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Xing XY, Wu ZZ, Wang HD, Xu W, Cao D, Liu ZR, Wu GC. The awareness rate of knowledge of chronic diseases and influencing factors among 4790 adults in anhui province: An online survey using WeChat. Heliyon 2024; 10:e28366. [PMID: 38590849 PMCID: PMC10999857 DOI: 10.1016/j.heliyon.2024.e28366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
Objective To investigate public awareness about core information regarding chronic diseases and identify factors influencing that awareness among Anhui Province residents, provide a scientific basis for policy-making, and formulate corresponding intervention measures. Methods From March to April 2021, 12 provincial-level representative counties and districts of Anhui province in the China Adult Chronic Disease and Nutrition Surveillance were selected as survey sites, and 4790 residents were recruited for the survey using stratified multi-stage cluster random sampling. Basic details about the study participants were collected and their awareness of core information about major chronic diseases was measured through an online survey using WeChat. Results In 2021, the awareness rate of core information about chronic diseases among residents of Anhui Province was 54.93%. Multivariate logistic regression analysis showed that a higher awareness rate was associated with the following factors: non-housework occupations (agriculture, forestry, animal husbandry, and fishery: OR = 1.309, commercial services and production and transportation: OR = 1.450, institutions, and professional and technical personnel: OR = 1.461), a high education level (high school/junior high school/technical school OR = 1.357, college and above OR = 2.133), and residence in the southern and northern Anhui areas (southern Anhui OR = 1.282, northern Anhui OR = 1.431); whereas in rural areas (by district and country) (OR = 0.863), the awareness rate was low (all P < 0.05). Conclusions The awareness rate of core information about chronic diseases among residents of Anhui, China, is low. It is necessary to strengthen awareness about chronic disease prevention and management by targeting specific groups of people in this region.
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Affiliation(s)
- Xiu-Ya Xing
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Zhen-Zhen Wu
- Department of Otorhinolaryngology and Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Hua-Dong Wang
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Wei Xu
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Dan Cao
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Zhi-Rong Liu
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Hefei, 230032, Anhui, China
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Xu J, Yu M, Zhang Z, Gong S, Li B. Is sub-national healthcare social protection sufficient for protecting rare disease patients? the case of China. Front Public Health 2023; 11:1198368. [PMID: 37397721 PMCID: PMC10311551 DOI: 10.3389/fpubh.2023.1198368] [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: 04/01/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Background Failing to provide social support to cover healthcare costs for rare diseases would lead to great financial distress for the patients and their families. People from countries without a well-developed health safety-net are particularly vulnerable. Existing literature on rare diseases in China focuses on the unmet needs for care of the patients and the difficulties of caregivers and physicians. Very few studies examine the state of social safety-net, the unresolved issues and whether the current localized arrangements are sufficient. This study aimed to gain in-depth knowledge of the current policy system and make sense of the local varieties, which would be essential for developing strategies for future policy changes. Methods This systematic policy review focuses on the provincial level policies on subsidizing the healthcare costs for people with rare diseases in China. The cut-off point for the policies was March 19, 2022. The researchers coded the healthcare cost reimbursement policies and identified the different provincial level models based on the usage of reimbursement components in each provinces reimbursement arrangements. Results 257 documents were collected. Five provincial level models (Process I, II, III, IV and V) have been identified with the five components across the country: Basic Medical Insurance for Outpatient Special Diseases (OSD), Catastrophic Medical Insurance for Rare Diseases (CMIRD), Medical Assistance for Rare Diseases (MARD), Special Fund for Rare Diseases (SFRD) and Mutual Medical Fund (MMF). The local health safety-net in each region is a combination of one or more of the five processes. Regions vary greatly in their rare diseases coverage and reimbursement policies. Conclusion In China, the provincial health authorities have developed some level of social protection for rare disease patients. However, there are still gaps regarding coverage and regional inequality; and there is room for a more integrated healthcare safety-net for people suffering from rare diseases at the national level.
