Current Application Status and Insights of the Ecology of Medical Care Model in Health Services Research: A Scoping Review
Keywords:
Ecology of medical care model, Health services needs and demand, Resource allocation, Health inequities, Population medicine, Scoping reviewAbstract
Background: Over the past decade, the ecology of medical care model has gained significant attention from scholars due to its prominent application value. Variations and shifts in the theoretical modeling constructs of this model can serve as indicators of the transformation in healthcare delivery, offering insights into the health needs of the population and the utilization of health services in China. Objective: This study aims to integrate and compare research utilizing the ecology of medical care model, describe the current status of such research, and contrast research methodologies and key findings. Methods: A comprehensive search was conducted in June 2022 using PubMed, Ovid Medline, Web of Science, Embase, China Biomedical Literature Service System, CNKI, and Wanfang databases. The search covered the period from 1961 to 2022 and was not limited by language. The Joanna Briggs Institute (JBI) methodology manual for scoping review guided the literature screening, information extraction, and descriptive analysis. Results: A total of 28 articles met the inclusion criteria, with 22 (78.6%) published after 2010. Most studies employing the ecology of medical care model focused on population health needs, healthcare resource utilization patterns, healthcare-seeking behavior, and disease referrals. Regarding the study population, 11 articles (39.3%) encompassed all age groups, while seven studies (25.0%) targeted specific populations. Four studies were conducted in urban areas of China. Compared to developed countries (regions), developing countries (regions) showed less emphasis on self-seeking help by patients (e.g., over-the-counter medicines, massages). Available ecological models indicated lower rates of patient self-reporting of health issues (symptoms) but higher rates of hospital outpatient and emergency room visits in developing countries (regions). Conclusion: The ecology of medical care model and its research methods have undergone significant evolution in the last two decades, maintaining their value as tools for researchers and policymakers to understand healthcare demand and the dynamics between healthcare resource supply and demand. Currently, the application of this model is limited in China, highlighting the need for future studies to utilize it to expose health inequities and unmet health needs in the country. Such research in the field of population medicine will provide evidence to enhance the rational allocation of health resources among the Chinese population.
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