154 results
Search Results
2. Hukou-based rural–urban disparities in maternal health service utilization and delivery modes in two Chinese cities in Guangdong Province.
- Author
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Shen, Menghan, Wu, Yushan, and Xiang, Xin
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MATERNAL health services ,HEALTH services accessibility ,CONFIDENCE intervals ,RURAL conditions ,AGE distribution ,HEALTH status indicators ,MEDICAL care ,REGRESSION analysis ,TERTIARY care ,MEDICAL care costs ,MEDICAL care use ,DESCRIPTIVE statistics ,METROPOLITAN areas ,PRENATAL care ,ODDS ratio ,CESAREAN section ,DELIVERY (Obstetrics) - Abstract
Background: Most existing research on rural–urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural–urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China. Methods: Utilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015–2019) and 25,849 live births in City B (2018–2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable. Results: While there is no statistically significant difference in rural and urban mothers' probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively. Conclusions: Rural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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3. Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance.
- Author
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Fu, Xian-zhi
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CONFIDENCE intervals ,MEDICAL care costs ,HEALTH insurance ,DESCRIPTIVE statistics ,INSURANCE - Abstract
Background: After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). Methods: We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. Results: From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. Conclusions: In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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4. Tracking the effects of COVID-19 in rural China over time.
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Wang, Huan, Zhang, Markus, Li, Robin, Zhong, Oliver, Johnstone, Hannah, Zhou, Huan, Xue, Hao, Sylvia, Sean, Boswell, Matthew, Loyalka, Prashant, and Rozelle, Scott
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HEALTH services accessibility ,INCOME ,INTERVIEWING ,MEDICAL care use ,QUARANTINE ,QUESTIONNAIRES ,RURAL conditions ,RURAL population ,UNEMPLOYMENT ,EMPIRICAL research ,SOCIOECONOMIC factors ,DESCRIPTIVE statistics ,COVID-19 - Abstract
Background: China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time. Methods: We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China's overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February. Results: There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas. Conclusions: By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities. [ABSTRACT FROM AUTHOR]
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- 2021
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5. Control under times of uncertainty: the relationship between hospital competition and physician-patient disputes.
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Qian Yang and Pan, Jay
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HOSPITALS ,CONFLICT (Psychology) ,GEOGRAPHIC information systems ,PHYSICIAN-patient relations ,SOCIAL control ,EFFECT sizes (Statistics) ,ECONOMIC competition - Abstract
Background: Recently, cases of medical disputes and even acts of violence toward physicians by patients in China have been escalating. It remains unknown whether competition improves the patient-physician relationship. Methods: This paper analyzes the relationship between hospital competition and the probability of medical disputes occurrence according to the theory of social control. Data from all hospitals in the Sichuan province of China from 2011 to 2014 were included in the study. The fixed radius approach with GIS information was employed to define hospital market, and the differences in competition over time and across regions were utilized. Our analysis is based on the fixed effect estimation, which accounts for the time-invariant unobserved heterogeneity among hospitals. Results: We found an inversed U-shaped relationship between HHI and the likelihood of medical disputes. As beneath either situation of monopoly or full competition, the burst of physician-patient dispute was downward into a valley, but it rises and then falls again with the increase of HHI, it reached the peak at the typical semi-market hospital competition structure. Conclusions: Our results highlight the probability of change in disputes occurrence with the transition of hospital competition and its psychological explanation, providing implications for China's future health reform. [ABSTRACT FROM AUTHOR]
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- 2017
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6. What limits the utilization of health services among china labor force? analysis of inequalities in demographic, socioeconomic and health status.
