Preventative care utilization and associated health‐related measurements among older adults following the 2009 health reform in China

The Effect of Health Check-Ups on Health Among the Elderly in China: Evidence From 2011–2018 Longitudinal Data

Objectives: To assess the effect of health check-ups on health among the elderly Chinese.

Methods: The first dataset was panel data extracted from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The second dataset was cross-sectional data come from CLHLS 2018 linked with the lagged term of health check-ups in CLHLS 2011. Health check-ups were measured by a binary variable annual health check-up (AHC). Health was assessed by a binary variable self-rated health (SRH). A coarsened exact matching method and individual fixed-effects models, as well as logistic regressions were employed.

Results: AHC attendance among the elderly increased from 2011 to 2018, with higher utilization of AHC also detected in the rural group. AHC had positive effects on SRH among rural respondents (short-term effect: OR = 1.567, p < 0.05; long-term effect: OR = 3.385, p < 0.001).

Conclusion: This study highlights a higher utilization of AHC in rural area, and the effectiveness of AHC in SRH improvement among rural participants. It indicates enhanced access to public healthcare services in rural area and underlying implications of health check-ups for reducing urban–rural health inequalities.

The association mechanism between social network types and health-related behaviours among the elderly in rural Hubei Province, China

China's rural population ageing situation is extremely serious, and the social network has become a very important social and environmental factor to ensure the health. This study aims to explore the association mechanism between social network types and health-related behaviours among the elderly in rural Hubei Province, China. A cross-sectional cluster sample survey method was used to investigate elderly individuals aged 60 or older. The following three results were obtained: (1) the level of health-related behaviours differed significantly depending on their social network types. The rural elderly embedded in restricted and family restricted networks had lower levels of health-related behaviours than those in other networks, especially those in diverse networks; (2) Social network types were found to be significantly associated with health-related behaviours, the perceived quality of social relationships and social support and (3) Social network types not only had a direct effect on health-related behaviours (except for health-seeking behaviour), but also an indirect effect through the mediating effects of the perceived quality of social relationships and social support. Policy makers should formulate relevant measures to improve unfavourable social network types of the rural elderly, thus promoting their health.

Establishment and Empirical Evaluation of a Quality Indicator System for Postoperative Pain Management

OBJECTIVES

This study aimed to establish a quality indicator system for postoperative pain management and test its reliability, validity, and discrimination in China.

METHODS

We established a quality indicator system using the Delphi method. Further, we designed and administered a survey questionnaire in the orthopedic departments of nine hospitals, located in the Zhejiang and Jiangsu Provinces, through purposive and convenience sampling methods to examine the reliability, validity, and discrimination of the quality indicator system.

RESULTS

We established a quality indicator system to assess structure, process, and outcome measures of postoperative pain management using three first-level, eight subordinate second-level, and 32 subordinate third-level quality indicators. The scale-level content validity indexes of the three sections of the questionnaire, assessing structure, process, and outcomes measures, were 0.99, 0.98, and 0.98, respectively. We identified two common factors from the third section that demonstrated a cumulative variance contribution rate of 80.38% and a Cronbach's α coefficient of 0.95. The total scores and scores of the structure, process, and outcome quality indicators demonstrated statistically significant differences (P < 0.05) between the wards (N = 4) that participated in the "Painless Orthopedics Ward" quality improvement program and those (N = 5) that did not.

CONCLUSIONS

This quality indicator system highlights the need for multidisciplinary cooperation and process characteristics of postoperative pain management, along with interdepartmental quality comparisons. And it demonstrates acceptable reliability, validity, and discrimination; thus it may be completely or partially employed in Chinese hospitals.

Changes in preventive care utilisation and its influencing factors among Chinese adults before and after the healthcare reform: cross-sectional evidence from the China Health and Nutrition Survey in 2004-2015

OBJECTIVE

China launched its health reform in 2009. This study aimed to assess changes in preventive care utilisation (PCU) and its relationship with the healthcare reform.

DESIGN

A cross-sectional study using demographic characteristics, socioeconomic status, environmental factors, and lifestyle and health status data of adults from five waves (2004-2015) of the China Health and Nutrition Survey (CHNS) was conducted. Multilevel mixed-effects logistic regression models were used.

SETTING

Data were derived from urban and rural communities of nine provinces in China.

PARTICIPANTS

Data were obtained from five waves of the CHNS, with 9960 participants in 2004, 9888 in 2006, 10 286 in 2009, 9709 in 2011, and 10 628 in 2015.

OUTCOME

The primary outcome was PCU.

RESULTS

PCU in 2004-2015 among adults was 3.29%, 3.13%, 3.77%, 4.95% and 2.73%, respectively. Whether before or after the health reform, having a history of disease and female gender were positive influencing factors of PCU. Before 2009, PCU was significantly associated with gender, income, medical insurance status and region. Age, medical insurance status, history of drinking and education level significantly affected PCU in 2009-2011. Having medical insurance was no longer a positive influencing factor of PCU, while high income had a negative effect on PCU, in 2011-2015.

CONCLUSIONS

PCU from 2004 to 2015 was low and the health reform in China may lack sustainable effect on PCU. Further studies on how to ensure sustainability of PCU are necessary, and further reforms on preventive care services should be aimed at different ages, rural areas and participants without history of disease.

Is preventive care utilization associated with lower outpatient and inpatient health-care expenses among Chinese older adults? A longitudinal analysis

BACKGROUND

China has made major improvements to its health-care system since the early 21st century. However, the effectiveness of preventive care utilization on health-care costs remains limited. This study seeks to understand the effect of preventive care utilization on outpatient and inpatient health-care expenses.

METHODS

With the use of the Chinese Longitudinal Healthy Longevity Survey with older adults who were 65 years old or above (n = 2828), Tobit regression models were estimated to examine the association of preventive care utilization and expenses with medical treatments. Preventive care utilization in the previous wave was used to predict health-care costs for treatments in the next wave. Propensity score matching was used to reduce potentially confounding factors.

FINDINGS

Results indicated that preventive care utilization was positively associated with outpatient health care among Chinese older adults (β = 231.8, standard error [SE] = 71.5, P < .01). The association between preventive care utilization and inpatient health-care expenses was not significant.

CONCLUSIONS

Despite the results from previous studies suggesting that preventive care utilization can help reduce health-care expenses, this study does not support such a claim among Chinese older adults. The long-term association between preventive care utilization and health-care expenses for treatment should be studied further.