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Amgalan N, Shin JS, Lee SH, Badamdorj O, Ravjir O, Yoon HB. The socio-economic transition and health professions education in Mongolia: a qualitative study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:16. [PMID: 33678178 PMCID: PMC7938553 DOI: 10.1186/s12962-021-00269-5] [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: 09/25/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Former socialist countries have undergone a socio-economic transition in recent decades. New challenges for the healthcare system have arisen in the transition economy, leading to demands for better management and development of the health professions. However, few studies have explored the effects of this transition on health professions education. Thus, we investigated the effects of the socio-economic transition on the health professions education system in Mongolia, a transition economy country, and to identify changes in requirements. Methods We used a multi-level perspective to explore the effects of the transition, including the input, process, and output levels of the health professions education system. The input level refers to planning and management, the process level refers to the actual delivery of educational services, and the output level refers to issues related to the health professionals, produced by the system. This study utilized a qualitative research design, including document review and interviews with local representatives. Content analysis and the constant comparative method were used for data analysis. Results We explored tensions in the three levels of the health professions education system. First, medical schools attained academic authority for planning and management without proper regulation and financial support. The government sets tuition fees, which are the only financial resource of medical schools; thus, medical schools attempt to enroll more students in order to adapt to the market environment. Second, the quality of educational services varies across institutions due to the absence of a core curriculum and differences in the learning environment. After the transition, the number of private medical schools rapidly increased without quality control, while hospitals started their own specialized training programs. Third, health professionals are struggling to maintain their professional values and development in the market environment. Fixed salaries lead to a lack of motivation, and quality evaluation measures more likely reflect government control than quality improvement. Conclusions Mongolia continues to face the consequences of the socio-economic transition. Medical schools’ lack of financial authority, the varying quality of educational services, and poor professional development are the major adverse effects. Finding external financial support, developing a core curriculum, and reforming a payment system are recommended.
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Affiliation(s)
- Nomin Amgalan
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jwa-Seop Shin
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Seung-Hee Lee
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Oyungoo Badamdorj
- Division of Educational Policy and Management, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Oyungerel Ravjir
- Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Hyun Bae Yoon
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea.
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Yang T, Ma T, Liu P, Liu Y, Chen Q, Guo Y, Zhang S, Deng J. Perceived social support and presenteeism among healthcare workers in China: the mediating role of organizational commitment. Environ Health Prev Med 2019; 24:55. [PMID: 31481032 PMCID: PMC6724257 DOI: 10.1186/s12199-019-0814-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/27/2019] [Indexed: 12/19/2022] Open
Abstract
Objectives We assessed the role of social support in presenteeism by examining organizational commitment among Chinese healthcare workers. Methods One thousand four hundred thirty-four healthcare workers from 6 hospitals in 4 Chinese cities completed a questionnaire measuring presenteeism, social support, and organizational commitment. With organizational commitment as the mediator, regression analyses and structural equation modeling were used to test the model. Results Organizational commitment was directly inversely associated with presenteeism (β = − 0.42, p < 0.001). Coworker support was moderately but significantly inversely associated with presenteeism (β = − 0.15, p < 0.001), but the path from supervisor support to presenteeism was not significant (β = 0.05, p > 0.05). The correlation between supervisor support and coworker support was significant (β = 0.71, p <0.001). Supervisor support and coworker support were significantly positively associated with organizational commitment (β = 0.41, p < 0.001, and β = 0.14, p < 0.001, respectively). Conclusions Supervisor support was more important in promoting organizational commitment, while coworker support was more effective in reducing presenteeism. The mediating effect of organizational commitment was significant.
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Affiliation(s)
- Tianan Yang
- School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China.,Sustainable Development Research Institute for Economy and Society of Beijing, Beijing, 100081, China.,Chair of Sport and Health Management, School of Management, Technical University of Munich, Uptown Munich Campus D, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Tengyang Ma
- School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China.,Sustainable Development Research Institute for Economy and Society of Beijing, Beijing, 100081, China
| | - Pucong Liu
- School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China.,Sustainable Development Research Institute for Economy and Society of Beijing, Beijing, 100081, China
| | - Yuanling Liu
- Human Resources Department, Guangdong Women's and Children Hospital, Guangzhou, 510180, China
| | - Qian Chen
- Medical Affairs Department, Peking Union Medical College Hospital, Beijing, 100010, China
| | - Yilun Guo
- School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China.,Sustainable Development Research Institute for Economy and Society of Beijing, Beijing, 100081, China
| | - Shiyang Zhang
- Hospital Infection Management Department, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Jianwei Deng
- School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China. .,Sustainable Development Research Institute for Economy and Society of Beijing, Beijing, 100081, China.
