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Wei Q, Yuan B, Xu J, He P, Xu H, Meng Q. Continuity of health care: measurement and application in two rural counties of Guangxi Province, China. BMC Health Serv Res 2023; 23:917. [PMID: 37644426 PMCID: PMC10464216 DOI: 10.1186/s12913-023-09916-4] [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: 05/16/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Continuity of care (COC) is highly regarded in health promotion and health system strengthening. However, there is a lack of multidimensional quantitative assessment of continuity, making it challenging to evaluate and compare. Our objective was to create a novel measurement for COC and apply it in two rural counties in China to assess its validity and feasibility in evaluating health system reform. METHOD This study conducted a scoping literature review on COC, examining existing frameworks and indicators. Following an online expert poll, a composite indicator was developed using the analytical hierarchy process (AHP). The measurement tool was then applied to assess the current state of COC in two rural counties in China. In addition to descriptive analysis, demographic and economic characteristics were analyzed for their association with COC scores using t-tests and multiple linear regression models. RESULTS The final COC measurement encompasses three dimensions, six sub-dimensions, and ten individual indicators, which integrated and improved the current frameworks and indicators. Relational continuity, informational continuity, and management continuity were identified as the primary dimensions of COC measurement. The COC score is 0.49 in County A and 0.41 in County B, with information continuity being the highest-scoring dimension. Notably, the disparity in continuity scores is most pronounced among individuals with varying attitudes towards health, demonstrating a positive correlation. CONCLUSION The construction of the composite indicator in this study offers a scientific and effective metric for comprehensively measuring continuity of care. The empirical data analysis conducted in Western China serves as an illustrative application of the indicator, demonstrating its efficiency. The results obtained from this analysis provide a solid foundation and valuable reference for strengthening the health system.
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Affiliation(s)
- Qianchen Wei
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Jin Xu
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Hanyi Xu
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China.
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Qiang H, Jin‐mei S, Yan‐fei H, Yong‐bo Z. Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID-19 pandemic. Brain Behav 2023; 13:e2977. [PMID: 36974385 PMCID: PMC10175972 DOI: 10.1002/brb3.2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time-dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect. METHODS One hospital-based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset-to-door time (ODT) in the first 50%, while the door-to-needle time (DNT) was in the last quartile. DNT (in-hospital delay) was further subdivided into several time intervals [door-to-examination time (DET), door-to-imaging time (DIT), door-to-laboratory time (DLT), and decision-making time (DMT) of the patients or their proxies. RESULTS A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female. Baseline characteristics were similar between the two groups (all p > .05). For the comparisons of the time intervals, DIT (26 versus 15 min, p = .001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p > .05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036-1.118; p < .001], and history of coronary heart disease (OR, 3.898; 95%CI, 1.415-10.735; p = .008) were independently associated with deadline effect in the binary logistic regression model, while admitted in the working day (OR, 0.674; 95%CI, 0.096-0.907; p = .033), and having medical insurance (OR, 0.350; 95% CI, 0.132-0.931; p = .035) were negatively associated with the deadline effect. CONCLUSIONS A speed-safety tradeoff phenomenon from the deadline effect was observed in 17.2% of IVT cases during the COVID-19 pandemic, where longer DIT contributed a lot to this time delay. Patients without medical insurance, or admitted in official holidays were more likely to experience a delay of the deadline effect.
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Affiliation(s)
- Huang Qiang
- Department of NeurologyBeijing Friendship Hospital, Capital Medical UniversityBeijingPeople's Republic of China
| | - Sun Jin‐mei
- Department of NeurologyBeijing Friendship Hospital, Capital Medical UniversityBeijingPeople's Republic of China
| | - Han Yan‐fei
- Department of NeurologyBeijing Friendship Hospital, Capital Medical UniversityBeijingPeople's Republic of China
| | - Zhang Yong‐bo
- Department of NeurologyBeijing Friendship Hospital, Capital Medical UniversityBeijingPeople's Republic of China
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3
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Si Y, Bateman H, Chen S, Hanewald K, Li B, Su M, Zhou Z. Quantifying the financial impact of overuse in primary care in China: A standardised patient study. Soc Sci Med 2023; 320:115670. [PMID: 36669284 DOI: 10.1016/j.socscimed.2023.115670] [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: 06/09/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Overuse of health care is a potential factor in explaining the rapid increase in health care expenditure in many countries; however, it is difficult to measure overuse. This study employed the novel method of using unannounced standardised patients (SPs) to identify overuse, document its patterns and quantify its financial impact on patients in primary care in China. We trained 18 SPs to present consistent cases of two common chronic diseases and recorded 492 physician-patient interactions in 63 public and private primary hospitals in a capital city in western China in 2017 and 2018. Overuse, defined as the provision of unnecessary medical tests and drugs, was identified by a panel of medical experts based on national clinical guidelines. We estimated linear regression models to investigate how hospital, physician and patient characteristics were associated with overuse and to quantify the financial impact of overuse after controlling for a series of fixed effects. We found overuse in 72.15% of the SP visits. The high prevalence of overuse was similar among public and private hospitals, low-competence and high-competence physicians, male and female physicians, junior and senior physicians and male and female patients, but it varied between patients presenting different diseases. Compared to the non-overuse group, overuse significantly increased the total cost by 117.8%, the test cost by 58.8% and the drug cost by 100.3%. The financial impact of overuse was consistent across the aforementioned hospital, physician and patient characteristics. We suggest that the overuse observed in this study is unlikely to be attributable to physician incompetence but rather to the financing framework for primary care in China. These findings illuminate the cost escalation of primary care in China, which is a form of medical inefficiency that should be urgently addressed.
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Affiliation(s)
- Yafei Si
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia; School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia.
| | - Hazel Bateman
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia; School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Shu Chen
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia; School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Katja Hanewald
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia; School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Bingqin Li
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
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4
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Sun L, Buijsen M. Mobile Health in China: Well Integrated or a New Divide? Camb Q Healthc Ethics 2022; 32:1-10. [PMID: 36419326 DOI: 10.1017/s0963180122000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The application of mobile health holds promises of achieving greater accessibility in the evolving health care sector. The active engagement of private actors drives its growth, while the challenges that exist between health care privatization and equitable access are a concern. This article selects the private internet hospital in China as a case study. It indicates that a market-oriented regulatory mechanism of private mobile health will contribute little to improving health equity from the perspectives of egalitarians and libertarians. By integrating the capability approach and the right to health, it is claimed that mobile health is a means of accessing health care for everyone, where substantive accessibility should be emphasized. With this view, this article provides policy recommendations that reinforce private sector engagement for mobile health, recognizing liberty, equity, and collective responsibility in the Chinese context.
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Affiliation(s)
- Lujia Sun
- Erasmus School of Law, Erasmus University Rotterdam, The Netherlands
| | - Martin Buijsen
- Erasmus School of Law and Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands
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Zhang J, Eggink E, Zhang X, Li X, Jiang B, Liu H, Ge S, Zhang W, Lyu J, Niu Y, Yu Y, Hou H, Xu X, Ye X, Wang W, Terlou R, Richard E, Wang W, Wang Y, Moll van Charante EP, Song M. Needs and views on healthy lifestyles for the prevention of dementia and the potential role for mobile health (mHealth) interventions in China: a qualitative study. BMJ Open 2022; 12:e061111. [PMID: 36414280 PMCID: PMC9684993 DOI: 10.1136/bmjopen-2022-061111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Over the coming decades, China is expected to face the largest worldwide increase in dementia incidence. Mobile health (mHealth) may improve the accessibility of dementia prevention strategies, targeting lifestyle-related risk factors. Our aim is to explore the needs and views of Chinese older adults regarding healthy lifestyles to prevent cardiovascular disease (CVD) and dementia through mHealth, supporting the Prevention of Dementia using Mobile Phone Applications (PRODEMOS) study. DESIGN Qualitative semi-structured interview study, using thematic analysis. SETTING Primary and secondary care in Beijing and Tai'an, China. PARTICIPANTS Older adults aged 55 and over without dementia with an increased dementia risk, possessing a smartphone. Participants were recruited through seven hospitals participating in the PRODEMOS study, purposively sampled on age, sex, living area and history of CVD and diabetes. RESULTS We performed 26 interviews with participants aged 55-86 years. Three main themes were identified: valuing a healthy lifestyle, sociocultural expectations and need for guidance. First, following a healthy lifestyle was generally deemed important. In addition to generic healthy behaviours, participants regarded certain specific Chinese lifestyle practices as important to prevent disease. Second, the sociocultural context played a crucial role, as an important motive to avoid disease was to limit the care burden put on family members. However, time-consuming family obligations and other social values could also impede healthy behaviours such as regular physical activity. Finally, there seemed to be a need for reliable and personalised lifestyle advice and for guidance from a health professional. CONCLUSIONS The Chinese older adults included in this study highly value a healthy lifestyle. They express a need for personalised lifestyle support in order to adopt healthy behaviours. Potentially, the PRODEMOS mHealth intervention can meet these needs through blended lifestyle support to improve risk factors for dementia and CVD. TRIAL REGISTRATION NUMBER ISRCTN15986016; Pre-results.
