Health insurance coverage and access to care in China

Air pollution and upper respiratory diseases: an examination among medically insured populations in Wuhan, China

Multiple evidence has supported that air pollution exposure has detrimental effects on the cardiovascular and respiratory systems. However, most investigations focus on the general population, with limited research conducted on medically insured populations. To address this gap, the current research was designed to examine the acute effects of inhalable particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), ground-level ozone (O3), and sulfur dioxide (SO2) on the incidence of upper respiratory tract infections (URTI), utilizing medical insurance data in Wuhan, China. Data on URTI were collected from the China Medical Insurance Basic Database for Wuhan covering the period from 2014 to 2018, while air pollutant data was gathered from ten national monitoring stations situated in Wuhan city. Statistical analysis was performed using generalized additive models for quasi-Poisson distribution with a log link function. The analysis indicated that except for ozone, higher exposure to four other pollutants (NO2, SO2, PM2.5, and PM10) were significantly linked to an elevated risk of URTI, particularly during the previous 0-3 days and previous 0-4 days. Additionally, NO2 and SO2 were found to be positively linked with laryngitis. Furthermore, the effects of air pollutants on the risk of URTI were more pronounced during cold seasons than hot seasons. Notably, females and the employed population were more susceptible to infection than males and non-employed individuals. Our findings gave solid proof of the link between ambient air pollution exposure and the risk of URTI in medically insured populations.

Prevalence, perceptions and associated factors of health insurance enrollment among older persons in selected cash grant communities in Ghana: a cross-sectional mixed method

BACKGROUND

Universal Health Coverage has been openly recognized in the United Nations health-related Sustainable Development Goals by 2030, though missing under the Millennium Development Goals. Ghana implemented the National Health Insurance Scheme programme in 2004 to improve financial access to healthcare for its citizens. This programme targeting low-income individuals and households includes an Exempt policy for older persons and indigents. Despite population ageing, evidence of the participation and perceptions of older persons in the scheme in cash grant communities is unknown. Hence, this paper examined the prevalence, perceptions and factors associated with health insurance enrollment among older persons in cash grant communities in Ghana.

METHODS

Data were from a cross-sectional household survey of 400 older persons(60 + years) and eight FGDs between 2017 and 2018. For the survey, stratified and simple random sampling techniques were utilised in selecting participants. Purposive and stratified sampling techniques were employed in selecting the focus group discussion participants. Data analyses included descriptive, modified Poisson regression approach tested at a p-value of 0.05 and thematic analysis. Stata and Atlas-ti software were used in data management and analyses.

RESULTS

The mean age was 73.7 years. 59.3% were females, 56.5% resided in rural communities, while 34.5% had no formal education. Two-thirds were into agriculture. Three-fourth had non-communicable diseases. Health insurance coverage was 60%, and mainly achieved as Exempt by age. Being a female [Adjusted Prevalence Ratio (APR) 1.29, 95%CI:1.00-1.67], having self-rated health status as bad [APR = 1.34, 95%CI:1.09-1.64] and hospital healthcare utilisation [APR = 1.49, 95%CI:1.28-1.75] were positively significantly associated with health insurance enrollment respectively. Occupation in Agriculture reduced insurance enrollment by 20.0%. Cited reasons for poor perceptions of the scheme included technological challenges and unsatisfactory services.

CONCLUSION

Health insurance enrollment among older persons in cash grant communities is still not universal. Addressing identified challenges and integrating the views of older persons into the programme have positive implications for securing universal health coverage by 2030.

Experience of financial toxicity and coping strategies in young and middle-aged patients with stroke: a qualitative study

BACKGROUND

While financial toxicity (FT) is prevalent in patients with cancer, young and middle-aged patients with stroke are also affected by FT, which can exacerbate their physical and psychological challenges. Understanding the patient's experience and response measures can further understand the impact of FT on patients with stroke, to help alleviate FT. However, little is known concerning the experience of patients with stroke with FT or their coping strategies. Therefore, this study aimed to describe the experiences of FT in young and middle-aged patients with stroke and their coping strategies.

METHODS

A phenomenological method was utilized. Semi-structured interviews were conducted with 21 young and middle-aged stroke patients (aged 18-59) between October 2022 and March 2023. The participants were recruited from a tertiary hospital in Shanghai, China. The research team used NVivo 12.0 software. Giorgi's phenomenological analysis method was used to analyse the interview data.

RESULTS

The interview results were divided into two categories in terms of patients' experiences of FT and their coping strategies. Nine subthemes were constructed. The experience category included four subthemes: (1) taking on multifaceted economic pressure, (2) dual choice of treatment, (3) decline in material living standards, and (4) suffering from negative emotions such as anxiety and depression. The coping strategy category included five subthemes: (1) reducing expenses, (2) improving living habits, (3) proactive participation in medical decision-making, (4) making a job position choice, and (5) seeking social support.