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Regulating private medical institutions: a case study of China. HEALTH ECONOMICS POLICY AND LAW 2019; 16:124-137. [PMID: 31441396 DOI: 10.1017/s1744133119000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The expansion of privatisation in health care has been discussed extensively in most European countries and remains a hot topic nowadays. In China, privatisation results in considerable changes in its health care system, especially accelerating the ever-growing private medical institutions (PMIs). The rapid growth of PMIs raises the question of regulation for the Chinese government. Given the fact that few studies are available on the regulation of PMIs in China, I attempted to fill that gap by discussing the development of PMIs with a special focus on legal-regulatory strategies. After assessing current legal-regulatory strategies concerning PMIs, the paper identifies three major concerns regarding effective legal rules (i.e. weak coherence, inconsistency and legislative vacancy) and three difficult issues regarding government capacity (i.e. the negative effects of decentralised political structure, the low professionalism of bureaucrats and lack of reliability) that impede the well-functioning of regulatory agencies in China. As a plausible response, the paper recommends that the newly drafted basic health law should assign a separate chapter to regulate PMIs and also an independent regulatory body should be established to manage the issues of PMIs in China. Detailed recommendations are the practical implications of ICESCR General Comment No. 14.
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Supervisor Support, Coworker Support and Presenteeism among Healthcare Workers in China: The Mediating Role of Distributive Justice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050817. [PMID: 30845703 PMCID: PMC6427268 DOI: 10.3390/ijerph16050817] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022]
Abstract
Healthcare workers in China are exposed to extremely high job stress and inequitable work conditions, and the Healthy China 2030 blueprint has made them an important focus of policymakers. To examine the importance of distributive justice in Chinese medical reform, we analyzed data from 1542 healthcare workers employed in 64 primary, secondary and tertiary hospitals in 28 Chinese cities in Western, Central and Eastern China in 2018. Supervisor support, coworker support, distributive justice, and presenteeism were assessed with the supervisor support scale, coworker support scale, distributive justice scale and perceived ability to work scale, respectively. Structural equation modeling was used to examine relationships among variables. The mediating effect of distributive justice on associations between supervisor support, coworker support, and presenteeism was examined with the Sobel test. The results revealed that significant indirect effects between supervisor support and presenteeism and between coworker support and presenteeism were significantly mediated by distributive justice. Better supervisor and coworker support might improve distributive justice among healthcare workers in Chinese hospitals, thereby increasing their performance.
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Liu Y, Chen Y, Tzeng GH. Identification of key factors in consumers' adoption behavior of intelligent medical terminals based on a hybrid modified MADM model for product improvement. Int J Med Inform 2017; 105:68-82. [PMID: 28750913 DOI: 10.1016/j.ijmedinf.2017.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND As a new application technology of the Internet of Things (IoT), intelligent medical treatment has attracted the attention of both nations and industries through its promotion of medical informatisation, modernisation, and intelligentisation. Faced with a wide variety of intelligent medical terminals, consumers may be affected by various factors when making purchase decisions. PURPOSE To examine and evaluate the key influential factors (and their interrelationships) of consumer adoption behavior for improving and promoting intelligent medical terminals toward achieving set aspiration level in each dimension and criterion. METHOD A hybrid modified Multiple Attribute Decision-Making (MADM) model was used for this study, based on three components: (1) the Decision-Making Trial and Evaluation Laboratory (DEMATEL) technique, to build an influential network relationship map (INRM) at both 'dimensions' and 'criteria' levels; (2) the DEMATEL-based analytic network process (DANP) method, to determine the interrelationships and influential weights among the criteria and identify the source-influential factors; and (3) the modified Vlse Kriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method, to evaluate and improve for reducing the performance gaps to meet the consumers' needs for continuous improvement and sustainable products-development. First, a consensus on the influential factors affecting consumers' adoption of intelligent medical terminals was collected from experts' opinion in practical experience. Next, the interrelationships and influential weights of DANP among dimensions/criteria based on the DEMATEL technique were determined. Finally, two intelligent medicine bottles (AdhereTech, A1 alternative; and Audio/Visual Alerting Pillbox, A2 alternative) were reviewed as the terminal devices to verify the accuracy of the MADM model and evaluate its performance on each criterion for improving the total certification gaps by systematics according to the modified VIKOR method based on an INRM. RESULTS In this paper, the criteria and dimensions used to improve the evaluation framework are validated. The systematic evaluation in index system is constructed on the basis of five dimensions and corresponding ten criteria. Influential weights of all criteria ranges from 0.037 to 0.152, which shows the rank of criteria importance. The evaluative framework were validated synthetically and scientifically. INRM (influential network relation map) was obtained from experts' opinion through DEMATEL technique shows complex interrelationship among factors. At the dimension level, the environmental dimension influences other dimensions the most, whereas the security dimension is most influenced by others. So the improvement order of environmental dimension is prior to security dimension. The newly constructed approach was still further validated by the results of the empirical case, where performance gap improvement strategies were analyzed for decision-makers. The modified VIKOR method was especially validated for solving real-world problems in intelligent medical terminal improvement processes. For this paper, A1 performs better than A2, however, promotion mix, brand factor, and market environment are shortcomings faced by both A1 and A2. In addition, A2 should be improved in the wireless network technology, and the objective contact with a high degree of gaps. CONCLUSIONS Based on the evaluation index system and the integrated model proposed here, decision-makers in enterprises can identify gaps when promoting intelligent medical terminals, from which they can get valuable advice to improve consumer adoption. Additionally, an INRM and the influential weights of DANP can be combined using the modified VIKOR method as integrated weightings to determine how to reduce gaps and provide the best improvement strategies for reaching set aspiration levels.