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Affiliation(s)
- Jinxia Zhang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Esmé Eggink
- Department of General Practice, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Xiaoyu Zhang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xingming Li
- Department of Health Administration and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Bin Jiang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Hongmei Liu
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Siqi Ge
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Wei Zhang
- Centre for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital,Capital Medical University, Beijing, China
| | - Jihui Lyu
- Centre for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Yixuan Niu
- Department of Geriatrics, The Second Medical Centre & National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yueyi Yu
- Innovation Centre for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haifeng Hou
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Science, Tai'an, Shandong, China
| | - Xizhu Xu
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Science, Tai'an, Shandong, China
| | - Xiaoyan Ye
- Comvee Research Institute, Fuzhou Comvee Network & Technology Co., Ltd, Fuzhou, China
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | | | - Edo Richard
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Science, Tai'an, Shandong, China
- Centre for Precision Health, Edith Cowan University, Perth, Western Australia, Australia
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Perth, Western Australia, Australia
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Manshu Song
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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Tong X, Li X, Pratt NL, Hillen JB, Stanford T, Ward M, Roughead EE, Lai ECC, Shin JY, Cheng FW, Peng K, Lau CS, Leung WK, Wong IC. Monoclonal antibodies and Fc-fusion protein biologic medicines: A multinational cross-sectional investigation of accessibility and affordability in Asia Pacific regions between 2010 and 2020. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100506. [PMID: 35789824 PMCID: PMC9249810 DOI: 10.1016/j.lanwpc.2022.100506] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Monoclonal antibody (mAb) and Fc-fusion protein (FcP) are highly effective therapeutic biologics. We aimed to analyse consumption and expenditure trends in 14 Asia-Pacific countries/regions (APAC) and three benchmark countries (the UK, Canada, and the US). METHODS We analysed 440 mAb and FcP biological products using the IQVIA-MIDAS global sales database. For each year between 2010 and 2020 inclusive, we used standard units (SU) sold per 1000 population and manufacture level price (standardised in 2019 US dollars) to evaluate consumption (accessibility) and expenditure (affordability). Changes of consumption and expenditure were estimated using compound annual growth rate (CAGR). Correlations between consumption, country's economic and health performance indicators were measured using Spearman correlation coefficient. FINDINGS Between 2010 and 2020, CAGRs of consumption in each region ranged from 7% to 34% and the CAGRs of expenditure ranged from 9% to 31%. The median consumption of biologics was extremely low in lower-middle-income economies (0·29 SU/1000 population) compared with upper-middle-income economies (1·20), high-income economies (40·94) and benchmark countries (109·55), although the median CAGRs of biologics consumption in lower-middle-income economies (31%) was greater than upper-middle-income (14%), high-income economies (13%) and benchmark countries (9%). Consumption was correlated with GDP per capita [Spearman's rank correlation coefficient (r) = 0·75, p < 0·001], health expenditure as a percentage of total (r = 0·83, p < 0·001) and medical doctors' density (r = 0·85, p < 0·001). INTERPRETATION There have been significant increases in mAb and FcP biologics consumption and expenditure, however accessibility of biological medicines remains unequal and is largely correlated with country's income level. FUNDING This research was funded by NHMRC Project Grant GNT1157506 and GNT1196900; Enhanced Start-up Fund for new academic staff and Internal Research Fund, Department of Medicine, LKS Faculty of Medicine, University of Hong Kong.
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Affiliation(s)
- Xinning Tong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xue Li
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Nicole L. Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
| | - Jodie B. Hillen
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
| | - Tyman Stanford
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
| | - Michael Ward
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ju-Young Shin
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Franco W.T. Cheng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kuan Peng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chak Sing Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Keung Leung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C.K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, United Kingdom
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7
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Xu M, Pei X. Does coinsurance reduction influence informer-sector workers' and farmers' utilization of outpatient care? A quasi-experimental study in China. BMC Health Serv Res 2022; 22:914. [PMID: 35836258 PMCID: PMC9281155 DOI: 10.1186/s12913-022-08301-x] [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: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, the Chinese government has been trying to improve informal-sector workers’ and farmers’ access to healthcare and reduce their financial burdens by introducing a plan of cost-sharing reduction, but the effect on outpatient care utilization remains unknown. Furthermore, scarce evidence has been provided to help understand the impact of cost-sharing reduction on healthcare use in low- and middle-income countries. The policy change of the coinsurance reduction for outpatient care from 75 to 55% for the enrollees of the Urban and Rural Residents Basic Medical Insurance in Taizhou, China in 2015 provides us a good quasi-experimental setting to explore such an impact. Methods We do a quasi-experimental study to explore the impact of coinsurance reduction on outpatient care use among the informal-sector workers and farmers aged 45 and above by estimating a fixed-effects negative binomial model with the difference-in-differences approach and the matching method. Heterogeneous effects in primary care clinics and for the older people aged 60 and above are also examined. Our data is from the China Health and Retirement Longitudinal Study 2013 and 2015. Results We find neither statistically significant impact of coinsurance reduction on outpatient care utilization in all health facilities for informal-sector workers and farmers aged 45 and above, nor heterogeneous effects in primary care clinics and for older people aged 60 and above. Conclusions We conclude that the coinsurance reduction cannot effectively improve the informal-sector workers’ and farmers’ utilization of healthcare if the cost-sharing undertaken by patients remains high even after the reduction. Besides, improving healthcare quality in primary care clinics may play a more important role than merely introducing a cost-sharing reduction plan in enhancing the role of primary care clinics as gatekeepers. We propose that only a substantial coinsurance reduction may help influence the utilization of healthcare for informal-sector workers and farmers, and enhancing the healthcare quality in primary care clinics should be given priority in low- and middle-income countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08301-x.
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Affiliation(s)
- Mingming Xu
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen, 518107, China. .,Department of Economics and Management, Karlsruhe Institute of Technology, Kronenstraβe 34, 76133, Karlsruhe, Germany.
| | - Xingtong Pei
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen, 518107, China
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Ao Y, Yang C, Li P, Wang F, Peng S, Wang HY, Wang J, Zhao MH, Zhang L, Yuan Y, Qin X. Cost-effectiveness of medical migration for chronic kidney disease: a national cross-sectional study in China. BMC Health Serv Res 2022; 22:912. [PMID: 35831849 PMCID: PMC9281168 DOI: 10.1186/s12913-022-08266-x] [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: 04/13/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The phenomenon of medical migration is common in China. Due to the limited capacity and substantial geographical variation in medical practice, patients with chronic kidney disease (CKD) travel more frequently to seek medical care. We aimed to assess the cost-effectiveness of medical migration for CKD patients in China and provide real-world evidence for the allocation of CKD resources. Methods Records of patients with CKD between January 2014 and December 2018 were extracted from a large national database. A patient is defined as a medical migrant if she travelled across the provincial border to a non-residential province to be admitted for inpatient care. The propensity score matching method is used to estimate the effect of medical migration on medical expenditure, length of hospital stay, and in-hospital mortality. The cost-effectiveness is evaluated by comparing the estimated cost per life saved with contemporaneous estimates of the value of a statistical life. Results Among 4,392,650 hospitalizations with CKD, medical migrants accounted for 4.9% in 2018. Migrant patients were estimated to incur a 26.35% increase in total medical expenditure, experience a 0.24-percentage-points reduction in in-hospital mortality rates, and a 0.49-days reduction in length of hospital stay compared to non-migrant patients. Overall, medical migration among CKD patients incurred an average of 1 million yuan per life saved, which accounted for 20–40% of contemporaneous estimates of the value of a statistical life. Compared with migrant patients with self-payment and commercial insurance, migrant patients with public health insurance (urban basic medical insurance and new rural co-operative medical care) incurred lower cost per life saved. Cost per life saved for CKD patients was similar between female and male, lower among older population, and varied substantially across regions. Conclusions The medical care seeking behaviors of CKD patients was prominent and medical resources of kidney care were unevenly allocated across regions. Medical migration led to a reduction in mortality, but was associated with higher medical expenditure. It is imperative to reduce the regional disparity of medical resources and improve the clinical capacity. Our study shows that it is imperative to prioritize resource allocation toward improving kidney health and regional health care planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08266-x.
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Affiliation(s)
- Yumeng Ao
- School of Economics, Peking University, Beijing, 100871, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology, Beijing, 100034, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China.,Advanced Institute of Information Technology, Peking University, Hangzhou, 311215, Zhejiang, China
| | - Pengfei Li
- Advanced Institute of Information Technology, Peking University, Hangzhou, 311215, Zhejiang, China
| | - Fulin Wang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China.,Peking University First Hospital, Beijing, 100034, China
| | - Suyuan Peng
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Huai-Yu Wang
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology, Beijing, 100034, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology, Beijing, 100034, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology, Beijing, 100034, China. .,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China. .,Advanced Institute of Information Technology, Peking University, Hangzhou, 311215, Zhejiang, China. .,National Institute of Health Data Science at Peking University, Beijing, 100191, China.
| | - Ye Yuan
- School of Economics, Peking University, Beijing, 100871, China.
| | - Xuezheng Qin
- School of Economics, Peking University, Beijing, 100871, China.
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Krings MF, van Wijngaarden JDH, Yuan S, Huijsman R. China's Elder Care Policies 1994-2020: A Narrative Document Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106141. [PMID: 35627677 PMCID: PMC9141963 DOI: 10.3390/ijerph19106141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
Until the 1980s, institutional elder care was virtually unknown in China. In a few decades, China had to construct a universal social safety net and assure basic elderly care. China’s government has been facing several challenges: the eroding traditional family care, the funding to assure care services for the older population, as well as the shortage of care delivery services and nursing staff. This paper examines China’s Five-Year Policy Plans from 1994 to 2020. Our narrative review analysis focuses on six main topics revealed in these policies: care infrastructure, community involvement, home-based care, filial piety, active aging and elder industry. Based on this analysis, we identified several successive and often simultaneously strategic steps that China introduced to contend with the aging challenge. In Western countries, elder care policies have been shifting to the home care approach. China introduced home care as the elder care cornerstone and encouraged the revival of the filial piety tradition. Although China has a unique approach, the care policies for the aged population in China and Western countries are converging by emphasizing home-based care, informal care and healthy aging.
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Affiliation(s)
- Marion F. Krings
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 738, 3000 DR Rotterdam, The Netherlands; (M.F.K.); (J.D.H.v.W.); (R.H.)
| | - Jeroen D. H. van Wijngaarden
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 738, 3000 DR Rotterdam, The Netherlands; (M.F.K.); (J.D.H.v.W.); (R.H.)
| | - Shasha Yuan
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
- Correspondence:
| | - Robbert Huijsman
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 738, 3000 DR Rotterdam, The Netherlands; (M.F.K.); (J.D.H.v.W.); (R.H.)
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10
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The Comparison of Various Types of Health Insurance in the Healthcare Utilization, Costs and Catastrophic Health Expenditures among Middle-Aged and Older Chinese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105956. [PMID: 35627490 PMCID: PMC9141905 DOI: 10.3390/ijerph19105956] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023]
Abstract
Rapid aging in China is increasing the number of older people who tend to require health services for their poor perceived health. Drawing on the China Health and Retirement Longitudinal Study (CHARLS) 2018 data, we used two-part model and binary logistic regression to compare various types of health insurance in the healthcare utilization, costs and catastrophic health expenditures (CHE) among the middle-aged and older adults in China. Compared with uninsured, all types of health insurance promoted hospital utilization rate (ranged from 8.6% to 12.2%) and reduced out-of-pocket (OOP) costs (ranged from 64.9% to 123.6%), but had no significant association with total costs. In contrast, the association of health insurance and outpatient care was less significant. When Urban Employee Medical Insurance (UEMI) as reference, other types of insurance did not show a significant difference. Health insurance could not reduce the risk of CHE. The equity in healthcare utilization improved and healthcare costs had been effectively controlled among the elderly, but health insurance did not protect against CHE risks. Policy efforts should further focus on optimizing healthcare resource allocation and inclining toward the lower socio-economic and poor-health groups.