CONCLUSIONS

FT in young and middle-aged patients with stroke, which affected their physical and mental health, led them to implement strategies for dealing with FT. The Chinese government needs to broaden the reach of health insurance coverage and advance the fairness of healthcare policies. Healthcare professionals must pay active attention to FT in such patients in terms of strengthening their health education and considering their needs and preferences. Patients need to improve their sense of self-efficacy, actively reintegrate into society, and adhere to rehabilitation and treatment. Individuals at a high risk of stroke are recommended to purchase health insurance. Multifaceted efforts are needed to reduce the impact of FT in young and middle-aged patients with stroke.

Demoralization syndrome and its impact factors among cancer patients in China

PURPOSE

This study aimed to investigate the status of demoralization syndrome among cancer patients and explore the key factors influencing demoralization syndrome.

METHOD

Cross-sectional study design of cancer patients in Xiamen, China. Patients completed the Mandarin version of the Perceived Social Support Scale, Patient-Reported Outcome Measures, The Anderson Symptom Inventory, and the Demoralization Scale.

FINDINGS

187/199 (94%) of patients completed questionnaires. This study found that almost half of the cancer patients in Xiamen, China experience moderate to high levels of demoralization syndrome. Furthermore, the findings indicated that the family residence (Large Urban: b = 2.73, p = 0.02), average monthly income (b=-3.05, p = 0.03), source of income, religiousness (b = 1.37, p = 0.04) and financial toxicity (b = 3.3, p < 0.001), and social support (b = 1.02; p < 0.001) are the influencing factors of cancer patients' demoralization syndrome.

CONCLUSION

These findings emphasize the importance of addressing psychological distress and providing adequate social and financial support for cancer patients to maintain their morale and overall well-being.

Diabetic retinopathy in China: Epidemiology, screening and treatment trends-A review

Diabetic retinopathy (DR) is the leading cause of vision impairment in the global working-age population. In China, with one-third of the world's diabetes population estimated at 141 million, the blindness prevalence due to DR has increased significantly. The country's geographic variations in socioeconomic status have led to prominent disparities in DR prevalence, screening and management. Reported risk factors for DR in China include the classic ones, such as long diabetes duration, hyperglycaemia, hypertension and rural habitats. There is no national-level DR screening programme in China, but significant pilot efforts are underway for screening innovations. Novel agents with longer durations, noninvasive delivery or multi-target are undergoing clinical trials in China. Although optimised medical insurance policies have enhanced accessibility for expensive therapies like anti-VEGF drugs, further efforts in DR prevention and management in China are required to establish nationwide cost-effective screening programmes, including telemedicine and AI-based solutions, and to improve insurance coverage for related out-of-pocket expenses.

Impact of Agricultural Mechanization Level on Farmers' Health Status in Western China: Analysis Based on CHARLS Data

Agricultural mechanization is an important component of agricultural modernization, as it contributes to the improvement of agricultural technology and the rapid transformation of agricultural development. However, research on the connection between agricultural mechanization and farmers' health status is scarce. Thus, using the 2018 China Health and Retirement Longitudinal Survey (CHARLS) data, this study explored how agricultural mechanization can affect farmers' health. OLS and 2SLS models were used for the study's analysis. Furthermore, we used a PSM model to check the robustness of our analysis. The findings showed that: (1) the current state of agricultural mechanization in western China harms the health of rural residents; (2) agricultural mechanization can mitigate the adverse effects on health by increasing farmers' living expenditure and improving their living environment; and (3) agricultural mechanization's effects on farmers' health are regionally and income-heterogeneous. Agricultural mechanization has a more significant impact on health in Tibetan areas and high-income regions. It has an almost minimal effect in non-Tibetan and low-income areas. This paper suggests approaches that can be used to encourage the rational development of agricultural mechanization and improve rural populations' health.

Dialect culture and the utilization of public health service by rural migrants: Insights from China

The right to health is a fundamental human right for human beings to live in dignity. Everyone has the right to enjoy the fair and accessible highest standard of health by utilizing public health services. However, access to essential public health services also highly depends on the dialect culture. It is believed that the dialect culture also influences the efficiency of public health policies. To explore the phenomenon empirically, the current study utilized data sourced from geographical distribution information of Chinese dialects and the China Migrants Dynamic Survey for 2017. The study employed the Probit, IVprobit, and Eprobit models to estimate the impact of dialect culture on migrants' use of public health services. The findings revealed that the dialect culture significantly hinders the migrants' utilization of public health services. Further, by employing heterogeneity analysis, the findings revealed that the results are more pronounced in migrants, born after 1980, and are female with low educational background and also those migrants having local medical experiences and moving toward non-provincial cities. Finally to explore the mechanism of dialect culture influencing migrants' public health service, the study employed mediation analysis and KHB Method. The findings revealed that information transmission, health habits, social capital, and cultural identity are the potential pathways influencing the migrants' use of public health services. The findings conclude that rural-to-urban migrants' access to public health services is influenced by their cultural adaptation. Hence, the study proposes that the government should amend the policy inefficiency concerns caused by cultural differences and strengthen the regional cultural exchanges to build trust.