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Hu F, Heming L, Wenxuan C, Xuemei W, Qijun L, Xiaobin H. Enhancing pooling levels strengthens the risk resilience of healthcare insurance: a case study of basic medical insurance fund operations data in Gansu, China. BMC Public Health 2024; 24:1129. [PMID: 38654172 DOI: 10.1186/s12889-024-18558-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In China, enhancing the pooling levels of basic health insurance has consistently been regarded as a pivotal measure to promote the refinement of the healthcare insurance system. From 2020 to 2022, the widespread outbreak of COVID-19 posed new challenges to China's basic health insurance. METHODS The research utilizes Data Envelopment Analysis (DEA), Malmquist index assessment, and fixed-effects panel Tobit models to analyze panel data from 2020 to 2022, assessing the efficiency of basic health insurance in Gansu Province. RESULTS From 2020 to 2022, the average overall efficiency of the municipal pooling of Basic Medical Insurance for Urban and Rural Residents was 0.941, demonstrating a stable trend with a modest increase. The efficiency frontier regions have expanded from 5 (35.71%) to 7 (50%). Operational efficiency exhibited a negative correlation with per capita hospitalization expenses and per capita fund balance but a positive correlation with per capita accumulated fund balance and reimbursement rates for hospitalized patients. In 2021, compared to 2020, the county-pooling Basic Medical Insurance for Urban Employees saw a decline of 0.126 in overall efficiency, reducing the efficiency frontier regions from 8 to 3. However, from 2021 to 2022, the municipal-coordinated Basic Medical Insurance for Urban Employees experienced a 0.069 increase in overall efficiency, with the efficiency frontier regions expanding from 3 to 5. Throughout 2020 to 2022, the operational efficiency of the Urban Employee Basic Medical Insurance showed a consistent negative correlation with per capita fund balance. CONCLUSION From 2020 to 2022, the overall operational performance of basic health insurance in Gansu Province was satisfactory, and enhancing the pooling level is beneficial in addressing the impact of unforeseen events on the health insurance system.
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Affiliation(s)
- Feng Hu
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, China
| | - Liu Heming
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, China
| | - Cao Wenxuan
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, China
| | - Wang Xuemei
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, China
| | - Liang Qijun
- Gansu Provincial Medical Insurance Service Centre, 730000, Gansu, China
| | - Hu Xiaobin
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000, Lanzhou, Gansu, China.
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Cui Y, Lv J, Hu X, Zhu D. Health insurance as a moderator in the relationship between financial toxicity and medical cost-coping behaviors: Evidence from patients with lung cancer in China. Cancer Med 2024; 13:e6911. [PMID: 38168130 PMCID: PMC10807627 DOI: 10.1002/cam4.6911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/05/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This study investigates the relationship between financial toxicity and medical cost-coping behaviors (MCCB) in Chinese patients with lung cancer, with a particular focus on the moderating role of health insurance. METHODS We surveyed 218 patients with lung cancer and assessed their Comprehensive Score for Financial Toxicity (COST) and self-reported MCCB. Patients were categorized into Urban Employee's Basic Medical Insurance (UEBMI) group and Urban-Rural Resident Basic Medical Insurance Scheme (URRBMI) groups by their medical insurance, and matched for socioeconomic, demographic, and disease characteristics via propensity score. RESULTS Significant different characteristics were noted between UEBMI patients and URRBMI patients. Patients with UEBMI had higher COST scores but lower levels of MCCB compared to URRBMI patients in the original dataset. After data matching, multivariate logit regression analysis showed that better financial toxicity was associated with lower levels of MCCB (OR = 0.95, 95% CI: 0.92-0.99). Health insurance type did not have a direct association with cost-coping behaviors, but an interaction was observed between health insurance type and financial toxicity. Among patients with URRBMI, better financial toxicity was associated with lower levels of cost-coping behaviors (OR = 0.89, 95% CI: 0.83-0.95). Patients with UEBMI had a lower probability of engaging in any cost-coping behaviors in situations of worse financial toxicity compared to patients with URRBMI. CONCLUSION The findings suggest that financial toxicity is correlated with MCCB in Chinese patients with lung cancer. The type of health insurance, specifically UEBMI and URRBMI, plays a moderating role in this relationship. Understanding these dynamics is essential for developing targeted interventions and policies to mitigate financial toxicity and improve patients' management of medical costs.
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Affiliation(s)
- Yongchun Cui
- Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jingjing Lv
- Expanded Program Immunization Division of Shandong Provincial Center for Disease Control and PreventionShandong Provincial Key Laboratory of Infectious Disease Control and PreventionJinanChina
- School of Public Health, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Xiaoyu Hu
- Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Dawei Zhu
- China Center for Health Development StudiesPeking UniversityBeijingChina
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Wu J, Peng Y. Understanding unmet medical needs through medical crowdfunding in China. Public Health 2023; 223:202-208. [PMID: 37672833 DOI: 10.1016/j.puhe.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 07/08/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Online medical crowdfunding has gained popularity in recent years in China. The objective of this study was to identify unmet medical needs in the public healthcare system through analysis of Chinese medical crowdfunding data. STUDY DESIGN Text information extraction and statistical analysis based on large-scale data. METHODS From 19 June 2011 to 15 March 2020, data from 30,704 medical crowdfunding projects were collected from Tencent GongYi, which is one of the largest Chinese medical crowdfunding platforms. Text mining methods were used to extract data on the medical conditions and locations of the applicants of medical crowdfunding. In addition, 125 medical crowdfunding projects initiated by leukaemia patients in Chongqing and Nanyang were further investigated through manual data extraction, and the factors impacting the fundraising goals were explored using a generalised linear model. RESULTS The most common conditions using medical crowdfunding to raise funds were as follows: cancer (31.87%), chronic conditions (18.14%), accidental injury (7.80%) and blood system-related conditions (7.75%). Treatments for cancer and blood system-related conditions are expensive and have serious long-term impacts on the lives of patients. Results showed that the cities of Nanyang and Chongqing had the largest number of crowdfunding projects. CONCLUSIONS This study found that the medical conditions that prompted individuals to apply for crowdfunding were those with long treatment cycles, complexities and expensive medical or non-medical costs. Furthermore, discrepancies in health insurance policies between different regions and residents seeking treatments outside their insurance locations were also important factors that triggered medical crowdfunding applications. Adjusting health insurance policies accordingly may improve the efficiency of utilising health insurance resources and reduce the financial burden on patients.
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Affiliation(s)
- Junhong Wu
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Peng
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, China.
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Wang H, Gong X. Adverse selection and health insurance decisions of young migrant workers: An empirical study in China. Front Public Health 2023; 11:1084133. [PMID: 36960379 PMCID: PMC10027710 DOI: 10.3389/fpubh.2023.1084133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/02/2023] [Indexed: 03/09/2023] Open
Abstract
Using data from the China Migrants Dynamic Survey (CMDS) in 2017, this study assessed adverse selection and the impact of mobility factors on adverse selection by analyzing two samples of young migrant workers. The results of the sample analysis showed that young migrant workers with higher health risks were more inclined to enroll in health insurance, indicating the presence of adverse selection. Mobility distance and settle intention have a heterogeneous effect on adverse selection, with young workers who migrate inter-provincially and intend to settle down being more susceptible. The analysis of the insured samples showed that the phenomenon of adverse selection was also evident in the choice of health insurance, with individuals with higher risks preferring Urban Employee Basic Medical Insurance (UEBMI), which has better financial coverage and benefits compared to Rural Residents' Basic Medical Insurance (URRBMI). The heterogeneity test confirmed that mobility distance plays a role in determining the likelihood of adverse selection, with inter-city and inter-province young migrant workers being more likely to show adverse selection.
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Affiliation(s)
| | - Xi Gong
- School of Public Administration and Policy, Renmin University of China, Beijing, China
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Association between multimorbidity patterns and healthcare costs among middle-aged and older adults in China. Arch Gerontol Geriatr 2023; 109:104959. [PMID: 36804649 DOI: 10.1016/j.archger.2023.104959] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND This study investigated multimorbidity patterns among middle-aged and older Chinese people and whether healthcare costs varied among different multimorbidity patterns. METHODS Data were from the 2011-2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We included 20,855 unique observations with information coming from their last wave of interviews and aged at least 45 years or older. Latent class analysis (LCA) was performed to classify individuals with common multimorbidity clusters based on 14 self-reported chronic diseases. Healthcare costs were from participants' self-reports and categorized into outpatient, inpatient, and self-treatment. Two-part regression was performed to analyze the association of multimorbidity patterns with healthcare costs. RESULTS Five multimorbidity clusters were identified: minimal disease, arthritis, cardiovascular disease (CVD), lung/asthma, and multisystem morbidity. The multisystem morbidity group had the highest use in all three types of healthcare and the highest self-treatment cost. Compared with the minimal disease group, the other four groups did not show significant differences in outpatient costs. Relative to the minimal disease group, the lung/asthma group reported lower inpatient costs. CONCLUSION Healthcare use and costs varied across multimorbidity patterns among middle-aged and older Chinese people. Implementing an integrated care plan for multimorbidity is suggested to improve the cost-effectiveness of healthcare provision and reduce the financial burden of the healthcare system. Reimbursement policy design should also take multimorbidity patterns into account.
