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Viewpoint | Innovations in Health Care Delivery

Medical Informatics and the “Three Long, One Short” Problem of Large Urban Hospitals in China

Jingyao Dai, MD, PhD1,2; Xiaofei Wang, MS2,3; Francisco J. Ayala, PhD2
[+] Author Affiliations
1Xijing Hospital, Fourth Military Medical University, Xi’an, China
2Department of Ecology and Evolutionary Biology, University of California, Irvine
3School of Humanities and Social Sciences, Xi’an JiaoTong University, Xi’an, China
JAMA. 2016;316(3):269-270. doi:10.1001/jama.2016.5487.
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This Viewpoint discusses ways in which use of informatics technologies have improved triage, reduced patient waiting times, and mitigated overcrowding at large urban hospitals in China.

China accounts for 19% of the world population1 but only 5.5% of total gross domestic product for health expenditures.2 Most of the medical resources (eg, well-trained medical workers, advanced medical equipment) are concentrated in large tertiary hospitals. The large tertiary hospitals in the large cities have been overcrowded and adversely affected by the so-called three long, one short conditions (long registration and queue times; long waiting times; long dispensary and payment queue times; and short physician visit times). These factors have led to widespread patient dissatisfaction and have contributed to the fatigue of Chinese physicians who work long hours with overloaded schedules. State President Xi Jinping has described large urban hospitals in China as war zones, always in a “state of war” and overcrowded.3 The relatively scarce and uneven distribution of medical resources causes a serious imbalance between supply and demand, which has contributed to deteriorating patient-physician relationships. The frequent incidence of patient-physician disputes resulting in violence directed at some physicians in recent years is a matter of great concern to the Chinese government and to the global medical community.4

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