This study aims to assess the coupling and coordination between disease prevention, medical services, and healthcare financing in China from 2012 to 2021, with the goal of providing a comprehensive evaluation of the progress made in building an integrated healthcare system.
The study employs the Entropy Weight Method (EWM) to determine the weight of each system index, followed by the Coupling Coordination Degree Model (CCDM) to measure the coordination among the three components. The Grey Correlation Analysis (GCA) is used to identify key driving factors, and the Grey Prediction Model (GM (1.1)) is applied to forecast future trends of integrated healthcare development across Chinese provinces.
The coupling coordination degree of the three systems ranged from 0.12 to 0.73 from 2012 to 2021, reflecting a shift from moderate imbalance to mild imbalance over time. Regional disparities were observed, with eastern provinces showing higher levels of integration than western provinces. The disease prevention subsystem emerged as the primary constraint to the overall integration process. Most regions exhibited a consistent upward trend in the coupling coordination index, though development speeds varied significantly across provinces.
While China's integrated healthcare system has shown progress, there is still considerable room for improvement. Strengthening disease prevention efforts is critical to enhancing the overall coordination of the healthcare system. This study provides valuable insights for other developing countries facing similar challenges in healthcare integration.
全民健康覆盖是可持续发展目标的核心组成部分，综合医疗保健被视为实现全民健康覆盖的关键途径。中国旨在实现“健康中国2035”目标的医疗改革在确保疾病预防、医疗服务和医疗融资协调发展方面面临挑战。然而，评估中国这三个系统整合情况的实证研究却很匮乏。
本研究旨在评估2012年至2021年中国疾病预防、医疗服务和医疗融资之间的耦合与协调情况，以期全面评估中国在构建综合医疗保健系统方面取得的进展。
本研究采用熵权法确定各系统指标的权重，然后运用耦合协调度模型来衡量三个组成部分之间的协调性。利用灰色关联分析来识别关键驱动因素，并应用灰色预测模型（GM(1,1)）预测中国各省综合医疗保健发展的未来趋势。
2012年至2021年，这三个系统的耦合协调度在0.12至0.73之间，反映出随着时间的推移，从中度失衡向轻度失衡的转变。观察到区域差异，东部省份的整合水平高于西部省份。疾病预防子系统成为整体整合过程的主要制约因素。尽管各省的发展速度差异显著，但大多数地区的耦合协调指数呈现出一致的上升趋势。
虽然中国的综合医疗保健系统已取得进展，但仍有很大的改进空间。加强疾病预防工作对于提高医疗保健系统的整体协调性至关重要。本研究为其他在医疗保健整合方面面临类似挑战的发展中国家提供了有价值的见解。