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Affiliation(s)
- Yupeng Liu
- School of Economics and Management, Harbin Institute of Technology, 2, West Wenhua Rd., Weihai City 264209, Shandong Province, People's Republic of China.
| | - Yifei Chen
- School of Economics and Management, Harbin Institute of Technology, 2, West Wenhua Rd., Weihai City 264209, Shandong Province, People's Republic of China
| | - Gwo-Hshiung Tzeng
- Graduate Institute of Urban Planning, College of Public Affairs, National Taipei University, 151, University Rd., San Shia District, New Taipei City 23741, Taiwan.
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A Comparison of Quality of Community Health Services Between Public and Private Community Health Centers in Urban China. Med Care 2016; 53:888-93. [PMID: 26366520 DOI: 10.1097/mlr.0000000000000414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study was the first of its kind to evaluate and compare the quality of private and public community health centers (CHCs) in urban China. METHODS A total of 2501 CHCs in 35 cities were chosen in 2011 using a multistage sampling method, and data on human resources, medical equipment and drug inventory were collected. A subset of 422 CHCs was randomly selected and 100 prescriptions from each CHCs were reviewed to evaluate prescribing practice. In total, 12,386 patients who visited the selected 422 CHCs were interviewed to assess patient satisfaction and payments. RESULTS Controlling for population covered per CHC and geographic regions, private CHCs were higher than public CHCs in average building area (2310.96 vs. 2000.92 square meters), average number of medical equipment (6.42 vs. 6.14), average number of physicians and nurses per 10,000 population (4.86 vs. 3.81 and 3.38 vs. 2.62), and average number of medicines in stock (435.08 vs. 375.83), but lower in average percentage of medicines on the national essential medicines list (67.29% vs. 77.55%). Prescriptions from private CHCs had significantly higher number of drugs per prescription (2.38 vs. 2.24), higher percentage of prescriptions with injections (36.44% vs. 30.50%), and higher percentage of prescriptions with antibiotics (37.17% vs. 30.14%). Patient satisfaction was similar between the 2 groups, and patient payments per visit were lower in private CHCs after controlling for patients' sociodemographic characteristics. CONCLUSIONS Private CHCs are better equipped and better staffed than public CHCs but are less compliant with national policy on essential medicines and have poorer prescribing quality in China, warranting more rigorous government supervision.
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Wang Y, Eggleston K, Yu Z, Zhang Q. Contracting with private providers for primary care services: evidence from urban China. HEALTH ECONOMICS REVIEW 2013; 3:1. [PMID: 23327666 PMCID: PMC3599686 DOI: 10.1186/2191-1991-3-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 01/07/2013] [Indexed: 06/01/2023]
Abstract
Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China's recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance.We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services.
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Affiliation(s)
- Yan Wang
- Shandong Provincial Health Department, Division of Disease Control, 9 Yang Dong Xin Lu, Shandong, 250014, China
| | - Karen Eggleston
- Asia Health Policy Program, Walter H. Shorenstein Asia-Pacific Research Center, Stanford University, 616 Serra St., Encina Hall E311, Stanford, CA, 94305-6055, USA
| | - Zhenjie Yu
- Weifang Medical University, Weifang, Shandong, China
| | - Qiong Zhang
- Central University of Finance and Economics, School of Economics, Beijing, China
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Yang J. Serve the people: understanding ideology and professional ethics of medicine in China. HEALTH CARE ANALYSIS 2011; 18:294-309. [PMID: 19787458 DOI: 10.1007/s10728-009-0127-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The article explores the communist ideology that has guided the formation of professional ethics of medicine in China. It first explores the constitutions of the People's Republic of China and the Chinese Communist Party and codes of practice for medicine enforced since 1949, showing that the core of the ideology in relation to health provision and doctor-patient relationship has always been 'serving the people wholeheartedly'. The ideological undertaking, however, has never been successfully exercised. In the pre-reform era, the bureaucratisation of health professionals led to the emergence of 'bureaucratic medicine' featuring negligence of patients' interests. In the reform era, the prevailing commercialisation of health care is in fundamental conflict with the ideological commitment to serving the people. As a result, the socialist professional ethics of medicine has not been satisfactorily practiced in reality.
