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Ye J, Feng J, Li X, Qu G, Lei Z, Jiang H, Sun Y, Zhang R, Shen A, Wan Z, Gan Y, Liu C. Public trust in general practitioners and its association with primary care contracts: a cross-sectional study of community residents in China. Public Health 2024; 231:55-63. [PMID: 38626672 DOI: 10.1016/j.puhe.2024.03.014] [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: 08/02/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES This study aimed to assess the level of public trust in general practitioners (GPs) and its association with primary care contract services (PCCS) in China. STUDY DESIGN Cross-sectional study. METHODS Between September and December 2021, 4158 residents across eastern, central, and western China completed a structured self-administered questionnaire. Trust was assessed using the Chinese version of Wake Forest Physician Trust Scale. Multivariable linear regression models were established to identify predictors of trust. The effect size of PCCS on trust was estimated by the average treatment effect for the treated (ATT) through propensity score matching. RESULTS The study participants had a mean Wake Forest Physician Trust Scale score of 36.82 (standard deviation = 5.45). Enrollment with PCCS (β = 0.14, P < 0.01), Han ethnicity (β = 0.03, P < 0.05), lower educational attainment (β = -0.06, P < 0.01), higher individual monthly income (β = 0.03, P < 0.05), better self-rated health (β = 0.04, P < 0.05), chronic conditions (β = 0.07, P < 0.01), and higher familiarity with primary care services (β = 0.12, P < 0.01) and PCCS (β = 0.21, P < 0.01) were associated with higher trust in GPs. The ATT of PCCS exceeded 1 (P < 0.05). CONCLUSIONS PCCS are associated with higher levels of trust in GPs. PCCS may become an effective tool to attract public trust in GPs, although the relationship between the two may be bi-directional.
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Affiliation(s)
- Jun Ye
- Department of Public Management, College of Medical Humanities and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing Feng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinyan Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ge Qu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zihui Lei
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Heng Jiang
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Yuchao Sun
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ruofan Zhang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Aoqi Shen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhengyi Wan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Chaojie Liu
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.
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Li J, Gao T, Zhao D, Chai S, Luo J, Wang X, Wang X, Sun J, Li P, Zhou C. Catastrophic health expenditure and health-related quality of life among older adults in Shandong, China: the moderation effect of daily care by adult children. Int J Equity Health 2024; 23:51. [PMID: 38468257 DOI: 10.1186/s12939-023-02057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/12/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) has a considerable impact on older people in later life, but little is known about the relationship between catastrophic health expenditure and health-related quality of life (HRQOL). The aim of this study was to examine the relationship between catastrophic health expenditure and health-related quality of life in older people, and to explore whether the daily care provided by adult children is a moderator in this relationship. METHODS Data from the sixth National Health Services Survey in Shandong Province, China. The sample consisted of 8599 elderly people (age ≥ 60 years; 51.7% of female). Health-related quality of life was measured by the health utility value of EQ-5D-3 L. Interaction effects were analyzed using Tobit regression models and marginal effects analysis. RESULTS The catastrophic health expenditure prevalence was 60.5% among older people in Shandong, China. catastrophic health expenditure was significantly associated with lower health-related quality of life (β= - 0.142, P < 0.001). We found that adult children providing daily care services to their parents mitigated the effect of catastrophic health expenditure on health-related quality of life among older people (β = 0.027, P = 0.040). CONCLUSIONS Our findings suggested that catastrophic health expenditure was associated with health-related quality of life and the caring role of older adult children moderated this relationship. Reducing the damage caused by catastrophic health expenditure helps to improve health-related quality of life in older people. Adult children should increase intergenerational contact, provide timely financial and emotional support to reduce the negative impact of catastrophic health expenditure on health-related quality of life.
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Affiliation(s)
- Jiayan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Tingting Gao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Shujun Chai
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Jingjing Luo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Xuehong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Xueqing Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China.
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University), Jinan, 250012, China.
