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Wei H, Jiang K, Zhao Y, Pu C. Equity of health resource allocation in Chongqing, China, in 2021: a cross-sectional study. BMJ Open 2024; 14:e078987. [PMID: 38238051 PMCID: PMC10806633 DOI: 10.1136/bmjopen-2023-078987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Chongqing, the most populous city in Southwest China. This study aims to examine the equity of health resource allocation in Chongqing using the latest statistics, analyse possible shortcomings and propose strategies to address these issues. METHODS This cross-sectional study used healthcare resource, population, area and gross domestic product data from the Seventh National Census Bulletin of Chongqing, the National County Statistical Yearbook, the Chongqing Municipal Bureau of Statistics and the Chongqing Health Statistical Yearbook 2022. We also studied the equity of health resource allocation in Chongqing by using the Gini coefficient, Lorenz curve and Theil index, and used the Analytical Hierarchy Process and Technique for Order of Preference by Similarity to Ideal Solution (AHP-TOPSIS) method to comprehensively evaluate the health resources in the four major regions of Chongqing. RESULTS The Gini coefficient of health resources in Chongqing in 2021 was the highest when allocated according to geographical area, between 0.4285 and 0.6081, both of which exceeded 0.4, and the Gini coefficient of medical equipment was the highest and exceeded 0.6. The inter-regional Theil index of each resource was greater than the intraregional Theil index, and the contribution of inter-regional differences ranged from 64.83% to 80.21%. The results of the AHP-TOPSIS method showed that the relative proximity between health resources and ideal solutions in four regions of Chongqing ranged from 0.0753 to 0.9277. CONCLUSION The allocation of health resources in Chongqing exhibits pronounced inequities, particularly in the distribution of medical equipment according to geographical area. Moreover, there exists a substantial gap in the equity of health resource allocation among the four regions of Chongqing. As such, this study emphasises the need for Chongqing, China, to prioritise the equitable allocation of health resources and increase consideration of geographic factors. Implementing measures to promote equitable allocation of health resources, particularly in geographic terms, is critical.
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Affiliation(s)
- Hao Wei
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Center for early warning of health-related major social risks Chongqing Medical University sub center, Chongqing, China
| | - Ke Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Yong Zhao
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Pu
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Center for early warning of health-related major social risks Chongqing Medical University sub center, Chongqing, China
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Shao Q, Yuan J, Ma J, Ding H, Huang W. Exploring the determinants of synergetic development of social organizations participating in home-based elderly care service: An SEM method. PLoS One 2020; 15:e0244880. [PMID: 33382827 PMCID: PMC7775099 DOI: 10.1371/journal.pone.0244880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
The current aging service industry has problems in meeting the ever-increasing demand for the home-based elderly care service (HECS). Social organizations participating in HECS seems to be a promising way to address these problems but also raises new challenges, like uncoordinated cooperation among stakeholders, which could lead to low management efficiency and low service quality. However, Synergetic development can be promising to enhance the participation of social organizations and to improve social welfare. This study introduces a conceptual model to explore relationships between five determinants and synergetic development of social organizations participating in HECS. A structural equation model (SEM) based on questionnaire survey is used as a test methodology. The results indicated that stakeholder engagement plays a critical role in synergetic development in HECS, resource allocation can only be improved by institutional climate, and supervision capacity cannot facilitate information sharing. This study provides effective strategies and directions for the improvement of home-based elderly care services.