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Affiliation(s)
- Jingqing Yang
- Faculty of Arts and Social Sciences, University of Technology, Sydney, Broadway, P.O. Box 123, Sydney, NSW, 2007, Australia.
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Mahmood MA, Raulli A, Yan W, Dong H, Aiguo Z, Ping D. Cooperative medical insurance and the cost of care in Shandong, PR China: perspectives of patients and community members. Asia Pac J Public Health 2010; 27:NP897-902. [PMID: 20702447 DOI: 10.1177/1010539510376664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This research was conducted to identify the cost of care associated with utilization of village clinics and membership of the New Cooperative Medical Scheme (NCMS) in 2 counties of Shandong province, PR China. A total of 397 community members and 297 patients who used the village clinics were interviewed. The average cost for primary care treatment of 1 episode of illness was about 55 yuan (about US$8). Although more than 50% of people had NCMS membership, many consider the monetary reimbursements as insufficient. The low insurance reimbursement rates and inability to pay out-of-pocket expenses compromise access to care. Delays can cause more serious illnesses with potential to overburden the secondary care at the township and county hospitals. Those rural people who have not yet enjoyed the benefits of China's economic development may not benefit from recent health care reform and finance mechanisms unless schemes such as the NCMS provide more substantial subsidies.
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Affiliation(s)
| | - Alexandra Raulli
- University of Adelaide, Adelaide, Australia Tropical Population Health Service, Queensland Health, Cairns, Queensland, Australia
| | - Wang Yan
- Health Department of Shandong Province, Jinan, Shandong Province, China
| | - Han Dong
- Health Department of Shandong Province, Jinan, Shandong Province, China
| | - Zhang Aiguo
- Health Department of Shandong Province, Jinan, Shandong Province, China
| | - Dong Ping
- Health Department of Shandong Province, Jinan, Shandong Province, China
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Braithwaite J, Travaglia JF, Corbett A. Can Questions of the Privatization and Corporatization, and the Autonomy and Accountability of Public Hospitals, Ever be Resolved? HEALTH CARE ANALYSIS 2010; 19:133-53. [DOI: 10.1007/s10728-010-0152-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang D, Zheng J, Kurosawa M, Inaba Y, Kato N. Changes in activities of daily living (ADL) among elderly Chinese by marital status, living arrangement, and availability of healthcare over a 3-year period. Environ Health Prev Med 2009; 14:128-41. [PMID: 19568857 DOI: 10.1007/s12199-008-0072-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 12/09/2008] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess how changes from different baselines of activities of daily living (ADL) can be explained by marital status, living arrangement and healthcare. METHODS Using data from the Chinese Longitudinal Health Longevity Study conducted in 2002 and 2005, 8,099 surviving and 3,822 deceased elderly aged 65 years and over were evaluated using multinomial logistic regression. RESULTS After adjusting for demographic, socioeconomic and health factors, elderly who were either married or living alone were less likely to encounter ADL decline compared to their counterparts. This was true only for those with fully independent ADL at baseline. Notably, once the functional status of the elderly declined from baseline and they became dependent on others, the status of living alone was no longer a significant predictor of the rate of future decline. On the other hand, elderly who had a spouse, children or other relatives as caregivers were more likely to experience a faster recovery and lower likelihood of death, compared to those who were cared by unrelated live-in caregivers. In addition, Chinese elderly with health insurance had a lower likelihood of death than their counterparts lacking health insurance, among those with ADL at the dependent baseline. CONCLUSIONS Although there has been a change in family structure and living arrangements, the majority of Chinese elderly still rely on traditional forms of family support, especially after acquiring dependency status. As the elderly have different functional levels, healthcare policies in China should consider the need for both community and family support systems.