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Zhao N, Gu M, Li J, Zhang H, Yang J. Factors influencing contracting of residents with family doctors in China: a national cross-sectional survey. BMC Health Serv Res 2024; 24:213. [PMID: 38360648 PMCID: PMC10870580 DOI: 10.1186/s12913-024-10606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Family doctor contract services (FDCS) have been introduced in China in 2009 [1] and rapidly expanded recently. This study sought to investigate factors that influenced the willingness of Chinese residents to use FDCS. METHODS We employed multistage stratified and convenience sampling to administer questionnaires to 1455 Beijing, Qinghai, and Fujian residents. The willingness of residents in each province to contract family doctors was analyzed using the chi-square test and binary logistic regression. RESULTS The analysis in this study found that the signing rate of family doctors in China was about 27.77%, with differences in the signing up levels in Beijing (13.68%), Fujian (64.49%) and Qinghai (11.22%). In addition, the binary logistic regression results emphasized the relative importance of age, education, medical preference and policy knowledge on the willingness to sign up. Distrust of family doctors' medical skills (65.7%), not knowing how to contract (47.8%), and not knowing what medical problems can be solved (41.1%) were the top three reasons accounting for the reluctance of residents to contract with family doctors. CONCLUSION Residents from different backgrounds have different willingness to sign up, so the specific circumstances and needs of different groups should be taken into account. In order to increase the signing-up rate, consideration can be given to promoting the family doctor model in Fujian throughout the country. Individual hesitation can be eliminated by increasing the reimbursement rate of health insurance, reducing the out-of-pocket expenses of contracted patients, and providing incentives of certain discounts for consecutive contracted patients.
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Affiliation(s)
- Ning Zhao
- School of Public Health, Capital Medical University, Beijing, China
| | - Mei Gu
- School of Public Health, Capital Medical University, Beijing, China
| | - Jin Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- Department of Health Education, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, China
| | - Jia Yang
- School of Public Health, Capital Medical University, Beijing, China.
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Fu Y, Zhang S, Guo X, Lu Z, Sun X. Socioeconomic status and quality of life among older adults with hypertension in rural Shandong, China: a mediating effect of social capital. Front Public Health 2023; 11:1248291. [PMID: 37927868 PMCID: PMC10622776 DOI: 10.3389/fpubh.2023.1248291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023] Open
Abstract
Background Improving the quality of life (QoL) of older adults is becoming an important global issue. However, very few studies have been focused on the relationship between socioeconomic status (SES) and QoL in older adults with hypertension. The purpose of this study is to investigate (a) the status of QoL and (b) the mediating effect of social capital in the relationship between SES and QoL, among rural older adults with hypertension in China. Methods Using multistage stratified random sampling, a face-to-face questionnaire survey was conducted among rural older adults with hypertension in Shandong province of China from June to July 2021. Three typical measures representing SES were used, namely, annual household income, educational level, and employment status. Individual social capital and QoL were assessed by the Resource Generator-China Scale (RG-China) and a 34-item simplified Patient Report Outcome (PRO)-specific scale for older adults with hypertension, respectively. A total of 950 rural older adults with hypertension were included in the analysis. The mediation model based on bootstrap analyses was employed to explore the relationship between SES and QoL and the mediating role of social capital in the SES-QoL nexus. Results The sampled rural older adults with hypertension had an upper-middle level of QoL, and the average score was 132.57 ± 19.40. SES was positively correlated with both QoL and individual social capital; individual social capital was significantly positively correlated with QoL. Controlling for sociodemographic variables, SES was still significantly associated with individual social capital (β = 0.140, P < 0.001), and the higher the individual social capital, the better QoL (β = 0.153, P < 0.001). Individual social capital played a partially mediating role in the association between SES and QoL (indirect effect = 0.021, 95% CI: 0.010-0.038), which accounted for 9.38% of the total effect. Conclusion This study provides evidence that the effect of SES on QoL was partially mediated by individual social capital among rural older adults with hypertension in China. The government should pay more attention to the rural older hypertensive population with lower SES and strive to reduce the negative impact of poor SES on their QoL, based on effective strategies including improving their individual social capital.
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Affiliation(s)
- Yingjie Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Shuo Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Zilong Lu
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
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Lv B, Zhang L, Meng K. Effect of multiple chronic conditions on family doctor contracting in the elderly in China: the moderating role of socioeconomic status. BMC Public Health 2023; 23:1540. [PMID: 37573398 PMCID: PMC10422842 DOI: 10.1186/s12889-023-16438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND China's family doctor contracting service is an important part of deepening the reform of the healthcare systems, aiming to further develop chronic disease management services, enhance the capacity of primary health care services and improve the health of residents. The purpose of this study was to explore the influence of multiple chronic conditions in the elderly on family doctor contracting and whether socioeconomic status played a moderating role. METHODS A cross-sectional survey was conducted in Beijing, China. A total of 1814 elderly people over 60 years old were included in this study using a whole-group sampling method. The univariate analysis and logistic regression analysis was used to analyze the data. RESULTS 21.72% of the elderly signed up with family doctors. The multiple chronic conditions was a factor influencing the elderly to sign up with family doctors (OR = 1.44, 95%CI = 1.28-1.61), and the higher the degree of multiple chronic conditions, the stronger willingness to sign up. Socioeconomic status positively moderates the effect of multiple chronic conditions on signing. Also, physical activity intensity (OR = 1.25, 95%CI = 1.03-1.54) and willingness to first visit primary care facilities (OR = 1.38, 95%CI = 1.25-1.54) influenced the elderly to sign up with family doctors. CONCLUSIONS The elderly with a high degree of multiple chronic conditions, high activity intensity, and a strong willingness to first visit primary care facilities were more likely to sign up with family doctors. The health literacy of the elderly should be further improved, and publicity on the family doctor contracting service policies for the elderly with lower socioeconomic status should be strengthened to guide them to sign up with family doctors. At the same time, the service capacity of primary care facilities should be further improved to meet the health needs of the elderly.
