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Li M, Chu M, Zhang S, Shen Y, Sun X, Gong J, Yang G, Shi J, Ding X, Gu Z, Li C, Zhang C, Xia Y, Wang Z, Lip GYH, Chen M. Is it high time to leave the chronic disease care of rural older people to village doctors in China: Insights from a population-based atrial fibrillation screening study. Curr Probl Cardiol 2024; 49:102759. [PMID: 39067720 DOI: 10.1016/j.cpcardiol.2024.102759] [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: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE No study has systematically investigated the quality of long-term care delivered to the rural older people with chronic diseases, such as atrial fibrillation (AF) in China. This study aims to provide contemporary data on the prevalence and awareness of AF among the older population in rural China and to evaluate healthcare knowledge and delivery by village doctors. DESIGN A cross-sectional study. SETTING Rural villages in Daqiao and Xiaoji towns of Jiangsu Province, China. PARTICIPANTS Rural population aged ≥65 years. OUTCOME MEASURES AF was identified using 12-lead electrocardiography in the first-step (government-led health examination) and single-lead electrocardiography in the second-step (in-house AF screening). Questionnaire surveys were designed for the AF patients and their village doctors. RESULTS Among 31,342 permanent residents, 12,630 (40.3 %) declined, 7,956 (25.3 %) participated in the first-step and 10,756 (34.3 %) in the second-step. The overall AF detection rate was 4.3 % (810/18,712). Of the 810 AF patients (mean age 76.1±5.9 years; 51.4 % female), 51.5 % were illiterate, only 2.6 % could use smartphone applications, and 8.1 % lived with their children. Common risk factors were older age, men, hypertension, diabetes, prior stroke, vascular disease, and congestive heart failure. Among the 402 patients with known AF, 367 were at high risk of stroke and 10.9 % (40/367) were anticoagulated. Only 17.6 % patients with known hypertension had blood pressure level <140/90 mmHg, and 6.0 % with known diabetes had a fasting blood glucose level ≤6.1 mmol/L. Only 7.3 % (9/122) village doctors reported having the knowledge of integrated care AF management. CONCLUSIONS This study identified AF in 4.3 %, but AF management was suboptimal in rural China. The current village doctor-dominant rural healthcare system is far from delivering standardized AF management for older patients in rural China. There is an urgent need to empower the village doctors in optimising the care of AF patients.
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Affiliation(s)
- Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Ming Chu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Shimeng Zhang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Youmei Shen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Xingxing Sun
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Jinlong Gong
- Division of Cardiology, Jiangdu People's Hospital, China
| | - Gang Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Jiaojiao Shi
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Xiangwei Ding
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Zhoushan Gu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Chengzong Li
- Division of Cardiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Chaoqun Zhang
- Division of Cardiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Yaodongqin Xia
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Zhirong Wang
- Division of Cardiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China.
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Peng Z, Laporte A, Wei X, Sha X, Coyte PC. Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city. HEALTH ECONOMICS REVIEW 2024; 14:39. [PMID: 38850390 PMCID: PMC11162028 DOI: 10.1186/s13561-024-00516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Although countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care. METHODS The dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care. RESULTS We demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual's risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts. CONCLUSION This study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.
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Affiliation(s)
- Zixuan Peng
- School of Public Health, Southeast University, Suite 137, Kangjian Building, 87 Dingjiaqiao, Nanjing, Jiangsu, 210009, China
| | - Audrey Laporte
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Xiaolin Wei
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Xinping Sha
- Xiangya School of Medicine, Central South University, 172 Tongzipo Rd, Yuelu District, Changsha, Hunan, 410013, China.
| | - Peter C Coyte
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Song F, Wei R, Wang C, Zhang Y. Residents' willingness towards first-contact with primary health care under uncertainty in healthcare: a cross-sectional study in rural China. BMJ Open 2024; 14:e077618. [PMID: 38749685 PMCID: PMC11097851 DOI: 10.1136/bmjopen-2023-077618] [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] [Received: 07/25/2023] [Accepted: 04/10/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To estimate Chinese rural residents' willingness degree of initially contacting primary healthcare (PHC) under uncertainty in healthcare and to explore its influencing factors. SETTING This study collected primary data from rural residents in Dangyang, Hubei Province in China. PARTICIPANTS The study investigated 782 residents and 701 finished the survey. The response rate was 89.64%. A further 27 residents failed the internal consistency test, so the effective sample size was 674. DESIGN In this cross-sectional study, residents' willingness was reflected by the threshold of disease severity for PHC (TDSP), the individual maximal disease scope for considering PHC based on residents' decision-making framework. TDSP was measured through scenario tests. Univariate analysis and unordered multiple logistic regression were used to explore the influencing factors of three-level TDSP: low, general, and high. RESULTS Only 28.2% of respondents had high TDSP and high willingness towards PHC. Compared with general TDSP, respondents who were younger than 40 (OR 7.344, 95% CI 2.463 to 21.894), rich (OR 1.913, 95% CI 1.083 to 3.379), highly risk-averse (OR 1.958, 95% CI 1.016 to 3.774), had substitute medical decision-maker (OR value of parent/child was 2.738, 95% CI 1.386 to 5.411) and had no visits to PHC in the last 6 months (OR 2.098, 95% CI 1.316 to 3.346) tended to have low TDSP and low willingness towards PHC. Compared with general TDSP, no factors were found to significantly influence respondents' high TDSP. CONCLUSIONS TDSP can be a good indicator of residents' willingness. TDSP results demonstrate rural residents' generally low willingness towards first-contact with PHC that some residents refuse to consider PHC even for mild diseases. This study provides practical significance for elaborating the underutilisation of PHC from resident decision-making and offers advice to policymakers and researchers for future modifications.
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Affiliation(s)
- Fei Song
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Ran Wei
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chenzhou Wang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Levy M, Buckell J, Clarke R, Wu N, Pei P, Sun D, Avery D, Zhang H, Lv J, Yu C, Li L, Chen Z, Yip W, Chen Y, Mihaylova B. Association between health insurance cost-sharing and choice of hospital tier for cardiovascular diseases in China: a prospective cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 45:101020. [PMID: 38380231 PMCID: PMC10876671 DOI: 10.1016/j.lanwpc.2024.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024]
Abstract
Background Hospitals in China are classified into tiers (1, 2 or 3), with the largest (tier 3) having more equipment and specialist staff. Differential health insurance cost-sharing by hospital tier (lower deductibles and higher reimbursement rates in lower tiers) was introduced to reduce overcrowding in higher tier hospitals, promote use of lower tier hospitals, and limit escalating healthcare costs. However, little is known about the effects of differential cost-sharing in health insurance schemes on choice of hospital tiers. Methods In a 9-year follow-up of a prospective study of 0.5 M adults from 10 areas in China, we examined the associations between differential health insurance cost-sharing and choice of hospital tiers for patients with a first hospitalisation for stroke or ischaemic heart disease (IHD) in 2009-2017. Analyses were performed separately in urban areas (stroke: n = 20,302; IHD: n = 19,283) and rural areas (stroke: n = 21,130; IHD: n = 17,890), using conditional logit models and adjusting for individual socioeconomic and health characteristics. Findings About 64-68% of stroke and IHD cases in urban areas and 27-29% in rural areas chose tier 3 hospitals. In urban areas, higher reimbursement rates in each tier and lower tier 3 deductibles were associated with a greater likelihood of choosing their respective hospital tiers. In rural areas, the effects of cost-sharing were modest, suggesting a greater contribution of other factors. Higher socioeconomic status and greater disease severity were associated with a greater likelihood of seeking care in higher tier hospitals in urban and rural areas. Interpretation Patient choice of hospital tiers for treatment of stroke and IHD in China was influenced by differential cost-sharing in urban areas, but not in rural areas. Further strategies are required to incentivise appropriate health seeking behaviour and promote more efficient hospital use. Funding Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China Ministry of Science and Technology, and National Natural Science Foundation of China.
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Affiliation(s)
- Muriel Levy
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - John Buckell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, UK
| | - Nina Wu
- School of Public Health, Capital Medical University, Beijing, China
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Dianjianyi Sun
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Daniel Avery
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Hua Zhang
- NCDs Prevention and Control Department, Qingdao Centre for Disease Control and Prevention, Qingdao, China
| | - Jun Lv
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Canqing Yu
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Liming Li
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Winnie Yip
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Lin Y, Li L, Liu B. Assessing the price levels of medical service and influential factors: evidence from China. BMC Public Health 2024; 24:119. [PMID: 38191342 PMCID: PMC10775578 DOI: 10.1186/s12889-024-17639-2] [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: 09/19/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Medical service prices play a crucial role in cost containment in China. This study aimed to assess the change in medical service price levels at the macro level and the relationship with relevant macroeconomic factors. METHODS Data from the 2022 China Statistics Yearbook, the 2022 China Health Statistics Yearbook, and the 2020 China National Health Accounts Report were used. Time trends of health price levels, utilization, and health expenditure were examined. A time-series regression model was employed to measure the impact of service utilization and medical service prices on total medical service expenditure growth from 2000 to 2021. The Johansen cointegration test was conducted to test the cointegrating relationship between medical service price levels and total medical service expenditure, average wage of employees and CPI. The Granger causality test was performed to observe the direction of causality. RESULTS Descriptive analyses showed consistent growth in utilization and medical service price levels from 2000 to 2021. The time-series model indicated that medical service expenditure was influenced by the rise in inpatient admissions and price levels of medical service and medicine. The Johansen cointegration test identified a long-term equilibrium relationship between medical service price levels and total medical service expenditure, average wage and CPI. The change in medical service price levels was the Granger cause of the change in medical service expenditure, but it had no impact on average wage and CPI. However, the change in medical service price levels was influenced by these three macroeconomic factors. CONCLUSIONS The growth of medical service expenditure in China was driven by inpatient use and price level. There was a long-term equilibrium relationship between medical service price levels and relevant macroeconomic factors. However, medical service price levels only affected medical service expenditure and have no impact on average wage and CPI. It is necessary to improve the value transmission mechanism of medical service prices.
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Affiliation(s)
- Yanxian Lin
- Department of Health Economics, School of Public Health, Fudan University, 130 Dong An Rd, Shanghai, 200032, China
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China
| | - Luo Li
- Department of Health Economics, School of Public Health, Fudan University, 130 Dong An Rd, Shanghai, 200032, China
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China
| | - Bao Liu
- Department of Health Economics, School of Public Health, Fudan University, 130 Dong An Rd, Shanghai, 200032, China.
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China.
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Costa-Font J, Cowell F, Shi X. Health inequality and health insurance coverage: The United States and China compared. ECONOMICS AND HUMAN BIOLOGY 2024; 52:101346. [PMID: 38159466 DOI: 10.1016/j.ehb.2023.101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
We study inequality in the distribution of self-assessed health (SAH) in the United States and China, two large countries that have expanded their insurance provisions in recent decades, but that lack universal coverage and differ in other social determinants of health. Using comparable health survey data from China and the United States, we compare health inequality trends throughout the period covering the public health insurance coverage expansions in the two countries. We find that whether SAH inequality is greater in the US or in China depends on the concept of status and the inequality-sensitivity parameter used; however, the regional pattern of SAH inequality is clearly associated with health-insurance coverage expansions in the US but not significant in China.
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Affiliation(s)
- Joan Costa-Font
- London School of Economics and Political Science (LSE), United Kingdom
| | - Frank Cowell
- London School of Economics and Political Science (LSE), United Kingdom
| | - Xuezhu Shi
- School of Insurance and Economics, University of International Business and Economics, China; Institute for Global Health and Development, Peking University, China.