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Affiliation(s)
- Dewen Wang
- Institute of Population Research, Xiamen University, 361005, Xiamen, China,
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The emergence of proprietary medical facilities in China. Health Policy 2008; 88:141-51. [DOI: 10.1016/j.healthpol.2008.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 02/29/2008] [Accepted: 03/10/2008] [Indexed: 11/21/2022]
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Harris DM, Wu CC. Medical malpractice in the People's Republic of China: the 2002 Regulation on the Handling of Medical Accidents. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2005; 33:456-77. [PMID: 16240729 DOI: 10.1111/j.1748-720x.2005.tb00512.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In China, there have been numerous reports that doctors or other health care workers have been attacked by patients or members of patient’s families. From 2000 to 2003, there were 502 reports of violence against health care workers in the city of Beijing, in which 90 health care workers were wounded or disabled. From January 1991 to July 2001, in Hubei Province, 568 attacks on health care facilities and workers were reported, and some health care workers were even killed. In Jiangsu Province, from 2000 to 2002, violent events against health care facilities and workers increased by 35% every year, with an average of 177 such events occurring each year. Those acts of violence have been attributed, in part, to the inadequacy of the legal system for handling medical disputes that was in effect prior to 2002.
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Affiliation(s)
- Dean M Harris
- Department of Health Policy andAdministration, School of Public Health, University of North Carolina at Chapel Hill, USA
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Lim MK, Yang H, Zhang T, Zhou Z, Feng W, Chen Y. China's evolving health care market: how doctors feel and what they think. Health Policy 2004; 69:329-37. [PMID: 15276312 DOI: 10.1016/j.healthpol.2004.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2003] [Accepted: 01/04/2004] [Indexed: 10/26/2022]
Abstract
This paper reports on a questionnaire survey and 12 focus groups conducted among doctors in three provinces of China, namely Guangdong, Shanxi, and Sichuan. The survey (N = 720) and focus group participants were drawn from both rural and urban areas, as well as public and private sectors, in equal numbers The aim was to gauge how Chinese doctors feel about themselves and what they think of the Chinese health care system. We found low satisfaction levels with own income (8%), job (27%), skill (30%), and other important aspects of their professional life. The health care system received only 32% approval rating. Quality of care and patient safety issues were major concerns, especially in the growing but poorly regulated private sector. The public sector came under criticism for its high fees and bad service quality. The feedback point to the need for an appropriate regulatory framework to guide the development of China's evolving health care market. A revitalized medical profession that is fully engaged in the reform process could also significantly impact the success of ongoing health care reform efforts.
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Affiliation(s)
- Meng-Kin Lim
- Department of Community, Occupational & Family Medicine, Faculty of Medicine MD3, National University of Singapore, 16 Medical Drive, Singapore 117597, Singapore.
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Abstract
The purpose of this study was to examine the degree to which commonly used social class indicators-education, income, and occupation-are associated with health in the context of rural China. Data were collected from 10,226 individuals of working age (16-60) living in HeBei Province, the PRC. The association between education and income observed resembles the patterns documented in industrial societies, but the health status of farmers is quite similar to that of white collar employees. Persons in other than mainstream occupations report the poorest health status. Social selection and the costs of relative deprivation appear to be useful to the understanding of health inequality in rural China, though in a manner shaped by the particular social context.
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Affiliation(s)
- Ofra Anson
- Faculty of Health Sciences and the Recanti School of Community Health Professions, Ben-Gurion University of the Negev, PoB 653, Beer-Sheva 84105, Israel.
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Sepehri A, Chernomas R, Akram-Lodhi AH. If they get sick, they are in trouble: health care restructuring, user charges, and equity in Vietnam. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2003; 33:137-61. [PMID: 12641269 DOI: 10.2190/mxc5-cq0a-xk3m-kpub] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The transition from a centrally planned economy in the 1980s and the implementation of a series of neoliberal health policy reform measures in 1989 affected the delivery and financing of Vietnam's health care services. More specifically, legalization of private medical practice, liberalization of the pharmaceutical industry, and introduction of user charges at public health facilities have effectively transformed Vietnam's near universal, publicly funded and provided health services into a highly unregulated private-public mix system, with serious consequences for Vietnam's health system. Using Vietnam's most recent household survey data and published facility-based data, this article examines some of the problems faced by Vietnam's health sector, with particular reference to efficiency, access, and equity. The data reveal four important findings: self-treatment is the dominant mode of treatment for both the poor and nonpoor; there is little or no regulation to protect patients from financial abuse by private medical providers, pharmacies, and drug vendors; in the face of a dwindling share of the state health budget in public hospital revenues and low salaries, hospitals increasingly rely on user charges and insurance premiums to finance services, including generous staff bonuses; and health care costs, especially hospital costs, are substantial for many low- and middle-income households.
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Affiliation(s)
- Ardeshir Sepehri
- Department of Economics, University of Manitoba, Winnipeg, Canada.
