1
|
He Y, Wang P, Du Y, Li H, Chen Y, Zhu J. Policy perception, job satisfaction and intentions to remain in rural area: evidence from the National Compulsory Service Programme in China. Glob Health Res Policy 2024; 9:16. [PMID: 38689363 PMCID: PMC11059768 DOI: 10.1186/s41256-024-00348-z] [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: 08/15/2023] [Accepted: 03/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Exploring factors that may influence general practitioners (GPs)' intentions to remain in rural area is necessary to inform the training and placement of future medical workforce in rural area. However, little is known about how GPs' perception towards the National Compulsory Service Programme (NCSP) and job satisfaction impact their turnover intention. This paper explores GPs' intentions to remain in rural China and how their policy perception and job satisfaction predict the intentions. METHODS We conducted a cross-sectional, online survey from December 2021 to February 2022 to investigate GPs' perception towards NCSP, job satisfaction, and intentions to remain in rural area. Eligible participants were GPs who were required to provide health services as part of NCSP at township health centres of 9 provinces which could represent all NCSP GPs in China. Multinomial logistic regression analyses were performed to explore the associations between policy perceptions, job satisfaction, and intentions to remain. RESULTS Of 3615 GPs included in the analysis, 442 (12.2%) would like to remain in rural area and 1266 (35.0%) were unsure. Results of the multinomial logistic regression analyses showed that compared with GPs who would leave, GPs with higher perception scores for the restriction on taking postgraduate exam (RRR: 1.93, 95% CI 1.72, 2.16) and the commitment to work for six years (RRR: 1.53, 95% CI 1.31, 1.78) were more likely to remain. In contrast, GPs who had higher perception scores for completing standardised residency training (RRR: 0.75, 95% CI 0.64, 0.88) and passing National Medical Licensing Examinations (RRR: 0.74, 95% CI 0.62, 0.87) were more likely to leave. GPs who were satisfied with the freedom of choosing work methods (RRR: 1.52, 95% CI 1.25, 1.84) and chances of promotion (RRR: 1.60, 95% CI 1.32, 1.94) were more likely to remain. CONCLUSIONS This study highlights the significance of policy perception and job satisfaction on GPs' intentions to remain in rural area. Factors such as career advancement and the empowerment of GPs to build on and use their skills and abilities should be taken into account when designing rural placement programmes.
Collapse
Affiliation(s)
- Yanrong He
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Yanrong Du
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Hange Li
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Yanhua Chen
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
- School of Medicine, Tsinghua University, Beijing, China.
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
| |
Collapse
|
2
|
Zhang Y. Does Participating in New Rural Cooperative Medical Insurance Change Catastrophic Health Expenditure? Evidence from the China Household Income Project. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241251747. [PMID: 38679801 DOI: 10.1177/27551938241251747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
A primary goal of the New Rural Cooperative Medical Insurance (NRCMI) is to provide financial protection against health care costs and alleviate the financial burdens of rural residents in China. This article examines whether NRCMI participation impacted the incidence of catastrophic health expenditure (CHE) among middle-aged and older adults (45 years old and above). The analysis utilized data from the 2007 China Household Income Project survey in rural areas and an instrumental variable estimation method in Anhui and Sichuan provinces, which exhibited heterogeneity in the NRCMI implementation schedule. The results show that NRCMI participation was not associated with changes in the CHE incidence among families. The finding is consistent with the prior literature using quasi-experimental study designs. This study provides empirical evidence for policymakers, highlighting that the impact of NRCMI participation on financial protections is limited despite its extensive population coverage. The limited effects are probably due to the low reimbursement rate and increased utilization of expensive health care services.
Collapse
Affiliation(s)
- Yalu Zhang
- School of Social Welfare, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
3
|
Lin L, Zai X. Assessing the impact of public insurance on healthcare utilization and mortality: A nationwide study in China. SSM Popul Health 2024; 25:101615. [PMID: 38322784 PMCID: PMC10844660 DOI: 10.1016/j.ssmph.2024.101615] [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: 11/09/2023] [Revised: 12/29/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
We investigate the effects of a significant health insurance expansion in rural China known as the New Cooperative Medical Scheme (NCMS). Our analysis is based on a nationwide dataset spanning from 2004 to 2011. We find that the NCMS effectively increases healthcare utilization, particularly inpatient admissions, and reduces the incidence for infectious diseases. In addition to the increased healthcare utilization, the reduction in the incidence for infectious diseases can be attributed to improved health knowledge and health behavior, both of which are associated with the expansion of insurance coverage. Our findings affirm the importance of insurance coverage in safeguarding low-income individuals from the adverse health consequences linked to infectious diseases.
Collapse
Affiliation(s)
- Lin Lin
- School of Public Management, East China Normal University, Shanghai, China
| | - Xianhua Zai
- Department of Labor Demography, Max Planck Institute for Demographic Research, Rostock, Germany
- Max Planck – University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland
| |
Collapse
|
4
|
Fang G, Li X, Tang T. Growing up without health insurance: Evidence from rural China. HEALTH ECONOMICS 2024; 33:363-390. [PMID: 37933917 DOI: 10.1002/hec.4778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/20/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
This paper examines the long-term effects of health insurance on children's educational attainment in a developing country. Utilizing the county-by-county rollout of the New Rural Cooperative Medical Scheme in rural China, we find that exposure to the health insurance program in early life leads to improved educational attainment in adulthood. Empirical tests suggest that a short-term increase in health care utilization is unlikely to be a potential channel. We provide some evidence for the channel that health insurance reduces household financial burdens and increases household expenditure on children's nutrition.
Collapse
Affiliation(s)
- Guanfu Fang
- School of Business, Shanghai University of International Business and Economics, Shanghai, China
| | - Xin Li
- School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai, China
| | - Tianyu Tang
- School of Economics, Central University of Finance and Economics, Beijing, China
| |
Collapse
|
5
|
Li Z, Chen Y, Ding J. Health Poverty Alleviation Project in Rural China: Impact on Poverty Vulnerability, Health Status, Healthcare Utilization, Health Expenditures. Risk Manag Healthc Policy 2023; 16:2685-2702. [PMID: 38095012 PMCID: PMC10716013 DOI: 10.2147/rmhp.s438352] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/02/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND China has lead to the inception of the Health Poverty Alleviation Project (HPAP) in 2015. While the previous studies suggest that, despite its apparent reduction in patients' financial strain, the long-term poverty reduction effects are yet to be fully elucidated. This study explores HPAP's enduring impact on poverty reduction and the potential moral hazards. METHODS Data were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011-2018. We employed difference-in-differences (DID) models to gauge HPAP's influence on participants' poverty vulnerability, health outcomes, and healthcare utilization. The dynamic DID model is employed to test the robustness of HPAP policy effects. The mediation effect models were used to understand HPAP policy outcomes through physical examinations and inpatient care. RESULTS Our dataset encompassed 40,384 participants, of which 5946 (14.72%) had been exposed to HPAP and 34,438 (85.28%) had not access. Our findings reveal that HPAP decreases poverty vulnerability by 3.3% (p < 0.01) and attenuates health deterioration by 1.84% (p < 0.01). Furthermore, HPAP enhances inpatient care utilization by 9.34% (p < 0.01) and self-treatment behaviors by 4.1% (p < 0.01) while significantly slashing outpatient and inpatient expenses (p < 0.05). The implementation of HPAP has significantly reduced healthcare costs by 72.8% (p < 0.05) out-of-pocket (OOP) payments of outpatient care during the past month for the last time, and 89.39% (p < 0.05) out-of-pocket (OOP) payments of inpatient care during past the year for the last time. Mechanistic analyses have shown that the indirect effect of the HPAP policy decreases poverty vulnerability by -0.132% (p < 0.05) physical examinations and -0.309% (p < 0.05) inpatient care. CONCLUSION The HPAP initiative markedly attenuates poverty vulnerability and forestalls health decline among the rural populace. Moreover, HPAP bolsters healthcare service use, such as physical examinations and inpatient care, primarily attributed to the release of pent-up demand rather than moral hazards.