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Affiliation(s)
- Juan Xu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Research Center for Health Technology Assessment, Wuhan, China
| | - Mingren Yu
- Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiguo Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Research Center for Health Technology Assessment, Wuhan, China
| | - Shiwei Gong
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Bingqin Li
- Social Policy Research Centre, University of New South Wales, Sydney, NSW, Australia; China Studies Centre, Sydney University, Sydney, NSW, Australia
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Wang P, Cheng L, Li Y, Zhang Y, Huang W, Li S, Wang Z, Shan L, Jiao M, Wu Q. Factors and key problems influencing insured's poor perceptions of convenience of basic medical insurance: a mixed methods research of a northern city in China. BMC Public Health 2023; 23:1066. [PMID: 37277834 DOI: 10.1186/s12889-023-15993-1] [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: 01/07/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND This study aimed to explore the factors that affect insured's perceptions of convenience of the basic medical insurance (PCBMI) in Harbin, China and to diagnose the key problems to further propose corresponding measures. The findings provide evidence-based support for the reform of convenience of the basic medical insurance system (BMIS) and the cultivation of public literacy. METHODS We adopted a mixed methods design composing a multivariate regression model using the data from a cross-sectional questionnaire survey (n = 1045) of residents who were enrolled for BMIS in Harbin to identify the factors influencing the PCBMI. A quota sampling method was further adopted. Semi-structured interviews were then conducted with 30 important information providers selected by convenience sampling. Interpretative phenomenological analysis was employed to summarize and analyze the key problems. RESULTS Overall, approximately 51% of respondents reported poor PCBMI. The logistic regression model showed that insured without outpatient experience within two weeks (OR = 2.522, 95% CI = 1.267-5.024), had poorer levels of understanding of basic medical insurance information (OR = 2.336, 95% CI = 1.612-3.386), lived in rural areas (OR = 1.819, 95% CI = 1.036-3.195), had low levels of annual out-of-pocket medical expenses (OR = 1.488, 95% CI = 1.129-1.961), and were more likely to give the PCBMI a worse evaluation than their counterparts. The results of the qualitative analysis showed that the key problem areas of the PCBMI were the design of the BMIS, the cognitive biases of the insured, publicity information about the BMIS, and the health system environment. CONCLUSIONS This study found that in addition to the design of BMIS, the cognition of the insured, the BMIS information publicity and the health system environment are also the key problems hindering PCBMI. While optimizing system design and implementation, Chinese policymakers need to focus on the insured with low PCBMI characteristics. Moreover, it is necessary to focus on exploring effective BMIS information publicity methods, supporting public policy literacy and improving the health system environment.
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Affiliation(s)
- Peng Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Lixia Cheng
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Ye Li
- School of Public Health, Harbin Medical University, Harbin, 150081, China
- Research Center of Health Policy and Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Yuchao Zhang
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Weiqi Huang
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Shuyi Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Zhizhen Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China.
- School of Public Health, Harbin Medical University, Harbin, 150081, China.
| | - Mingli Jiao
- School of Public Health, Harbin Medical University, Harbin, 150081, China.
- Research Center of Health Policy and Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China.
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China.
- School of Public Health, Harbin Medical University, Harbin, 150081, China.
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Wang P, Li S, Wang Z, Jiao M, Zhang Y, Huang W, Ning N, Gao L, Shan L, Li Y, Wu Q. Perceptions of the benefits of the basic medical insurance system among the insured: a mixed methods research of a northern city in China. Front Public Health 2023; 11:1043153. [PMID: 37139382 PMCID: PMC10149763 DOI: 10.3389/fpubh.2023.1043153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Background The perceptions of the benefits of the basic medical insurance system among the insured not only reflect the system's performance but also the public's basic medical insurance policy literacy, valuable information for countries that have entered the stage of deepening reform. This study aims to examine the factors that affect the perceptions of the benefits of the basic medical insurance system in China, diagnose the key problems, and propose corresponding measures for improvement. Methods A mixed method design was used. Data for the quantitative study were obtained from a cross-sectional questionnaire survey (n = 1,045) of residents of Harbin who had enrolled for basic medical insurance system. A quota sampling method was further adopted. A multivariate logistic regression model was then employed to identify the factors influencing the perceptions of the benefits of the basic medical insurance system, followed by semi-structured interviews with 30 conveniently selected key informants. Interpretative phenomenological analysis was used to analyze the interview data. Results Approximately 44% of insured persons reported low perceptions of benefits. The logistic regression model showed that low perceptions of the benefits of the basic medical insurance system was positively correlated with the experience of daily drug purchases (OR = 1.967), perceptions of recognition with basic medical insurance system (OR = 1.948), perceptions of the financial burden of participation costs (OR = 1.887), perceptions of the convenience of using basic medical insurance for medical treatment (OR = 1.770), perceptions of the financial burden of daily drug purchases costs (OR = 1.721), perceptions of the financial burden of hospitalization costs (OR = 1.570), and type of basic medical insurance system (OR = 1.456). The results of the qualitative analysis showed that the key problem areas of perceptions of the benefits of the basic medical insurance system were: (I) system design of basic medical insurance; (II) intuitive cognition of the insured; (III) rational cognition of the insured; and (IV) the system environment. Conclusions Improving the perceptions of the benefits of the basic medical insurance system of the insured requires joint efforts in improving system design and implementation, exploring effective publicity methods of basic medical insurance system information, supporting public policy literacy, and promoting the health system environment.