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Heitlinger A. The paradoxical impact of health care restructuring in Canada on nursing as a profession. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2003; 33:37-54. [PMID: 12641262 DOI: 10.2190/rmay-nja9-kfw7-1uew] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article draws on the concept of "countervailing powers" to explore some of the contradictory effects of Canadian health care restructuring on nursing. The main focus is on key institutional powers in the nursing field, the major individual and collective strategies nurses have adopted in response to restructuring, and the ways in which the interaction between global and national market forces and the aggregate responses of nurses has created a severe shortage of nurses. The global shortage has led to a global competition for nurses' labor. This, along with government budget surpluses, has increased nurses' bargaining power, forcing governments and hospital managers to reverse nursing spending cuts; to offer more secure professional jobs, as opposed to casual work; to engage in aggressive, bonuses-laden recruitment of nurses, both within Canada and abroad; and, more generally, to rethink some of their restructuring strategies. However, since the bargaining power of nurses is largely market dependent and, as such, highly variable, there does not seem to be much potential for a sustained increase in the institutionalized power of the nursing profession.
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Affiliation(s)
- Alena Heitlinger
- Department of Sociology, Trent University, Peterborough, Ontario, Canada.
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18
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Abstract
Gender differences in health and health behavior are well established in Western societies, but little is known about gender health inequalities in rural China. We examine patterns of age-sex differences in health and health behavior of men and women in rural HeBei, People's Republic of China, and consider the extent to which these patterns resemble gender health inequalities observed in North America and Western Europe. The data analyzed were collected from 14,895 individuals residing in 288 villages in the HeBei Province. The results show that gender differences emerged at a later age than generally reported in Western societies. Poorer health among women, as compared with men, becomes observable during young adulthood (25-44) rather than at adolescence, and reached its peak among older adults (45-59) rather than during the productive and reproductive stage of the life course. Among the elderly, the differences between the health and the health behavior of men and women narrowed, similar to many reports in North America and Western Europe. Most importantly, no gender differences in mental health were observed. These findings suggest that the older adult age group (45-59) may be appropriate for interdisciplinary efforts to advance the understanding regarding the relative contributions of nature and nurture to gender differences in health.
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Affiliation(s)
- Ofra Anson
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Anson O, Haanappel FW. "Remnants of feudalism"? Women's health and their utilization of health services in rural China. Women Health 2000; 30:105-23. [PMID: 10813270 DOI: 10.1300/j013v30n01_07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Almost five decades ago, the Chinese Communist Party wished to abolish all "remnants of feudalism," including the patriarchal social order. Just one year after the revolution, the Marriage Law endorsed women's rights within the family, but no operative measures were taken to enforce it. Some of the economic reforms since independence even strengthened patrilocality and, possibly, patriarchal values. The purpose of this study was to explore the degree to which patrilocality served to maintain the traditional patriarchal stratification among women in the household by exploring women's health patterns and utilization of health services. Data were collected from 3859 women residing in rural Hebei, and variation in health and help seeking of six categories of relation to household head--mothers, wives, daughters, daughters-in-law, family heads, and other relatives--were explored. Utilization of health services is not dependent on women's position in the household, but primarily on per-capita income. Health patterns seem to indicate that mothers of the head of the household still have a considerable power to define their roles and share of household work. Women head of family, most of whom are married, appear to be under strain, which could be a result of their culturally "deviant" position. We conclude that old patriarchal values are intertwined with values of equality in current rural China.
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Affiliation(s)
- O Anson
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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20
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McPake B, Asiimwe D, Mwesigye F, Ofumbi M, Ortenblad L, Streefland P, Turinde A. Informal economic activities of public health workers in Uganda: implications for quality and accessibility of care. Soc Sci Med 1999; 49:849-65. [PMID: 10468391 DOI: 10.1016/s0277-9536(99)00144-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper reports the results of a study in Uganda of the 'informal' economic activities of health workers, defined as those which earn incomes but fall outside official duties and earnings. The study was carried out in 10 sub-hospital health facilities of varying size and intended role and used a variety of quantitative and qualitative methods. The paper focuses on those activities which are carried out inside public health facilities and which directly affect quality and accessibility of care. The main strategies in this category were the leakage of drug supply, the informal charging of patients and the mismanagement of revenues raised from the formal charging of patients. Few of the drugs supplied to health units were prescribed and issued in those sites. Most health workers who have the opportunity to do so, levy informal charges. Where formal charges are collected, high levels of leakage occur both at the point of collection and at higher levels of the system. The implications of this situation for the quality and accessibility of services in public health facilities were assessed. Utilisation levels are less than those expected of the smallest rural units and this workload is managed by a handful of the expected staff complement who are available for a fraction of the working week. Even given these few patients, drugs available after leakage were sufficient to cover less than half of those attending in most facilities. Evidence on staff motivation was mixed and better motivation was associated with better performance only in a minority of units. Informal charging was associated with better performance regarding hours worked by health workers and utilisation rates. Drug leakage was associated with worse performance with respect to both of these and unsurprisingly, with drug availability. Short term strategies to effect marginal performance improvements may focus on the substitution of strategies based inside health units (such as informal charging) for those based outside (facilitated by drug leakage). In the long term, only substantially higher funding of the sector can be expected to facilitate major change, but alone will be insufficient. Investment strategies supported by appropriate policy development has to be informed by understanding and monitoring of the 'informal' dimension of health sector activity.
