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Li Y, Zhang M, Xu Y, Li X, Lu T. Availability, price, and affordability of anti-hepatitis B virus drugs: a cross-sectional study in China. Int J Clin Pharm 2024; 46:694-703. [PMID: 38472597 DOI: 10.1007/s11096-024-01706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/20/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The global prevalence of hepatitis B virus (HBV) has presented a persistent challenge for public health prevention and treatment. However, studies that assess the public's access to anti-HBV drugs are absent. AIM To examine the availability, pricing, and affordability of anti-HBV drugs in Jiangsu province, China and provide recommendations for improvement. METHOD An enhanced methodology developed by the World Health Organization (WHO) and Health Action International was applied in a cross-sectional study that included 1026 healthcare facilities distributed in 13 prefectural-level cities in Jiangsu province. RESULTS Since almost all drugs had an availability of less than 30%, the accessibility of anti-HBV drugs was notably low. Primary healthcare facilities had the lowest availability, reporting 1.4% for Original Brands (OBs) and 1.7% for lowest-priced generics (LPGs). Furthermore, the northern Jiangsu region recorded the lowest availability at 0.7%. LPGs demonstrated higher availability than OBs, with median availability probabilities of 2.6% and 1.4%, respectively. The drugs listed on the WHO Essential Medicines List exhibited higher availability than those on other lists. The median price ratios for OBs, LPGs, and volume-based purchasing drugs were 0.83, 0.50, and 0.27, respectively, less than 1.5 times the international reference price. Despite favorable pricing, affordability rate was 23% for urban residents and 0% for rural residents, which was discouraging. CONCLUSION Low availability and affordability of anti-HBV drugs were observed. Policy recommendations should emphasize the improvement of LPG availability by incentivizing priority prescribing. Healthcare subsidies should be provided more effectively and equitably.
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Affiliation(s)
- Yue Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 210009, People's Republic of China
| | - Mengdie Zhang
- Department of Pharmaceutical Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yi Xu
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, People's Republic of China
| | - Xin Li
- Department of Pharmaceutical Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, People's Republic of China
| | - Tao Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 210009, People's Republic of China.
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Pan Y, Wu X, Liu Y, Li Z, Yang Y, Luo Y. Urbanization and Cognitive Function Among Middle-Aged and Old Adults in China. J Gerontol B Psychol Sci Soc Sci 2022; 77:2338-2347. [PMID: 35908238 DOI: 10.1093/geronb/gbac102] [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: 01/24/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Our study examined the effect of urbanization on cognitive function and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration. METHODS Using data from the China Health and Retirement Longitudinal Study, we compared cognitive function among three groups (urbanized-rural residents, rural nonmigrants, and urban nonmigrants). Logistic regression and structural equation models were applied to explore the impact of urbanization on cognitive function and the potential mechanisms. RESULTS Compared with the urbanized-rural group, urban nonmigrants had better cognitive function, with a significant coefficient of 1.56 (95% CI: 1.22, 1.89) for global cognition scores and 0.37 (95% CI: 0.22, 0.53) for episodic memory scores. The rural nonmigrants had the worst cognitive function (β = -0.79, 95% CI: -1.04, -0.55) and lower scores of mental intactness (β = -0.65, 95% CI: -0.84, -0.57) and episodic memory (β = -0.14, 95% CI: -0.26, -0.03). The association between urbanization and cognitive function was mainly mediated by income and living conditions among middle-aged and older adults. DISCUSSION Rural people who experienced planned urbanization in China had higher cognitive scores than rural non-migrants. Urbanization could thus have a beneficial and cumulative effect on cognitive function. Improvements in living conditions and changes in income are the main drivers behind the relationship. However, urbanization could compensate for the negative impact on cognitive function from disadvantaged early-life conditions, but it cannot completely eliminate the gap between urbanized-rural people and urban nonmigrants.
