Poster Abstracts
Climate change and quality of health care: evidence from
Published Online
October 18, 2019
School of Public Policy and
Administration, Xi’an Jiaotong
University, Xi’an, Shaanxi,
China (Y Si MPhil,
Prof Z Zhou PhD, M Su PhD); and
Department of Health Policy
and Management (Y Si,
Prof X Chen) and Department of
Economics (Y Si, Prof X Chen),
Yale University, New Haven,
CT, USA
Correspondence to:
Prof Xi Chen, Department of
Health Policy and Management
and Department of Economics,
Yale University, New Haven,
CT 06510, USA
xi.chen@yale.edu
94 www.thelancet.com
extreme heat
Yafei Si, Zhongliang Zhou, Min Su, Xi Chen
Abstract
Background Extreme temperatures, one of the most notable consequences of climate change, can reduce worker
productivity in physically demanding occupations and even inhibit cognitive skill development. We aimed to examine
whether heat waves can affect access to and quality of health care provided by physicians.
Methods We investigated the effect of heat waves on physicians using unique data on the quality of health care
provided at 63 community health centres in urban Xi’an, China. We used standardised patients recruited from the
local community and trained them to present consistent cases of illness to providers. Adherence to two clinical
checklists, thoroughness of physical examination, and accuracy of diagnoses were used to assess quality of primary
care through 492 interactions between physicians and standardised patients in Aug 17–28, 2017, and
July 30 to Aug 10, 2018. Exploiting random fluctuations in temperature and other weather patterns (air pollution,
wind speed, rainfall, sunlight hours, barometric pressure, and humidity) according to the exact time and geographical
locations of the interviews, we identified the effect of transitory exposures to heat waves on quality of health service
delivery in models with day-specific and community health centre-specific fixed effects.
Findings Extremely hot days are associated with improved quality of care. One Fahrenheit temperature increase
improves the adherence to clinical checklists by 1·51 units, representing an increase of 36·92% over the mean number
of checklist items completed by physicians (4·09 items; p<0·001). This improvement could be explained by fewer
patients waiting for services during hot days. However, the improved adherence to the clinical checklists was not
accompanied with a larger chance of physicians offering correct diagnoses or appropriate treatments. On average,
examinations ordered by physicians during heatwaves were 7·91 CNY more costly with one Fahrenheit temperature
increase.
Interpretation Higher temperatures improve quality of care via inducing fewer patients to seek necessary health
service and increasing physician adherence to clinical checklists when interacting with patients.
Funding National Natural Science Foundation of China, Shaanxi Social Science Foundation, Shaanxi Soft Science,
Shaanxi Provincial Youth Star of Science and Technology 2016, Xi’an Jiaotong University, Top-notch Young
Professionals of China and China Medical Board, China Scholarship Council, the US PEPPER Center Scholar Award,
National Institutes of Health, National Institute on Aging.
Contributors
XC and ZZ led the research and conceived the study. YS and MS did the field survey, and collected and analysed the data. YS and XC designed
the study, data analysis and interpretation, and drafted the manuscript. ZZ and MS designed the study and revised the abstract. All authors read
and approved the final version.
Declaration of interests
We declare no competing interests.
Acknowledgments
Ethics approval was obtained by the Ethics Committee of Xi’an Jiaotong University Health Science Center (approval number 2015-406).