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Affiliation(s)
- Peng Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Shuyi Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Zhizhen Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Mingli Jiao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- Research Center of Health Policy and Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Yuchao Zhang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Weiqi Huang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ning Ning
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ye Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- Research Center of Health Policy and Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
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Guo Z, He Z, Li H, Zheng L, Shi L, Guan X. Effect of the full coverage policy of essential medicines on medication adherence: A quasi-experimental study in Taizhou, China. Front Public Health 2022; 10:981262. [PMID: 36311635 PMCID: PMC9597622 DOI: 10.3389/fpubh.2022.981262] [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: 06/29/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023] Open
Abstract
Objective Different forms of full coverage policy of essential medicines (FCPEMs) have been adopted worldwide to lower medication expenditure and improve adherence. This study aims to analyse the effect of FCPEMs on patients' medication adherence in Taizhou city, China. Methods This study was a quasi-experimental study and set treatment and control groups. We extracted Electronic Health Records (EHRs) for hypertension and diabetes 1 year before and after FCPEMs implementation and their medication adherence level assessed by physicians. We applied the propensity score matching (PSM) method to balance the bias between the two groups. Then, the descriptive analysis was used to compare the differences in the reported medication adherence. Using the Difference-In-Differences (DIDs) method, the fixed-effect model with the logistic regression was built to analyse the effects of FCPEMs. Results 225,081 eligible patients were identified from the original database. In the baseline year, FCPEM covered 39,251 patients. After PSM, 6,587 patients in the treatment group and 10,672 patients in the control group remained. We found that the proportion of patients with high adherence in the treatment group increased by 9.1% (60.8 to 69.9%, P < 0.001) and that in the control group increased by 2.6% (62.5 to 65.2%, P < 0.001). The regression results showed that FCPEMs significantly increased patients' medication adherence (OR = 2.546, P < 0.001). Conclusion FCPEMs significantly improved medication adherence. Socially disadvantaged individuals might benefit more from continuing FCPEM efforts. Expanding the coverage of FCPEMs to other medicines commonly used in patients with chronic diseases may be a promising strategy to manage chronic diseases and promote patient outcomes.