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Affiliation(s)
- Yao Pan
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China
| | - Xiaofang Wu
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China
| | - Yan Liu
- Institute of Population Research, Peking University, Beijing, China
| | - Zhuo Li
- School of Social Sciences, Tsinghua University, Beijing, China
| | - Yingkai Yang
- School of Nursing, Peking University, Beijing, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China
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Wang H, Liang D, Zhang D, Hou Z. How does domestic migration pose a challenge in achieving equitable social health insurance benefits in China? A national cross-sectional study. BMJ Open 2022; 12:e060551. [PMID: 35998949 PMCID: PMC9403113 DOI: 10.1136/bmjopen-2021-060551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the benefit distribution of social health insurance among domestic migrants in China. DESIGN A national cross-sectional survey. SETTING 348 cities from 32 provincial units in China. PARTICIPANTS 1165 domestic migrants who used inpatient care services in the city of a new residence and had social health insurance. PRIMARY AND SECONDARY OUTCOME MEASURES The probability of receiving reimbursements from social health insurance, the amounts and ratio of reimbursement received. RESULTS Among migrants who used inpatient care in 2013, only 67% received reimbursements from social health insurance, and the reimbursement amount only accounted for 47% of the inpatient care expenditure. The broader the geographical scope of migration, the lower the probability of receiving reimbursement and the reimbursement ratio, but the higher the reimbursement amount. Specifically, the probability of receiving reimbursements for those who migrated across cities or provinces was significantly lower by 14.7% or 26.0%, respectively, than those who migrated within a city. However, they received significantly higher reimbursement amounts by 33.4% or 27.2%, respectively, than those who migrated within a city. And those who migrated across provinces had the lowest reimbursement ratio, although not reaching significance level. CONCLUSIONS The unequal benefit distribution among domestic migrants may be attributed to the fragmented health insurance design that relies on localised administration, and later reimbursement approach that migrating patients pay for health services up-front and get reimbursement later from health insurance. To improve the equity in social health insurance benefits, China has been promoting the portability of social health insurance, immediate reimbursement for inpatient care used across regions, and a more integrated health insurance system. Efforts should also be made to control inflation of healthcare expenditures and prevent inverse government subsidies from out-migration regions to in-migration regions. This study has policy implications for China and other low/middle-income countries that experience rapid urbanisation and domestic migration.
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Affiliation(s)
- Haiqin Wang
- Administrative Office, The International Peace Maternity and Child Health Hospital of China Welfare Institute, Shanghai, China
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Di Liang
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York, USA
| | - Zhiyuan Hou
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
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Hu M, Mao W, Xu R, Chen W, Yip W. Have Lower-Income Groups Benefited More from Increased Government Health Insurance Subsidies? Benefit Incidence Analysis in Ningxia, China. Health Policy Plan 2022; 37:1295-1306. [PMID: 35788317 DOI: 10.1093/heapol/czac054] [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: 01/11/2022] [Revised: 06/11/2022] [Accepted: 07/04/2022] [Indexed: 11/14/2022] Open
Abstract
China's government subsidies on the demand side - such as subsidizing medical insurance premiums - have accelerated progress towards universal health coverage. We examined whether the increased government subsidies had benefited the population, especially the poor. We conducted two rounds of household surveys and collected the annual claims reports of a rural medical insurance scheme in Ningxia (a relatively underdeveloped region in Western China). We used benefit incidence analysis to evaluate the distribution of benefit for different health services received by individuals with different living standards, as measured by the household wealth index. From 2009 to 2015, the benefit received per capita tripled from 101 to 332 CNY, most (>94%) of which was received for inpatient care. The overall distribution of benefit improved and became pro-poor in 2015 (the concentration index [CI] changed from -0.017 to -0.092), mainly driven by inpatient care. The poorer groups benefited disproportionately more from inpatient care from 2009 to 2015 (the CI changed from -0.013 to -0.093). County and higher-level inpatient care had the greatest improvements towards a pro-poor distribution. The distribution of subsidies for outpatient services significantly favoured the poorer groups in 2009, but less so in 2015 (CI changed from -0.093 to -0.068), and it became less pro-poor in village clinics (CI changed from -0.209 to -0.020). The increased government subsidies for the rural medical insurance scheme mainly contributed to inpatient care and allowed the poor to use more services at county and higher-level hospitals. China's government subsidies on the demand side have contributed to equity in benefit incidence, yet there is a noticeable increasing trend in utilizing services at higher levels of providers. Our findings also indicate that outpatient services need more coverage from rural medical insurance schemes to improve equity.