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Qian J, Ramesh M. Strengthening primary health care in China: governance and policy challenges. HEALTH ECONOMICS, POLICY, AND LAW 2024; 19:57-72. [PMID: 37846025 DOI: 10.1017/s1744133123000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Primary care is often the weakest link in health systems despite its acknowledged central importance in promoting population's health at economical cost. A key reason for the lacunae is that both scholars and practitioners working on the subject typically underestimate the enormity of the task and the range of complementary measures required to build an effective primary care system. The objective of the paper is to highlight theoretical gaps and practical limitations to strengthening primary care. The challenges and difficulties are illustrated through a case study of China where primary care continues to struggle despite the government's strong political, financial and policy support in recent years. In this paper, we review the development of primary health care in China and how it is governed, provided, and financed, highlighting the gaps and misalignments that undermine its performance. We argue that governance deficiencies coupled with flawed financing and payments arrangements are major impediments to improving performance. China's experience offers valuable lessons for other governments seeking to strengthen primary health care.
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Affiliation(s)
- Jiwei Qian
- East Asian Institute, National University of Singapore, Singapore
| | - M Ramesh
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
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Zhao D, Chen S, Jin S, Chen L, Zheng C, Wang X, Huang Y. Predictors of referral behaviour and intention amongst physicians in a medical consortium based on the theory of planned behaviour: a cross-sectional study in China. Front Public Health 2023; 11:1159207. [PMID: 37655287 PMCID: PMC10466405 DOI: 10.3389/fpubh.2023.1159207] [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: 02/05/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction To promote patients' referral across healthcare institutions and integrated care delivery, we identified predictors of physicians' behaviour and intention to refer patients in a county medical consortium in China on the basis of the theory of planned behaviour (TPB). Methods This census-based cross-sectional study was conducted in Yangxi Hospital Group (YHG). All physicians in county hospitals and township health centres were invited to participate. Structural equation modelling was employed to analyse the relationships between referral intention and behaviour and other TPB variables in the group of whole participants and in sub-groups. Results In total, 330 physicians participated in this study. One-third of participants were general practitioners, and half of them were from county hospitals. Referral behaviour of females (χ2 = 20.372, p < 0.001), who had lower education levels (χ2 = 17.859, p = 0.001), lower professional title (χ2 = 14.963, p = 0.005), and lower monthly salary (χ2 = 33.753, p < 0.001) were less frequent than the others. Among them, 116 (35.2%), 108 (32.7%), and 106 (32.1%) respondents reported that they had never referred patients, had referred patients 1-9 times, and had referred patients over 10 times during the past 3 months, respectively. The mean score of referral intention was 4.23/5 (SD = 0.71). In the model with all participants, a stronger referral intention (β = 0.218, 95% CI = 0.080-0.356) was associated with more frequent referral behaviour. The subjective norm (β = 0.703, 95% CI = 0.590-0.817) was the strongest predictor of physicians' referral intention, followed by perceived behavioural control (β = 0.234, 95% CI = 0.090-0.378). Mediated by referral intention, subjective norms (β = 0.153, p < 0.01) and perceived behavioural control (β = 0.190, p < 0.01) had significant indirect effects on physicians' referral behaviour. The model with participants in county hospitals showed similar results to the model with all participants. Meanwhile, in the model with participants in township health centres, there were no significant associations between referral behaviour and other TPB constructs. Conclusion Physicians' referral behaviour was influenced by intention, subjective norms, and perceived behavioural control in Chinese county hospitals.
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Vu PH, Sepehri A, Tran LTT. Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam's Household Living Standard Survey 2006-2018. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:237-254. [PMID: 35419672 DOI: 10.1007/s10754-022-09330-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/22/2022] [Indexed: 05/05/2023]
Abstract
Much of the existing empirical literature on the association between health insurance and out-of-pocket (OOP) expenditures on facility-based delivery in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in OOP expenditures and the health insurance nexus. Using seven biennial waves of Vietnam's Household Living Standard Survey covering the period 2006-2018 and a generalized linear model this study examines trends in OOP expenditures on facility-based delivery and financial protection afforded by Vietnam's social health insurance system. Over the period under consideration, the pattern of health facility utilization among the insured shifted steadily from commune health centers towards higher-level government hospitals. Real OOP for delivery was 52.7% higher in 2018 than in 2006-2008 and insurance reduced OOP expenditures by 28.5%. Compared to district hospitals, giving birth at higher-level government hospitals increased OOP expenditures by 72.3% while giving birth at commune health centers reduced OOP expenditures by 55.7%. Additional analysis involving interactions between insurance status, types of public health facility and year dummies suggested a drop in financial protection of insurance, from 48% to 26.9% among women delivering at district hospitals and from 31.2 to 18.7% among those delivering at higher-level government hospitals. The modest financial protection of health insurance and its declining trend calls for policy measures that would strengthen the quality of maternal care at primary care institutions, strengthen financial protection and curb the provision of two-tiered clinical services and charges.
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Affiliation(s)
- Phuong Hung Vu
- School of Banking & Finance, National Economics University, Hanoi, Vietnam
| | - Ardeshir Sepehri
- Department of Economics, University of Manitoba, Winnipeg, MB, R3T 5V5, Canada.
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Qi X, Jia N, Hu J, Meng LB, Zeng P, Liu J, Shi J, Zeng X, Li H, Zhang Q, Li J, Liu D. Analysis of the status of social frailty in Chinese older adults with cardiovascular and cerebrovascular diseases: a national cross-sectional study. Front Public Health 2023; 11:1022208. [PMID: 37293616 PMCID: PMC10244724 DOI: 10.3389/fpubh.2023.1022208] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 05/05/2023] [Indexed: 06/10/2023] Open
Abstract
Background Social frailty is one type of frailty. Physical frailty with cardiovascular and cerebrovascular diseases (CCVD) have been studied a lot, but less research on social frailty. Objectives To study the prevalence, related risk factors and regional differences of social frailty with CCVD in Chinese older adults. Methods SSAPUR was a national cross-sectional survey. Participants aged 60 years or older were recruited in August 2015. Demographic data and information regarding family, health and medical conditions, living environment conditions, social participation, spiritual and cultural life, and health condition were obtained. Social frailty was assessed in five areas (HALFE Social Frailty Index) including inability to help others, limited social participation, loneliness, financial difficulty, and living alone. The prevalence of CCVD with social frailty, related risk factors and regional differences in CCVD with social frailty were studied. Results A total of 222,179 participants were enrolled. 28.4% of them had CCVD history. The prevalence of social frailty in the CCVD group was 16.03%. In CCVD participants, compared with the group without social frailty, there were significant differences in gender, age, urban-rural distribution, ethnicity, marital status, and education levels in the social frailty group. Significant differences were also found in physical exercise participation, health status, cataract, hypertension, diabetes mellitus, hospitalization within 1 year, self-assessed health status, crutch or wheelchair usage, urinary and fecal incontinence, need for care from others, fall history, housing satisfaction, and self-assessed happiness in the social frailty group. Women with CCVD had a higher prevalence of social frailty than men. By age in CCVD with social frailty, the highest prevalence was found in participants 75-79 years old. The prevalence of CCVD was significant difference between social frailty in urban and rural group. The prevalence of social frailty with CCVD was significantly different in different regions. The highest prevalence was 20.4% in southwest area, and the lowest prevalence was 12.5% in northeast with area. Conclusion The prevalence of social frailty among the CCVD older adults is high. Factors such as gender, age, region, urban-rural residence, and the state of the disease may be associated with social frailty.
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Affiliation(s)
- Xin Qi
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Jia
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiabin Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Ling-bing Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ping Zeng
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Junmeng Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Shi
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuezhai Zeng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Juan Li
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Deping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Tang Y, Zhang F, Xu DR. The implications of decolonization on China's academic global health: a dialogue with Stephen Gloyd at the Luhu Global Health Salon. Glob Health Res Policy 2023; 8:14. [PMID: 37198704 PMCID: PMC10190061 DOI: 10.1186/s41256-023-00299-x] [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: 02/27/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023] Open
Abstract
The call for decolonization in global health is growing alongside China's increasing involvement in the field. This perspective paper presents and extends with a further literature review of a dialogue with Stephen Gloyd, a global health professor from the University of Washington, conducted in July 2022 at the Luhu Global Health Salon. Drawing from Gloyd's four decades of experiences in low- and middle-income countries, as well as his role in creating the University of Washington's global health department, the doctoral program in implementation science, and the non-governmental organization, Health Alliance International, this paper delves into the concept of decolonization in global health and explores how Chinese universities can expand their participation in global health while striving for equity and justice. Focusing on China's academic global health research, education, and practice, the paper proposes specific recommendations for building an equity-focused global health curriculum, addressing power imbalances and inequalities in university-affiliated organizations, and strengthening South-South cooperation in practice. The paper offers implications for Chinese universities on expanding future global health cooperation, promoting global health governance, and avoiding recolonization.
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Affiliation(s)
- Yu Tang
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Feifei Zhang
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China.
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12
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Wang W, Weng F, Chen Y, Zhu M. Two-stage dual-game model approach to view the difficulty of healthcare accessibility. Front Public Health 2023; 11:1078675. [PMID: 36969632 PMCID: PMC10033865 DOI: 10.3389/fpubh.2023.1078675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
This study proposed a two-stage dual-game model methodology to evaluate the existing difficulty of healthcare accessibility in China. First, we analyzed a multi-player El Farol bar game with incomplete information by mixed strategy to explore the Nash equilibrium, and then a weighted El Farol bar game was discussed to identify the existence of a contradiction between supply and demand sides in a tertiary hospital. Second, the overall payoff based on healthcare quality was calculated. In terms of the probability of medical experience reaching that expected level, residents are not optimistic about going to the hospital, and the longer the observation period is, the more pronounced this trend becomes. By adjusting the threshold value to observe the change in the probability of being able to obtain the expected medical experience, it is found that the median number of hospital visits is a key parameter. Going to the hospital did bring benefits to people with consideration of the payoffs, while the benefits varied significantly with the observation period among different months. This study is recommended as a new method and approach to quantitatively assess the tense relationship in access to medical care between the demand and supply sides and a foundation for policy and practice improvements to ensure the efficient delivery of healthcare.
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Affiliation(s)
- Weiwei Wang
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
- Data Mining Research Center of Xiamen University, Xiamen University, Xiamen, China
| | - Futian Weng
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
- Data Mining Research Center of Xiamen University, Xiamen University, Xiamen, China
| | - Yusheng Chen
- Finance and Economics College, Jimei University, Xiamen, China
| | - Miao Zhu
- School of Statistics, Huaqiao University, Xiamen, China
- *Correspondence: Miao Zhu
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13
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Sepehri A, Minh KN, Vu PH. Challenges in moving toward universal health coverage: rising cost of outpatient care among Vietnam's insured rural residents, 2006-2018. Public Health 2023; 215:56-65. [PMID: 36642040 DOI: 10.1016/j.puhe.2022.12.002] [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: 07/06/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this study was to assess temporal trends in out-of-pocket (OOP) expenditures per outpatient contact by the insured residents in rural Vietnam. STUDY DESIGN This was a repeated cross-sectional study. METHODS Seven biennial waves from the Vietnam's Household Living Standard Survey covering the period 2006-2018 and a two-part model were used to assess temporal trends in OOP expenditures and its variations across various health facilities while controlling for a wide array of individual- and household-specific characteristics. RESULTS The pattern of health facility utilization shifted steadily from commune health centers toward higher level government hospitals and private health facilities between 2006 and 2018. The regression results indicated an upward trend in the amount of OOP expenditures, with the amount of OOP expenditures incurred per outpatient contact being 40.3% higher in 2010-2012 than in 2006-2008 and by as much as 155.5% higher in 2018. These high-cost pressures were attenuated by 63%-65% when accounting for the types of health facility contacted. The cost inflation was more pronounced for care sought at higher level government hospitals and private hospitals than at other health facilities. CONCLUSION The cost of accessing outpatient care rose sharply between 2006 and 2018, particularly for visits involving higher level government hospitals and private hospitals. These findings suggest that beside expanding the coverage over the transition path to universal coverage, efforts should be directed at reforming Vietnam's hospital-centric and fragmented delivery system as a way of containing costs and ensuring financial sustainability of social health insurance system.
