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Wang Y, Wang R, Jiang M, Ying X. Provincial inequality of China's progress towards universal health coverage: An empirical analysis in 2016-21. J Glob Health 2024; 14:04122. [PMID: 38939928 PMCID: PMC11211969 DOI: 10.7189/jogh.14.04122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the regional economy and resource allocation, subnational evidence in China is urgently needed. This study aimed to monitor provincial progress from 2016 to 2021, thereby informing the development of region-specific strategies. Methods Based on the UHC monitoring framework proposed by the World Health Organization, a UHC index was constructed comprising the service coverage dimension (16 indicators) and financial protection dimension (four indicators). In this observational study, routinely collected health data from 25 provinces (autonomous regions and municipalities) in mainland China were obtained from statistical yearbooks, relevant literature, and nationally representative surveys. The indices were calculated using geometric means. Socioeconomic inequalities among provinces were quantified using the slope index of inequality (SII) and relative index of inequality (RII). Results From 2016 to 2021, China made laudable progress towards achieving UHC, with the index rising from 56.94 in 2016 to 63.03 in 2021. Most provinces demonstrated better performance in service coverage. Western provinces generally presented faster rates of progress, which were attributed to more substantial increases in financial protection. Despite significant disparities, with the UHC index ranging from 77.94 in Shanghai to 54.61 in Fujian in 2021, the overall equity of UHC has improved across the 25 provinces. SII decreased from 17.78 (95% confidence interval (CI) = 11.64, 23.93) to 12.25 (95% CI = 5.86, 18.63) and RII from 1.38 (95% CI = 1.29, 1.46) to 1.22 (95% CI = 1.16, 1.29). However, the non-communicable disease (NCD) domain experienced a drop in both index score and equity, underscoring the need for prioritised attention. Conclusions In the context of SDGs and the 'Healthy China 2030' initiative, China has made commendable progress towards UHC, and inter-provincial equity has improved. However, substantial differences persisted. The equitable realisation of UHC necessitates prioritising the enhancement of service capacity and financial protection in less developed regions, particularly by addressing shortages in the general practitioner workforce and mitigating catastrophic payments. Developed regions should focus on preventing NCDs through effective interventions targeting key risk factors. This study provides insights for other countries to adopt comprehensive monitoring frameworks, identify subnational disparities, and introduce targeted policy initiatives.
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Affiliation(s)
- Yining Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Ruixin Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Mingzhu Jiang
- School of Public Health, Fudan University, Shanghai, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China
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Zhang M, Du X, Jia G, Xia Q, Xu Y, Wu J, He Y, Wu J. Comparative Study on the Satisfaction of Healthcare Service Providers with the Synergistic Development of Rural Healthcare Systems in China: Medical Alliance Counties vs. Non-Medical Alliance Counties. Int J Integr Care 2024; 24:26. [PMID: 38911946 PMCID: PMC11192093 DOI: 10.5334/ijic.7677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/10/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction This study aimed to explore whether the establishment of county medical alliances can improve satisfaction with the vertical integration of healthcare systems among rural medical and healthcare service provider managers and service providers. Our study also sought to provide recommendations for the sustainable development of vertical integration in healthcare systems. Methods A semi-structured interview with 30 healthcare service providers was employed in this research, and Nvivo software was utilized to analyze factors that influence vertical integration. From April to July 2021, a multi-stage random sampling method was used to select participants. The sample included two leading hospitals in medical consortia, 15 member units (healthcare service providers and medical staff), two county-level hospitals, and 15 township health centers/community healthcare service centers from non-medical consortia. Questionnaire surveys were conducted with these groups. Factor analysis was used to calculate satisfaction scores for healthcare service providers with the cross-institutional synergistic development of healthcare systems in both medical and non-medical consortia (denoted as M(IQR)). Propensity score matching was employed to reduce confounding factors between groups. The Mann-Whitney U test was used to compare satisfaction differences between groups. Results The overall satisfaction scores for lead-county hospital managers, member institution managers, medical staff at the lead-county hospital, and medical staff at member institutions were 4.80 (1.00), 4.17 (1.17), 4.00 (1.38), and 4.00 (1.12), respectively. Lead-county hospital managers' satisfaction with cross-institutional collaboration, development capacity enhancement, and structure and resource integration in the Medical Alliance group showed higher satisfaction than the Non-Medical Alliance. Similarly, lead-county hospital medical staff in the Medical Alliance group reported greater satisfaction with collaboration efforts, supportive environment, and development capacity enhancement. Notably, while the Medical Alliance group's satisfaction scores were higher, the differences between the two groups were not statistically significant for lead-county hospital managers and medical staff. The Medical Alliance group did show statistically significant differences in member institution managers' satisfaction with collaboration, development capacity enhancement, and structure and resource integration. Additionally, medical staff of member institutions in the Medical Alliance group reported statistically significant higher satisfaction with collaboration, supportive environment, development capacity enhancement, healthcare service integration, and human resource development. Conclusion To facilitate the establishment of county medical alliances, managers of leading county-level hospitals should adopt a healthcare system integration strategy. This strategy involves evolution from being a member of a single institution to a coordinator of cross-institutional vertical integration of medical and healthcare services. Additionally, revamping remuneration and appraisal systems for members of county medical alliances is necessary. This will encourage cooperation among healthcare institutions within the three-tiered system and their medical staff, ultimately facilitating the provision of integrated services.
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Affiliation(s)
- Meng Zhang
- Department of Health Management and Policy, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - XiaoNan Du
- Center for Project Supervision and Management National Health Commission, P.R. China, Beijing, China
| | - GeGe Jia
- Department of Health Management and Policy, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - QingYun Xia
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - YanYun Xu
- Department of Health Management and Policy, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jvxiao Wu
- School of Journalism and Communication, Wuhan University, Wuhan, China
| | - YiLin He
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jian Wu
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, China
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Hafiz O, Yin X, Sun S, Yang J, Liu H. Examining the Use and Application of the WHO Integrated People-Centred Health Services Framework in Research Globally - a Systematic Scoping Review. Int J Integr Care 2024; 24:9. [PMID: 38681978 PMCID: PMC11049668 DOI: 10.5334/ijic.7754] [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: 10/05/2023] [Accepted: 04/09/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction The World Health Organisation (WHO) accepted the Integrated People-centred Health Services (IPCHS) framework in 2016 as an essential component for achieving universal health coverage in fragmented health systems. We aimed to examine the empirical applications of the WHO IPCHS framework to guide its use in strengthening health-service research. Methods Academic databases and the IPCHS website were searched for relevant articles published between 2016 and July 2023. Two reviewers independently screened and extracted data on the study design, setting, IPCHS framework components, and facilitators and barriers to implementing the IPCHS strategies. Descriptive and content analyses were conducted. Results Six studies were identified using the IPCHS framework. Studies have examined a combination of the five IPCHS strategies. All studies reported building strong primary care-based systems and coordinating care for individuals. Continued relationships and trust, co-production of health programmes, diversity of health care team, and technology were major facilitators, while low health literacy, lack of primary setting capacity and healthcare workforce were principal barriers to IPCHS implementation. Conclusion This scoping review offers an overview of IPCHS strategies employed in healthcare research. Generally, the IPCHS framework remains underutilised in primary research. These results offer guidance for future research to support effective healthcare delivery.
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Affiliation(s)
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Jingsong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
- Sydney Institute for Women, Children and Families, Sydney Local Health District, Sydney, Australia
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Chen J, Feng H, Sun J, Jiang Y. Omicron wave during December 2022 - January 2023: access to pharmaceuticals and healthcare resources and impacts on health outcomes in Shenzhen, China. J Pharm Policy Pract 2024; 17:2306867. [PMID: 38357548 PMCID: PMC10866053 DOI: 10.1080/20523211.2024.2306867] [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] [Indexed: 02/16/2024] Open
Abstract
Purpose This study described pharmaceutical and medical resource accessibility of COVID-19 treatment in Shenzhen, China during the peak of COVID-19 infection from December 2022 to January 2023, and examined its influence on clinical outcomes. Methods We surveyed Shenzhen residents on COVID-19-related topics using electronic questionnaires. We conducted descriptive statistical analyses and multiple regressions including logistic and Tobit models to explore the impacts of resource constraints on patient outcomes. Resource utilisation and attempts to seek medical care were also described for severity-stratified subgroups. Results 76.8% of respondents reported experiencing COVID-19 symptoms between December 7, 2022 and January 29, 2023. Of those who attempted to purchase medication, 72.8% reported drug shortage. 49% of those seeking medical treatment experienced difficulties. Compared with those who did not experience drug shortages, those who did had an odds ratio of 1.959 (95% CI: 1.159 ∼3.313) of presenting with moderate to severe symptoms. Compared with those without difficulties in seeking medical treatment, those who did had an average of 0.39 (95% CI: 0.110 ∼0.670) more days absent from work. Conclusion Shenzhen residents with COVID-19 symptoms from December 2022 to January 2023 experienced a certain degree of pharmaceutical and medical resource constraints, which might have compromised their prognosis.
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Affiliation(s)
- Jiayue Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Haisu Feng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Jiatong Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
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Zhang C, Ji X, Wei J, Dou X, Chen D, Zhang X. Improving regional medical laboratory center report quality through a report recall management system. Clin Chem Lab Med 2024; 62:341-352. [PMID: 37673465 DOI: 10.1515/cclm-2023-0786] [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: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Currently, most medical laboratories do not have a dedicated software for managing report recalls, and relying on traditional manual methods or laboratory information system (LIS) to record recall data is no longer sufficient to meet the quality management requirements in the large regional laboratory center. The purpose of this article was to describe the research process and preliminary evaluation results of integrating the Medical Laboratory Electronic Record System (electronic record system) laboratory report recall function into the iLab intelligent management system for quality indicators (iLab system), and to introduce the workflow and methods of laboratory report recall management in our laboratory. METHODS This study employed cluster analysis to extract commonly used recall reasons from laboratory report recall records in the electronic record system. The identified recall reasons were validated for their applicability through a survey questionnaire and then incorporated into the LIS for selecting recall reasons during report recall. The statistical functionality of the iLab system was utilized to investigate the proportion of reports using the selected recall reasons among the total number of reports, and to perform visual analysis of the recall data. Additionally, we employed P-Chart to establish quality targets and developed a "continuous improvement process" electronic flow form. RESULTS The reasons for the recall of laboratory reports recorded in the electronic recording system were analyzed. After considering the opinions of medical laboratory personnel, a total of 12 recall reasons were identified, covering 73.05 % (1854/2538) of the recalled laboratory reports. After removing data of mass spectra lab with significant anomalies, the coverage rate increased to 82.66 % (1849/2237). The iLab system can generate six types of statistical graphs based on user needs, including statistical time, specialty labs (or divisions), test items, reviewers, reasons for report recalls, and distribution of the recall frequency of 0-24 h reports. The control upper limit of the recall rate of P-Chart based on laboratory reports can provide quality targets suitable for each professional group at the current stage. Setting the five stages of continuous process improvement reasonably and rigorously can effectively achieve the goal of quality enhancement. CONCLUSIONS The enhanced iLab system enhances the intelligence and sustainable improvement capability of the recall management of laboratory reports, thus improving the efficiency of the recall management process and reducing the workload of laboratory personnel.