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Affiliation(s)
- Min Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Wenhui Mao
- School of Public Health, Fudan University, Shanghai, China.,The Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, US
| | - Ruyan Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, China
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Ye X, Zhu D, He P. Earlier migration, better cognition? The role of urbanization in bridging the urban-rural cognition gaps in middle and older age. Aging Ment Health 2022; 26:477-485. [PMID: 33467900 DOI: 10.1080/13607863.2021.1872490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES With the process of population aging and urbanization, a vast amount of studies have confirmed the increasing urban-rural cognition gaps, while less is known about the extent to which cognition gaps can be explained by urban-rural difference and urbanization status. This study aimed to examine the role of urbanization in bridging the cognition gaps for Chinese middle-aged and older adults. METHOD Based on the national representative China Health and Retirement Longitudinal Study (CHARLS) 2015, the Blinder-Oaxaca decomposition method was employed. The method uses stratified linear regression to disaggregate cognition gaps into explained and unexplained differences, as well as the absolute and relative attribution of explanatory factors. RESULTS There were significant cognitive differences between urban and rural samples. Migrating to the urban predicts better cognition among the rural-born. A larger environment-related explained gap existed for those fully urbanized and those migrating earlier, indicating that migration can operate through a beneficial and cumulative change in the environment and bridge the urban-rural cognition gap. CONCLUSION Public health actions targeting cognitive disparities can benefit from focusing on the unequal distribution in urban-rural social and economic recourses. Areas of priority include promoting their socioeconomic status, physical functioning, social support, and lifestyles.
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Affiliation(s)
- Xin Ye
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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Li M, Diao Y, Ye J, Sun J, Jiang Y. The Public Health Insurance Coverage of Novel Targeted Anticancer Medicines in China-In Favor of Whom? A Retrospective Analysis of the Insurance Claim Data. Front Pharmacol 2022; 12:778940. [PMID: 34992534 PMCID: PMC8724523 DOI: 10.3389/fphar.2021.778940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives: This study took Fuzhou city as a case, described how the public health insurance coverage policy in 2016 of novel anti-lung cancer medicines benefited patients, and who benefited the most from the policy in China. Methods: This was a retrospective study based on health insurance claim data with a longitudinal analysis of the level and trend changes of the monthly number of patients to initiate treatment with the novel targeted anti-lung cancer medicines gefitinib and icotinib before and after health insurance coverage. The study also conducted a multivariate linear regression analysis to predict the potential determinants of the share of patient out-of-pocket (OOP) expenditure for lung cancer treatment with the study medicines. Results: The monthly number of the insured patients in Fuzhou who initiated the treatment with the studied novel targeted anti-lung cancer medication abruptly increased by 26 in the month of the health insurance coverage (95% CI: 14–37, p < 0.01) and kept at an increasing level afterward (p < 0.01). By controlling the other factors, the shares of OOP expenditure for lung cancer treatment of the patients who were formal employee program enrollees not entitled to government-funded supplementary health insurance coverage and resident program enrollees were 18.3% (95% CI: 14.1–22.6) and 26.7% (95% CI: 21.0–32.4) higher than that of the patients who were formal employee program enrollees with government-funded supplementary health insurance coverage. Conclusion: The public health insurance coverage of novel anti-lung cancer medicines benefited patients generally. To enable that patients benefit from this policy more equally and thoroughly, in order to achieve the policy goal of not to leave anyone behind, it is necessary to strengthen the benefits package of the resident program and to optimize the current financing mechanism of the public health insurance system.
