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Chen J, Wang S, Lu L, Yang Y, Wang K, Zheng J, Zhou Z, Guo P, Cai Y, Zhang Q. Potentially inappropriate prescribing among older adults with hypertension in China: prevalence and related comorbidities across different outpatient settings. Front Pharmacol 2024; 15:1439230. [PMID: 39211782 PMCID: PMC11357909 DOI: 10.3389/fphar.2024.1439230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose Potentially inappropriate prescribing (PIP) is commonly encountered in older adults; yet, there is limited information on the occurrence of PIP among older adults with hypertension. This study aims to determine and compare the prevalence of PIP and its association with comorbidities in older adult outpatients with hypertension across hospitals and community health centers (CHCs). Methods This 3-year (2015-2017) repeated cross-sectional study used electronic medical records from Shenzhen, China, involving 62 hospitals and 678 primary medical institutions. PIP was defined using the 2019 Beers Criteria. Older adults (≥65 years) with hypertension and at least one outpatient prescription were included. Modified Poisson regression analysis was used to assess the association between chronic comorbidities, healthcare settings, and PIP. Results The prevalence of PIP in old adult outpatients with hypertension in 2015, 2016, and 2017 was 46.32%, 46.98%, and 46.58% in hospitals, with a sample size of 38,411, 46,235, and 50,495, respectively, and 29.14%, 26.66%, and 29.84% in CHCs, with a sample size of 26,876, 29,434, and 34,775 respectively. The top four most popular PIP in hospitals and CHCs was proton-pump inhibitors (PPIs), diuretics, benzodiazepines, and non-cyclooxygenase-selective non-steroidal anti-inflammatory drugs (NSAIDs), respectively. PIP was most associated with chronic gastrointestinal disease (adjusted prevalence ratio = 1.54, 95% confidence interval [CI] = 1.50-1.59) and mental and behavioral disorders (adjusted prevalence ratio = 1.49, 95% CI = 1.46-1.53) in hospitals and with mental and behavioral disorders (adjusted prevalence ratio = 1.99; 95% CI = 1.95-2.03) and musculoskeletal system and connective tissue disorders (adjusted prevalence ratio = 1.33; 95% CI = 1.31-1.36) in CHCs. The prevalence of PIP was significantly higher in hospital settings than in CHCs (adjusted prevalence ratio = 1.65; 95% CI = 1.63-1.66). Conclusion Among older adult outpatients with hypertension in Shenzhen, PIP was more prevalent in hospitals than in CHCs. The comorbidities most strongly associated with PIP were chronic gastrointestinal disease and mental and behavioral disorders in hospitals and mental and behavioral disorders in CHCs. Clinical pharmacy integration needs to be considered to reduce inappropriate prescribing in this vulnerable population.
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Affiliation(s)
- Jiaqi Chen
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Shuang Wang
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China
| | - Lvliang Lu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Yujie Yang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Kai Wang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Jing Zheng
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China
| | - Zhijiang Zhou
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Yunpeng Cai
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Qingying Zhang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
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Xie P, Li X, Guo F, Zhang D, Zhang H. Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City. Front Public Health 2023; 11:1146914. [PMID: 37228711 PMCID: PMC10203198 DOI: 10.3389/fpubh.2023.1146914] [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: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China. Methods Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses. Results The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001). Conclusions The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.
