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Xu L, Xu N, Jiang X, Peng H, Wu Y, Lang Z, Zhou L, Ma D, Chen Z, Yin C, Yu Q. Study on the evaluation and influencing factors of contracted residents on the coordination of primary medical institutions. Front Public Health 2024; 12:1307765. [PMID: 38894990 PMCID: PMC11183267 DOI: 10.3389/fpubh.2024.1307765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/09/2024] [Indexed: 06/21/2024] Open
Abstract
Background The implementation of family doctor contract service is a pivotal measure to enhance primary medical services and execute the hierarchical diagnosis and treatment system. Achieving service coordination among various institutions is both a fundamental objective and a central element of contract services. Objective The study aims to assess residents' evaluations and determining factors related to the coordination of health services within primary medical institutions across different regions of Shandong Province. The findings intend to serve as a reference for enhancing the coordination services offered by these institutions. Methods The study employed a multi-stage stratified random sampling method to select three prefecture-level cities in Shandong Province with different economic levels. Within each city, three counties (districts) were randomly sampled using the same method. Within each county (district), three community health service centers and township health centers implementing family doctor contract services were selected randomly. Face-to-face questionnaire surveys were conducted with contracted residents using the coordination dimension of the revised Primary Care Assessment Tools Scale (PCAT) developed by the research team. Data analysis was conducted using such methods as one-way analysis of variance and multiple linear regression. Results The sample included 3,859 contracted residents. The coordination dimension score of primary medical institutions averaged 3.41 ± 0.18, with the referral service sub-dimension scoring 3.60 ± 0.58 and the information system sub-dimension scoring 3.34 ± 0.65. The overall score of the referral service sub-dimension surpassed that of the information system sub-dimension. Regression results indicated that the city's economic status, the type of contracted institutions, gender, education, marital status, income, occupation, health status, and endowment insurance payment status significantly influenced the coordinated service score of primary medical institutions (p < 0.05). Conclusion The coordination of primary medical institutions in Shandong Province warrants further optimization. Continued efforts should focus on refining the referral system, expediting information infrastructure development, enhancing the service standards of primary medical institutions, and fostering resident trust. These measures aim to advance the implementation of the hierarchical diagnosis and treatment and two-way referral system.
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Affiliation(s)
- Lingfeng Xu
- School of Management, Shandong Second Medical University, Shandong, China
| | - Na Xu
- School of Management, Shandong Second Medical University, Shandong, China
| | - Xiaoli Jiang
- School of Management, Shandong Second Medical University, Shandong, China
| | - Haibo Peng
- School of Management, Shandong Second Medical University, Shandong, China
| | - Yixuan Wu
- School of Management, Shandong Second Medical University, Shandong, China
| | - Zihan Lang
- School of Management, Shandong Second Medical University, Shandong, China
| | - Lifang Zhou
- School of Public Health, Shandong Second Medical University, Shandong, China
| | - Dongping Ma
- School of Management, Shandong Second Medical University, Shandong, China
| | - Zhongming Chen
- School of Management, Shandong Second Medical University, Shandong, China
| | - Chengliang Yin
- School of Basic Medical Sciences, Shandong Second Medical University, Shandong, China
| | - Qianqian Yu
- School of Management, Shandong Second Medical University, Shandong, China
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Dong Y, Wang A. Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review. J Multidiscip Healthc 2024; 17:2239-2250. [PMID: 38751666 PMCID: PMC11095522 DOI: 10.2147/jmdh.s463894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024] Open
Abstract
Background The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people. Methods Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature. Results Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results. Conclusion In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.