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Affiliation(s)
- Zhigang Guo
- Department of Pharmacy, Peking University School and Hospital of Stomatology, Beijing, China,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Zixuan He
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Liguang Zheng
- Department of Pharmacy, Peking University School and Hospital of Stomatology, Beijing, China
| | - Luwen Shi
- International Research Center for Medicinal Administration, Peking University, Beijing, China,School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaodong Guan
- International Research Center for Medicinal Administration, Peking University, Beijing, China,School of Pharmaceutical Sciences, Peking University, Beijing, China,*Correspondence: Xiaodong Guan
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Geng J, Bao H, Feng Z, Meng J, Yu X, Yu H. Investigating patients' preferences for new anti-diabetic drugs to inform public health insurance coverage decisions: a discrete choice experiment in China. BMC Public Health 2022; 22:1860. [PMID: 36199056 PMCID: PMC9533494 DOI: 10.1186/s12889-022-14244-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Diabetes is a major public health concern with a considerable impact on healthcare expenditures. Deciding on health insurance coverage for new drugs that meet patient needs is a challenge facing policymakers. Our study aimed to assess patients’ preferences for public health insurance coverage of new anti-diabetic drugs in China. Methods We identified six attributes of new anti-diabetic drugs and used the Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). The DCE was conducted in consecutive samples of type 2 diabetes patients in Jiangsu Province. The mixed logit regression model was applied to estimate patient-reported preferences for each attribute. The interaction model was used to investigate preference heterogeneity. Results Data from 639 patients were available for analysis. On average, the most valued attribute was the improvement in health-related quality of life (HRQoL) (β = 1.383, p < 0.001), followed by positive effects on extending life years (β = 0.787, p < 0.001), and well-controlled glycated haemoglobin (β = 0.724, p < 0.001). The out-of-pocket cost was a negative predictor of their preferences (β = -0.138, p < 0.001). Elderly patients showed stronger preferences for drugs with a lower incidence of serious side effects (p < 0.01) and less out-of-pocket costs (p < 0.01). Patients with diabetes complications favored more in the length of extended life (p < 0.01), improvement in HRQoL (p < 0.05), and less out-of-pocket costs (p < 0.001). Conclusion The new anti-diabetic drugs with significant clinical effectiveness and long-term health benefits should become the priority for public health insurance. The findings also highlight the value of accounting for preference heterogeneity in insurance policy-making. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14244-z.
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Affiliation(s)
- Jinsong Geng
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China.
| | - Haini Bao
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China.,The First People's Hospital of Lianyungang, 222061, Lianyungang, Jiangsu, China
| | - Zhe Feng
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China
| | - Jingyi Meng
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China
| | - Xiaolan Yu
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 02215, Boston, MA, USA
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Cheng W, Wang S, Liu X, Wu Y, Cheng J, Sun W, Yan X, Wang Q, Peng L, Liu X, Sha T, Shi J, Yang F. Construction and validation of a revised satisfaction index model for the Chinese urban and rural resident-based basic medical insurance scheme. BMC Med Inform Decis Mak 2022; 22:259. [PMID: 36192716 PMCID: PMC9531354 DOI: 10.1186/s12911-022-02002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality is the most important factor in satisfaction. However, the existing satisfaction index model of urban and rural resident-based basic medical insurance scheme (SIM_URRBMI) lacks the segmentation of perceived quality elements, it couldn't provide a reference for quality improvement and satisfaction promotion. This study aims to construct a revised SIM_URRBMI that can accurately and detailly measure perceived quality and provide feasible and scientific suggestions for improving the satisfaction of urban and rural residents' basic medical insurance scheme (URRBMI) in China. METHODS Based on the theoretical framework of the American Customer Satisfaction Index, the elements of perceived quality were refined through literature review and expert consultation, and a pool of alternative measurement variables was formed. A three-stage randomized stratified cluster sampling was adopted. The main decision makers of URRBMI in the families of primary school students in 8 primary schools in Changsha were selected. Both the classic test theory and the item response theory were used for measurement variables selection. The reliability and validity of the model were tested by partial least squares (PLS)-related methods. RESULTS A total of 1909 respondents who had URRBMI for their children were investigated. The SIM_URRBMI1.0 consists of 11 latent variables and 28 measurement variables with good reliability and validity. Among the three explanatory variables of public satisfaction, perceived quality had the largest total effect (path coefficient) (0.737). The variable with the greatest effect among the five first-order latent variables on perceived quality was the quality of the medical insurance policy (0.472). CONCLUSIONS The SIM_URRBMI1.0 consists of 28 measurement variables and 11 latent variables. It is a reliable, valid, and standard satisfaction measurement tool for URRBMI with good prediction ability for public satisfaction. In addition, the model provides an accurate evaluation of the perceived quality, which will greatly help with performance improvement diagnosis. The most critical aspects of satisfaction improvement are optimizing the scope and proportion of reimbursement as well as setting appropriate level of deductible and capitation of URRBMI.
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Affiliation(s)
- Wenwei Cheng
- Department of Medical Administration, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Shiwen Wang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Xiaofang Liu
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Yanyan Wu
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Jin Cheng
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Weichu Sun
- Department of Orthopedics, University of South China, Hengyang, Hunan, China
| | - Xiaofang Yan
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Qi Wang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Liai Peng
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Xiaoli Liu
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Tingting Sha
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China
| | - Jingcheng Shi
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China.
| | - Fang Yang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha, 410078, Hunan, China.
