The impact of healthcare reform on the dynamic changes in health service utilization and equity: a 10-year follow-up study

A study on the factors influencing the vulnerability of women of childbearing age to health poverty in rural western China

The health of women of childbearing age in rural areas is crucial for the development of individuals, families, and society. Research on the identification and influencing factors of health vulnerability in impoverished and disadvantaged groups is important for adjusting and implementing health poverty alleviation policies. However, there is limited research on the health vulnerability of women of childbearing age in rural Western China. Based on panel data from the Rural Residents' Family Health Status Survey in 2019 and 2022, the vulnerability to health poverty of women of childbearing age in rural areas was constructed using the three-stage feasible generalized least squares method. Variables from four dimensions-physical capital, financial capital, social capital, and human capital-were included in the sustainable livelihood analysis framework for analysis. The Tobit model was used to analyze the influencing factors of vulnerability to health poverty among women of childbearing age in rural Western China, and the contribution rates of various factors were studied using the Shapley value decomposition method. In 2019 and 2022, under the poverty line standards of $1.90 and $2.15, respectively, the vulnerability to health poverty among rural women of childbearing age exceeded 20%. Tobit regression analysis revealed that the type of drinking water being well water significantly increased the vulnerability to health poverty of rural women of childbearing age (P < 0.05), whereas the separation of housing and kitchen, registered poor households, household loans, annual per capita household income, expenditures on social interactions, educational level, self-assessed health status, respondent age, and the utilization of hospital services significantly reduced the vulnerability to health poverty of rural women of childbearing age (P < 0.05). Shapley's decomposition shows that annual per capita household income, expenditures on social interactions, respondent age, and household loans are the factors contributing most to the vulnerability to health poverty of rural women of childbearing age, while other variables have a smaller contribution rate. The health poverty situation of women of childbearing age in rural Western China is not optimistic. Preintervention for health poverty should be strengthened among rural women of childbearing age, early warning mechanisms for the risk of falling back into poverty due to illness should be established, the precise identification of highly vulnerable rural women of childbearing age should be improved, and the medical insurance system for rural women of childbearing age should be enhanced to help improve their current health poverty situation.

Regional differences in health resource allocation: a longitudinal study in the Chengdu-Chongqing economic circle, China

OBJECTIVE

To analyse regional differences in health resource allocation in the Chengdu-Chongqing economic circle.

DESIGN

A longitudinal analysis that collected data on health resource allocation from 2017 to 2021.

SETTING

The number of beds, health technicians, licensed (assistant) physicians, registered nurses and financial allocations per 1000 population in the 42 regions of Chengdu-Chongqing economic circle were used for the analysis.

METHODS

The entropy weight technique for order preference by similarity to an ideal solution (TOPSIS) method and the rank sum ratio (RSR) method were used to evaluate the health resource allocation.

RESULTS

The number of licensed (assistant) physicians per 1000 population in the Chengdu-Chongqing economic circle (3.01) was lower than the average in China (3.04) in 2021. According to the entropy weight-TOPSIS method, Yuzhong in Chongqing had the largest C-value and the highest ranking. Jiangbei in Chongqing and Chengdu and Ya'an in Sichuan Province had higher C-values and were ranked in the top 10. Jiangjin, Hechuan, Tongnan and Zhongxian in Chongqing and Guang'an in Sichuan Province had lower C-values and were all ranked after the 30th place. According to the RSR method, the 42 regions were divided into three grades of good, medium and poor. The health resource allocations of Yuzhong, Jiangbei, Nanchuan, Jiulongpo and Shapingba in Chongqing and Chengdu and Ya'an in Sichuan Province were of good grade, those of Tongnan, Jiangjin, Yubei and Dazu in Chongqing and Guang'an and Dazhou in Sichuan Province were of poor grade, and the rest of the regions were of medium grade.

CONCLUSION

The regional differences in health resource allocation in the Chengdu-Chongqing economic circle were more obvious, the health resource allocation in Chongqing was more polarised and the health resource allocation in Sichuan Province was more balanced, but the advantaged regions were not prominent enough.

Association Between Perceived Access to Healthcare and the Perception of Illness Among Peruvian Adults with Chronic Diseases During COVID-19 Pandemic

The COVID-19 pandemic has greatly affected the provision of care for patients with chronic diseases. Due to social restrictions and reductions in contact with health services, the negative perception of chronic disease is expected to have increased. The aim of this study was to determine the association between perceived access to healthcare and the perception of illness among Peruvian population with chronic disease. It was a cross-sectional analytical study, with a sample of 987 inhabitants to whom the questionnaires “Coverage of health services” and “The Brief Illness Perception Questionnaire” (BIPQ) were applied. Having health insurance (PRa = 0.683; 95% CI = 0.613-0.761) acts as a protective factor for a positive illness perception of chronic disease, however, a waiting time greater than 3 months to obtain a medical appointment (PRa = 1.417; 95% CI = 1.319-1.522) and poor access to health services (PRa = 1.435; 95% CI = 1.226-1.681) resulted in the probability of a negative illness perception of chronic disease. Thus, there is an association between perceived poor access to healthcare and the negative illness perception of chronic disease in Peruvian population during pandemic COVID-19.