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Zhuoga C, Cuomu Z, Li S, Dou L, Li C, Dawa Z. Income-related equity in inpatient care utilization and unmet needs between 2013 and 2018 in Tibet, China. Int J Equity Health 2023; 22:85. [PMID: 37165400 PMCID: PMC10173530 DOI: 10.1186/s12939-023-01889-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/08/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Providing equitable access to health care for all populations is an important sustainable development goal. China has made significant progress in achieving equity in healthcare utilization. However, research on equity in healthcare utilization in Tibet is sparse. This study aims to evaluate changes in income-related inequity in inpatient care utilization and unmet needs between 2013 and 2018 among the Tibetan population and identify the inequity source. METHODS Data for this cross-sectional study were obtained from the fifth and sixth waves of the National Health Services Survey in 2013 and 2018. After excluding observations with missing values for key variables, 11,092 and 10,397 respondents were included in this study, respectively. The outcome variables of interest were inpatient service utilization and unmet hospitalization needs. The concentration index and horizontal inequity index (HI) were used to assess income-related inequity. Non-linear decompositions were performed to identify the main contributors to inequity. In the decomposition method, need variables included sex, age, chronic diseases, and the EuroQol-Visual Analog Scale; non-need variables consisted of income, education, employment status, marital status, and health insurance schemes. RESULTS The probability of inpatient care utilization increased from 6.40% in 2013 to 8.50% in 2018. The HI for inpatient care utilization was 0.19 (P < 0.001) in 2013, whereas it decreased to 0.07 (P < 0.001) in 2018. The contribution of income to inequity in inpatient care utilization decreased from 87.09% in 2013 to 59.79% in 2018. As for unmet inpatient care needs, although its probability increased from 0.76 to 1.48%, the percentage of reasons for financial hardship decreased from 47.62 to 28.57%. The HI for unmet hospitalization need was - 0.07 in 2013 and - 0.05 in 2018, and neither was statistically significant. The New Rural Cooperative Medical Scheme made majority contributions to promote equity in unmet hospitalization need. Moreover, the female respondents reporting low EuroQol-Visual Analog Scale scores and patients with chronic disease were not only more likely to seek for inpatient care, but also have more unmet need than the reference groups. CONCLUSIONS The inequity in inpatient care utilization in Tibet narrowed from 2013 to 2018, and there was no inequity in unmet hospitalization needs in 2013 and 2018. Income and the New Rural Cooperative Medical Scheme are the main drivers of equity promotion. To promote access to inpatient care utilization and decrease the probability of unmet hospitalization need in future, policymakers should target high-need residents in Tibet to improve accessibility, availability, and acceptability.
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Affiliation(s)
- Cidan Zhuoga
- Medical College of Tibet University, Lhasa, 850000, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China
| | - Zhaxi Cuomu
- Medical College of Tibet University, Lhasa, 850000, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Chaofan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, Jinan, 250012, China.
| | - Zhaxi Dawa
- Medical College of Tibet University, Lhasa, 850000, China.
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China.
- High Altitude Health Science Research Center, Tibet University, Lhasa, 850000, China.
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Sulku SN, Tokatlioglu Y, Cosar K. Receiving or not deemed necessary healthcare services. BMC Public Health 2023; 23:208. [PMID: 36721134 PMCID: PMC9887775 DOI: 10.1186/s12889-023-15135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Avoiding deemed necessary healthcare needs may worsen prognosis and treatment options, and damage people's ability to perform their roles in society. Our study investigates why people avoid healthcare services in an upper-middle-income country, Türkiye. METHODS We apply TurkStat's 2012 Health Survey Data that includes a comprehensive health and social-demographic information of 28,055 survey participants who were 15 + aged. We use bivariate probit model to analyze the avoidance behavior in inpatient level in accordance with outpatient level because of the observed significant correlation between people's avoidance behavior under tertiary and lower level health care. RESULTS The findings show that 2.6% of 15 + aged population avoided deemed necessary hospital services. Furthermore, we found that high cost (31%), organizational factors (21%) and fear (12%) are prominent reasons of avoiding tertiary care. Thereafter, in our bivariate probit model findings, we figure out that being covered by social security schemes decreases the probability of avoiding both outpatient and inpatient health services by 6.9%. Moreover, being female, living in rural area, having lower income increase the chance of being avoider in both stages of healthcare. CONCLUSION We conclude that social inequalities are the main underlying determinants of the avoiding behavior.