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Affiliation(s)
- Chuang Zhang
- School of Medicine, Anhui University of Science and Technology Huainan, P.R. China
| | - Xiang Ji
- Medical Laboratory of the Third Affiliated Hospital of Shenzhen University Shenzhen, P.R. China
| | - Jiehong Wei
- Medical Laboratory of the Third Affiliated Hospital of Shenzhen University Shenzhen, P.R. China
| | - Xiaowen Dou
- Medical Laboratory of the Third Affiliated Hospital of Shenzhen University Shenzhen, P.R. China
| | - Dayang Chen
- Medical Laboratory of the Third Affiliated Hospital of Shenzhen University Shenzhen, P.R. China
| | - Xiuming Zhang
- Medical Laboratory of the Third Affiliated Hospital of Shenzhen University Shenzhen, P.R. China
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He YT, Zhang YC, Wu RK, Huang W, Wang RN, He LX, Li B, Zhang YL. Dynamic evolution and spatial difference of public health service supply in economically developed provinces of China: typical evidence from Guangdong Province. BMC Health Serv Res 2024; 24:23. [PMID: 38178099 PMCID: PMC10768127 DOI: 10.1186/s12913-023-10444-4] [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: 04/10/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE The outbreak of the COVID-19 pandemic has drawn attention from all sectors of society to the level of public health services. This study aims to investigate the level of public health service supply in the four major regions of Guangdong Province, providing a basis for optimizing health resource allocation. METHODS This article uses the entropy method and panel data of 21 prefecture-level cities in Guangdong Province from 2005 to 2021 to construct the evaluation index system of public health service supply and calculate its supply index. On this basis, the standard deviation ellipse method, kernel density estimation, and Markov chain are used to analyze the spatiotemporal evolution trend of the public health service supply level in Guangdong Province. The Dagum Gini coefficient and panel regression model are further used to analyze the relative differences and the key influencing factors of difference formation. Finally, the threshold effect model is used to explore the action mechanism of the key factors. RESULTS Overall, the level of public health service supply in Guangdong Province is on an upward trend. Among them, polarization and gradient effects are observed in the Pearl River Delta and Eastern Guangdong regions; the balance of public health service supply in Western Guangdong and Northern Mountainous areas has improved. During the observation period, the level of public health services in Guangdong Province shifted towards a higher level with a smaller probability of leapfrogging transition, and regions with a high level of supply demonstrated a positive spillover effect. The overall difference, intra-regional difference and inter-regional difference in the level of public health service supply in Guangdong Province during the observation period showed different evolutionary trends, and spatial differences still exist. These differences are more significantly positively affected by factors such as the level of regional economic development, the degree of fiscal decentralization, and the urbanization rate. Under different economic development threshold values, the degree of fiscal decentralization and urbanization rate both have a double threshold effect on the role of public health service supply level. CONCLUSION The overall level of public health service supply in Guangdong Province has improved, but spatial differences still exist. Key factors influencing these differences include the level of regional economic development, the degree of fiscal decentralization, and the urbanization rate, all of which exhibit threshold effects. It is suggested that, in view of the actual situation of each region, efforts should be made to build and maintain their own advantages, enhance the spatial linkage of public health service supply, and consider the threshold effects of key factors in order to optimize the allocation of health resources.
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Affiliation(s)
- Yan-Ting He
- School of Health Management, Southern Medical University, Guangzhou510515, China
| | - Yue-Chi Zhang
- School of Social & Political Sciences, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Rang-Ke Wu
- School of Foreign Studies, Southern Medical University, Guangzhou510515, China
| | - Wen Huang
- The Fifth Affiliate Hospital of Southern Medical University, Guangzhou510515, China
| | - Ruo-Nan Wang
- School of Health Management, Southern Medical University, Guangzhou510515, China
| | - Luo-Xuan He
- School of Health Management, Southern Medical University, Guangzhou510515, China
| | - Bei Li
- School of Health Management, Southern Medical University, Guangzhou510515, China.
| | - Yi-Li Zhang
- School of Health Management, Southern Medical University, Guangzhou510515, China.
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Yan Wang N, Liu X, Kong X, Sumi Y, Chhetri JK, Hu L, Zhu M, Kang L, Liang Z, Ellis JW, Shi L. Implementation and impact of the World Health Organization integrated care for older people (ICOPE) program in China: a randomised controlled trial. Age Ageing 2024; 53:afad249. [PMID: 38251736 DOI: 10.1093/ageing/afad249] [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: 10/04/2023] [Revised: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Fragmentation of services increases health and social care burden as people live longer with higher prevalence of diseases, frailty and dependency. Local evidence for implementing person-centred integrated care is urgently needed to advance practice and policies to achieve healthy ageing. OBJECTIVE To test the feasibility and impact of World Health Organization's (WHO) Integrated Care for Older People (ICOPE) approach in China. DESIGN A randomised controlled trial examining the feasibility of implementing ICOPE approach, evaluating its impact on health outcomes and health resource utilisation. SETTING Primary care setting in urban and suburban communities of Chaoyang District, Beijing, China. SUBJECTS Community-dwelling older adults screened as at-risk of functional declines and randomised into intervention (537) and control (1611) groups between September 2020 and February 2021. METHODS A 6-month intervention program following WHO's ICOPE care pathways implemented by integrated care managers compared to standard available care. RESULTS After 1 to 1 propensity score matching, participants in intervention and control groups (totally 938) had comparable baseline characteristics, demonstrated feasibility of implementing ICOPE with satisfaction by participants (97-99%) and providers (92-93%). All outcomes showed improvements after a 6-month intervention, while statistically significant least-squares mean differences (control-intervention) in vitality (Mini-Nutritional Assessment Short Form to measure vitality, -0.21, 95% CI, -0.40-0.02), mobility (Short Physical Performance Battery to measure mobility, -0.29, 95% CI, -0.44-0.14) and psychological health (Geriatric Depression Scale five items to measure psychological health, 0.09, 95% CI, 0.03-0.14) were observed (P < 0.05). CONCLUSIONS It is feasible to localise and implement WHO's ICOPE approach in regions with fragmented resources such as China. Preliminary evidence supports its acceptance among key stakeholders and impact on health outcomes.
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Affiliation(s)
- Ninie Yan Wang
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaohong Liu
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangrong Kong
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuka Sumi
- Ageing and Health (AAH), Department of Maternal, Newborn, Child & Adolescent Health & Ageing (MCA), World Health Organization, Geneva, Switzerland
| | - Jagadish K Chhetri
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linlin Hu
- School of Health Policy and Management, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Minglei Zhu
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen Liang
- Shenzhen People's Hospital, Shenzhen, China
| | - John W Ellis
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Zhang T, Liu J, Wang X, Liu C. County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis. Health Syst Reform 2023; 9:2258770. [PMID: 37788424 DOI: 10.1080/23288604.2023.2258770] [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: 09/07/2022] [Accepted: 09/11/2023] [Indexed: 10/05/2023] Open
Abstract
This study aimed to assess the effects of a two-stage funding reform, involving DRGs-based (Diagnostic Related Groups) payments for inpatient care and capitation funding for outpatient care, respectively, on services volume and care expenditure of county hospitals in Zhejiang province, China. A quasi-experimental design was adopted, involving 6 hospitals from 2 counties in the intervention group and 12 hospitals from 5 counties in the control group. The DRGs-based payments for inpatient care and capitation funding for outpatient care were introduced in January 2018 and January 2019, respectively. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms using monthly data over the period from January 2017 to December 2019. The volume of inpatient care decreased after the introduction of the first-stage DRGs-based payments, which was accompanied by an increase in the volume of outpatient visits. The DRGs-based payments led to a reduction of on average 1390 Yuan total expenditure per episode of inpatient care and 1116 Yuan out-of-pocket (OOP) payment per episode of inpatient care. However, the average outpatient expenditure per visit increased. So did the corresponding OOP payment per outpatient visit. The introduction of the second-stage capitation funding for outpatient care reversed the increasing trend of outpatient care. The average expenditure and OOP payment per outpatient visit decreased. The funding reforms create a significant effect on service volumes and expenditures in county hospitals. A coordinated approach to both inpatient and outpatient funding mechanisms is needed to minimize cost-shifting between inpatient and outpatient care and to achieve the intended policy outcomes.
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Affiliation(s)
- Tao Zhang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jing Liu
- Administrative Office, Yuebei People's Hospital, Shaoguan, Guangdong, China
| | - Xiaohe Wang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Yip W, Fu H, Jian W, Liu J, Pan J, Xu D, Yang H, Zhai T. Universal health coverage in China part 2: addressing challenges and recommendations. Lancet Public Health 2023; 8:e1035-e1042. [PMID: 38000883 DOI: 10.1016/s2468-2667(23)00255-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/26/2023]
Abstract
This report analyses the underlying causes of China's achievements and gaps in universal health coverage over the past 2 decades and proposes policy recommendations for advancing universal health coverage by 2030. Although strong political commitment and targeted financial investment have produced positive outcomes in reproductive, maternal, newborn, and child health and infectious diseases, a fragmented and hospital-centric delivery system, rising health-care costs, shallow benefit coverage of health insurance schemes, and little integration of health in all policies have restricted China's ability to effectively prevent and control chronic disease and provide adequate financial risk protection, especially for lower-income households. Here, we used a health system conceptual framework and we propose a set of feasible policy recommendations that draw from international experiences and first-hand knowledge of China's unique institutional landscape. Our six recommendations are: instituting a primary care-focused integrated delivery system that restructures provider incentives and accountability mechanisms to prioritise prevention; leveraging digital tools to support health behaviour change; modernising information campaigns; improving financial protection through insurance reforms; promoting a health in all policy; and developing a domestic monitoring framework with refined tracer indicators that reflects China's disease burden.
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Affiliation(s)
- Winnie Yip
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; School of Public Administration, Sichuan University, Chengdu, China
| | - Duo Xu
- Institute of Population and Labor Economics, Chinese Academy of Social Sciences, Beijing, China
| | - Hanmo Yang
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Tiemin Zhai
- China National Health Development Research Center, Beijing, China
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Wang X, Zheng C, Wang Y, Birch S, Huang Y, Valentijn P. Patients' and Care Professionals' Evaluation of the Effect of a Hospital Group on Integrated Care in Chinese Urban Health Systems: A Propensity Score Matching and Difference-in-differences Regression Approach. Int J Health Policy Manag 2023; 12:7897. [PMID: 38618775 PMCID: PMC10843371 DOI: 10.34172/ijhpm.2023.7897] [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: 12/19/2022] [Accepted: 10/28/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND A hospital group is an organizational integration strategy that has recently been widely implemented in Chinese urban health systems to promote integrated care. This study aims to evaluate the effect of hospital group on integrated care from the perspectives of both patients and care professionals. METHODS Two cross-sectional surveys were conducted in Shenzhen city of China, in June 2018 and July 2021. All thirty Community Health Stations (CHSs) in the hospital group were included in the intervention group, with 30 CHSs in the same district selected as the control group by simple random sampling. All care professionals within both the intervention and the control groups were invited to participate in the surveys. Twelve CHSs were selected from 30 CHSs in the intervention and the control groups by simple random sampling, and 20 patients with type 2 diabetes mellitus (T2DM) were selected from each of these selected CHSs to participate in the survey by systematic sampling. The Rainbow Model of Integrated Care-Measurement Tool (Chinese version) was used to assess integrated care. Propensity score matching and difference-in-differences regression (PSM-DID) were used to evaluate the effect of the hospital group on integrated care. RESULTS After matching, 528 patients and 1896 care professionals were included in the DID analysis. Results from care professionals indicated that the hospital group significantly increased technical competence of the health system by 0.771 points, and cultural competence by 1.423 points. Results from patients indicated that the hospital group significantly decreased organizational integration of the health system by 0.649 points. CONCLUSION The results suggests that the effect of the hospital group on integrated care over and above routine strategies for integrated care is limited. Therefore, it is necessary to pay attention to implementing professional, clinical and other integration strategies beyond establishing hospital groups, in urban Chinese health systems.