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Affiliation(s)
- A Sepehri
- Department of Economics, University of Manitoba, Winnipeg, Canada.
| | - K N Minh
- Department of Economics and Management, Thang Long University, Hanoi, Viet Nam.
| | - P H Vu
- School of Banking & Finance, National Economics University, Hanoi, Viet Nam.
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14
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Liu P, Gong X, Yao Q, Liu Q. Impacts of the medical arms race on medical expenses: a public hospital-based study in Shenzhen, China, during 2009-2013. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:73. [PMID: 36567370 PMCID: PMC9791778 DOI: 10.1186/s12962-022-00407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Has the medical arms race (MAR) increased healthcare expenditures? Existing literature has yet to draw a consistent conclusion. Hence, this study aims to reexamine the relationship between the MAR and medical expenses by the data from public hospitals in Shenzhen, China, during the period of 2009 to 2013. METHODS This study's data were collected through panel datasets spanning 2009 to 2013 from the Shenzhen Statistical Yearbook, Shenzhen Health Statistical Yearbook, and annual reports from the Shenzhen Municipal Health Commission. The Herfindahl-Hirschman index and hierarchical linear modeling were combined for empirical analysis. RESULTS The MAR's impact on medical examination fees differed during the inpatient and outpatient stages. Further analysis verified that the MAR had the most significant impact on outpatient examination fees. Due to the characteristics of China's medical system, government regulations in the healthcare market may consequently accelerate the MAR among public hospitals. Strict government regulations on the medical system have also promoted increased medical examination costs to some extent. Once medical service prices are under strict administrative control, only drug and medical examination fees are the primary forms of extra income for hospitals. After the proportion of drug fees is further regulated, medical examinations will then become another staple method to generate extra revenue. These have distorted Chinese public hospitals' medical fees, which completely differ from those in other countries. CONCLUSION The government should confirm that they have allocated sufficient financial investments for public hospitals; otherwise, the competition among hospitals will transfer the burden to patients, and especially to those who can afford to pay for care. A core task for public hospitals involves providing safer, less expensive, and more reliable medical services.
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Affiliation(s)
- Paicheng Liu
- grid.443347.30000 0004 1761 2353School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Xue Gong
- grid.10420.370000 0001 2286 1424Department of East Asian Studies, University of Vienna, Vienna, Austria
| | - Qianhui Yao
- grid.443347.30000 0004 1761 2353School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Qiong Liu
- grid.459584.10000 0001 2196 0260School of Politics and Public Administration, Guangxi Normal University, No.15, Yucai Road, Qixing District, Guilin, Guangxi People’s Republic of China
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15
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Habebo TT, Jaafaripooyan E, Mosadeghrad AM, Foroushani AR, Gebriel SY, Babore GO. A Mixed Methods Multicenter Study on the Capabilities, Barriers, and Opportunities for Diabetes Screening and Management in the Public Health System of Southern Ethiopia. Diabetes Metab Syndr Obes 2022; 15:3679-3692. [PMID: 36465989 PMCID: PMC9709844 DOI: 10.2147/dmso.s391926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background More than half of diabetics' in Ethiopia live undiagnosed, and the majority of those who already knew their status also struggle to manage their diseases. However, the underlying challenges are less understood in the study area. Therefore, this study aimed to assess diabetes screening and management capabilities, barriers, and opportunities in southern Ethiopia. Methods We applied a mixed methods study. To assess the healthcare systems' capabilities, we collected quantitative data from randomly selected ten hierarchically organized healthcare facilities, and purposive maximum variation sampling was applied to recruit twenty-nine individuals for face-to-face in-depth interviewing. The interviews were audio recorded, transcribed verbatim, thematically analyzed, and presented accordingly. Results Our study findings indicated that there were good opportunities and encouraging capabilities like government commitment and expansion of services to improve diabetes screening and management in southern Ethiopia. Nevertheless, poor governance, the system's structural problems, skilled professionals' inaccessibility and lack of teamwork, poor service integration, poor planning, and lack of monitoring and evaluation mechanisms have been hampering the service delivery at the system level. While service unaffordability, low awareness level, and lifestyle modification problems were the main challenges at the patient level. Furthermore, outdated paper-based medical record documentation, frequent essential drug stock-outing, essential laboratory service interruptions, and none-use of some available services like HbA1c have been contributing to the barriers. Conclusion Despite favorable capabilities available, diabetes management in southern Ethiopia has been struggling with solvable structural defects, poor service delivery and inaccessibility, and patients' poor lifestyle modification. Therefore, public health system restructuring, optimum financing, computerization of medical records documentation, and health system and patient capacity building are strongly recommended interventions to tackle the problem at the grass-root level.
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Affiliation(s)
- Teshome Tesfaye Habebo
- Disease Prevention and Control Directorate, Kembata Tembaro Zone Health Department, Durame, SNNPRS, Ethiopia
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Mohammad Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Getachew Ossabo Babore
- Department of Nursing, College of Health Sciences and Medicine, Wachemo University, Hossana, Ethiopia
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16
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Zhang A, Quan J, Eggleston K. Association between the quality of primary care, insurance coverage, and diabetes-related health outcomes in a cohort of older adults in China: results from the China Health and Retirement Longitudinal Study. BMJ Open 2022; 12:e059756. [PMID: 36167393 PMCID: PMC9516163 DOI: 10.1136/bmjopen-2021-059756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults. DESIGN AND SETTING Data from the China Health and Retirement Longitudinal Study, a nationally-representative panel survey of people aged 45 and over in China. PARTICIPANTS Among participants with valid diabetes-related and hypertension-related medical history and biomarkers (n=8207), participants with diabetes (n=1318) were identified using biomarkers and self-reported medical history. Individual models were run using complete case analysis. RESULTS Among 1318 individuals with diabetes in 2011, 59.8% were unaware of their disease status. Diagnosis rates were significantly higher among participants with more generous public health insurance coverage (OR 3.58; 95% CI 2.15 to 5.98) and among those with other comorbidities such as dyslipidemia (OR 2.88; 95% CI 2.03 to 4.09). After adjusting for demographics, individuals with more generous public health insurance coverage did not have better glucose control at 4 years follow-up (OR 0.55; 95% CI 0.26 to 1.18) or fewer inpatient hospital admissions at 4 years (OR 1.29; 95% CI 0.72 to 2.33) and 7 years follow-up (OR 1.12; 95% CI 0.62 to 2.05). Individuals living in counties with better county-level primary care did not have better glucose control at 4 years follow-up (OR 0.69; 95% CI 0.01 to 33.36), although they did have fewer inpatient hospital admissions at 4 years follow-up (OR 0.03; 95% CI 0.00 to 0.95). Diabetes diagnosis was a significant independent predictor of both better glucose control at 4 years follow-up (OR 13.33; 95% CI 8.56 to 20.77) and increased inpatient hospital stays at 4 years (OR 1.72; 95% CI 1.20 to 2.47) and 7 years (OR 1.82; 95% CI 1.28 to 2.58) follow-up. CONCLUSIONS These findings suggest that participants with diabetes are often diagnosed concurrently with other comorbid disease conditions or after diabetes-related complications have already developed, thus leading to worse health outcomes in subsequent years despite improvements in health associated with better primary care. These findings suggest the importance of strengthening primary care and insurance coverage among older adults to focus on diagnosing and treating diabetes early, in order to prevent avoidable health complications and promote healthy aging.
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Affiliation(s)
- Adary Zhang
- School of Medicine, Stanford University, Stanford, California, USA
| | - Jianchao Quan
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Karen Eggleston
- Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California, USA
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17
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He AJ. Scaling-up through piloting: dual-track provider payment reforms in China's health system. Health Policy Plan 2022; 38:218-227. [PMID: 36103333 PMCID: PMC9923375 DOI: 10.1093/heapol/czac080] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/14/2022] Open
Abstract
Gaining wide prominence in the global health arena, scaling-up increases the coverage of health innovations emerging from pilots and experimental projects to a larger scale. However, scaling-up in the health sector should not follow a linear 'pilot-diffusion' pathway in order to better facilitate local adaptation and policy refinement. This paper puts forth 'scaling-up through piloting' as a distinctive pathway for the strategic management of scaling-up in the health sector. It analyses the recent development of provider payment reforms in China, focusing particularly on the ongoing pilot programmes, namely diagnosis-related groups (DRGs) and diagnosis-intervention packet (DIP), that are being piloted in a dual-track fashion since 2020. Data were drawn from extensive documentary analysis and 20 in-depth interviews with key stakeholders, including decision-makers and implementers. This paper finds that scaling-up through piloting helps Chinese policymakers minimize the vast uncertainties associated with complex payment reforms and maximize the local adaptability of provider payment innovations. This pathway has forged a phased implementation process, allowing new payment models to be tested, evaluated, compared and adjusted in a full spectrum of local contexts before national rollout. The phased implementation creates a 'slower is faster' effect, helping reduce long-term negative consequences arising from improperly managed scaling-up in a complex system. Error detection and correction and recalibration of new policy tools can support national-level policy refinement in a more robust and dynamic fashion. Several key factors have been identified as crucial for strategic scaling-up: necessary central steering, a pragmatic piloting design, strong technical capacity and effective policy learning mechanisms.
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Affiliation(s)
- Alex Jingwei He
- *Corresponding author. Department of Asian and Policy Studies, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong SAR, China. E-mail:
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18
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Fang Y, Jiang S, Jiang P, Zhou H, Yang M. Are Rural Primary Care Providers Able to Competently Manage Common Illnesses? A Cross-Sectional Study in Rural Sichuan, Western China. Healthcare (Basel) 2022; 10:healthcare10091750. [PMID: 36141362 PMCID: PMC9498850 DOI: 10.3390/healthcare10091750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Strengthening primary care is a key focus of the latest healthcare reforms in China. However, many challenges, including the workforce competence, still exist. This study aimed to evaluate the common disease management competency of rural primary care providers in Sichuan Province, western China. Methods: A cross-sectional study was conducted in 9 township health centers and 86 village clinics in 3 counties. Diarrhea and respiratory infection were selected as the evaluation cases. General partitioners were assessed through their abilities to (1) take history; (2) make diagnoses; (3) propose treatment; and (4) deal with clinical cases. Results: In total, 362 healthcare workers were surveyed, and 130 general practitioners were enrolled into our study. On average, rural primary care providers could only answer 46.4% of questions absolutely correctly, with 29.7% partly correctly and 23.8% incorrectly. Conclusion: We suggest strengthening training to improve rural primary care providers’ competencies, especially their capacities of history taking. Policy action is also needed to address regional disparities.
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Affiliation(s)
- Yian Fang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- School of Public Health, Peking University, Beijing 100191, China
| | - Shaohua Jiang
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi 833054, China
| | - Pei Jiang
- School of Public Health, North Sichuan Medical College, Nanchong 637100, China
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Min Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- Faculty of Health, Design and Art, Swinburne University of Technology, Melbourne 3122, Australia
- Correspondence:
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Ren Y, Zhou Z, Cao D, Ma BH, Shen C, Lai S, Chen G. Did the Integrated Urban and Rural Resident Basic Medical Insurance Improve Benefit Equity in China? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1548-1558. [PMID: 35514010 DOI: 10.1016/j.jval.2022.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The reform of merging 2 major health insurance schemes into Urban and Rural Resident Basic Medical Insurance (URRBMI) is recognized as a vital step to safeguard equal healthcare and benefit to each enrollee in China. Against this backdrop, this article aims to evaluate the impact of URRBMI integration on benefit and its contribution to benefit equity. METHODS The data of this study were derived from the China Health and Retirement Longitudinal Study 2011 and 2015. A total of 11 383 individuals were included in the final sample. Coarsened exact matching with difference-in-difference approach was firstly adopted to investigate the treatment effects of URRBMI on benefits. Next, the decomposition of concentration index (CI) was conducted to explore the contribution of URRBMI to benefit equity. RESULTS The coarsened exact matching with difference-in-difference results revealed that the consolidation of URRBMI has significantly improved outpatient benefit. The decomposition results showed that the contribution rates of URRBMI scheme to outpatient benefit rate (CI -0.0114), benefit probability (CI 0.0673), compensation fee (CI 0.0076), and reimbursement ratio (CI 0.0483) were 11.26%, -3.38%, -7.67%, and -0.81%, suggesting that this reform makes contribution to the propoor inequity in the outpatient benefit rate and relieves the prorich inequity in outpatient benefit probability and the degree of benefits. CONCLUSIONS The findings of this study provide novel evidence of enhanced benefits and benefit equity for outpatient care with the integration of URRBMI. Further efforts should be made to the expansion of URRBMI coverage and the elimination of income disparities that affecting benefit equity.