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11
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Xiao Y, Wu XH, Chen J, Xie FF. Challenges in establishing a graded diagnosis and treatment system in China. Fam Pract 2022; 39:214-216. [PMID: 34324644 DOI: 10.1093/fampra/cmab089] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yu Xiao
- Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xiao-Hong Wu
- Department of Nursing, Sichuan Cancer Hospital, Chengdu, China
| | - Jia Chen
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Fang-Fei Xie
- Department of Psychiatry, Chengdu Dekang Hospital, Chengdu, China
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12
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Jiang Q, Lou Y, Chen F, Lu Z, Cao S. Keys to promoting the graded diagnosis and treatment system based on the integrated health care system in China. Fam Pract 2022; 39:217-218. [PMID: 34423371 DOI: 10.1093/fampra/cmab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Qingqing Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yiling Lou
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fan Chen
- Quality Control Office, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shiyi Cao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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13
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Wu R, Ercia A. Analysing the impact of private health insurance on inequities in health care utilization: a longitudinal study from China. Health Policy Plan 2021; 36:1593-1604. [PMID: 34417798 DOI: 10.1093/heapol/czab107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/25/2021] [Accepted: 08/20/2021] [Indexed: 11/14/2022] Open
Abstract
Since the early 2000s, Chinese government has sought to encourage the growth of private health insurance (PHI) while simultaneously expanding the breadth of coverage in its social health insurance (SHI) system. This paper examines how the prevalence of PHI has changed during this period and the extent to which PHI contributed to the growth of horizontal and geographical inequities with a focus on healthcare utilization. National data from China Health and Nutrition Survey between 2000 and 2015 were analysed using a multilevel modelling approach. The analysis investigated the impact of SHI membership as related to PHI uptake, PHI enrolees' utilization of health services and out-of-pocket (OOP) expenses. This study found being covered by an SHI scheme reduced the uptake of PHI between 2004 and 2015. Having PHI caused an increase in utilizing outpatient care but did not affect OOP expenses. Coverage prevalence of PHI in a residential community was positively associated with the average level of healthcare utilization. Coverage prevalence of PHI and its effects on healthcare utilization varied geographically. The findings suggest that expanding the role of PHI was not effective without clear support from government policy. Furthermore, the expansion of PHI may cause an increase in horizontal and geographical inequities in healthcare utilization.
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Affiliation(s)
- Runguo Wu
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, Whitechapel, London E1 2AB, UK.,Global Health Policy Unit, School of Social and Political Science, the University of Edinburgh, 15a George Square, Edinburgh EH8 9LD, UK
| | - Angelo Ercia
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK.,Cievert, an Evergreen Life Company, Evergreen Business Centre, Clowes Street, Manchester M3 5NA, UK
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14
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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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15
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Chen SL, Zhang H, Gale RP, Tang JY, Pui CH, Chen SJ, Liang Y. Toward the Cure of Acute Lymphoblastic Leukemia in Children in China. JCO Glob Oncol 2021; 7:1176-1186. [PMID: 34292767 PMCID: PMC8457838 DOI: 10.1200/go.21.00049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study explored results of therapy of children with acute lymphoblastic leukemia (ALL) in China, recent progress, and challenges. Included are a survey of therapy outcomes of ALL in Chinese children nationwide, comparison of these data with global ALL therapy outcomes, analyses of obstacles to improving outcomes, and suggestions of how progress can be achieved. Therapy outcomes at many Chinese pediatric cancer centers are approaching those of resource-rich countries. However, nationwide outcomes still need improvement. Obstacles include suboptimal clinical trials participation, children without adequate health care funding, human resource shortages, especially physicians expert in pediatric hematology and oncology, and social-economic disparities. We suggest how these obstacles have been and continue to be remedied including expanded access to protocol-based therapy, improved supportive care, health care reforms, recruitment of trained personnel, and international collaborations. China has made substantial progress treating children with ALL. We envision even better outcomes in the near future.
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Affiliation(s)
- Si-Liang Chen
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Zhang
- Department of Hematology and Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Robert Peter Gale
- Department of Immunology and Inflammation, Haematology Research Centre, Imperial College London, London, United Kingdom
| | - Jing-Yan Tang
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Department of Hematology and Oncology, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ching-Hon Pui
- Departments of Oncology, Global Pediatric Medicine, and Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Sai-Juan Chen
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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16
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Luo D, Deng J, Becker ER. Urban-rural differences in healthcare utilization among beneficiaries in China's new cooperative medical scheme. BMC Public Health 2021; 21:1519. [PMID: 34362340 PMCID: PMC8348873 DOI: 10.1186/s12889-021-11573-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The New Cooperative Medical Scheme (NCMS) is a voluntary social health insurance program launched in 2002 for rural Chinese residents where 80% of people were without health insurance of any kind. Over time, several concerns about this program have been raised related to healthcare utilization disparities for NCMS participants in urban versus rural regions. Our study uses 2015 national survey data to evaluate the extent of these urban and rural disparities among NCMS beneficiaries. METHODS Data for our study are based on the Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our 12,190-patient sample are urban and rural patients insured by NCMS. We use logistic regression analyses to compare the extent of disparities for urban and rural residence of NCMS beneficiaries in (1) whether individuals received any inpatient or outpatient care during 2015 and (2) for those individuals that did receive care, the extent of the variation in the number of inpatient and outpatient visits among each group. RESULTS Our regression results reveal that for urban and rural NCMS patients in 2015, there were no significant differences in inpatient or outpatient utilization for either of the dependent variables - 1) whether or not the patient had a visit during the last year, or 2) for those that had a visit, the number of visits they had. Patient characteristics: age, sex, employment, health status, chronic conditions, and per capita annual expenditures - all had significant impacts on whether or not there was an inpatient or outpatient visit but less influence on the number of inpatient or outpatient visits. CONCLUSIONS For both access to inpatient and outpatient facilities and the level of utilization of these facilities, our results reveal that both urban and rural NCMS patients have similar levels of resource utilization. These results from 2015 indicate that utilization angst about urban and rural disparities in NCMS patients do not appear to be a significant concern.
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Affiliation(s)
- Dian Luo
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jing Deng
- School of Public Health and Management, Chongqing Medical University, Chongqing, China.,The Research Center for Medicine and Social Development, The Collaborative Innovation Center for Social Risk Governance in Health, Chongqing, China
| | - Edmund R Becker
- Department of Health Policy and Management, Rollins School of Public Health at Emory University, 1518 Clifton Road NE, 30322, Atlanta, GA, USA.
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17
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Wang J, Tan X, Qi X, Zhang X, Liu H, Wang K, Jiang S, Xu Q, Meng N, Chen P, Li Y, Kang Z, Wu Q, Shan L, Amporfro DA, Ilia B. Minimizing the Risk of Catastrophic Health Expenditure in China: A Multi-Dimensional Analysis of Vulnerable Groups. Front Public Health 2021; 9:689809. [PMID: 34422747 PMCID: PMC8377675 DOI: 10.3389/fpubh.2021.689809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background: In moving toward universal health coverage in China, it is crucial to identify which populations should be prioritized for which interventions rather than blindly increasing welfare packages or capital investments. We identify the characteristics of vulnerable groups from multiple perspectives through estimating catastrophic health expenditure (CHE) and recommend intervention priorities. Methods: Data were from National Health Service Survey conducted in 2003, 2008, and 2013. According to the recommendation of WHO, this study adopted 40% as the CHE threshold. A binary regression was used to identify the determinants of CHE occurrence; a probit model was used to obtain CHE standardized incidence under the characteristics of single and two dimensions in 2013. Results: The total incidence of CHE in 2013 was 13.9%, which shows a general trend of growth from 2003 to 2013. Families in western and central regions and rural areas were more at risk. Factors related to social demography show that households with a female or an unmarried head of household or with a low socioeconomic status were more likely to experience CHE. Households with older adults aged 60 and above had 1,524 times higher likelihood of experiencing CHE. Among the health insurance schemes, the participants covered by the New Rural Cooperative Medical Scheme had the highest risk compared with the participants of all basic health insurance schemes. Households with several members seeking outpatient, inpatient care or with non-communicable diseases were more likely to experience CHE. Households with members not seeing a doctor or hospitalized despite the need for it were more likely to experience CHE. Characteristics such as a household head with characteristics related to low socioeconomic status, having more than two hospitalized family members, ranked high. Meanwhile, the combination of having illiterate household heads and with being covered by other health insurance plans or by none ranked the first place. Cancer notably caused a relatively high medical expenditure among households with CHE. Conclusion: In China, considering the vulnerability of the population across different dimensions is conducive to the alleviation of high CHE. Furthermore, people with multiple vulnerabilities should be prioritized for intervention. Identifying and targeting them to offer help and support will be an effective approach.
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Affiliation(s)
- Jiahui Wang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Xiao Tan
- Shenzhen Hospital of Guangzhou University of Traditional Chinese Medicine (Futian), Shenzhen, China
| | - Xinye Qi
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Xin Zhang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Huan Liu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Kexin Wang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Shengchao Jiang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Qiao Xu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Nan Meng
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Peiwen Chen
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Ye Li
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Linghan Shan
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Daniel Adjei Amporfro
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Bykov Ilia
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
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18
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Millar R. From Mao to McDonaldization? Assessing the rationalisation of health care in China. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1643-1659. [PMID: 34382703 PMCID: PMC9292377 DOI: 10.1111/1467-9566.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
China's 2009 health care reform agenda has been referred to as one of the most ambitious health policy programmes in modern history. Significant investment has combined with new structures, incentives, and regulations that have aimed to improve access, as well as gain greater control over a health care market much criticised for putting profit before patients. A range of health services research has been undertaken to analyse these efforts. Sociological perspectives have also been documented yet up to now a review and synthesis combining these various contributions has not been undertaken. By drawing on the lens of McDonaldization, the paper presents a narrative review that analyses the extent to which China's 2009 reform agenda has increased efficiency, calculability, predictability, and control over service provision. The review identifies elements of McDonaldization within China's 2009 reform agenda, however, notable gaps remain. In response to the limits of McDonaldization as a lens for understanding China's health care reform, the paper calls for alternative perspectives that are better able to understand the sociocultural dynamics shaping service provision, as well as an interdisciplinary research agenda that is able to generate new insights and understanding regarding health care in China.