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Peng R, Zhang W, Deng X, Wu B. Public trust in the long-term care insurance pilot program in China: An analysis of mediating effects. Front Public Health 2022; 10:928745. [PMID: 35928487 PMCID: PMC9343673 DOI: 10.3389/fpubh.2022.928745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022] Open
Abstract
Objective This study aimed to evaluate the implementation of the long-term care insurance (LTCI) pilot program in China through an examination of public trust in the system and its associated factors of insurance awareness and satisfaction with the LTCI policy. Method An online survey was used to collect data from 786 participants in the city of Guangzhou, one of the pilot sites of the LTCI. Ordinal logistic regression models were used to investigate the related factors of public trust in the LTCI. Structural equation modeling (SEM) was conducted to test the mediating effect of satisfaction with LTCI policy on the relationship between insurance awareness and public trust. Results More than 60% of participants gave a positive evaluation of the LTCI pilot program. More than 70% of the participants recognized the important role of the program. Both an understanding of insurance and satisfaction with LTCI policies were associated with public trust. The proportion of the indirect effect with regard to the total effect of satisfaction on trust was 70.133%, greater than the direct effect of 29.867%. Conclusions Our findings supported the hypothesis that satisfaction with the LTCI policy plays a mediating role between insurance awareness and public trust. Optimalization of the LTCI policy was recommended to improve public trust in the LTCI program.
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Affiliation(s)
- Rong Peng
- Institute of New Development, Guangdong University of Finance and Economics, Guangzhou, China
- *Correspondence: Rong Peng
| | - Wansha Zhang
- Institute of New Development, Guangdong University of Finance and Economics, Guangzhou, China
| | - Xueqin Deng
- Institute of New Development, Guangdong University of Finance and Economics, Guangzhou, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York City, NY, United States
- Bei Wu
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9
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Yuan SU, Yueping LI. Relationship between subjective socioeconomic status and sense of gain of health-care reform and the mediating role of self-rated health: a cross-sectional study in China. BMC Public Health 2022; 22:790. [PMID: 35440075 PMCID: PMC9020010 DOI: 10.1186/s12889-022-13106-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/30/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The sense of gain has gradually become the main evaluation index for the effectiveness of China's deepening reform and is affected by many factors. However, there is no relevant research on the sense of gain of health-care reform (SGHR) and its influencing factors. The purpose of this study was to explore the influence of subjective socioeconomic status (SSS) on SGHR and the mediating role of self-rated health (SRH) between them. METHODS Data (25,149 samples total) from China Family Panel Studies (CFPS) in 2018 were included in the analysis. A nonparametric test was used to explore the differences in demographic characteristics of SGHR, and a correlation analysis and mediating effect model were used to explore the influence of SSS on SGHR and the mediating effect of SRH. RESULTS Demographic characteristics such as age, urban and rural areas, educational background, marriage and choice of medical treatment had significant differences in the distribution of perceived acquisition of medical reform. SSS, SRH and SGHR are statistically positively correlated with each other. SSS has a positive statistical correlation with SGHR, and may have an indirect effect through SRH. CONCLUSIONS SSS is an important predictor of SGHR, and SRH may play a partially mediating role in SGHR.
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Affiliation(s)
- S U Yuan
- School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - L I Yueping
- School of Arts and Sciences, Fujian Medical University, Fuzhou, 350122, China.
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10
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Pu X, Wang Y, Zhang W, Zeng M. Can Basic Medical Insurance Reduce Elderly Family Income Inequality in China? Front Public Health 2022; 10:838733. [PMID: 35242735 PMCID: PMC8885622 DOI: 10.3389/fpubh.2022.838733] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Basic medical insurance is the critical medical security system to realize common prosperity in China. This study explores the impact of basic medical insurance on elderly family income inequality in China using the China Family Panel Studies (CFPS) data in 2018. Our finding shows that basic medical insurance is significantly negatively correlated with elderly family income inequality, indicating basic medical insurance has a positive impact on narrowing the elderly family income inequality. The heterogeneity analysis shows that basic medical insurance has a more significant reduction effect among the eastern elderly and the younger elderly family. The results also suggest that health performance significantly mediates the relationship between basic medical insurance and elderly family income inequality. This study implies that the Chinese government should increase the proportion of basic medical insurance reimbursement and expand the scope of reimbursement for basic medical insurance to realize income fairness among elderly families.