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Affiliation(s)
- Qiuhu Shao
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Jingfeng Yuan
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Junwei Ma
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Hongxing Ding
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Wei Huang
- School of Civil Engineering, Sanjiang University, Nanjing, Jiangsu Province, P. R. China
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Kumar P, Dhillon P. Structural equation modeling on the relationship between maternal characteristics and pregnancy complications: A study based on National Family Health Survey. J Obstet Gynaecol Res 2020; 47:592-605. [PMID: 33191654 DOI: 10.1111/jog.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/12/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to understand the complex relationship between maternal complications and women's characteristics in India. METHODS The present study builds structural equation modeling (SEM) using the data from the National Family Health Survey round 4 (2015-16) and includes 190, 898 women who had given their last birth during 5 years preceding the survey. Based on eight questions related to maternal complications, the SEM constructed two latent variables - complications during pregnancy (PREGCOMP) and delivery (DELCOMP). RESULTS Result shows that prolonged labor was highly prevalent (42%) among women, followed by vaginal bleeding (34%) and swelling in legs, body or face (32%). Women from affluent households (β = -0.02 for each-middle, richer and richest quantile), with higher education (β = -0.02), timing when they received first ANC (β = -0.003) and women who received full ANC (β = -0.01) had a lower risk of PREGCOMP. However, consanguineous marriage (β = 0.01) was positively related to PREGCOMP. Further, women with PREGCOMP (β = 0.20), rural residents (β = 0.02), having exposure to mass media (β = 0.01), and who had facility delivery (β = 0.04) were at high risk of DELCOMP. Women with pregnancy complications are more likely to have delivery complications. [Correction added on 27 November, after first online publication: The statement "who received full antenatal care (ANC) (β = -0.05)" has been removed.] CONCLUSION: Socioeconomic and demographic factors significantly affect both the latent variables. This study concludes that the use of intensive healthcare services reduces health complications. The paper recommends early visits and full ANC checkups to reduce pregnancy complications.
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Affiliation(s)
- Pradeep Kumar
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Preeti Dhillon
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
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Purnama SG, Susanna D. Attitude to COVID-19 Prevention With Large-Scale Social Restrictions (PSBB) in Indonesia: Partial Least Squares Structural Equation Modeling. Front Public Health 2020; 8:570394. [PMID: 33194970 PMCID: PMC7661637 DOI: 10.3389/fpubh.2020.570394] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/28/2020] [Indexed: 12/17/2022] Open
Abstract
There is a continuous increase in the number of COVID-19 cases in Indonesia. To control its spread, the government has implemented several strategies, such as policies associated with large-scale social restrictions (Indonesian: Pembatasan Sosial Berskala Besar or PSBB). The purpose of this study is to determine the variables that influence attitudes toward PSBB policies in Indonesia. This is a cross-sectional study with data obtained from 856 respondents from all provinces in Indonesia using the partial least squares and structural equation model (PLS-SEM). A total of 23 indicators were used to examine these policies, which were grouped into five variables: benefits of the PSBB (5 indicators), positive perception (5 indicators), negative perception (3 indicators), threatened perceptions of COVID-19 (5 indicators), and attitude toward the PSBB policy (5 indicators). The model explains over 50% of attitudes exhibited toward PSBB policy implementation and how it is influenced by the perceived benefits, negative and positive perceptions as well as the threat associated with COVID-19. The policy of stay at home, physical distancing, and always using face masks needs to be continued for the public to have a supportive attitude of the PSBB policy in preventing the transmission of COVID-19.
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Affiliation(s)
- Sang Gede Purnama
- Doctoral Program in Public Health, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Dewi Susanna
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
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Perceived Impact of Taiwan's National Health Insurance Allocation Strategy: Health Professionals' Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030467. [PMID: 30764553 PMCID: PMC6388230 DOI: 10.3390/ijerph16030467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 11/17/2022]
Abstract
Studies on health care demand have indicated high levels of public satisfaction with Taiwan’s National Health Insurance (NHI). However, the global budget allocation mechanism (GBAM) used by NHI has led to various adjustments in the providers’ way of practice, quality of care, utilization of care, and health expenditure. Studies focusing on the satisfaction of providers with health care supply, however, remain limited. We therefore explored the provider’s perceived impact of the NHI allocation plan. A cross-sectional data of 299 health professionals was collected at Taipei Medical University Hospitals in April 2012. Perceptions and attitudes were assessed using a validated 5-point Likert-type questionnaire before using a structural equation modeling technique to explore the complex interrelationships of the NHI’s perceived impact. The causal path relationships between the latent variables ‘characteristics of NHI’s allocation plan’ and ‘perceived positive effect’ (β = 0.39), ‘perceived positive effect’ and ‘satisfaction of health professionals’ (β = 0.53), and between ‘characteristics of NHI’s allocation plan’ and ‘satisfaction of health professionals’ (β = 0.30) were positively associated; while the path relationships between the latent variables ‘perceived negative effect’ and ‘satisfaction of health professionals’ (β = −0.27) and ‘characteristics of NHI’s allocation plan’ and ‘attitude toward allocation criteria’ (β = −0.22) were negatively associated. These results indicate that providers perceived a positive impact of the NHI allocation strategy. The NHI allocation plan is an important decision-making tool among policy makers since it helps optimize outcomes. Research based on its impact at both horizontal and vertical levels on the supply side may be useful towards understanding Taiwan’s GBAM. Policy-makers should therefore consider understanding the impact of GBAM at both the demand and supply side in adjusting allocation criteria.