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Affiliation(s)
- Seher Nur Sulku
- grid.509259.20000 0004 7221 6011Department of Econometrics, Ankara Haci Bayram Veli University, Muammer Bostanci Caddesi No: 4, 06500 Ankara, Türkiye Turkey
| | - Yagmur Tokatlioglu
- Department of Econometrics, Ankara Haci Bayram Veli University, Muammer Bostanci Caddesi No: 4, 06500, Ankara, Türkiye, Turkey.
| | - Kubra Cosar
- grid.509259.20000 0004 7221 6011Department of Econometrics, Ankara Haci Bayram Veli University, Muammer Bostanci Caddesi No: 4, 06500 Ankara, Türkiye Turkey
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Wang J, Xu J, Nie Y, Pan P, Zhang X, Li Y, Liu H, Liang L, Gao L, Wu Q, Hao Y, Shah S. Effects of Social Participation and Its Diversity, Frequency, and Type on Depression in Middle-Aged and Older Persons: Evidence From China. Front Psychiatry 2022; 13:825460. [PMID: 35546944 PMCID: PMC9085245 DOI: 10.3389/fpsyt.2022.825460] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Depression is one of the greatest public health problems worldwide. The potential benefit of social participation (SP) on mental health has been widely acknowledged. Nevertheless, a few studies have used propensity score matching (PSM) to reduce the influence of data bias and confounding variables. This study explored the effect of social participation on depression among middle-aged and older Chinese persons through a PSM method, considering the frequency, type, and quantity of SP. Effects were compared among different age groups, genders, and places of residence. Methods The datasets were obtained from the 2018 wave of the China Health and Retirement Longitudinal Study. A total of 9,404 respondents aged 45 and above were included in the study. PSM and ordinary least squares methods were used to estimate the effect of social participation on depression. Results PSM estimation results showed that SP had a significantly positive effect on decreasing depression scores (p < 0.001) by 0.875-0.898 compared with persons without SP. All types of SP had a significantly positive effect (p < 0.001), and participating in community activities had the largest effect (β = -1.549 to -1.788, p < 0.001). Higher frequency of participation and more types of SP promoted lower depression scores; subgroup analyses revealed that the promotion effect was significantly greater among women, those aged ≥75 years, and those living in urban areas. Conclusion PSM indicated that SP could alleviate the depression of middle-aged and older Chinese persons. Targeted measures should be adopted to promote SP and thereby improve mental health and promote healthy and active aging.
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Affiliation(s)
- Jiahui Wang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Jiao Xu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Yizhen Nie
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
- Physical Examination Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pochuan Pan
- Department of Government Policy and Public Management, Graduate School of Chinese Academy of Social Sciences, Beijing, China
| | - Xin Zhang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Ye Li
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Huan Liu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Libo Liang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Yanhua Hao
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Saleh Shah
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
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Zhou S, Huang T, Li A, Wang Z. Does universal health insurance coverage reduce unmet healthcare needs in China? Evidence from the National Health Service Survey. Int J Equity Health 2021; 20:43. [PMID: 33478484 PMCID: PMC7819183 DOI: 10.1186/s12939-021-01385-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND China has nearly achieved universal health insurance coverage, but considerable unmet healthcare needs still exist. Although this topic has attracted great attention, there have been few studies examining the relationship between universal health insurance coverage and unmet healthcare needs. This study aimed to clarify the impact of universal health insurance coverage and other associated factors on Chinese residents' unmet healthcare needs. METHODS Data was derived from the fourth, fifth, and sixth National Health Service Survey of Jiangsu Province, which were conducted in 2008, 2013, and 2018, respectively. Descriptive statistics were used to analyze the prevalence of unmet healthcare needs. Binary multivariate logistic regression was used to estimate the association between unmet healthcare needs and universal health insurance coverage, along with other socioeconomic factors. RESULTS 8.99%, 1.37%, 53.37%, and 13.16% of the respondents in Jiangsu Province reported non-use of outpatient services, inpatient services, physical examinations, and early discharge from hospital, respectively. The trend in the prevalence of unmet healthcare needs showed a decline from 2008 to 2018. Health insurance had a significant reducing effect on non-use of outpatient services, inpatient services, or early discharge from hospital. People having health insurance in 2013 and 2018 were significantly less likely to report unmet healthcare needs compared to those in 2008. The effect of health insurance and its universal coverage on reducing unmet healthcare needs was greater in rural than in urban areas. Other socioeconomic factors, such as age, marital status, educational level, income level, or health status, also significantly affected unmet healthcare needs. CONCLUSIONS Universal health insurance coverage has significantly reduced Chinese residents' unmet healthcare needs. Policy efforts should pay more attention to the benefits of health insurances in rural areas and optimize urban-rural health resources to promote effective utilization of healthcare.