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Shi Z, He P, Zhu D, Lu F, Meng Q. Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China. BMC Health Serv Res 2022; 22:1226. [PMID: 36192795 PMCID: PMC9528155 DOI: 10.1186/s12913-022-08602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China expanded health coverage to residents in informal economic sectors by the rural new cooperative medical scheme (NCMS) for rural population and urban resident basic medical insurance scheme (URBMI) for non-working urban residents. Fragmentation of resident social health insurance schemes exacerbated the health inequity and China started the integration of urban and rural resident medical insurance schemes since 2016. Beijing finished the insurance integration in 2017 and has been implementing a unified urban and rural resident basic medical insurance scheme (URRBMI) since the beginning of 2018. This study aims to examine changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes. METHODS We used household survey data from Beijing Health Services Survey in 2013 and 2018. Respondents who were 15 or older and covered by URBMI, NCMS or URRBMI were included in this study. Our study finally included 8,554 individuals in 2013 and 6,973 individuals in 2018, about 70% of which were rural residents in each year. Descriptive analysis was used to compare the healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure between different groups. A series of two-part regression models were used to analyze the changes of healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure. RESULTS From 2013 to 2018, urban-rural disparity in outpatient care utilization seemed widened because urban residents' utilization of outpatient care increased 131% while rural residents' utilization only increased 72%; both rural and urban residents' spending on outpatient care increased about 50%. Utilization of inpatient care changed little and poor residents still used significantly less inpatient care compared with the rich residents. Poor residents still suffered heavily catastrophic health expenditures. CONCLUSION From 2013 to 2018, residents' utilization of healthcare, especially outpatient care, increased in Beijing. Health insurance reforms increased residents' utilization of healthcare but failed to reduce their healthcare financial burden, especially for poor people. Our study advocates more pro-poor insurance policies and more efforts on the efficiency of health system.
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Affiliation(s)
- Zhenyu Shi
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Feng Lu
- Beijing Municipal Health Big Data and Policy Research Center, Beijing, China
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China.
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Li J, Lan Q, Zhu E, Xu Y, Zhu D. A Study of Health Insurance Fraud in China and Recommendations for Fraud Detection and Prevention. J ORGAN END USER COM 2022. [DOI: 10.4018/joeuc.301271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Healthcare insurance fraud influences not only organizations by overburdening the already fragile healthcare systems, but also individuals in terms of increasing premiums in health insurance and even fatalities. Identifying the behavioral characteristics of fraudulent claims can help shed light on the development of artificial intelligence and machine learning technologies to detect fraud in health information system research. In this paper, a theoretical model of medical insurance fraud identification is proposed, which characterizes the judgment variables of fraud from the three dimensions of time, quantity, and expenses. The model is verified with large-scale, real-world medical records. Our study shows that, in comparison with claims made by normal people, fraudulent claims usually have a greater frequency of hospital visits, and more medical bills, accompanied by higher amounts of medical expenses. An interesting discovery is that the price per bill for fraudulent cases is not statistically different from the normal cases.
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Affiliation(s)
- Jie Li
- Hebei University of Technology, China
| | | | | | - Yong Xu
- Hebei University of Technology, China
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Ye C, Zheng X, Aihemaitijiang S, Wang R, Halimulati M, Huang X, Zhang Z. Sarcopenia and catastrophic health expenditure by socio-economic groups in China: an analysis of household-based panel data. J Cachexia Sarcopenia Muscle 2022; 13:1938-1947. [PMID: 35470981 PMCID: PMC9178372 DOI: 10.1002/jcsm.12997] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/19/2022] [Accepted: 03/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sarcopenia was thought to be associated with adverse outcomes and will cause lots of health expenditure. But the relationship between sarcopenia and catastrophic health expenditure (CHE) had been little explored. Here, we examined the distribution of sarcopenia in relation to medical and payment burdens. METHODS We used data from three waves of China Health and Retirement Longitudinal Study including 14 130 participants from 9077 households aged over 50 years old. Sarcopenia was operationalized according to the Asian Working Group for Sarcopenia 2019. Medical expenditure was obtained by self-reported data, and CHE was identified by WHO definitions. We used the negative binomial regression model and logistic mixed-effects models to examine the associations between sarcopenia and medical and CHE. RESULTS A total of 14 130 participants [52.2% female, aged 60.8 (SD 9.3)] from 9077 households were included in this study. The prevalence of sarcopenia was 19.8%, 11.9% for moderate sarcopenia, and 7.9% for severe sarcopenia, respectively. We identified 1416 household CHE events in all three waves. Severe sarcopenia was associated with an increase in the number of inpatient visits [incidence rate ratio 1.31, 95% confidence interval (CI): 1.03-1.66, P = 0.03] and the risk of CHE (odds ratio: 1.04, 95% CI: 1.01-1.07, P < 0.01). We saw similar effects in health service use of sarcopenia in different socio-economic groups. Moderate sarcopenia increased the risk of CHE in the lowest socio-economic group (odds ratio 1.03, 95% CI: 1.01-1.06, P = 0.03) and had no statistical significance in other groups. The association between severe sarcopenia and CHE did not attenuate after the adjustment of disease factors. CONCLUSIONS Severe sarcopenia may increase the risk of CHE. Timely and effective intervention on moderate sarcopenia from severe sarcopenia will contribute to reduce the health burden.
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Affiliation(s)
- Chen Ye
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xu Zheng
- Peking University Third Hospital, Beijing, China
| | - Sumiya Aihemaitijiang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ruoyu Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Mairepaiti Halimulati
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xiaojie Huang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhaofeng Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
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Xu Y, Zhou Y, Pramono A, Liu Y, Jia C. A 25-Year Trend of Catastrophic Health Expenditure and Its Inequality in China: Evidence from Longitudinal Data. Risk Manag Healthc Policy 2022; 15:969-981. [PMID: 35592442 PMCID: PMC9112452 DOI: 10.2147/rmhp.s358641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/04/2022] [Indexed: 01/26/2023] Open
Abstract
Purpose The Chinese government has carried out two major cycles of reform to improve the health system and reduce the disease burden on residents. This study aims to comprehensively track the trends in the occurrence of catastrophic health expenditure (CHE) and its inequality in the past 25 years, which may help better understand the influence of health system reforms on CHE and its inequality. Methods The study employed the subset of data from China Health and Nutrition Survey conducted from 1991 to 2015. Health payments and net household income were used to calculate CHE. Concentration index and decomposition analysis were used to measure the magnitude of income-related inequality in CHE and decompose it into determinants, respectively. Results The incidence of CHE in China increased from 3.10% in 1993 to 8.90% in 2004 and still maintained at a high level in the following years. The incidence gap of CHE between the richest and poorest became increasingly wider over year. Moreover, the values of adjusted concentration indexes were all negative in each year, decreasing from −0.202 in 1991 to −0.613 in 2015. Income was consistently the largest contributor to the inequality in CHE. The basic medical insurance did not decrease the incidence of CHE and showed the second largest contribution on its inequality before 2004. However, this contribution began to decline after 2006. Conclusion After the New Health Care Reform, despite many measures taken by the Chinese government, there was still a high incidence of CHE and an increasing inequality from 1991 to 2015. The basic medical insurance in China was not enough to protect households from CHE. The use of big data tools and techniques to effectively screen the poor households, and strengthening the social medical aid system would be helpful to decrease the inequality in CHE.
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Affiliation(s)
- Yongjian Xu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Correspondence: Yongjian Xu, School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049, People’s Republic of China, Tel +8618202985437, Email
| | - Yiting Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Andi Pramono
- Community and Aged Care Services, Hunter New EnglAnd Health, NSW, Australia
| | - Yazhuo Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Cong Jia
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Zuo F, Zhai S. The Influence of China's COVID-19 Treatment Policy on the Sustainability of Its Social Health Insurance System. Risk Manag Healthc Policy 2021; 14:4243-4252. [PMID: 34703336 PMCID: PMC8523901 DOI: 10.2147/rmhp.s322040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background While past experiences show that a health system financing mechanism can support resilience to shocks, the impact on the sustainability of the financing system is exceptionally important considering the magnitude of the COVID-19 pandemic. The role of Social Health Insurance (SHI) in responding to the pandemic brings about an influence on insurance system sustainability. This study investigates the impact of China’s COVID-19 treatment policy on the sustainability of its SHI system, explores influences of the policy on Wuhan’s system, and discusses the effects of an assumed equivalent emergency on SHI funds for five other provincial capital cities in China. Methods The study was conducted using pay-as-you-go actuarial models of Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI) funds, which constitute China’s basic health insurance system. Current and accumulated balances of the funds in 2020 are predicted and utilized to measure the sustainability of health insurance funds during emergencies. Results The findings suggest a disparity in the capacities of insurance schemes and localities. If the surplus before 2018 is not considered, it is likely that the URRBMI fund of Wuhan would suffer a deficit, whereas the UEBMI would retain a considerable surplus. To maintain the current actuarial balance of the URRBMI fund, coverage for ordinary inpatient and outpatient expenses would have to be significantly reduced in Wuhan, potentially affecting enrollees’ wellbeing. A similar situation may occur in three other cities, some with underdeveloped economies and lower per capita income are likely to be encountered with worse situation than Wuhan. Conclusion Concerning fragmentation of China’s SHI system, to strengthen longer-term preparedness to manage future emergencies, this study suggests the integration of insurance schemes and provincial pooling, fund balance adjusting and an emergency safety net are also advised. All options call for more public health investments.
