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Zhang M, Li S, Han D, Wu Y, Zhao J, Liao H, Ma Y, Yan C, Wang J. Association of Job Characteristics and Burnout of Healthcare Workers in Different Positions in Rural China: A Cross-Sectional Study. Int J Public Health 2023; 68:1605966. [PMID: 37600525 PMCID: PMC10434533 DOI: 10.3389/ijph.2023.1605966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives: Health workers in rural primary care systems are at increased risk of job burnout, but their associations with different positions have received scant attention in the literature. Thus, this study aims to measure job burnout in different positions in rural China and to identify factors associated with it. Methods: A cross-sectional survey was conducted with a total of 15,627 participants from six provinces in China. And job burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS). Multilevel regression analyses were used in examining factors potentially associated with job burnout in different positions. Results: Overall, more than half of providers suffered from moderate burnout. The degree of job burnout varied among different positions. Middle managers showed higher levels personal stress, while general staff showed the lowest interpersonal and self-evaluation dimensions of burnout. Job duty, job capability, job treatment, and career advancement are potential factors affecting these results. Conclusion: Interventions aimed at providing appropriate training and development opportunities, developing relevant career planning and management strategies, and implementing reasonable staffing and job design may be promising strategies for alleviating burnout in different positions and improving health system performance.
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Affiliation(s)
- Mei Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sangsang Li
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Han
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yunyi Wu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Zhao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hui Liao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying Ma
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaoyang Yan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Institute for Poverty Reduction and Development, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Li Q, Fan X, Jian W. Impact of Diagnosis-Related-Group (DRG) payment on variation in hospitalization expenditure: evidence from China. BMC Health Serv Res 2023; 23:688. [PMID: 37355657 DOI: 10.1186/s12913-023-09686-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/11/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Diagnosis-Related-Group (DRG) payment is considered a crucial means of addressing the rapid increases of medical cost and variation in cost. This paper analyzes the impact of DRG payment on variation in hospitalization expenditure in China. METHOD Patients with chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI) and cerebral infarction (CI) in a Chinese City Z were selected. Patients in the fee-for-service (FFS) payment group and the DRG payment group were used as the control group and intervention group, respectively, and propensity-score-matching (PSM) was conducted. Interquartile distance (IQR), standard deviation (SD) and concentration index were used to analyze variation and trends in terms of hospitalization expenditure across the different groups. RESULTS After DRG payment reform, the SD of hospitalization expenditure in respect of the COPD, AMI and CI patients in City Z decreased by 11,094, 4,833 and 4,987 CNY, respectively. The concentration indices of hospitalization expenditures for three diseases are all below 0 (statistically significant), with the absolute value tending to increase year by year. CONCLUSION DRG payment can be seen to guide medical service providers to provide effective treatment that can improve the consistency of medical care services, bringing the cost of medical care closer to its true clinical value.
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Affiliation(s)
- Qiaosheng Li
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Xiaoqi Fan
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China.
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Yang Y, Man X, Yu Z, Nicholas S, Maitland E, Huang Z, Ma Y, Shi X. Managing Urban Stroke Health Expenditures in China: Role of Payment Method and Hospital Level. Int J Health Policy Manag 2022; 11:2698-2706. [PMID: 35219287 PMCID: PMC9818124 DOI: 10.34172/ijhpm.2022.5117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 02/08/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Stroke is one of the leading public health issues in China and imposes a heavy financial burden on patients and the healthcare system. This study assess which payment method provides the lowest hospital costs for China's healthcare system and the lowest out-of-pocket (OOP) expense for insured patients. METHODS This is a 4-year cross-sectional study. From the China Health Insurance Research Association (CHIRA) database, a 5% random sample of urban health insurance claims was obtained. Descriptive analysis was conducted and a generalized linear model (GLM) with a gamma distribution and a log link was estimated. RESULTS For outpatients, capitation payment had the lowest hospital cost (RMB180.9/US$28.8) and lowest OOP expenses (RMB75.6/US$12.0) per patient visit in primary hospitals compared with fee-for-service (FFS) payments. The global budget (GB) displayed the lowest total hospital costs (RMB344.7/US$54.8) in secondary hospitals, and was 27.4% (95% CI=-0.32, -0.29) lower than FFS. FFS had the lowest OOP expenses (RMB123.4/US$19.6 vs. RMB151.8/US$24.1) in secondary and tertiary hospitals. For inpatients, FFS had the lowest total hospital costs (RMB5918.7/US$941.1) per visit and capitation payments had the lowest OOP expenses (RMB876.5/US$139.4, 40.1% lower than FFS, 95% CI=-0.58, -0.15) in primary hospitals. Capitation payment had both the lowest hospital costs (RMB7342.9/US$1167.5 vs. RMB17 711.7/US$2816.2) and the lowest OOP expenses (RMB1664.2/US$264.6 vs. RMB3276.3/US$520.9) for both secondary and tertiary hospitals. CONCLUSION For outpatients in primary hospitals and inpatients in secondary and tertiary hospitals, the capitation payment was the most money-saving payment method delivering both the lowest OOP expenses for patients and the lowest hospital total costs for hospitals. We recommend that health policymakers prioritize the implementation of the payment method with the lowest OOP expenses when the payment method does not deliver both the lowest hospital costs for the health system and lowest OOP expenses for patients.