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Affiliation(s)
- Yu Dong
- The First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Aiping Wang
- The First Hospital of China Medical University, Shenyang, People’s Republic of China
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Wang S, Cheng F, Xu J. The impact of family doctor contract services on the utilization of and satisfaction with primary health care among Chinese residents: A cross-sectional study. J Family Med Prim Care 2024; 13:1887-1893. [PMID: 38948628 PMCID: PMC11213444 DOI: 10.4103/jfmpc.jfmpc_1724_23] [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: 10/24/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 07/02/2024] Open
Abstract
Introduction Family doctor contract service (FDCS) is a vital part of China's primary health care system. This study aims to explore whether contracting with FDCS affects residents' utilization of and satisfaction with primary health care. Methods A structured questionnaire was employed to collect data in January 2022. The questionnaire mainly included the following three parts: the social-demographic characteristics, health-related information, and utilization of and satisfaction with primary health care. Propensity score matching (PSM) was used to adjust for social-demographic differences between participants who contracted with a family doctor and those who did not. For the matched population, we used the Chi-square test to examine the differences in the utilization of and satisfaction with primary health care between contracted and non-contracted participants. Moreover, multiple logistic regression and linear regression were used to explore the influencing factors of the utilization of and satisfaction with primary health care. Results A total of 10,850 people were investigated and 10,419 participants were incorporated into the data analysis. After matching, there were no significant differences in most of the matching variables between the contracted and non-contracted groups (P > 0.05). The utilization rate was significantly higher among the contracted population than of the non-contracted (96.3% vs 92.6%, P < 0.001). The quality of services (e.g., good service attitude, high medical level, and a trusted family doctor) was more likely to be cited as the main reasons for the contracted people to utilize primary health care than for the non-contracted. The contracted people were also significantly more satisfied than the non-contracted in all terms of satisfaction. Moreover, people who contracted with a family doctor were more likely to use primary health care with OR = 1.979 (95% CI, 1.511-2.593). Conclusion The contracted people were more likely to utilize and be satisfied with primary health care than the non-contracted. In addition, the contracted people tended to use primary health care because of the quality of services rather than because of the close distance or short waiting time. Therefore, it is important to further promote the high quality of FDCS to ensure residents' sense of gain and improve their satisfaction.
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Affiliation(s)
- Shuo Wang
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Junfang Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wang X, Chu J, Zhao D, Gao T, Luo J, Wang X, Chai S, Li J, Sun J, Li P, Zhou C. The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter? BMC PRIMARY CARE 2024; 25:130. [PMID: 38658816 PMCID: PMC11040762 DOI: 10.1186/s12875-024-02383-8] [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: 08/06/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND This study aimed to explore the association between hypertension follow-up management and family doctor contract services, as well as to examine whether socioeconomic status (SES) had an interaction effect on this relationship among older adults in China. METHODS We used data from the sixth National Health Service Survey of Shandong Province, China, including 3,112 older adults (age ≥ 60 years) with hypertension in 2018. Logistic regression models and a margins plot were used to analyze the role of SES in the relationship between hypertension follow-up management and family doctor contract services. RESULTS The regular hypertension follow-up management rate and family doctor contracting rate were 81.8% and 70.9%, respectively, among older adults with hypertension. We found that participants with regular hypertension follow-up management were more likely to sign family doctor contract services (OR=1.28, 95%CI: 1.04, 1.58, P=0.018). The interaction effect occurred in the groups who lived in rural areas (OR=1.55, 95%CI: 1.02, 2.35), with high education level (OR=0.53, 95%CI: 0.32, 0.88) and had high incomes (OR=0.53, 95%CI: 0.35, 0.81). CONCLUSIONS Our findings suggested that regular hypertension follow-up management was associated with family doctor contract services and SES influenced this relationship. Primary health care should improve the contracting rate of family doctors by strengthening follow-up management of chronic diseases. Family doctors should focus on improving services quality and enriching the content of service packages especially for older adults with higher income and education level.
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Affiliation(s)
- Xuehong Wang
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jie Chu
- Shandong Center for Disease Control and Prevention, Jinan, 250012, China.