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Liming Lu, Jingchun Zeng, and Zhi Zeng
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CHRONIC disease treatment ,HEALTH policy ,AGE distribution ,CLUSTER analysis (Statistics) ,CONFIDENCE intervals ,HEALTH services accessibility ,HEALTH status indicators ,INSURANCE ,HEALTH insurance ,MARITAL status ,MEDICAL care use ,NOMADS ,STATISTICAL sampling ,SELF-evaluation ,SOCIAL classes ,LOGISTIC regression analysis ,SOCIOECONOMIC factors ,EDUCATIONAL attainment ,CROSS-sectional method ,DESCRIPTIVE statistics ,ODDS ratio - Abstract
Background: Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. This paper identifies the inequalities which limit the utilization of health services among China labor force, and provides a reference point for health policy. Methods: Data were collected from 23,505 participants aged 15 to 65, from the 2014 China Labor Force Dynamic Survey (a nationwide cross-sectional survey covering 29 provinces with a multi-stage cluster, and stratified, probability sampling strategy) conducted by Sun Yat-sen University. Logistic regression models were used to study the effects of demographic (age, gender, marital status, type of hukou and migration status), socio-economic (education, social class and insurance) and health status (self-perceived general health and several chronic illnesses) variables on the utilization of health services (two-week visiting and hospitalization during the past 12 months). Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating curve (AUC). Results: Migrants with more than 1 (OR 2.80, 95% CI 1.01 ~ 7.82) or none chronic illnesses (OR 1.26, 95% CI 1.01 ~ 7.82) are more likely to be two week visiting to the clinic than non-migrants; migrants with none chronic illnesses (OR 0.61, 95% CI 0.45 ~ 0.82) are less likely to be in hospitalization during the past 12 months than non-migrants. Female, elder, hukou of non-agriculture, higher education level, higher social class, purchasing more insurance and poorer selfperceived health were predictors for more utilization of health service. More insurance benefited more two-week visiting (OR 1.12, 95% CI 1.06 ~ 1.17) and hospitalization during the past 12 months (OR 1.12, 95% CI 1.07 ~ 1.18) for individuals with none chronic illness but not ≥1 chronic illnesses. All models achieved good calibration (Hosmer-Lemeshow test's P range of 0.258-0.987) and discrimination (AUC range of 0.626-0.725). Conclusions: This study has shown that there are inequalities of demographic, socio-economic and health status in the utilization of health services for China labor force. Prudent health policy with equitable utilization of health services eliminating mentioned inequalities should be a priority in shaping China's healthcare system reform. [ABSTRACT FROM AUTHOR]
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- 2017
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7. Geographic distribution of hospital beds throughout China: a county-level econometric analysis.
- Author
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Pan, Jay and Shallcross, David
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COST control ,HEALTH care rationing ,HEALTH services accessibility ,HEALTH status indicators ,HOSPITALS ,MAPS ,RESEARCH methodology ,POPULATION geography ,REGRESSION analysis ,DESCRIPTIVE statistics - Abstract
Background: Geographical distribution of healthcare resources is an important dimension of healthcare access. Little work has been published on healthcare resource allocation patterns in China, despite public equity concerns. Methods: Using national data from 2043 counties, this paper investigates the geographic distribution of hospital beds at the county level in China. We performed Gini coefficient analysis to measure inequalities and ordinary least squares regression with fixed provincial effects and additional spatial specifications to assess key determinants. Results: We found that provinces in west China have the least equitable resource distribution. We also found that the distribution of hospital beds is highly spatially clustered. Finally, we found that both county-level savings and government revenue show a strong positive relationship with county level hospital bed density. Conclusions: We argue for more widespread use of disaggregated, geographical data in health policy-making in China to support the rational allocation of healthcare resources, thus promoting efficiency and equity. [ABSTRACT FROM AUTHOR]
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- 2016
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8. Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China.