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Affiliation(s)
- Fei Zuo
- Department of Finance, Economics and Management School, Northwest University, Xi'an, Shaanxi Province, People's Republic of China
| | - Shaoguo Zhai
- Department of Social Security, Public Management School, Northwest University, Xi'an, Shaanxi Province, People's Republic of China
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Jiang H, Zhao M, Tian G, Zhao Z, Ding D, Yin M. Perceived effect of financial risk protection by the Urban-Rural Resident Basic Medical Insurance Scheme: a mixed-methods study of rural residents in China. BMJ Open 2021; 11:e047699. [PMID: 34667000 PMCID: PMC8527163 DOI: 10.1136/bmjopen-2020-047699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is to explore the perceived financial risk protection effect of the Urban-Rural Resident Basic Medical Insurance Scheme (URRBMI) and its influencing factors to provide evidence to further improve the URRBMI. DESIGN It is a cross-sectional survey. PARTICIPANTS This mixed-methods study is conducted in five provinces in rural China. Through stratified cluster random sampling, 1681 rural residents participate in a cross-sectional questionnaire survey (1657 valid questionnaires are retrieved). Thirty rural residents participate in in-depth interviews. PRIMARY AND SECONDARY OUTCOME MEASURES A multivariate logistic regression analysis is adopted to identify factors influencing respondents' perceptions. Semistructured interviews are used to identify the reasons why some respondents believed the URRBMI to be ineffective. RESULTS Overall, 77.5% of respondents believe that the URRBMI is effective. Respondents, who are older, have a higher household income, prefer primary health facilities and provide a higher rating for critical illness compensation and maximum compensatory payouts. They are more likely to give the URRBMI a higher effectiveness rating than their counterparts. Qualitatively, participants who believe the URRBMI to be ineffective list the following reasons: low outpatient service coverage, insufficient or undersupplied drugs and services in the insurance list, problems in the arrangement of deductibles and maximum compensatory payouts, provider-induced behaviour and increased healthcare service price. CONCLUSIONS This exploration focuses on the reasons why rural residents think the scheme is invalid, which are vital for policy reform. Policies should focus on benefits design and coverage, the assumption of a supervisory role, avoiding financial risk stemming from critical illness and cross-sectoral actions to strengthen the primary healthcare system and comprehensive social security wealth.
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Affiliation(s)
- Huan Jiang
- Humanities and Social Sciences College, Harbin Medical University, Harbin, China
| | - Miaomiao Zhao
- Department of health management, Shcool of public health, Nantong university, Nantong, Jiangsu,China
| | - Guomei Tian
- Fourth affiliate hospital of Harbin Medical University, Harbin, Heilongjiang,China
| | - Zihua Zhao
- Scientific Research Department, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ding Ding
- Department of Social Medicine, Dalian Medical University, Dalian, China
| | - Mei Yin
- Humanities and Social Sciences College, Harbin Medical University, Harbin, China
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Ma C, Huo S, Chen H. Does integrated medical insurance system alleviate the difficulty of using cross-region health Care for the Migrant Parents in China-- evidence from the China migrants dynamic survey. BMC Health Serv Res 2021; 21:1053. [PMID: 34610829 PMCID: PMC8493687 DOI: 10.1186/s12913-021-07069-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many internal migrants during the urbanization process in China are Migrant Parents, the aging group who move to urban areas to support their family involuntarily. They are more vulnerable economically and physically than the younger migrants. However, the fragmentation of rural and urban health insurance schemes divided by "hukou" household registration system limit migrant's access to healthcare services in their resident location. Some counties have started to consolidate the Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical Scheme (NRCMS) as one Integrated Medical Insurance Schemes (IMIS) from 2008. The consolidation aimed to reduce the disparity between different schemes and increase the health care utilization of migrants. RESULTS Using the inpatient sample of migrant parents from China Migrants Dynamic Survey in 2015, we used Ordinary Least Squares (OLS) for regression models. We found that the migrant parents covered by the IMIS are more likely to choose inpatient services and seek medical treatment in the migrant destination. We further subdivide Non-IMISs into NCMSs and URBMIs in the regression to alleviate the doubt about endogenous. The results revealed that the migrant parents in IMIS use more local medical services than both of them in URBMI and NCMS. CONCLUSIONS The potential mechanisms of our results could be that IMIS alleviates the difficulty of seeking medical care in migrant destinations by improving the convenience of medical expense reimbursement and enhancing health insurance benefits.
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Affiliation(s)
- Chao Ma
- Southeast University, School of Economics and Management, Nanjing, Jiangsu China
| | - Shutong Huo
- University of California, Irvine, Program of Public Health, Irvine, CA USA
| | - Hao Chen
- University of International Business and Economics, Institute of International Economy, Irvine, CA USA
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Jia J, Song L, Li L. WITHDRAWN: Impact of basic medical insurance fund risk on the health risk assessment of urban residents. Work 2021:WOR205352. [PMID: 34308921 DOI: 10.3233/wor-205352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ahead of Print article withdrawn by publisher.
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Affiliation(s)
- Jianyu Jia
- School of Economics, Beijing Technology and Business University, Beijing, China
| | - Li Song
- School of Economics, Beijing Technology and Business University, Beijing, China
| | - Lin Li
- Lyceum of the Philippines University, Manila, Philippines
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Liu C, Liu ZM, Nicholas S, Wang J. Trends and determinants of catastrophic health expenditure in China 2010-2018: a national panel data analysis. BMC Health Serv Res 2021; 21:526. [PMID: 34051762 PMCID: PMC8164806 DOI: 10.1186/s12913-021-06533-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Catastrophic health expenditures (CHE) are out-of-pocket payments (OOP) that exceed a predefined percentage or threshold of a household's resources, usually 40 %, that can push households into poverty in China. We analyzed the trends in the incidence and intensity, and explored the determinants, of CHE, and proposed policy recommendation to address CHE. METHODS A unique 5-year national urban-rural panel database was constructed from the China Family Panel Studies (CFPS) surveys. CHE incidence was measured by calculating headcount (percentage of households incurring CHE to the total household sample) and intensity was measured by overshoot (degree by which an average out of pocket health expenditure exceeds the threshold of the total sample). A linear probability model was employed to assess the trend in the net effect of the determinants of CHE incidence and a random effect logit model was used to analyse the role of the characteristics of the household head, the household and household health utilization on CHE incidence. RESULTS CHE determinants vary across time and geographical location. From 2010 to 2018, the total, urban and rural CHE incidence all showed a decreasing tend, falling from 14.7 to 8.7 % for total households, 12.5-6.6 % in urban and 16.8-10.9 % in rural areas. CHE intensity decreased in rural (24.50-20.51 %) and urban (22.31-19.57 %) areas and for all households (23.61-20.15 %). Inpatient services were the most important determinant of the incidence of CHE. For urban households, the random effect logit model identified household head (age, education, self-rated health); household characteristics (members 65 + years, chronic diseases, family size and income status); and healthcare utilization (inpatient and outpatient usage) as determinants of CHE. For rural areas, the same variables were significant with the addition of household head's sex and health insurance. CONCLUSIONS The incidence and intensity of CHE in China displayed a downward trend, but was higher in rural than urban areas. Costs of inpatient service usage should be a key intervention strategy to address CHE. The policy implications include improving the economic level of poor households, reforming health insurance and reinforcing pre-payment hospital insurance methods.
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Affiliation(s)
- Cai Liu
- School of Management, Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Zhao-min Liu
- Jining Medical University, 669 Xueyuan Road, Donggang District, 276826 Rizhao City, Shandong Province China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, 1 Central Avenue Australian Technology Park, Eveleigh, NSW 2015 Sydney, Australia
- School of Economics and School of Management, Tianjin Normal University, West Bin Shui Avenue, 300074 Tianjin, China
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun Avenue North, 510420 Guangzhou, China
- Newcastle Business School, University of Newcastle, University Drive, 2308 Newcastle, NSW Australia
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, No.54 Dongsi Lishi Hutong, Dongcheng District, 100010 Beijing, China
- Center for Health Economics and Management, School of Economics and Management, Wuhan University, 299 Bayi Road, Wuchang District, 430072 Wuhan, Hubei Province China
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15
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Lyu X, Liu Y, Yu H, Mi M, Shang L, Zhong Y, Xie D. Development and validation of a risk perception scale of medical help-seeking behavior in Chinese adults. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1352. [PMID: 33313097 PMCID: PMC7723601 DOI: 10.21037/atm-20-1656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background When people require medical treatment, many risk factors including adverse medical events, economic burdens, and social–psychological consequences may contribute to their hesitation to seek medical help. Therefore, a reliable and valid instrument that can comprehensively assess the risk perception of medical help-seeking behavior among ordinary Chinese adults should be developed. Methods The basic dimensions of the scale were determined based on literature review and in-depth interviews with patients. Then, an item pool with 32 items and six dimensions was developed. After the item reduction process based on item and factor analyses, a three-factor, 16-item scale was established. From March 2019, this scale was distributed among 639 healthy adults, outpatients, or inpatients in 20 provinces and municipalities in the mainland of China by convenience sampling. Then, the reliability and validity of the scale were examined. Results The scale consists of three dimensions (treatment risks, burden risks, and stigma risks) and 16 items. The root-mean-square error of approximation, comparative fit index, and Tucker-Lewis index of this model were 0.069, 0.925, and 0.910, respectively. The internal consistency reliability of the scale was 0.893, and the test-retest reliability was 0.784. The criterion-related validity was 0.720 (P<0.01). Conclusions The risk perception scale of medical help-seeking behavior is a reliable and valid instrument to measure Chinese adults’ perception for potential risks in the process of medical treatment.