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Affiliation(s)
- Yong Yang
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaowei Man
- School of Management, Beijing University of Chinese Medicine, Beijing, China
- National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China
| | - Zhe Yu
- School of Management, Beijing University of Chinese Medicine, Beijing, China
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia
| | - Elizabeth Maitland
- University of Liverpool Management School, University of Liverpool, Liverpool, UK
| | - Zhengwei Huang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yong Ma
- China Health Insurance Research Association, Beijing, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
- National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China
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Li Z, Shi M, He R, Zhang M, Zhang C, Xiong X, Zhang L, Li B. Association between service scope of primary care facilities and patient outcomes: a retrospective study in rural Guizhou, China. BMC Health Serv Res 2021; 21:885. [PMID: 34454504 PMCID: PMC8400844 DOI: 10.1186/s12913-021-06877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extending service scope of primary care facilities (PCFs) has been widely concerned in China. However, no current data about association between service scope of PCFs with patient outcomes are available. This study aims to investigate association between service scope of PCFs and patient outcomes. METHODS A multistage, stratified clustered sampling method was used to collect information about service scope of PCFs from rural Guizhou, China. Claim data of 299,633 inpatient cases covered by 64 PCFs were derived from local information system of New Rural Cooperation Medical Scheme. Service scope of PCFs was collected with self-administrated questionnaires. Primary outcomes were (1) level of inpatient institutions, (2) length of stay, (3) per capita total health cost, (4) per capita out-of-pocket cost, (5) reimbursement ratio, (6) 30-day readmission. A total of 64 PCFs were categorized into five groups per facility-level service scope scores. Generalized linear regression models, logistic regression model, and ordinal regression model were conducted to identify association between service scope of PCFs and patient outcomes. RESULTS On average, the median service scope score of PCFs was 20, with wide variation across PCFs. After controlling for demographic and clinical characteristics, patients living in communities with PCFs of greatest service scope (Quintile V vs. I) tended to have smaller rates of admission by county-level hospitals (-6.2 % [-6.5 %, -5.9 %], city-level hospitals (-1.9 % [-2.0 %, -1.8 %]), and provincial hospitals (-2.1 % [-2.2 %, -2.0 %]), smaller rate of 30-day readmission (-0.5 % [-0.7 %, -0.2 %]), less total health cost (-201.8 [-257.9, -145.8]) and out-of-pocket cost (-210.2 [-237.2, -183.2]), and greater reimbursement ratio (2.3 % [1.9 %, 2.8 %]) than their counterparts from communities with PCFs of least service scope. CONCLUSIONS Service scope of PCFs varied a lot in rural Guizhou, China. Greater service scope was associated with a reduction in secondary and tertiary hospital admission, reduced total cost and out-of-pocket cost, and 30-day readmission and increased reimbursement ratio. These results raised concerns about access to care for patients discharged from hospitals, which suggests potential opportunities for cost savings and improvement of quality of care. However, further evidence is warranted to investigate whether extending service scope of PCFs is cost-effective and sustainable.