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Affiliation(s)
- Shenping Zhou
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
| | - Tianyu Huang
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
| | - Anqi Li
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166 P.R. China
- Creative Health Policy Research Group, Nanjing Medical University, Nanjing, 211166 China
- Center for Global Health, Nanjing Medical University, Nanjing, 211166 China
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Telfar Barnard LF. Time for time off? Secondary public holiday shows minimal net hospitalisation benefit. J Epidemiol Community Health 2020; 75:jech-2020-215327. [PMID: 33243758 DOI: 10.1136/jech-2020-215327] [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: 08/11/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND We aimed to use New Zealand's Anzac Day to test the public health effect of secondary public holidays; and to use weekly hospitalisation counts to identify which dates were more health suitable for a potential new public holiday. METHODS We conducted a retrospective population cohort study of hospital admissions in New Zealand between 23 April and 27 May 1988-2018. We compared acute and arranged hospitalisation and mortality rates in holiday (Anzac Day Monday to Friday) and non-holiday (Anzac Day Saturday or Sunday) years, for mid-week holidays and long weekends; and measured total weekly average acute and arranged hospitalisation counts. RESULTS Hospitalisation rates were lower in holiday years than non-holiday years (rate ratio (RR) 0.96, 95% CI 0.95 to 0.96, p<0.001), with fewer arranged admissions (RR 0.93, 95% CI 0.93 to 0.94, p<0.001), but no significant difference for acute admissions (RR 1.00, 95% CI 0.99 to 1.00, p=0.087). Holiday year acute admission rates were lower than non-holiday years for children aged 0-4 years, but higher for adults aged 15-44 years. Holidays reduced arranged admissions most in children and areas of higher socioeconomic deprivation. There was no significant difference for mortality. Average weekly acute hospitalisations were higher than arranged admissions between 10 June and 7 October. CONCLUSION Secondary holidays do not reduce deaths; or acute hospital admissions except in the holiday week; and may delay elective treatment. However, if New Zealand is to add a new public holiday, it would have least detrimental health effect scheduled between 10 June and 7 October.
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Lee SE, Yeon M, Kim CW, Yoon TH, Kim D, Choi J. Neighborhood Deprivation and Unmet Health Care Needs: A Multilevel Analysis of Older Individuals in South Korea. Osong Public Health Res Perspect 2019; 10:295-306. [PMID: 31673491 PMCID: PMC6816357 DOI: 10.24171/j.phrp.2019.10.5.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives In this study the relationship between neighborhood deprivation and the unmet health care needs of elderly individuals (≥ 65 years) was examined. Some previous studies suggested that neighborhood characteristics affect access to health care, yet research on the unmet needs of older individuals is limited. Methods Multilevel logistic regression analysis was used to assess the relationship of neighborhood-level factors with unmet health care needs due to costs, adjusting for individual-level factors, in individuals ≥ 65 years in the 2017 Korean Community Health Survey (n = 63,388). Results There were 2.6% of elderly individuals who experienced unmet health care needs due to costs. Following adjustment for individual and neighborhood characteristics, the neighborhood deprivation in urban areas was found to have an inverse association with unmet needs (odds ratio = 0.50; 95% confidence interval = 0.24-1.06) for the most deprived quartile versus the least deprived quartile). However, in rural areas neighborhood deprivation was not a significant variable. Among the individual-level variables, household income was one of the strongest correlates with unmet needs in both urban and rural areas. Conclusion The present findings suggest that targeted policy interventions reflecting both neighborhood and individual characteristics, should be implemented to reduce the unmet health care needs of elderly individuals.