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Tingting Gao
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jingjing Luo
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Xueqing Wang
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Shujun Chai
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jiayan Li
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
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Xing XY, Wu ZZ, Wang HD, Xu W, Cao D, Liu ZR, Wu GC. The awareness rate of knowledge of chronic diseases and influencing factors among 4790 adults in anhui province: An online survey using WeChat. Heliyon 2024; 10:e28366. [PMID: 38590849 PMCID: PMC10999857 DOI: 10.1016/j.heliyon.2024.e28366] [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: 09/07/2022] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
Objective To investigate public awareness about core information regarding chronic diseases and identify factors influencing that awareness among Anhui Province residents, provide a scientific basis for policy-making, and formulate corresponding intervention measures. Methods From March to April 2021, 12 provincial-level representative counties and districts of Anhui province in the China Adult Chronic Disease and Nutrition Surveillance were selected as survey sites, and 4790 residents were recruited for the survey using stratified multi-stage cluster random sampling. Basic details about the study participants were collected and their awareness of core information about major chronic diseases was measured through an online survey using WeChat. Results In 2021, the awareness rate of core information about chronic diseases among residents of Anhui Province was 54.93%. Multivariate logistic regression analysis showed that a higher awareness rate was associated with the following factors: non-housework occupations (agriculture, forestry, animal husbandry, and fishery: OR = 1.309, commercial services and production and transportation: OR = 1.450, institutions, and professional and technical personnel: OR = 1.461), a high education level (high school/junior high school/technical school OR = 1.357, college and above OR = 2.133), and residence in the southern and northern Anhui areas (southern Anhui OR = 1.282, northern Anhui OR = 1.431); whereas in rural areas (by district and country) (OR = 0.863), the awareness rate was low (all P < 0.05). Conclusions The awareness rate of core information about chronic diseases among residents of Anhui, China, is low. It is necessary to strengthen awareness about chronic disease prevention and management by targeting specific groups of people in this region.
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Affiliation(s)
- Xiu-Ya Xing
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Zhen-Zhen Wu
- Department of Otorhinolaryngology and Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Hua-Dong Wang
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Wei Xu
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Dan Cao
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Zhi-Rong Liu
- Department of Chronic Non-communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, 230601, China
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Hefei, 230032, Anhui, China
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Gao T, Yan G, Zhang M, Leng B, Jiang F, Mi W. Effect of social integration on family doctor contracting services among migrant populations in China: a national cross-sectional survey. Fam Pract 2023; 40:538-545. [PMID: 37555256 DOI: 10.1093/fampra/cmad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The family doctor (FD) contracting system is a key reform in the development of the Chinese health system, and is considered an effective way to ensure equitable access to healthcare services. This study investigates the effects of social integration on FD contracting services among migrant populations. METHODS In total, 120,106 respondents from the 2018 China Migrants Dynamic Survey were included in this study. Two multivariate regression models were used to estimate the effect of social integration and other factors on FD contracting services among migrant populations. RESULTS This study found that only 14.0% of the migrant populations had a FD. Multiple dimensions of social integration and some covariates were shown to be positively associated with FD contracting services, including average monthly household income, local medical insurance (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.29-1.39), employment status (OR = 0.86, 95% CI = 0.82-0.91), settlement intention (OR = 1.15, 95% CI = 1.09-1.22), received health education (OR = 4.88, 95% CI = 4.51-5.27), sex (OR = 1.16, 95% CI = 1.12-1.20), age (OR = 1.66, 95% CI = 1.51-1.82), marital status (OR = 1.38, 95% CI = 1.31-1.46), sickness within a year (OR = 0.84, 95% CI = 0.79-0.89), and flow range (OR = 1.12, 95% CI = 1.07-1.16). CONCLUSIONS All dimensions of social integration, including economic integration, social identity, and social involvement, are associated with FD contracting services among migrant populations. Policymakers should focus on improving the signing rates of migrant populations and implement more effective measures to enhance their social integration, such as settlement incentives and encouraging social participation.