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Affiliation(s)
- Peixuan Xie
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xuezhu Li
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feifan Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Donglan Zhang
- Division of Health Services Research, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Hui Zhang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Li J, Guo B, Huang X, Wang H, Zuo G, Lu W. Study of the medical service efficiency of county-level public general hospitals based on medical quality constraints: a cross-sectional study. BMJ Open 2023; 13:e059013. [PMID: 36690403 PMCID: PMC9872475 DOI: 10.1136/bmjopen-2021-059013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/08/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Since the new medical reform in 2009, county-level hospitals in China have achieved rapid development, but health resource waste and shortage issues still exist. DESIGN We applied the meta-frontier and slacks-based measurement-undesirable data envelopment analysis model to measure the medical service efficiency with or without medical quality constraints of the county-level public general hospitals (CPGHs). The assessment includes four inputs, three desirable outputs and one undesirable output. We conducted the assessment via Max-DEA V.8.19 software. Moreover, we analyse the factors affecting CPGHs' medical service efficiency based on the fractional response model. SETTING A total of 77 sample CPGHs were selected from Shanxi province in China from 2013 to 2018. RESULTS The results of this study showed that the efficiency level of county-level public hospitals in Shanxi Province is relatively low overall (the mean value of efficiency is 0.61 without quality constraints and 0.63 under quality constraints). This showed that ignoring medical quality constraints will result in lower efficiency and lower health resource usage for high medical quality hospitals. The medical service efficiency of CPGHs differs greatly among different regions. Under the meta-frontier, the hospitals in the central region had the highest efficiency (efficiency score 0.70), followed by those in the south (efficiency score 0.63) and the hospitals in the north had the lowest efficiency (efficiency score 0.54). Factors that have larger impacts on the service efficiency of county public hospitals are the average length of hospital stay, per capita disposable income and financial subsidy income. CONCLUSIONS To improve CPGHs' medical service efficiency, the government should increase investment in the northern region, and hospitals should improve the management level and allocate human resources rationally.
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Affiliation(s)
- Jing Li
- School of Economics, Hefei University of Technology, Hefei, China
| | - Binbin Guo
- School of Economics, Hefei University of Technology, Hefei, China
| | - Xiaojun Huang
- School of Management, Hainan Medical University, Haikou, Hainan, China
| | - Huakang Wang
- School of Management, Hainan Medical University, Haikou, Hainan, China
| | - Guangyan Zuo
- School of Management, Hainan Medical University, Haikou, Hainan, China
| | - Wei Lu
- School of Management, Hainan Medical University, Haikou, Hainan, China
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Ruan Y, Dai Y, Zhu D. Risk perceptions and risk-averse attitude influenced older patients' first-diagnosis-seeking behaviour at tertiary hospitals. Int J Health Plann Manage 2022; 37:2710-2726. [PMID: 35513895 DOI: 10.1002/hpm.3497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 03/31/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This qualitative study aimed to investigate the associations of older patients' inappropriate healthcare-seeking behaviour at tertiary hospitals in China with their risk perceptions and attitude. METHODS The study was based on nine focus group interviews (involving 41 older patients, with three to six per group) and involved the grounded theory method. The participants were recruited at tertiary hospitals. RESULTS The results of this study showed that older patients' inappropriate first-diagnosis-seeking behaviour at tertiary hospitals was impacted by their risk perceptions and risk-averse attitude. Both external factors (family/friends and the Internet) and internal factors (preferences and habits) had played important roles in related processes. CONCLUSION Thus, to guide older patients' healthcare-seeking behaviour, changing the thoughts and behaviour of the older patients themselves, their spouses, adult children, other relatives, and friends are all important. More attention should be paid on guiding appropriate risk perceptions and attitude regarding lower-level medical institutions, increasing their preferences and habit formation regarding lower-level medical institutions, enhancing older patients' social support and improving and standardising online health information. These are important for the future development of the hierarchical medical system in China.