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Affiliation(s)
- Xin Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Caiyun Zheng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yao Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, Australia
| | - Yixiang Huang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Pim Valentijn
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, The Netherlands
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Wang Y, Guo D, Wang M, Hu M, Zhu D, Yu Q, Li Z, Zhang X, Ding R, Zhao M, He P. Community-based integrated care for patients with diabetes and depression (CIC-PDD): study protocol for a cluster randomized controlled trial. Trials 2023; 24:550. [PMID: 37608381 PMCID: PMC10464429 DOI: 10.1186/s13063-023-07561-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Managing the multimorbidity of diabetes and depression remains a clinical challenge for patients and healthcare professionals due to the fragmented healthcare delivery system. To effectively cope with multimorbidity, there is an urgent need for the health system to transform into people-centered integrated care (PCIC) system globally. Therefore, this paper describes the protocol of community-based integrated care for patients with diabetes and depression (CIC-PDD) project, an integrated and shared-care intervention project. METHODS/DESIGN CIC-PDD project is conducted in two phases, namely "care model development" and "implementation and evaluation." In the first phase, CIC-PDD model was designed and developed based on the four criteria of collaborative care model (CCM) and was subsequently adjusted to align with the context of China. The second phase entails a pragmatic, two-arm, cluster randomized controlled implementation trial, accompanied by parallel mixed-methods process evaluation and cost-effectiveness analysis. DISCUSSION We anticipate CIC-PDD project will facilitate the development and innovation of PCIC model and related theories worldwide, particularly in low- and middle-income countries (LMICs). In addition, CIC-PDD project will contribute to the exploration of primary health care (PHC) in addressing the multimorbidity of physical and mental health issues. TRIAL REGISTRATION ClinicalTrials.gov registration ChiCTR2200065608 (China Clinical Trials Registry https://www.chictr.org.cn ). Registered on November 9, 2022.
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Affiliation(s)
- Yanshang Wang
- School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Dan Guo
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Ming Wang
- School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Mingzheng Hu
- School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Qianqian Yu
- School of Management, Weifang Medical University, Weicheng District, 7166 Baotong Street, Weifang, 261053, Shandong, China
| | - Zhansheng Li
- Health Commission of Weifang, 6396 Dongfeng East Street, Weifang, 261061, Shandong, China
| | - Xiaoyi Zhang
- Health Commission of Weifang, 6396 Dongfeng East Street, Weifang, 261061, Shandong, China
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Miaomiao Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Xuhui District, 600 Wanping South Street, Shanghai, 200030, China
- Center for Mental Health Management, China Hospital Development Institute, Shanghai Jiao Tong University, Xuhui District, 600 Wanping South Street, Shanghai, 200030, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China.
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Xu YW, Fan L. Emotional labor and job satisfaction among nurses: The mediating effect of nurse-patient relationship. Front Psychol 2023; 14:1094358. [PMID: 37342648 PMCID: PMC10278545 DOI: 10.3389/fpsyg.2023.1094358] [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: 11/10/2022] [Accepted: 03/06/2023] [Indexed: 06/23/2023] Open
Abstract
Emotional labor is considered an important part of the role in the nursing field. Previous studies have found inconsistencies between emotional labor and job satisfaction of nurses, this is due to the relationship between them being affected by other factors. However, the current nurse-patient relationship is tense and leads to an unsafe and unstable working environment for nurses. It has yet to be confirmed whether the nurse-patient relationship can be used as a mediating variable to further explain the association that exists between emotional labor and job satisfaction. Therefore, this study tested the mediating effect of the nurse-patient relationship between emotional labor and job satisfaction among Chinese nurses. A total of 496 nurses were included in the study. Data collection was from December 2021 to March 2022 using the convenience sampling method. SPSS 26.0 and AMOS 23.0 software were used to perform structural equation modeling and analyze the relationship between variables. The results showed surface acting negatively affected nurse-patient relationships and job satisfaction, contrary to deep acting and naturally felt emotions. The parallel mediation of nurse-patient trust and patient-centered nursing in the relationship between emotional labor and job satisfaction was found to be statistically significant. Our study highlighted the important mediation of nurse-patient trust and the importance of the positive effects of emotional labor. Future studies can use these findings as a reference to develop interventions.
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Zhang Z, Yuan M, Shi K, Xu C, Lin J, Shi Z, Fang Y. Association between multimorbidity trajectories, healthcare utilization, and health expenditures among middle-aged and older adults: China Health and Retirement Longitudinal Study. J Affect Disord 2023; 330:24-32. [PMID: 36868387 DOI: 10.1016/j.jad.2023.02.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND To identify the latent groups of multimorbidity trajectories among middle-aged and older adults and examine their associations with healthcare utilization and health expenditures. METHODS We included adults aged ≥45 years who participated in the China Health and Retirement Longitudinal Study from 2011 to 2015 and were without multimorbidities (<2 chronic conditions) at baseline. Multimorbidity trajectories underlying 13 chronic conditions were identified using group-based multi-trajectory modeling based on the latent dimensions. Healthcare utilization included outpatient care, inpatient care, and unmet healthcare needs. Health expenditures included healthcare costs and catastrophic health expenditures (CHE). Random-effects logistic regression, random-effects negative binomial regression, and generalized linear regression models were used to examine the association between multimorbidity trajectories, healthcare utilization, and health expenditures. RESULTS Of the 5548 participants, 2407 developed multimorbidities during follow-up. Three trajectory groups were identified among those with new-onset multimorbidity according to the increasing dimensions of chronic diseases: "digestive-arthritic" (N = 1377, 57.21 %), "cardiometabolic/brain" (N = 834, 34.65 %), and "respiratory/digestive-arthritic" (N = 196, 8.14 %). All trajectory groups had a significantly increased risk of outpatient care, inpatient care, unmet healthcare needs, and higher healthcare costs than those without multimorbidities. Notably, participants in the "digestive-arthritic" trajectory group had a significantly increased risk of incurring CHE (OR = 1.70, 95%CI: 1.03-2.81). LIMITATIONS Chronic conditions were assessed using self-reported measures. CONCLUSIONS The growing burden of multimorbidity, especially multimorbidities of digestive and arthritic diseases, was associated with a significantly increased risk of healthcare utilization and health expenditures. The findings may help in planning future healthcare and managing multimorbidity more effectively.
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Affiliation(s)
- Zeyun Zhang
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Manqiong Yuan
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Kanglin Shi
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Chuanhai Xu
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Jianlin Lin
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Zaixing Shi
- Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Ya Fang
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China.
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The Early Impact of the People-centred Integrated Care on the Hypertension Management in Shenzhen. Int J Integr Care 2023; 23:6. [PMID: 36819616 PMCID: PMC9912848 DOI: 10.5334/ijic.6539] [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: 03/04/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
Objective To evaluate the impact of the integrated care in Luohu, China on the hypertension management. Methods Hypertensive patients aged 35-74 years were recruited by the cluster-randomized sampling method from Luohu district which adopted integrated care and another district that remained original routine care during October 2018~January 2020, with 1353 and 583 patients from integrated and routine care communities, respectively. Health information, knowledge, attitude, and practice (KAP) towards cardiovascular diseases, pharmaceutical expenditure on hypertension and its comorbidities, and healthcare-related satisfaction were collected by questionnaires, with the expenditure additionally verified by hospitals' billing records database. Continuous and categorical variables were compared by Wilcoxon test and Chi-square test, respectively. The age-standardized hypertension control rate was calculated by direct standardization. Results The standardized hypertension management rate in the integrated care communities (45.75%) was significantly higher than that in routine care communities (14.07%) (P < 0.0001), while the age-standardized hypertension control rates were similar (integrated care: 50.3%, routine care: 52.65%, P = 0.518). The pharmaceutical expenditure on hypertension and its comorbidities in the integrated care communities was Ұ264.23 ± 357.38/month/person, lower than that in the routine care communities (Ұ354.56 ± 430.59/month/person). Patients in the integrated care had higher KAP scores (73.48 ± 11.54), compared with routine care (68.89 ± 15.51) (P < 0.0001). Moreover, the integrated care communities had higher satisfaction rates towards the convenience of dual referral (90.15% vs. 77.99%) and service quality (95.18% vs. 87.81%) than routine care communities (P < 0.0001). Conclusion The practice of the integrated care in Luohu has substantially improved the hypertension management and the healthcare-related satisfaction while with relatively low pharmaceutical expenditure. The investigation of long-term impact of the integrated care on hypertension control and management is warranted.
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La DTV, Zhao Y, Arokiasamy P, Atun R, Mercer S, Marthias T, McPake B, Pati S, Palladino R, Lee JT. Multimorbidity and out-of-pocket expenditure for medicines in China and India. BMJ Glob Health 2022; 7:bmjgh-2021-007724. [DOI: 10.1136/bmjgh-2021-007724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
IntroductionUsing nationally representative survey data from China and India, this study examined (1) the distribution and patterns of multimorbidity in relation to socioeconomic status and (2) association between multimorbidity and out-of-pocket expenditure (OOPE) for medicines by socioeconomic groups.MethodsSecondary data analysis of adult population aged 45 years and older from WHO Study on Global Ageing and Adult Health (SAGE) India 2015 (n=7397) and China Health and Retirement Longitudinal Study (CHARLS) 2015 (n=11 570). Log-linear, two-parts, zero-inflated and quantile regression models were performed to assess the association between multimorbidity and OOPE for medicines in both countries. Quantile regression was adopted to assess the observed relationship across OOPE distributions.ResultsBased on 14 (11 self-reported) and 9 (8 self-reported) long-term conditions in the CHARLS and SAGE datasets, respectively, the prevalence of multimorbidity in the adult population aged 45 and older was found to be 63.4% in China and 42.2% in India. Of those with any long-term health condition, 38.6% in China and 20.9% in India had complex multimorbidity. Multimorbidity was significantly associated with higher OOPE for medicines in both countries (p<0.05); an additional physical long-term condition was associated with a 18.8% increase in OOPE for medicine in China (p<0.05) and a 20.9% increase in India (p<0.05). Liver disease was associated with highest increase in OOPE for medicines in China (61.6%) and stroke in India (131.6%). Diabetes had the second largest increase (China: 58.4%, India: 91.6%) in OOPE for medicines in both countries.ConclusionMultimorbidity was associated with substantially higher OOPE for medicines in China and India compared with those without multimorbidity. Our findings provide supporting evidence of the need to improve financial protection for populations with an increased burden of chronic diseases in low-income and middle-income countries.