Collapse
Affiliation(s)
- Zhipeng Li
- Qu Qiubai School of Government, Changzhou University, Changzhou City, People’s Republic of China
| | - Yuqian Chen
- School of Economics and Management, Shanghai University of Political Science and Law, Shanghai, People’s Republic of China
| | - Jing Ding
- School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai, People’s Republic of China
| |
Collapse
|
6
|
Li Z, Chen Y, Ding J. Impact of health insurance equity on poverty vulnerability: evidence from urban-rural health insurance integration in rural China. Front Public Health 2023; 11:1328265. [PMID: 38106900 PMCID: PMC10722085 DOI: 10.3389/fpubh.2023.1328265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Background In 2016, the Chinese government introduced an integration reform of the health insurance system with the aim to enhance equity in healthcare coverage and reduce disparities between urban and rural sectors. The gradual introduction of the policy integrating urban and rural medical insurance in pilot cities provides an opportunity to evaluate the policy impact. This study attempts to assess the policy impact of urban-rural health insurance integration on the chronic poverty of rural residents and to analyze the mechanisms. Method Based on the four waves of data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018, we employed a staggered difference-in-differences (staggered DID) model to assess the impact of integrating urban-rural health insurance on poverty vulnerability among rural inhabitants and a mediation model to analyze the mechanism channel of the policy impact. Results (1) Baseline regression analysis revealed that the urban-rural health insurance integration significantly reduced the poverty vulnerability of rural residents by 6.32% (p < 0.01). The one health insurance system with one unified scheme of contributions and benefits package (OSOS, 6.27%, p < 0.01) is more effective than the transitional one health insurance system with multiple schemes (OSMS, 3.25%, p < 0.01). (2) The heterogeneity analysis results showed that the urban-rural health insurance integration had a more significant impact on vulnerable groups with relatively poor health (7.84%, p < 0.1) than those with fairly good health (6.07%, p < 0.01), and it also significantly reduced the poverty vulnerability of the group with chronic diseases by 9.59% (p < 0.01). The integration policy can significantly reduce the poverty vulnerability of the low consumption and low medical expenditure groups by 8.6% (p < 0.01) and 7.64% (p < 0.01), respectively, compared to their counterparts. (3) The mechanism analysis results showed that the urban-rural health insurance integration can partially enhance labor supply (14.23%, p < 0.01) and physical examinations (6.28%, p < 0.01). The indirect effects of labor supply and physical examination in reducing poverty vulnerability are 0.14%, 0.13% respectively. Conclusion The urban-rural health insurance integration policy significantly reduced poverty vulnerability, and the OSOS is more effective than the OSMS. The urban-rural health insurance integration policy can significantly reduce poverty vulnerability for low consumption and poor health groups. Labor supply and physical examination are indirect channels of the impact. Both channels potentially increase rural household income and expectations of investment in human health capital to achieve the policy objective of eliminating chronic poverty.
Collapse
Affiliation(s)
- Zhipeng Li
- Qu Qiubai School of Government, Changzhou University, Changzhou, China
| | - Yuqian Chen
- School of Economics and Management, Shanghai University of Political Science and Law, Shanghai, China
| | - Jing Ding
- School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai, China
| |
Collapse
|
7
|
Liu C, Qiu L, Wang H. Willingness rate of the first visit to primary healthcare services and the associated factors in China: a meta-analysis. Aust J Prim Health 2022; 28:459-468. [PMID: 35858635 DOI: 10.1071/py21296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In September 2015, the State Council of China issued guidelines on building a hierarchical medical system, stating that the first visit rate to primary healthcare (PHC) facilities should be increased to 70% for all medical facilities by 2017. This meta-analysis aims to estimate the willingness of the first visit to PHC services in China after the year 2015 and identify its determinants. METHODS A meta-analysis was conducted. RESULTS The combined estimate from 23 studies in China for the willingness rate of the first visit to PHC services was 56% (95% CI: 47-65). Chronic diseases may be one source of heterogeneity. We identified five main associated factors with the pooled odds ratio ranging from 1.39 to 10.28, including fair self-reported health status; high understanding of service content; good service attitude; solid expertise and advanced diagnostic methods; and a good medical environment. CONCLUSION In comparison with China's State Council recommendations, the willingness rate for the first visit to PHC services was significantly lower. The Government should develop strategies to facilitate the implementation of a hierarchical system for diagnosis and treatment.
Collapse
Affiliation(s)
- Chong Liu
- Research Institute of Management Science, Hohai University, No. 8 Fucheng West Road, Jiangning District, Nanjing 211100, Jiangsu, China; and Personnel Department, Nanjing University of Finance and Economics, No. 3 Wenyuan Road, Xianlin Street, Qixia District, Nanjing 210023, Jiangsu, China
| | - Lei Qiu
- Research Institute of Management Science, Hohai University, No. 8 Fucheng West Road, Jiangning District, Nanjing 211100, Jiangsu, China
| | - Huimin Wang
- Research Institute of Management Science, Hohai University, No. 8 Fucheng West Road, Jiangning District, Nanjing 211100, Jiangsu, China; and State Key Laboratory of Hydrology-Water Resources and Hydraulic Engineering, Hohai University, No. 1 Xikang Road, Gulou District, Nanjing 210098, Jiangsu, China
| |
Collapse
|
8
|
Cao N, Li X, Jiang J, Xu W. The effect of basic medical insurance on the changes of primary care seeking behavior: An application of hierarchical age-period-cohort analysis. Front Public Health 2022; 10:929896. [PMID: 35991071 PMCID: PMC9382404 DOI: 10.3389/fpubh.2022.929896] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/05/2022] [Indexed: 12/05/2022] Open
Abstract
In order to encourage residents to go to primary care facilities, China has set up differentiated basic medical insurance reimbursement ratios. The study aims to use the dynamic point of view of longitudinal data to examine the changes in the impact of basic medical insurance on primary care. The data for this study comes from the Chinese Family Panel Study (CFPS) in 2010, 2012, 2014, 2016, and 2018. We adopted Hierarchal Age-period-cohort-Cross-Classified Random Effects Models (HAPC-CCREM) to examine the changes in the impact of basic medical insurance on primary care. Compared with non-insured groups, participants of the New Rural Cooperative Medical System (coefficient = 0.730) have a relatively high incidence of primary care seeks, while Urban Residents' Basic Medical Insurance (coefficient = −0.482) and Urban Employees' Basic Medical Insurance (coefficient = −0.663) are lower, respectively. Age, period over time and cohort have a more obvious moderating effect on primary care seeks. The study of primary care behavior is an important direction for the construction of a hierarchical medical system. As basic medical insurance is the source of power for the hierarchical medical system, we can provide certain direction for policy formulation on the changes of basic medical insurance in primary care behavior.
Collapse
Affiliation(s)
- Na Cao
- School of Public Health, Wuhan University, Wuhan, China
| | - Xuyang Li
- School of Public Health, Wuhan University, Wuhan, China
| | - Junfeng Jiang
- School of Sociology, Central China Normal University, Wuhan, China
| | - Wenyan Xu
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- *Correspondence: Wenyan Xu
| |
Collapse
|
9
|
Wu Y, Ye R, Wang Q, Sun C, Meng S, Sylvia S, Zhou H, Friesen D, Rozelle S. Provider competence in hypertension management and challenges of the rural primary healthcare system in Sichuan province, China: a study based on standardized clinical vignettes. BMC Health Serv Res 2022; 22:849. [PMID: 35778732 PMCID: PMC9248120 DOI: 10.1186/s12913-022-08179-9] [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: 11/12/2021] [Accepted: 06/01/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Improving primary care providers' competence is key to detecting and managing hypertension, but evidence to guide this work has been limited, particularly for rural areas. This study aimed to use standardized clinical vignettes to assess the competence of providers and the ability of the primary healthcare system to detect and manage hypertension in rural China. METHODS A multi-stage random sampling method was administered to select target health facilities, providers, and households. The clinical vignette script was developed to evaluate provider competence in managing first-visit patients with symptoms of hypertension. Logistic regression was used to explore the factors correlated with provider competence. Provider referral and management rates were combined with patients' facility sorting behaviors to assess the ability of the rural healthcare system to manage hypertension in three policy scenarios. RESULTS A total of 306 providers and 153 facilities were enrolled in our study. In the 306 clinical vignette interactions, 25.9% of providers followed the national guidelines for hypertension consultation. The correct diagnosis was achieved by only 10.1% of providers, and 30.4% of providers were able to prescribe the correct treatment. Multi-variable regression results showed that younger providers (OR = 0.85, 95%CI: 0.73, 0.98) and those who work in township health centers (OR = 4.47, 95%: 1.07, 18.67) were more likely to provide a correct diagnosis. In a free-selection scenario, 29.8% of patients with hypertension were managed correctly throughout the rural system. When all patients first visit village clinics, system-level correct management is reduced to 20.5% but increases to 45.0% when all patients first visit township health centers. CONCLUSIONS Rural primary care providers do not have enough competence to detect and treat hypertension cases in China to an acceptable degree. Policy constraints may limit the competence of the rural healthcare system. Research to improve detection and treatment competence in hypertension and optimize health policy is needed.