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Affiliation(s)
- Bo Lv
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Ling Zhang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
| | - Kai Meng
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
- Beijing Tiantan Hospital, Capital Medical University, No.119 South of the Fourth Ring Road, Fengtai District, Beijing, 100070, China.
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Lin W, Huang W, Mei C, Liu P, Wang H, Yuan S, Zhao X, Wang Y. Associations between the signing status of family doctor contract services and cervical cancer screening behaviors: a cross-sectional study in Shenzhen, China. BMC Public Health 2023; 23:573. [PMID: 36973711 PMCID: PMC10045612 DOI: 10.1186/s12889-023-15462-9] [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] [Received: 08/19/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND As a core part of the primary healthcare system, family doctor contract services (FDCS) may help healthcare providers promote cervical cancer screening to the female population. However, evidence from population-based studies remains scant. This study aimed to investigate the potential associations between the signing status of FDCS and cervical cancer screening practices in Shenzhen, China. METHODS A cross-sectional survey among female residents was conducted between July to December 2020 in Shenzhen, China. A multistage sampling method was applied to recruit women seeking health services in community health service centers. Binary logistic regression models were established to assess the associations between the signing status of FDCS and cervical cancer screening behaviors. RESULTS Overall, 4389 women were recruited (mean age: 34.28, standard deviation: 7.61). More than half (54.3%) of the participants had signed up with family doctors. Women who had signed up for FDCS performed better in HPV-related knowledge (high-level rate: 49.0% vs. 35.6%, P<0.001), past screening participation (48.4% vs. 38.8%, P<0.001), and future screening willingness (95.9% vs. 90.8%, P<0.001) than non-signing women. Signing up with family doctors was marginally associated with past screening participation (OR: 1.13, 95%CI: 0.99-1.28), which tended to be robust among women with health insurance, being older than 25 years old at sexual debut, using condom consistently during sexual intercourse, and with a low level of HPV related knowledge. Similarly, signing up with family doctors was positively associated with future screening willingness (OR: 1.68, 95%CI: 1.29-2.20), which was more pronounced among women who got married and had health insurance. CONCLUSIONS This study suggests that signing up with family doctors has positive associations with cervical cancer screening behaviors among Chinese women. Expanding public awareness of cervical cancer prevention and FDCS may be a feasible way to achieve the goal of cervical cancer screening coverage.
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Affiliation(s)
- Wei Lin
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518048, China
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Weikang Huang
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Chaofan Mei
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Peiyi Liu
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
- Research Institute of Maternity and Child Medicine, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - He Wang
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
- Research Institute of Maternity and Child Medicine, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Shixin Yuan
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
- Research Institute of Maternity and Child Medicine, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Xiaoshan Zhao
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518048, China
| | - Yueyun Wang
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518048, China.
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China.
- Research Institute of Maternity and Child Medicine, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China.