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Ludwick T, Endriyas M, Morgan A, Kane S, Kelaher M, McPake B. Challenges in Implementing Community-Based Healthcare Teams in a Low-Income Country Context: Lessons From Ethiopia's Family Health Teams. Int J Health Policy Manag 2022; 11:1459-1471. [PMID: 34273919 PMCID: PMC9808330 DOI: 10.34172/ijhpm.2021.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/27/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Addressing chronic diseases and intra-urban health disparities in low- and middle-income countries (LMICs) requires new health service models. Team-based healthcare models can improve management of chronic diseases/complex conditions. There is interest in integrating community health workers (CHWs) into these teams, given their effectiveness in reaching underserved populations. However healthcare team models are difficult to effectively implement, and there is little experience with team-based models in LMICs and with CHW-integrated models more generally. Our study aims to understand the determinants related to the poor adoption of Ethiopia's family health teams (FHTs); and, raise considerations for initiating CHW-integrated healthcare team models in LMIC cities. METHODS Using the Consolidated Framework for Implementation Research (CFIR), we examine organizational-level factors related to implementation climate and readiness (work processes/incentives/resources/leadership) and system-level factors (policy guidelines/governance/financing) that affected adoption of FHTs in two Ethiopian cities. Using semi-structured interviews/focus groups, we sought implementation perspectives from 33 FHT members and 18 administrators. We used framework analysis to deductively code data to CFIR domains. RESULTS Factors associated with implementation climate and readiness negatively impacted FHT adoption. Failure to tap into financial, political, and performance motivations of key stakeholders/FHT members contributed to low willingness to participate, while resource constraints restricted capacity to implement. Workload issues combined with no financial incentives/perceived benefit contributed to poor adoption among clinical professionals. Meanwhile, staffing constraints and unavailability of medicines/supplies/transport contributed to poor implementation readiness, further decreasing willingness among clinical professionals/managers to prioritize non-clinic based activities. The federally-driven program failed to provide budgetary incentives or tap into political motivations of municipal/health centre administrators. CONCLUSION Lessons from Ethiopia's challenges in implementing its FHT program suggest that LMICs interested in adopting CHW-integrated healthcare team models should closely consider health system readiness (budgets, staffing, equipment/medicines) as well as incentivization strategies (financial, professional, political) to drive organizational change.
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Affiliation(s)
- Teralynn Ludwick
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Misganu Endriyas
- Health Research and Technology Transfer Office, SNNPR Regional Health Bureau, Hawassa, Ethiopia
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Margaret Kelaher
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Horizontal Integration and Financing Reform of Rural Primary Care in China: A Model for Low-Resource and Remote Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148356. [PMID: 35886206 PMCID: PMC9323543 DOI: 10.3390/ijerph19148356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
Abstract
Primary health care (PHC) systems are compromised by under-resourcing and inadequate governance, and fail to provide high-quality health care services in most low- and middle-income countries (LMICs). As a response to solve the problems of underfunding and understaffing, Pengshui County, an impoverished area in rural Chongqing, China, implemented a profound reform of its PHC delivery system in 2009, focusing on horizontal integration and financing mechanisms. This paper aims to present new evidence from the Pengshui model, and to assess the relevant changes over the past 10 years (2009–2018). An inductive approach was adopted, based on analysis of national and local policy documents and administrative data. From 2009 to 2018, the proportion of outpatients who sought first-contact care in rural community or township health centers increased from 29% (522,700 of 1,817,600) in 2009, to 40% (849,900 of 2,147,800) in 2018 (the national average in 2018 was 23%). Our findings suggest that many positive results have been achieved through the reform, and that innovations in financial governance and incentive mechanisms are the main driving forces behind the improvement. Pengshui County’s experience has proven to be a successful experiment, particularly in rural and low-income areas.
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Ye Z, Jiang Y. Title: the impact of a pilot integrated care model on the quality and costs of inpatient care among chinese elderly: a difference-in-difference analysis of repeated cross-sectional data. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:28. [PMID: 35752860 PMCID: PMC9233857 DOI: 10.1186/s12962-022-00361-4] [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: 01/28/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background Recently, integrated care has received tremendous popularity in China, a leading example of which is the Luohu model. In the present analysis, we aimed to examine the impacts of the Luohu model on the quality and costs of inpatient care. Methods We conducted a retrospective analysis using administrative claims databases of Shenzhen City (the city that the Luohu district sits) from Jan 2015–Apr 2017, which encompassed the time before and after the implementation of the pilot model. The outcomes were 30-day readmission, inpatient costs, and length of stay (LOS). Multivariable difference-in-difference analyses were conducted. Results In the first year following the integration, the Luohu model did not have impacts on any of the outcomes. Although its effect on readmission (ratio of odds ratio: 1.082; 95% CI: 0.865 to 1.353) was still not identified in the first four months of the second post-integration year, it decreased inpatient costs by CN¥ 1224.1 (95% CI: 372.7 to 2075.5) and LOS by 0.938 days (95% CI: 0.0416 to 1.835) per hospitalization episode during the same period. Conclusions The Luohu model may reduce costs and LOS in the long term. It is potentially a viable approach to improve the value of inpatient care in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-022-00361-4.
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Affiliation(s)
- Zhaojia Ye
- Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China. .,Sun Yat-sen University, 66 Gongchang Road, Guangming District, Shenzhen, Guangdong, China.
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Healthcare Professionals’ Views of the Integrated County Healthcare Consortium in Zhejiang, China. Int J Integr Care 2022; 22:25. [PMID: 35812799 PMCID: PMC9231573 DOI: 10.5334/ijic.5690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/02/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: The integrated county healthcare consortium (ICHC) is becoming an important measure to improve the capacity of primary-level medical services and to achieve grading diagnosis and treatment system in China. However, it is not clear whether health professionals are satisfied with this reform and what are the problems with it. This study aimed to understand the satisfaction of healthcare professionals to the ICHC in Zhejiang Province, China, and analyze the problems and improvement measures of the ICHC. Methods: A cross-sectional study was carried out in the 11 pilot counties (cities and districts) implementing the construction of the ICHC in Zhejiang in November 2019. Healthcare professionals from the leading county-level hospital, three township health centers (THCs) or community health centers (CHCs) in each ICHC were invited to participate in this survey. Results: A total of 3531 healthcare professionals were included, 85.92% of the participants agreed that the integration of the Centers for Disease Control and Prevention (CDC) and other professional public health institutions into the construction of ICHC could actively promote basic public health work. The most severe problem was the lack of financial guarantee fund input (severity score: 2.92 ± 1.76). The most crucial measure to promote the construction of the ICHC was to increase government financial input and improve the security mechanism (importance score: 4.81 ± 0.47). The satisfaction of the healthcare professionals to the ICHC was 89.41%. The satisfaction of healthcare professionals from county-level hospitals was 2.37 (95% CI: 1.760–3.238) times higher than that of healthcare professionals from the township health centers (THCs) or community health centers (CHCs). The satisfaction of health professionals with a college degree or below was 3.215 (95% CI: 1.413–6.786) times higher than that of health professionals with a master’s degree or above. Conclusions: Zhejiang Province has taken adequate measures to promote the construction of the ICHC. However, there are still some problems. Appropriate and effective policies should be implemented to enhance policy coordination and promote competition among ICHCs, as well as to strengthen medical service quality management and improve performance appraisal scheme.
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Yang R, Li Q, Hayat K, Zhai P, Liu W, Chen C, Saeed A, Chang J, Li P, Du Q, Xu S, Wen J, Fang Y. Views of Pharmacists and Government Representatives Toward the Pilot Chief Pharmacist System in Chinese Hospitals: A Multicenter Exploratory Qualitative Study. Front Public Health 2022; 10:895649. [PMID: 35784261 PMCID: PMC9240424 DOI: 10.3389/fpubh.2022.895649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background In China, the pharmacy departments of most hospitals have changed their main focus from drug procurement and distribution to providing pharmaceutical care services. Various regions of China have successively implemented the pilot Chief Pharmacist System (CPS) to help improve pharmaceutical care services and rational drug use in hospitals. This study was designed to explore the perspectives of pharmacists and government officials on CPS, including the advantages and barriers to the successful implementation of CPS. Methods A qualitative study, based on semi-structured interviews, was conducted from October 1, 2018 to March 1, 2019. The interview data were gathered from 18 pharmacy staff and government representatives working in five distinct regions of China using purposive sampling. A thematic analysis approach and NVivo version 12 Plus was utilized to code and analysis of all interviews. Results Five broad themes were identified: the role of the chief pharmacist; their attitudes toward the CPS; the advantages and results of the CPS; the barriers toward CPS; and their suggestions toward CPS. Most of the participants believed that the chief pharmacist played a vital role in a hospital. Under CPS, the hospital pharmacy department pays more attention to prescription review, medication monitoring, and pharmaceutical consultation. However, an insufficient number of pharmacy personnel, unclear authority, and inadequate salaries were the main barriers to the implementation of the CPS. Conclusion The attitudes of most of the participants were found to be positive toward CPS in China. The CPS can enhance the prestige of the hospital pharmacy department, improve the quality of hospital pharmaceutical care services, and promote rational drug use. Nevertheless, certain barriers highlighted in this study should be addressed promptly.
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Affiliation(s)
- Ruomeng Yang
- Department of Industrial Economics and Trade, School of Economics and Finance, Xi'an Jiaotong University, Xi'an, China
| | - Qian Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Panpan Zhai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Wenchen Liu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Chen Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Qianqian Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Sen Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Jun Wen
- Department of Industrial Economics and Trade, School of Economics and Finance, Xi'an Jiaotong University, Xi'an, China
- Jun Wen
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
- Shaanxi Centre for Health Reform and Development Research, Xi'an, China
- *Correspondence: Yu Fang
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Li P, Luo Y, Yu X, Mason E, Zeng Z, Wen J, Li W, Jalali MS. Readiness of healthcare providers for e-hospitals: a cross-sectional analysis in China before the COVID-19 period. BMJ Open 2022; 12:e054169. [PMID: 35190431 PMCID: PMC8861885 DOI: 10.1136/bmjopen-2021-054169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The growth and development of smartphones and eHealth technologies have enabled the potential for extended care hospitals (e-hospitals) in China in order to facilitate the success of a primary healthcare centre (PHC)-based integrated delivery model. Although the adoption of e-hospitals is essential, few studies have directed their research towards understanding the perspectives of healthcare providers. This study aims to identify the current readiness of healthcare providers to adopt e-hospital technologies, determine the factors influencing this adoption and describe the perceived facilitators and barriers in regard to working at e-hospitals. DESIGN A cross-sectional study conducted in Sichuan, China, between June and September 2019. SETTINGS Information was collected from healthcare providers who have more than 3 years of work experience from a tertiary hospital, secondary hospital, PHCs and private hospital. PARTICIPANTS 2298 medical professionals were included in this study. OUTCOME MEASURE This study included a self-administered questionnaire that was used to assess participants' sociodemographic characteristics, online medical practices, willingness to use e-hospitals and perceived facilitators/barriers to working at e-hospitals. Multivariate regression analysis was performed in order to evaluate the independent factors associated with e-hospital work. RESULTS Overall, 86.3% had a positive response towards working at e-hospitals. Age (p<0.05), familiarity with e-hospitals (p<0.001) and prior work practices in online healthcare settings (p<0.001) were associated with participants' readiness to work at e-hospitals. Gender, education level, professional level, the tier of their affiliated hospital and workload were not statistically associated. Healthcare providers who had positive attitudes towards e-hospitals considered improved efficiency, patient satisfaction, communication among physicians, increased reputation and income, and alleviated workload to be advantages of adoption. The participants who were unwilling to work at e-hospitals perceived lack of time, insufficient authenticity/reliability and underdeveloped policies as potential barriers. CONCLUSION Improving operative proficiency in electronic devices, accommodating to work schedules, increasing familiarity with e-hospitals and regulating practices will improve the readiness of healthcare providers to work at e-hospitals.