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Affiliation(s)
- Xiaokang Lyu
- Computational Social Science Laboratory, Nankai University, Tianjin, China.,Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Ying Liu
- Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Huaran Yu
- Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Mingdi Mi
- Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Lijun Shang
- Computational Social Science Laboratory, Nankai University, Tianjin, China
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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16
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Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176327. [PMID: 32878066 PMCID: PMC7504160 DOI: 10.3390/ijerph17176327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
On-the-spot settlements of medical bills for internal migrants enrolled with a social health insurance program outside of their residential location have been encouraged by the Chinese government, with the intention to improve equality in healthcare services. This study compared the use of health services between the internal migrants who had local health insurance coverage and those who did not. Data (n = 144,956) were obtained from the 2017 China Migrants Dynamic Survey. Use of health services was assessed by two indicators: visits to physicians when needed and registration (shown as health records) for essential public health services. Multi-level logistic regression models were established to estimate the effect size of fund location on the use of health services after controlling for variations in other variables. The respondents who enrolled with a social health insurance scheme locally were more likely to visit physicians when needed (adjusted odds ratio (AOR) = 1.18, 95% CI = 1.06–1.30) and to have a health record (AOR = 1.47, 95% CI = 1.30–1.65) compared with those who enrolled outside of their residential location: a gap of 3.5 percentage points (95% CI: 1.3%–5.8%) and 6.1 percentage point (95% CI: 4.3%–7.8%), respectively. The gaps were larger in the rural-to-urban migrants than those in the urban-to-urban migrants (AOR = 1.17, 95% CI = 0.93–1.48 for visiting physicians when needed; AOR = 0.71, 95% CI = 0.54–0.93 for having a health record). The on-the-spot medical bill settlement system has yet to fully achieve its proposed potential as inequalities in both medical and public health services remain between the internal migrants with and without local health insurance coverage. Further studies are needed to investigate how on-the-spot settlements of medical bills are implemented through coordination across multiple insurance funds.
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17
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Zhao Y, Atun R, Oldenburg B, McPake B, Tang S, Mercer SW, Cowling TE, Sum G, Qin VM, Lee JT. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. LANCET GLOBAL HEALTH 2020; 8:e840-e849. [PMID: 32446349 PMCID: PMC7241981 DOI: 10.1016/s2214-109x(20)30127-3] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 01/28/2023]
Abstract
Background Multimorbidity, the presence of two or more mental or physical chronic non-communicable diseases, is a major challenge for the health system in China, which faces unprecedented ageing of its population. Here we examined the distribution of physical multimorbidity in relation to socioeconomic status; the association between physical multimorbidity, health-care service use, and catastrophic health expenditures; and whether these associations varied by socioeconomic group and social health insurance schemes. Methods In this population-based, panel data analysis, we used data from three waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS) for 2011, 2013, and 2015. We included participants aged 50 years and older in 2015, who had complete follow-up for the three waves. We used 11 physical non-communicable diseases to measure physical multimorbidity and annual per-capita household consumption spending as a proxy for socioeconomic status. Findings Of 17 708 participants in CHARLS, 11 817 were eligible for inclusion in our analysis. The median age of participants was 62 years (IQR 56–69) in 2015, and 5766 (48·8%) participants were male. 7320 (61·9%) eligible participants had physical multimorbidity in China in 2015. The prevalence of physical multimorbidity was increased with older age (odds ratio 2·93, 95% CI 2·71–3·15), among women (2·70, 2·04–3·57), within a higher socioeconomic group (for quartile 4 [highest group] 1·50, 1·24–1·82), and higher educational level (5·17, 3·02–8·83); however, physical multimorbidity was more common in poorer regions than in the more affluent regions. An additional chronic non-communicable disease was associated with an increase in the number of outpatient visits (incidence rate ratio 1·29, 95% CI 1·27–1·31), and number of days spent in hospital as an inpatient (1·38, 1·35–1·41). We saw similar effects in health service use of an additional chronic non-communicable disease in different socioeconomic groups and among those covered by different social health insurance programmes. Overall, physical multimorbidity was associated with a significantly increased likelihood of catastrophic health expenditure (for the overall population: odds ratio 1·29, 95% CI 1·26–1·32, adjusted for sociodemographic variables). The effect of physical multimorbidity on catastrophic health expenditures persisted even among the higher socioeconomic groups and across all health insurance programmes. Interpretation Concerted efforts are needed to reduce health inequalities that are due to physical multimorbidity, and its adverse economic effect in population groups in China. Social health insurance reforms must place emphasis on reducing out-of-pocket spending for patients with multimorbidity to provide greater financial risk protection. Funding None.
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Affiliation(s)
- Yang Zhao
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia; The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health and Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Brian Oldenburg
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia
| | - Barbara McPake
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Thomas E Cowling
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vicky Mengqi Qin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - John Tayu Lee
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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18
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What Are the Determinants of the Decision to Purchase Private Health Insurance in China? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155348. [PMID: 32722244 PMCID: PMC7432421 DOI: 10.3390/ijerph17155348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess the determinants of the decision to purchase private health insurance (PHI) in China. Nationally representative data from the fourth wave of the China Household Finance Survey from 2017 were used, and the dataset comprised 105,691 individuals aged 18 years or older. The Andersen health services utilization model was used to inform the research. Chi-square tests and logistic regression analyses were used to estimate the decision to purchase PHI. The proportion of the sample that had PHI was small, at 5.06%, but coverage for social basic medical insurance (SBMI) was 90.64%. Among PHI holders, the overwhelming majority (87.40%) also had SBMI. Logistic regression analysis demonstrated that predisposing factors (age, education, marital status, household size), enabling factors (household income, SBMI status, geographical factors, household medical expense, and medical debt), and needs-based factors (health status) were statistically significant determinants of the decision to purchase PHI. This study suggests that the socio-economic circumstances of households play a crucial role in the decision to acquire PHI. The findings may be used by the insurance industry to inform actions to enhance PHI coverage and by policy decision-makers that seek to improve equality in access to PHI.
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19
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O'Connor CT, Mulcahy D. COVID-19: the heart and other issues. THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:18. [PMID: 35747083 PMCID: PMC9205237 DOI: 10.5837/bjc.2020.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
From the time that the first cases were reported from Wuhan, China on the 31st December 2019,1 our knowledge of the clinical and virological associations of the novel coronavirus (COVID-19) has been evolving at a rapid pace. On 18th May 2020, COVID-19 had caused over 4.82 million cases worldwide and resulted in 316,959 deaths.2 Whilst the primary focus of management for patients with COVID-19 remains close monitoring of respiratory function, there have been high levels of cardiac dysfunction in emerging cross-sectional and observational analyses, suggesting the need for heightened awareness in patients who may require cardiac input as part of a multidisciplinary approach. We review the current data on the association of COVID-19 and the heart.
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Affiliation(s)
| | - David Mulcahy
- Consultant Cardiologist, Tallaght University Hospital, Dublin 24, Ireland
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20
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Wo T, Liu J, Li G, Xi X. Factors influencing individuals' take-up of tax-subsidized private health insurance: a cross-sectional study in China. J Med Econ 2020; 23:760-766. [PMID: 32122186 DOI: 10.1080/13696998.2020.1737535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: To identify factors influencing individuals' take-up of tax-subsidized private health insurance.Methods: A self-administered questionnaire survey was conducted to collect data in Hangzhou, China. A logistic regression analysis was applied to find factors influencing individuals' take-up of tax-subsidized private health insurance.Results: A total of 1,610 participants joined the survey, and 1,543 valid cases were obtained. The logistic regression results showed that educational level, marital status, the number of elderly people to support, types of basic medical insurance covered, disease history, reimbursement rate of outpatient visits, reimbursement rate of inpatient visits, knowledge of tax-subsidized private health insurance, and ratio of the deduction to income influenced individuals' take-up of tax-subsidized private health insurance.Limitations: Sample representativeness may be sacrificed by the fact that the data were collected from one city (Hangzhou) in a cross-sectional investigation.Conclusions: Demographic variables, such as educational level, marital status, and the number of elderly people to support, have an impact on individuals' take-up of tax-subsidized private health insurance, while age and gender are not significant. People with disease history are more likely to take out tax-subsidized private health insurance. The ratio of deduction to income is positively correlated with the take-up of tax-subsidized private health insurance. Suggestions, such as strengthening the publicity of tax-subsidized private health insurance, increasing the deduction amount, and encouraging employers to provide tax-subsidized private health insurance for employees' families are provided with the hope to promote the development of tax-subsidized private health insurance in China.
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Affiliation(s)
- Tian Wo
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Jie Liu
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Gaojie Li
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
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21
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Qin VM, McPake B, Raban MZ, Cowling TE, Alshamsan R, Chia KS, Smith PC, Atun R, Lee JT. Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample. BMC Health Serv Res 2020; 20:372. [PMID: 32366235 PMCID: PMC7197140 DOI: 10.1186/s12913-020-05194-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. Method We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. Findings Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). Conclusion Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.
