Dataset Information

Policy practice for narrowing urban-rural healthcare gaps: determinants and implementation path of the urban doctors servicing rural areas policy in Beijing, China.

ABSTRACT:

Background

The urban-rural disparities in healthcare resources and service quality remain a critical challenge for equitable public health development in China. To address this, Beijing has implemented the "Urban Doctors Serving Rural Areas (UDSR)" policy-a key counterpart support initiative. Its core goal is to bridge urban-rural healthcare gaps by mobilizing urban medical professionals to serve rural institutions.

Methods

Grounded in Van Meter and Van Horn's policy implementation framework, this study employs fuzzy-set Qualitative Comparative Analysis (fsQCA). It examines 39 annual observations from 13 paired urban-rural hospitals in Beijing over 2017-2019. To capture temporal changes, the study applies time-series QCA techniques. It analyzes conditions including support project quantity, subsidy source diversification, prescription rights, professional matching, communication channels, and policy cognition, with rural medical technology improvement as the outcome variable.

Results

Three critical determinants of UDSR policy effectiveness are identified: the number of support projects, diversified subsidy sources, and prescription rights for urban doctors in rural institutions. Four implementation pathways are uncovered: (1) goal-and-cognition-driven, (2) professional-matching-driven, (3) external-funding-driven, and (4) comprehensive-factor-driven. Temporal analysis reveals two evolutionary paths: a dominant path achieved via integrating multiple factors, and a transitional path shifting from external funding reliance to professional alignment and goal cognition-reflecting adaptive maturation of the UDSR policy.

Conclusion

This study advances understanding of counterpart support policy implementation by revealing synergistic combinations of influencing factors and dynamic evolutionary paths. The findings make two key contributions. Theoretically, they provide insights for policy implementation research in non-western contexts; practically, they offer guidance for optimizing urban-rural healthcare resource allocation and provide a framework for refining targeted support mechanisms in China and similar developing countries.

SUBMITTER: Liu Y

PROVIDER: S-EPMC12497779 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Policy practice for narrowing urban-rural healthcare gaps: determinants and implementation path of the urban doctors servicing rural areas policy in Beijing, China.

Liu Yao Y Lu Chen C Sheng Jiale J Zou Yurou Y

Frontiers in public health 20250922

<h4>Background</h4>The urban-rural disparities in healthcare resources and service quality remain a critical challenge for equitable public health development in China. To address this, Beijing has implemented the "Urban Doctors Serving Rural Areas (UDSR)" policy-a key counterpart support initiative. Its core goal is to bridge urban-rural healthcare gaps by mobilizing urban medical professionals to serve rural institutions.<h4>Methods</h4>Grounded in Van Meter and Van Horn's policy implementatio ...[more]

PMID: 41059173

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Project description:Atmospheric particulate matter (PM) is a recognized risk factor for the global burden of disease in human populations. We are presenting here the application of toxicogenomics in the evaluation of the toxic effects of organic content of atmospheric particle matter (PM), from urban and rural environments (city of Barcelona and village of La Pobla, NE Spain), using the developing zebrafish embryo. The main goal is to identify the metabolic pathways involved in the adverse effects observed in zebrafish embryos exposed to PM organic content from urban and rural environments, also allowing the selection of genes of interest that are differentially expressed. The relevance of particle size to the PM toxicity is also addressed. Indeed, the zebrafish embryos were exposed to PM of aerodynamic diameter larger than 7.2 Î¼m and smaller than 0.5 Î¼m (PM10 and PM0.5, respectively). PM0.5 concentrated biological and toxic activities linked to organic substances. Transcriptomic analyses showed strong induction of the AhR signalling pathway (a.k.a. dioxin-like activity) for embryos exposed to both rural and urban extracts, correlating with the concentrations of PAHs. Urban extracts, with strong contribution of traffic emissions, specifically de-regulated oxidative stress-related genes, as well as pancreatic and eye-lens specific genes, two organs known to be affected by air pollution in humans. Exposure to rural extracts, with high contribution of wood burning emissions, affected genes implicated in basic cellular functions, in agreement with their strong embryotoxicity. Extracts from rural and urban samples elicited both common and specific transcriptome responses, suggesting different potentially adverse outcomes depending on PM source and composition. The authors thank the financial support of the Spanish Ministry (project TEA-PARTICLE, grant number CGL2011-29621) and the Portuguese Foundation for Science and Technology for the doctoral grant of Sofia R. Mesquita (SFRH/BD/80710/2011) funded by the Program POPH-QREN through the Portuguese Ministry of Education and Science and the European Social Fund, and support through project PEst-C/MAR/LA0015/2013. The PM filter samples used in the present study were PM10 and PM0.5 from the urban site - total of 4 samples from 2 sampling months; and PM0.5 from the rural site - total of 2 samples from 2 sampling months (PM10 samples from the rural site were not tested due to their very low concentration in organic compounds, and insignificant biological activity, previously measured). Sampling occurred during the cold periods of the year 2012/2013. The organic fraction of PM samples was extracted by sonication using a mixture of dichloromethane:methanol. Then, the extracts were filtered, evaporated and re-dissolved in Dimethyl sulfoxide (DMSO). Zebrafish fertilized eggs were exposed to PM organic extracts (0.2% DMSO) from the urban and rural sites from 24 to 120h post-fertilization. Total RNA was isolated from whole embryos (pools of 20 individuals), using Trizol reagent protocol (Invitrogen Life Technologies, Carlsberg, CA). The microarray study was performed using the Agilent Two-colour D. rerio Oligo Microarray v3 platform, following the Agilent Microarray â?? Based Gene Expression Analysis protocol. Three biological replicates were performed for each PM sample and controls. Biological replicates, a technical replicate and a self-to-self, were simultaneously amplified and labelled using Cyanine 3 (Cy3) and Cyanine 5 (Cy5) dye. After cRNA purification (RNeasy Kit, Quiagen GmbH, Hilden, Germany), the cRNA concentration and labelling were quantified in the NanoDrop spectrophotometer, obtaining incorporation rates in the range of 15-20pmol of cyanide dye/Âµl cRNA and yield values > 0.825ug, as recommended. cRNA was fragmented and hybridized in 4x44K arrays, for 17h at 65oC. After the hybridization the array slides were washed, and immediately scanned using Microarray Scanner Agilent G2505C system. Data was extracted using Agilent Feature Extraction Software v10.5.1.1, and the quality of microarray data was evaluated using the Quality Control report provided by Agilent Software. Based on the microarray data analysis, 22 primers were selected and designed using Primer Express 2.0 software (Applied Biosystems, Foster City, CA). Genes were quantified by real-time PCR to validate the microarray data, and a subset of 13 genes were further selected by their robust behaviour in the validation assays, allowing to differentiate the toxic potential of PM from urban and rural sources.

Dataset Information

Policy practice for narrowing urban-rural healthcare gaps: determinants and implementation path of the urban doctors servicing rural areas policy in Beijing, China.

Background

Methods

Results

Conclusion

Publications

Policy practice for narrowing urban-rural healthcare gaps: determinants and implementation path of the urban doctors servicing rural areas policy in Beijing, China.

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