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Affiliation(s)
- Mingshuang Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yifan Diao
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchun Ye
- Healthcare Security Administration of Fujian Province, Fuzhou, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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De Allegri M, Rudasingwa M, Yeboah E, Bonnet E, Somé PA, Ridde V. Does the implementation of UHC reforms foster greater equality in health spending? Evidence from a benefit incidence analysis in Burkina Faso. BMJ Glob Health 2021; 6:bmjgh-2021-005810. [PMID: 34880059 PMCID: PMC8655516 DOI: 10.1136/bmjgh-2021-005810] [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: 03/23/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Burkina Faso is one among many countries in sub-Saharan Africa having invested in Universal Health Coverage (UHC) policies, with a number of studies have evaluated their impacts and equity impacts. Still, no evidence exists on how the distributional incidence of health spending has changed in relation to their implementation. Our study assesses changes in the distributional incidence of public and overall health spending in Burkina Faso in relation to the implementation of UHC policies. Methods We combined National Health Accounts data and household survey data to conduct a series of Benefit Incidence Analyses. We captured the distribution of public and overall health spending at three time points. We conducted separate analyses for maternal and curative services and estimated the distribution of health spending separately for different care levels. Results Inequalities in the distribution of both public and overall spending decreased significantly over time, following the implementation of UHC policies. Pooling data on curative services across all care levels, the concentration index (CI) for public spending decreased from 0.119 (SE 0.013) in 2009 to −0.024 (SE 0.014) in 2017, while the CI for overall spending decreased from 0.222 (SE 0.032) in 2009 to 0.105 (SE 0.025) in 2017. Pooling data on institutional deliveries across all care levels, the CI for public spending decreased from 0.199 (SE 0.029) in 2003 to 0.013 (SE 0.002) in 2017, while the CI for overall spending decreased from 0.242 (SE 0.032) in 2003 to 0.062 (SE 0.016) in 2017. Persistent inequalities were greater at higher care levels for both curative and institutional delivery services. Conclusion Our findings suggest that the implementation of UHC in Burkina Faso has favoured a more equitable distribution of health spending. Nonetheless, additional action is urgently needed to overcome remaining barriers to access, especially among the very poor, further enhancing equality.
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Affiliation(s)
- Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Martin Rudasingwa
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Edmund Yeboah
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Emmanuel Bonnet
- IRD, UMR 215 Prodig, CNRS, Université Paris 1 Panthéon-Sorbonne, AgroParisTech, 5, cours des Humanités, F-93 322, Aubervilliers Cedex, France
| | | | - Valéry Ridde
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal.,Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
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Li Z, Yu Q, Lu X, Liu Y, Ji B. Efficacy of radiofrequency ablation versus laparoscopic liver resection for hepatocellular carcinoma in China: a comprehensive meta-analysis. Wideochir Inne Tech Maloinwazyjne 2021; 16:455-471. [PMID: 34691297 PMCID: PMC8512513 DOI: 10.5114/wiitm.2021.105377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) has been the second leading cause of cancer-related death in China. Radiofrequency ablation is a relatively novel treatment that may improve the treatment of HCC. AIM To evaluate and compare the efficacy and safety of radiofrequency ablation (RFA) versus laparoscopic liver resection (LLR) in the treatment of HCC. MATERIAL AND METHODS We searched for relevant published studies in English (PubMed, Cochrane Library, EMBASE) and in Chinese (CBM, CNKI and Wanfang) from their inception until September 23, 2019. The quality of included studies was evaluated by the Newcastle-Ottawa Scale. RESULTS A total of 19 retrospective studies including 2038 patients were eligible for the meta-analysis. The results of the meta-analysis demonstrated that LLR was superior to RFA in terms of 3-year overall survival rate (OR = 0.62), 1 to 3-year disease-free survival rates (OR = 0.57; OR = 0.41, respectively) and local recurrence rates (OR = 2.71). CONCLUSIONS The meta-analysis demonstrates that laparoscopic liver resection should be preferred in tumors of size 3-5 cm, while for < 3 cm the long term results are equal.
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Affiliation(s)
- Zhijun Li
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital, Jilin University, Changchun, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Qiong Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xiaozheng Lu
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital, Jilin University, Changchun, China
| | - Yahui Liu
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital, Jilin University, Changchun, China
| | - Bai Ji
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital, Jilin University, Changchun, China
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Selvaraj S, Karan AK, Mao W, Hasan H, Bharali I, Kumar P, Ogbuoji O, Chaudhuri C. Did the poor gain from India's health policy interventions? Evidence from benefit-incidence analysis, 2004-2018. Int J Equity Health 2021; 20:159. [PMID: 34246269 PMCID: PMC8272306 DOI: 10.1186/s12939-021-01489-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Health policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context. Methods Employing Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups. Results Utilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018. Conclusions Improvement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01489-0.