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Affiliation(s)
- Vicky Mengqi Qin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Thomas E Cowling
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Riyadh Alshamsan
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Peter C Smith
- Centre for Health Economics, University of York, York, UK.,Imperial College London, London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - John Tayu Lee
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
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22
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Liu N, Bao G, He AJ. Does health insurance coverage reduce informal payments? Evidence from the "red envelopes" in China. BMC Health Serv Res 2020; 20:95. [PMID: 32028953 PMCID: PMC7006416 DOI: 10.1186/s12913-020-4955-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Representing a major threat to both equity and efficiency of health systems, the corrupt practice of informal payments is widely found in developing and transition countries. As informal payments are more likely to occur in health systems characterized by a high out-of-pocket payment rate, it is argued that formalized prepaid health insurance programs may help to curb such practice. METHODS Using panel data from the China Health and Retirement Longitudinal Survey, this study examined the association between changes in health insurance coverage on patient's behavior proxied with informal payments. RESULTS The statistical results reveal that health insurance status in fact increases the probability of patients making informal payments to physicians. However, this association varies among population groups and insurance programs, particularly between social health insurance and private health insurance status. CONCLUSIONS In a health system characterized by unequal allocation of medical resources, the dual pursuit of cost saving and quality of care may drive patients to make informal payments for personal gains. This study argues that health policy interventions aimed at curbing informal payments must be based on a thorough understanding of their complex socioeconomic causes and attack the perverse incentives in a coherent and bona fide manner.
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Affiliation(s)
- Ning Liu
- School of Management and Research Center for Hospital Management, Lanzhou University, 222 Tianshui South Road, Lanzhou City, Gansu Province, China
| | - Guoxian Bao
- School of Management and Research Center for Hospital Management, Lanzhou University, 222 Tianshui South Road, Lanzhou City, Gansu Province, China
| | - Alex Jingwei He
- Department of Asian and Policy Studies, The Education University of Hong Kong, 10 Lo Ping Road, New Territories, Tai Po, Hong Kong.
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23
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Du Y, Min R, Zhang X, Fang P. Factors associated with the healthcare expenditures of patients with multiple sclerosis in urban areas of China estimated by a generalized estimating equation. Expert Rev Pharmacoecon Outcomes Res 2020; 21:137-144. [PMID: 31984811 DOI: 10.1080/14737167.2020.1722103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Multiple sclerosis (MS) has a significant healthcare burden. This study examined the medical cost and out-of-pocket (OOP) expenses, and quantified the impact factors contributing to the costs. Methods: This is a retrospective study in 77 Chinese urban cites from 2013 to 2015. The data included the details of the utilization of medical resources, cost, and reimbursement ratio of all patients with a diagnosis of MS. A generalized estimating equation model was used to estimate the factors influencing the direct medical cost and OOP expenses for in- and outpatients. Results: A total of 267 patients with MS were identified. The mean cost per in- and outpatient was respectively 16996.2 and 2294.2 renminbi ($2768.12 and $373.65, €2087.16 and €281.73). Approximately 27% of the expenses were paid by the patients OOP. Factors contributing to high cost and high OOP expenses for inpatients were tertiary hospital admission, length of stay and residence in the east regions of China. Females and outpatients with resident insurance paid more OOP. Conclusion: This study illustrates the medical costs and burden of MS in Chinese patients and provides real-world data on MS that are essential for the improvement of health policies.
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Affiliation(s)
- Yaling Du
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, China.,First Affiliated Hospital, School of Medicine, Shihezi University , Shihezi, Xinjiang, China
| | - Rui Min
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, China
| | - Xiaoyan Zhang
- School of Political Science and Public Administration, Hubei University , Wuhan, Hubei, China
| | - Pengqian Fang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, China.,Academy of Health Policy and Management, Huazhong Unversity of Science and Technology , Wuhan, Hubei Province, China
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24
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Ke L, Chen J, Jia J, Ke P, Chen X, Mao Z, Liu B. Outpatients' Satisfaction in the Context of 10 Years of Health-Care Reform: A Cross-Sectional Study of Tertiary Hospitals in Shiyan, China. Patient Prefer Adherence 2020; 14:191-202. [PMID: 32099337 PMCID: PMC6996206 DOI: 10.2147/ppa.s233472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study aimed to evaluate outpatient satisfaction in tertiary hospitals in Shiyan, China, to predict which items had highest priorities for outpatient satisfaction, and to identify population groups on which the medical institutions should focus. PATIENTS AND METHODS A cross-sectional survey was conducted at three tertiary hospitals in Shiyan city of China, from March to June 2018. An 18-item outpatient satisfaction questionnaire was applied. We conducted matrix analysis to describe the distribution of satisfaction score and the degree of influence of the items. Outpatient satisfaction was classified into the lowest and highest groups according to the 80/20 rule. Logistic regression model was used to identify demographic factors which might influence outpatient satisfaction. RESULTS A total of 2109 valid questionnaires were completed. The "waiting time", "diagnosis and treatment time" and "medical charges" items showed relatively higher degrees of influence but earned lower levels of satisfaction. Outpatients with a college level or above educational background (AOR=1.36, 95% CI=1.03-1.79) and with a family per-capita monthly income (FPMI)>7000 CNY (AOR=3.30, 95% CI=1.60-6.81) were more prevalent in the lowest satisfaction group. Outpatients with college level or above education background (COR=0.77, 95% CI=0.60-0.99), FPMI of 3001-5000 CNY (AOR=0.76, 95% CI=0.60-0.96), non-local residents (AOR=1.48, 95% CI=1.07-2.04), and urban workers with medical insurance (AOR=1.74, 95% CI=1.27-2.39) were more prevalent in the highest satisfaction group. CONCLUSION The survey indicated that "long time to wait for treatment", "short treatment time", and "medical charges too expensive" were the top three aspects that need to be improved with priority by medical institutions. Education level, income level, residence and type of health insurance were the sociodemographic characteristics that significantly affect the outpatient satisfaction in tertiary hospitals. These factors need to be paid more attention by healthcare professionals to improve the patients' satisfaction.
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Affiliation(s)
- Li Ke
- School of Nursing, Hubei University of Medicine, Shiyan, People’s Republic of China
- Global Health Institute, Wuhan University, Wuhan, People’s Republic of China
| | - Jingshu Chen
- School of Public Health and Management, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Jia Jia
- School of Nursing, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Pan Ke
- Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Xueqin Chen
- Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Zongfu Mao
- Global Health Institute, Wuhan University, Wuhan, People’s Republic of China
| | - Bing Liu
- School of Public Health and Management, Hubei University of Medicine, Shiyan, People’s Republic of China
- Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, People’s Republic of China
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Liu H, Zhu H, Wang J, Qi X, Zhao M, Shan L, Gao L, Kang Z, Jiao M, Pan L, Chen R, Liu B, Wu Q, Ning N. Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system. BMC Public Health 2019; 19:1761. [PMID: 31888591 PMCID: PMC6937839 DOI: 10.1186/s12889-019-8121-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. METHODS The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. RESULTS The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is - 0.071 and - 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders' educational attainment both in integrated areas and non-integrated areas. CONCLUSIONS The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.
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Affiliation(s)
- Huan Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Hong Zhu
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Jiahui Wang
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Xinye Qi
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Miaomiao Zhao
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Linghan Shan
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Mingli Jiao
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Lin Pan
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Ruohui Chen
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Baohua Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China.
| | - Ning Ning
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China.
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26
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Zhao Y, Oldenburg B, Mahal A, Lin Y, Tang S, Liu X. Trends and socio-economic disparities in catastrophic health expenditure and health impoverishment in China: 2010 to 2016. Trop Med Int Health 2019; 25:236-247. [PMID: 31713972 DOI: 10.1111/tmi.13344] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate trends and socio-economic disparities in the catastrophic health expenditure (CHE) and health impoverishment in China after major reform of the health system and to examine the impacts of the chronic disease on CHE and impoverishment. METHODS We obtained data from four rounds of the China Family Panel Studies 2010-2016, with a sample size of 14 960 households. We defined CHE as the point at which annual household health payments exceeded 40% of annual capacity to pay. Impoverishment is measured by the $1.90 per day poverty line. Multivariate logistic regression models were performed to identify impacts of the family member with chronic disease on CHE and impoverishment. RESULTS Between 2010 and 2016, the incidence of CHE in China decreased from 19.37% to 15.11% and from 7.39% to 5.14% for health impoverishment; however, the decrease in level of impoverishment was less in rural areas (from 6.16% down to 3.03%) than in urban areas (from 8.46% down to 7.81%). The gap between impoverishment rates across the income quartiles is growing. Multivariable analysis showed that households with two or more members suffering chronic diseases were significantly more likely to incur CHE (aOR: 2.46, 95% CI: 1.93-3.13) and impoverishment (aOR: 2.66, 95% CI: 1.87-3.78) than households with no members suffering chronic diseases, after adjusting for sociodemographic covariates. CONCLUSIONS Important advances have been made in achieving greater financial protection for Chinese citizens. Nevertheless, greater attention to the poor households with chronic disease members is needed. Policymakers in China should focus on optimising integrated rural-urban health insurance by expanding the current benefit packages and strengthening poverty alleviation efforts.