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Affiliation(s)
- Yangling Ren
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China.
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Bernice Hua Ma
- Centre for Health Economics, Monash University, Melbourne, Australia.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
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20
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Wu D, Wang Y, Yang SZ, Wang N, Sun KS, Lam TP, Zhou XD. A Socio-ecological Framework for Understanding Workplace Violence in China's Health Sector: A Qualitative Analysis of Health Workers' Responses to an Open-ended Survey Question. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP9168-NP9190. [PMID: 33323032 DOI: 10.1177/0886260520980386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Workplace violence (WPV) in the health sector is a global public health issue. The magnitude of WPV is a particular concern in China's health system. To examine the potential causes of WPV, we analyzed 3,045 qualitative responses to an open-ended question in a survey with health workers in the Zhejiang province, China. We adapted a four-level socio-ecological framework (societal/systemic, community/organizational, interpersonal, and individual) to thematically analyze the data. Ten sub-themes emerged. Within the societal/systemic level, we identified three sub-themes: (a) lack of legislation against WPV, (b) suboptimal accessibility and affordability of health services due to maldistributed health resources, commercialized health services, and inadequate health insurance, and (c) unregulated mass media reports. Within the community/organizational level, three sub-themes emerged: (a) lack of supportive health facility leadership, (b) inaction by government authorities, and (c) inefficient law enforcement agencies. Within the interpersonal level, two sub-themes were identified: (a) poor provider-patient communication and (b) distrust between health workers and patients. Finally, we identified the personal characteristics of health workers (e.g., competence and professionalism) and patients (e.g., sociodemographic background and expectations/satisfaction) as two individual-level sub-themes.We recognized interactions among different levels. The weak state of Chinese legislation in this area and lack of high-level political will and guidance (societal/systemic) has left health facilities and law enforcement agencies (community/organizational) unclear about how to address WPV. The maldistribution of quality health resources (societal/systemic) has led to overcrowded outpatient clinics at higher-level care facilities (community/organizational). In light of the insufficient government funding and profit-oriented health services (societal/systemic), health workers were motivated to seek profits by providing unnecessary services, which compromised their professionalism (individual). Provider-patient relationships deteriorated (interpersonal), and patients sometimes held unrealistically high expectations associated with high medical expenses (individual). We propose multisectoral prevention strategies to address WPV in the health sector at all levels using a socio-ecological framework.
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Affiliation(s)
- Dan Wu
- London School of Hygiene and Tropical Medicine, London, UK
- The University of Hong Kong, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yun Wang
- Washington University School of Medicine in St Louis, MO, USA
| | - Sheng Zhi Yang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Nan Wang
- University of California, San Francisco, USA
| | | | | | - Xu Dong Zhou
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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21
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Chen Y, Sylvia S, Wu P, Yi H. Explaining the declining utilization of village clinics in rural China over time: A decomposition approach. Soc Sci Med 2022; 301:114978. [PMID: 35461080 DOI: 10.1016/j.socscimed.2022.114978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
Abstract
With a goal of improving health system quality and efficiency, reforms of China's health system over the past decade have sought to strengthen primary healthcare in lower-level clinics and health centers. Despite these wide-ranging reforms and initiatives, population-based studies have documented dramatic declines in patients' use of primary care facilities during this period. In this paper, we explore the determinants of this trend in China's rural areas using detailed longitudinal data following a nationally-representative sample of rural households and village clinics from 2011 to 2018. We estimate that between 2011 and 2018, the probability that individuals sought care at village clinics when ill dropped by 44%. At the same time, the utilization of outpatient services in county hospitals increased by 56% and patient self-treatment increased by 20%. Detailed Kitagawa-Oaxaca-Blinder decompositions suggest four primary drivers of this trend: the shifting burden of disease in rural areas, changes in how patients choose to seek care given different disease conditions, declining drug inventory in village clinics, and the decreasing importance of remoteness as a determinant of healthcare seeking behavior. Our results highlight the deteriorating role of village clinics in the rural healthcare system and the increasing importance of self-treatment and higher-tier primary care services.
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Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Paiou Wu
- School of Advanced Agricultural Sciences, Peking University, Beijing, China.
| | - Hongmei Yi
- School of Advanced Agricultural Sciences, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
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22
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Li J, Zhao N, Zhang H, Yang H, Yang J. Patients' Willingness of First Visit in Primary Medical Institutions and Policy Implications: A National Cross-Sectional Survey in China. Front Public Health 2022; 10:842950. [PMID: 35433566 PMCID: PMC9010779 DOI: 10.3389/fpubh.2022.842950] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background The Chinese hierarchical treatment system expects patients to first visit primary medical institutions (PMIs), and patients' willingness determined their utilization of primary health care. The aim of this study was to explore the factors associated with patients' willingness to make their first visit to PMIs. Methods We employed multistage stratified sampling and convenience sampling to administer questionnaires to 1,507 patients in Beijing, Qinghai, and Fujian. Patients' willingness of first visit in PMIs was analyzed using Chi-square test and binary logistic regression. Results Of the 1,507 participants in the survey, 55.1% were willing to make their first visit in PMIs. Fewer patients in Beijing (17.6%) are willing to make their first visit in PMIs than those in Qinghai (71.9%) and Fujian provinces (72.0%). Binary logistic regression analysis revealed that higher recognition of the community first visit policy and higher satisfaction with the medical technology of PMIs are associated with patients' willingness of first visit in PMIs. Conclusions Due to differences in local economic conditions, medical resources, and policy formulation, there are differences among provinces in patients' willingness of first visit in PMIs. To increase patients' rate of visits in PMIs, it is important to improve service capacity and quality of PMIs and change residents' attitudes for PMIs.
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Affiliation(s)
- Jin Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Ning Zhao
- 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
| | - Hui Yang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jia Yang
- School of Public Health, Capital Medical University, Beijing, China
- *Correspondence: Jia Yang
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Liu K, Liu W, Frank R, Lu C. Assessing the Long-Term Effects of Basic Medical Insurance on Catastrophic Health Spending in China. Health Policy Plan 2022; 37:747-759. [PMID: 35238921 DOI: 10.1093/heapol/czac020] [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: 09/23/2021] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Many developing countries have implemented social health insurance programs to protect their citizens against the financial risks of seeking healthcare. While many studies have explored how individual insurance enrollments affect catastrophic health spending (CHS) in the short term, there is a lack of evidence on the long-term macro-level effects of social health insurance on CHS in low- and middle-income countries. This study examines the long-term effects of Basic Medical Insurance (BMI) on individual CHS in China, a middle-income country that has witnessed one of the highest worldwide increases in CHS rates despite its remarkable achievement of universal health insurance coverage. Specifically, we used existing longitudinal data from 1989 to 2015, therein assessing BMI policy effects by constructing two macro-level indicators, including the year of BMI presence at the prefectural level and number of years relative to BMI introduction. We employed a three-level difference-in-differences approach for the estimation. There were two main findings. First, BMI policy did not significantly reduce the probability of incurring CHS for BMI enrollees over time. Years after BMI was introduced, the policy even predicted a significant increase in the probability of incurring CHS for individuals who shifted their enrollments from traditional insurance to BMI. Second, BMI policy had spillover effects on the increase in the probability of incurring CHS for non-BMI individuals a few years after its inception. We believe there are three possible explanations for these findings: (1) shrinking BMI service coverage compared to pre-existing government-funded insurance schemes, (2) a profit-driven hospital reform that induces the overuse of expensive medicines and diagnostic tests, and (3) the absence of strategic purchasing among local BMI agencies. We also discuss how relevant policy interventions may alleviate insurance-driven financial risks.
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Affiliation(s)
- Kai Liu
- Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China
| | - Wenting Liu
- Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China
| | - Richard Frank
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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24
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Malik MA. Fragility and challenges of health systems in pandemic: lessons from India's second wave of coronavirus disease 2019 (COVID-19). GLOBAL HEALTH JOURNAL 2022; 6:44-49. [PMID: 35070474 PMCID: PMC8767801 DOI: 10.1016/j.glohj.2022.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 12/14/2022] Open
Abstract
The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak of COVID-19 second wave in India, the health system of country was virtually at the brink of collapse. Therefore, to identify the factors that resulted into breakdown and the challenges, Indian healthcare system faced during the second wave of COVID-19 pandemic, this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization (WHO). Applying integrated review approach, we found that the factors such as poor infrastructure, inadequate financing, lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India. Although health system in India faced these challenges from the very beginning, but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic. To sum-up given the likely future challenges of pandemic, while healthcare should be prioritized with adequate financing, strong capacity-building measures and integration of public and private sectors in India. Likewise fiscal stimulus, risk assessment, data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.
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Li H, McIver DJ, Ji W, Du J, Zhao H, Jia X, Zhai Y, Xue X. The Impact of a National Stewardship Policy on the Usage Patterns of Key Monitoring Drugs in a Tertiary Teaching Hospital: An Interrupted Time Series Analysis. Front Pharmacol 2022; 13:847353. [PMID: 35250599 PMCID: PMC8895446 DOI: 10.3389/fphar.2022.847353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The management of Key Monitoring Drugs has become one of important aspects to control the growth of pharmaceutical expenditures in China. The first batch of the China National Key Monitoring Drugs (NKMDs) policy was released in July 2019. However, little is known about the impact of the national stewardship on the trends of NKMDs prescribing practice in hospitals, especially in the Northwestern China.Methods: We collected 8-years of monthly NKMDs usage data from a tertiary hospital between 2014 and 2021. A segmented regression model of interrupted time series (ITS) analysis was used to evaluate the Defined Daily Doses (DDDs) and spending trends of ten NMKDs in the hospital throughout the study period. The pre-implementation period was from January 2014 to November 2019 and the post-implementation period was from December 2019 to June 2021.Results: Prior to the implementation of the NKMDs policy, there was an increasing trend both in DDDs and spending for 8 of 10 NKMDs. The interventions managed by clinical pharmacists after the implementation of the national stewardship policy led to a significant decreasing trend of DDDs in the 19 months following implementation, of 430 fewer DDDs per month in total, compared to the pre-implementation period (p < 0.001). A similar decrease in spending was seen in the post-implementation period, with a trend of $4,682 less total spending on medications in those months compared to the pre-implementation trend (p = 0.003). There was a significant decrease in both monthly DDDs and spending for 6 of the 10 medications in the post-implementation period, while there was a significant increased trend both in monthly DDDs and spending on 1 medication in that period.Conclusion: Using ITS analysis, the total DDDs and spending on 10 NKMDs in this hospital indicated sustained reductions over 19 months after multidimensional interventions under the implementation of the national policy guidance. The national stewardship policy could therefore be considered an effective strategy. Additional comprehensive policies should be introduced to further improve the rational use of NKMDs.