Collapse
Affiliation(s)
- Yuju Wu
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ruixue Ye
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qingzhi Wang
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chang Sun
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Sha Meng
- Department of Operation Management, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Huan Zhou
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Dimitris Friesen
- Freeman Spogli Institute for International Studies, Stanford University, California, Stanford, USA
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, California, Stanford, USA
| |
Collapse
|
10
|
Abstract
OBJECTIVES This study aimed to quantify increases in the medical expenditures of public hospitals associated with changes in service use and prices, which could inform policy efforts to curb the future growth of hospital medical expenditures. DESIGN Nationwide and provincial data regarding service volume, service price and intensity of public hospitals' outpatient and inpatient care from 2008 to 2018 were extracted from the China Health Statistical Yearbooks, and population size data were obtained from the 2019 China Statistical Yearbook. METHODS A decomposition analysis was performed to measure the relative effects of changes in service use (volume or its subcomponent factors) and service price and intensity on the increase in the inpatient and outpatient total medical expenditures of public hospitals from 2008 to 2018. RESULTS After adjusting for price inflation, the total medical expenditure of public hospitals increased by approximately threefold from 2008 to 2018. During this period, the increase in service volume was associated with 67.4% of the observed increase in the total medical expenditures in the inpatient sector and 57.2% of the observed increase in the total medical expenditures in the outpatient sector. Most of the service volume effect is due to an increase in the hospital utilisation rate. The growth in the utilisation rate was associated with 73.7% of the observed growth in the total medical expenditures in the inpatient sector and 60.3% of the observed growth in the total medical expenditures in the outpatient sector. CONCLUSION Service use, rather than price, appears to be the major driver of increases in medical expenditures in Chinese hospitals. An important policy implication for China and other countries with similar drivers is that the effect of controlling price and intensity growth on containing medical costs could be limited and controlling service utilisation growth could be essential.
Collapse
Affiliation(s)
- Xiaoling Yan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, Beijing, China
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Chaoyang District, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, Beijing, China
| | - Keqin Rao
- China Health Economics Association, Beijing, China
| | - Jinlei Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, Beijing, China
| |
Collapse
|
11
|
Sun JL, Tao R, Wang L, Jin LM. Does Social Medical Insurance Achieve a Poverty Reduction Effect in China? Front Public Health 2022; 9:800852. [PMID: 35096749 PMCID: PMC8791013 DOI: 10.3389/fpubh.2021.800852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
This paper aims to explore the impact of social medical insurance (SMI) on poverty reduction (PR) in China. Considering the time-varying characteristics of factors, this paper uses the bootstrap Granger full sample causality and subsample rolling window model to find the relationship between SMI and PR. The results highlight that in some periods, there is a bidirectional causal link between SMI and PR. Influenced by the medical insurance reform and medication measures. Social medical insurance does not have a positive impact on poverty reduction in some periods. These results are supported by the Utility Maximization Model of Insurance Consumption, which highlights that individuals make utility maximization choices when choosing insurance. The effect of medical insurance on poverty alleviation depends on whether an individual's investment in medical insurance can maximize its utility. If the proportion of social medical insurance reimbursement is too low, individuals will give up buying social medical insurance. Thus, the anti-poverty effect of social medical insurance is difficult to achieve. Therefore, authorities need to pay attention to specific contexts and social medical insurance policies and further improve the social medical insurance system to promote the realization of the anti-poverty of social medical insurance.
Collapse
Affiliation(s)
- Ji-Le Sun
- School of Economics, Qingdao University, Qingdao, China
| | - Ran Tao
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Lei Wang
- School of Management, Lanzhou University, Lanzhou, China
| | - Li-Min Jin
- Lanzhou Vocational and Technical College of Resources and Environment, Lanzhou, China
| |
Collapse
|
12
|
Rao S, Xue H, Teuwen DE, Shi H, Yi H. Measurements of quality of village-level care and patients' healthcare-seeking behaviors in rural China. BMC Public Health 2021; 21:1873. [PMID: 34657604 PMCID: PMC8520638 DOI: 10.1186/s12889-021-11946-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Although the progress in global health initiatives has improved the availability of primary health care (PHC), unqualified healthcare remains a serious challenge in low- and middle-income countries, where PHC is often underutilized. This study examines factors associated with patients’ healthcare-seeking behaviors in rural Chin—seeking healthcare at village-level PHC providers, at higher-level health facilities, self-medicating, and refraining from seeking medical help. We focus on provider-side factors, including (1) the unobservable quality indicator, (2) the observable quality indicator, and (3) the observable signal indicator. Methods We analyzed 1578 episodes of healthcare-seeking behaviors of patients with diarrhea or cough/runny nose symptom from surveys conducted in July 2017 and January 2018 in 114 villages of the Yunnan province. We investigated the correlation between quality-related factors with patients’ healthcare-seeking behaviors by multinomial logit regression. Results We found that rural patients were insensitive to the unobservable quality of healthcare providers, as measured by standardized clinical vignettes, which might be attributable to the credence nature of PHC. The observable quality indicator, whether the clinician has received full-time junior college formal medical education, was associated with patients’ healthcare choices. Patients, however, were more likely to select healthcare based on the observable signal indicator, which was measured by the availability of medicines. Additionally, the observable signal indicator had no significant association with two quality indicators. Notably, socioeconomically-disadvantaged patients relied more on the village-level PHC, which emphasized the role of PHC in promoting the welfare of rural populations. Conclusions Our study found an inconsistency between objective quality of healthcare provided by providers and subjective quality perceived by patients. Patients could not identify the actual quality of PHC precisely, while they were more likely to make decisions based on the observable signal indicator. Therefore, the quality of PHC should be more observable to patients. This study not only supplements the literature on healthcare-seeking choices by examining four types of behaviors simultaneously but also clarifies rural patients’ perceptions of the quality of PHC for policy decision-making on increasing the utilization of PHC and improving the medical welfare of the vulnerable. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11946-8.
Collapse
Affiliation(s)
- Sihang Rao
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Room 408B, Wangkezhen Building, No. 5, Yiheyuan Road, Haidian, Beijing, 100871, China
| | - Hao Xue
- Stanford Center on China's Economy and Institutions, Stanford University, California, USA
| | - Dirk E Teuwen
- Medical Sustainability, UCB, Brussels, Belgium.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Haonan Shi
- Business Development Center, Red Cross Society of China, Beijing, China
| | - Hongmei Yi
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Room 408B, Wangkezhen Building, No. 5, Yiheyuan Road, Haidian, Beijing, 100871, China.
| |
Collapse
|
13
|
Chen H, Xiao G, Xing J, Zhou Q. Empirical Study on the Impact of Urban and Rural Resident Basic Medical Insurance on Children's Educational Outcomes. Front Public Health 2021; 9:764364. [PMID: 34650957 PMCID: PMC8505893 DOI: 10.3389/fpubh.2021.764364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
This paper employs data from the 2016 and 2018 China Family Panel Studies (CFPS) to study the impact of participation in Urban and Rural Resident Basic Medical Insurance (URRBMI) on children's educational outcomes by using the logit model, double selection Lasso model, and propensity score matching. It is found that participating in URRBMI has no significant effect on children's Chinese performance, but has a significant negative effect on children's mathematics performance. The negative effect is more obvious for children who participating in the New Cooperative Medical Scheme (NCMS). The paper also studies the channel effects of participation in URRBMI on children's educational outcomes trough two different ways. It is noticed that both channel effects are not significant, that is, participation in URRBMI neither improves children's health nor changes household education expenditures.
Collapse
Affiliation(s)
- Hua Chen
- School of Insurance, Central University of Finance and Economics, Beijing, China
| | - Gandan Xiao
- School of Insurance, Central University of Finance and Economics, Beijing, China
| | - Jianing Xing
- School of Insurance, Central University of Finance and Economics, Beijing, China
| | - Qing Zhou
- School of Finance and Economics, Guangdong Polytechnic Normal University, Guangzhou, China
| |
Collapse
|
14
|
Cai J, Wu D, Sun KS, Yang S, Lam KF, Li L, Lam TP, Zhou X. Primary care physicians' views on the factors for enhancing patients' trust in rural areas of Zhejiang province, China: a cross-sectional study. BMJ Open 2021; 11:e049114. [PMID: 34315796 PMCID: PMC8317079 DOI: 10.1136/bmjopen-2021-049114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To examine primary care physicians' (PCPs) perception of patients' trust and associated factors for enhancing perceived trust in rural China. DESIGN A cross-sectional questionnaire study. SETTING All township health centres (primary care facilities in rural areas of China) in both developed and less developed counties of Zhejiang province, China, were chosen as the study sites. PARTICIPANTS A total of 849 questionnaires were distributed from December 2019 to January 2020, and 673 PCPs working in township health centres completed the questionnaires. The response rate was 79.3%. OUTCOME MEASURES PCPs' perceived patients' trust in them, PCPs' practices to meet patients' expectations and PCPs' perceived conflicting patient and employer interests were measured by a self-designed and verified questionnaire. Confirmatory factor analysis was applied to verify the measurement model of PCPs' practices. Multivariable logistic regression analyses were performed to explore the association between clinical practice characteristics, discordant patient and employer interests and perceived patient trust after controlling for social-demographic characteristics. RESULTS Among all participants, 572 (85.0%) PCPs often/always perceived patients' trust in their clinical competence, and over two-thirds of PCPs reported ever perceived patient worries about overprescriptions. After adjustment for social-demographic characteristics, regression model results indicated that, among PCPs' clinical practices characteristics, emotional support (OR=1.23, 95% CI=1.06 to 1.42) and accurate diagnosis and treatment (OR=1.35, 95% CI=1.17 to 1.55) were positively associated with PCPs' perceived patients' trust in their clinical competence. A strong association was found between accurate diagnosis and treatment (OR=1.20, 95% CI=1.08 to 1.34, p<0.001; OR=1.22, 95% CI=1.10 to 1.35, p<0.001), conflicting patient and employer interests (OR=1.35, 95% CI=1.12 to 1.63, p<0.01; OR=1.29, 95% CI=1.07 to 1.54, p<0.01) and PCPs' perceived patient worries about unnecessary medicine or tests, respectively. CONCLUSIONS PCPs' emotional support to patients as well as their abilities to make accurate diagnosis and provide appropriate treatment is positively associated with PCPs' self-reported patients' trust. It is recommended that reforms to realign patient and employer's interests be investigated.