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Affiliation(s)
- Yang Zhao
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Vic., Australia.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Vic., Australia
| | - Brian Oldenburg
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Vic., Australia.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Vic., Australia
| | - Ajay Mahal
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Yaqi Lin
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Xiaoyun Liu
- China Centre for Health Development Studies, Peking University, Beijing, China
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Li C, Tang C, Wang H. Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China. Int J Equity Health 2019; 18:166. [PMID: 31665019 PMCID: PMC6820904 DOI: 10.1186/s12939-019-1068-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China. METHODS The data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization. RESULTS The integration had no significant effects on probability of outpatient visits (β = 0.01, P > 0.05), inpatient visits (β = 0.01, P > 0.05), and unmet hospitalization needs (β =0.01, P > 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P < 0.05) and inpatient visits (β = 0.39, P < 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P < 0.05) and inpatient visits (β = 0.49, P < 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P < 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P > 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011. CONCLUSIONS The findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.
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Affiliation(s)
- Chaofan Li
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, 518000, China
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, 510006, China
| | - Haipeng Wang
- School of Health Care Management, Shandong University, Jinan, 250012, China.
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Shandong University, Jinan, 250012, China.
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28
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Ye L, Luo J, Shia BC, Fang Y. Multidimensional Health Groups and Healthcare Utilization Among Elderly Chinese: Based on the 2014 CLHLS Dataset. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203884. [PMID: 31614969 PMCID: PMC6843216 DOI: 10.3390/ijerph16203884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 12/17/2022]
Abstract
Based on multidimensional health, we aimed to identify health groups among the elderly Chinese population, and examine its relationship with socio-demographic factors on healthcare utilization. Chinese Longitudinal Healthy Longevity Survey in 2014 was adopted. For 2981 participants aged ≥65 years, without missing any health indicators, latent class analysis was adopted to identify health groups. For 1974 participants with complete information, the two-part model was used to assess how health groups and socio-demographic characteristics influence the outpatient and inpatient expenditure. Four health groups were identified and labeled as “Lacking Socialization” (10.4%), “High Comorbidity” (16.7%), “Severe Disability” (7.8%), and “Relative Health” (65.1%). Compared with the relative health group, the lacking socialization group cost higher inpatient expenditure (p = 0.02). Those in the high comorbidity and severe disability groups were more likely to use healthcare services and cost higher outpatient expenditure (p < 0.01 for all). The effects of socio-demographic factors were also discussed. The findings enhanced our understanding of the heterogeneity of multidimensional health status and complex healthcare demands in the elderly Chinese population. Moreover, it is valuable for improving the allocation of healthcare resource targeted for different groups of the ageing population.
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Affiliation(s)
- Linglong Ye
- School of Public Health, Xiamen University, Xiang'an South Road, Xiamen 361102, China.
- School of Economics, Xiamen University, 422 Siming South Road, Xiamen 361006, China.
| | - Jiecheng Luo
- School of Public Health, Xiamen University, Xiang'an South Road, Xiamen 361102, China.
| | - Ben-Chang Shia
- School of Management, Taipei Medical University, 250 Wuxing Street, Taipei 11031, China.
| | - Ya Fang
- School of Public Health, Xiamen University, Xiang'an South Road, Xiamen 361102, China.
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29
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Zhao M, Liu B, Shan L, Li C, Wu Q, Hao Y, Chen Z, Lan L, Kang Z, Liang L, Ning N, Jiao M. Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China. BMC Health Serv Res 2019; 19:654. [PMID: 31500617 PMCID: PMC6734466 DOI: 10.1186/s12913-019-4480-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 08/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China's health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to its ineffectiveness. METHODS A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices. RESULTS Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality. CONCLUSIONS The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed.
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Affiliation(s)
- Miaomiao Zhao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Chongchuan District, Nantong, 226019, Jiangsu, China
| | - Baohua Liu
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Cui Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Zhuo Chen
- Department of Health Policy and Management College of Public Health, University of Georgia, Athens, GA, 30602, USA
- School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo, 199 Taikang East Road, Ningbo, Zhejiang, 315100, China
| | - Lan Lan
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Zheng Kang
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ning Ning
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Mingli Jiao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
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30
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Ruiz M, Hu Y, Martikainen P, Bobak M. Life course socioeconomic position and incidence of mid-late life depression in China and England: a comparative analysis of CHARLS and ELSA. J Epidemiol Community Health 2019; 73:817-824. [PMID: 31255999 DOI: 10.1136/jech-2019-212216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/04/2019] [Accepted: 06/16/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite the growing prevalence of depression in the Chinese elderly, there is conflicting evidence of life course socioeconomic position (SEP) and depression onset in China, and whether this association is akin to that observed in Western societies. We compared incident risk of mid-late life depression by childhood and adulthood SEP in China and England, a country where mental health inequality is firmly established. METHODS Depression-free participants from the China Health and Retirement Longitudinal Study (N=8508) and the English Longitudinal Study of Ageing (N=6184) were studied over 4 years. Depressive symptoms were classified as incident cases using the Center for Epidemiologic Studies Depression Scale criteria. Associations between SEP (education, wealth, residence ownership and childhood/adolescent deprivation) and depression symptom onset were assessed using Cox proportional hazards models. In China, we also investigated children's government employment status as a SEP marker. RESULTS Higher education and wealth predicted lower incidence of depression in both countries. The association with non-ownership of residence appeared stronger in England (HR 1.61, 95% CI 1.41 to 1.86) than in China (HR 1.11, 95% CI 0.95 to 1.29), while that with childhood/adolescent deprivation was stronger in China (HR 1.43, 95% CI 1.29 - 1.60) than in England (HR 1.33, 95% CI 0.92 to 1.92). Chinese adults whose children were employed in high-status government jobs, had lower rates of depression onset. CONCLUSIONS Consistent findings from China and England demonstrate that SEP is a pervasive determinant of mid-late life depression in very diverse social contexts. Together with conventional measures of SEP, the SEP of children also affects the mental health of older Chinese.
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Affiliation(s)
- Milagros Ruiz
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Yaoyue Hu
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Pekka Martikainen
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany.,Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
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31
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Qiu C, Wu X. The Effect of Medical Insurance on Outpatient Visits by the Elderly: An Empirical Study with China Health and Retirement Longitudinal Study Data. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:175-187. [PMID: 30411304 DOI: 10.1007/s40258-018-0443-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND As the largest developing country in the world, China is still on its way towards building an adequate system of health insurance through continuous reforms. For the elderly in China, an effective medical security system might be especially helpful. OBJECTIVE This study investigates the effect of medical insurance on outpatient visits by elderly Chinese in order to identify effective policies to improve the Chinese medical security system. METHODS Based on data taken from the China Health and Retirement Longitudinal Study, eleven candidate models were analyzed, among which a finite mixture negative binomial model with two components was chosen as the theoretical foundation for an analysis of the effect of medical insurance on outpatient visits by elderly Chinese. RESULTS The significant variables were found to be basic medical insurance (BMI), sex, surveyed area, education level, health status, economic area, income level, and the number of living children for the elderly aged 60-69 years; BMI, age, health status, number of household members, and income level for the elderly aged 70-79 years; and BMI, age, sex, and the presence of chronic disease for the elderly aged 80 years and above. CONCLUSION Enrollment in BMI was found to be significantly associated with an increased number of outpatient visits, whereas supplementary medical insurance membership did not have a significant effect. The effects of BMI enrollment also differed by scheme and age. For those with a high rate of outpatient medical services utilization, the enhancing effect of BMI on the number of outpatient visits was not significant, so new medical insurance policies should be provided to the elderly population in China.
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Affiliation(s)
- Chunjuan Qiu
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science, East China Normal University, Ministry of Education, Shanghai, China.
| | - Xianyi Wu
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science, East China Normal University, Ministry of Education, Shanghai, China
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32
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Miao Y, Yuan X, Gu J, Zhang L, He R, Sandeep S, Wu J. Constructing a value-based healthcare system for hypertensive patients through changing payment mode: evidence from a comparative study in rural China. J Med Econ 2019; 22:245-251. [PMID: 30547700 DOI: 10.1080/13696998.2018.1558864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio. METHODS This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the control group, respectively. The Social Health Insurance Fund of the intervention group budgeted 600 yuan per capita per year to insured patients with third stage hypertension to cover their outpatient expenditures, while the outpatient expenditures of the control group were not covered by its Social Health Insurance Fund. The inpatient expenditure reimbursement policies in both groups were not adjusted during the study. Value improvement in this study was defined as reduction in medical costs and improvement in health outcomes within the pilot healthcare system. A propensity score matching model combined with a difference-in-differences model was used to estimate the changes in medical costs and health outcomes. RESULTS In total, 1,673 pairs of patients were enrolled into statistical analysis after the propensity score matching. The intervention increased per capita annual outpatient expenditure by 81.2 (+31.8%) yuan (p > .05), but decreased the per capita annual inpatient expenditure and total medical expenditure by 475.4 (-40.7%) yuan and 394.2 (-27.7%) yuan, respectively (p < .05). Accordingly, the per capita annual total medical expenditure reimbursement decreased by 192.3 (-28.5%) yuan (p < .05), and the per capita annual total out-of-pocket expenditure by 201.9 (-29.9%) yuan (p < .05). The diastolic blood pressure of the intervention group decreased significantly by 2.9 mmHg (p < .05), but no significant change was found in systolic blood pressure and prevalence of hypertension complications (p > .05). CONCLUSION Increasing the outpatient expenditures, the reimbursement ratio was beneficial to the value of the healthcare system for hypertensive patients. Outpatient care for patients with chronic diseases should be prioritized for rural China and healthcare settings with inadequate health insurance funds.
