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Xue S, Zeng W, Yang X, Li J, Zhu L, Zou G. Factors associated with the enrollment of commercial medical insurance in China: Results from China General Social Survey. PLoS One 2024; 19:e0303997. [PMID: 38781252 PMCID: PMC11115273 DOI: 10.1371/journal.pone.0303997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The Chinese government has been promoting commercial medical insurance (CMI) in recent decades as it plays an increasingly important role in addressing disease burden, health inequities, and other healthcare challenges. However, compared with developed countries, the CMI is still less fledged with low coverage. OBJECTIVE This study aims to explore the factors associated with enrollment in CMI, with regards to explicit characteristics (including sociodemographic characteristics and family economic status), latent characteristics (including social security status), and the global incentive compatibility index (including health status), to inform the design of CMI to improve its coverage in China. METHODS Based on the principal-agent model, we summarized and classified the factors associated with the enrollment in CMI, and then analyzed the data generated from the Chinese General Social Survey in 2015,2018 and 2021 respectively. A comparison of factors regarding sociodemographic characteristics, family economic status, social security status, and health status was conducted between individuals enrolled and unenrolled in CMI using Mann-Whitney U test and Chi-square test. Binary logistic regression analysis was used to explore factors influencing the enrollment status of CMI. RESULTS Of all individuals, the proportion of enrolled individuals shows an increasing trend year by year, with 8.7%,11.8% and 14.1% enrolled in CMI in 2015,2018 and 2021, respectively. The binary regression analysis further suggested that the factors associated with the enrollment in CMI were consistent in 2015,2018 and 2021.We found that individuals divorced, obese, who had a higher level of education, had non-agricultural household registration, perceived themselves as the upper social status, conducted daily exercise, had more family houses, had a car, had investment activities, or did not have basic health insurance were more likely to be enrolled in CMI. CONCLUSIONS We identified multidimensional factors associated with the enrollment of CMI, which help inform the government and insurance industry to improve the coverage of CMI.
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Affiliation(s)
- Songyue Xue
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wu Zeng
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaocong Yang
- School of Public Administration, Guangzhou University, Guangzhou, China
| | - Jianguo Li
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Zhu
- School of Postgraduate Studies, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
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Huang X, Tung CL, Wang X, Xu X, Lam FI, Zhang T. Configurations of the driving factors promoting China's commercial health insurance: A comparative qualitative analysis based on the technology–organization–environment framework. Heliyon 2022; 8:e11522. [PMID: 36387432 PMCID: PMC9663891 DOI: 10.1016/j.heliyon.2022.e11522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/24/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
With the nation's remarkable improvement in living standards, China's health insurance system cannot satisfy people's higher demands; therefore, it is necessary to promote the supply of commercial health insurance (CHI) in China. Based on the technology–organization–environment (TOE) framework, this study constructs a novel analysis framework to investigate the driving path of China's CHI. Employing the data of 31 provincial regions of China in 2018, a fuzzy-set qualitative comparative analysis is conducted to analyze configurations. We also adopt a necessary condition analysis in the robustness check to examine the necessary conditions, determining that no necessary relationship exists between possible conditions and the performance of CHI. More particularly, three sufficient configurations, TOE strategy, government attention (GA)–environment adaptability (EA)–citizen demand (CD) strategy, and dual EA–CD strategy are demonstrated to achieve high performance, and the other three configurations of technological management capability (TMC)–EA-CD strategy, technological infrastructure (TI)–EA strategy, and combined TI–TMC–EA strategy do not result in high performance. In addition, technological conditions (TI and TMC) and EA are relatively more important than the other configurations. Notably, government departments' financial expenditure is found to have a negative effect on CHI promotion.
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Affiliation(s)
- Xiuquan Huang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
| | - Chih-Lin Tung
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
| | - Xi Wang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
| | - Xiaocang Xu
- School of Economics and Management, Huzhou University, Huzhou, 313000, China
| | - Fat-Iam Lam
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
| | - Tao Zhang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, China
- Corresponding author.
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Shi H, Gao L, Wang G. How Does Media Use Promote the Purchase of Private Medical Insurance? A Moderated Mediation Model. Front Psychol 2022; 13:894195. [PMID: 35756258 PMCID: PMC9226612 DOI: 10.3389/fpsyg.2022.894195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Various information media (such as TV and the Internet) have become the main channels through which for people to obtain information. Previous studies showed that media use influences the purchase of private medical insurance; however, research on its internal influence mechanism is still relatively weak. Using data from the Chinese General Social Survey 2017, this study constructed a moderated mediation model to analyze the mechanism of the influence of media use on the purchase of private medical insurance. Individuals' self-rated health status was used as a mediator and individual cognitive ability was used as a moderator. The results showed that self-rated health status played a partial mediating role and individual cognitive ability played a negative moderating role in the direct path between media use and the purchase of private medical insurance. Furthermore, in the indirect path, individual cognitive ability negatively moderated the impact of media use on self-rated health status.