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Shi, Huanyu, Cheng, Zhichao, Liu, Zhichao, Zhang, Yang, and Zhang, Peng
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MEDICAL care use ,POLICY sciences ,PROSPECTIVE payment systems ,INSURANCE ,RESEARCH funding ,MEDICAL care ,HEALTH policy ,LOGISTIC regression analysis ,HOSPITALS ,TIME series analysis ,TERTIARY care ,DESCRIPTIVE statistics ,HEALTH care reform ,GOVERNMENT programs ,LABOR incentives ,HEALTH promotion ,CASE studies ,PAY for performance ,REGRESSION analysis - Abstract
Background: The construction of the ordered health delivery system in China aims to enhance equity and optimize the efficient use of medical resources by rationally allocating patients to different levels of medical institutions based on the severity of their condition. However, superior hospitals have been overcrowded, and primary healthcare facilities have been underutilized in recent years. China has developed a new case-based payment method called "Diagnostic Intervention Package" (DIP). The government is trying to use this economic lever to encourage medical institutions to actively assume treatment tasks consistent with their functional positioning and service capabilities. Methods: This study takes Tai'an, a DIP pilot city, as a case study and uses an interrupted time series analysis to analyze the impact of DIP reform on the case severity and service scope of medical institutions at different levels. Results: The results show that after the DIP reform, the proportion of patients receiving complicated procedures (tertiary hospitals: β
3 = 0.197, P < 0.001; secondary hospitals: β3 = 0.132, P = 0.020) and the case mix index (tertiary hospitals: β3 = 0.022, P < 0.001; secondary hospitals: β3 = 0.008, P < 0.001) in tertiary and secondary hospitals increased, and the proportion of primary-DIP-groups cases decreased (tertiary hospitals: β3 = -0.290, P < 0.001; secondary hospitals: β3 = -1.200, P < 0.001), aligning with the anticipated policy objectives. However, the proportion of patients receiving complicated procedures (β3 = 0.186, P = 0.002) and the case mix index (β3 = 0.002, P < 0.001) in primary healthcare facilities increased after the reform, while the proportion of primary-DIP-groups cases (β3 = -0.515, P = 0.005) and primary-DIP-groups coverage (β3 = -2.011, P < 0.001) decreased, which will reduce the utilization efficiency of medical resources and increase inequity. Conclusion: The DIP reform did not effectively promote the construction of the ordered health delivery system. Policymakers need to adjust economic incentives and implement restraint mechanisms to regulate the behavior of medical institutions. [ABSTRACT FROM AUTHOR]- Published
- 2024
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9. Can single disease payment impact hospitalization expenses and quality in district hospital? A case study in Fujian, China.
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Zhang, Liangwen, Sha, Wanqiu, Lin, Qiyu, and Fang, Ya
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PUBLIC hospitals ,CESAREAN section ,CLINICAL medicine ,RESEARCH funding ,INSURANCE ,EVALUATION of human services programs ,SINGLE-payer health care ,HOSPITAL care ,LACUNAR stroke ,KEY performance indicators (Management) ,QUESTIONNAIRES ,DESCRIPTIVE statistics ,HEALTH care reform ,JOB satisfaction ,MEDICAL records ,TYPE 2 diabetes ,QUALITY assurance ,PATIENT satisfaction ,MEDICAL care costs - Abstract
Background: China is exploring payment reform methods for patients to address the escalating issue of increasing medical costs. While most district hospitals were still in the stage of Single Disease Payment (SDP) due to conditions, there is a scarcity of research on comprehensive assessment of SDP. This study aims to evaluate the implementation of SDP in a district hospital, and provided data support and scientific reference for improving SDP method and accelerating medical insurance payment reform at district hospitals. Methods: Data was collected from 2337 inpatient medical records at a district hospital in Fuzhou, China from 2016 to 2021. These diagnoses principally included type 2 diabetes, planned cesarean sections, and lacunar infarction. Structural variation analysis was conducted to examine changes in the internal cost structure and dynamic shifts in medical expenses for both the insured (treatment group) and uninsured (control group) patients, pre- and post-implementation of the SDP policy on August 1, 2018. The difference-in-differences (DID) method was employed to assess changes in hospitalization expenses and quality indicators pre- and post-implementation. Furthermore, subjective evaluation of medical quality was enhanced through questionnaire surveys with 181 patients and 138 medical staff members. Results: The implementation of SDP decreased the medical expenses decreased significantly (P < 0.05), which can also optimize the cost structure. The drug cost ratio descended significantly, and the proportion of laboratory fee rose slightly. The changes in infection rate, cure rate, and length of stay indicated enhanced medical quality (P < 0.05). The satisfaction of inpatients with SDP was high (89.2%). Medical staff expressed an upper middle level of satisfaction (77.2%) but identified difficulties with the implementation such as "insufficient coverage of disease types". Conclusion: After the implementation of SDP in district hospitals, considerable progress has been achieved in restraining medical expenses, coupled with notable enhancements in both medical quality and patient satisfaction levels. However, challenges persist regarding cost structure optimization and underutilization of medical resources. This study suggests that district hospitals can expedite insurance payment reform by optimizing drug procurement policies, sharing examination information, and strengthening the management of medical records. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Inter-provincial inequality of public health services in China: the perspective of local officials' behavior.