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Affiliation(s)
- Peiyi Li
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology,West China Hospital, Sichuan University, Chengdu, Sichuan, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunmei Luo
- West China Medical Publishers,West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuexin Yu
- Biomedical Big Data Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Elizabeth Mason
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhi Zeng
- Institute of Hospital Management, Sichuan University, West China Hospital, Chengdu, Sichuan, China
| | - Jin Wen
- Institute of Hospital Management, Sichuan University, West China Hospital, Chengdu, Sichuan, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Sichuan University West China Hospital, Chengdu, China
- Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Institute of Technology Sloan School of Management, Cambridge, Massachusetts, USA
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Searle K, Blashki G, Kakuma R, Yang H, Lu S, Li B, Xiao Y, Minas H. Adapting the depression component of WHO Mental Health Gap Intervention Guide (mhGAP-IG.v2) for primary care in Shenzhen, China: a DELPHI study. Int J Ment Health Syst 2022; 16:13. [PMID: 35168656 PMCID: PMC8845283 DOI: 10.1186/s13033-022-00523-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHC) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization’s mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China’s emergent mental health system. Methods A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either “somewhat agree/definitely agree”, or “definitely disagree/somewhat disagree” on a five-point scale for agreement. Results 79% of statements received consensus with a mean score of 4.26 (i.e. “somewhat agree”). Agreed adaptations for mhGAP-IG.v2 included:- an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians’ roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide. Conclusions An adapted mhGAP-IG.v2 for depression recognises China’s cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00523-0.
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Affiliation(s)
- Kendall Searle
- Global and Cultural Mental Health Unit, Centre for Mental Health, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Ritsuko Kakuma
- London School of Hygiene and Tropical Medicine, London, WC1E 7HTE, England, UK
| | - Hui Yang
- Monash Institute for Health and Clinical Education, School of Primary Health Care, Monash University, Notting Hill, VIC, 3168, Australia
| | - Shurong Lu
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Baoqi Li
- Shenzhen Guangming Hospital of the University of Chinese Academy of Sciences, Bao'an District, Shenzhen, 518107, China
| | - Yingying Xiao
- Shenzhen Guangming Hospital of the University of Chinese Academy of Sciences, Bao'an District, Shenzhen, 518107, China
| | - Harry Minas
- Global and Cultural Mental Health Unit, Centre for Mental Health, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
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Jiang Q, Lou Y, Chen F, Lu Z, Cao S. Keys to promoting the graded diagnosis and treatment system based on the integrated health care system in China. Fam Pract 2022; 39:217-218. [PMID: 34423371 DOI: 10.1093/fampra/cmab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Qingqing Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yiling Lou
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fan Chen
- Quality Control Office, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shiyi Cao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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The Pathway of China's Integrated Delivery System: Based on the Analysis of the Medical Consortium Policies. Curr Med Sci 2022; 42:1164-1171. [PMID: 36245032 PMCID: PMC9573817 DOI: 10.1007/s11596-022-2654-9] [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: 08/11/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
With the deepening of China's health-care reform, an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system. For China's integrated delivery system, a medical consortium plays an important role in integrating public hospitals and primary care facilities. The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system. This paper illustrates the possible future pathway of China's medical consortium through retrospection of the 10-year process, changes of the series of policies, and characteristics of the policy issued in 2020. We considered that a fully integrated medical consortium would be a major phenomenon in China's medical industry, which would lead to the formation of a dualistic care pattern in China.
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Xu RH, Zhou LM, Wong ELY, Wang D. Investigating Medical Student's Preferences for Internet-Based Healthcare Services: A Best-Worst Scaling Survey. Front Public Health 2021; 9:757310. [PMID: 34938703 PMCID: PMC8685198 DOI: 10.3389/fpubh.2021.757310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to investigate the importance of providing Internet-based healthcare services based on the preference of a sample of medical students in China. Methods: An online best-worst scaling (BWS) survey with Case 1 design was conducted. Balanced independent block design generated 12 choice task profiles for each participant to answer. Descriptive analysis was used to describe the respondents' characteristics; Multinomial and mixed logit regression methods were used to investigate the importance of Internet-based services based on respondents' preferences. Results: A total of 1,296 students completed the online survey and rated "Clinical Service," "Decision Aids," and "Public health" as the three most important services that should be provided through an Internet-based healthcare system. Providing "Medical Education" via the Internet was chosen as the least important service by the respondents. Subgroup analysis indicated that students studying clinical medicine and non-clinical medicine considered providing "Medical Education" and "Public Health," respectively, as more important services than others. Conclusions: This BWS study demonstrated that providing "Clinical Service," "Decision Aids," and "Public Health" through the Internet are the three most important services based on medical students' preferences in China. Further research is needed to investigate how to improve medical students' skills in using internet-based healthcare services in medical education programs.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- JC School of Public Health and Primary Care The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ling-ming Zhou
- School of Health Management Southern Medical University, Guangzhou, China
| | - Eliza Lai-yi Wong
- JC School of Public Health and Primary Care The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Dong Wang
- School of Health Management Southern Medical University, Guangzhou, China
- Institute of Health Management Southern Medical University, Guangzhou, China
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Eliciting Preferences of Providers in Primary Care Settings for Post Hospital Discharge Patient Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168317. [PMID: 34444067 PMCID: PMC8391536 DOI: 10.3390/ijerph18168317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 11/26/2022]
Abstract
Background: Post-hospital discharge follow-up has been a principal intervention in addressing gaps in care pathways. However, evidence about the willingness of primary care providers to deliver post-discharge follow-up care is lacking. This study aims to assess primary care providers’ preferences for delivering post-discharge follow-up care for patients with chronic diseases. Methods: An online questionnaire survey of 623 primary care providers who work in a hospital group of southeast China. Face-to-face interviews with 16 of the participants. A discrete choice experiment was developed to elicit preferences of primary care providers for post-hospital discharge patient follow-up based on six attributes: team composition, workload, visit pattern, adherence of patients, incentive mechanism, and payment. A conditional logit model was used to estimate preferences, willingness-to-pay was modelled, a covariate-adjusted analysis was conducted to identify characteristics related to preferences, 16 interviews were conducted to explore reasons for participants’ choices. Results: 623 participants completed the discrete choice experiment (response rate 86.4%, aged 33 years on average, 69.5% female). Composition of the follow-up team and adherence of patients were the attributes of greatest relative importance with workload and incentives being less important. Participants were indifferent to follow-up provided by home visit or as an outpatient visit. Conclusion: Primary care providers placed the most importance on the multidisciplinary composition of the follow-up team. The preference heterogeneity observed among primary care providers suggests personalized management is important in the multidisciplinary teams, especially for those providers with relatively low educational attainment and less work experience. Future research and policies should work towards innovations to improve patients’ engagement in primary care settings.
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Longitudinal study of the earliest pilot of tiered healthcare system reforms in China: Will the new type of chronic disease management be effective? Soc Sci Med 2021; 285:114284. [PMID: 34388618 DOI: 10.1016/j.socscimed.2021.114284] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In 2016, the tiered healthcare model featuring "specialists + general practitioners + health managers" in Xiamen was recognized by the Medical Reform Office of State Council and was promoted as a model to replace hospital-centric care with community-based care. This study evaluated the impact of the Xiamen's tiered healthcare system reform on health outcomes and healthcare spending among chronic disease patients. METHODS Data were derived from Xiamen's electronic health record (EHR) and medical claims systems. The sample included 154,651 individuals with hypertension and 50,722 individuals with diabetes from Xiamen between 2012 and 2016. The dependent variables included rates of disease under control and total treatment costs. Patients were grouped by the types of chronic disease management: precision management, regular management, or without management. Kaplan-Meier, Cox survival analysis and PSM + DID method (Propensity score matching and difference-in-difference method) were used to compare the management outcomes by group. FINDINGS The precision management group showed better clinical quality performance than the regular management group. Under-control disease rates in the precision management group showed a continuous improvement trend, while the regular management group showed a ceiling effect after ten months. Under-control rates in the precision management group increased over 40% for hypertension and over 30% for diabetes, higher than that increases found in the regular management group. Reform was also associated with consistent reductions in annual per capita total treatment costs across groups. The cost-savings in the precision management group between 2014 and 2016 was 381 Chinese yuan (CNY) for hypertension and 1117 CNY for diabetes, compared with the group without management. INTERPRETATION The results in this study demonstrated the associations between tiered healthcare system reform and better clinical quality performance and improved treatment cost-saving. Developing methods to promote the policy and increase implementation are also important aspects of healthcare reform.
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Jia M, Wang F, Ma J, Tian M, Zhao M, Shen L. Implementation and Early Impacts of an Integrated Care Pilot Program in China: Case Study of County-level Integrated Health Organizations in Zhejiang Province. Int J Integr Care 2021; 21:7. [PMID: 34539291 PMCID: PMC8415178 DOI: 10.5334/ijic.5605] [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: 08/16/2020] [Accepted: 08/06/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND One of the most noticeable integrated care-related policies in China is the growth and proliferation of County-level Integrated Health Organizations (CIHOs), which take over a set of primary healthcare institutions to form an integrated delivery network in order to achieve an ordered hierarchical delivery system by strengthening primary care. OBJECTIVES This paper presents emerging findings from an ongoing evaluation of the early impacts of the demonstrator site, Deqing CIHO, in Zhejiang Province, in order to examine the extent to which the implementation has achieved its core objectives: (1) establishing the hierarchical referral system, (2) capacity building of primary healthcare providers, and (3) reducing the costs. DESIGN This case study was conducted to determine institutional and managerial processes. SETTINGS Data were collected and analyzed at the CIHO and county level. A structured questionnaire was used for data collection. PRIMARY AND SECONDARY OUTCOME MEASURES Indicators were selected from the existing database of the county health system and arranged into three segments to assess (1) service utilization among each level of care; (2) capacity-building progress for primary care centers, (3) cost-related indicators for both levels of care. RESULTS Service utilization data show that one year after CIHO implementation, the proportion of patients who chose to get inpatient care outside of the county decreased from 27.3% to 24.5%. Hospital admissions were retrieved from outside the county, while service volume slightly shifted from hospitals to primary care sites. Capacity-building indicators for township health centers show that 6 out of 12 items showed better performance compared to the national average growth rate, and a moderated growth rate appeared in terms of per capita cost. CONCLUSION Progress evaluation results from Deqing CIHO indicated some positive effects on three main outcomes, which reveal the potential of CIHOs in not only strengthening primary care but also controlling cost as a result of early implementation. Further emphases of evaluation are required to determine the impacts on the quality and experience of care that are estimated using claim-based data at the individual level.
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Affiliation(s)
- Meng Jia
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, CN
| | - Fang Wang
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, CN
| | - Jiangen Ma
- Health Commission in Huzhou, Zhejiang, CN
| | - Miaomiao Tian
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, CN
| | - Minjie Zhao
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, CN
| | - Liming Shen
- Medical Administration Department of Health Commission in Deqing County, Zhejiang, CN
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29
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Zhao Y, Atun R, Anindya K, McPake B, Marthias T, Pan T, Heusden AV, Zhang P, Duolikun N, Lee J. Medical costs and out-of-pocket expenditures associated with multimorbidity in China: quantile regression analysis. BMJ Glob Health 2021; 6:bmjgh-2020-004042. [PMID: 33632770 PMCID: PMC7908909 DOI: 10.1136/bmjgh-2020-004042] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Multimorbidity is a growing challenge in low-income and middle-income countries. This study investigates the effects of multimorbidity on annual medical costs and the out-of-pocket expenditures (OOPEs) along the cost distribution. Methods Data from the nationally representative China Health and Retirement Longitudinal Study (CHARLS 2015), including 10 592 participants aged ≥45 years and 15 physical and mental chronic diseases, were used for this nationally representative cross-sectional study. Quantile multivariable regressions were employed to understand variations in the association of chronic disease multimorbidity with medical cost and OOPE. Results Overall, 69.5% of middle-aged and elderly Chinese had multimorbidity in 2015. Increased number of chronic diseases was significantly associated with greater health expenditures across every cost quantile groups. The effect of chronic diseases on total medical cost was found to be larger among the upper tail than those in the lower tail of the cost distributions (coefficients 12, 95% CI 6 to 17 for 10th percentile; coefficients 296, 95% CI 71 to 522 for 90th percentile). Annual OOPE also increased with chronic diseases from the 10th percentile to the 90th percentile. Multimorbidity had larger effects on OOPE and was more pronounced at the upper tail of the health expenditure distribution (regression coefficients of 8 and 84 at the 10th percentile and 75th percentile, respectively). Conclusion Multimorbidity is associated with escalating healthcare costs in China. Further research is required to understand the impact of multimorbidity across different population groups.