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Affiliation(s)
| | - Anup K Karan
- Indian Institute of Public Health, Gurugram, India
| | - Wenhui Mao
- Centre for Policy Impact in Global Health, Duke University, Durham, NC, 27708, USA
| | - Habib Hasan
- Indian Institute of Public Health, Gurugram, India
| | - Ipchita Bharali
- Centre for Policy Impact in Global Health, Duke University, Durham, NC, 27708, USA
| | - Preeti Kumar
- Public Health Foundation of India, Gurugram, India
| | - Osondu Ogbuoji
- Centre for Policy Impact in Global Health, Duke University, Durham, NC, 27708, USA
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Jin Y, Assanangkornchai S, Du Y, Liu J, Bai J, Yang Y. Measuring and explaining inequality of continuous care for people living with HIV receiving antiretroviral therapy in Kunming, China. PLoS One 2021; 16:e0251252. [PMID: 33974670 PMCID: PMC8112695 DOI: 10.1371/journal.pone.0251252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background In the context of scaling up free antiretroviral therapy (ART), healthcare equality is essential for people living with HIV. We aimed to assess socioeconomic-related inequalities in uptake of continuous care for people living with HIV receiving ART, including retention in care in the last six months, routine toxicity monitoring, adequate immunological and virological monitoring, and uptake of mental health assessment in the last 12 months. We also determined the contributions of socioeconomic factors to the degree of inequalities. Methods A hospital-based cross-sectional survey was conducted among consecutive clients visiting an HIV treatment center in Kunming, China in 2019. Participants were 702 people living with HIV aged ≥18 years (median age: 41.0 years, 69.4% male) who had been on ART for 1–5 years. Socioeconomic-related inequality and its contributing factors were assessed by a normalized concentration index (CIn) with a decomposition approach. Results The uptake of mental health assessment was low (15%) but significantly higher among the rich (CIn 0.1337, 95% CI: 0.0140, 0.2534). Retention in care, toxicity, and immunological monitoring were over 80% but non-significant in favor of the rich (CIn: 0.0117, 0.0315, 0.0736, respectively). The uptake of adequate virological monitoring was 15% and higher among the poor (CIn = -0.0308). Socioeconomic status positively contributed to inequalities of all care indicators, with the highest contribution for mental health assessment (124.9%) and lowest for virological monitoring (2.7%). Conclusions These findings suggest virological monitoring and mental health assessment be given more attention in long-term HIV care. Policies allocating need-oriented resources geared toward improving equality of continuous care should be developed.
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Affiliation(s)
- Yongmei Jin
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- * E-mail:
| | - Yingrong Du
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
| | - Jun Liu
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
| | - Jingsong Bai
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
| | - Yongrui Yang
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
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Jia Q, Chen H, Chen X, Tang Q. Barriers to Low-Dose CT Lung Cancer Screening among Middle-Aged Chinese. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7107. [PMID: 32998298 PMCID: PMC7579028 DOI: 10.3390/ijerph17197107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE The current study aims to explore the barriers for middle-aged Chinese to learn about and uptake low-dose computed tomography (LDCT) lung cancer screening. METHODS Data were collected via an online survey in December 2019. Final valid sample included 640 respondents, aged 40-60 years old, from 21 provinces of China. We performed multiple linear regressions to test the potential barriers to LDCT scan. FINDINGS Cost concerns, distrust in doctors, fears of disease, lack of knowledge, and optimistic bias are negatively associated with the intention to learn about and uptake LDCT scan. IMPLICATIONS Our study contributes to understanding the negative predictors of middle-aged Chinese to get LDCT lung cancer scans. Future campaign programs should help audiences to build comprehensive understandings about lung cancer and LDCT scan. To better promote LDCT scan in China, the government should fund more trial programs continuously and public efforts should be made to rebuild the patient-doctor trust.