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Affiliation(s)
- Yuhui Ruan
- School of Politics and Public Administration, Soochow University, Suzhou, China.,Institute of Public Health, Soochow University, Suzhou, China.,School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
| | - Yaqi Dai
- Southern Califorlia Injury Treatment Center, California, California, USA.,Spetrum MRI Imaging Center, California, California, USA
| | - Demi Zhu
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,China Institute for Urban Governance, Shanghai Jiao Tong University, Shanghai, China
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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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Ruan Y, Luo J, Lin H. Why Do Patients Seek Diagnose Dis-accordance With Hierarchical Medical System Related Policies in Tertiary Hospitals? A Qualitative Study in Shanghai From the Perspective of Physicians. Front Public Health 2022; 10:841196. [PMID: 35400060 PMCID: PMC8990090 DOI: 10.3389/fpubh.2022.841196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAlthough the Hierarchical Medical System has been utilized in China for many years, it is inadequate for guiding patients in adopting appropriate diagnose-seeking behaviors in accordance with related policies. This study examined how patients' diagnose-seeking behavior in tertiary hospitals that is dis-accordance with Hierarchical Medical System related policy (“DSB-dis-accordance”) arise and ways to guide patients away from such behaviors, both from the perspective of physicians.MethodsA qualitative study based on a mixed method including in-depth interviews and grounded theory. Twenty-seven physicians with more than 2 years of experience serving in tertiary hospitals of Shanghai were involved after reviewing the related purposes and requirements. Patients' “DSB-dis-accordance” was studied from the perspective of physicians.ResultsPatient-related factors (habits, trust, and knowledge), physician-related factors (conservative preference, risk avoidance), and system-related factors (accessibility, operability) affected patients' diagnose-seeking behavior.ConclusionsPatient-related, physician-related, and system-related factors affecting patients' diagnose-seeking behaviors in tertiary hospitals should be addressed by investing more health resources in lower-level hospitals, enhancing dissemination of health-related and policy-related knowledge, refining the classification of diseases, incentivizing physicians, and developing appropriate follow-up measures. Physicians could then become more involved in guiding patients' “DSB-dis-accordance,” thereby benefitting development of the Hierarchical Medical System in China.
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Affiliation(s)
- Yuhui Ruan
- School of Politics and Public Administration, Soochow University, Suzhou, China
- Institute of Public Health, Soochow University, Suzhou, China
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
- Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yuhui Ruan
| | - Jin Luo
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
- Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
- Jin Luo
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Medical Science Popularization, Fudan University, Shanghai, China
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Zeng Y, Yu Y, Liu Q, Su S, Lin Y, Gu H, Chen S, Li P, Xu T, Sun N, Lin T, Huang Q, Fan Y, Wang F, Yan S. Comparison of the prevalence and nature of potentially inappropriate medication use in geriatric outpatients between tertiary and community healthcare settings: a multicenter cross-sectional study. Int J Clin Pharm 2022; 44:619-629. [PMID: 35212907 DOI: 10.1007/s11096-022-01380-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/22/2022] [Indexed: 11/05/2022]
Abstract
Background Geriatric outpatients with polypharmacy have a high risk of potentially inappropriate medication (PIM) use. Aim To identify differences in both prevalence and patterns of PIMs and drug-related problems (DRPs) in older outpatients who visited the tertiary hospitals (THs) and community health centers (CHCs) and analyze associated factors. Method A prospective cross-sectional study was conducted in five THs and five CHCs from September 2018 to November 2019 in Beijing, China. Data were collected from outpatients aged ≥ 65 years with chronic diseases and polypharmacy. PIMs were evaluated using the 2015 and 2019 Beers Criteria and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria. DRPs were classified using the Helper-Strand DRP Classification. The prevalence and types of PIMs and DRPs were compared, and relevant factors were analyzed. Results The prevalence of PIMs based on the 2015 Beers Criteria was higher in patients from the THs, while PIMs based on the 2019 Beers Criteria did not show a significant difference. PIM prevalence based on STOPP Criteria and DRPs was higher in patients from CHCs. Visiting CHCs was an independent factor of PIMs based on the 2015 Beers Criteria (OR 0.774, 95% CI 0.604-0.992) and the STOPP Criteria (OR 2.427, 95% CI 1.883-3.128), and DRPs (OR 3.612, 95% CI 2.682-4.865). Conclusion Differences in PIM and DRP might be due to the patients and settings. Specific measures to improve the appropriateness of medications in both settings should be used.
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Affiliation(s)
- Yan Zeng
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Yongpei Yu
- Department of Biostatistics, Peking University Clinical Research Institution, Beijing, China
| | - Qingyang Liu
- Department of Clinical Pharmacy, Capital Medical University, Beijing, China
| | - Su Su
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongyan Gu
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shicai Chen
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Pengmei Li
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Tong Xu
- Department of Pharmacy, Taiyanggong Community Health Center, Beijing, China
| | - Naizhao Sun
- Department of Pharmacy, Datun Community Health Center, Beijing, China
| | - Tao Lin
- Department of Pharmacy, Ganjiakou Community Health Center, Beijing, China
| | - Qian Huang
- Department of Pharmacy, Konggang Community Health Center, Beijing, China
| | - Yujie Fan
- Department of Pharmacy, Guangnei Community Health Center, Beijing, China
| | - Fengzhi Wang
- Department of Data Management, Peking University Clinical Research Institute, Beijing, China
| | - Suying Yan
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China.