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Affiliation(s)
- Hao Shi
- School of Insurance, University of International Business and Economics, Beijing, China
| | - Lifei Gao
- School of Economics, Beijing Technology and Business University, Beijing, China
| | - Guojun Wang
- School of Insurance, University of International Business and Economics, Beijing, China
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Min R, Fang Z, Zi C, Tang C, Fang P. Do Migrant Residents Really Achieve Health Equity by Obtaining Urban Hukou? A Comparative Study on Health Service Utilization and Urbanization in Central China. Front Public Health 2022; 10:784066. [PMID: 35480587 PMCID: PMC9037327 DOI: 10.3389/fpubh.2022.784066] [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: 09/27/2021] [Accepted: 03/08/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction With more than 120 million rural-to-urban migrants, urbanization of the rural population requires deeply exploration in China. Objective This study focused on settled citizens who obtained urban Hukou (household registration) during urbanization and investigated their perceptions of health services in China. Method A cross-sectional comparison study with an original, closed questionnaire was conducted in two major cities of Hubei, central China, covering health status and both the satisfaction with and utilization of health services. In total, 863 residents with urban Hukou participated in this study; migrants formed the study group and original city residents formed the control group. Propensity score matching (PSM) was used to reduce choice bias in the analysis steps. Besides basic description of the data, ordinary least squares regression (OLS regression) was used to discover the relationship between basic demographic indicators and health expenditure. Results PSM yielded 290 effective pairs for analysis. The results indicated an improvement in health status for migrant residents (study group) with a higher average score of self-reported health status and lower prevalence of chronic diseases than the control group. These scores were also better than the standard urban level in central China. The study group showed a higher clinic visit utility (69.63%), lower hospitalization utility (8.28%), less convenience of health service utility, and lower health expenditure than the control group. For the study group, the biggest difference was observed in satisfaction with health service costs, which was the least improved aspect after they obtained urban Hukou. The regression results demonstrated that age, family size, living expenditures, and marital status impacted health costs in the overall model and the influences of these factors differed between the study and control groups. Conclusions Obtaining urban Hukou helps migrant residents to meet their health service needs and receive equal access to health services. However, after obtaining urban Hukou, migrants also face great pressure in terms of health consumption. This study therefore offers guidance on the next steps for progressing China's urbanization.
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Affiliation(s)
- Rui Min
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zi Fang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Changmin Tang
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Pengqian Fang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Academy of Health Policy and Management, Huazhong University of Science and Technology, Wuhan, China
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National survey of do not attempt resuscitation decisions on out-of-hospital cardiac arrest in China. BMC Emerg Med 2022; 22:25. [PMID: 35148674 PMCID: PMC8832739 DOI: 10.1186/s12873-022-00581-0] [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: 08/23/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate and understand the determinants of decisions not to attempt resuscitation following out-of-hospital cardiac arrest, to contribute to establishing rules that are appropriate to China. METHODS We recruited participants through directors of emergency medical services across China. A 28-question web survey was available between February 5 and March 6, 2021 that targeted demographic information and views on emergency work and cardiopulmonary resuscitation. Each question was assigned a value between 1 and 7 based on the level of importance from low to high. T-tests, one-way analysis of variance, and Kruskal-Wallis H-tests were used to compare continuous variables. Binary logistic regression analysis was used to identify factors influencing when people considered it suitable to initiate cardiopulmonary resuscitation. RESULTS The study involved 4289 participants from 31 provinces, autonomous regions and municipalities in mainland China, of whom 52.8% were male. The top three reasons for not attempting cardiopulmonary resuscitation were decomposition/hypostasis/rigor mortis (6.39 ± 1.44 points), massive injury (4.57 ± 2.08 points) and family members' preference (4.35 ± 1.98 points). In total, 2761 (64.4%) thought emergency services should not attempt cardiopulmonary resuscitation when cardiac arrest had happened more than 30 min before, and there had been no bystander cardiopulmonary resuscitation. Gender (OR 1.233, p = 0.002), religion (OR 1.147, p = 0.046), level (OR 0.903, p = 0.028) or classification of city (OR 0.920, p = 0.049), years of work experience (OR 0.884, p = 0.004), and major (OR 1.032, p = 0.044) all influenced how long after cardiac arrest was considered suitable for initiating cardiopulmonary resuscitation. CONCLUSIONS Chinese emergency physicians have different perceptions of when not to attempt resuscitation to those practicing elsewhere. The existing guidelines for resuscitation are not suitable for China, and China-specific guidelines need to be established.