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Affiliation(s)
- Seung Eun Lee
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Miyeon Yeon
- Department of Statistics, Florida State University, Tallahassee, Florida, United States
| | - Chul-Woung Kim
- Department of Preventive Medicine and Public Health, College of Medicine, Chungnam National University, Research Institute for Medical Sciences, Daejeon, Korea
| | - Tae-Ho Yoon
- Department of Preventive Medicine, School of Medicine, Busan National University, Busan, Korea
| | - Dongjin Kim
- Center for Health Policy Research, Korea Institute for Health and Social Affairs, Sejong, Korea
| | - Jihee Choi
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Korea
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Zhang T, Liu J, Liu C. Changes in Perceived Accessibility to Healthcare from the Elderly between 2005 and 2014 in China: An Oaxaca-Blinder Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3824. [PMID: 31658753 PMCID: PMC6843178 DOI: 10.3390/ijerph16203824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 11/22/2022]
Abstract
Elderly people are characterized with high needs for healthcare, accompanied by high barriers in access to healthcare. This study aimed to identify temporal changes in access to healthcare and determinants of such changes from the elderly in China, over the period between 2005 and 2014. Two waves (2005 and 2014) of data were extracted from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), measuring changes in perceived accessibility to healthcare when needed by the elderly (≥65 years). The effects of the explanatory variables (need, predisposing and enabling factors) on the changes were divided into two components using the Oaxaca-Blinder decomposition method: (1) the endowment portion as a result of distribution differences of the explanatory variables and (2) the coefficient portion as a result of differential responses of the dependent variable to the explanatory variables. Perceived accessibility to healthcare from the elderly increased from 89.6% in 2005 to 96.7% in 2014. The coefficient portion (82%) contributed more to the change than the endowment portion (63%) after adjustments for a negative interaction effect (-45%) between the two. Lower perceived accessibility was associated with older age, lower income, lower affordability of daily expenses and lower insurance coverage. But the coefficient effects suggested that their impacts on perceived accessibility to healthcare declined over time. By contrast, the impacts of gender and out-of-pocket payment ratio for medical care on perceived accessibility to healthcare increased over time. Perceived accessibility to healthcare from the elderly improved between 2005 and 2014. Gender gaps are closing. But the increased effect of out-of-pocket medical payments on perceived accessibility to healthcare deserves further investigation and policy interventions.
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Affiliation(s)
- Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 43003, China.
| | - Jing Liu
- Department of Health Information Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 43003, China.
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia.
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Allocation of Eldercare Responsibilities between Children and the Government in China: Does the Sense of Injustice Matter? POPULATION RESEARCH AND POLICY REVIEW 2019; 38:1-25. [PMID: 32661448 DOI: 10.1007/s11113-018-9501-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
China's large aging population poses grim challenges to eldercare provision. Against the background of withering traditional kinship-based eldercare and the increasing significance of government-sponsored support programs, this study draws on data from the 2013 Chinese General Social Survey to investigate not only the correlation between the sense of social injustice and the preference to allocate eldercare responsibilities between public and private agents but also how this correlation varies between urban-versus-rural regions. We find that perceived social injustice is significantly correlated with the odds of designating the government, instead of family members, to shoulder eldercare responsibilities. Further mediation analysis suggests that this correlation is mediated through concerns about eldercare. On average, the link between perceived social injustice and the preference for eldercare duty allocation is weaker in rural China than in urban China. Theoretical and policy implications are discussed.
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Li X, Cai H, Wang C, Guo C, He Z, Ke Y. Economic burden of gastrointestinal cancer under the protection of the New Rural Cooperative Medical Scheme in a region of rural China with high incidence of oesophageal cancer: cross-sectional survey. Trop Med Int Health 2016; 21:907-16. [PMID: 27125226 DOI: 10.1111/tmi.12715] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Xiang Li
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
| | - Hong Cai
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
| | | | - Chuanhai Guo
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
| | - Yang Ke
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
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Dai B. Does China's new cooperative medical scheme promote rural elders' access to healthcare services in relation to chronic conditions? Int Health 2014; 7:32-41. [PMID: 25091022 DOI: 10.1093/inthealth/ihu050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study examined use of healthcare services by elderly people with a long-term condition living in rural China and participating in that country's New Cooperative Medical Scheme (NCMS). METHODS Data were taken from the 2009 China Health and Nutrition Survey. RESULTS The study results showed that education level and annual income were low among rural elders (aged ≥65 years); the illiteracy rate was 58.0% (200/345) and 67.6% (92/136) had an annual income of less than 5000 Chinese yuan renminbi. The elders had low rates of treatment and use of preventive healthcare services while the prevalence of chronic disease was highest among them when compared to other age groups. Among the few elders who received preventive healthcare, most received it at village clinics. CONCLUSIONS Preventive healthcare services and chronic disease management are urgently needed by rural elders in China. NCMS should initiate payments to township health centers to enable them to undertake community outreach and education campaigns among rural residents, and train village doctors in standard chronic condition management and prevention, with prioritization of the provision of prevention and management of chronic conditions by village clinics.
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Affiliation(s)
- Baozhen Dai
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China
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Li M, Zhang Y, Zhang Z, Zhang Y, Zhou L, Chen K. Rural-urban differences in the long-term care of the disabled elderly in China. PLoS One 2013; 8:e79955. [PMID: 24224025 PMCID: PMC3818274 DOI: 10.1371/journal.pone.0079955] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/27/2013] [Indexed: 11/24/2022] Open
Abstract
Background In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors. Methods This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates. Results Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively), but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products. Conclusions The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.