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Affiliation(s)
- Ross Millar
- Health Services Management CentreUniversity of BirminghamBirminghamUK
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19
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Yu X, Zhang W, Liang J. Physician distribution across China's cities: regional variations. Int J Equity Health 2021; 20:162. [PMID: 34256753 PMCID: PMC8276398 DOI: 10.1186/s12939-021-01503-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Distribution of physicians is a key component of access to health care. Although there is extensive research on urban-rural disparities in physician distribution, limited attention has been directed to the heterogeneity across urban areas. This research depicts variations in physician density across over 600 cities in the context of China's rapid urbanization. METHODS Data came from National Census Surveys and China statistical yearbooks, 2000-2003, and 2010-2013. Cities were characterized in terms of not only administrative level but also geographic regions and urban agglomerations. We analyzed variations in physician supply by applying generalized estimating equations with an ordinal logistic linking function. RESULTS Although overall physician density increased between 2003 and 2013, with population and socioeconomic attributes adjusted, physician density declined in urban China. On average, urban districts had a higher physician density than county-level cities, but there were regional variations. Cities in urban agglomerations and those outsides did not differ in physician density. CONCLUSION Despite the reduced inequality between 2003 and 2013, the growth in physician density did not appear to be commensurate with the changes in population health demand. Assessment in physician distribution needs to take into account heterogeneity in population and socioeconomic characteristics.
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Affiliation(s)
- Xuexin Yu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610040, Sichuan, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610040, Sichuan, China.
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
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20
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Effect of healthcare system reforms on public hospitals' revenue structures: Evidence from Beijing, China. Soc Sci Med 2021; 283:114210. [PMID: 34274783 DOI: 10.1016/j.socscimed.2021.114210] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/07/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022]
Abstract
To reduce the heavy reliance of public hospitals on drug sales and use of advanced technologies and to contain the escalating medical expenditures, Beijing implemented two rounds of comprehensive public hospital reform in 2017 and 2019, respectively. The first round focused on separating drug sales from hospital revenue (reform1), and the second round extended to include zero markup on medical consumables and price adjustments for medical services (reform2). To estimate how these two rounds of reform have affected public hospitals' revenue structures, we used observational data of medical revenues from 2016 to 2019 covering 354 healthcare facilities. A Panel-interrupted time-series (PITS) model was used to analyze the effects. The results suggest that the reforms have changed the structure of public hospitals' revenues. The proportion of drug sales in hospital revenues fell from 43.96% in 2016 (pre-reform) to 34.08% in 2019 (post-reform); the proportions of medical consumables decreased by 0.73% after reform 2; and the proportion of medical consultation service fees increased from 15.16% in 2016 to 24.51% in 2019. PITS analysis showed that the proportion of drug sales dropped by 5.46% in the month of reform 1, and it dropped by 0.20% per month on average after reform 2(p < 0.001). The proportion of medical consumables decreased by 0.04% per month on average after reform 2 (p < 0.001). The proportion of medical consultation service increased by 7.13% in the month of reform 1, and it increased by 0.14% per month on average after reform 2(p < 0.001). Similar trends were seen in hospital revenue structures from both inpatient services and from outpatient and accident and emergency services. Thus, Beijing's reforms successfully contained rising medical expenditures and optimized hospitals' revenue structures. These reforms can provide a reference for further public hospital reforms in China and other countries with similar systems.
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21
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Liu T, Tan X. Troublemaking in hospitals: performed violence against the healthcare professions in China. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2021; 30:157-170. [PMID: 34018912 DOI: 10.1080/14461242.2020.1779105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/03/2020] [Indexed: 06/12/2023]
Abstract
Yi Nao describes a type of violence displayed in Chinese hospitals which involves organised disturbances led by patients' relatives and/or Yi Nao gangs. Drawing on media reports of Yi Nao, we argue that the phenomenon of Yi Nao transforms hospitals into 'power arenas' in which a struggle over moral and political resources (capital) takes place between patients, Yi Nao gangs, doctors, government agencies, and hospital management. Two interrelated rules that are crucial to understanding the ad hoc local strategies of the actors involved in Yi Nao are examined: the 'publicity rule', and the 'rule of risk-avoidance'. We also argue that the political discourse of 'stability' has been internalised by the officials in the Chinese government and public hospitals in mediating social disputes. At the same time, Yi Nao actors use this discourse to creatively adapt to social resistance, as reflected in the disposition to use performative disturbance in pursuit of material or symbolic compensation.
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Affiliation(s)
- Tianyang Liu
- School of Political Science and Public Administration, Wuhan University, Wuhan, People's Republic of China
| | - Xiao Tan
- Asia Institute, University of Melbourne, Melbourne, Australia
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Li X, Zhang L, Li Z, Tang W. Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study. Front Public Health 2021; 9:665282. [PMID: 34249837 PMCID: PMC8261039 DOI: 10.3389/fpubh.2021.665282] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/24/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction: Gatekeeping mechanism of primary care institutions (PCIs) is essential in promoting tiered healthcare delivery system in China. However, patients seeking for higher-level institutions instead of gatekeepers as their first contact has persisted in the past decade. This study aims to explain patients' choice and willingness and to provide potential solutions. Methods: A survey was conducted among residents who had received medical care within the previous 14 days. Patients' choice and willingness of PCIs for first contact together with influencing factors were analyzed using binary logistic regression. Results: Of 728 sampled patients in Hubei, 55.22% chose PCIs for first contact. Patients who are older, less educated, with lower family income, not living near non-PCIs, with better self-perceived health status, only buying medicines, and living in rural instead of urban area had significantly higher probability of choosing PCIs. As of willingness, over 90% of the patients inclined to have the same choice for their first contact under similar health conditions. Service capability was the primary reason limiting patients' choice of PCIs. Conclusions: The gatekeeper system did not achieve its goal which was 70% of PCIs among all kinds of institutions for first contact. Future measures should aim to improve gate-keepers' capability.
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Affiliation(s)
- Xia Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.,Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.,Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Zhong Li
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.,Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Wenxi Tang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.,Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, China
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Zhang X, Li C, Yue C, Jiang X, Cao J, Ten Cate O. Why clinical training in China should improve: a cross-sectional study of MD graduates. BMC MEDICAL EDUCATION 2021; 21:266. [PMID: 33971857 PMCID: PMC8108351 DOI: 10.1186/s12909-021-02647-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 04/05/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND China is experiencing major medical education reforms that include establishing national training standards, standards for health professionals, and advanced health delivery system requirements. Graduate medical education (GME) is being piloted as a merger of Doctor of Medicine (MD) with PhD programs to improve academic research and clinical training. However, the academic degree-centred system has led to a preoccupation with research rather than clinical training. Unfortunately, there is a shortage of quality information regarding the clinical training of MD graduates from Chinese medical schools. To fill this gap, this general investigation aims to provide the perspective of recent MD graduates in China for the different subspecialties of clinical training as experienced in different contexts. METHODS There were 432 MD graduates who participated in an online survey regarding their clinical training. Information collected included overall satisfaction, educational supervision, supervised learning events, curriculum coverage, local teaching, teamwork, educational governance, workload, supportiveness of the environment, feedback, clinical experience, patient safety, handovers, and reporting systems. RESULTS Only 37.4% reported satisfaction with the overall clinical training quality; 54.6% rated the informal and bedside quality as "good"; 64.4% reported they knew who provided clinical supervision; but only 35.5% rated the quality of clinical supervision as high; 51.8% reported that they judged senior physicians as "not competent"; 41.9% agreed that the staff treated each other respectfully; 97.4% admitted that they worked beyond the mandatory hours and claimed they were regularly short of sleep; 84.2% raised concerns about patient safety; 45.3% reported that they received regular informal feedback; 48.1% believed that their concerns about education and training would be addressed. CONCLUSIONS This study suggests that the quality of clinical training for MD graduates should be improved. While the overall satisfaction with the teaching quality was acceptable, the quality of many clinical training aspects scored poorly. A major problem seems an undue focus on research in MD/PhD training at the cost of the quality of clinical training, due to career perspectives that undervalue clinical competence. The findings of this study should benefit from a deeper investigation to understand the causes and possible remediation. Suggestions include defining subspecialties and training lengths; monitoring, evaluation, and integration SST with MD degree; providing funds or rewards for academic and clinical training; establishing supervising teams to guide clinical training; and establishing physician scientist task force to help overcome challenges.
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Affiliation(s)
- Xiaoning Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, China.
- Department of Neonatology, he Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
- School of Nursing, Capital Medical University, Beijing, China.
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.
| | - Chong Li
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Cailing Yue
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Xue Jiang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Junli Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands
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Xu M, Yang W. Who will drop out of voluntary social health insurance? Evidence from the New Cooperative Medical Scheme in China. Health Policy Plan 2021; 36:1013-1022. [PMID: 33963364 PMCID: PMC8530158 DOI: 10.1093/heapol/czab017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/25/2021] [Accepted: 06/23/2021] [Indexed: 11/14/2022] Open
Abstract
Although public voluntary health insurance (VHI) has been adopted in many low- and middle-income countries to improve access to care for the population, a common issue with VHI is its high dropout rate. Using the New Cooperative Medical Scheme (NCMS)-a public VHI in China-as a case study, this article employs a fixed-effects negative binomial regression model combining the difference-in-difference-in-differences approach and multivariate distance matching to examine the factors associated with dropping out and the impact of dropout on outpatient care utilization among middle-aged and older people in rural China. Drawing data from the China Health and Retirement Longitudinal Study, our results showed that healthy people, vulnerable people and people who use less healthcare tended to drop out. Dropout had a significant negative impact on outpatient care utilization, especially for those with worse health statuses and those living in poorer provinces. We also found that the impact of dropout on outpatient utilization was more pronounced at secondary and tertiary hospitals than at primary care clinics. We urge policymakers to rethink the design of the NCMS by waiving premiums for the most vulnerable people.
