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已发表论文
医防融合对老年人慢性病管理中资源利用效率的影响：伦理与经济视角
Authors Huang XM, Zhao JF, Wang YW, Gong ZF, Li J, Li ZL
Received 16 September 2025
Accepted for publication 9 December 2025
Published 25 December 2025 Volume 2025:18 Pages 8237—8247
DOI https://doi.org/10.2147/JMDH.S564477
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Charles V Pollack
Xiao-Meng Huang,1,2 Jing-Fan Zhao,3 Yan-Wei Wang,4 Zhi-Fu Gong,5 Jun Li,6 Zhen-Liang Li7
1Medical Department, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei Province, 075000, People’s Republic of China; 2Chengde Medical University, Chengde, Hebei Province, 067000, People’s Republic of China; 3Technology Department, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei Province, 075000, People’s Republic of China; 4Quality Management Department, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei Province, 075000, People’s Republic of China; 5Discipline Inspection and Supervision Office, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei Province, 075000, People’s Republic of China; 6General Practice Medicine Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, 067000, People’s Republic of China; 7Higher Education Research Office, Hebei North College, Zhangjiakou, Hebei Province, 075000, People’s Republic of China
Correspondence: Zhen-Liang Li, Higher Education Research Office, Hebei North College, 11 Zuanshi South Road, Economic Development Zone, Zhangjiakou, Hebei Province, 075000, People’s Republic of China, Tel +8618931316690, Email lizhenliang0828@126.com Jun Li, General Practice Medicine Department, Affiliated Hospital of Chengde Medical University, 36 Nanyingzi Avenue, Chengde, Hebei Province, 067000, People’s Republic of China, Tel +8618503147726, Email ljunchengde@126.com
Objective: This study examined the impact of the medical-prevention integration model on the efficiency of medical resource utilization in the management of chronic diseases (primarily hypertension and diabetes) among older adults. The analysis focused on its ethical implications (eg, progress in urban-rural equity of resource allocation, residual disparities in underdeveloped regions, and potential biases in service access for disadvantaged groups) and economic effects, with the goal of informing evidence-based health policies to support the “Healthy China” strategy.
Methods: We included 10,236 adults aged ≥ 60 with chronic diseases from six counties in Guangdong, two rural counties in Sichuan, and one suburban area in Jiangsu. A mixed-methods approach was applied: quantitative analysis of medical costs and related indicators using the Heckman two-stage model, supplemented by qualitative case studies and semi-structured interviews. Indicators for economic performance, efficiency, and equity were constructed, with subgroup analyses by age and education.
Results: Model implementation was associated with significant efficiency gains: average annual per capita outpatient costs fell by 18.1%, hospitalization costs by 18.3%, chronic disease control rates rose by 13.6% (p< 0.001), and emergency visits declined by 27.4%. The urban-rural control rate gap narrowed from 12.7% to 5.9% (53.2% reduction), though disparities remained (5% in Guangdong, 3% in Jiangsu, 11% in rural Sichuan). Subgroup analysis showed greater cost reductions for ages 60– 70 (20.1%, p< 0.01) than > 70 (15.3%, p< 0.05), and higher control rates among more educated participants (75.2% vs 59.7%, p< 0.001).
Conclusion: The integration model improves efficiency and equity in chronic disease management, generating economic savings and reducing disparities. However, persistent regional gaps and barriers among vulnerable subgroups (eg, limited mobility in > 70, low health literacy) require targeted interventions. Findings are generalizable to similar aging middle-income settings and support strengthening primary care and equitable resource allocation.
Keywords: chronic disease, chronic disease management, ethics, medical-prevention integration, medical resources
1Medical Department, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei Province, 075000, People’s Republic of China; 2Chengde Medical University, Chengde, Hebei Province, 067000, People’s Republic of China; 3Technology Department, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei Province, 075000, People’s Republic of China; 4Quality Management Department, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei Province, 075000, People’s Republic of China; 5Discipline Inspection and Supervision Office, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei Province, 075000, People’s Republic of China; 6General Practice Medicine Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, 067000, People’s Republic of China; 7Higher Education Research Office, Hebei North College, Zhangjiakou, Hebei Province, 075000, People’s Republic of China
Correspondence: Zhen-Liang Li, Higher Education Research Office, Hebei North College, 11 Zuanshi South Road, Economic Development Zone, Zhangjiakou, Hebei Province, 075000, People’s Republic of China, Tel +8618931316690, Email lizhenliang0828@126.com Jun Li, General Practice Medicine Department, Affiliated Hospital of Chengde Medical University, 36 Nanyingzi Avenue, Chengde, Hebei Province, 067000, People’s Republic of China, Tel +8618503147726, Email ljunchengde@126.com
Objective: This study examined the impact of the medical-prevention integration model on the efficiency of medical resource utilization in the management of chronic diseases (primarily hypertension and diabetes) among older adults. The analysis focused on its ethical implications (eg, progress in urban-rural equity of resource allocation, residual disparities in underdeveloped regions, and potential biases in service access for disadvantaged groups) and economic effects, with the goal of informing evidence-based health policies to support the “Healthy China” strategy.
Methods: We included 10,236 adults aged ≥ 60 with chronic diseases from six counties in Guangdong, two rural counties in Sichuan, and one suburban area in Jiangsu. A mixed-methods approach was applied: quantitative analysis of medical costs and related indicators using the Heckman two-stage model, supplemented by qualitative case studies and semi-structured interviews. Indicators for economic performance, efficiency, and equity were constructed, with subgroup analyses by age and education.
Results: Model implementation was associated with significant efficiency gains: average annual per capita outpatient costs fell by 18.1%, hospitalization costs by 18.3%, chronic disease control rates rose by 13.6% (p< 0.001), and emergency visits declined by 27.4%. The urban-rural control rate gap narrowed from 12.7% to 5.9% (53.2% reduction), though disparities remained (5% in Guangdong, 3% in Jiangsu, 11% in rural Sichuan). Subgroup analysis showed greater cost reductions for ages 60– 70 (20.1%, p< 0.01) than > 70 (15.3%, p< 0.05), and higher control rates among more educated participants (75.2% vs 59.7%, p< 0.001).
Conclusion: The integration model improves efficiency and equity in chronic disease management, generating economic savings and reducing disparities. However, persistent regional gaps and barriers among vulnerable subgroups (eg, limited mobility in > 70, low health literacy) require targeted interventions. Findings are generalizable to similar aging middle-income settings and support strengthening primary care and equitable resource allocation.
Keywords: chronic disease, chronic disease management, ethics, medical-prevention integration, medical resources