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Zheng X, Zhang Y, Chen Y, Fang X. Internal Migration Experience and Depressive Symptoms among Middle-Aged and Older Adults: Evidence from China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010303. [PMID: 35010562 PMCID: PMC8744975 DOI: 10.3390/ijerph19010303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023]
Abstract
Background: This study aimed to examine the association of internal migration experience with depressive symptoms among middle-aged and elderly Chinese, as well as explore possible mechanisms of the relationship. Methods: Participants were from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative sample of residents aged 45 years and older (n = 43,854). Survey data on depressive symptoms and internal migration experience were collected from biennial CHARLS surveys (CHARLS 2011/2013/2015) and a unique CHARLS life history survey in 2014, respectively. Multiple logistic regressions and the Karlson–Holm–Breen (KHB) method were employed in the statistical analyses. Results: The overall prevalence rate of depressive symptoms among middle-aged and older adults was 34.6%. Internal migration experience was associated with higher risks of depressive symptoms (OR = 1.07, 95% CI = 1.02–1.12, p < 0.01), especially among females (OR = 1.08, 95% CI = 1.01–1.14, p < 0.05), middle-aged adults (OR = 1.12, 95% CI = 1.06–1.19, p < 0.001), rural-to-urban migrants who had not obtained an urban hukou (OR = 1.13, 95% CI = 1.07–1.19, p < 0.001), and those who had low migration frequency and first migrated out at 35 years of age or older. Chronic disease (17.98%, p < 0.001), physical injury (7.04%, p < 0.001), medical expenditure (7.98%, p < 0.001), pension insurance (4.91%, p < 0.001), and parent–child interaction (4.45%, p < 0.01) were shown to mediate the association of internal migration experience with depressive symptoms. Conclusions: This study indicates that there is a significant association between internal migration experience and high risks of depression onset later in life. It is suggested to reduce institutional barriers for migrants and implement evidence-based interventions to improve migrants’ mental health.
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Affiliation(s)
- Xiaodong Zheng
- School of Economics, Zhejiang Gongshang University, Hangzhou 310018, China;
- Correspondence:
| | - Yue Zhang
- School of Economics, Zhejiang Gongshang University, Hangzhou 310018, China;
| | - Yu Chen
- Department of Agricultural and Applied Economics, The University of Georgia, Athens, GA 30602, USA;
| | - Xiangming Fang
- College of Economics and Management, China Agricultural University, Beijing 100083, China;
- School of Public Health, Georgia State University, Atlanta, GA 30303, USA
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Sun N, Yang F. Impacts of internal migration experience on health among middle-aged and older adults-Evidence from China. Soc Sci Med 2021; 284:114236. [PMID: 34293677 DOI: 10.1016/j.socscimed.2021.114236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/22/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
As a life course factor, internal migration plays a role in shaping health condition in middle age and later life. Using data from the 2014 and 2015 China Health and Retirement Longitudinal Study (CHARLS), the present study examined the impacts and mechanism of internal migration experience on the health of middle-aged and older adults in China. Internal migration experience had significant negative impacts on health, whether in relation to self-reported health or number of chronic diseases. The impact increased with the frequency of internal migration. Compared to individuals that had not migrated, those who first migrated between age 18-35 had a worse overall health status. Initial internal migration occurring below age 18 significantly increased the number of chronic diseases. Medical service was found to be an important mechanism in the impact of internal migration experience on health. Given the insufficient protections related to internal migration, enhanced formal social support, especially healthcare services, should be implemented to mitigate the health disparities associated with internal migration.
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Affiliation(s)
- Nan Sun
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Fan Yang
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, China.