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Affiliation(s)
- Qike Jia
- School of Management, Zhejiang University of Technology, Hangzhou 310023, China;
| | - Hongliang Chen
- College of Media and International Culture, Public Diplomacy and Strategic Communication Research Center, Zhejiang University, Hangzhou 310058, China
| | - Xuewei Chen
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, OK 74078, USA;
| | - Qichuan Tang
- College of Media and International Culture, Zhejiang University, Hangzhou 310058, China;
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12
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Yang F, Cao J, Qian D, Ma A. Stronger Increases in Cognitive Functions among Socio-Economically Disadvantaged Older Adults in China: A Longitudinal Analysis with Multiple Birth Cohorts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072418. [PMID: 32252350 PMCID: PMC7177365 DOI: 10.3390/ijerph17072418] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/19/2023]
Abstract
Highly variable changes in cognitive functions occur as people get older, and socio-economically disadvantaged older adults are more likely to suffer from cognitive decline. This study aims to identify the longitudinal trend in cognitive functions among different socio-economic groups of older adults. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) followed up 32,323 individuals aged 65 years and older over a 12-year period. A series of mixed-effects models was used to explicitly assess cohort trend and its socio-economic disparity in the cognitive functions of older adults. Scores for significant increase in cognitive functions by birth cohort were smaller by 0.49, 0.28, and 0.64 among older adults with more educational experience, a lower household income, or economic dependence relative to their counterparts. Scores for differences in cognitive function between older adults with higher and lower incomes were smaller by 0.46 among those living in urban areas than among those living in rural areas. Although there were larger cohort growth trends in cognitive functions among older adults with lower educational attainment, lower household income, and who were economically dependent, effective public intervention targeting these socio-economically disadvantaged populations is still necessary.
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Affiliation(s)
- Fan Yang
- School of International Pharmaceutical Business, China Pharmaceutical University, No.639 Longmian Str, Jiangning District, Nanjing 211198, China;
| | - Jiangling Cao
- School of Health Policy & Management, Nanjing Medical University, 101 Longmian Avenue, Nanjing 210029, China; (J.C.); (D.Q.)
| | - Dongfu Qian
- School of Health Policy & Management, Nanjing Medical University, 101 Longmian Avenue, Nanjing 210029, China; (J.C.); (D.Q.)
| | - Aixia Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, No.639 Longmian Str, Jiangning District, Nanjing 211198, China;
- Correspondence:
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13
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Fan C, Ouyang W, Tian L, Song Y, Miao W. Elderly Health Inequality in China and its Determinants: A Geographical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2953. [PMID: 31426371 PMCID: PMC6719074 DOI: 10.3390/ijerph16162953] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/20/2019] [Accepted: 07/31/2019] [Indexed: 11/16/2022]
Abstract
Inter-regional health differences and apparent inequalities in China have recently received significant attention. By collecting health status data and individual socio-economic information from the 2015 fourth sampling survey of the elderly population in China (4th SSEP), this paper uses the geographical differentiation index to reveal the spatial differentiation of health inequality among Chinese provinces. We test the determinants of inequalities by multilevel regression models at the provincial and individual levels, and find three main conclusions: 1) There were significant health differences on an inter-provincial level. For example, provinces with a very good or good health rating formed a good health hot-spot region in the Yangtze River Delta, versus elderly people living in Gansu and Hainan provinces, who had a poor health status. 2) Nearly 2.4% of the health differences in the elderly population were caused by inter-provincial inequalities; access (or lack of access) to economic, medical and educational resources was the main reason for health inequalities. 3) At the individual level, inequalities in annual income served to deepen elderly health differences, and elderly living in less developed areas were more vulnerable to urban vs. rural-related health inequalities.