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Affiliation(s)
- Haiyan Li
- Department of Pharmacy, Xi’an People’s Hospital (Xi’an Fourth Hospital), The Affiliated Hospital of Northwestern Polytechnical University, Xi’an, China
| | - David J. McIver
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Wenjing Ji
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Wenjing Ji,
| | - Jiaxi Du
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
| | - Hang Zhao
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
| | - Xiaoni Jia
- Department of Science and Education, Xi’an Mental Health Center, Xi’an, China
- Department of Pharmacy, Xi’an Mental Health Center, Xi’an, China
| | - Yuyao Zhai
- Department of Pharmacy, Xi’an People’s Hospital (Xi’an Fourth Hospital), The Affiliated Hospital of Northwestern Polytechnical University, Xi’an, China
| | - Xiaorong Xue
- Department of Pharmacy, Xi’an People’s Hospital (Xi’an Fourth Hospital), The Affiliated Hospital of Northwestern Polytechnical University, Xi’an, China
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Li C, Sun J. The impact of current smoking, regular drinking, and physical inactivity on health care-seeking behavior in China. BMC Health Serv Res 2022; 22:52. [PMID: 35012543 PMCID: PMC8751354 DOI: 10.1186/s12913-022-07462-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background People with lifestyle behaviors, such as current smoking, regular drinking, and physical inactivity, may experience a lack of or delayed health care, leading to severe sickness and higher health care expenditures in the future. Hence, the current study aims to ascertain the effects of current smoking, regular drinking, and physical inactivity on health care-seeking behavior among adults who report physical discomfort in China. Methods The data used in this study were obtained from the China Family Panel Studies (CFPS). The final sample consisted of 44,362 individuals who participated in all five waves of data collection. Logistic regression models were used for the analysis. Results The results of fixed effects logistic regression showed that among those who reported physical discomfort, adults who currently smoked cigarettes were 0.65 times less likely to seek health care than those who formerly smoked. Compared to nondrinkers, adults who regularly drank alcohol had a decreased likelihood of seeking health care. Adults who never engaged in physical exercise had 24% lower odds of seeking health care than those who engaged in physical exercise. Conclusions Current smoking, regular drinking, and physical inactivity decreased the probability of seeking health care among adults who reported physical discomfort. Therefore, screening and brief advice programs should be delivered by primary-level care and should pay more attention to individuals who engage in lifestyle behaviors such as current smoking, regular drinking, and physical inactivity, thus avoiding missed opportunities to treat chronic conditions and detect new diseases early.
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Affiliation(s)
- Changle Li
- School of Health Management, Inner Mongolia Medical University, Hohhot, 010110, China
| | - Jing Sun
- School of Health Management, Inner Mongolia Medical University, Hohhot, 010110, China.
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Zhang Z, Dong J, Zhao C, Li Q. Trends of Healthy Life Expectancy of the Elderly in China in 1994-2015: Revisiting From the Perspective of Morbidity Transition. Front Public Health 2022; 9:774205. [PMID: 35071160 PMCID: PMC8766505 DOI: 10.3389/fpubh.2021.774205] [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] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Research on healthy life expectancy (HLE) in China has been fueled by a spate of new data sources and studies, yet no consensus is reached on the pattern of HLE changes and the underlying mechanism. This study examined the change of HLE in China over 20 years with long term national data. Health status, measured by activities of daily living, is combined with mortality to calculate the disability-free life expectancy by the Sullivan method. The results show that the HLE rose slower than life expectancy (LE) in 1994-2004, indicating morbidity expansion. However, in 2010-2015, the proportion of HLE to LE increased, manifesting morbidity compression. A counterfactual analysis further shows that health improvement has been increasingly important in increasing HLE in 2010-2015, despite the dominance of mortality decline. The findings suggest that morbidity can transition between compression, expansion and dynamic equilibrium over a long period due to different combinations of mortality and health improvements. Given the limited data in this study, whether and how morbidity transitions unfold in the future remains open and requires further research.
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Affiliation(s)
- Zhen Zhang
- Institute of Population Research, School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Junhan Dong
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Chenyuan Zhao
- Population Research Institute, School of Social Development, East China Normal University, Shanghai, China
| | - Qiang Li
- Population Research Institute, School of Social Development, East China Normal University, Shanghai, China
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Mbachu C, Okeke C, Obayi C, Gatome-Munyua A, Olalere N, Ogbonna I, Uzochukwu B, Onwujekwe O. Supporting strategic health purchasing: a case study of annual health budgets from general tax revenue and social health insurance in Abia state, Nigeria. HEALTH ECONOMICS REVIEW 2021; 11:47. [PMID: 34928450 PMCID: PMC8690461 DOI: 10.1186/s13561-021-00346-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Tracking general trends in strategic purchasing of health financing mechanisms will highlight where country demands may exist for technical support and where progress in being made that offer opportunities for regional learning. Health services in Abia State, Nigeria are funded from general tax-revenues (GTR), and a new state social health insurance scheme (SSHIS) is proposed to overcome the failings of the GTR and expand coverage of services. This study examined purchasing functions within the GTR and the proposed SSHIS to determine if the failings in GTR have been overcome, identify factors that shape health purchasing at sub-national levels, and provide lessons for other states in Nigeria pursuing a similar intervention. METHODS Data was collected through document review and key informant interviews. Government documents were retrieved electronically from the websites of different organizations. Hard copies of paper-only files were retrieved from relevant government agencies and departments. Interviews were conducted with seven key personnel of the State Ministry of Health and State Health Insurance Agency. Thematic analysis of data was based on a strategic health purchasing progress tracking framework which delves into the governance arrangements and information architecture needed for purchasing to work well; and the core purchasing decisions of what to buy; who to buy from; and how to buy. RESULTS There are differences in the purchasing arrangements of the two schemes. Purchaser-provider split does not exist for the GTR, unlike in the proposed SSHIS. There are no data systems for monitoring provider performance in the GTR-funded system, unlike in the SSHIS. Whereas GTR is based on a historical budgeting system, the SSHIS proposes to use a defined benefit package, which ensures value-for-money, as the basis for resource allocation. The GTR lacks private sector engagement, provider accreditation and contracting arrangements while the SSHIS will accredit and engage private providers through selective contracting. Likewise, provider payment is not linked to performance or adherence to established standards in the GTR, whereas provider payment will be linked to performance in the SSHIS. CONCLUSIONS The State Social Health Insurance has been designed to overcome many of the limitations of the budgetary allocation to health. This study provides insights into the enabling and constraining factors that can be used to develop interventions intended to strengthen the strategic health purchasing in the study area, and lessons for the other Nigeria states with similar characteristics and approaches.
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Affiliation(s)
- Chinyere Mbachu
- Health Policy Research Group, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria.
- Department of Community Medicine, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria.
| | - Chinyere Okeke
- Health Policy Research Group, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
- Department of Community Medicine, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Chinonso Obayi
- Department of Community Medicine, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Agnes Gatome-Munyua
- Strategic Purchasing Africa Resource Center (SPARC), Nairobi, Kenya
- Results for Development (R4D), Nairobi, Kenya
| | - Nkechi Olalere
- Strategic Purchasing Africa Resource Center (SPARC), Nairobi, Kenya
| | | | - Benjamin Uzochukwu
- Health Policy Research Group, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
- Department of Community Medicine, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
- Department of Health Administration and Management, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
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Lu L, Lin X, Pan J. Heterogeneous effects of hospital competition on inpatient expenses: an empirical analysis of diseases grouping basing on conditions' complexity and urgency. BMC Health Serv Res 2021; 21:1322. [PMID: 34893077 PMCID: PMC8662870 DOI: 10.1186/s12913-021-07331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background
Multiple pro-competition policies were implemented during the new round of healthcare reform in China. Differences in conditions’ complexity and urgency across diseases associating with various degrees of information asymmetry and choice autonomy in the process of care provision, would lead to heterogeneous effects of competition on healthcare expenses. However, there are limited studies to explore it. This study aims to examine the heterogeneous effects of hospital competition on inpatient expenses basing on disease grouping according to conditions’ complexity and urgency. Methods Collecting information from discharge data of inpatients and hospital administrative data of Sichuan province in China, we selected representative diseases. K-means clustering was used to group the selected diseases and Herfindahl-Hirschman Index (HHI) was calculated based on the predicted patient flow to measure the hospital competition. The log-linear multivariate regression model was used to examine the heterogeneous effects of hospital competition on inpatient expenses. Results We selected 19 representative diseases with significant burdens (more than 1.1 million hospitalizations). The selected diseases were divided into three groups, including diseases with highly complex conditions, diseases with urgent conditions, and diseases with less complex and less urgent conditions. For diseases with highly complex conditions and diseases with urgent conditions, the estimated coefficients of HHI are mixed in the direction and statistical significance in the identical regression model at the 5% level. For diseases with less complex and less urgent conditions, the coefficients of HHI are all positive, and almost all of them significant at the 5% level. Conclusions We found heterogeneous effects of hospital competition on inpatient expenses across disease groups: hospital competition does not play an ideal role in reducing inpatient expenses for diseases with highly complex conditions and diseases with urgent conditions, but it has a significant effect in reducing inpatient expenses of diseases with less complex and less urgent conditions. Our study offers implications that the differences in condition’s complexity and urgency among diseases would lead to different impacts of hospital competition, which would be given full consideration when designing the pro-competition policy in the healthcare delivery system to achieve the desired goal. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07331-1.
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Affiliation(s)
- Liyong Lu
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China.,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Xiaojun Lin
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China.,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China. .,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
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Peng Z, Zhan C, Ma X, Yao H, Chen X, Sha X, Coyte PC. Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China. BMC Health Serv Res 2021; 21:1205. [PMID: 34742310 PMCID: PMC8571884 DOI: 10.1186/s12913-021-07211-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/22/2021] [Indexed: 02/06/2023] Open
Abstract
Background The zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures). Methods A pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively. Results Four key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts. Conclusions Although the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.
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Affiliation(s)
- Zixuan Peng
- Institute of Health Policy, Management & Evaluation, Dalla Lana school of public health, University of Toronto, Toronto, Canada
| | - Chaohong Zhan
- Xiangya Hospital, Central South University, Changsha, China
| | - Xiaomeng Ma
- Institute of Health Policy, Management & Evaluation, Dalla Lana school of public health, University of Toronto, Toronto, Canada
| | - Honghui Yao
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Xu Chen
- School of Social Science and Public Policy, King's College of London, London, UK
| | - Xinping Sha
- Xiangya Hospital, Central South University, Changsha, China.
| | - Peter C Coyte
- Institute of Health Policy, Management & Evaluation, Dalla Lana school of public health, University of Toronto, Toronto, Canada
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Yue J, Fu Q, Zhou Y, Zhang Y, Ning J, Yin G, Tao H. Evaluating the accessibility to healthcare facilities under the Chinese hierarchical diagnosis and treatment system. GEOSPATIAL HEALTH 2021; 16. [PMID: 34730320 DOI: 10.4081/gh.2021.995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/04/2021] [Indexed: 06/13/2023]
Abstract
An accurate assessment of current healthcare resource allocations is essential to address existing inequities in the hierarchical diagnosis and treatment system introduced in China. The data come from statistical reports of local governments and the developer platform of Amap, a Chinese mobile map. The data were analysed using the hierarchical two-step floating catchment area method. By spatial accessibility analysis, the distribution of accessibility to hierarchical healthcare facilities in Zhongshan City, Guangdong Province was found to be uneven, with clustered high accessibility in the central, north-western and southern parts of the city. To enhance the capacity of healthcare services, the government should allocate healthcare resources rationally to better associate with population densities.