Collapse
Affiliation(s)
- Jingjing Cai
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Dan Wu
- International Diagnostic Centre, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Kai Sing Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, People's Republic of China
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Shengzhi Yang
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Lu Li
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Xudong Zhou
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| |
Collapse
|
15
|
Xu M, Yang W. Who will drop out of voluntary social health insurance? Evidence from the New Cooperative Medical Scheme in China. Health Policy Plan 2021; 36:1013-1022. [PMID: 33963364 PMCID: PMC8530158 DOI: 10.1093/heapol/czab017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/25/2021] [Accepted: 06/23/2021] [Indexed: 11/14/2022] Open
Abstract
Although public voluntary health insurance (VHI) has been adopted in many low- and middle-income countries to improve access to care for the population, a common issue with VHI is its high dropout rate. Using the New Cooperative Medical Scheme (NCMS)-a public VHI in China-as a case study, this article employs a fixed-effects negative binomial regression model combining the difference-in-difference-in-differences approach and multivariate distance matching to examine the factors associated with dropping out and the impact of dropout on outpatient care utilization among middle-aged and older people in rural China. Drawing data from the China Health and Retirement Longitudinal Study, our results showed that healthy people, vulnerable people and people who use less healthcare tended to drop out. Dropout had a significant negative impact on outpatient care utilization, especially for those with worse health statuses and those living in poorer provinces. We also found that the impact of dropout on outpatient utilization was more pronounced at secondary and tertiary hospitals than at primary care clinics. We urge policymakers to rethink the design of the NCMS by waiving premiums for the most vulnerable people.
Collapse
Affiliation(s)
- Mingming Xu
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Kronenstraße 34, 76133 Karlsruhe, Germany
| | - Wei Yang
- Department of Global Health and Social Medicine, Faculty of Social Science and Public Policy, King's College London, 3.09 Bush House NE, Strand, London WC2R 2LS, UK
| |
Collapse
|
16
|
Lu R, Li Y, Zheng Z, Yan Z. Exploring Factors Associated with Self-Management Compliance among Rural Elders with Diabetes. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211012491. [PMID: 33899547 PMCID: PMC8082998 DOI: 10.1177/00469580211012491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of the study was to examine the social-ecological factors associated with diabetic self-management compliance among elders with diabetes in China. A total of 2,586 rural elderly residents who were 60-years-old or above participated in the survey. Socio-demographic factors, social support, healthcare accessibility and health risk factors were measured, along with self-reported medication and blood glucose monitoring data. Among the 117 individuals with diabetes, the medication compliance rate was 79.49%. The elderly who had high economic status were more likely to meet medication treatment compliance. Only 58.97% of study participants monitored blood glucose once a month. Younger age (<70-year-old), higher economic status, more social support and better healthcare accessibility were associated with higher blood glucose monitoring compliance odds. Diabetic medication and blood glucose testing tools should be more comprehensively covered by the national insurance program. Healthcare accessibility should be increased through transportation support, building more local facilities, such as mobile labs, and promoting affordable home-visit care. Self-management education programs about diabetes for rural elders should be promoted.
Collapse
Affiliation(s)
- Ruoyan Lu
- Public Health School of Fujian Medical University, Fuzhou, China
| | - Yueping Li
- Public Health School of Fujian Medical University, Fuzhou, China
| | - Zhenquan Zheng
- Public Health School of Fujian Medical University, Fuzhou, China
| | - Zi Yan
- School of Health Sciences, Merrimack College, North Andover, MA, USA
| |
Collapse
|
17
|
Green C, Hollingsworth B, Yang M. The impact of social health insurance on rural populations. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:473-483. [PMID: 33638010 PMCID: PMC7954739 DOI: 10.1007/s10198-021-01268-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
Improving health outcomes of rural populations in low- and middle-income countries represents a significant challenge. A key part of this is ensuring access to health services and protecting households from financial risk caused by unaffordable medical care. In 2003, China introduced a heavily subsidised voluntary social health insurance programme that aimed to provide 800 million rural residents with access to health services and curb medical impoverishment. This paper provides new evidence on the impact of the scheme on health care utilisation and medical expenditure. Given the voluntary nature of the insurance enrolment, we exploit the uneven roll-out of the programme across rural counties as a natural experiment to explore causal inference. We find little effect of the insurance on the use of formal medical care and out-of-pocket health payments. However, there is evidence that it directed people away from informal health care towards village clinics, especially among patients with lower income. The insurance has also led to a reduction in the use of city hospitals among the rich. The shift to village clinics from informal care and higher-level hospitals suggests that the NRCMS has the potential to improve efficiency within the health care system and help patients to obtain less costly primary care. However, the poor quality of primary care and insufficient insurance coverage for outpatient services remains a concern.
Collapse
Affiliation(s)
- Colin Green
- Present Address: Department of Economics, Norweigian University of Science and Technology, Trondheim, Norway
| | | | - Miaoqing Yang
- Department of Economics, Lancaster University Management School, Lancaster University, Lancaster, LA2 0PF UK
- Present Address: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF UK
| |
Collapse
|
18
|
Fang C, He C, Rozelle S, Shi Q, Sun J, Yu N. Heterogeneous Impacts of Basic Social Health Insurance on Medical Expenditure: Evidence from China's New Cooperative Medical Scheme. Healthcare (Basel) 2019; 7:healthcare7040131. [PMID: 31684191 PMCID: PMC6955686 DOI: 10.3390/healthcare7040131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 10/27/2019] [Accepted: 11/01/2019] [Indexed: 12/03/2022] Open
Abstract
This paper examines the effects of China’s New Cooperative Medical Scheme (NCMS) on medical expenditure. Utilizing the quasi-random rollout of the NCMS for a difference-in-difference analysis, we find that the NCMS increased medical expenditure by 12.3%. Most significantly, the good-health group witnessed a 22.1% rise in medical expenditure, and the high-income group saw a rise of 20.6%. The effects, however, were not significant among the poor-health or low-income groups. The findings are suggestive of the need for more help for the very poor and less healthy.
Collapse
Affiliation(s)
- Conglong Fang
- Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai 200030, China.
| | - Chaofei He
- School of Finance, Nanjing Audit University, Nanjing 211815, China.
| | - Scott Rozelle
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA.
| | - Qinghua Shi
- Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai 200030, China.
| | - Jiayin Sun
- Department of Statistics, University of British Columbia, Vancouver, BC V6T1Z4, Canada.
| | - Ning Yu
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA.
- Institute for Social and Economic Research, Nanjing Audit University, Nanjing 211815, China.
| |
Collapse
|
19
|
Liu Y, Kong Q, de Bekker-Grob EW. Public preferences for health care facilities in rural China: A discrete choice experiment. Soc Sci Med 2019; 237:112396. [PMID: 31404884 DOI: 10.1016/j.socscimed.2019.112396] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/10/2019] [Accepted: 07/01/2019] [Indexed: 11/18/2022]
Abstract
To successfully tackle the problems with the underutilization of primary care in rural China, it is important to align resource allocation with the preferences of the rural population. However, despite growing interest in the factors influencing the rural population's choice of facility, it is unclear how much weight should be placed on these factors, especially under different scenarios of disease severity. In the first study to elicit quantified trade-offs among influential factors in choosing health care facilities, we carried out a discrete choice experiment (DCE) in rural China. We used a Bayesian efficient design to construct 36 choice sets, and then divided them into three blocks. Each block formed one version of questionnaire that contained 12 choice questions. Each question was assigned a hypothetical perceived severity scenario of either minor or severe disease. 559 Rural residents completed the DCE through face-to-face interviews in December 2017-March 2018. We used mixed logit models to analyze the choice data. The factors regarding the availability and affordability of a facility, such as visit time, travel time, and out-of-pocket cost, were highly valued. When the facilities changed simultaneously from the worst to the best case, a huge increase (from 4.8% to 66.5%) in the predicted choice probability of choosing to visit a facility was observed under perceived minor disease scenario, whereas there was no significant change under perceived severe disease scenario. Improvements to drug availability, medical professional skill and equipment in rural primary care system can induce potential medical care seeking, and redirect patient flow from higher level hospitals to primary level. Especially, township health centers, which provide service to the residents in rural communities, have great potential to be the ideal facilities for first-contact care.