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Affiliation(s)
- B McPake
- Health Economic and Financing Programme, London School of Hygiene and Tropical Medicine, UK.
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21
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Choi KH, Zheng X, Zhou H, Chen W, Mandel J. Treatment delay and reliance on private physicians among patients with sexually transmitted diseases in China. Int J STD AIDS 1999; 10:309-15. [PMID: 10361920 DOI: 10.1258/0956462991914177] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined health-care seeking practices among patients with sexually transmitted diseases (STDs) in south China. In 1995, we recruited a consecutive sample of 939 STD patients attending the STD clinics of the Municipal STD Control Centers of Guangzhou and Shenzhen, 'special economic zones' near Hong Kong. Attending physicians interviewed patients face-to-face using a standard survey questionnaire. Twenty-seven per cent of all subjects had sought treatment elsewhere for their presenting complaints, before visiting a study clinic. The main sources of prior treatment were private physicians followed by public clinics and drugstores. Women were more likely than men to delay in presenting their current symptoms to a study clinic (32% vs 25%, P=0.046). Factors associated with treatment delay differed by gender. Among men, seeking prior treatment from private physicians (OR=3.31; 95% CI=1.70, 6.43), having no urethral discharge (OR=4.00; 95% CI=2.33, 6.85), having engaged in sex trade (OR=1.64; 95% CI=1.03, 2.63), or being a resident in Shenzhen (OR=1.80; 95% CI=1.12, 2.89) were more likely to delay seeking treatment. Among women, only living in Shenzhen (OR=2.86; 95% CI=1.56, 5.25) was associated with treatment delay. Promotion of appropriate health-seeking behaviours and better management of STDs must be a top priority to slow a rapid spread of STD/HIV in China. Health education, improvement of STD care in the public and private sectors, and regulations of unauthorized private physicians, may help with STD control and HIV prevention.
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Affiliation(s)
- K H Choi
- University of California-San Francisco, Center for AIDS Prevention Studies, 94105, USA
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Bloom G, Shenglan T. Rural health prepayment schemes in China: towards a more active role for government. Soc Sci Med 1999; 48:951-60. [PMID: 10192561 DOI: 10.1016/s0277-9536(98)00395-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A large majority of China's rural population were members of health prepayment schemes in the 1970's. Most of these schemes collapsed during the transition to a market economy. Some localities subsequently reestablished schemes. In early 1997 a new government policy identified health prepayment as a major potential source of rural health finance. This paper draws on the experience of existing schemes to explore how government can support implementation of this policy. The decision to support the establishment of health prepayment schemes is part of the government's effort to establish new sources of finance for social services. It believes that individuals are more likely to accept voluntary contributions to a prepayment scheme than tax increases. The voluntary nature of the contributions limits the possibilities for risk-sharing and redistribution between rich and poor. This underlines the need for the government to fund a substantial share of health expenditure out of general revenues, particularly in poor localities. The paper notes that many successful prepayment schemes depend on close supervision by local political leaders. It argues that the national programme will have to translate these measures into a regulatory system which defines the responsibilities of scheme management bodies and local governments. A number of prepayment schemes have collapsed because members did not feel they got value for money. Local health bureaux will have to cooperate with prepayment schemes to ensure that health facilities provide good quality services at a reasonable cost. Users' representatives can also monitor performance. The paper concludes that government needs to clarify the relationship between health prepayment schemes and other actors in rural localities in order to increase the chance that schemes will become a major source rural health finance.
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Affiliation(s)
- G Bloom
- Institute of Development Studies, University of Sussex, Brighton, UK.
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Abstract
China and Vietnam developed low cost rural health services between the 1950s and the mid-1970s. These services contributed to substantial improvements in health. Both countries have been liberalising their economies for a number of years. Partly as a result of these changes health facilities have become increasingly dependent on user charges, and they have gained considerable independence from political or bureaucratic control. There has also been a growth in private provision. This has given people a wider choice of health services, but costs have risen and there are greater differences in access to medical care. The Chinese and Vietnamese governments face fundamental questions about the future development of the health sector.
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Affiliation(s)
- G Bloom
- Institute of Development Studies, University of Sussex, Brighton, UK.