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Affiliation(s)
- Jingkai Yue
- Logistics Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
| | - Qiang Fu
- Department of Community Health, School of Arts and Sciences, Tufts University, Medford, MA.
| | - Ying Zhou
- Human Resource Department, Wuhan Forth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
| | - Yue Zhang
- Department of Public Administration, Wuhan University of Science and Technology, Wuhan.
| | - Jie Ning
- Medical Insurance Office, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou.
| | - Gang Yin
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
| | - Hongbing Tao
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
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Liu N, Chen Z, Bao G. Unpacking the red packets: institution and informal payments in healthcare in China. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1183-1194. [PMID: 34100172 DOI: 10.1007/s10198-021-01330-z] [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: 10/25/2020] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
Informal cash payments from patient to healthcare providers for services provided by the healthcare system have attracted increasing scholarly interest. However, the root and mechanism of informal payments are not well understood. This paper contributes to the literature by positing informal payments as informal institutions. We use a nationally representative longitudinal survey in 28 provinces in China to explore the root of informal payments. Our empirical findings suggest that patients' informal payments for healthcare services may originate from information acquisition and processing, failure of government and market in allocating healthcare resources, and disparities in utilization. Further, this informal institution could be changed by the self-reinforcement of individual patients. These findings suggest that policies to facilitate transparency and to remove institutional barriers, such as the introduction of market competition, may reduce the incidence of informal payments.
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Affiliation(s)
- Ning Liu
- School of Management, Lanzhou University, #222 Tianshui South Rd, Lanzhou, 730000, China.
- China Research Center for Government Performance Management, Lanzhou University, Lanzhou, China.
| | - Zhuo Chen
- College of Public Health, University of Georgia, Athens, USA
- School of Economics, University of Nottingham, Ningbo, China
| | - Guoxian Bao
- School of Management, Lanzhou University, #222 Tianshui South Rd, Lanzhou, 730000, China
- China Research Center for Government Performance Management, Lanzhou University, Lanzhou, China
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Zhang L, Zhang Q, Li X, Shao W, Ma J, Zhang R, Zhou A, Li J. The effect of patient perceived involvement on patient loyalty in primary care: The mediating role of patient satisfaction and the moderating role of the family doctor contract service. Int J Health Plann Manage 2021; 37:734-754. [PMID: 34697826 DOI: 10.1002/hpm.3355] [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: 11/22/2020] [Revised: 08/06/2021] [Accepted: 10/04/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Chinese government has taken many incentives to promote the implementation of the family doctor (FD) contract service; however, whether primary health care providers establishing a strong relationship with patients that shapes their loyalty is still unknown. Under this circumstance, drawing the public attention to patient loyalty in primary care and clarifying the underlying mechanism of loyalty is imperative to the development of primary care. OBJECTIVE To analyse the effect of patient perceived involvement on patient loyalty in primary care, investigate the mediating role of patient satisfaction, and explore the moderating role of the FD contract service on the relationship between patient perceived involvement and patient loyalty. METHODS A cross-sectional questionnaire survey of patients in primary health facilities was conducted in Jilin province of China. Participants comprised 1334 patients selected via a multi-stage sampling method. RESULTS Patient perceived involvement not only had a direct positive impact on patient loyalty but also had an indirect effect on patient loyalty via patient satisfaction. Furthermore, for patients who contracted with FDs, patient perceived involvement had a higher direct effect and indirect effect on patient loyalty when compared with patients who did not contract with FDs. CONCLUSIONS Our findings suggest that health managers should encourage patients to participate in medical visits to improve patient satisfaction. Additionally, customised and tailored health services that meet individuals' specific needs and preferences should be designed and implemented to attract more patients to contract the FD contract service.
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Affiliation(s)
- Li Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Qian Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Xinru Li
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Weiya Shao
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jingyu Ma
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Ruijie Zhang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Angdi Zhou
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jinghua Li
- School of Public Health, Jilin University, Changchun, Jilin Province, China
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Jiang H, Zhao M, Tian G, Zhao Z, Ding D, Yin M. Perceived effect of financial risk protection by the Urban-Rural Resident Basic Medical Insurance Scheme: a mixed-methods study of rural residents in China. BMJ Open 2021; 11:e047699. [PMID: 34667000 PMCID: PMC8527163 DOI: 10.1136/bmjopen-2020-047699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is to explore the perceived financial risk protection effect of the Urban-Rural Resident Basic Medical Insurance Scheme (URRBMI) and its influencing factors to provide evidence to further improve the URRBMI. DESIGN It is a cross-sectional survey. PARTICIPANTS This mixed-methods study is conducted in five provinces in rural China. Through stratified cluster random sampling, 1681 rural residents participate in a cross-sectional questionnaire survey (1657 valid questionnaires are retrieved). Thirty rural residents participate in in-depth interviews. PRIMARY AND SECONDARY OUTCOME MEASURES A multivariate logistic regression analysis is adopted to identify factors influencing respondents' perceptions. Semistructured interviews are used to identify the reasons why some respondents believed the URRBMI to be ineffective. RESULTS Overall, 77.5% of respondents believe that the URRBMI is effective. Respondents, who are older, have a higher household income, prefer primary health facilities and provide a higher rating for critical illness compensation and maximum compensatory payouts. They are more likely to give the URRBMI a higher effectiveness rating than their counterparts. Qualitatively, participants who believe the URRBMI to be ineffective list the following reasons: low outpatient service coverage, insufficient or undersupplied drugs and services in the insurance list, problems in the arrangement of deductibles and maximum compensatory payouts, provider-induced behaviour and increased healthcare service price. CONCLUSIONS This exploration focuses on the reasons why rural residents think the scheme is invalid, which are vital for policy reform. Policies should focus on benefits design and coverage, the assumption of a supervisory role, avoiding financial risk stemming from critical illness and cross-sectoral actions to strengthen the primary healthcare system and comprehensive social security wealth.
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Affiliation(s)
- Huan Jiang
- Humanities and Social Sciences College, Harbin Medical University, Harbin, China
| | - Miaomiao Zhao
- Department of health management, Shcool of public health, Nantong university, Nantong, Jiangsu,China
| | - Guomei Tian
- Fourth affiliate hospital of Harbin Medical University, Harbin, Heilongjiang,China
| | - Zihua Zhao
- Scientific Research Department, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ding Ding
- Department of Social Medicine, Dalian Medical University, Dalian, China
| | - Mei Yin
- Humanities and Social Sciences College, Harbin Medical University, Harbin, China
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Reshaping the Regional Order of Health Care Resources in China: The Institutional Participants in an Inter-City Integrated Delivery System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179176. [PMID: 34501766 PMCID: PMC8431651 DOI: 10.3390/ijerph18179176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/17/2022]
Abstract
Over the past decades, pro-growth policies in China led to rapid economic development but overlooked the provision of health care services. Recently, increasing attention is paid to the emergence of integrated delivery systems (IDS) in China, which is envisioned to consolidate regional health care resources more effectively by facilitating patient referral among hospitals. IDS at an inter-city scale is particularly interesting because it involves both the local governments and the hospitals. Incentives among them will affect the development of an inter-city IDS. This paper thereby builds an economic model to examine both the inter-local government and inter-hospital incentives when participating in an inter-city IDS in China. The findings suggest that while inter-hospital incentives matter, inter-local government incentives should also be considered because the missing incentives at the local government level may oppose the development of inter-city IDSs.
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Li C, Chen Z, Khan MM. Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China. BMC Health Serv Res 2021; 21:895. [PMID: 34461884 PMCID: PMC8406824 DOI: 10.1186/s12913-021-06908-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China. METHODS Random effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used. RESULTS Two in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing. CONCLUSIONS The findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system.
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Affiliation(s)
- Changle Li
- Department of Health Economics, School of Health Management, Inner Mongolia Medical University, Hohhot, China.,Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA.,Centre for Health Economics, School of Economics, University of Nottingham Ningbo China, Ningbo, China
| | - M Mahmud Khan
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA.
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Van Doorslaer E, O'Donnell O, Gwatkin D, Yazbeck AS, Lindelow M, Bredenkamp C, Yip W, Bales S, McIntyre D, Filmer DP, De Walque D, Couffinhal A, Hafez R. In Appreciation of Adam: Reflections from Friends and Colleagues. Health Syst Reform 2021; 7:e1968564. [PMID: 34554034 DOI: 10.1080/23288604.2021.1968564] [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: 10/20/2022] Open
Abstract
Some of Adam Wagstsaff's colleagues and research collaborators submitted short reflections about the different ways Adam made a difference through his amazing research output to health equity and health systems as well as a leader and mentor. The Guest Editors of this Special Issue selected a set of six essays related to dimensions of Adam's contributions.The first contribution highlights his role early on in his career, prior to joining the World Bank, in defining and expanding an important field of research on equity in health ("Adam and Equity," by Eddy van Doorslaer and Owen O'Donnell). The second contribution focuses on Adam's early work on equity and health within the World Bank and his leadership on important initiatives that have had impact far beyond the World Bank ("Adam and Health Equity at the World Bank," by Davidson Gwatkin and Abdo Yazbeck). The next contribution focuses on Adam's deep dive into providing support, through research, for country-specific programs and reforms, with a special focus on some countries in East Asia ("Adam and Country Health System Research," by Magnus Lindelow, Caryn Bredenkamp, Winnie Yip, and Sarah Bales). The next contribution highlights Adam's many ways of contributing to the International Health Economics Association, from the impressive technical contributions to leadership and organizational reform ("Adam and iHEA," by Diane McIntyre). The next to last contribution focuses on Adam's long-term leadership in the research group at the World Bank and the long-lasting influence on integrating the research produced into World Bank operations and creating an environment that rewarded producing evidence for action ("Adam the Research Manager," by Deon Filmer and Damien de Walque). The last contribution pulls on the thread found in many of the earlier ones, mentorship with honesty, directness, caring, commitment, and equity ("Adam the Mentor," by Agnes Couffinhal, Caryn Bredenkamp, and Reem Hafez).
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Affiliation(s)
- Eddy Van Doorslaer
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Owen O'Donnell
- Erasmus School of Economics and School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Tinbergen Institute, University of Lausanne, Switzerland
| | | | - Abdo S Yazbeck
- International Health Department, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Magnus Lindelow
- Health, Nutrition and Population Global Practice, The World Bank Group, Washington, DC, USA
| | - Caryn Bredenkamp
- Human Development Practice Group, World Bank, Washington, DC, USA.,Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Winnie Yip
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah Bales
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Diane McIntyre
- Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Deon P Filmer
- Development Research Group, The World Bank Group, Washington, DC, USA
| | - Damien De Walque
- Development Research Group, The World Bank Group, Washington, DC, USA
| | - Agnès Couffinhal
- Health, Nutrition and Population Global Practice, The World Bank Group, Washington, DC, USA
| | - Reem Hafez
- Health, Nutrition and Population Global Practice, The World Bank Group, Washington, DC, USA
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Zhao P, Cai Z, Huang A, Liu C, Li H, Yang S, Hu LQ. Why is the labor epidural rate low and cesarean delivery rate high? A survey of Chinese perinatal care providers. PLoS One 2021; 16:e0251345. [PMID: 34019570 PMCID: PMC8139447 DOI: 10.1371/journal.pone.0251345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/23/2021] [Indexed: 12/29/2022] Open
Abstract
Objective China has a high cesarean delivery (CD) and low labor epidural analgesia (LEA) rate. This online survey was conducted to explore the reasons behind this phenomenon and potential solutions. Methods A voluntary, anonymous survey was distributed via both WeChat and professional websites for 4 months amongst groups of Chinese perinatal professionals. Data was collected and analyzed using a Chi-square test and presented as percentages of respondents. Results 1412 respondents were recorded (43% anesthesiologists, 35% obstetricians, 15.5% midwives or labor and delivery nurses, and 6.5% others), and 1320 respondents were care providers. It was found that 82.7% (1092/1320) of the provider respondents used CD per patient request in fear of lawsuits or yinao/yibao and 63.4% (837/1320) used CD for respecting superstitious culture. The number one reason (noted by 60.2% (795/1320) of all the three specialties) for low LEA use was lack of anesthesia manpower without statistical difference among specialties. The most recommended solution was increasing the anesthesia workforce, proposed by 79.8% (1053/1320) of the three specialties. However, the top solution provided by the two non-anesthesia specialties is different from the one proposed by anesthesiologists. The later (83%, 504/606) suggested increasing the incentive to provide the service is more effective. The answers to questions related to medical knowledge about CD and LEA, and unwillingness of anesthesiologists, parturients and their family members to LEA were similar for the most part, while the opinions regarding low LEA use related to poor experiences and unwillingness of obstetricians and hospital administrators were significantly divided among the three specialties. In the providers’ point of view, the unwillingness to LEA from parturient’s family members was the most salient (26.1%, 345/1320), which is more than all care providers, hospital administrators, and parturients themselves (16.8%, 222/1320). Conclusion The reasons for high CD rate and low LEA use are multifactorial. The sociological issues (fear of yinao/yibao and superstitious culture) were the top two contributing factors for the high CD rate in China, while lack of anesthesia manpower was the top response for the low LEA use, which contributes to its being the most recommended solution overall from the three specialties. An incentive approach to providers is a short-term solution while training more perinatal care providers (especially among anesthesiologists and midwives), improving billing systems, and reforming legal systems are 3 systemic approaches to tackling this problem in the long-term.