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Affiliation(s)
- Yudong Miao
- a Department of General Medicine of Henan Provincial People's Hospital , Zhengzhou , China
- b School of Health Policy and Management , Nanjing Medical University , Nanjing , China
| | - Xiangdong Yuan
- c Guangdong General Hospital , Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Jianqin Gu
- a Department of General Medicine of Henan Provincial People's Hospital , Zhengzhou , China
| | - Liang Zhang
- d School of Medicine and Health Management , Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China
| | - Ruibo He
- d School of Medicine and Health Management , Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China
| | - Sandeep Sandeep
- d School of Medicine and Health Management , Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China
| | - Jian Wu
- e College of Public Health , Zhengzhou University , Zhengzhou , China
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Spatial Organization of Hierarchical Medical Services within the City Proper of Tianjin, China: Towards Efficient Medical Alliances. SUSTAINABILITY 2019. [DOI: 10.3390/su11010229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
To address the low performance of health care service delivery in the half-market system, the Chinese government has begun to advocate the medical alliance (MA) recently. Instead of strict regulations on the procedure of diagnosis and treatment, flexible resource sharing among medical institutions of different grades inside each MA is encouraged. By now, many attempts have been made for MA establishment from different perspectives, but there is no effective model maturely developed. For the promotion of the spatial accessibility to medical services at different levels, it is important to organize the hierarchial medial services according to the distributions of different grades of health care facilities in a city. With the city proper of Tianjin as the study case, we explored the optimal establishment of MAs using the geographic information system (GIS). By means of the Voronoi Diagrams, the service regions of different medical institutions were precisely defined and the organizational structure of hierarchical medical services in MAs was determined. Through interpolation analysis, accessibility to different levels of medical services was measured, and on this basis, discussions were conducted on the service efficiency of the MAs. According to the results from Tianjin, (1) under the proposed organizational model for MAs, the fit of the service regions of the first grade and the other two higher grades of medical institutions was good. but the fit of the second and the third grade medical institutions was insufficient. (2) Although the overall service efficiency was excellent, there were still deficiencies in a number of the MAs. (3) Increasing the number of second and third grade medical institutions in specific regions near the city’s edge, as well as the number of first grade institutions, could further improve the performance of hierarchical medical services.
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Shan L, Zhao M, Ning N, Hao Y, Li Y, Liang L, Kang Z, Sun H, Ding D, Liu B, Liang C, Yu M, Wu Q, Hao M, Fan H. Dissatisfaction with current integration reforms of health insurance schemes in China: are they a success and what matters? Health Policy Plan 2018; 33:345-354. [PMID: 29325081 PMCID: PMC5886065 DOI: 10.1093/heapol/czx173] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 11/16/2022] Open
Abstract
Integration reforms have been piloted as key policies to address the fragmented health insurance system in China. They are also regarded as a better choice for realizing a Universal Basic Medical Insurance System (UBMIS). This study has attempted to explore the determinants that may affect respondents' dissatisfaction with the reforms. The aim is to provide evidence for more effective policy adjustment during the next round of nationwide integration reforms in China. A cross-sectional questionnaire survey was conducted in Ningbo, Chongqing and Heilongjiang from 2014 to 2015. A stratified cluster sampling method was adopted. A total of 1644 respondents, working in units related to health insurance, were selected. A multivariate logistic regression model was employed to identify any association between dissatisfaction and the features of the ongoing integration reforms of health insurance schemes. Overall, about 47.6% of the respondents reported dissatisfaction with the ongoing integration reforms. This high level of dissatisfaction was found to be associated with ineffective outcomes of the integration reforms in achieving management system improvement [odds ratio (OR) = 1.846], inequity reduction (OR = 1.464) and actual coverage expansion (OR = 1.350), as perceived by the respondents. Those who were satisfied with the previously separated health insurance schemes (OR = 0.643), and those who preferred other policy options for achieving a UBMIS (OR = 1.471) were more likely to report dissatisfaction with the current reforms. Higher expectations of the risk-pooling level (with ORs ranging from 1.361 to 1.661) also significantly contributed to dissatisfaction. Health insurance managers in China have conflicting opinions about the performance of piloted integration reforms. Many believe that these reforms have failed significantly to improve the management systems, narrow inequity and expand actual benefit coverage. Various strategies should be undertaken in order to address these issues, such as clarifying the administrative institution behind the merged schemes at the central level, unifying the insurance information network, developing consistent policies and bridging the differences in benefits among schemes and regions.
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Affiliation(s)
- Linghan Shan
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Miaomiao Zhao
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Ning Ning
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Yanhua Hao
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Ye Li
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Libo Liang
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Zheng Kang
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Hong Sun
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Ding Ding
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Baohua Liu
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Chao Liang
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Miao Yu
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Mo Hao
- Research Institute of Health Development Strategies, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China and
| | - Hua Fan
- Section of Scientific Research of the Second Affiliated Hospital of Hainan Medical University, No.48 Baishuitang Road, Xiuying District, Haikou, Hainan, 570100, China
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Liu K, He AJ. Able to purchase? Agency problems in China's social health insurance system and the pitfalls of third‐party strategic purchasing. Int J Health Plann Manage 2018; 33:1045-1059. [DOI: 10.1002/hpm.2559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kai Liu
- School of Labor and Human ResourcesRenmin University of China Beijing China
| | - Alex Jingwei He
- Department of Asian and Policy StudiesThe Education University of Hong Kong Tai Po Hong Kong
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Yang J, Siri JG, Remais JV, Cheng Q, Zhang H, Chan KKY, Sun Z, Zhao Y, Cong N, Li X, Zhang W, Bai Y, Bi J, Cai W, Chan EYY, Chen W, Fan W, Fu H, He J, Huang H, Ji JS, Jia P, Jiang X, Kwan MP, Li T, Li X, Liang S, Liang X, Liang L, Liu Q, Lu Y, Luo Y, Ma X, Schwartländer B, Shen Z, Shi P, Su J, Wu T, Yang C, Yin Y, Zhang Q, Zhang Y, Zhang Y, Xu B, Gong P. The Tsinghua-Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China. Lancet 2018; 391:2140-2184. [PMID: 29678340 PMCID: PMC7159272 DOI: 10.1016/s0140-6736(18)30486-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Jun Yang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China
| | - José G Siri
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Justin V Remais
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Qu Cheng
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Han Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Karen K Y Chan
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Zhe Sun
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Yuanyuan Zhao
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Na Cong
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Xueyan Li
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Wei Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Yuqi Bai
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China
| | - Jun Bi
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China
| | - Wenjia Cai
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China
| | - Emily Y Y Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wanqing Chen
- National Office for Cancer Prevention and Control, National Central Cancer Registry Cancer Institute/Hospital, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Cancer Center, Beijing, China
| | - Weicheng Fan
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Hua Fu
- Fudan Health Communication Institute, School of Public Health, Fudan University, Shanghai, China
| | - Jianqing He
- China National Engineering Research Center for Human Settlements, Beijing, China
| | - Hong Huang
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, China; Nicholas School of the Environment, Duke University, Durham, NC, USA; Harvard Center Shanghai, Asia-Pacific Research Center, Harvard Business School, Boston, MA, USA
| | - Peng Jia
- Department of Earth Observation Science, Faculty of Geo-information Science and Earth Observation (ITC), University of Twente, Enschede, Netherlands
| | | | - Mei-Po Kwan
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands
| | - Tianhong Li
- Department of Internal Medicine, Division of Hematology & Oncology, University of California Davis School of Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Xiguang Li
- School of Journalism and Communication, Tsinghua University, Beijing, China
| | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lu Liang
- Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China; Arkansas Forest Resources Center, University of Arkansas Division of Agriculture, School of Forestry and Natural Resources, University of Arkansas at Monticello, Monticello, AR, USA
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongmei Lu
- Department of Geography, Texas State University, San Marcos, TX, USA
| | - Yong Luo
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China
| | - Xiulian Ma
- Chinese Academy of Governance, Beijing, China
| | | | | | - Peijun Shi
- Joint Center for Global Change Studies (JCGCS), Beijing, China; State Key Laboratory of Earth Surface Processes and Resource Ecology/Academy of Disaster Reduction and Emergency Management, Beijing Normal University, Beijing, China
| | - Jing Su
- School of Medicine, Tsinghua University, Beijing, China
| | - Tinghai Wu
- School of Architecture, Tsinghua University, Beijing, China
| | - Changhong Yang
- Institute for Public Health Information, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yongyuan Yin
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Qiang Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China
| | - Yinping Zhang
- Bureau of Disease Prevention and Control, National Health and Family Planning Commission, Beijing, China
| | - Yong Zhang
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Department of Building Science, Tsinghua University, Beijing, China
| | - Bing Xu
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China.
| | - Peng Gong
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China.