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Ndwiga C, Warren CE, Ritter J, Sripad P, Abuya T. Exploring provider perspectives on respectful maternity care in Kenya: "Work with what you have". Reprod Health 2017; 14:99. [PMID: 28830492 PMCID: PMC5567891 DOI: 10.1186/s12978-017-0364-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/10/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Promoting respect and dignity is a key component of providing quality care during facility-based childbirth and is becoming a critical indicator of maternal health care. Providing quality care requires essential skills and attitudes from healthcare providers, as their role is central to optimizing interventions in maternity settings. METHODS In 13 facilities in Kenya we conducted a mixed methods, pre-post study design to assess health providers' perspectives of a multi-component intervention (the Heshima project), which aimed to mitigate aspects of disrespect and abuse during facility-based childbirth. Providers working in maternity units at study facilities were interviewed using a two-part quantitative questionnaire: an interviewer-guided section on knowledge and practice, and a self-administered section focusing on intrinsic value systems and perceptions. Eleven distinct composite scores were created on client rights and care, provider emotional wellbeing, and work environments. Bivariate analyses compared pre- and post-scores. Qualitative in-depth interviews focused on underlying factors that affected provider attitudes and behaviors including the complexities of service delivery, and perceptions of the Heshima interventions. RESULTS Composite scales were developed on provider knowledge of client rights (Chronbach α = 0.70), client-centered care (α = 0.80), and HIV care (α = 0.81); providers' emotional health (α = 0.76) and working relationships (α = 0.88); and provider perceptions of management (α = 0.93), job fairness (α = 0.68), supervision (α = 0.84), promotion (α = 0.83), health systems (α = 0.85), and work environment (α = 0.85). Comparison of baseline and endline individual item scores and composite scores showed that provider knowledge of client rights and practice of a rights-based approach, treatment of clients living with HIV, and client-centered care during labor, delivery, and postnatal periods improved (p < 0.001). Changes in emotional health, perceptions of management, job fairness, supervision, and promotion seen in composite scores did not directly align with changes in item-specific responses. Qualitative data reveal health system challenges limit the translation of providers' positive attitudes and behaviors into implementation of a rights-based approach to maternity care. CONCLUSION Behavior change interventions, central to promoting respectful care, are feasible to implement, as seen in the Heshima experience, but require sustained interaction with health systems where providers practice. Provider emotional health has the potential to drive (mis)treatment and affect women's care.
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Affiliation(s)
| | - Charlotte E Warren
- Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008, USA
| | - Julie Ritter
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pooja Sripad
- Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008, USA
| | - Timothy Abuya
- Population Council, PO Box 17643-00500, Nairobi, Kenya
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Owili PO, Muga MA, Chou YJ, Hsu YHE, Huang N, Chien LY. Relationship between women's characteristics and continuum of care for maternal health in Kenya: Complex survey analysis using structural equation modeling. Women Health 2016; 57:942-961. [PMID: 27613111 DOI: 10.1080/03630242.2016.1222327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study was to understand and estimate the complex relationships in the continuum of care for maternal health to provide information to improve maternal and newborn health outcomes. Women (n = 4,082) aged 15-49 years in the 2008/2009 Kenya Demographic and Health Survey data were used to explore the complex relationships in the continuum of care for maternal health (i.e., before, during, and after delivery) using structural equation modeling. Results showed that the use of antenatal care was significantly positively related to the use of delivery care (β = 0.06; adjusted odds ratio [AOR] = 1.06; 95% confidence interval [CI]: 1.02-1.10) but not postnatal care, while delivery care was associated with postnatal care (β = 0.68; AOR = 1.97; 95% CI: 1.75-2.22). Socioeconomic status was significantly related to all elements in the continuum of care for maternal health; barriers to delivery of care and personal characteristics were only associated with the use of delivery care (β = 0.34; AOR = 1.40; 95% CI: 1.30-1.52) and postnatal care (β = 0.03; AOR = 1.03; 95% CI: 1.01-1.05), respectively. The three periods of maternal health care were related to each other. Developing a referral system of continuity of care is critical in the Sustainable Development Goals era.