Collapse
Affiliation(s)
- Yun Liu
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Qingxia Kong
- Rotterdam School of Management, Erasmus University Rotterdam, P.O. Box 1738, , 3000 DR, Rotterdam, the Netherlands
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands; Erasmus Choice Modelling Center, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
| |
Collapse
|
20
|
Determinants and Differences of Township Hospital Efficiency among Chinese Provinces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091601. [PMID: 31067779 PMCID: PMC6539220 DOI: 10.3390/ijerph16091601] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 12/27/2022]
Abstract
This study aimed to measure the efficiency and change in efficiency over time of township hospitals among Chinese provinces, to decompose the difference in efficiency between districts, and to study the correlations between the difference in efficiency and its determinants. Based on Chinese provincial panel data, the empirical analysis was established using data envelopment analysis (DEA), Malmquist index, Theil index decomposition method and Grey correlation analysis method. First, it was found that the township hospitals in most provinces were operating in an inefficient state, and the township hospitals in most provinces achieved gains in efficiency. Second, from 2003 to 2016 the shrinkage of the difference in provincial efficiency of township hospitals progressed slowly. Intra-regional difference is the main cause of the overall provincial efficiency difference of Chinese township hospitals, while inter-regional difference is the minor cause of the overall difference. Third, the correlation between the difference of overall provincial efficiency and the difference of economic development level is the highest among all the correlations, while other determinants rank second to seventh place in their degree of correlation with respect to the overall difference in provincial efficiency. Furthermore, the correlations between the intra-regional difference of provincial efficiency of Chinese township hospitals and its determinants vary tremendously across regions. Based on our findings, we can conclude, first, that efforts should be made to improve the overall provincial difference in efficiency of Chinese township hospitals, and enhance the utilization level of input resources, and to reduce resource waste. Second, in order to shrink the overall provincial efficiency of Chinese township hospitals, the most important measure that should be taken is to improve the economic development level in relatively backward provinces in order to lay a solid economic foundation for the improvement of efficiency and shrink the differences in efficiency between provinces. Third, more attention should be paid to the shrinkage of intra-regional efficiency differences in Chinese township hospitals, while the narrowing of inter-regional efficiency difference should not be ignored. For each region, it is necessary to recognize the difference in the relative importance of determinants, and to make development strategies according to local conditions so as to make full use of local characteristics and advantages.
Collapse
|
21
|
Sun X, Meng H, Ye Z, Conner KO, Duan Z, Liu D. Factors associated with the choice of primary care facilities for initial treatment among rural and urban residents in Southwestern China. PLoS One 2019; 14:e0211984. [PMID: 30730967 PMCID: PMC6366770 DOI: 10.1371/journal.pone.0211984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/23/2019] [Indexed: 01/04/2023] Open
Abstract
Objective To explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China. Methods A face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents’ characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment. Results The result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09–0.26; urban: OR = 0.19, 95%CI = 0.10–0.36), had fair (rural: OR = 0.49, 95%CI = 0.26–0.92; urban: OR = 0.31, 95%CI = 0.15–0.64) or poor (rural: OR = 0.14, 95%CI = 0.07–0.30; urban: OR = 0.22, 95%CI = 0.11–0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08–0.59), being retired (OR = 0.90, 95%CI = 0.44–1.84) and earning a per capita annual income of household of 10,000–29,999 (OR = 0.24, 95%CI = 0.11–0.52) and 30,000–49,999 (OR = 0.26, 95%CI = 0.07–0.92) were associated with lower rates of seeking care at PCFs. Conclusion Efforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account.
Collapse
Affiliation(s)
- Xiaxia Sun
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Zhiqiu Ye
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Kyaien O. Conner
- Department of Mental Health Law & Policy, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Zhanqi Duan
- Health and Family Planning Information Centre of Sichuan Province, Chengdu, China
| | - Danping Liu
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
- * E-mail:
| |
Collapse
|
22
|
Liao J, Chen Y, Cai Y, Zhan N, Sylvia S, Hanson K, Wang H, Wasserheit JN, Gong W, Zhou Z, Pan J, Wang X, Tang C, Zhou W, Xu D. Using smartphone-based virtual patients to assess the quality of primary healthcare in rural China: protocol for a prospective multicentre study. BMJ Open 2018; 8:e020943. [PMID: 29997138 PMCID: PMC6089284 DOI: 10.1136/bmjopen-2017-020943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Valid and low-cost quality assessment tools examining care quality are not readily available. The unannounced standardised patient (USP), the gold standard for assessing quality, is costly to implement while the validity of clinical vignettes, as a low-cost alternative, has been challenged. Computerised virtual patients (VPs) create high-fidelity and interactive simulations of doctor-patient encounters which can be easily implemented via smartphone at low marginal cost. Our study aims to develop and validate smartphone-based VP as a quality assessment tool for primary care, compared with USP. METHODS AND ANALYSIS The study will be implemented in primary health centres (PHCs) in rural areas of seven Chinese provinces, and physicians practicing at township health centres and village clinics will be our study population. The development of VPs involves three steps: (1) identifying 10 VP cases that can best represent rural PHCs' work, (2) designing each case by a case-specific development team and (3) developing corresponding quality scoring criteria. After being externally reviewed for content validity, these VP cases will be implemented on a smartphone-based platform and will be tested for feasibility and face validity. This smartphone-based VP tool will then be validated for its criterion validity against USP and its reliability (ie, internal consistency and stability), with 1260 VP/USP-clinician encounters across the seven study provinces for all 10 VP cases. ETHICS AND DISSEMINATION Sun Yat-sen University: No. 2017-007. Study findings will be published and tools developed will be freely available to low-income and middle-income countries for research purposes.
Collapse
Affiliation(s)
- Jing Liao
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yiyuan Cai
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Nan Zhan
- Department of Health Management, School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kara Hanson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hong Wang
- Health Economics, Financing & Systems, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Judith N Wasserheit
- Departments of Global Health, Medicine, and Epidemiology, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Jay Pan
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, China
| | - Wei Zhou
- Hospital Administration Institute, Xiangya Hospital, Central South University, Changsha, China
| | - Dong Xu
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University
| |
Collapse
|
23
|
Zhou M, Liu S, Kate Bundorf M, Eggleston K, Zhou S. Mortality In Rural China Declined As Health Insurance Coverage Increased, But No Evidence The Two Are Linked. Health Aff (Millwood) 2018; 36:1672-1678. [PMID: 28874497 DOI: 10.1377/hlthaff.2017.0135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health insurance holds the promise of improving population health and survival and protecting people from catastrophic health spending. Yet evidence from lower- and middle-income countries on the impact of health insurance is limited. We investigated whether insurance expansion reduced adult mortality in rural China, taking advantage of differences across Chinese counties in the timing of the introduction of the New Cooperative Medical Scheme (NCMS). We assembled and analyzed newly collected data on NCMS implementation, linked to data from the Chinese Center for Disease Control and Prevention on cause-specific, age-standardized death rates and variables specific to county-year combinations for seventy-two counties in the period 2004-12. While mortality rates declined among rural residents during this period, we found little evidence that the expansion of health insurance through the NCMS contributed to this decline. However, our relatively large standard errors leave open the possibility that the NCMS had effects on mortality that we could not detect. Moreover, mortality benefits might arise only after many years of accumulated coverage.