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Affiliation(s)
- Yang Zhao
- The George Institute for Global Health at Peking University Health Science Centre, Beijing, China .,Collaborating Centre on Implementation Research for Prevention & Control of NCDs, WHO, Melbourne, Victoria, Australia
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Kanya Anindya
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara McPake
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tiara Marthias
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tianxin Pan
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander van Heusden
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Centre, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Nadila Duolikun
- The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
| | - John Lee
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Liu C. Antibiotic stewardship challenges in an evolving health-care market in China. THE LANCET INFECTIOUS DISEASES 2021; 21:753-754. [DOI: 10.1016/s1473-3099(20)30685-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/16/2023]
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Zhao Y, Zhang P, Oldenburg B, Hall T, Lu S, Haregu TN, He L. The impact of mental and physical multimorbidity on healthcare utilization and health spending in China: A nationwide longitudinal population-based study. Int J Geriatr Psychiatry 2021; 36:500-510. [PMID: 33037674 DOI: 10.1002/gps.5445] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/31/2020] [Accepted: 10/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND In China, little evidence exists on the effect of mental and physical multimorbidity on individuals and the health system. This study aims to examine the prevalence of mental-physical multimorbidity and its impact on health service utilization and health expenditures. METHODS We conducted a panel study using two waves of data (in 2011 and 2015) from the China Health and Retirement Longitudinal Study, including 10,181 participants aged 45 years and older. Generalized linear regression models were used to assess the association of multimorbidity with total health expenditure and out-of-pocket expenditure (OOPE) on outpatient and inpatient care. Random-effects logistic regression models were used to examine the impact of multimorbidity on outpatient visits, admission to hospital and incidence of catastrophic health expenditure (CHE). RESULTS Overall, 3210 participants (31.53% of 10,181) had mental-physical multimorbidity in 2015 in China. Compared to patients with a single physical disease, individuals with physical-mental multimorbidity had over 150% of the increase in the number of outpatient visits and days of hospitalization. The percentage change of OOPE for outpatient and inpatient care was 156.8% and 163.6%, respectively. Mental-physical multimorbidity was associated with an increased likelihood of experiencing CHE (OR = 2.205, 95% CI = 2.048, 2.051). CONCLUSION Multimorbidity, particularly mental-physical multimorbidity, is associated with higher levels of health service use and a greater financial burden to individuals in China. Healthcare system needs to shift from single-disease models to new financing and service delivery models to more effectively manage mental-physical multimorbidity.
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Affiliation(s)
- Yang Zhao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, Victoria, Australia
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Oldenburg
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, Victoria, Australia
| | - Teresa Hall
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shurong Lu
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tilahun Nigatu Haregu
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, Victoria, Australia
| | - Li He
- College of Physical Education and Sport, Beijing Normal University, Beijing, China
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Associations between mental health disorder and management of physical chronic conditions in China: a pooled cross-sectional analysis. Sci Rep 2021; 11:5731. [PMID: 33707604 PMCID: PMC7952541 DOI: 10.1038/s41598-021-85126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Abstract
Physical non-communicable diseases (NCDs) and mental health disorders are a rapidly increasing health burden in low-and middle-income countries. This study aims to examine the relationships between mental health disorders and cascade of care in managing four common physical NCDs (hypertension, diabetes, dyslipidemia, chronic kidney disease) in China. We utilized two waves of nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011, 2015) of older adult population aged 45 and above. A series of unadjusted and adjusted mixed-effect logistic regression was applied to evaluate the association between presence of mental health disorder and physical chronic disease awareness, treatment, and control. We found that the odds of dyslipidemia (AOR 1.81, 95% CI 1.36–2.39) and kidney disease awareness (AOR 2.88, 95% CI 2.12–3.92) were higher for individuals with mental chronic conditions, compared to those without mental chronic conditions. The odds of having hypertension treatment was higher for subjects with mental health disorder, compared to those without (AOR 1.32, 95% CI 1.02–1.70). The odds of having physical chronic conditions controlled was not significantly associated with having mental chronic conditions (P > 0.05). These results indicated that adults with mental health disorder have a greater likelihood of awareness of having dyslipidemia and kidney disease, and receiving treatment for hypertension. Strategies to address the growing burden of physical-mental NCDs in China should include efforts to improve management of patients with comorbid health condition and improve access to continual high-quality treatment after the first diagnosis.
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Marthias T, Anindya K, Ng N, McPake B, Atun R, Arfyanto H, Hulse ES, Zhao Y, Jusril H, Pan T, Ishida M, Lee JT. Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study. BMJ Open 2021; 11:e041870. [PMID: 33597135 PMCID: PMC7893673 DOI: 10.1136/bmjopen-2020-041870] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To examine non-communicable diseases (NCDs) multimorbidity level and its relation to households' socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss. DESIGN This study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5). SETTING The original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population. PARTICIPANTS We included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents. PRIMARY OUTCOME MEASURES We examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables, RESULTS: Women were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD. CONCLUSIONS NCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbidity in low-income and middle-income countries.
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Affiliation(s)
- Tiara Marthias
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Kanya Anindya
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nawi Ng
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Barbara McPake
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | | | - Emily Sg Hulse
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yang Zhao
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia
| | - Hafizah Jusril
- Center for Health Research, Universitas Indonesia, Depok, Indonesia
| | - Tianxin Pan
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Ishida
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Integrated Healthcare Systems Response Strategies Based on the Luohu Model During the COVID-19 Epidemic in Shenzhen, China. Int J Integr Care 2021; 21:1. [PMID: 33597832 PMCID: PMC7863846 DOI: 10.5334/ijic.5628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
COVID-19 has affected primary health-care delivery in metropolitan areas. An integrated health-care system offers advantages in response to the community outbreak and transmission of highly infectious diseases. On the basis of practitioner experience with a pioneering integrated health-care system in Shenzhen, China, this article presents the following effective strategies in response to the epidemic: (1) enhance the public workforce in primary health care; (2) integrate resources to allow regional sharing and efficient use; (3) employ teams centered on general practitioners for community containment; and (4) adopt e-health and telemedicine for health-care delivery. An integrated health-care system is usually very specific to a particular regional context; however, the core strategies and mechanisms based on the Luohu model can contribute to improving the public health capacity in emergency responses; they can transform health-care delivery in the COVID-19 epidemic. The experience in Shenzhen may help other cities in enhancing and coordinating the preparedness of their health-care systems in dealing with future public health emergencies.
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Xu RH, Zhou LM, Wang D. The Relationship Between Decisional Regret and Well-Being in Patients With and Without Depressive Disorders: Mediating Role of Shared Decision-Making. Front Psychiatry 2021; 12:657224. [PMID: 34220572 PMCID: PMC8242166 DOI: 10.3389/fpsyt.2021.657224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The objectives of this study were two-fold: (1) to assess the relationship between patients' decisional regret and their well-being and (2) to examine the mediated effect of shared decision-making (SDM) on this relationship. Methods: A cross-sectional survey was conducted in five cities in Southern China. Patients were asked to fill out questionnaires assessing their decisional regret, SDM, subjective well-being, and depressive status. Mediation analysis was used to investigate the effect of SDM on the relationship between patients' decisional regret and their subjective well-being. Results: The findings showed significant direct negative effects of decisional regret on subjective well-being and SDM. For non-depressive patients, SDM exerted a significant and indirect effect on reducing the negative influence of decisional regret on subjective well-being. Conclusions: Findings suggest that implementation of SDM can decrease patients' decisional regret and improve their well-being; however, there is a need to examine their depressive status as part of routine healthcare.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.,Center for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling-Ming Zhou
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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36
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Zhou LM, Xu RH, Xu YH, Chang JH, Wang D. Inpatients' Perception of Patient-Centered Care in Guangdong Province, China: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059482. [PMID: 34872361 PMCID: PMC8655447 DOI: 10.1177/00469580211059482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the perceptions of patient-centered care (PCC) among inpatients in Guangdong Province (GD), China. Based on these perspectives, we sought to understand existing PCC practices in medical institutions and identify the impacts of inpatients’ sociodemographic status on their perceived PCC. A self-developed PCC questionnaire was used to investigate inpatients’ perceptions of PCC. A cross-sectional survey was conducted in nine tertiary-level hospitals across five cities in GD. Descriptive statistics was used to describe the levels of PCC in GD. The differences in PCC levels across different sociodemographic groups were assessed using analysis of variance and multivariate linear regression. Valid responses were provided by 1863 inpatients. The mean overall PCC score was 8.58 (standard deviation [SD] = 1.36); inpatients from the Pearl River Delta and eastern GD area reported significantly higher scores than those from western and northern GD area (P<.01). Inpatients from rural areas tended to report lower PCC scores than their urban counterparts. Among the PCC questionnaire sub-domains, inpatients scored highest and lowest in “patient experience” (mean = 8.96, SD = 1.34) and “medical insurance” (mean = 7.93, SD = 2.05), respectively. This study provided a comprehensive overview of inpatients’ perceptions of PCC in the public healthcare system in GD, China. Our findings highlighted that a majority of inpatients were satisfied with the PCC in public healthcare system; however, a significant discrepancy between inpatients with different sociodemographic status remained.
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Affiliation(s)
- Ling-Ming Zhou
- School of Health Management, 70570Southern Medical University, Guangdong, China.,The Second Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Richard Huan Xu
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong SAR, China.,Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yan-Hua Xu
- Hospital Office, Meizhou People's Hospital, Guangdong, China
| | - Jing-Hui Chang
- School of Health Management, 70570Southern Medical University, Guangdong, China
| | - Dong Wang
- School of Health Management, 70570Southern Medical University, Guangdong, China.,Institute of health management, Southern Medical University, Guangdong, China
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37
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Sun M, Rasooly A, Fan X, Jian W. Assessing the quality of primary healthcare for diabetes in China: multivariate analysis using the China Health and Retirement Longitudinal Study (CHARLS) Database. BMJ Open 2020; 10:e035192. [PMID: 33318105 PMCID: PMC7737069 DOI: 10.1136/bmjopen-2019-035192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To assess the quality of primary healthcare (PHC) for patients with diabetes in China from 2011 to 2015. SETTING This study analysed data on 1006, 1472 and 1771 participants with diabetes who were surveyed in 2011, 2013 and 2015, respectively, in the China Health and Retirement Longitudinal Study, a nationally representative survey conducted in 29 provinces of China. OUTCOME MEASURES The study measured the proportions of patients with diabetes who received diabetes-related health education, examinations and treatments, as well as the hospital admission rate due to diabetes of these patients. Multilevel logistic regression was used to adjust sociodemographic variables. RESULTS According to the multivariate analysis, the proportion of patients who received diabetes-related health education decreased significantly (OR=0.74, 95% CI 0.61 to 0.90), and the proportion of those receiving examinations and treatments remained unchanged from 2011 to 2015. Diabetes-related hospitalisation increased from 4.01% in 2011 to 6.08% in 2013 (OR=1.47, 95% CI 0.97 to 2.22), and recurrent hospitalisations increased from 18.87% in 2011 to 28.45% in 2015 (OR=1.78, 95% CI 1.44 to 2.20). The proportions of patients with diabetes-related and recurrent hospitalisations in western China were higher than those in the east (OR=1.80, 95% CI 1.13 to 2.87; OR=1.92, 95% CI 1.50 to 2.45). CONCLUSIONS Nationally, the analysis of patient-reported process and outcome indicators cannot confirm that the quality of PHC has improved in China during 2011-2015. Regional disparities in primary diabetes care require urgent resource allocation to western China. Establishing a national quality registry for PHC, which transparently reports outcomes by region and social-economic position, is essential for countries sharing the challenge of improving both quality and equity of PHC.