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Affiliation(s)
- Mei Li
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Yang Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Zhenyu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Ying Zhang
- Clinical Evaluation Analysis Center, Traditional Chinese Medicine Hospital of Zhejiang, Hangzhou, China
| | | | - Kun Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou, China
- * E-mail:
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Osorio RG, Servo LMS, Piola SF. [Unmet health care needs in Brazil: an investigation about the reasons for not seeking health care]. CIENCIA & SAUDE COLETIVA 2012; 16:3741-54. [PMID: 21987318 DOI: 10.1590/s1413-81232011001000011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 07/06/2011] [Indexed: 11/22/2022] Open
Abstract
Herein, unmet health care needs, defined by the authors as the situation when an individual feels the need but does not seek healthcare, are studied from the data of the health questionnaires of the 1998, 2003 and 2008 rounds of the National Household Sampling Survey (Pnad). From 1998 to 2008, the percentage of the population with healthcare needs during the two weeks prior to the interview did not change, remaining at around 17%, whilst the share with unmet healthcare needs fell from 3.5% to 2.9%. There were also changes in the reasons chosen by the interviewees to justify why they did not seek healthcare. The percentage of those who said they could not afford it decreased though it is still the reason given most frequently thereby boosting the percentages of those alleging problems with the healthcare system, such as long waiting times and a lack of professionals and services. People with less income or schooling, residing in the poorer regions of the country or in rural areas, blacks, males, adults, workers, people living with other people with unmet healthcare needs or that have not been to an appointment with a doctor in the last year, and those without health plans, are less likely to seek healthcare and therefore stand a higher chance of having unmet healthcare needs.
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Affiliation(s)
- Rafael Guerreiro Osorio
- Diretoria de Estudos e Políticas Sociais, Instituto de Pesquisa Econômica Aplicada, Brasília, DF, 70076-900, Brazil.
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Dai B, Zhou J, Mei YJ, Wu B, Mao Z. Can the New Cooperative Medical Scheme promote rural elders' access to health-care services? Geriatr Gerontol Int 2011; 11:239-45. [PMID: 21545383 DOI: 10.1111/j.1447-0594.2011.00702.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to examine the impact of the New Cooperative Medical Scheme (NCMS) on rural elders' access to health-care services. Articles were identified from PubMed, Elsevier, Wiley, EBSCO, EMBASE, SCI Expanded, ProQuest, Google, and CNKI which is the most informative database in Chinese, with the search terms "rural", "China", "old", "older", or "elder", "elderly", or "aged", "aging", "medical insurance", or "community-based medical insurance", or "cooperative medical scheme". Related websites and yearbooks were searched as well. The NCMS has improved the health-care utilization of rural elders, and they have the highest satisfaction with it among all age groups. However, affordability difficulty remained the common barrier for the rural elderly to access quality health care, in spite of the special considerations given to the rural elderly, such as premium remission and free check-ups. Faced with ever-growing health challenges, some impoverished rural elders with poor physical health and functional limitations may lack sufficient access to basic health-care services. Followed by the provider payment reform initiated by the NCMS, a stricter regulation for doctors' prescriptions, clinical practice and disease management is needed to promote rural elders' access to health-care services. Health management for rural elders can be expected for the NCMS to promote rural elders' health-care access once a better coordination between the NCMS and health-care system can be achieved.
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Affiliation(s)
- Baozhen Dai
- Department of Social Medicine, School of Public Health Economics and Management School, Wuhan University, Wuhan, China
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Shi W, Chongsuvivatwong V, Geater A, Zhang J, Zhang H, Brombal D. The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China. Int J Equity Health 2010; 9:7. [PMID: 20178565 PMCID: PMC2838900 DOI: 10.1186/1475-9276-9-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 02/23/2010] [Indexed: 11/10/2022] Open
Abstract
Background The New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes. Methods A cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview. Results NRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2%) owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of household's capacity to pay) and medical impoverishment (household per capita income falling below the poverty line due to medical expense) was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness) were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved from impoverishment. Conclusion The coverage of NRCMS among the rural population was high but not adequate to improve access to in-patient care and protect against financial catastrophe and household impoverishment due to health payment, especially for the poor and the chronically ill. Furthermore, MFA played almost no such role; therefore, the current schemes need to be improved.
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Affiliation(s)
- Wuxiang Shi
- Health Human Resources Development Center, Ministry of Health, Beijing 100097, China.
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