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Silver Spoon and Green Lifestyle: A National Study of the Association between Childhood Subjective Socioeconomic Status and Adulthood Pro-Environmental Behavior in China. SUSTAINABILITY 2021. [DOI: 10.3390/su13147661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Based on the life history theory, this study is aimed at examining the associations among childhood subjective socioeconomic status, adulthood pro-environmental behavior, and commercial insurance purchase. We used the data from the 2013 Chinese General Social Survey (CGSS2013) and obtained a sample of 11,172 respondents, with ages ranging from 18 to 97 years old. The respondents were selected using multistage stratified sampling. Correlational, mediational and moderational analyses were conducted using SPSS. The results show that the childhood subjective socioeconomic status is positively associated with adulthood pro-environmental behavior, independent of the current subjective socioeconomic status. In addition, commercial insurance purchase acts as a mediator of the association between childhood subjective socioeconomic status and adulthood pro-environmental behavior. Using conditional process analysis, we demonstrated that age moderated both the path where childhood subjective socioeconomic status influenced adulthood pro-environmental behavior and the path where childhood subjective socioeconomic status influenced commercial insurance purchase. Theoretically, the results provide empirical support for evolutionary perspective on sustainable behavior and demonstrate that childhood environment can constrain individual consumer choices and lifestyle. Practically, positioning target customers to commercial insurance clients may be an effective marketing strategy to increase consumers’ actual purchase of ethical products. Moreover, to realize environmental goals, social policy makers can make efforts to publicize the importance of insurance and expand the coverage of insurance by increasing the corresponding financial subsidies for low socioeconomic status families.
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Liu X, Chu H, Zhao J, Qiao R, Liu Y, Li N, Zeng L, Wang X, Tao L, Zhang H, Shi Y, Zhuo L, Zhang L, Zhao Y. Exploring the barriers of patients with diabetic foot complications in China: a qualitative interview study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:792. [PMID: 34268405 PMCID: PMC8246227 DOI: 10.21037/atm-20-7569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/10/2021] [Indexed: 01/13/2023]
Abstract
Background Patients with diabetic foot complications are associated with high rates of morbidity, disability, and mortality. Through findings of qualitative interviews with patients with this disease, we aimed to explore the barriers they encountered, provide evidence to improve the efficacy of medical services, discuss prevention and treatment strategies for future policymakers, and attract widespread attention from the Chinese society. Methods Patients with diabetic foot complications were recruited from three tertiary hospitals in China between July to September 2020. Patients were included who had a clinical diagnosis of diabetic foot complications, were 18 years or older, spoke Chinese as their first language, and were willing to share treatment experiences. An interview guide was used during the in-person semi-structured interviews that lasted 20 to 50 minutes and were audio-recorded. Transcripts were analyzed for qualitative themes. Results Forty-one patients (range, 38-79 years; 12 men, 29 women) were recruited. Data analysis indicated five thematic dimensions on barriers encountered by patients with diabetic foot complications: hospital visits, doctor-patient communication, mental burden, economic burden, and social support. Conclusions Patients with diabetic foot complications face serious financial, mental, and social burdens in China. Future studies can use the five dimensions to help solve the existing problems and improve treatment outcomes of this patient population.
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Affiliation(s)
- Xiaoli Liu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Hongling Chu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Jinghui Zhao
- Department of Interventional Radiology and Vascular Surgery, Wound Healing Center, Peking University Third Hospital, Beijing, China
| | - Rui Qiao
- Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Yuqiang Liu
- Department of Pharmacy, Changzhi People's Hospital, Changzhi, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yanyan Shi
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Lin Zhuo
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Long Zhang
- Department of Interventional Radiology and Vascular Surgery, Wound Healing Center, Peking University Third Hospital, Beijing, China
| | - Yiming Zhao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
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Li Y, Nima Q, Yu B, Xiao X, Zeng P, Suolang D, He R, Ciren Z, Wangqing P, Laba C, Silang Y, Song L, Kangzhu Y, Li J. Determinants of self-rated health among an older Tibetan population in a Chinese plateau area: analysis based on the conceptual framework for determinants of health. BMC Public Health 2021; 21:489. [PMID: 33706725 PMCID: PMC7953750 DOI: 10.1186/s12889-021-10359-x] [Citation(s) in RCA: 3] [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: 12/03/2020] [Accepted: 01/21/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Self-rated health (SRH) has been frequently used in population health surveys. However, most of these studies only focus on specific factors that might directly affect SRH, so only partial or confounding information about the determinants of SRH is potentially obtained. Conducted in an older Tibetan population in a Chinese plateau area, the aim of our study is to assess interrelationships between various factors affecting SRH based on the conceptual framework for determinants of health. METHODS Between May 2018 and September 2019, 2707 Tibetans aged 50 years or older were recruited as part of the China Multi-Ethnic Cohort Study (CMEC) from the Chengguan District of Lhasa city in Tibet. The information included SRH and variables based on the conceptual framework for determinants of health (i.e., socioeconomic status, health behaviors, physical health, mental health, and chronic diseases). Structural equation modeling (SEM) was used to estimate the direct and indirect effects of multiple factors in the conceptual framework. RESULTS Among all participants, 5.54% rated their health excellent, 51.16% very good, 33.58% good, 9.12% fairly poor and 0.59% poor. Physical health (β = - 0.23, P < 0.001), health behaviors (β = - 0.44, P < 0.001), socioeconomic status (β = - 0.29, P < 0.001), chronic diseases (β = - 0.32, P < 0.001) and gender (β = 0.19, P < 0.001) were directly associated with SRH. Socioeconomic status, physical health and gender affected SRH both directly and indirectly. In addition, there are potential complete mediator effects in which age and mental health affect SRH through mediators, such as physical health, health behaviors and chronic diseases. CONCLUSIONS The findings suggested that interventions targeting behavioral changes, health and chronic disease management should be attached to improve SRH among older populations in plateau areas without ignoring gender and socioeconomic disparities.