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Affiliation(s)
- Meiping Sun
- Department of Health Policy and Management, Peking University Health Science Centre, Beijing, China
| | - Alon Rasooly
- School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Xiaoqi Fan
- School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Weiyan Jian
- Department of Health Policy and Management, Peking University Health Science Centre, Beijing, China
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38
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Fang EF, Xie C, Schenkel JA, Wu C, Long Q, Cui H, Aman Y, Frank J, Liao J, Zou H, Wang NY, Wu J, Liu X, Li T, Fang Y, Niu Z, Yang G, Hong J, Wang Q, Chen G, Li J, Chen HZ, Kang L, Su H, Gilmour BC, Zhu X, Jiang H, He N, Tao J, Leng SX, Tong T, Woo J. A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks. Ageing Res Rev 2020; 64:101174. [PMID: 32971255 PMCID: PMC7505078 DOI: 10.1016/j.arr.2020.101174] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/13/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022]
Abstract
One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+). China has become an ageing society, and as it continues to age it will continue to exacerbate the burden borne by current family and public healthcare systems. Major healthcare challenges involved with caring for the elderly in China include the management of chronic non-communicable diseases (CNCDs), physical frailty, neurodegenerative diseases, cardiovascular diseases, with emerging challenges such as providing sufficient dental care, combating the rising prevalence of sexually transmitted diseases among nursing home communities, providing support for increased incidences of immune diseases, and the growing necessity to provide palliative care for the elderly. At the governmental level, it is necessary to make long-term strategic plans to respond to the pressures of an ageing society, especially to establish a nationwide, affordable, annual health check system to facilitate early diagnosis and provide access to affordable treatments. China has begun work on several activities to address these issues including the recent completion of the of the Ten-year Health-Care Reform project, the implementation of the Healthy China 2030 Action Plan, and the opening of the National Clinical Research Center for Geriatric Disorders. There are also societal challenges, namely the shift from an extended family system in which the younger provide home care for their elderly family members, to the current trend in which young people are increasingly migrating towards major cities for work, increasing reliance on nursing homes to compensate, especially following the outcomes of the 'one child policy' and the 'empty-nest elderly' phenomenon. At the individual level, it is important to provide avenues for people to seek and improve their own knowledge of health and disease, to encourage them to seek medical check-ups to prevent/manage illness, and to find ways to promote modifiable health-related behaviors (social activity, exercise, healthy diets, reasonable diet supplements) to enable healthier, happier, longer, and more productive lives in the elderly. Finally, at the technological or treatment level, there is a focus on modern technologies to counteract the negative effects of ageing. Researchers are striving to produce drugs that can mimic the effects of 'exercising more, eating less', while other anti-ageing molecules from molecular gerontologists could help to improve 'healthspan' in the elderly. Machine learning, 'Big Data', and other novel technologies can also be used to monitor disease patterns at the population level and may be used to inform policy design in the future. Collectively, synergies across disciplines on policies, geriatric care, drug development, personal awareness, the use of big data, machine learning and personalized medicine will transform China into a country that enables the most for its elderly, maximizing and celebrating their longevity in the coming decades. This is the 2nd edition of the review paper (Fang EF et al., Ageing Re. Rev. 2015).
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Affiliation(s)
- Evandro F Fang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway; Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, 510080, Guangzhou, China; Institute of Geriatric Immunology, School of Medicine, Jinan University, 510632, Guangzhou, China; Department of Geriatrics, The First Affiliated Hospital, Zhengzhou University, 450052, Zhengzhou, China.
| | - Chenglong Xie
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Joseph A Schenkel
- Durham University Department of Sports and Exercise Sciences, Durham, United Kingdom.
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, China; Duke Global Health Institute, Duke University, Durham, 27710, North Carolina, USA.
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, China.
| | - Honghua Cui
- Department of Endodontics, Shanghai Stomatological Hospital, Fudan University, China; Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, China.
| | - Yahyah Aman
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Johannes Frank
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Jing Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510275, Guangzhou, China; Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, 510275, Guangzhou, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Ninie Y Wang
- Pinetree Care Group, 515 Tower A, Guomen Plaza, Chaoyang District, 100028, Beijing, China.
| | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
| | - Xiaoting Liu
- School of Public Affairs, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
| | - Tao Li
- BGI-Shenzhen, Beishan Industrial Zone, 518083, Shenzhen, China; China National GeneBank, BGI-Shenzhen, 518120, Shenzhen, China.
| | - Yuan Fang
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Zhangming Niu
- Aladdin Healthcare Technologies Ltd., 25 City Rd, Shoreditch, London EC1Y 1AA, UK.
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW3 6NP, UK; and National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, United Kingdom.
| | | | - Qian Wang
- Department of Geriatrics, The First Affiliated Hospital, Zhengzhou University, 450052, Zhengzhou, China.
| | - Guobing Chen
- Institute of Geriatric Immunology, School of Medicine, Jinan University, 510632, Guangzhou, China.
| | - Jun Li
- Department of Biochemistry and Molecular Biology, The Institute of Basic Medical Sciences, The Chinese Academy of Medical Sciences (CAMS)& Peking Union Medical University (PUMC), 5 Dondan Santiao Road, Beijing, 100730, China.
| | - Hou-Zao Chen
- Department of Biochemistry and Molecular Biology, The Institute of Basic Medical Sciences, The Chinese Academy of Medical Sciences (CAMS)& Peking Union Medical University (PUMC), 5 Dondan Santiao Road, Beijing, 100730, China.
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Huanxing Su
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao.
| | - Brian C Gilmour
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway.
| | - Xinqiang Zhu
- Department of Toxicology, Zhejiang University School of Public Health, Hangzhou, 310058, Zhejiang, China; The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Na He
- School of Public Health, Fudan University, 200032, Shanghai, China; Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China; Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, 200032, Shanghai, China.
| | - Jun Tao
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, 510080, Guangzhou, China.
| | - Sean Xiao Leng
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| | - Tanjun Tong
- Research Center on Ageing, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing Key Laboratory of Protein Posttranslational Modifications and Cell Function, Beijing, China.
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Sun Z, Wang S, Zhao H, Yu H. Does Descending Resources Reform Improve Patient Satisfaction and Reshape Choice of Care Providers? A Cross-Sectional Study in Zhejiang, China. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020956899. [PMID: 32909479 PMCID: PMC7488616 DOI: 10.1177/0046958020956899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient satisfaction and choice of care providers have been the core concerns of
China’s descending resources reform launched in 2013. This health care reform
attempts to improve low-level hospitals’ capability and patient satisfaction
through compulsory descending of doctors from high-level hospitals, thereby
reshaping patients’ behavior (loyalty). The goal of this paper is to explore the
determinants of patient satisfaction, and its impact on patient loyalty with an
emphasis on low-level hospitals in the reform context. By using a self-made
5-point scale that incorporates socio-demographic variables, reform, and
revealed preference into the European Consumer Satisfaction Index model (ECSI),
cross-sectional data from 17 hospitals, and 1287 questionnaires in Zhejiang
province is collected to conduct empirical research. Satisfaction is measured as
ordinary variables with the reform and with the low-level hospitals,
respectively. Loyalty is measured by patients’ willingness to choose low-level
hospitals when suffering illness or severe illness. Analysis of variance and
multiple comparisons are utilized to examine the different level of hospitals.
An ordered logit model and ordinary least squares regression are applied to
examine the determinants of satisfaction and loyalty. The results indicate that
patient satisfaction can be explained by variables of perceived quality, patient
expectations, and corporate image. Socio-demographic variable, providers, and
the reform also have significant effects. Patients’ satisfaction plays a
pronounced role on improving their loyalty. The descending resources reform
positively affects low-level hospitals’ capability and patient satisfaction. The
cost reduction and convenience significantly increase the reform satisfaction.
Capability, medical environment, and accessibility of descending doctors are
positively associated with the satisfaction with low-level hospitals. This paper
evidences that the descending resources reform is an effective way to reallocate
resources in supply side of health service market and reshape patients’ choice
of care providers with the accessibility and spillover of descending human
capital.
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Affiliation(s)
- Zesheng Sun
- School of Finance and Business, Shanghai Normal University, China
| | - Shuhong Wang
- Department of Stomatology, Tongde Hospital of Zhejiang Province, Hangzhou, China.,Department of Stomatology, First People's Hospital of Akesu, China
| | - Hongjun Zhao
- School of Finance and Business, Shanghai Normal University, China
| | - Haiming Yu
- School of Economics and Management, Zhejiang University of Science and Technology, Hangzhou, China
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Xu J, Powell-Jackson T, Mills A. Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China. BMJ Glob Health 2020; 5:e002792. [PMID: 32792410 PMCID: PMC7430328 DOI: 10.1136/bmjgh-2020-002792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This paper evaluates the effectiveness of a gatekeeping pilot in shifting resources and patient visits from hospitals to primary care facilities under the Chinese New Rural Cooperative Medical Scheme. METHODS We applied a difference-in-differences regression analysis using claims data from a pilot district in northern China. The study covered 200 685 enrollees in 17 townships in 2012 and followed-up the townships over 12 year-quarters until the end of 2014. RESULTS The gatekeeping pilot led to significantly more patients visiting primary care facilities (55.3%, p=0.001), but there was little evidence of increased ambulatory spending on primary care (1.6%, p=0.884). The pilot reduced hospital visits by 23.9% (p=0.048) and ambulatory spending at the hospitals by 22.4% (p=0.011). CONCLUSIONS This first impact evaluation of gatekeeping outside high-income countries found that gatekeeping policy did not seem to have expanded the care provided by primary care facilities, despite an increased volume of claimed visits. Although claimed patient visits and expenditure at hospitals reduced, we suspect this may have been because patients found it either cumbersome or difficult to obtain reimbursement for their care.
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Affiliation(s)
- Jin Xu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Timothy Powell-Jackson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Mills
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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He H, Yu P, Li L, Xiao X, Long Y, Wang L, Zeng J, Li Y. Patient safety culture and obstacles to adverse event reporting in nursing homes. J Nurs Manag 2020; 28:1536-1544. [PMID: 32667710 DOI: 10.1111/jonm.13098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
AIMS To investigate patient safety culture and its relationship with obstacles to adverse event reporting in Chinese nursing homes. BACKGROUND Reporting obstacles are related to high incidences and unreported rates of adverse events. Patient safety culture is also associated with adverse events. However, the relationship between reporting obstacles and patient safety culture in nursing homes is unclear. METHODS A cross-sectional survey was conducted with a random sampling method among 549 staff members in six nursing homes using instruments of the Nursing Home Survey on Patient Safety Culture and the Adverse Event Reporting Obstacle Scale. The Pearson correlation coefficient, independent t tests, ANOVA tests and multivariate regression analysis were used. RESULTS Patient safety culture in nursing homes was associated with facility ownership (p < .001), facility scale (p < .001), reporting management (p < .001), whether it was an integrated care institution (p = .006), frequency of concern about patient safety (p = .001), occurrence of adverse events in departments (p = .001) and a punitive atmosphere (p = .044). Adverse event reporting obstacles were negatively correlated with patient safety culture (p < .05). CONCLUSION An improvement in patient safety culture was associated with a reduction in reporting obstacles in nursing homes. IMPLICATIONS FOR NURSING MANAGEMENT A barrier-free adverse event reporting system should be built to reduce reporting obstacles and create a non-punitive patient safety culture in nursing homes.