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Affiliation(s)
- Mingming Xu
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Kronenstraße 34, 76133 Karlsruhe, Germany
| | - Wei Yang
- Department of Global Health and Social Medicine, Faculty of Social Science and Public Policy, King's College London, 3.09 Bush House NE, Strand, London WC2R 2LS, UK
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Sun T, Shi Y, Yin D, Zhang S, Wang X. Assessment of Need for Recovery and Its Relationship With Work Characteristics and Health in a Sample of Chinese Doctors: A Cross-Sectional Survey. Front Public Health 2021; 9:600179. [PMID: 34026700 PMCID: PMC8138448 DOI: 10.3389/fpubh.2021.600179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background: China is launching an unprecedented health care system reform. However, the long-term interests of doctors seem to have been ignored during this process especially considering that the work environment and work-life balance for doctors have severely deteriorated over the past decade.Their well-being and health are facing substantial threats due to heavy workloads and inadequate recovery opportunities. This study aimed to investigate the extent of need for recovery (NFR) among Chinese doctors and to examine their work-related fatigue. The study also examines the relationship of NFR with workplace satisfaction and health outcomes among Chinese doctors. Methods: A total of 2,617 doctors from 30 administrative regions in China participated in this study to assess the need for recovery and its relationship with work characteristics and health. A cross-sectional survey was conducted using the Chinese version of the Need for Recovery Scale (NFRS). Participants were invited to complete an anonymous online survey during May 2016. Data were analyzed using descriptive statistics, one-way ANOVA, reliability analysis, Pearson correlations, and hierarchical multiple regression analysis. Results: Significant differences in NFR scores were found across demographic characteristics such as age, service years, hospital levels, educational attainment, professional positions, work shifts, and working time. Regardless of any illnesses they might be experiencing, about 70.0% of participants remained at their job even though many doctors (22.1%) must continue working under the policies of the organization, which led to more pronounced NFR (P < 0.001). Further, a higher NFR was negatively related to workplace well-being and self-reported health outcomes of participants. Conclusions: Work-induced fatigue is a growing threat to doctors in China and their recovery opportunities are extremely limited in the workplace. High NFR exerts a considerable effect on their workplace well-being and health. China's hospital managers should pay close attention to the fact that doctors have little chance of recovery, and should offer doctors' positive encouragement and support to enhance well-being. To improve doctors' working conditions, targeted prevention policies must be introduced by policymakers to control this spreading crisis.
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Affiliation(s)
- Tao Sun
- Department of Health Management to Medical College, Hangzhou Normal University, Hangzhou, China
| | - Yu Shi
- Department of Health Management, College of Public Health of Harbin Medical University, Harbin, China
| | - Dong Yin
- Department of Health Management, College of Public Health of Harbin Medical University, Harbin, China
| | - Shu'e Zhang
- Department of Health Management, College of Public Health of Harbin Medical University, Harbin, China
| | - Xiaohe Wang
- Department of Health Management to Medical College, Hangzhou Normal University, Hangzhou, China
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26
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Chen F, Jiang Q, Lu Z, Cao S. General practitioners' perspectives of the integrated health care system: a cross-sectional study in Wuhan, China. Fam Pract 2021; 38:103-108. [PMID: 32893290 DOI: 10.1093/fampra/cmaa088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In recent years, the Chinese government has introduced a new system called the integrated health care system to deepen health care reform and enhance the capacity of the primary health care services. OBJECTIVE We aimed to investigate the perceptions and opinions of general practitioners (GPs) on the integrated health care system. METHODS A cross-sectional investigation involving 764 GPs in Hubei province of China was conducted. We used a self-designed questionnaire to collect information on demographics, GPs' knowledge and attitude of the integrated health care system. Data on 749 GPs with completed questionnaires were analysed descriptively. We conducted Spearman rank correlation analysis to test correlation of grade data. RESULTS 60.92% of the 749 GPs were familiar with the integrated health care system. 88.25% of the GPs were apt to support its development and 70.09% thought it could promote downward referral of patients. The GPs' familiarity with the integrated health care system was significantly related to professional guidance from doctors in higher hospitals (P < 0.05), but not job titles of GPs (P > 0.05). 78.0% of GPs thought that the main benefit of the integrated health care system was the reduction of patients' health care costs; 70.1% believed that the most difficulty was insufficient publicity. CONCLUSIONS The GPs' general cognition of the integrated health care system was general. Most of the GPs supported the integrated health care system and believed that it contributed to decrease the patients' health care costs. Insufficient publicity and the incomplete two-way referral mechanism were regarded to be the main obstacles to its development.
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Affiliation(s)
- Fan Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qingqing Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shiyi Cao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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27
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Bao M, Huang C. Job preferences of medical and nursing students seeking employment in rural China: a discrete choice experiment. BMC MEDICAL EDUCATION 2021; 21:146. [PMID: 33673842 PMCID: PMC7934374 DOI: 10.1186/s12909-021-02573-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND China has a shortage of health workers in rural areas, but little research exists on policies that attract qualified medical and nursing students to rural locations. We conducted a discrete choice experiment to determine how specific incentives would be valued by final-year students in a medical university in Guizhou Province, China. METHODS Attributes of potential jobs were developed through the literature review, semi-structured interviews, and a pilot survey. Forty choice sets were developed using a fractional factorial design. A mixed logit model was used to estimate the relative strength of the attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates. RESULTS The final sample comprised 787 medical and nursing students. The statistically significant results indicated "Bianzhi" (the number of personnel allocated to each employer by the government) and physical conflicts between doctors and patients were two of the most important non-monetary job characteristics that incentivized both medical and nursing students. Policy simulation suggested that respondents were most sensitive to a salary increase, and the effect of incentive packages was stronger for students with a rural family background. CONCLUSIONS Strategies for patient-doctor relationships, Bianzhi and salary should be considered to attract final-year medical and nursing students to work in rural China. In addition, specific recruitment policy designs tailored for students with different majors and backgrounds should be taken into account.
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Affiliation(s)
- Meiling Bao
- School of Public Health, Sun Yat-sen University, Zhongshan Road #2, Guangzhou, 510080, China
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, Zhongshan Road #2, Guangzhou, 510080, China.
- School of Public Health, Zhengzhou University, Zhengzhou, China.
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28
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Yang W, Wu B, Tan SY, Li B, Lou VWQ, Chen ZA, Chen X, Fletcher JR, Carrino L, Hu B, Zhang A, Hu M, Wang Y. Understanding Health and Social Challenges for Aging and Long-Term Care in China. Res Aging 2021; 43:127-135. [PMID: 32677535 PMCID: PMC7961665 DOI: 10.1177/0164027520938764] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The second King's College London Symposium on Ageing and Long-term Care in China was convened from 4 to 5th July 2019 at King's College London in London. The aim of the Symposium was to have a better understanding of health and social challenges for aging and long-term care in China. This symposium draws research insights from a wide range of disciplines, including economics, public policy, demography, gerontology, public health and sociology. A total of 20 participants from eight countries, seek to identify the key issues and research priorities in the area of aging and long-term care in China. The results published here are a synthesis of the top four research areas that represent the perspectives from some of the leading researchers in the field.
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Affiliation(s)
- Wei Yang
- Department of Global Health & Social Medicine, 4616King's College London, London, United Kingdom
| | - Bei Wu
- Rory Meyers College of Nursing, 5894New York University, New York, USA
| | - Si Ying Tan
- Lee Kuan Yew School of Public Policy, 37580National University of Singapore, Singapore
| | - Bingqin Li
- Social Policy Research Centre, 7800University of New South Wales, Sydney, Australia
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, Department of Social Work & Social Administration, The 25809University of Hong Kong, China
| | - Zhuo Adam Chen
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA
- School of Economics, 56668University of Nottingham Ningbo China, Ningbo, Zhejiang, China
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Department of Economics, 5755Yale University, New Haven, CT, USA
| | - James Rupert Fletcher
- Department of Global Health & Social Medicine, 4616King's College London, London, United Kingdom
| | - Ludovico Carrino
- Department of Global Health & Social Medicine, 4616King's College London, London, United Kingdom
| | - Bo Hu
- Personal Social Services Research Unit, Department of Health Policy, 4905London School of Economics and Political Science, United Kingdom
| | - Anwen Zhang
- Adam Smith Business School, 3526University of Glasgow, United Kingdom
| | - Min Hu
- Department of Health Economics, School of Public Health, 12478Fudan University, Shanghai, China
| | - Yixiao Wang
- Department of Global Health & Social Medicine, 4616King's College London, London, United Kingdom
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Zhang J, Han X, Yang Z, Wang Z, Zheng J, Yang Z, Zhu J. Radiology residency training in China: results from the first retrospective nationwide survey. Insights Imaging 2021; 12:25. [PMID: 33595737 PMCID: PMC7889775 DOI: 10.1186/s13244-021-00970-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives This was the first study to systematically landscape and examine China’s nationwide standardized residency training in radiology. Methods In this retrospective cross-sectional study, we used data from the 2019 national survey of the first two cohorts of 3679 radiology residents who completed training in 2017 and 2018 across all 31 provinces in China. A total of 1163 (32%) residents participated in the survey. Multivariable logistic regression was used to examine the implementation frequency of 24 identified training tasks (categorized into six competencies) by region, demographics, and other residency information. Results Among the 1163 respondents, 592 (51%) were trained in the more developed eastern region. Of the 24 identified training tasks, 15 were implemented significantly differently across regions, while the frequency of the most frequently conducted tasks (e.g., CT, MR, and radiograph interpretation and reporting) was consistent. The top 10 tasks all fell into the patient care and medical knowledge competency domains, while other competencies tended to be neglected. We found region and marital status were the most influential factors of training task implementation frequencies. Respondents trained in the northeast and the west were more likely to report, for instance, radiological examination recommendation (OR = 1.91, 95%CI = 1.27–2.88), as “very frequent.” Married respondents were more likely to report first-line night shift as “very frequent” (OR = 1.71, 95%CI = 1.29–2.26). Conclusions Despite the fast-win achievements of developing a national radiology residency training program, there is a gap to train quality and homogeneous radiologists across regions. Future improvement should be more tailored to residents’ personal characteristics and emphasize some “soft” competencies (e.g., communication skills).
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Affiliation(s)
- Jingfeng Zhang
- Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Xinxin Han
- School of Medicine, Tsinghua University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zheng
- Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zimo Yang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China.
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30
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Xiao Y, Zhu SY, Huang YH. Standardised training system for specialists in China: a new opportunity and challenge for doctors. Postgrad Med J 2021; 98:e155-e156. [PMID: 33452157 DOI: 10.1136/postgradmedj-2020-139408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Yu Xiao
- Department of Psychiatry, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China .,Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Shao-Yi Zhu
- Department of Psychiatry, Shantou University Mental Health Center, Shantou, China
| | - Yu-Hong Huang
- Department of Psychiatry, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
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31
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Li C, Yao NA. Socio-Economic Disparities in Dental Health and Dental Care Utilisation Among Older Chinese. Int Dent J 2021; 71:67-75. [PMID: 33616055 PMCID: PMC9275339 DOI: 10.1111/idj.12600] [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] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Dental care is mostly excluded from healthcare coverage in China. This study examines disparities in dental care and in the costs of such care, according to insurance type and socio-economic status, among Chinese older adults. METHODS The data were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). A final sample of 5,230 respondents was included, with a mean age of 72 years. Edentulousness, any dental visit and per-patient dental care expenditure were used as outcome variables. Both unweighted and weighted logistic regression analyses were used to examine the association of socio-economic status (education, insurance type and income) associated with edentulousness and use of dental care. RESULTS We found that 28% of Chinese older adults have no remaining teeth and that only 19% had used dental care in the past year. The uninsured and those with rural resident insurance had edentulousness rates of 31%, while the edentulousness rate in those with urban employee insurance was 19%. About 13% of the uninsured study respondents and 15% of those with rural resident insurance had used dental care compared with 30% of those with urban employee insurance. Those in the highest income and education groups and those enrolled in a plan with a lower coinsurance rate had a higher likelihood of using dental care services and spending more on dental care than did those in the lowest socio-economic groups. CONCLUSIONS Dental care disparities in China may be reduced through increasing the proportion of the population with insurance and expanding the range of dental treatments covered by all three major insurance schemes.
