Evaluation of hospice and palliative care policies in China: a Theme-Instrument-Effectiveness (TIE) framework based on text analysis.
4 affiliations
- 1Department of Public Administration, School of Law, Jianghan University, Wuhan, 430056, China.
- 2Wuhan Institute for Megacity Governance, Wuhan, 430056, China.
- 3Department of Public Administration, School of Law, Jianghan University, Wuhan, 430056, China. [email protected].
- 4Wuhan Institute for Megacity Governance, Wuhan, 430056, China. [email protected].
Abstract
Background
China is undergoing rapid population aging, which has substantially increased the demand for hospice and palliative care (HPC). Systematic and quantitative evaluation of China's HPC policy corpus remains limited. This study addresses this gap through an integrated three-dimensional analytical framework examining policy themes, policy instruments, and text-based policy effectiveness.Methods
A corpus of 95 national-level, provincial-level, and selected sub-provincial pilot HPC policy documents (January 2011-May 2026) was analyzed using a Theme-Instrument-Effectiveness (TIE) framework combining three approaches: (1) Latent Dirichlet Allocation (LDA) topic modeling optimized by coherence score and perplexity, with labels reviewed by two independent coders until consensus; (2) NVivo-assisted content coding with substantial inter-coder reliability for policy-instrument coding (Cohen's κ = 0.75); and (3) a Policy Modeling Consistency (PMC) Index Model applied to 28 analytically representative policies across nine dimensions using binary coding with equal-weight aggregation.Results
Eight latent topics were identified, covering cancer prevention and control, digital economy, medical and health care, medical insurance management, elderly health, elderly care services, hospice and palliative care, and population development. Equity-oriented themes concerningrural elderly care, disabled and dementia elderly groups, grassroots service accessibility, rare disease prevention and treatment, and regionally balanced medical-resource allocation were not represented as standalone topics. Content coding of 1,784 coded text segments revealed a supply-dominant instrument structure (supply-side: 51.18%; environment-side: 29.99%; demand-side: 18.83%), with public awareness (1.01%) and financial support (2.86%) being the least-used subcategories. PMC evaluation yielded a mean score of 6.73 (Excellent); Policy Instruments (X4 = 0.98) and Policy Objectives (X5 = 0.87) performed strongest, while Policy Timeliness (X2 = 0.33) and Policy Perspective (X3 = 0.60) received comparatively lower scores, although the uniform X2 score was partly attributable to its operational definition.Conclusions
China's HPC policy system has established a broad institutional foundation but retains structural gaps in equity coverage and instrument balance. Future policies should strengthen legal safeguards, rebalance instruments toward demand- and environment-side mechanisms, expand coverage of underserved populations, and embed performance evaluation provisions to improve the internal coherence, operability, and accountability of policy texts.
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BibTeX
@article{li2026evaluation,
title = {{Evaluation of hospice and palliative care policies in China: a Theme-Instrument-Effectiveness (TIE) framework based on text analysis.}},
author = {Xinran Li and Lu Ke and Shuai Zheng and Haoran Qu and Jingkai Yue},
journal = {BMC palliative care},
year = {2026},
month = jul,
doi = {10.1186/s12904-026-02236-4},
url = {https://europepmc.org/article/MED/42897573},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Evaluation of hospice and palliative care policies in China: a Theme-Instrument-Effectiveness (TIE) framework based on text analysis.
AU - Xinran Li
AU - Lu Ke
AU - Shuai Zheng
AU - Haoran Qu
AU - Jingkai Yue
PY - 2026
DA - 2026/07/01
JO - BMC palliative care
DO - 10.1186/s12904-026-02236-4
UR - https://europepmc.org/article/MED/42897573
AB - Background China is undergoing rapid population aging, which has substantially increased the demand for hospice and palliative care (HPC). Systematic and quantitative evaluation of China's HPC policy corpus remains limited. This study addresses this gap through an integrated three-dimensional analytical framework examining policy themes, policy instruments, and text-based policy effectiveness.Methods A corpus of 95 national-level, provincial-level, and selected sub-provincial pilot HPC policy documents (January 2011-May 2026) was analyzed using a Theme-Instrument-Effectiveness (TIE) framework combining three approaches: (1) Latent Dirichlet Allocation (LDA) topic modeling optimized by coherence score and perplexity, with labels reviewed by two independent coders until consensus; (2) NVivo-assisted content coding with substantial inter-coder reliability for policy-instrument coding (Cohen's κ = 0.75); and (3) a Policy Modeling Consistency (PMC) Index Model applied to 28 analytically representative policies across nine dimensions using binary coding with equal-weight aggregation.Results Eight latent topics were identified, covering cancer prevention and control, digital economy, medical and health care, medical insurance management, elderly health, elderly care services, hospice and palliative care, and population development. Equity-oriented themes concerningrural elderly care, disabled and dementia elderly groups, grassroots service accessibility, rare disease prevention and treatment, and regionally balanced medical-resource allocation were not represented as standalone topics. Content coding of 1,784 coded text segments revealed a supply-dominant instrument structure (supply-side: 51.18%; environment-side: 29.99%; demand-side: 18.83%), with public awareness (1.01%) and financial support (2.86%) being the least-used subcategories. PMC evaluation yielded a mean score of 6.73 (Excellent); Policy Instruments (X4 = 0.98) and Policy Objectives (X5 = 0.87) performed strongest, while Policy Timeliness (X2 = 0.33) and Policy Perspective (X3 = 0.60) received comparatively lower scores, although the uniform X2 score was partly attributable to its operational definition.Conclusions China's HPC policy system has established a broad institutional foundation but retains structural gaps in equity coverage and instrument balance. Future policies should strengthen legal safeguards, rebalance instruments toward demand- and environment-side mechanisms, expand coverage of underserved populations, and embed performance evaluation provisions to improve the internal coherence, operability, and accountability of policy texts.
SN - 1472-684X
ER -