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Affiliation(s)
- Chenjing Fan
- School of Architecture, Tsinghua University, Beijing 100084, China
- College of Landscape Architecture, Nanjing Forestry University, Nanjing 210037, China
| | - Wei Ouyang
- School of Public Administration, Renmin University of China, Beijing 100872, China
| | - Li Tian
- School of Architecture, Tsinghua University, Beijing 100084, China.
| | - Yan Song
- Department of City and Regional Planning, University of North Carolina at Chapel Hill, NC 27599-3140, USA
| | - Wensheng Miao
- China Research Center on Aging, Beijing 100054, China
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14
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Song H, Zuo X, Cui C, Meng K. The willingness of patients to make the first visit to primary care institutions and its influencing factors in Beijing medical alliances: a comparative study of Beijing's medical resource-rich and scarce regions. BMC Health Serv Res 2019; 19:361. [PMID: 31174523 PMCID: PMC6556011 DOI: 10.1186/s12913-019-4184-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve the efficiency of the use of medical resources, China has implemented medical alliances (MAs) to implement a hierarchical diagnosis and treatment system. The willingness to undertake a first visit to primary care institutions (PCIs) is an important indicator of the effect of this system. Beijing has also built MAs since 2013, but to date, there have been few studies on the first visit to PCIs in Beijing. The purpose of this study is to analyze patients' willingness to make their first visit to PCIs and its influencing factors to provide references for the realization of a hierarchical diagnosis and treatment system. METHODS Two relatively different districts with large differences in resources in Beijing, D and F, were selected, and a self-reported questionnaire and convenience sampling method were applied. A cross-sectional survey was administered to 1221 patients of MAs. The chi-square test and binary logistic regression were used to analyze the influencing factors of patients' willingness to undertake a first visit to a PCI. RESULTS Fewer patients in District D received medical alliance services (44.42%) than those in District F (59.25%), but patients in District D had a higher degree of satisfaction with the services they received (72.04%) than those in District F (28.96%). Patients in District D had a higher willingness to undertake a first visit (64.00%) than those in District F (58.18%). Patients of an older age, low medical expenses, participation in urban employees' basic medical insurance, a high understanding of MAs and high satisfaction with medical services were indicators of being more willing to choose primary care institutions for their first visit. CONCLUSIONS The different medical resources and MA constructions in the two districts have resulted in a difference between the two districts in terms of the willingness of individuals to make their first visit to PCIs. Strengthening the service capabilities of PCIs remains a priority. The government should propose solutions to solve the problems encountered in practice and actively promote the realization of MAs and hierarchical diagnosis and treatment.
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Affiliation(s)
- Haiyan Song
- Department of Social Medicine and Health Management, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Xu Zuo
- Department of Social Medicine and Health Management, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Chengsen Cui
- Department of Social Medicine and Health Management, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Kai Meng
- Department of Social Medicine and Health Management, School of Public Health, Capital Medical University, Beijing, 100069, China.
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Tang Y, Liu C, Liu J, Zhang X, Zuo K. Effects of County Public Hospital Reform on Procurement Costs and Volume of Antibiotics: A Quasi-Natural Experiment in Hubei Province, China. PHARMACOECONOMICS 2018; 36:995-1004. [PMID: 29671132 PMCID: PMC6021466 DOI: 10.1007/s40273-018-0654-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The overuse of antibiotics has become a major public health challenge worldwide, especially in low- and middle-income countries, including China. In 2009, the Chinese government launched a series of measures to de-incentivise over-prescription in public health facilities, including decoupling the link between facility income and the sale of medicines. OBJECTIVES We evaluated the effects of these measures on procurement costs and the volume of antibiotics in county public hospitals. METHODS The study was undertaken in the Hubei province of China, where 64 county public hospitals implemented the reform in sequence at three different stages. A quasi-natural experiment design was employed. We performed generalised linear regressions with a difference-in-differences approach using 22,713 procurement records of antibiotics from November 2014 to December 2016. RESULTS The regression results showed that the reform contributed to a 14.79% increase in total costs for antibiotics (p = 0.013), particularly costs for injectable antibiotics (p = 0.022) and first-line antibiotics (p = 0.030). The procurement prices for antibiotics remained largely comparable to those in the control group, but the reform led to a 17.30% increase in the procurement volume (expressed as defined daily doses) of second-line antibiotics (p = 0.032). CONCLUSIONS County public hospitals procured more antibiotics and greater numbers of expensive antibiotics, such as those administered via injection, to compensate for the loss of income from the sale of medicines, leading to an increased total cost of antibiotics.