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Affiliation(s)
- Tiantian Gao
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Genquan Yan
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Meiying Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bing Leng
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fan Jiang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Wei Mi
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Chen Y, Liu W. Utilization and out-of-pocket expenses of primary care among the multimorbid elderly in China: A two-part model with nationally representative data. Front Public Health 2022; 10:1057595. [PMID: 36504938 PMCID: PMC9730339 DOI: 10.3389/fpubh.2022.1057595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Multimorbidity has become an essential public health issue that threatens human health and leads to an increased disease burden. Primary care is the prevention and management of multimorbidity by providing continuous, comprehensive patient-centered services. Therefore, the study aimed to investigate the determinants of primary care utilization and out-of-pocket expenses (OOPE) among multimorbid elderly to promote rational utilization of primary care and reduce avoidable economic burdens. Methods The study used data from CHARLS 2015 and 2018, which included a total of 4,384 multimorbid elderly aged 60 and above. Guided by Grossman theory, determinants such as education, gender, marriage, household economy, and so on were included in this study. A two-part model was applied to evaluate primary care utilization and OOPE intensity in multimorbid populations. And the robustness testing was performed to verify research results. Results Primary care visits rate and OOPE indicated a decline from 2015 to 2018. Concerning primary outpatient care, the elderly who were female (OR = 1.51, P < 0.001), married (OR = 1.24, P < 0.05), living in rural areas (OR = 1.77, P < 0.001) and with poor self-rated health (OR = 2.23, P < 0.001) had a significantly higher probability of outpatient utilization, whereas those with middle school education (OR = 0.61, P < 0.001) and better household economy (OR = 0.96, P < 0.001) had a significantly less likelihood of using outpatient care. Rural patients (β = -0.72, P < 0.05) may have lower OOPE, while those with better household economy (β = 0.29, P < 0.05; β = 0.58, P < 0.05) and poor self-rated health (β = 0.62, P < 0.001) occurred higher OOPE. Regarding primary inpatient care, adults who were living in rural areas (OR = 1.48, P < 0.001), covered by Urban Employee Basic Medical Insurance (UEBMI) or Urban Rural Basic Medical Insurance (URBMI) (OR = 2.46, P < 0.001; OR = 1.81, P < 0.001) and with poor self-rated health (OR = 2.30, P < 0.001) had a significantly higher probability of using inpatient care, whereas individuals who were female (OR = 0.74, P < 0.001), with middle school education (OR = 0.40, P < 0.001) and better household economy (OR = 0.04, P < 0.001) had a significantly lower tendency to use inpatient care. Significantly, more OOPE occurred by individuals who were women (β = 0.18, P < 0.05) and with better household economy (β = 0.40, P < 0.001; β = 0.62, P < 0.001), whereas those who were covered by URBMI (β = -0.25, P < 0.05) and satisfied with their health (β = -0.21, P < 0.05) had less OOPE. Conclusion To prompt primary care visits and reduce economic burden among subgroups, more policy support is in need, such as tilting professional medical staff and funding to rural areas, enhancing awareness of disease prevention among vulnerable groups and so on.
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Mai S, Cai J, Li L. Factors associated with access to healthcare services for older adults with limited activities of daily living. Front Public Health 2022; 10:921980. [PMID: 36276353 PMCID: PMC9583939 DOI: 10.3389/fpubh.2022.921980] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/02/2022] [Indexed: 01/22/2023] Open
Abstract
Background Limited studies focused on the situation and related factors of access to healthcare services for older adults with limited activities of daily living (ADL) in China. This study explores factors associated with access to healthcare services of them based on Andersen's healthcare utilization model (namely, need, predisposing, and enabling dimensions). Methods A total of 3,980 participants aged 65 years and older adults with limited ADL from the latest wave (2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Binary logistic regression was used to explore the influencing factors. Results Factors in enabling dimension were associated with access to healthcare services for older adults with limited ADL. Those who lived with better economic status (fair vs poor, OR = 2.98, P < 0.01; rich vs poor, OR = 7.23, P = 0.01), could afford daily life (yes vs no, OR = 2.33, P = 0.03), and lived in the eastern or central region of China (eastern vs western, OR = 2.91, P < 0.01; central vs western, OR = 2.40, P = 0.02) could access to healthcare services more easily. However, factors in predisposing dimension and need dimension showed no statistical significance. Meanwhile, inconvenience in the movement was the major barrier reported by some participants for not going to the hospital when they got sick. Conclusion Access to healthcare services for older adults with ADL limitation was mainly related to the factors of economic status, affordability for daily life, and living regions in enabling dimension. Strategies focused on health insurance, healthcare system, barrier-free facilities, and social support were proposed to increase the access to healthcare services for participants, which could benefit their health.
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Affiliation(s)
- Shumin Mai
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jingjing Cai
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Li
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China,Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China,*Correspondence: Lu Li
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