Using tiered accreditation and decentralized governance to achieve population-based equity in pulmonary and critical care medicine in the Chinese mainland

Description

Naijian Li and colleagues evaluate in 2026 whether China's flexible accreditation drive spread lung and critical care services fairly across the mainland. Since 2018, hospitals could build pulmonary and critical care departments step by step, meeting standards suited to local capacity rather than one fixed bar. The team analyzed all 31 provincial-level regions from 2018 to 2023, using the national specialty registry, health yearbooks, and census data.

Department numbers grew 470.9 percent, from 409 to 2,335, with the fastest growth in previously underserved regions. Fairness by population improved, the Gini coefficient falling from 0.288 to 0.169. Fairness by land area stayed poor at 0.644, worst in western provinces. Government health spending and public hospital supply tracked most closely with the gaps. Nurse-to-doctor ratios, at 1.96, lagged international benchmarks. The authors conclude that tiered accreditation with local control can expand specialty care quickly and fairly by population, while geography and staffing still need attention.

Catalog record

Source: https://europepmc.org/article/MED/PMC13601544