Collapse
Affiliation(s)
- Maigeng Zhou
- Maigeng Zhou is deputy director of the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), in Beijing
| | - Shiwei Liu
- Shiwei Liu is a professor at the National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC
| | - M Kate Bundorf
- M. Kate Bundorf is a professor of health research and policy at the Stanford School of Medicine, in California, and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts
| | - Karen Eggleston
- Karen Eggleston is a senior fellow at the Freeman Spogli Institute for International Studies (FSI) and deputy director of FSI's Shorenstein Asia-Pacific Research Center, at Stanford University, in California; and a faculty research fellow at the National Bureau of Economic Research
| | - Sen Zhou
- Sen Zhou is a postdoctoral researcher at the China Institute for Educational Finance Research at Peking University, in Beijing
| |
Collapse
|
24
|
Fe E, Powell-Jackson T, Yip W. Doctor Competence and the Demand for Healthcare: Evidence from Rural China. HEALTH ECONOMICS 2017; 26:1177-1190. [PMID: 27524208 DOI: 10.1002/hec.3387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/16/2016] [Accepted: 06/15/2016] [Indexed: 06/06/2023]
Abstract
The agency problem between patients and doctors has long been emphasised in the health economics literature, but the empirical evidence on whether patients can evaluate and respond to better quality care remains mixed and inconclusive. Using household data linked to an assessment of village doctors' clinical competence in rural China, we show that there is no correlation between doctor competence and patients' healthcare utilisation, with confidence intervals reasonably tight around zero. Household perceptions of quality are an important determinant of care-seeking behaviour, yet patients appear unable to recognise more competent doctors - there is no relationship between doctor competence and perceptions of quality. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Eduardo Fe
- Department of Economics, University of Strathclyde, Glasgow, UK
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Winnie Yip
- Blavatnik School of Government, University Oxford, Oxford, UK
| |
Collapse
|
25
|
Abstract
China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners’ and patients’ interests can be better aligned is essential for reforms to succeed.
Collapse
Affiliation(s)
- Gordon G. Liu
- National School of Development, Peking University, Beijing 100871, China
| | - Samantha A. Vortherms
- Department of Political Science, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Xuezhi Hong
- School of Management, Beijing University of Chinese Medicine, Beijing 10029, China
| |
Collapse
|
26
|
Dai T, Hu HP, Na X, Li YZ, Wan YL, Xie LQ. Effects of New Rural Cooperative Medical Scheme on Medical Service Utilization and Medical Expense Control of Inpatients: A 3-year Empirical Study of Hainan Province in China. Chin Med J (Engl) 2017; 129:1280-4. [PMID: 27231163 PMCID: PMC4894036 DOI: 10.4103/0366-6999.182842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The New Rural Cooperative Medical Scheme (NCMS) has been further adjusted and optimized to reduce the financial burden of rural residents and to achieve universal coverage for them. In this study, we aimed to explore the impact of NCMS on medical service utilization and medical expense of inpatients in recent years. Methods: The research data of Hainan Province were extracted from the Chinese NCMS platform from 2012 to 2014. Detailed information included total expenditure, average inpatients costs, average out-of-pocket payments, actual reimbursement rate, and average annual growth rate of the above indicators. Descriptive analysis was used to gauge the effects of NCMS. Results: In the utilization of medical services, NCMS inpatients in tertiary hospital decreased from 25.49% in 2012 to 20.39% in 2014, inpatients in county hospitals increased from 39.49% to 55.92%, simultaneously. The total expenditure in county hospitals rose steadily from 28.46% to 46.66%, meanwhile, the total expenditure in tertiary hospitals fell from 60.44% to 44.51%.The average out-of-pocket costs of rural inpatients remained stable over the years. Furthermore, the compensation fund of NCMS inpatients grew significantly. The actual inpatient reimbursement rate at township health centers increased from 76.93% to 84.04%. Meanwhile, the rate at county hospitals and tertiary hospitals increased slightly from 59.37% and 46.10% to 61.25% and 47.71%, respectively. Conclusions: With the improvement of the reimbursement ability, especially after the new health care reform in 2009, the NCMS have been playing a prominent role in alleviating the economic burden of farmers’ medical treatment. Meanwhile, more patients go to primary hospitals than tertiary hospitals, and the capability of primary hospitals has been greatly improved.
Collapse
Affiliation(s)
- Tao Dai
- Center for Health Policy and Management, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China
| | - Hong-Pu Hu
- Center for Health Policy and Management, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China
| | - Xu Na
- Center for Health Policy and Management, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China
| | - Ya-Zi Li
- Center for Health Policy and Management, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China
| | - Yan-Li Wan
- Center for Health Policy and Management, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China
| | - Li-Qin Xie
- Center for Health Policy and Management, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China
| |
Collapse
|
27
|
How does the pharmaceutical industry influence prescription? A qualitative study of provider payment incentives and drug remunerations in hospitals in Shanghai. HEALTH ECONOMICS POLICY AND LAW 2016; 11:379-95. [PMID: 26918751 DOI: 10.1017/s1744133116000086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Over-prescription has become one major problem in China's health care sector. Incorporating interview data from hospitals in Shanghai, this paper provided empirical evidence on how the process of over-prescription was carried out in day-to-day clinical settings, and demonstrates various mechanisms that allow over-prescription to continue vigorously in the context of the Chinese health care system. In particular, this study identified four levels of incentives that over-prescription was carried out: hospital, medical department, doctors and pharmaceutical companies. Due to the insufficient funding from the government and rising operational costs, hospitals had to rely on the sales of drugs and provision of medical services to survive. This funding pressure then transferred to specific revenue targets for medical departments. A combination of incentives, including drug remunerations, bonus system, low pay and high workloads motivated over-prescription at doctor level. At pharmaceutical company level, high profits of pharmaceuticals products as well as lack of emphasis on efficacy of drugs led to under-table payments and illicit drug remunerations. The study argued that the way that the Chinese health care system operates was based on the profit-seeking principle rather than on fulfilling its social functions, and called for a systematic reform of provider incentives to eradicating the problem of over-prescription.
Collapse
|
28
|
Liang D, Zhang D, Huang J, Schweitzer S. Does Rapid and Sustained Economic Growth Lead to Convergence in Health Resources: The Case of China From 1980 to 2010. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 53:53/0/0046958016631699. [PMID: 26895881 PMCID: PMC5798700 DOI: 10.1177/0046958016631699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
China’s rapid and sustained economic growth offers an opportunity to ask whether the advantages of growth diffuse throughout an economy, or remain localized in areas where the growth has been the greatest. A critical policy area in China has been the health system, and health inequality has become an issue that has led the government to broaden national health insurance programs. This study investigates whether health system resources and performance have converged over the past 30 years across China’s 31 provinces. To examine geographic variation of health system resources and performance at the provincial level, we measure the degree of sigma convergence and beta convergence in indicators of health system resources (structure), health services utilization (process), and outcome. All data are from officially published sources: the China Health Statistics Year Book and the China Statistics Year Book. Sigma convergence is found for resource indicators, whereas it is not observed for either process or outcome indicators, indicating that disparities only narrowed in health system resources. Beta convergence is found in most indicators, except for 2 procedure indicators, reflecting that provinces with poorer resources were catching up. Convergence found in this study probably reflects the mixed outcome of government input, and market forces. Thus, left alone, the equitable distribution of health care resources may not occur naturally during a period of economic growth. Governmental and societal efforts are needed to reduce geographic health variation and promote health equity.
Collapse
Affiliation(s)
- Di Liang
- University of California, Los Angeles, USA
| | | | - Jiayan Huang
- Fudan University, Shanghai, People's Republic of China
| | | |
Collapse
|
29
|
Zhang L, Li S, Yi H, d'Intignano LM, Ding Y. Correlation Between New Cooperative Medical Scheme Policy Design and Catastrophic Medical Payment: Evidence From 25 Counties in Rural China. Asia Pac J Public Health 2015; 28:26-38. [PMID: 26512031 DOI: 10.1177/1010539515612907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few studies have examined the association between the New Cooperative Medical Scheme (NCMS) policy design and its achievement of providing financial protection to rural residents. This study collected data on NCMS policy design and health care spending from 25 counties and rural households in their catchment areas. It shows that on average, NCMS has a growing but small effect on the reduction of catastrophic medical payment (CMP) incidence. If outpatient spending can be reimbursed from an NCMS pooled account, the incidence of CMP before a reimbursement and that after a reimbursement will be reduced. Higher nominal reimbursement rate for inpatient spending at provincial hospitals is correlated with higher incidence of CMP before a reimbursement. Higher ceiling for annual reimbursement from NCMS is associated with lower incidence of CMP after a reimbursement. Thus, NCMS policy design can be improved to strengthen its effects on the reduction of CMP incidence.