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Wang A, Tang C, Zhou L, Lv H, Song J, Chen Z, Yin W. How surface acting affects turnover intention among family doctors in rural China: the mediating role of emotional exhaustion and the moderating role of occupational commitment. HUMAN RESOURCES FOR HEALTH 2023; 21:3. [PMID: 36703192 PMCID: PMC9878490 DOI: 10.1186/s12960-023-00791-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Family doctors in rural China are the main force for primary health care, but the workforce has not been well stabilized in recent years. Surface acting is an emotional labor strategy with a disparity between inner feelings and emotional displays, provoking negative effects such as emotional exhaustion, occupational commitment reduction, and, consequently, increasing turnover rate. With the Conservation of Resources theory, this study explores how the surface acting of rural family doctors affects turnover intention through emotional exhaustion and investigates what role occupational commitment plays in this relationship. METHODS With a valid response rate of 93.89%, 953 valid data were collected by an anonymous self-administered questionnaire survey in December 2021 in Shandong Province, China. Cronbach's Alpha and confirmatory factor analysis (CFA) were used to estimate reliability and construct validity, respectively. The PROCESS macro in SPSS was performed to analyze the mediating and moderated mediation effects of surface acting, emotional exhaustion, occupational commitment, and turnover intention. RESULTS Reliability and validity indicated that the measurement instruments were acceptable. Surface acting had a direct positive effect on turnover intention (β = 0.481, 95% CI [0.420, 0.543]). Emotional exhaustion partially mediated the effect of surface acting on turnover intention (indirect effect: 0.214, 95% CI [0.175, 0.256]). Occupational commitment moderated the effect of emotional exhaustion on turnover intention (β = - 0.065, 95% CI [- 0.111, - 0.019]), and moderated the indirect effect of surface acting on turnover intention via emotional exhaustion (index of moderated mediation: - 0.035). CONCLUSIONS Emotional exhaustion partially mediates the relationship between surface acting and turnover intention among family doctors in rural China, and occupational commitment moderates the direct effect of emotional exhaustion on turnover intention and further moderates the mediating effect. Policymakers should pay more attention to the effects of emotional labor and emotional resource depletion on the stability of rural health human resources.
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Affiliation(s)
- Anqi Wang
- School of Public Health, Weifang Medical University, Weifang, China
| | - Changhai Tang
- School of Public Affairs, Zhejiang University, Hangzhou, China
- School of Business, NingboTech University, Ningbo, China
| | - Lifang Zhou
- School of Management, Weifang Medical University, Weifang, China
| | - Haiyuan Lv
- School of Management, Weifang Medical University, Weifang, China
| | - Jia Song
- School of Management, Weifang Medical University, Weifang, China
| | - Zhongming Chen
- School of Management, Weifang Medical University, Weifang, China
| | - Wenqiang Yin
- School of Management, Weifang Medical University, Weifang, China
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Deng P, Fu Y, Chen M, Si L. Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study. Front Public Health 2022; 10:943271. [PMID: 36438282 PMCID: PMC9684646 DOI: 10.3389/fpubh.2022.943271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background Cancer, the leading cause of mortality in China, is a significant burden on patients, their families, the medical system, and society at large. However, there is minimal data on health service utilization and catastrophic health expenditure (CHE) among cancer patients in China. The objective of this study was to identify factors associated with health care utilization and CHE in Chinese cancer patients. Methods The 2018 wave of a nationally representative dataset, the China Health and Retirement Longitudinal Study, was used in our study. Of 18,968 respondents recruited for the analysis, 388 were clinically diagnosed with cancer. CHE was defined as household health expenditure that exceeded 40% of non-food household expenses. A binary logistic regression model was used to identify the risks of cancer exposure among all participants, along with the likelihood of CHE in households with cancer patients at the 40% threshold. A negative binomial regression model was used to identify determinants of health service utilization among cancer patients. Results Contracting a family physician (incidence rate ratio IRR: 2.38, 1.18-4.77), Urban Employee Basic Medical Insurance (IRR: 4.02, 1.91-8.46, compared to the uninsured), Urban and Rural Resident Basic Medical Insurance (IRR: 3.08, 1.46-6.49, compared to the uninsured), and higher per-capita household consumption were positively associated with inpatient service utilization. Patients with a college education and above reported a greater number of outpatient visits (IRR: 5.78, 2.56-13.02) but fewer inpatient hospital days (IRR: 0.37, 0.20-0.67). Being diagnosed with a non-cancer chronic non-communicable disease was associated with an increased number of outpatient visits (IRR: 1.20, 1.10-1.31). Of the 388 participants, 50.1% of households had CHE, which was negatively correlated with a larger household size (odds ratio OR: 0.52, 0.32-0.86) and lower socioeconomic status [for quintile 5 (lowest group) OR: 0.32, 0.14-0.72]. Conclusions The socioeconomic characteristics of cancer patients had a considerable impact on their healthcare utilization. Individualized and targeted strategies for cancer management should be implemented to identify high-risk populations and trace the utilization of care among Chinese cancer patients. Strategic purchasing models in cancer care and social health insurance with expanded benefits packages for cancer patients are crucial to tackling the cancer burden in China.