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Affiliation(s)
- Chaofan Li
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong, China; School of Health Care Management (Key Laboratory of Health Economics and Policy Research, National Health Commission), Shandong University, Ji'nan, Shandong, China
| | - Nengliang Aaron Yao
- School of Health Care Management (Key Laboratory of Health Economics and Policy Research, National Health Commission), Shandong University, Ji'nan, Shandong, China; Home Centered Care Institute, Schaumburg, IL, USA; University of Virginia School of Medicine, Charlottesville, VA, USA.
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32
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Zhang X, Li Y, Yang C, Jiang G. Trends in Workplace Violence Involving Health Care Professionals in China from 2000 to 2020: A Review. Med Sci Monit 2021; 27:e928393. [PMID: 33417590 PMCID: PMC7802374 DOI: 10.12659/msm.928393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The safety of health care workers in China has received an increasing amount of attention owing to numerous incidents of hospital-based violence against medical professionals. When pictures and videos of violent injuries are posted on the internet with real-time data, such as gender or location, researchers can access the information to learn about the incident, its causes, and/or threats to survival. We examined the causes and risk factors for workplace violence by analyzing relevant data retrieved from reports by Chinese internet media for all incidents from 2000 to 2020. We present frequency data on hospital-based violence against medical professionals. A total of 345 incidents occurred in health care settings. The person who committed the violent act was a patient or sick person in the workplace or a co-worker in 95.4% of the incidents; 54 of the incidents resulted in the victim’s murder. We provide the characteristics and risk factors of violent criminals. We describe China’s past and current clinical practices and health care policies, and we discuss the challenges faced by medical professionals who are victims of hospital-based violence from the perspectives of patients, physicians, hospital leaders, and the government. We conclude by making recommendations for preventing violence in hospital settings. It is urgent for the public to understand that the occupational safety of health care workers must be protected, and treatment should be provided to patients in a harmonious and safe environment. This review aims to describe the trends in workplace violence involving health care professionals in China from 2000 to 2020 and to discuss possible strategies for improving working conditions in hospitals and other health care settings.
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Affiliation(s)
- Xin Zhang
- Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland).,Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland)
| | - Yizhi Li
- Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland).,Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland)
| | - Chunsheng Yang
- Department of Dermatology, The Affiliated Huai'an Hospital of Xuzhou Medical University, the Second People's Hospital of Huai'an, Huai'an, Jiangsu, China (mainland)
| | - Guan Jiang
- Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland).,Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland)
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Abstract
BACKGROUND Burnout is an occupational hazard among Chinese pediatric orthopedists, characterized by extreme physical and emotional exhaustion, and reduced professional efficacy; however, it has yet to be studied among this group of professionals in China. Our study aimed to assess the levels of burnout in Chinese pediatric orthopedists, and to identify the potential risk factors for burnout. METHODS A 32-question, anonymous, cross-sectional survey was conducted from August to September 2019. Overall, 1392 Chinese pediatric orthopedists participated in the survey. RESULTS Seven hundred valid questionnaires (50.3% response rate) were retrieved from 387 (55.3%) and 313 (44.7%) full-time and part-time pediatric orthopedists, respectively. Overall, 73.7% of the participants experienced burnout, of which 64.7% and 9.0% had some and severe burnout symptoms, respectively. The burnout levels significantly differed based on age (P=0.005), years in service (P=0.006), professional rank (P=0.03), weekly working hours (P<0.001), and monthly income (P=0.03). A binary logistic regression model showed that longer weekly working hours (adjusted odds ratio=1.29, 95% confidence interval: 1.09-1.52, P=0.004) was a risk factor for burnout, while higher monthly income (adjusted odds ratio=0.78, 95% confidence interval: 0.64 to 0.95, P=0.02) was protective against burnout, suggesting that younger pediatric orthopedists were more susceptible. No significant difference between full-time and part-time pediatric orthopedists or between sexes was detected in the adjusted analysis. CONCLUSIONS Chinese pediatric orthopedists have a relatively high rate of burnout. Younger pediatric orthopedists have a greater chance of experiencing burnout. These results highlight the need for further policies, especially focused on younger pediatric orthopedists, to assist in better developing Chinese pediatric orthopedics. LEVEL OF EVIDENCE Level: IV.
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Zhou LM, Xu RH, Xu YH, Chang JH, Wang D. Inpatients' Perception of Patient-Centered Care in Guangdong Province, China: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059482. [PMID: 34872361 PMCID: PMC8655447 DOI: 10.1177/00469580211059482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the perceptions of patient-centered care (PCC) among inpatients in Guangdong Province (GD), China. Based on these perspectives, we sought to understand existing PCC practices in medical institutions and identify the impacts of inpatients’ sociodemographic status on their perceived PCC. A self-developed PCC questionnaire was used to investigate inpatients’ perceptions of PCC. A cross-sectional survey was conducted in nine tertiary-level hospitals across five cities in GD. Descriptive statistics was used to describe the levels of PCC in GD. The differences in PCC levels across different sociodemographic groups were assessed using analysis of variance and multivariate linear regression. Valid responses were provided by 1863 inpatients. The mean overall PCC score was 8.58 (standard deviation [SD] = 1.36); inpatients from the Pearl River Delta and eastern GD area reported significantly higher scores than those from western and northern GD area (P<.01). Inpatients from rural areas tended to report lower PCC scores than their urban counterparts. Among the PCC questionnaire sub-domains, inpatients scored highest and lowest in “patient experience” (mean = 8.96, SD = 1.34) and “medical insurance” (mean = 7.93, SD = 2.05), respectively. This study provided a comprehensive overview of inpatients’ perceptions of PCC in the public healthcare system in GD, China. Our findings highlighted that a majority of inpatients were satisfied with the PCC in public healthcare system; however, a significant discrepancy between inpatients with different sociodemographic status remained.
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Affiliation(s)
- Ling-Ming Zhou
- School of Health Management, 70570Southern Medical University, Guangdong, China.,The Second Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Richard Huan Xu
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong SAR, China.,Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yan-Hua Xu
- Hospital Office, Meizhou People's Hospital, Guangdong, China
| | - Jing-Hui Chang
- School of Health Management, 70570Southern Medical University, Guangdong, China
| | - Dong Wang
- School of Health Management, 70570Southern Medical University, Guangdong, China.,Institute of health management, Southern Medical University, Guangdong, China
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Yan J. Evaluating the healthcare practice by defining healthcare principles: An autoregressive integrated moving average model based on time series. Int J Health Plann Manage 2020; 36:561-578. [PMID: 33351200 DOI: 10.1002/hpm.3101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
AIM This study developed a set of health care principles to evaluate the health care practice in China long-term via time series. METHODS This study was divided into four parts. First, the variables were designed by defining a set of conceptual tools. Second, qualitative text was collected and coded according to the defined conceptual tools. Third, the sampling text was qualitatively analysed. Fourth, the variables were analysed through an autoregressive integrated moving average model based on a time series. Lastly, the qualitative and variable analyses were combined and the basic conclusions of the study were drawn. RESULTS We found that the health care principle of accessibility was significantly positively affected by abnormal event, policy experimentation and policy authority shift. Quality was found to be significantly positively affected by policy experimentation and policy authority shift, while cost control was significantly positively affected by policy experimentation. CONCLUSION This study implies that the collective activities of the government and health care practitioners, such as abnormal events, policy failures, policy experimentations and policy authority shifts, as well as health care practice itself, become increasingly interconnected over time.
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Affiliation(s)
- Jingjing Yan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
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Wu YC, Lo WC, Lu TH, Chang SS, Lin HH, Chan CC. Mortality, morbidity, and risk factors in Taiwan, 1990-2017: findings from the Global Burden of Disease Study 2017. J Formos Med Assoc 2020; 120:1340-1349. [PMID: 33309080 DOI: 10.1016/j.jfma.2020.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 08/28/2020] [Accepted: 11/24/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Taiwan has implemented a national health insurance system since 1995 with high coverage and utilization rate. However, the health care system in Taiwan is facing immense challenges due to rapid population ageing. We have evaluated the landscape of population health by revisiting the results of GBD 2017 study. METHODS Taiwan vital registration data (1980-2016) and Taiwan national health insurance database (2016) were used. We also conducted benchmarking comparisons with selected countries in East Asia from 1990 to 2017. RESULTS The age-standardized disability-adjusted life-year (DALY) rates decreased by one-quarter from 1990 to 2017; however, progress was relatively slow compared to the comparator countries and has been stagnant recently. The Social-demographic Index (SDI) level in Taiwan in 2017 was 0.86, which is similar to Japan, Singapore, and South Korea in 2017, while the SDI level of China in 2017 was similar to that of Taiwan (0.69) in 1990. Although Taiwan's SDI reached the same level as those in Japan, Singapore, and South Korea in 2017, modifiable risk factors still contributed to nearly half of Taiwan's total disease burden. Five leading risk factors (high fasting plasma glucose, high body-mass index, alcohol use, illicit drug use, and impaired kidney function) accounted for a higher DALY rate in Taiwan than comparator countries in 2017. CONCLUSION Taiwan made marked progress in health from 1990 to 2017. However, interventions targeted on major modifiable disease risk factors should be prioritized to realize the full potential of heath improvement in the process of rapid socioeconomic development.
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Affiliation(s)
- Yun-Chun Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei-Cheng Lo
- Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Master of Global Health Program, College of Public Health, National Taiwan University, Taiwan.
| | - Chang-Chuan Chan
- Institute of Environmental Health, College of Public Health, National Taiwan University, Taiwan.