Collapse
Affiliation(s)
- Linxiu Zhang
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Shaoping Li
- University of Chinese Academy of Sciences, Beijing, China
| | - Hongmei Yi
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | | | - Yilei Ding
- School of Governance, Nanjing University, Nanjing, China National Health and Family Planning Commission, Beijing, China
| |
Collapse
|
30
|
An evaluation of China's new rural cooperative medical system: achievements and inadequacies from policy goals. BMC Public Health 2015; 15:1079. [PMID: 26494015 PMCID: PMC4619227 DOI: 10.1186/s12889-015-2410-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although much public scrutiny and academic attention has focused on the evaluations of system implementation since the beginning of New Rural Cooperative Medical System (NRCMS) in China, few studies have systematically evaluated the achievements of the stated policy goals. The purpose of this study is to examine to what extent the policy goals of NRCMS have been achieved. METHODS Using multistage sampling processes, two rounds of cross-sectional household surveys including 9787 and 7921 rural households were conducted in Eastern China in year 2000 and year 2008, respectively. A pre- and post-implementation comparison was used to evaluate the achievement of policy goals in three measures: impoverishment from major health hazards, household financial risk from medical expenses, and rural income inequity. Intention surveys were also applied to find out potential obstacles in the implementation of NRCMS. RESULTS The rate of re-impoverishment from health hazard was reduced from 2.69 % ex ante to 2.12 % ex post, a decrease of 21.13 %. The severity of impoverishment fell from a previous 4.66 % to 3.02 %, a decline of 35.18 %. Economic risk of medical treatment population relative to the whole population fell from 2.62 ex ante to 2.03 ex post, a 22.52 % reduction. As indication of effect on improving income equity, the Gini coefficient fell from 0.4629 to 0.4541. The effects of NRCMS were significantly better than those of RCMS. Despite the preliminary achievements, our intention survey of key respondents identified that technical difficulties in actuarial funding and more sustainable reimbursement schedules has become the most challenging barriers in achieving the goals of NRCMS, while raising the insurance premium on NRCMS was no longer as big a barrier. CONCLUSIONS With NRCMS, China has established a medical security system to reduce the financial burden of healthcare on rural residents. NRCMS has achieved some positive though limited effects; but technical difficulties in the implementation of NRCMS have become barriers to achieve the pre-set policy goals. Efforts should be made to improve the capacity building in the design of the reimbursement schemes for the implementers of NRCMS, such as identifying medical impoverishment, calculating actuarial funding levels for the risk pooling.
Collapse
|
31
|
Meng Q, Fang H, Liu X, Yuan B, Xu J. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet 2015; 386:1484-92. [PMID: 26466052 DOI: 10.1016/s0140-6736(15)00342-6] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes.
Collapse
Affiliation(s)
- Qingyue Meng
- China Centre for Health Development Studies, Peking University, Beijing, China.
| | - Hai Fang
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Xiaoyun Liu
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Beibei Yuan
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Jin Xu
- China Centre for Health Development Studies, Peking University, Beijing, China
| |
Collapse
|
32
|
Yang L, Liu C, Ferrier JA, Zhang X. Organizational barriers associated with the implementation of national essential medicines policy: A cross-sectional study of township hospitals in China. Soc Sci Med 2015; 145:201-8. [PMID: 26360408 DOI: 10.1016/j.socscimed.2015.08.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 08/18/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Abstract
This study identifies potential organizational barriers associated with the implementation of the Chinese National Essential Medicines Policy (NEMP) in rural primary health care institutions. We used a multistage sampling strategy to select 90 township hospitals from six provinces, two from each of eastern, middle, and western China. Data relating to eight core NEMP indicators and institutional characteristics were collected from January to September 2011, using a questionnaire. Prescription-associated indicators were calculated from 9000 outpatient prescriptions selected at random. We categorized the eight NEMP indicators using an exploratory factor analysis, and performed linear regressions to determine the association between the factor scores and institution-level characteristics. The results identified three main factors. Overall, low levels of expenditure of medicines (F1) and poor performance in rational use of medicines (F2) were evident. The availability of medicines (F3) varied significantly across both hospitals and regions. Factor scores had no significant relationship with hospital size (in terms of number of beds and health workers); however, they were associated with revenue and structure of the hospital, patient service load, and support for health workers. Regression analyses showed that public finance per health worker was negatively associated with the availability of medicines (p < 0.05), remuneration of prescribers was positively associated with higher performance in the rational use of medicines (p < 0.05), and drug sales were negatively associated with higher levels of drug expenditure (p < 0.01). In conclusion, irrational use of medicines remains a serious issue, although the financial barriers for gaining access to essential medicines may be less for prescribers and consumers. Limited public finance from local governments may reduce medicine stock lines of township hospitals and lead them to seek alternative sources of income, jeopardizing their capacity to meet the needs of local consumers.
Collapse
Affiliation(s)
- Lianping Yang
- School of Public Health, Sun Yat-sen University, PR China
| | - Chaojie Liu
- School of Public Health, La Trobe University, Australia
| | | | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, PR China.
| |
Collapse
|
33
|
Yi H, Miller G, Zhang L, Li S, Rozelle S. Intended And Unintended Consequences Of China’s Zero Markup Drug Policy. Health Aff (Millwood) 2015; 34:1391-8. [DOI: 10.1377/hlthaff.2014.1114] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hongmei Yi
- Hongmei Yi is an associate professor of agricultural economics at the Center for Chinese Agricultural Policy in the Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, in Beijing
| | - Grant Miller
- Grant Miller ( ) is director of Stanford Center for International Development, an associate professor of medicine, a senior fellow at the Freeman Spogli Institute for International Studies and the Stanford Institute for Economic Policy Research, and an associate professor, by courtesy, of economics and of health research and policy, all at Stanford University, in California
| | - Linxiu Zhang
- Linxiu Zhang is deputy director of and a professor of agricultural economics in the Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences
| | - Shaoping Li
- Shaoping Li is a PhD candidate in agricultural economics and management at the Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences
| | - Scott Rozelle
- Scott Rozelle is the Helen F. Farnsworth Senior Research Fellow at the Freeman Spogli Institute for International Studies and codirector of the Rural Education Action Program, both at Stanford University
| |
Collapse
|
34
|
Zou J, Yang W, Cook DM, Yuan Z, Zhang L, Wang X. New cooperative medical financing policy and hospitalization in rural China: multi-stage cross-sectional surveys. Int Health 2015; 8:59-66. [PMID: 26045482 DOI: 10.1093/inthealth/ihv029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/16/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2003 China began to implement the New-type rural Cooperative Medical System (NCMS). This provided enhanced funding for hospital-based medical services among farmers. We examined self-reported utilization data for evidence of changes following the new policy. METHODS We conducted a multistage stratified random cluster sampling method for Jiangxi Province, China. Data were collected via five surveys in 2003-4, 2006, 2008, 2010, and 2012. The study compared the rates of hospitalization, early discharge, and hospital avoidance as descriptive indices after weighting the data. Weighted multiple logistic regression analysis was used. Multi-stage cross-sectional analysis was used to explore the reasons for early discharge and for avoiding the hospital during illness. RESULTS We found that the rates of hospitalization, early discharge and hospital avoidance showed upward, downward and downward changes respectively. The logistic regression analysis showed that, controlling for other factors, the financing level significantly affected the changes of the three indexes (p<0.05). The proportion of finance-related early discharge and hospital avoidance dropped significantly (p<0.05). CONCLUSIONS NCMS improved the utilization of in-hospital services step by step as time went on, and greatly alleviated cost-related barriers to accessing health services. Even so, because costs continue to restrict access to services we should continue the NCMS policy and improve its guarantee levels.
Collapse
Affiliation(s)
- JiaoJiao Zou
- School of Public Health, Nanchang University, Nanchang, P.R. China
| | - Wei Yang
- School of Public Health, Nanchang University, Nanchang, P.R. China School of Community Health Sciences, University of Nevada, Reno, USA
| | - Daniel M Cook
- School of Community Health Sciences, University of Nevada, Reno, USA
| | - ZhaoKang Yuan
- School of Public Health, Nanchang University, Nanchang, P.R. China
| | - LianJun Zhang
- School of Public Health, Nanchang University, Nanchang, P.R. China
| | - Xi Wang
- School of Public Health, Nanchang University, Nanchang, P.R. China
| |
Collapse
|
35
|
Powell-Jackson T, Yip WCM, Han W. Realigning demand and supply side incentives to improve primary health care seeking in rural China. HEALTH ECONOMICS 2015; 24:755-772. [PMID: 24807650 DOI: 10.1002/hec.3060] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 02/20/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Abstract
China's recent and ambitious health care reform involves a shift from the reliance on markets to the reaffirmation of the central role of the state in the financing and provision of services. In collaboration with the Government of the Ningxia province, we examined the impact of two key features of the reform on health care utilisation using panel household data. The first policy change was a redesign of the rural insurance benefit package, with an emphasis on reorientating incentives away from inpatient towards outpatient care. The second policy change involved a shift from a fee-for-service payment method to a capitation budget with pay-for-performance amongst primary care providers. We find that the insurance intervention, in isolation, led to a 47% increase in the use of outpatient care at village clinics and greater intensity of treatment (e.g. injections). By contrast, the two interventions in combination showed no effect on health care use over and above that generated by the redesign of the insurance benefit package.