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Affiliation(s)
- Haiyan He
- Xiangya International Medical Centre, Xiangya Hospital, Central South University, Changsha, China.,Xiangya Nursing School, Central South University, Changsha, China.,Department of Nursing, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Centre of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Pingping Yu
- Xiangya International Medical Centre, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Centre of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Li Li
- Department of Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Xueling Xiao
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yanfang Long
- Xiangya International Medical Centre, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Centre of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Liqian Wang
- Xiangya Nursing School, Central South University, Changsha, China.,Department of Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Jiaqi Zeng
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yinglan Li
- Xiangya Nursing School, Central South University, Changsha, China.,Department of Nursing, Xiangya Hospital, Central South University, Changsha, China
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Xu RH, Zhou L, Li Y, Wang D. Doctor's Preference in Providing Medical Service for Patients in the Medial Alliance: A pilot Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2215. [PMID: 32224902 PMCID: PMC7177240 DOI: 10.3390/ijerph17072215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/16/2022]
Abstract
This cross-sectional survey study explored whether doctors in Guangdong, China preferred to provide extra healthcare services within the context of their medical alliances (MAs). Specifically, a discrete choice experiment (DCE) was conducted to investigate whether doctors preferred to provide extra services at low-tier hospitals within their MAs. A literature review, focus group interview, and expert group discussion resulted in three main attributes (i.e., working time, income, and hospital location) and corresponding levels, which were combined to create 24 profiles that were randomly presented to participants. A conditional logit model was then employed to calculate utility scores for all profiles. A total of 311 doctors completed the DCE questionnaire. The coefficients for each level within the three attributes were ordered and found to be statistically significant. Working time had the greatest influence on utility scores, increasing by one hour per week (beta = 1.4, odds ratio (OR) = 4.07, p < 0.001), followed by income, which increased by 30% per month (beta = 1.19, OR = 3.3, p < 0.001). The utility scores for all profiles ranged between -0.27 and 3.07. Findings indicated that participants made trade-offs with respect to providing extra services within their MAs. Furthermore, utility varied between different subpopulations.
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Affiliation(s)
- Richard Huan Xu
- Jockey Club School of public health and primary care, the Chinese University of Hong Kong, Hong Kong, China;
| | - Lingming Zhou
- School of Health Management, Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.)
| | - Yong Li
- School of Health Management, Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.)
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.)
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43
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Tao W, Zeng Z, Dang H, Li P, Chuong L, Yue D, Wen J, Zhao R, Li W, Kominski G. Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China. BMJ Glob Health 2020; 5:e002087. [PMID: 32257401 PMCID: PMC7103842 DOI: 10.1136/bmjgh-2019-002087] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 02/05/2023] Open
Abstract
Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and 'Healthy China 2030', the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change.
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Affiliation(s)
- Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Zeng
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Haixia Dang
- Research Center of Tradtional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peiyi Li
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Linh Chuong
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Dahai Yue
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Jin Wen
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zhao
- Department of drug policy and evaluation research, China National Health Development Research Center, Beijing, China
| | - Weimin Li
- President's Office, West China Hospital, Sichuan University, Chengdu, China
| | - Gerald Kominski
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
- UCLA Center for Health Policy Research, Los Angeles, California, USA
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44
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Building a People-Centred Integrated Care Model in Urban China: A Qualitative Study of the Health Reform in Luohu. Int J Integr Care 2020; 20:9. [PMID: 32210740 PMCID: PMC7082827 DOI: 10.5334/ijic.4673] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: China has adopted a people-centred integrated care model to reform its severely hospital-centric and fragmented delivery system. As a template of this model in urban China, the Luohu Hospital Group has generated considerable public and academic interest to scale it up. Methods: Guided by a policy triangle framework, this qualitative study explored the context, actors, content, and process of founding the Luohu Hospital Group. Three semi-structured interviews and five focus groups were conducted among 35 key informants. Content analysis was used to analyse the data. Results: The reform in Luohu took place in a competitive health care market, based on the comprehensive health reform in Shenzhen. Under the strong leadership of the district government, the reform adopted comprehensive strategies to strengthen primary care and care coordination, improve the quality and efficiency of health care delivery, and promote population health. The reform achieved a high level of organisational integration but was still in the process of fulfilling professional and clinical integration. Conclusions and discussion: The establishment of the Luohu Hospital Group transformed the originally fragmented delivery system into a tightly integrated service delivery networks. Though valuable lessons have been generated, the reform and its impacts require ongoing monitoring.
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45
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Qin X, Hsieh CR. Understanding and Addressing the Treatment Gap in Mental Healthcare: Economic Perspectives and Evidence From China. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2020; 57:46958020950566. [PMID: 32964754 PMCID: PMC7517998 DOI: 10.1177/0046958020950566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face 4 major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the 4 barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies.
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Wang X, Song K, Zhu P, Valentijn P, Huang Y, Birch S. How Do Type 2 Diabetes Patients Value Urban Integrated Primary Care in China? Results of a Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E117. [PMID: 31877946 PMCID: PMC6982164 DOI: 10.3390/ijerph17010117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022]
Abstract
Objectives: Fragmented healthcare in China cannot meet the needs of the growing number of type 2 diabetes patients. The World Health Organization proposed an integrated primary care approach to address the needs of patients with chronic conditions. This study aims to measure type 2 diabetes patients' preferences for urban integrated primary care in China. Methods: A discrete choice experiment was designed to measure type 2 diabetes patient preferences for seven priority attributes of integrated care. A two-stage sampling survey of 307 type 2 diabetes mellitus (T2DM) patients in 16 community health stations was carried out. Interviews were conducted to explore the reasons underpinning the preferences. A logit regression model was used to estimate patients' willingness to pay and to analyze the expected impact of potential policy changes. Results: Travel time to care providers and experience of care providers are the most valued attributes for respondents rather than out-of-pocket cost. Attention to personal situation, the attentiveness of care providers, and the friendliness and helpfulness of staff were all related to interpersonal communication between patients and health care providers. Accurate health information and multidisciplinary care were less important attributes. Conclusions: The study provides an insight into type 2 diabetes patients' needs and preferences of integrated primary care. People-centered interventions, such as increasing coverage by family doctor and cultivating mutual continuous relationships appear to be key priorities of policy and practice in China.
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Affiliation(s)
- Xin Wang
- School of Public Health, Health Development Research Center, Sun Yat-Sen University, Guangzhou 510080, China; (X.W.); (P.Z.)
| | - Kuimeng Song
- Shandong Institute of Medicine and Health Information, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250012, China;
| | - Paiyi Zhu
- School of Public Health, Health Development Research Center, Sun Yat-Sen University, Guangzhou 510080, China; (X.W.); (P.Z.)
| | - Pim Valentijn
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Integrated Care Evaluation, Essenburgh Research & Consultancy, 3849 AE Hierden, The Netherlands
| | - Yixiang Huang
- School of Public Health, Health Development Research Center, Sun Yat-Sen University, Guangzhou 510080, China; (X.W.); (P.Z.)
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD 4072, Australia;
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Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, Pan J, Hu M, Zhou Z, Chen Q, Mao W, Sun Q, Chen W. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet 2019; 394:1192-1204. [PMID: 31571602 DOI: 10.1016/s0140-6736(19)32136-1] [Citation(s) in RCA: 497] [Impact Index Per Article: 99.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 01/23/2023]
Abstract
In 2009, China launched a major health-care reform and pledged to provide all citizens with equal access to basic health care with reasonable quality and financial risk protection. The government has since quadrupled its funding for health. The reform's first phase (2009-11) emphasised expanding social health insurance coverage for all and strengthening infrastructure. The second phase (2012 onwards) prioritised reforming its health-care delivery system through: (1) systemic reform of public hospitals by removing mark-up for drug sales, adjusting fee schedules, and reforming provider payment and governance structures; and (2) overhaul of its hospital-centric and treatment-based delivery system. In the past 10 years, China has made substantial progress in improving equal access to care and enhancing financial protection, especially for people of a lower socioeconomic status. However, gaps remain in quality of care, control of non-communicable diseases (NCDs), efficiency in delivery, control of health expenditures, and public satisfaction. To meet the needs of China's ageing population that is facing an increased NCD burden, we recommend leveraging strategic purchasing, information technology, and local pilots to build a primary health-care (PHC)-based integrated delivery system by aligning the incentives and governance of hospitals and PHC systems, improving the quality of PHC providers, and educating the public on the value of prevention and health maintenance.
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Affiliation(s)
- Winnie Yip
- Harvard School of Public Health, Boston, MA, USA.
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Angela T Chen
- China Health Partnership, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Tiemin Zhai
- China National Health Development Center, Beijing, China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Roman Xu
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Min Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Qiulin Chen
- Institute of Population and Labor Economics, Chinese Academy of Social Sciences, Beijing, China
| | - Wenhui Mao
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Qiang Sun
- School of Health Care Management and Key Laboratory of Health Economic and Policy Research of National Health Commission, Shandong University, Jinan, China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, China
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Antibiotic Sales in Primary Care in Hubei Province, China: An Analysis of 2012-2017 Procurement Records. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183376. [PMID: 31547325 PMCID: PMC6765864 DOI: 10.3390/ijerph16183376] [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: 07/01/2019] [Revised: 09/01/2019] [Accepted: 09/07/2019] [Indexed: 12/12/2022]
Abstract
The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8–19.43%). The relative consumption of Fluoroquinolone (9.26–9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.
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Affiliation(s)
- Jin Xu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Weiyan Jian
- Peking University Health Science Centre, Beijing, China
| | - Kun Zhu
- Chinese Academy of Fiscal Sciences, Beijing, China
| | | | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
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50
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Effect of Patient Participation on Nurse and Patient Outcomes in Inpatient Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081344. [PMID: 30991640 PMCID: PMC6518109 DOI: 10.3390/ijerph16081344] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/17/2022]
Abstract
Using service-dominant logic as a theoretical lens, this study investigated the co-production of healthcare service and service value co-creation between nurses and patients. The main objective of this study was to: (1) examine the effect of patient participation on patient satisfaction and nurses' attitudes and behaviors; (2) examine boundary conditions of the effect of patient participation on patients and nurses. We proposed that patient participation positively impacted patient satisfaction and nurse job satisfaction, work engagement, and helping behaviors. We further proposed that first inpatient stay and length of stay moderated the effect of patient participation on patient satisfaction, and nurses' sociodemographic characteristics moderated the effect of patient participation on nurse job satisfaction, work engagement, and helping behaviors. Using survey data from 282 nurses and 522 inpatients from a public hospital in China, we found that the effect of patient participation on patient satisfaction was contingent upon first inpatient stay and length of stay. We also found that patient participation improved nurse job satisfaction, work engagement, and helping behaviors. Furthermore, nurses' sociodemographic characteristics, namely age and organizational tenure, moderated the effect of patient participation on nurse job satisfaction, but not on work engagement and helping behaviors. Theoretical and practical implications of our findings were discussed.
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