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Affiliation(s)
- Patrick Opiyo Owili
- a International Health Program, Institute of Public Health, School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Miriam Adoyo Muga
- b Institute of Community Health and Development , Great Lakes University of Kisumu , Kisumu , Kenya
| | - Yiing-Jenq Chou
- c Institute of Public Health, School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Yi-Hsin Elsa Hsu
- d School of Health Care Administration , Taipei Medical University , Taipei , Taiwan
| | - Nicole Huang
- e Institute of Hospital and Health Care Administration , National Yang-Ming University , Taipei , Taiwan
| | - Li-Yin Chien
- f Institute of Clinical and Community Health Nursing , National Yang-Ming University , Taipei , Taiwan
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Owili PO, Muga MA, Chou YJ, Hsu YHE, Huang N, Chien LY. Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries. BMC Public Health 2016; 16:414. [PMID: 27188624 PMCID: PMC4869316 DOI: 10.1186/s12889-016-3075-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/29/2016] [Indexed: 11/29/2022] Open
Abstract
Background Despite the progress in the Millennium Development Goals (MDGs) 4 and 5, inequity in the utilization of maternal, newborn and child health (MNCH) care services still remain high in sub-Saharan Africa (SSA). The continuum of care for MNCH that recognizes a tight inter-relationship between maternal, newborn and child health at different time periods and location is key towards reducing inequity in health. In this study, we explored the distributions in the utilization MNCH services in 12 SSA countries and further investigated the associations in the continuum of care for MNCH. Methods Using Demographic and Health Surveys data of 12 countries in SSA, structural equation modeling approach was employed to analyze the complex relationships in continuum of care for MNCH model. The Full Information Maximum Likelihood estimation procedure which account for the Missing at Random (MAR) and Missing Completely at Random (MCAR) assumptions was adopted in LISREL 8.80. The distribution of MNCH care utilization was presented before the estimated association in the continuum of care for MNCH model. Results Some countries have a consistently low (Mali, Nigeria, DR Congo and Rwanda) or high (Namibia, Senegal, Gambia and Liberia) utilization in at least two levels of MNCH care. The path relationships in the continuum of care for MNCH from ‘adequate antenatal care’ to ‘adequate delivery care’ (0.32) and to ‘adequate child’s immunization’ (0.36); from ‘adequate delivery care’ to ‘adequate postnatal care’ (0.78) and to ‘adequate child’s immunization’ (0.15) were positively associated and statistically significant at p < 0.001. Only the path relationship from ‘adequate postnatal care’ to ‘adequate child’s immunization’ (−0.02) was negatively associated and significant at p < 0.001. Conclusions In conclusion, utilization of each level of MNCH care is related to the next level of care, that is – antenatal care is associated with delivery care which is then associated with postnatal and subsequently with child’s immunization program. At the national level, identification of communities which are greatly contributing to overall disparity in health and a well laid out follow-up mechanism from pregnancy through to child’s immunization program could serve towards improving maternal and infant health outcomes and equity.
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Affiliation(s)
- Patrick Opiyo Owili
- International Health Program, Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Miriam Adoyo Muga
- Institute of Community Health and Development, Great Lakes University of Kisumu, Kisumu, Kenya
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yi-Hsin Elsa Hsu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yin Chien
- Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan
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