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Affiliation(s)
- Yajie Li
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Qucuo Nima
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Bin Yu
- West China Second University Hospital of Sichuan University and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiong Xiao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peibin Zeng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Deji Suolang
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Ruifeng He
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Zhuoga Ciren
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | | | - Ciren Laba
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Yangzong Silang
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Ling Song
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Yixi Kangzhu
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Jingzhong Li
- Tibet Center for Disease Control and Prevention, Lhasa, China.
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Gao L, Wang X. Healthcare Supply Chain Network Coordination Through Medical Insurance Strategies with Reference Price Effect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3479. [PMID: 31540517 PMCID: PMC6766012 DOI: 10.3390/ijerph16183479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022]
Abstract
China has established the universal medical insurance system and individual out of pocket costs have decreased, however, the average healthcare expenditure of the Chinese population and the expenses of the whole society have increased substantially. One major challenge which impedes the progress of attaining sustainable development of the social healthcare system in China is that the number of hospital admissions is disproportionate. Superior hospitals are overcrowded, whereas subordinate hospitals are experiencing low admissions. In this paper, we apply the game theory model to coordinate the healthcare supply chain network, which is composed of the government, medical insurance fund, superior hospitals, subordinate hospitals and patients. Especially by taking the reference price effect into account, this paper analyzes different medical insurance reimbursement strategies and their influence on patient choice and the healthcare supply chain network. The result shows that the reference price effect increases the leverage of medical insurance, guides patients' choice, optimizes the allocation of medical resources and reduces the medical expends. In comparison to a decentralized decision- making strategy, a centralized decision- making strategy can stimulate both superior hospital and subordinate hospital's cooperative intentions which benefits the social healthcare system.
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Affiliation(s)
- Lingyu Gao
- School of Economics and Management, Tongji University, Shanghai 201804, China.
| | - Xiaoli Wang
- School of Economics and Management, Tongji University, Shanghai 201804, China.
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Guan X, Fu M, Lin F, Zhu D, Vuillermin D, Shi L. Burden of visual impairment associated with eye diseases: exploratory survey of 298 Chinese patients. BMJ Open 2019; 9:e030561. [PMID: 31515429 PMCID: PMC6747637 DOI: 10.1136/bmjopen-2019-030561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the economic burden, prevalence of catastrophic healthcare expenditure (CHE) and the quality of life (QoL) of Chinese patients with visual impairment (VI) associated with eye diseases. DESIGN A questionnaire survey from March to May 2016 by structured face-to-face interviews of patients with VI. PARTICIPANTS 302 patients who were diagnosed with moderate VI or worse in both eyes (visual acuity <6/18) were included, and 298 patients (98.7%) who completed the survey questionnaires were eligible for the study. OUTCOME MEASURES The economic burden was estimated by calculating participants' direct costs covered in 2015 and the definition of CHE was out-of-pocket (OOP) costs exceeding 30% of annual household income. QoL was weighed by health utility value using time-trade-off valuation techniques. RESULTS Annual average direct costs per patient caused by VI were US$6988.6±US$10 834.3, and 70.3% were direct medical costs of which only 26.9% were reimbursable by medical insurance. 32.2% of households that suffered from CHE, in particular, were less wealthy patients with VI living in rural areas and without medical insurance. The health utility value was rated at 0.65 on average, and patients with VI aged 51-57, living alone and insured by commercial medical insurance had relatively less QoL. CONCLUSION Our study explored the economic burden and QoL of VI associated with patients with eye diseases in China, indicating a substantial economic burden and poor QoL. Preferential medical insurance policies should be designed in relation to people with VI to further reduce the health inequalities, avoid CHE and promote QoL.
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Affiliation(s)
- Xiaodong Guan
- School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Mengyuan Fu
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Fanghui Lin
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Dawei Zhu
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | | | - Luwen Shi
- School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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