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Affiliation(s)
- Penghong Deng
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yu Fu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China,Center for Global Health, Nanjing Medical University, Nanjing, China,*Correspondence: Mingsheng Chen
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia,The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
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Chen J, Wang Y, Du W, Liu S, Xiao Z, Wu Y. Analysis on the relationship between effort-reward imbalance and job satisfaction among family doctors in China: a cross-sectional study. BMC Health Serv Res 2022; 22:992. [PMID: 35922789 PMCID: PMC9351256 DOI: 10.1186/s12913-022-08377-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family doctor contract services was launched in Sichuan province in 2016. The focus was mainly on developing primary health care services but paying less attention to the work stress and job satisfaction of in-service family doctors. OBJECTIVE This study aims to explore the influencing factors of job satisfaction, and the relation between work stress indicators and job satisfaction among family physicians. METHODS An analytical online cross-sectional survey was performed among 1,105 family doctors from 23 districts and counties in Chengdu. Self-administered questionnaire was completed. Sociodemographic factors, work stress measured by Effort-Reward Imbalance (ERI)scale, and job satisfaction assessed by the short Chinese version of the Minnesota Satisfaction Questionnaire (MSQ) were collected in this study. A statistical analysis and hierarchical linear regression analysis were performed to explore the influencing factors and the correlations among related variables. RESULTS The overall mean MSQ score was 52.01 ± 13.23. Analysis of doctor satisfaction indicated that age, education, job rank, type of institution, years of working and monthly income were statistically significant (P < 0.05). There were negative correlation coefficients between general job satisfaction and effort/reward ratio (ERR) (r = -0.130, P < 0.001) and overcommitment (r = -0.615, P < 0.001). CONCLUSION The level of job satisfaction among family doctors was considerable low. Age, education, job rank, type of institution, years of working and monthly income were influencing factors of job satisfaction. ERI and overcommitment had a negative correlation with general job satisfaction.
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Affiliation(s)
- Jinhua Chen
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China
| | - Yijun Wang
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China
| | - Wen Du
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China
| | - Shuyi Liu
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China.
| | - Zhu Xiao
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China
| | - Yuelei Wu
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China.
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Wang H, Sun H, Jin C, Wang M, Luo Y, Song W, Wang H. Preference to Family Doctor Contracted Service of Patients with Chronic Disease in Urban China: A Discrete Choice Experiment. Patient Prefer Adherence 2022; 16:2103-2114. [PMID: 35989974 PMCID: PMC9384844 DOI: 10.2147/ppa.s371188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Shanghai is one of the pioneers proposing family doctor contract service (FDCS). However, there is no quantitative research focusing on the Shanghai experience from a demand-side perspective. This study investigated Shanghai chronic patients' relative preferences for FDCS using a discrete choice experiment method. METHODS A face-to-face discrete choice experiment (DCE) was performed to elicit the preference with 300 samples. Attributes and levels were extracted from the literature review and focus group consultation with patients. Seven attributes, follow-up frequency, medicine accessibility, family doctor competency, health management, referral convenience, appointment flexibility, and shared decision-making, were decided. Three levels were attached to each attribute. A mixed logit model was used to evaluate the multiple-choice data. RESULTS A total of 248 patients completed the survey. Patient valued FDCS medicine accessibility (β=0.57, P < 0.05), and high family doctor competency (β= 0.43, P < 0.05), regular health management activities (β=0.36, P < 0.05), high follow-up frequency (β=0.31, P < 0.05) the most. The good doctor-patient shared decision-making atmosphere (β=0.12, P < 0.05), high referral convenience (β=0.06, P < 0.05) and high appointment flexibility (β=0.04, P < 0.05) are valued as less important. No significant preference heterogeneity was identified for patients with different sociodemographic characteristics. Respondents reported other FDCS needs, including online health consultation, specialist services in local institutes, higher reimbursement rates, free rehabilitation guidance for the disabled and personal health management. CONCLUSION This research is the first discrete choice experiment FDCS preference research targeting on Chinese urban population. The results suggested that to increase the quality of FDCS, policy-makers should prioritize follow-up frequency, medicine accessibility, family doctor competency and health management. The service package should consider a higher reimbursement rate and rehabilitation guidance for the disabled if extra health-care resources available. Future FDCS policy should consider stated societal preference and be congruent with it.
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Affiliation(s)
- Haode Wang
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Hui Sun
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
- Key Laboratory of Health Technology Assessment, National Health Commission; School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Meifeng Wang
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Yashuang Luo
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Wenqian Song
- Shanghai Overseas Rescue and Aid Service Center, Shanghai, People’s Republic of China
| | - Haiyin Wang
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
- Correspondence: Haiyin Wang, Shanghai Health Development Research Center, Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People’s Republic of China, Tel +86- 18917769216, Email
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