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González Block MA. Comparative research and analysis methods for shared learning from health system reforms. Health Policy 1997; 42:187-209. [PMID: 10176300 DOI: 10.1016/s0168-8510(97)00072-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The pace and breadth of health reforms point to the need for a comparative methodology to support shared learning from country experiences. A common understanding of health reforms is a first prerequisite for comparative research. Dimensions characterising content, sequence, process, purpose and scope of policy change are identified on the basis of a literature review. Reforms can have a gradual build up, starting with piecemeal policy changes that can be eventually integrated to enhance their benefits. Comprehensive reforms can be defined as policy formulation and implementation that comprises the systemic, programmatic, organisational and instrumental policy levels through explicit strategies sustained in well-documented experiences and theories and implemented with the support of a specialised agency with consensus-building capacity. A minimum-data set is proposed on the basis of an extensive literature review to support the comparability of health reform case studies and descriptions. Its components are: the current health system, its background and context, the reform rationale, the specific proposals, political actors and processes, achievements and limitations, and lastly the reform's wider impact. Case studies can be compared historically, through particularistic comparisons, using ideal types and by means of exemplars. The advantages and limitation of each method are analysed as well as how they can be combined to frame the research questions and minimise resources. Finally, the International Clearinghouse for Health System Reform Initiatives is described as an instrument to disseminate comparative research and analysis in support of shared learning.
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Abstract
As a result of China's transition to a socialist market economy, its rural health services have undergone many of the changes commonly associated with health sector reform. These have included a decreased reliance on state funding, decentralisation of public health services, increased autonomy of health facilities, increased freedom of movement of health workers, and decreased political control. These changes have been associated with growing inequality in access to health services, increases in the cost of medical care, and the deterioration of preventive programmes in some poor areas. This paper argues that the government's strategy for addressing these problems has overemphasised the identification of new sources of revenue and has paid inadequate attention to factors that influence provider behaviour. The strategy also does not address contextual issues such as public sector employment practices and systems of local government finance. Other countries can learn from China's experience by taking a systematic approach to the formulation and implementation of strategies for health sector reform.
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Affiliation(s)
- G Bloom
- Institute of Development Studies, University of Sussex, Brighton, England, UK
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Liu X, Xu L, Wang S. Reforming China's 50,000 township hospitals--effectiveness, challenges and opportunities. Health Policy 1996; 38:13-29. [PMID: 10160161 DOI: 10.1016/0168-8510(96)00834-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The 50,000 publicly-owned Rural Township Hospitals (RTHs) in China play an important role in providing both curative and preventive services to China's 800 million rural population. Since the market oriented rural economic reform initiated in the early 1980s, the RTHs' position has been threatened by low efficiency and financial crisis. More than half of the RTH resources have been wasted and about one-third of the RTHs have run into deficit. Reforms have been undertaken, but the problems are still challenging. Several policy options are now being discussed including revolutionary strengthening of the RTHs to attract patients, leaving the RTHs as they are but guaranteeing the funds for prevention services, and strengthening the RTHs having relatively high efficiency. However the discussions have not been translated into national policies. The statistics for 1995 show that the RTHs are taking a turn for the better after a decade of continuous decline in both the number of visits and bed occupancy rates. These changes can be explained by the widespread government concerns with the development of RTHs, the incremental capacity-strengthening of RTHs, and government's efforts to construct a workable Cooperative Medical System (CMS). The authors recommend that the government should play a major and active role in regulating and financing the RTHs and CMS. Demand deflection through promoting CMS and repricing the RTH medical services at relatively low level is important, and government support to strengthen the RTHs is essential for maintaining the deflected demand. Neither of the two conditions can be ignored. Interventions should be made on both supply and demand side.
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Affiliation(s)
- X Liu
- Shandong Medical University, Faculty of Public Health, People's Republic of China
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Abstract
In the late 1970s China launched its agricultural reforms which initiated a decade of continued economic growth and significant transformation of the Chinese society. The agricultural reforms altered the peasants' incentives, weakened community organization and lessened the central government's control over local communities. These changes largely caused the collapse of the widely acclaimed rural cooperative medical system in China. Consequently China experienced a decreased supply of rural health workers, increased burden of illnesses, disintegration of the three tier medical system, reduced primary health care, and an increased demand for hospital medical services. More than ten years have elapsed since China changed its agricultural economic system and China is still struggling to find an equitable, efficient and sustainable way of financing and organizing its rural health services. The Chinese experiences provided several important lessons for other nations: there is a need to understand the limits of the market forces and to redefine the role of the government in rural health care under a market economy; community participation in and control of local health financing schemes is essential in developing a sustainable rural health system; the rural health system needs to be dynamic, rather than static, to keep pace with changing demand and needs of the population.
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Affiliation(s)
- Y Liu
- Harvard University School of Public Health, Program in Health Care Financing, Cambridge, MA 02138, USA
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