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Qin W, Xu L, Li J, Sun L, Ding G, Shao H, Xu N. Estimating benefit equity of government health subsidy in healthcare Services in Shandong Province, China: a cross-sectional study. Int J Equity Health 2018; 17:61. [PMID: 29776366 PMCID: PMC5960158 DOI: 10.1186/s12939-018-0775-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/08/2018] [Indexed: 11/11/2022] Open
Abstract
Background Government health subsidy (GHS) is an effective tool to improve population health in China. Ensuring an equitable allocation of GHS, particularly among the poorer socio-economic groups, is a major goal of China’s healthcare reform. The paper aims to explore how GHS was allocated across different socioeconomic groups, and how well the overall health system was performing in terms of the allocation of subsidy for different types of health services. Methods Data from China’s National Health Services Survey (NHSS) in 2013 were used. Benefit incidence analysis (BIA) was applied to examine if GHS was equally distributed across income quintile. Benefit incidence was presented as each quintile’s percentage share of total benefits, and the concentration index (CI) and Kakwani index (KI) were calculated. Health benefits from three types of healthcare services (primary health care, outpatient and inpatient services) were analyzed, separated into urban and rural populations. In addition, the distribution of benefits was compared to the distribution of healthcare need (measured by self-reported illness and chronic disease) across income quintiles. Results In urban populations, the CI value of GHS for primary care was negative. (− 0.14), implying an allocation tendency toward poor region; the CI values of outpatient and inpatient services were both positive (0.174 and 0.194), indicating allocation tendencies toward rich region. Similar allocation pattern was observed in rural population, with pro-poor tendency of primary care service (CI = − 0.082), and pro-rich tendencies of outpatient (CI = 0.153) and inpatient services (CI = 0.203). All the KI values of three health services in urban and rural populations were negative (− 0.4991,-0.1851 and − 0.1651; − 0.482, − 0.247and − 0.197), indicating that government health subsidy was progressive and contributed to the narrowing of economic gap between the poor and rich. Conclusions The inequitable distribution of GHS in China exited in different healthcare services; however, the GHS benefit is generally progressive. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.
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Affiliation(s)
- Wenzhe Qin
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China
| | - Lingzhong Xu
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China.
| | - Jiajia Li
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China
| | - Long Sun
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China
| | - Gan Ding
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China
| | - Hui Shao
- Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Ningze Xu
- Key Lab of Health Technology Assessment, National Health Commission of the Peoples Republic of China, School of Public Health, Fudan University, Shanghai, China
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Impacts of the type of social health insurance on health service utilisation and expenditures: implications for a unified system in China. HEALTH ECONOMICS POLICY AND LAW 2018; 14:468-486. [PMID: 29734968 DOI: 10.1017/s174413311800018x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI schemes were rolled out to serve different populations, the potential impacts of reform on service utilisation and health costs have not been systematically studied. Using data from the Chinese Health and Retirement Longitudinal Study (CHARLS), we compared the mean costs incurred for both inpatient and outpatient care under different health insurance schemes, and the impact of different SHI schemes on treatment utilisation and health care costs using a two-part model. Our results show that Urban Employee Medical Insurance, which offers the most generous benefits, incurs the highest total costs prior to reimbursement when compared to other SHI schemes. Our analysis also shows that utilisation of SHI did not show significant reduction in out-of-pocket payments for outpatients. We argue that, unless effective measures are introduced to deal with perverse provider payment incentives, the move towards a unified system with more generous benefits may usher in a new wave of cost escalation for health care systems in China.
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Reimbursement for injury-induced medical expenses in Chinese social medical insurance schemes: A systematic analysis of legislative documents. PLoS One 2018; 13:e0194381. [PMID: 29543913 PMCID: PMC5854375 DOI: 10.1371/journal.pone.0194381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/02/2018] [Indexed: 11/19/2022] Open
Abstract
Social medical insurance schemes are crucial for realizing universal health coverage and health equity. The aim of this study was to investigate whether and how reimbursement for injury-induced medical expenses is addressed in Chinese legislative documents relevant to social medical insurance. We retrieved legislative documents from the China National Knowledge Infrastructure and the Lawyee databases. Four types of social medical insurance schemes were included: urban employee basic medical insurance, urban resident basic medical insurance, new rural cooperative medical system, and urban and rural resident medical insurance. Text analyses were conducted on all identified legislative documents. As a result, one national law and 1,037 local legislative documents were identified. 1,012 of the 1,038 documents provided for reimbursement. Of the 1,012 documents, 828 (82%) provided reimbursement only for injuries without a legally responsible person/party or not caused by self-harm, alcohol use, drug use, or other law violations, and 162 (16%) did not include any details concerning implementation. Furthermore, 760 (92%) of the 828 did not provide an exception clause applying to injuries when a responsible person/party could not be contacted or for situations when the injured person cannot obtain reimbursement from the responsible person/party. Thus, most Chinese legislative documents related to social medical insurance do not provide reimbursement for medical expenses from injuries having a legally responsible person/party or those caused by illegal behaviors. We argue that all injury-induced medical expenses should be covered by legislative documents related to social medical insurance in China, no matter what the cause of the injury. Further research is needed to explore the acceptability and feasibility of such policy changes.
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Guan M. Should the poor have no medicines to cure? A study on the association between social class and social security among the rural migrant workers in urban China. Int J Equity Health 2017; 16:193. [PMID: 29115960 PMCID: PMC5678794 DOI: 10.1186/s12939-017-0692-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/01/2017] [Indexed: 12/01/2022] Open
Abstract
Background The rampant urbanization and medical marketization in China have resulted in increased vulnerabilities to health and socioeconomic disparities among the rural migrant workers in urban China. In the Chinese context, the socioeconomic characteristics of rural migrant workers have attracted considerable research attention in the recent past years. However, to date, no previous studies have explored the association between the socioeconomic factors and social security among the rural migrant workers in urban China. This study aims to explore the association between socioeconomic inequity and social security inequity and the subsequent associations with medical inequity and reimbursement rejection. Methods Data from a regionally representative sample of 2009 Survey of Migrant Workers in Pearl River Delta in China were used for analyses. Multiple logistic regressions were used to analyze the impacts of socioeconomic factors on the eight dimensions of social security (sick pay, paid leave, maternity pay, medical insurance, pension insurance, occupational injury insurance, unemployment insurance, and maternity insurance) and the impacts of social security on medical reimbursement rejection. The zero-inflated negative binomial regression model (ZINB regression) was adopted to explore the relationship between socioeconomic factors and hospital visits among the rural migrant workers with social security. Results The study population consisted of 848 rural migrant workers with high income who were young and middle-aged, low-educated, and covered by social security. Reimbursement rejection and abusive supervision for the rural migrant workers were observed. Logistic regression analysis showed that there were significant associations between socioeconomic factors and social security. ZINB regression showed that there were significant associations between socioeconomic factors and hospital visits among the rural migrant workers. Also, several dimensions of social security had significant associations with reimbursement rejections. Conclusions This study showed that social security inequity, medical inequity, and reimbursement inequity happened to the rural migrant workers simultaneously. Future policy should strengthen health justice and enterprises’ medical responsibilities to the employed rural migrant workers. Electronic supplementary material The online version of this article (10.1186/s12939-017-0692-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Guan
- Family Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China. .,School of Business, Xuchang University, Road Bayi 88, Xuchang, Henan, China.
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Lin X, Cai M, Tao H, Liu E, Cheng Z, Xu C, Wang M, Xia S, Jiang T. Insurance status, inhospital mortality and length of stay in hospitalised patients in Shanxi, China: a cross-sectional study. BMJ Open 2017; 7:e015884. [PMID: 28765128 PMCID: PMC5642755 DOI: 10.1136/bmjopen-2017-015884] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To determine insurance-related disparities in hospital care for patients with acute myocardial infarction (AMI), heart failure (HF) and pneumonia. SETTING AND PARTICIPANTS A total of 22 392 patients with AMI, 8056 patients with HF and 17 161 patients with pneumonia were selected from 31 tertiary hospitals in Shanxi, China, from 2014 to 2015 using the International Classification of Diseases, Tenth Revision codes. Patients were stratified by health insurance status, namely, urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), new cooperative medical scheme (NCMS) and self-payment. OUTCOME MEASURES Inhospital mortality and length of stay (LOS). RESULTS The highest unadjusted inhospital mortality rate was detected in NCMS patients independent of medical conditions (4.7%, 4.4% and 11.1% for AMI, HF and pneumonia, respectively). The lowest unadjusted inhospital mortality rate and the longest LOS were observed in UEBMI patients. After controlling patient-level and hospital-level covariates, the adjusted inhospital mortality was significantly higher for NCMS and self-payment among patients with AMI, for NCMS among patients with HF and for URBMI, NCMS and self-payment among patients with pneumonia compared with UEBMI. The LOS of the URBMI, NCMS and self-payment groups was significantly shorter than that of the UEBMI group. CONCLUSION Insurance-related disparities in hospital care for patients with three common medical conditions were observed in this study. NCMS patients had significantly higher adjusted inhospital mortality and shorter LOS compared with UEBMI patients. Policies on minimising the disparities among different insurance schemes should be established by the government.
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Affiliation(s)
- Xiaojun Lin
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Miao Cai
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| | - Hongbing Tao
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Echu Liu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| | - Zhaohui Cheng
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chang Xu
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Manli Wang
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuxu Xia
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tianyu Jiang
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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