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Chai P, Zhang Y, Zhou M, Liu S, Kinfu Y. Health system productivity in China: a comparison of pre- and post-2009 healthcare reform. Health Policy Plan 2020; 35:257-266. [PMID: 31828335 DOI: 10.1093/heapol/czz157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 11/13/2022] Open
Abstract
In 2009, China launched an ambitious health system reform that combined extending social health insurance scheme with improving efficiency, access and quality of care in the country. To assess the impact of the policy on efficiency and productivity change, we investigated the country's health system performance at provincial levels during pre- and post-reform period. Outputs were measured using multiple health outcomes (namely, non-communicable diseases free healthy life years and infant and maternal survival rates), while health expenditure, number of medical personnel and hospital beds per 1000 residents were used as proxy measures for health inputs. Changes in productivity were quantified using a bootstrap Malmquist productivity index (MPI). The analysis focused on the period between 2004 and 2015. This was to capture pre- and post-policy implementation experience and to ensure that enough time was allowed for the policy to work through. Finally, a bootstrap Tobit regression model for panel data was applied to examine the potential effects of contextual factors on productivity change. The result showed that the reform has had negative effects on productivity. Only scale efficiency had improved steadily, but the decline in the scale of technological change observed during the same period meant that the progress in scale efficiency had been masked. Better economic performance (as measured by per capita Gross Domestic Product (GDP)) and higher human resource to capital investment ratio (as measured by density of medical staff per hospital beds) tended to boost productivity growth, while population aging, low educational attainment and higher percentage of out-of-pocket (OOP) payments had adverse effects. Improving health system productivity in China requires improving financial risk protection and maintaining proper balance between human and capital investment in the country.
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Affiliation(s)
- Peipei Chai
- Faculty of Health, University of Canberra, Building 22, 11 Kirinari Street, Bruce, ACT 2617, Australia.,Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, B3 Wudong Building, 9 Chegongzhuang Street, Xicheng District, Beijing 100044, China
| | - Yuhui Zhang
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, B3 Wudong Building, 9 Chegongzhuang Street, Xicheng District, Beijing 100044, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China
| | - Shiwei Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China
| | - Yohannes Kinfu
- Faculty of Health, University of Canberra, Building 22, 11 Kirinari Street, Bruce, ACT 2617, Australia
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Wu TT, Liu WW, Zou M, Lei X, Yang Q, Sharma M, Zhao Y, Shi ZM. Changes in preventive care utilisation and its influencing factors among Chinese adults before and after the healthcare reform: cross-sectional evidence from the China Health and Nutrition Survey in 2004-2015. BMJ Open 2020; 10:e038763. [PMID: 33004399 PMCID: PMC7534708 DOI: 10.1136/bmjopen-2020-038763] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/25/2022] Open
Abstract
OBJECTIVE China launched its health reform in 2009. This study aimed to assess changes in preventive care utilisation (PCU) and its relationship with the healthcare reform. DESIGN A cross-sectional study using demographic characteristics, socioeconomic status, environmental factors, and lifestyle and health status data of adults from five waves (2004-2015) of the China Health and Nutrition Survey (CHNS) was conducted. Multilevel mixed-effects logistic regression models were used. SETTING Data were derived from urban and rural communities of nine provinces in China. PARTICIPANTS Data were obtained from five waves of the CHNS, with 9960 participants in 2004, 9888 in 2006, 10 286 in 2009, 9709 in 2011, and 10 628 in 2015. OUTCOME The primary outcome was PCU. RESULTS PCU in 2004-2015 among adults was 3.29%, 3.13%, 3.77%, 4.95% and 2.73%, respectively. Whether before or after the health reform, having a history of disease and female gender were positive influencing factors of PCU. Before 2009, PCU was significantly associated with gender, income, medical insurance status and region. Age, medical insurance status, history of drinking and education level significantly affected PCU in 2009-2011. Having medical insurance was no longer a positive influencing factor of PCU, while high income had a negative effect on PCU, in 2011-2015. CONCLUSIONS PCU from 2004 to 2015 was low and the health reform in China may lack sustainable effect on PCU. Further studies on how to ensure sustainability of PCU are necessary, and further reforms on preventive care services should be aimed at different ages, rural areas and participants without history of disease.
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Affiliation(s)
- Ting Ting Wu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Wei Wei Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Mao Zou
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Xun Lei
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Qiang Yang
- The Hospital on Integration of Chinese and Western Medical Science in Shapingba District, Chongqing, China
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, Mississippi, USA
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Zu Min Shi
- Human Nutrition Department, QU Health, Qatar University, Doha, Ad Dawhah, Qatar
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Zhang H, Wang W, Haggerty J, Schuster T. Predictors of patient satisfaction and outpatient health services in China: evidence from the WHO SAGE survey. Fam Pract 2020; 37:465-472. [PMID: 32064515 PMCID: PMC7474531 DOI: 10.1093/fampra/cmaa011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patient satisfaction is an essential indicator in medical practise and research. To monitor the health and well-being of adult populations and the ageing process, the World Health Organization (WHO) has initiated the Study on Global AGEing and Adult Health (SAGE), compiling longitudinal information in six countries including China as one major data source. OBJECTIVE The objective of this study was to identify potential predictors for patient satisfaction based on the 2007-10 WHO SAGE China survey. METHODS Data were analysed using random forests (RFs) and ordinal logistic regression models based on 5774 responses to predict overall patient satisfaction on their most recent outpatient health services visit over the last 12 months. Potential predictor variables included access to care, costs of care, quality of care, socio-demographic and health care characteristics and health service features. Increase of the mean-squared error (incMSE) due to variable removal was used to assess relative importance of the model variables for accurately predicting patient satisfaction. RESULTS The survey data suggest low frequency of dissatisfaction with outpatient services in China (1.8%). Self-reported treatment outcome of the respective visit of a care facility demonstrated to be the strongest predictor for patient satisfaction (incMSE +15%), followed by patient-rated communication (incMSE +2.0%), and then income, waiting time, residency and patient age. Individual patient satisfaction in the survey population was predicted with 74% accuracy using either logistic regression or RF. CONCLUSIONS Patients' perceived outcomes of health care visits and patient communication with health care professionals are the most important variables associated with patient satisfaction in outpatient health services settings in China.
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Affiliation(s)
- Hao Zhang
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Wenhua Wang
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montréal, Canada
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40
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Leadership characteristics for interprofessional collaboration in China. J Prof Nurs 2020; 36:356-363. [DOI: 10.1016/j.profnurs.2020.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 11/21/2022]
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41
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Li Y, Pan Q, Gao M, Guo L, Yan H, Li S. Secular trends and rural-urban differences in endocrine and metabolic disease mortality in China: an age-period-cohort modeling of National Data. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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42
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Nie JB, Xie G, Chen H, Cong Y. Conflict of Interest in Scientific Research in China: A Socio-ethical Analysis of He Jiankui's Human Genome-editing Experiment. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:191-201. [PMID: 32588181 DOI: 10.1007/s11673-020-09978-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
Extensive conflicts of interest (COI) at both individual and institutional levels are identifiable in scientific research and healthcare in China, as in many other parts of the world. A prominent new case from China is He Jiankui's experiment that produced the world's first gene-edited babies and that raises numerous ethical, political, socio-cultural, and transnational questions. Serious financial and other COI were involved in He's genetic adventure. Using He's infamous experiment as a case study, this paper explores the wider issue of financial and other COI in scientific research and healthcare in China, especially institutional conflict of interest (ICOI) and policy-related COI. Taking a socio-ethical perspective, it examines China's state policies and its massive efforts to transform and commercialize scientific research, the lack of policies and oversight mechanisms for regulating COI, as well as major ethical issues arising from COI including the undermining of public trust. Some practical suggestions are offered for institutional reform and institutional development so that COI, particularly ICOI, can be avoided or more effectively managed in scientific research in China.
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Affiliation(s)
- Jing-Bao Nie
- Bioethics Centre, Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO, New Zealand.
| | - Guangkuan Xie
- School of Health Humanities, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, P. R. China
| | - Hua Chen
- College of Marxism, Southern Medical University, 1023-1063 Shatai Road South, Baiyun District, Guangzhou, P. R. China
| | - Yali Cong
- School of Health Humanities, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, P. R. China
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43
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Wu C, Zou G, Chen M, Wan L, Kielmann K, McCormack B. Perceived challenges in delivering comprehensive care for patients following stroke: a qualitative study of stroke care providers in Guangdong Province, China. Disabil Rehabil 2020; 44:59-67. [PMID: 32343635 DOI: 10.1080/09638288.2020.1755896] [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: 10/24/2022]
Abstract
Purpose: To understand the challenges in delivering comprehensive care for patients recovering from stroke in Guangdong Province, China.Methods: A cross-sectional qualitative study was conducted in two tertiary hospitals with different socio-economic characteristics in Guangdong Province, Southern China. Interviews were conducted with 16 stroke care providers including doctors, nurses, rehabilitation therapists and care workers. The interviews were audiotaped, transcribed and translated from Mandarin to English. Thematic analysis was used to draw out descriptive and analytical themes relating to care providers' experiences of existing routine stroke care services and the perceptions of challenges in delivering comprehensive stroke care.Results: The interviews with stroke care providers highlighted three key factors that hinder the capacity of the two hospitals to deliver comprehensive stroke care. First, expertise and knowledge regarding stroke and stroke care are lacking among both providers and patients; second, stroke care systems are not fully integrated, with inadequate coordination of the stroke team and inconsistency in care following discharge of stroke patients; third, stroke patients have insufficient social support.Conclusions: While comprehensive stroke care has become a priority in China, our study highlights some important gaps in the current provision of stroke care.IMPLICATIONS FOR REHABILITATIONComprehensive integrated stroke care is essential to maximize the effectiveness of stroke services and in China it needs to be further improved.Multidisciplinary stroke care systems should strengthen collaborations across all relevant disciplines and should include a clear role for registered nurses.Follow-up care after discharge needs more engagement with family caregivers.
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Affiliation(s)
- Chanchan Wu
- School of Nursing, Sun Yat-sen University, Guangzhou, China.,School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Guanyang Zou
- School of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Minjie Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Lihong Wan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Brendan McCormack
- Division of Nursing, School of Health Sciences, Queen Margaret University, Edinburgh, UK
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Du X, Patel A, Anderson CS, Dong J, Ma C. Epidemiology of Cardiovascular Disease in China and Opportunities for Improvement: JACC International. J Am Coll Cardiol 2020; 73:3135-3147. [PMID: 31221263 DOI: 10.1016/j.jacc.2019.04.036] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 12/24/2022]
Abstract
The burden of cardiovascular (CV) disease is very high in China, due to highly prevalent and poorly controlled risk factors resulting from changing sociodemographic structure and lifestyles in its large population. Rapid economic development and urbanization have been accompanied by changing patterns, expression, and management of CV disease. However, the health care system in China lacks a hierarchical structure, with a focus on treating acute diseases in hospital while ignoring long-term management, and primary health care is too weak to effectively control CV risk factors. To address these challenges, the Chinese central government has ensured health is a national priority and has introduced reforms that include implementing policies for a healthy environment, strengthening primary care, and improving affordability and accessibility within the health system. Turning the inverted pyramid of the health care system is essential in the ongoing battle against CV disease.