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Ruan Y, Zhuang C, Chen W, Xie J, Zhao Y, Zhang L, Lin H. Limited knowledge and distrust are important social factors of out-patient' s 'inappropriate diagnosed seeking behaviour': a qualitative research in Shanghai. Int J Health Plann Manage 2021; 36:847-865. [PMID: 33615549 DOI: 10.1002/hpm.3134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/05/2021] [Accepted: 01/29/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS This study is designed to present out-patient's 'inappropriate diagnosed seeking behaviour' in tertiary hospitals and interpret its association with some potential social factors. METHODS A qualitative study based on grounded theory was designed in this paper. The participates were recruited by a two-stage process. The field observation and in-depth interview were adopted for data collection. Multi-round (five rounds) sampling and continuing data analysis were adopted as well. RESULTS Totally 26 out-patients from three tertiary hospitals in Shanghai were involved. Four focused codes, including 'limited policy-related knowledge', 'limited health-related knowledge', 'distrust on related policy' and 'distrust on medical networks', were identified. Then, a theoretical model about the association of out-patient's 'limited knowledge' with 'distrust' and its relationship with 'inappropriate first-diagnosed seeking behaviour' in tertiary hospitals was developed. CONCLUSION 'Inappropriate first-diagnosed seeking behaviour' of the out-patients in tertiary hospitals is closely associated with their limited knowledge and related distrust. Great effort on improving publics' knowledge and rebuilding a benign trust relationship with out-patients and the medical networks is found to be essential for guiding publics' appropriate first-diagnosed health behaviour in various levels of medical institutions.
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Affiliation(s)
- Yuhui Ruan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Chenyang Zhuang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weisin Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinyu Xie
- Huashan Hospital, Affiliated to Shanghai Fudan University, Shanghai, China
| | - Yaodong Zhao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lufa Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Institute of Medical Science Popularization, Fudan University, Shanghai, China
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9
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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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10
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Jing X, Xu L, Qin W, Zhang J, Lu L, Wang Y, Xia Y, Jiao A, Li Y. The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010369. [PMID: 31935834 PMCID: PMC6981471 DOI: 10.3390/ijerph17010369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022]
Abstract
Objectives: The aim of this study was to understand the willingness for downward referral among older adults who were hospitalized in the year before the survey and to explore its influencing factors. Methods: The sample was randomly selected by the multi-stage sampling method. A structural questionnaire was used to collect data from participants age 60 and above in Shandong, China, during August 2017. Data were analyzed by using descriptive statistics, one-way ANOVA, chi-square test, and multinomial logistic regression. Results: Of 1198 participants who were hospitalized in the year before the survey, 28.7% self-initiated downward referral, and 33.9% were willing to accept downward referral after a doctor’s advice. Multinomial logistic regression results showed that self-rated health, treatment effect in primary medical institutions, preference for outpatient service, choice of inpatient service, general understanding of essential medicines, the cost of essential medicines after zero-markup policy, and satisfaction with essential medicines’ reimbursement policy significantly correlated with older adults’ willingness for downward referral. Conclusions: The proportion of older adults who self-initiated downward referral was less than one-third. Doctors’ advice plays an important role in willingness for downward referral. More attention should be paid to improving the treatment effect of primary medical institutions, increasing the benefits of zero-markup policy, and ensuring a high reimbursement for the downward referral to work alongside doctors’ advice.
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Affiliation(s)
- Xiang Jing
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
- Correspondence: ; Tel.: +86-0531-8838-2648
| | - Wenzhe Qin
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Jiao Zhang
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Lu Lu
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Yali Wang
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Yu Xia
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - An’an Jiao
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Yaozu Li
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
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