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Affiliation(s)
- Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Melbourne, VIC, 3086, Australia
| | - Junjie Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Keyuan Zuo
- Hubei Public Resource Trading Center, No. 252 Zhongbei Road, Wuhan, 430030, People's Republic of China.
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16
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Qin W, Xu L, Li J, Sun L, Ding G, Shao H, Xu N. Estimating benefit equity of government health subsidy in healthcare Services in Shandong Province, China: a cross-sectional study. Int J Equity Health 2018; 17:61. [PMID: 29776366 PMCID: PMC5960158 DOI: 10.1186/s12939-018-0775-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/08/2018] [Indexed: 11/11/2022] Open
Abstract
Background Government health subsidy (GHS) is an effective tool to improve population health in China. Ensuring an equitable allocation of GHS, particularly among the poorer socio-economic groups, is a major goal of China’s healthcare reform. The paper aims to explore how GHS was allocated across different socioeconomic groups, and how well the overall health system was performing in terms of the allocation of subsidy for different types of health services. Methods Data from China’s National Health Services Survey (NHSS) in 2013 were used. Benefit incidence analysis (BIA) was applied to examine if GHS was equally distributed across income quintile. Benefit incidence was presented as each quintile’s percentage share of total benefits, and the concentration index (CI) and Kakwani index (KI) were calculated. Health benefits from three types of healthcare services (primary health care, outpatient and inpatient services) were analyzed, separated into urban and rural populations. In addition, the distribution of benefits was compared to the distribution of healthcare need (measured by self-reported illness and chronic disease) across income quintiles. Results In urban populations, the CI value of GHS for primary care was negative. (− 0.14), implying an allocation tendency toward poor region; the CI values of outpatient and inpatient services were both positive (0.174 and 0.194), indicating allocation tendencies toward rich region. Similar allocation pattern was observed in rural population, with pro-poor tendency of primary care service (CI = − 0.082), and pro-rich tendencies of outpatient (CI = 0.153) and inpatient services (CI = 0.203). All the KI values of three health services in urban and rural populations were negative (− 0.4991,-0.1851 and − 0.1651; − 0.482, − 0.247and − 0.197), indicating that government health subsidy was progressive and contributed to the narrowing of economic gap between the poor and rich. Conclusions The inequitable distribution of GHS in China exited in different healthcare services; however, the GHS benefit is generally progressive. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.
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Affiliation(s)
- Wenzhe Qin
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China
| | - Lingzhong Xu
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China.
| | - Jiajia Li
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China
| | - Long Sun
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China
| | - Gan Ding
- Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China
| | - Hui Shao
- Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Ningze Xu
- Key Lab of Health Technology Assessment, National Health Commission of the Peoples Republic of China, School of Public Health, Fudan University, Shanghai, China
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Chen M, Qian D, Feng Z, Si L. Is outpatient care benefit distribution of government healthcare subsidies equitable in rural ethnic minority areas of China? Results from cross-sectional studies in 2010 and 2013. BMJ Open 2018; 8:e019564. [PMID: 29431138 PMCID: PMC5829884 DOI: 10.1136/bmjopen-2017-019564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Government healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China's rural ethnic minority areas. SETTING Inner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province. DESIGN Two rounds of cross-sectional study. PARTICIPANTS One thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed. METHODS Benefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified samples were conducted. FINDINGS The overall CI for outpatient care was -0.0146 (P>0.05) in 2010 and -0.0992 (P<0.01) in 2013. In 2010, the CI was -0.0537 (P<0.01), -0.0085 (P>0.05) and -0.0034 (P>0.05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was -0.1353 (P<0.05), -0.0695 (P>0.05) and -0.1633 (P<0.01) at the levels of VCs, THCs and CHs, respectively. CONCLUSION Implementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients' care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution.
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Affiliation(s)
- Mingsheng Chen
- Department of Public Administration, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Institute of Healthy Jiangsu Construction and Development, Nanjing, China
| | - Dongfu Qian
- Department of Public Administration, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Institute of Healthy Jiangsu Construction and Development, Nanjing, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Si
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
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