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Affiliation(s)
- Xin Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Heart Health Research Center, Beijing, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Craig S Anderson
- Heart Health Research Center, Beijing, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; The George Institute for Global Health China at Peking University Health Science Center, Beijing, China
| | - Jianzeng Dong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Chen X, Li H, Lucero-Prisno DE, Abdullah AS, Huang J, Laurence C, Liang X, Ma Z, Mao Z, Ren R, Wu S, Wang N, Wang P, Wang T, Yan H, Zou Y. What is global health? Key concepts and clarification of misperceptions: Report of the 2019 GHRP editorial meeting. Glob Health Res Policy 2020; 5:14. [PMID: 32289081 PMCID: PMC7136700 DOI: 10.1186/s41256-020-00142-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
The call for "Working Together to Build a Community of Shared Future for Mankind" requires us to improve people's health across the globe, while global health development entails a satisfactory answer to a fundamental question: "What is global health?" To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word "global" in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of "international health" by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.
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Affiliation(s)
- Xinguang Chen
- Global Health Institute, Wuhan University, Wuhan, China
- Department of Epidemiology, University of Florida, Florida, USA
| | - Hao Li
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Abu S. Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Duke University, Durham, North Carolina USA
| | - Jiayan Huang
- School of Public Health, Fudan University, Shanghai, China
| | | | - Xiaohui Liang
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Zhenyu Ma
- School of Public Health, Guangxi Medical University, Guangxi, China
| | - Zongfu Mao
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Ran Ren
- Global Health Research Center, Dalian Medical University, Dalian, China
| | - Shaolong Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Nan Wang
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Peigang Wang
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Tingting Wang
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Yuliang Zou
- School of Health Sciences, Wuhan University, Wuhan, China
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Vandenberg O, Durand G, Hallin M, Diefenbach A, Gant V, Murray P, Kozlakidis Z, van Belkum A. Consolidation of Clinical Microbiology Laboratories and Introduction of Transformative Technologies. Clin Microbiol Rev 2020; 33:e00057-19. [PMID: 32102900 PMCID: PMC7048017 DOI: 10.1128/cmr.00057-19] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Clinical microbiology is experiencing revolutionary advances in the deployment of molecular, genome sequencing-based, and mass spectrometry-driven detection, identification, and characterization assays. Laboratory automation and the linkage of information systems for big(ger) data management, including artificial intelligence (AI) approaches, also are being introduced. The initial optimism associated with these developments has now entered a more reality-driven phase of reflection on the significant challenges, complexities, and health care benefits posed by these innovations. With this in mind, the ongoing process of clinical laboratory consolidation, covering large geographical regions, represents an opportunity for the efficient and cost-effective introduction of new laboratory technologies and improvements in translational research and development. This will further define and generate the mandatory infrastructure used in validation and implementation of newer high-throughput diagnostic approaches. Effective, structured access to large numbers of well-documented biobanked biological materials from networked laboratories will release countless opportunities for clinical and scientific infectious disease research and will generate positive health care impacts. We describe why consolidation of clinical microbiology laboratories will generate quality benefits for many, if not most, aspects of the services separate institutions already provided individually. We also define the important role of innovative and large-scale diagnostic platforms. Such platforms lend themselves particularly well to computational (AI)-driven genomics and bioinformatics applications. These and other diagnostic innovations will allow for better infectious disease detection, surveillance, and prevention with novel translational research and optimized (diagnostic) product and service development opportunities as key results.
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Affiliation(s)
- Olivier Vandenberg
- Innovation and Business Development Unit, LHUB-ULB, Groupement Hospitalier Universitaire de Bruxelles (GHUB), Université Libre de Bruxelles, Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Géraldine Durand
- bioMérieux, Microbiology Research and Development, La Balme Les Grottes, France
| | - Marie Hallin
- Department of Microbiology, LHUB-ULB, Groupement Hospitalier Universitaire de Bruxelles (GHUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Andreas Diefenbach
- Department of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Labor Berlin, Charité-Vivantes GmbH, Berlin, Germany
| | - Vanya Gant
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Patrick Murray
- BD Life Sciences Integrated Diagnostic Solutions, Scientific Affairs, Sparks, Maryland, USA
| | - Zisis Kozlakidis
- Laboratory Services and Biobank Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Alex van Belkum
- bioMérieux, Open Innovation and Partnerships, La Balme Les Grottes, France
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Building a People-Centred Integrated Care Model in Urban China: A Qualitative Study of the Health Reform in Luohu. Int J Integr Care 2020; 20:9. [PMID: 32210740 PMCID: PMC7082827 DOI: 10.5334/ijic.4673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: China has adopted a people-centred integrated care model to reform its severely hospital-centric and fragmented delivery system. As a template of this model in urban China, the Luohu Hospital Group has generated considerable public and academic interest to scale it up. Methods: Guided by a policy triangle framework, this qualitative study explored the context, actors, content, and process of founding the Luohu Hospital Group. Three semi-structured interviews and five focus groups were conducted among 35 key informants. Content analysis was used to analyse the data. Results: The reform in Luohu took place in a competitive health care market, based on the comprehensive health reform in Shenzhen. Under the strong leadership of the district government, the reform adopted comprehensive strategies to strengthen primary care and care coordination, improve the quality and efficiency of health care delivery, and promote population health. The reform achieved a high level of organisational integration but was still in the process of fulfilling professional and clinical integration. Conclusions and discussion: The establishment of the Luohu Hospital Group transformed the originally fragmented delivery system into a tightly integrated service delivery networks. Though valuable lessons have been generated, the reform and its impacts require ongoing monitoring.
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Lv H, Gu J, Yuan X, Miao Y. Prioritizing the perceived equity of the residents to construct an equitable health care system: evidence from a national cross-sectional study in China. BMC Health Serv Res 2020; 20:167. [PMID: 32131823 PMCID: PMC7057475 DOI: 10.1186/s12913-020-5026-9] [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] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 02/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Building an equitable health care system involves both the promotion of social justice in health and people's subjective perception of the promotion. This study aimed to analyze the overall status and associated factors of the perceived equity of the Chinese health care system, and then to offer policy recommendations for health care reform. METHODS Information on the perceived equity score (scale 0 to 10) of 10,243 valid cases in total were derived from the data set of Chinese Social Survey 2015. Univariate analysis methods were applied to present respondents' overall perceived equity of the Chinese health care system. Multivariate linear regression method was used to explore the associated factors of the perceived equity and examine their independent effect. RESULTS The respondents gave positive but relatively low marks (6.7 ± 2.6, 95% CI: = 6.64~6.74) of the equity of the Chinese health care system. Younger respondents reported a higher score of perceived equity than their elder counterparts (β = - 0.132, 95% CI: - 0.203~ - 0.062, P < 0.001). Respondents with lower education level were significantly more likely to consider the Chinese health care system equitable (β = - 0.104, 95% CI: - 0.153~ - 0.056, P < 0.001). Respondents satisfied with the Social Health Insurance reimbursement ratio tended to score the system higher in the survey (β = 0.044, 95% CI: 0.024~0.063, P < 0.001). Respondents residing in eastern China and rural areas were significantly more likely to consider the Chinese health care system equitable (β = - 0.268, 95% CI: - 0.338~ - 0.199, P < 0.001). Meanwhile, rural respondents reported higher scores of the perceived equity than urban respondents did (β = 0.348, 95% CI: 0.237~0.458, P < 0.001). Respondents from regions with adequate GPs scored the system higher in this survey (β = 0.087, 95% CI: 0.008~0.165, P < 0.001). The present study found no influence of gender, economic status, Social Health Insurance coverage, or satisfaction with the latest treatment on perceived equity. CONCLUSIONS Eliminating the sense of inequity among a range of populations should be prioritized in health care reform. A national-level investigation system to rate residents' perceived equity was necessary for global health care reform.
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Affiliation(s)
- Hui Lv
- Management Institute of Xinxiang Medical University, Xinxiang, China
| | - Jianqin Gu
- Department of General Medicine, Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Xiangdong Yuan
- Department of General Surgery of Guangdong General Hospital, Guangzhou, China
| | - Yudong Miao
- Department of General Medicine, Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou, China. .,Department of General Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China.
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The weakness of the strong: Examining the squeaky-wheel effect of hospital violence in China. Soc Sci Med 2020; 245:112717. [DOI: 10.1016/j.socscimed.2019.112717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022]
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50
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Lee YH, Chang YC, Shelley M. Is preventive care utilization associated with lower outpatient and inpatient health-care expenses among Chinese older adults? A longitudinal analysis. Int J Health Plann Manage 2020; 35:e142-e155. [PMID: 31670425 DOI: 10.1002/hpm.2945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND China has made major improvements to its health-care system since the early 21st century. However, the effectiveness of preventive care utilization on health-care costs remains limited. This study seeks to understand the effect of preventive care utilization on outpatient and inpatient health-care expenses. METHODS With the use of the Chinese Longitudinal Healthy Longevity Survey with older adults who were 65 years old or above (n = 2828), Tobit regression models were estimated to examine the association of preventive care utilization and expenses with medical treatments. Preventive care utilization in the previous wave was used to predict health-care costs for treatments in the next wave. Propensity score matching was used to reduce potentially confounding factors. FINDINGS Results indicated that preventive care utilization was positively associated with outpatient health care among Chinese older adults (β = 231.8, standard error [SE] = 71.5, P < .01). The association between preventive care utilization and inpatient health-care expenses was not significant. CONCLUSIONS Despite the results from previous studies suggesting that preventive care utilization can help reduce health-care expenses, this study does not support such a claim among Chinese older adults. The long-term association between preventive care utilization and health-care expenses for treatment should be studied further.
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Affiliation(s)
- Yen-Han Lee
- Department of Applied Health Sciences, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Yen-Chang Chang
- Center for General Education, National Tsing Hua University, Hsinchu City, Taiwan
| | - Mack Shelley
- Department of Political Science, Iowa State University, Ames Iowa, USA.,Department of Statistics, Iowa State University, Ames Iowa, USA
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