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Affiliation(s)
- Xiaohong Pu
- School of Public Administration, Sichuan University, Chengdu, China
| | - Yilong Wang
- School of Public Administration, Sichuan University, Chengdu, China
- School of Management, Northwest Minzu University, Lanzhou, China
| | - Weike Zhang
- School of Public Administration, Sichuan University, Chengdu, China
- *Correspondence: Weike Zhang
| | - Ming Zeng
- School of Public Administration, Sichuan University, Chengdu, China
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11
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Geng J, Chen X, Shi J, Bao H, Chen Q, Yu H. Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach. BMC Public Health 2021; 21:1886. [PMID: 34663271 PMCID: PMC8524814 DOI: 10.1186/s12889-021-11947-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China's public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap. METHODS We established a hypothetical model that comprised patients' awareness of insurance policies, the fulfillment of patients' expectations of insurance benefits, patients' perceived value of health insurance coverage, patients' satisfaction with health insurance programs, patients' complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases. RESULTS The SEM model, with good fit indices, showed that patients' awareness of health insurance policies, insurance program's fulfillment of expectations, and patients' perceived value of insurance coverage, positively predicted patient satisfaction (P < 0.01). The fulfillment of patients' expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P < 0.001), while the patients' perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average (P < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis. CONCLUSIONS Our findings highlight the importance of incorporating patients' perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients' expectations.
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Affiliation(s)
- Jinsong Geng
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China.
| | - Xiaowei Chen
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China.,Library and Reference Department, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Haini Bao
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Qian Chen
- Department of Ophthalmology, The Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
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12
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Zhou G, Jan S, Chen M, Wang Z, Si L. Equity in Healthcare Financing Following the Introduction of the Unified Residents' Health Insurance Scheme in China. Health Policy Plan 2021; 37:209-217. [PMID: 34651170 DOI: 10.1093/heapol/czab124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/14/2022] Open
Abstract
This study sought to explore whether there are significant disparities in the financing of healthcare between urban and rural populations following the introduction in 2016 of the Urban and Rural Resident Basic Medical Insurance (URRBMI) scheme in China. We used household survey data from Heilongjiang province to estimate separate concentration curves in the financing burden and the resultant Kakwani indices (KIs) for urban and rural populations. This enabled assessment of the progressivity (or otherwise) of this burden. The results show that in urban areas indirect taxes were proportional (KI = 0.0009, p = 0.8449), while indirect taxes in rural areas were progressive (KI = 0.0284, p = 0.0002). In both urban and rural areas, direct taxes were found to be progressive (urban: KI = 0.4628, p < 0.0001; rural: KI = 0.4087, p = 0.0064), while URRBMI was regressive (urban: KI = -0.6236, p < 0.0001; rural: KI = -0.4325, p < 0.0001). Out-of-pocket payments were proportional in urban areas (KI = -0.0064, p = 0.7490); in contrast, they were regressive in rural areas (KI = -0.1078, p = 0.0012). Overall, the burden of healthcare finance in urban China was found to be neither regressive nor progressive (KI = -0.0142, p = 0. 1397), whereas in rural China it was found to be regressive (KI = -0.1208, p < 0.0001). This result is driven by high reliance on regressive forms of funding, namely, fixed contributions to URRBMI, out-of-pocket costs and private health insurance. It is concluded that achieving equity in health financing in China will require strong measures to reduce the regressivity of financing, particularly for rural populations. This can be achieved through a shift towards means-adjusted URRBMI contributions, a greater reliance on tax-based financing and reducing the reliance on out-of-pocket payments and private health insurance.
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Affiliation(s)
- Guoliang Zhou
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | - Mingsheng Chen
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China.,Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China.,Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China.,Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China.,Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Lei Si
- The George Institute for Global Health, UNSW Sydney, NSW, Australia
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