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Affiliation(s)
- Peishan Zhao
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Zhenyu Cai
- Department of Obstetrics and Gynecology, Aviation General Hospital, China Medical University, Beijing, P.R. China
| | - Anna Huang
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Chunyuan Liu
- Department of Anesthesiology, Liangping County People’s Hospital, Chongqing, P.R. China
| | - Huiling Li
- Department of Obstetrics and Gynecology, The People’s Hospital, Peking University, Beijing, P.R. China
| | - Shuwei Yang
- No Pain Labor & Delivery—Global Health Initiative (China Chapter), ApgarCARE International, Inc., Xi’an, Shaanxi, P.R. China
| | - Ling-Qun Hu
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- * E-mail:
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Shi H, Fan M, Zhang H, Ma S, Wang W, Yan Z, Chen Y, Fan H, Bi R. Perceived health-care quality in China: a comparison of second- and third-tier hospitals. Int J Qual Health Care 2021; 33:6159655. [PMID: 33693896 DOI: 10.1093/intqhc/mzab027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate disparity in service quality between second- and third-tier hospitals and explore factors that affect patients' perception of service quality in China. DESIGN Cross sectional study. SETTING Twelve hospitals in China. PARTICIPANTS 5714 patients. INTERVENTION None. MAIN OUTCOME MEASURE Total score of the SERVQUAL scale and each of its five dimensions. RESULTS Patients from third-tier hospitals rated significantly higher scores overall and in all the five dimensions of the SERVQUAL scale. Those with lower education, urban residents and those who had higher degree of life satisfaction and attention paid to health perceived higher service quality. Inpatients perceived higher service quality compared with outpatients. CONCLUSION We found a significant gap in patient's perceived service quality between second- and third-tier hospitals in China. A variety of demographic and personality factors were found to significantly influence patient's perceived service quality.
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Affiliation(s)
- Hongmei Shi
- School of Management, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Ming Fan
- School of Management, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Hao Zhang
- Department of Healthare Policy and Research, Weill Cornell Medicine, New York, NY 10065, USA
| | - Shaoying Ma
- Department of Economics, The Graduate Center, City University of New York, New York, NY 10010, USA
| | - Wenxin Wang
- Department of Public Administration, Shantou University, Shantou, Guangdong 515063, China
| | - Zhigang Yan
- Department of Public Administration, Shantou University, Shantou, Guangdong 515063, China
| | - Yuandong Chen
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
| | - Hongjuan Fan
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
| | - Ronghua Bi
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
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Peng X, Tang X, Chen Y, Zhang J. Ranking the Healthcare Resource Factors for Public Satisfaction with Health System in China-Based on the Grey Relational Analysis Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030995. [PMID: 33498645 PMCID: PMC7908117 DOI: 10.3390/ijerph18030995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Public satisfaction with the health system is a very important comprehensive indicator. Given the limited healthcare resources in a society, it is always important for policymakers to have full information about the priority and the ranking order of the factors of healthcare resources for improving public satisfaction. (2) Methods: Grey Relational Analysis (GRA) is advantageous for satisfaction analysis because satisfaction is a “grey concept” of “having a clear boundary but vague connotation”. The data were from the CGSS and the China Health Statistics Yearbook (2013 and 2015), with a total of 15,969 samples (average satisfaction score = 68.5, age = 51.9, female = 49.4%). (3) Results: The government’s percentage of total expenditure on healthcare was ranked as the most important factor for public satisfaction with the health system in China in both 2013 and 2015. The second most important factor changed from “Out-of-pocket percentage of individuals” in 2013 to “Hospital beds per thousand populations” in 2015. Meanwhile, “Healthcare workforce per thousand populations” increased from the least important factor in 2013 to the 3rd in 2015. Disparities in the ranking orders of the factors among regions of China were identified too. (4) Conclusions: The analysis results suggest that during recent years the priority of Chinese residents’ healthcare satisfaction for healthcare resources has shifted on the national level from economic affordability to more intensive “people-centered” services, while the regional disparities and gaps need to receive more attention and be further improved in the healthcare reform of next round.
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Affiliation(s)
- Xinxin Peng
- School of Business, Macau University of Science and Technology, Macao 999078, China; (X.P.); (X.T.); (Y.C.)
- School of Business, Jiangsu University of Technology, Changzhou 213000, China
| | - Xiaolei Tang
- School of Business, Macau University of Science and Technology, Macao 999078, China; (X.P.); (X.T.); (Y.C.)
| | - Yijun Chen
- School of Business, Macau University of Science and Technology, Macao 999078, China; (X.P.); (X.T.); (Y.C.)
| | - Jinghua Zhang
- School of Business, Macau University of Science and Technology, Macao 999078, China; (X.P.); (X.T.); (Y.C.)
- Correspondence: ; Tel.: +853-8897-2986; Fax: +853-2882-7666
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Miao R, Xiang X, Wu Q, Jiang Z. Evaluation method of medical service system based on DEMATEL and the information entropy: A case study of hypertension diagnosis and treatment in China. PLoS One 2020; 15:e0243832. [PMID: 33318708 PMCID: PMC7735816 DOI: 10.1371/journal.pone.0243832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/26/2020] [Indexed: 01/03/2023] Open
Abstract
Precise and reasonable evaluation of the multi-attribute value of medical system is the basis for hospitals to implement total quality management. Excellent medical system is necessary as a part of modern urban governance. However, most of medical value evaluation work relies on scale and artificial scoring at present, lacking in objectivity. Therefore, a scientific and comprehensive medical value evaluation system is needed urgently to give full play to the guiding role of value evaluation and promote the improvement of the medical service system. In this study, DEMATEL and information entropy are used to quantify the degree of mutual influence between system indicators and the differences in medical market performance respectively, so as to obtain the objective index weight. Hypertension has the highest incidence in the whole chronic disease system, which seriously affects people's daily life. Based on the existing hypertension diagnosis and treatment index system, a comprehensive and objective evaluation model is established to evaluate the hypertension diagnosis and treatment behaviors of different medical institutions, which achieves good result. This method has effectively improved the relative deficiency of one-sided subjective evaluation and has a great guiding significance for the comparison of treatment in departments and the economical use of medical resources.
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Affiliation(s)
- Rui Miao
- School of Naval Architecture, Ocean & Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- China Institute for Urban Governance, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
| | - Xiaohao Xiang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Wu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhibin Jiang
- Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
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Shen M, He W, Li L, Wu Y. Comparison of health care utilization among users of public and private community health centres in urban China. Fam Pract 2020; 37:738-743. [PMID: 32556320 DOI: 10.1093/fampra/cmaa058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In China, the government has encouraged the participation of private sector facilities in primary care to improve health care quality. OBJECTIVE We compare health care utilization patterns among patients who select private versus public community health centres (CHCs) for reimbursed outpatient services. METHODS This paper uses data from the Urban Employee Basic Medical Insurance scheme from 2013 to 2016 in one of the largest cities in China. We used a Poisson model and a logistic model to examine outcomes on monthly outpatient visits and the probability of hospitalization, respectively. RESULTS Compared with being a user of a public CHC, being a user of a private CHC is associated with a 26.2% lower incidence rate of outpatient visits to hospitals [95% confidence interval (CI): 30.1-21.8%] and no difference in rates of visits to CHCs or hospitalization. Among patients with diabetes or hypertension, being a user of a private CHC is associated with a 12.9% lower incidence rate of outpatient visits to CHCs (95% CI: 19.8-5.4%), a 25.6% lower incidence rate of outpatient visits to hospitals (95% CI: 21.4-19.5%) and 22.3% higher odds of hospitalization (95% CI: 3.5-44.7%). CONCLUSION Being a user of a private CHC is associated with a reduction in outpatient visits to hospitals, which aligns with the goal of reducing hospital congestion at the outpatient level. For patients with chronic diseases, being a user of a private CHC is associated with a higher probability of hospitalization. More research is needed to understand the reason for this difference.
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Affiliation(s)
- Menghan Shen
- Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, Guangzhou, China
| | - Wen He
- School of Public Administration, Hunan University, Changsha, China
| | - Linyan Li
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Yushan Wu
- Department of Environmental Health, School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N. T., Hong Kong
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Zhang X, Lai H, Zhang L, He J, Fu B, Jin C. The impacts and unintended consequences of the nationwide pricing reform for drugs and medical services in the urban public hospitals in China. BMC Health Serv Res 2020; 20:1058. [PMID: 33225941 PMCID: PMC7682084 DOI: 10.1186/s12913-020-05849-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Since 2015, China has been rolling out the pricing reform for drugs and medical services (PRDMS) in the urban public hospitals in order to reduce drug expenditures and to relieve financial burdens of patients. This study aims at evaluating the effectiveness of the reform and investigating its positive impacts and unintended consequences to provide evidence basis for further policy making. Methods The Difference-in-difference (DID) approach was employed to analyze the reform impacts on the 31 provincial administrative areas in China based on data abstracted from China Statistics Yearbooks and China Health Statistics Yearbooks from 2012 to 2018. Results The reform resulted in a decrease of 7.59% in drug cost per outpatient visit, a decrease of 5.73% in drug cost per inpatient admission, a decrease of 3.63% in total cost per outpatient visit and an increase of 9.10% in surgery cost per inpatient admission in the intervention group. However, no significant change in examination cost was found. The reduction in the medical cost per inpatient admission was not yet demonstrated, nor was that in the total outpatient/ inpatient expenses. The nationwide pricing reform for drugs and medical services in urban public hospitals (PRDMS-U) in China is demonstrated to be effective in cutting down the drug expenditures. However, the revealed unintended consequences indicate that there are still significant challenges for the reform to reach its ultimate goal of curbing the medical expenditures. Conclusion We conclude that the pricing reform alone may not be enough to change the profit-driven behavior of medical service providers as the root cause lies in the unchanged incentive scheme for providers in the service delivery. This holds lessons for policy making of other low- and middle-income countries (LMICs) with similar health systems set up in the achievement of Universal Health Coverage (UHC).