Collapse
Affiliation(s)
- Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | |
Collapse
|
36
|
Cheng L, Liu H, Zhang Y, Shen K, Zeng Y. The impact of health insurance on health outcomes and spending of the elderly: evidence from China's New Cooperative Medical Scheme. HEALTH ECONOMICS 2015; 24:672-691. [PMID: 24777657 PMCID: PMC4790431 DOI: 10.1002/hec.3053] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 12/08/2013] [Accepted: 03/13/2014] [Indexed: 05/30/2023]
Abstract
This paper investigates the effects of China's New Cooperative Medical Scheme (NCMS) on health outcomes and healthcare expenditure of the elderly in rural China, using panel data from the 2005 and 2008 waves of the Chinese Longitudinal Healthy Longevity Survey. We employ a strategy that combines propensity score matching with a difference-in-differences approach to address selection bias. Results show that the NCMS has significantly improved the elderly enrollees' activities of daily living and cognitive function but has not led to better self-assessed general health status. We find no significant effect of NCMS on mortality for the previously uninsured elderly in NCMS counties, although there is moderate evidence that it is associated with reduced mortality for the elderly enrollees. We also find that the elderly participants are more likely to get adequate medical services when sick, which provides a good explanation for the beneficial health effects of NCMS. However, there is no evidence that the NCMS has reduced their out-of-pocket spending. Furthermore, we also find that low-income seniors benefit more from NCMS participation in terms of health outcomes and perceived access to health care, suggesting that the NCMS helps reduce health inequalities among the rural elderly.
Collapse
Affiliation(s)
- Lingguo Cheng
- School of Business, Nanjing University, Nanjing, China
| | - Hong Liu
- China Economics and Management Academy, Central University of Finance and Economics, Beijing, China
| | - Ye Zhang
- School of Business, Nanjing University, Nanjing, China
| | - Ke Shen
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Yi Zeng
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China
- Center for the Study of Aging and Human Development, Geriatrics Division of School of Medicine, Duke University, Durham, NC, USA
| |
Collapse
|
37
|
Wang X, He X, Zheng A, Ji X. The effects of China's New Cooperative Medical Scheme on accessibility and affordability of healthcare services: an empirical research in Liaoning Province. BMC Health Serv Res 2014; 14:388. [PMID: 25217224 PMCID: PMC4168209 DOI: 10.1186/1472-6963-14-388] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 09/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China's New Cooperative Medical Scheme (NCMS), launched in 2003, was intended to prevent the impoverishment due to catastrophic illness costs. Previous studies have been conducted on the "design flows" of the NCMS, for example, the irrational insurance benefit package. But after several years of implementation, very little has been known about the improvements made by the NCMS and rural residents' attitudes toward it. This article specifically focused on the improvements of healthcare services and the enrollees' choices of providers since the implementation of the NCMS in Liaoning province. METHODS We conducted a one-on-one interview with healthcare officials in order to get a better understanding of the NCMS policies of the local area. We conducted a door-to-door survey in 3 counties, 21 villages and 602 households to gauge population characteristics, respondents' healthcare preferences, satisfaction levels with providers, and their attitudes towards designated healthcare institutions. RESULTS We found that 43.6% of the respondents believed the NCMS brought more convenience to receive healthcare services. 35.2% of the rural residents thought the NCMS work ineffectively, mainly due to the high healthcare costs. 72.3% of the respondents preferred the county hospitals when they got severe diseases, mainly for the reason of better skills and more advanced equipment, while they preferred village clinics (56.5%) and township hospitals (23.2%) when they got minor diseases mainly for the reason of convenience. CONCLUSION We concluded that the NCMS improved the situation of hard to receive healthcare services but did not reduce the high healthcare fees. Furthermore, participants were unsatisfied with the NCMS designated hospitals. Based on our findings, a number of remedial actions were proposed, including redistributing healthcare resources, developing more domestic medical equipment to lower the treatment costs, and establishing a new talent flow mode.
Collapse
Affiliation(s)
- Xin Wang
- Department of the Health Service Management, China Medical University, No,92 North Second Road, Heping District, Shenyang, Liaoning Province 110001, China (PRC.
| | | | | | | |
Collapse
|
38
|
Dai B. Does China's new cooperative medical scheme promote rural elders' access to healthcare services in relation to chronic conditions? Int Health 2014; 7:32-41. [PMID: 25091022 DOI: 10.1093/inthealth/ihu050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study examined use of healthcare services by elderly people with a long-term condition living in rural China and participating in that country's New Cooperative Medical Scheme (NCMS). METHODS Data were taken from the 2009 China Health and Nutrition Survey. RESULTS The study results showed that education level and annual income were low among rural elders (aged ≥65 years); the illiteracy rate was 58.0% (200/345) and 67.6% (92/136) had an annual income of less than 5000 Chinese yuan renminbi. The elders had low rates of treatment and use of preventive healthcare services while the prevalence of chronic disease was highest among them when compared to other age groups. Among the few elders who received preventive healthcare, most received it at village clinics. CONCLUSIONS Preventive healthcare services and chronic disease management are urgently needed by rural elders in China. NCMS should initiate payments to township health centers to enable them to undertake community outreach and education campaigns among rural residents, and train village doctors in standard chronic condition management and prevention, with prioritization of the provision of prevention and management of chronic conditions by village clinics.
Collapse
Affiliation(s)
- Baozhen Dai
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China
| |
Collapse
|
39
|
Sylvia S, Shi Y, Xue H, Tian X, Wang H, Liu Q, Medina A, Rozelle S. Survey using incognito standardized patients shows poor quality care in China's rural clinics. Health Policy Plan 2014; 30:322-33. [PMID: 24653216 DOI: 10.1093/heapol/czu014] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Over the past decade, China has implemented reforms designed to expand access to health care in rural areas. Little objective evidence exists, however, on the quality of that care. This study reports results from a standardized patient study designed to assess the quality of care delivered by village clinicians in rural China. To measure quality, we recruited individuals from the local community to serve as undercover patients and trained them to present consistent symptoms of two common illnesses (dysentery and angina). Based on 82 covert interactions between the standardized patients and local clinicians, we find that the quality of care is low as measured by adherence to clinical checklists and the rates of correct diagnoses and treatments. Further analysis suggests that quality is most strongly correlated with provider qualifications. Our results highlight the need for policy action to address the low quality of care delivered by grassroots providers.
Collapse
Affiliation(s)
- Sean Sylvia
- School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA
| | - Yaojiang Shi
- School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA
| | - Hao Xue
- School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA
| | - Xin Tian
- School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA
| | - Huan Wang
- School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA
| | - Qingmei Liu
- School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA
| | - Alexis Medina
- School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA
| | - Scott Rozelle
- School of Economics, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872 China, Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, 199 South Chang'an Road, Xi'an, Shaanxi, 710062 China, School of Economics and Management, Northwest University, No. 1 Xuefu Da Road, Xi'an, Shaanxi, 710127 China, Shaanxi No. 4 Provincial People's Hospital, 512 Xianning East Rd, Xi'an, Shaanxi, 710043 China and Freeman Spogli Institute for International Studies, Stanford University, 616 Serra Street, Stanford, CA 94305, USA
| |
Collapse
|
40
|
Yang W, Wu X. Paying for outpatient care in rural China: cost escalation under China’s New Co-operative Medical Scheme. Health Policy Plan 2014; 30:187-96. [DOI: 10.1093/heapol/czt111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
41
|
China's new cooperative medical scheme and equity in access to health care: evidence from a longitudinal household survey. Int J Equity Health 2013; 12:20. [PMID: 23522336 PMCID: PMC3616826 DOI: 10.1186/1475-9276-12-20] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/25/2013] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION China's New Cooperative Medical Scheme (NCMS) was brought to life in 2003 in response to the deterioration in access to health services in rural areas. Despite its fast expansion, the scheme's impacts on access to health care have raised growing concerns, in particular regarding whether and to what extent the scheme has reduced inequity in access to health care in rural China. METHODS This study examines income-related inequity in access to health care from 2004 (before the national rollout of NCMS) to 2009 (after the expansion of NCMS across the rural China) by estimating Concentration Indices over both formal health care (outpatient care, prevention care) and informal health care use (folk doctor care). Data were drawn from a longitudinal household survey dataset - China Health and Nutrition Survey (CHNS). RESULTS The study suggested that the level of inequity remained the same for outpatient care, and an increased favouring-poor gap in terms of folk doctor care was observed. In terms of preventive care, a favouring-rich inequity was observed both in 2004 and 2009, but the effects of inequity were narrowed. The NCMS had some effects in reducing income-related health inequity in folk doctor care and preventive care, but the contribution was rather small. The study also found that the rural better-off had started to seek for commercial insurance to cover possible financial risks from the burden of diseases. CONCLUSION The study concludes that the impacts of the NCMS on improving access to formal care for the poor are limited. Without a more comprehensive insurance package that effectively targets the rural poor, the intended equity goals expected from the scheme will be difficult to realize.
Collapse
|