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Affiliation(s)
- Zhong Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Meng Shi
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Ruibo He
- School of Finance and Public Administration, Hubei University of Economics, Wuhan, Hubei China
| | - Mei Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Chi Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xinyu Xiong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Boyang Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
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Xu W, Pan Z, Li Z, Lu S, Zhang L. Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030727. [PMID: 31979154 PMCID: PMC7036765 DOI: 10.3390/ijerph17030727] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/18/2022]
Abstract
The health workers in rural primary care systems are at the increasing risk of job burnout. To explore the prevalence and associated factors of the job burnout among the primary healthcare worker in rural China, a cross-sectional survey was conducted among 15,627 participants in 459 township hospitals from six provinces. A combination of stratified multi-stage sampling and cluster sampling method, and a self-administrated questionnaire with the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS) were used in the investigation. Multilevel regression analyses were used to examine the potential associated factors on both individual and organisational levels. 47.6% of respondents were experiencing moderate burnout, and 3.3% were in severe burnout. Professionals working for over 40 h per week, at young age, with a college degree, and with professional titles at medium or high rank reported a higher degree of job burnout. At the institutional level, the high ratio of performance-based salary was associated with a higher level of depersonalization. Burnout has become prevalent among the primary healthcare workers in rural China, and multiple strategies are needed to reduce the work stress and some high-risk groups’ vulnerability to job burnout.
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Affiliation(s)
- Wanchun Xu
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (W.X.); (Z.P.); (Z.L.); (S.L.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430000, China
| | - Zijing Pan
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (W.X.); (Z.P.); (Z.L.); (S.L.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430000, China
| | - Zhong Li
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (W.X.); (Z.P.); (Z.L.); (S.L.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430000, China
| | - Shan Lu
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (W.X.); (Z.P.); (Z.L.); (S.L.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430000, China
| | - Liang Zhang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (W.X.); (Z.P.); (Z.L.); (S.L.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430000, China
- Correspondence: ; Tel.: +86-027-8361-0982
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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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He R, Miao Y, Zhang L, Yang J, Li Z, Li B. Effects of expanding outpatient benefit package on the rationality of medical service utilisation of patients with hypertension: a quasi-experimental trial in rural China. BMJ Open 2019; 9:e025254. [PMID: 31072851 PMCID: PMC6527979 DOI: 10.1136/bmjopen-2018-025254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/08/2019] [Accepted: 03/05/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To estimate the effects of expanding outpatient benefit package on ameliorating the issues of over-reliance on inpatient services and seeking higher level medical services in rural China. DESIGN A quasi-experimental design. SETTING AND PARTICIPANTS 1673 pairs of patients with hypertension were selected after using propensity score matching from Dangyang county (intervention group) and Zhijiang (control group) county, Hubei province. INTERVENTION The outpatient annual reimbursement capping line was expanding from ¥300 to ¥600, daily capping line from ¥10/12 to ¥150. The compensation scope and institution were also enlarged from January 2016. OUTCOME MEASURES The difference-in-differences model was used to estimate the effects on medical service type selection. χ2 test was used to verify the effects on medical institution selection. We also examined the effects on health outcomes through the length of stay and blood pressure changes. RESULTS The intervention was associated with 3.225 times (p=0.001) increase in total visits. Outpatient visits increased by 3.3 times (p=0.008), whereas the township level presented a maximum increase of 1.932 times (p=0.001). The inpatient visits declined by 0.075 times (p=0.000), whereas county-level inpatient visits reached a maximum decrease of 0.042 times (p=0.033). Meanwhile, the township level exhibited a maximum proportion growth of 14.8% in outpatient (p=0.000) and 13.3% in inpatient visits (p=0.048). Outpatient visits at the county level dropped at 13.2% (p=0.000), whereas inpatients visits declined by 7.7% (p=0.040). The length of stay and blood pressure were decreased, respectively, compared with the control group. CONCLUSION Improving outpatient benefit package alleviated patient dependence on inpatient services through motivating outpatient service utilisation, consolidated the primacy of township health centres and guided patients to return to primary medical institutions. The health insurance reform should 'take the long view' in the future, and more attention should be paid to the rationality of medical service utilisation.
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Affiliation(s)
- Ruibo He
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yudong Miao
- Department of General Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Yang
- Department of Medical Affairs, Guangdong General Hospital, Guangzhou, China
| | - Zhong Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Boyang Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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