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Affiliation(s)
- Xiaoxi Zhang
- Shanghai Health Development Research Center, 1477 Beijing West Rd., Shanghai, 200040, China
| | - Hongyu Lai
- School of Data Science, Fudan University, 220 Handan Rd, Shanghai, 200433, China
| | - Lidan Zhang
- School of Management, Fudan University, 220 Handan Rd, Shanghai, 200433, China
| | - Jiangjiang He
- Shanghai Health Development Research Center, 1477 Beijing West Rd., Shanghai, 200040, China
| | - Bo Fu
- School of Data Science, Fudan University, 220 Handan Rd, Shanghai, 200433, China.
| | - Chunlin Jin
- Shanghai Health Development Research Center, 1477 Beijing West Rd., Shanghai, 200040, China
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Safizadeh H, Mangolian Shahrbabaki P, Hafezpour S. Organizational Transformation to Improve Breast Cancer Screening Behaviors in Iranian Women: A Qualitative Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 42:21-27. [PMID: 33167793 DOI: 10.1177/0272684x20972647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Breast cancer is the most common cause of premature mortality among women, and screening is one of the most important means of early diagnosis of breast cancer. This qualitative study was conducted to explore strategies for promoting breast cancer screening behaviors from the perspective of health volunteers in south-east Iran. Data collection was performed through focus groups. Using the purposive sampling method, 35 participants were selected and data were analyzed using a specific qualitative content analysis framework. By analyzing the data to provide strategies for promoting breast cancer screening behaviors, the main theme of "organizational transformation" with five subthemes including the promotion of health-centered beliefs in society, the development of culture-based training, the media revolution, financial support, and the provision of efficient health-care providers were extracted. According to the results of the study, the development of organizational transformation plays an important role in planning for the promotion of breast cancer screening.
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Affiliation(s)
- Hossein Safizadeh
- Department of Community Medicine, School of Medicine, Research Center for Social Determinants of Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Hafezpour
- Community Health Practitioner, Shiraz University of Medical Sciences, Shiraz, Iran
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Guo W, Sylvia S, Umble K, Chen Y, Zhang X, Yi H. The competence of village clinicians in the diagnosis and treatment of heart disease in rural China: A nationally representative assessment. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 2:100026. [PMID: 34327377 PMCID: PMC8315592 DOI: 10.1016/j.lanwpc.2020.100026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
Background While strengthening primary care quality is key to China's health system reforms, evidence to guide this work has been limited, particularly for rural areas. This study provides the first nationally-representative assessment of village doctors’ competence in diagnosing and managing presumptive heart disease. Methods A cross-sectional study of village clinics was conducted across five provinces. We presented standardized clinical vignettes to evaluate clinicians’ competence in diagnosing and managing unstable angina. Enumerators accompanying mock patients documented the interaction, including questions, physical examinations, diagnoses, and management options provided by the doctor. We measured diagnostic process competence as adherence to “recommended” questions and examinations based on national clinical practice guidelines, diagnostic competence according to whether clinicians provided a correct diagnosis, and management as correct medication and/or referral. Management was assessed twice: following clinicians’ own diagnoses determined through questioning and examinations, and after enumerators provided doctors with the correct diagnosis. Findings Clinicians completed 26% (95% CI 24% to 28%) of recommended diagnostic questions and examinations; 20% (14% to 27%) arrived at a correct diagnosis. Rates of correct management were 43% (35% to 51%) following clinicians’ own diagnosis and 51% (43% to 59%) after being given the correct diagnosis. When given the correct diagnosis and only asked to provide treatment, clinicians prescribed 82% fewer potentially harmful medications than in treatments based on their own (potentially incorrect) diagnosis. Interpretation The ability of village doctors to diagnose a textbook case of unstable angina is limited. Deficits in diagnostic competence led to low rates of correct management.
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Affiliation(s)
- Wilson Guo
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Sean Sylvia
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Karl Umble
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Yunwei Chen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Xiaoyuan Zhang
- Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, NY, United States
| | - Hongmei Yi
- School of Advanced Agricultural Sciences, Peking University, Room 408B, Wangkezhen Building, No. 5, Yiheyuan Road, Haidian, Beijing 100871, China
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46
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Liang Z, Blackstock FC, Howard P, Liu C, Leggat G, Ma H, Zhang Z, Bartram T. Managers in the publicly funded health services in China - characteristics and responsibilities. BMC Health Serv Res 2020; 20:721. [PMID: 32762694 PMCID: PMC7409694 DOI: 10.1186/s12913-020-05577-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 07/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health service managers are integral to supporting the effective and efficient delivery of services. Understanding their competencies is essential to support reform and improvement of healthcare provision in China. This paper examines the characteristics and educational background of senior managers working in the community health and hospital sectors in China. We also examine their levels of commitment to continued professional development and continuous education. METHODS A self-administered paper-based questionnaire was administered to 477 level I, II and III managers in community health services and public hospitals in China. The response rate was over 80%. RESULTS Findings demonstrate significant differences in terms of educational background and commitment to ongoing professional development between the managers in China across levels of management, and between the community and hospital sectors. Hospital managers tend to be older; hospital managers at higher management levels are predominantly male but predominantly female in the community health services. A greater proportion of hospital managers have postgraduate qualifications. In addition, the participants identified specific management tasks that they considered important. CONCLUSIONS This is the first large scale study examining the educational background and commitment to professional development of senior health service managers in China. This study determined that there are differences between the demographics of managers in China across levels of management, but more importantly between the CHC and the hospital sectors. The identification of important managerial tasks will facilitate the development of appropriate education and training for Chinese healthcare managers. All sectors and levels reported the need for informal education focussed on the core roles of developing organisation image and public relations, improving quality and safety of service provision and provision of leadership. Further research to explore the underlying reasons for the above differences is needed to design appropriate professional development for China's health services managers. In addition, the importance of managerial tasks across sectors and management levels requires further investigation.
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Affiliation(s)
- Zhanming Liang
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
| | - Felicity C Blackstock
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia.
| | - Peter Howard
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Geoffrey Leggat
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Hongkun Ma
- Dongbei Agriculture University, Harbin, China
| | - Zhijun Zhang
- Puyuhuang Community Health Centre, Beijing, China
| | - Timothy Bartram
- School of Management, College of Business, RMIT University, Melbourne, Victoria, Australia
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47
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Zhang D, Rahman KMA. Government health expenditure, out-of-pocket payment and social inequality: A cross-national analysis of China and OECD countries. Int J Health Plann Manage 2020; 35:1111-1126. [PMID: 32725673 DOI: 10.1002/hpm.3017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 04/05/2020] [Accepted: 06/05/2020] [Indexed: 12/29/2022] Open
Abstract
This study aims to assess the association between Chinese out-of-pocket payments and government health spending, investigating their variation ratio in the context of OECD countries. Aggregated time-series data of 37 countries (from China and official OECD members) were collected from the World Bank Open Data source and analyzed using the multiple linear regression models. Benchmarking approach was applied to evaluate the causes of healthcare expenditure rise per capita. The results showed that China's government health expenditure was positively associated with out-of-pocket payment rise, with a higher variation score of 42.70%. The association was statistically significant at 5%. Likewise, the association between government expenditure and out-of-pocket payment in the OECD countries was positively significant at 1%, and their variation score was 2.41%. Health financing in OECD countries showed higher stability and equity than that in China. Policy implications for China is to reduce the distributional disparity of government health funds by tax adjustments in health services, universal health coverage, the removal of social health insurance disparities, and a single health payment method.
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Affiliation(s)
- Dunfu Zhang
- School of Sociology and Political Science, Shanghai University, Shanghai, China
| | - K M Atikur Rahman
- School of Sociology and Political Science, Shanghai University, Shanghai, China
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Xin Y, Jiang J, Chen S, Gong F, Xiang L. What contributes to medical debt? Evidence from patients in rural China. BMC Health Serv Res 2020; 20:696. [PMID: 32723325 PMCID: PMC7388505 DOI: 10.1186/s12913-020-05551-5] [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] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 07/17/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Rural households in developing countries usually have severe medical debt due to high out-of-pocket (OOP) payments, which contributes to bankruptcy. China implemented the critical illness insurance (CII) in 2012 to decrease patients' medical expenditure. This paper aimed to explore the medical debt of rural Chinese patients and its influencing factors. METHODS A questionnaire survey of health expenditures and medical debt was conducted in two counties of Central and Western China in 2017. Patients who received CII were used as the sample on the basis of multi-stage stratified cluster sampling. Descriptive statistics and multivariate analysis of variance were used in all data. A two-part model was used to evaluate the occurrence and extent of medical debt. RESULTS A total of 826 rural patients with CII were surveyed. The percentages of patients incurring medical debt exceeded 50% and the median debt load was 20,000 Chinese yuan (CNY, 650 CNY = US$100). Financial assistance from kin (P < 0.001) decreased the likelihood of medical debt. High inpatient expenses (IEs, P < 0.01), CII reimbursement ratio (P < 0.001), and non-direct medical costs (P < 0.001) resulted in increased medical debt load. CONCLUSIONS Medical debt is still one of the biggest problems in rural China. High IEs, CII reimbursement ratio, municipal or high-level hospitals were the risk determinants of medical debt load. Financial assistance from kin and household income were the protective factors. Increasing service capability of hospitals in counties could leave more patiemts in county-level and township hospitals. Improving CII with increased reimbursement rate may also be issues of concern.
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Affiliation(s)
- Yanjiao Xin
- School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China
| | - Junnan Jiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China
| | - Shanquan Chen
- School of Clinical Medicine, University of Cambridge, Cambridgeshire, UK
| | - Fangxu Gong
- School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China
| | - Li Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China.
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Silva AID. Perspectivas históricas e econômicas sobre a saúde na China no século XXI. ACTA ACUST UNITED AC 2020; 27:375-389. [PMID: 32667616 DOI: 10.1590/s0104-59702020000200004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
The historical precursors of the reforms made to the healthcare systems in China from Deng Xiaoping to Hu Jintao are presented, based on a literature review and descriptive research. A series of healthcare reforms were introduced as of the 1980s in response to different political and economic policy decisions and the introduction of market forces. Accordingly, access to healthcare, and its coverage, organization, and financing underwent changes. While under Deng and Jiang, coverage, access, and funding were reduced, under Hu Jintao, at the turn of the twenty-first century, attempts were made to expand health insurance coverage with a view to making it universal, while spending on public health was increased and reforms were made to the pharmaceutical market and public hospitals.
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Affiliation(s)
- Adriana Ilha da Silva
- Departamento de Serviço Social, Universidade Federal do Espírito Santo, Vitória, ES, Brasil,
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50
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Wang Y, Liao R, Feng XL. Equity in Essential Maternal, Newborn, and Child Health Interventions in Northeastern China, 2008 to 2018. Front Public Health 2020; 8:212. [PMID: 32714887 PMCID: PMC7343890 DOI: 10.3389/fpubh.2020.00212] [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: 11/06/2019] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: We aim to analyze equity in maternal, newborn, and child health (MNCH) interventions in Jilin, a northeastern province of China, 2008–2018. Study design: Cross-sectional study. Methods: We used provincially representative survey data from 2008, 2013, and 2018. We included 18 essential MNCH interventions, analyzed equity, and calculated the composite coverage score. We used logistic and multiple linear regressions to adjust sampling clusters and covariates. Results: Coverage of hospital-based interventions, such as hospital delivery and antenatal B-ultrasound tests, was nearly universal in Jilin province. Cesarean sections persisted at alarmingly high rates (57.6%). Enormous unmet needs and rural–urban inequalities existed for community-based interventions, such as improved drinking water sources (85.4 vs. 97.9%, p < 0.01), improved sanitation facilities (52.5 vs. 94.2%, p < 0.01), four government-funded antenatal care services (55.8 vs. 84.1%, p < 0.01), and at least eight antenatal care sessions (26.8 vs. 46.3%, p < 0.05). Compared to rural–urban inequity, individual-level disparities across income and education were either small in scale or statistically insignificant. The inequity in coverage of maternal and newborn care shrank during 2008–2018. Conclusions: Despite its success in reducing mortality, China's unique obstetrician-led safe motherhood strategy may come at the cost of over-medicalization and health inequity. Jilin province's recent efforts to revitalize primary health care show the potential to make a change. An integrated system that links families, communities, and all levels of health care organizations seems to be the most effective and efficient model to offer continuing MNCH care.
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Affiliation(s)
- Ying Wang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.,Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Ran Liao
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
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