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Chen, Tianxiang, Wang, Ying, Luo, Xiaoyi, Rao, Yuxuan, and Hua, Lei
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HEALTH services accessibility ,HEALTH status indicators ,LOCAL government ,PUBLIC health ,REGRESSION analysis ,GOVERNMENT aid ,GOVERNMENT policy - Abstract
Background: After economic reform, China experienced rising public health services inequality between the eastern developed and mid-west undeveloped provinces. The fiscal transfer payment system which aims to shape the disparities was considered inefficient. However, there are only a few studies that address the political reason when analyzing the inter-provincial public health services inequality. And the previous studies did not consider a possible non-linear relationship between the fiscal transfer payments and the inter-provincial public health services equalization. Methods: This paper argues that the local officials' fanatical pursuit of local economic growth which driven by the Political Promotion Tournament and the polarized fiscal self-sufficiency (fiscal capacities) of local governments are responsible for the inter-provincial inequality of public health services and the inefficiency of fiscal transfer payments. By constructing panel threshold regression models with fiscal self-sufficiency of local governments as threshold variable, this study tries to empirically investigate the optimal level of the local governments' self-sufficiency at which the fiscal transfer payments can effectively promote equalization. Results: Threshold effects exist between fiscal transfer payments and inter-provincial public health services equalization. The effects on inter-provincial public health services equalization show trends that first increase and then decrease as the fiscal self-sufficiency of local governments increases. And there exist a range of fiscal self-sufficiency between 29.236 and 43.765% or between 28.575 and 45.746% for local governments where the fiscal transfer payments can effectively achieve equalization. Currently, the vast majority of provinces in China remain in the ineffective regime where the fiscal transfer payments are inefficient in shaping inequality. Conclusions: This paper explains the reason of inequality in public health services and the inefficiency of fiscal transfer payment system from Chinese local officials' behavior aspect, and try to find out an effective solution by focusing on the local government's fiscal capacity. The effective way to narrow the inequality is to establish a flexible tax-sharing system to adjust local governments' fiscal capacities and give local governments with low fiscal self-sufficiency more fiscal resources. The new policy measures recently launched by Chinese central government coincide with our recommendations. [ABSTRACT FROM AUTHOR]
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- 2018
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11. Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey
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Nie, Peng, Ding, Lanlin, Chen, Zhuo, Liu, Shiyong, Zhang, Qi, Shi, Zumin, Wang, Lu, Xue, Hong, Liu, Gordon G., and Wang, Youfa
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- 2021
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12. Changing inequity in health service utilization and financial burden among patients with hypertension in China: evidence from China Health and Retirement Longitudinal Study (CHARLS), 2011–2018.
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Tang, Haoqing, Li, Mingyue, Liu, Larry Z., Zhou, Yanbing, and Liu, Xiaoyun
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HYPERTENSION ,CONFIDENCE intervals ,MEDICAL care costs ,MEDICAL care use ,FINANCIAL stress ,RESEARCH funding ,QUESTIONNAIRES ,HEALTH equity - Abstract
Background: China initiated a health system reform in 2009 to achieve Universal Health Coverage (UHC) by 2020. While the effectiveness of health-system reforms has been studied, equity in health-service utilization and financial burden remains underexplored. This study evaluated whether the health system reform has improved the equity in utilization and financial burden of health services among patients with hypertension in China. Methods: We obtained data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. The main outcome variables were outpatient and inpatient service utilization rates and catastrophic health expenditure (CHE) for patients with hypertension. The Standardized Concentration Index (CI) was used to measure the changing equity in health service utilization and affordability. Results: Outpatient service utilization was relatively equal among patients with varying socioeconomic statuses (SESs) (CI: 0.041 in 2011 and 0.064 in 2018). Inpatient service utilization inequity improved from CI 0.144 in 2011 to CI 0.066 in 2018. CHE incidence increased from 15.6% in 2011 to 24.2% in 2018. CI for CHE declined from -0.069 in 2011 to -0.012 in 2015 but increased to -0.063 in 2018. Conclusions: Health insurance expansion and poverty alleviation policies promoted equity in inpatient service utilization for hypertensive patients. However, the financial burden for the poor requires further attention through reimbursement policy adjustments for outpatient services in primary care settings. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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13. The effect of long-term care insurance on healthcare utilization of middle-aged and older adults: evidence from China health and retirement longitudinal study.
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Yang, Songhao, Guo, Dandan, Bi, Shengxian, and Chen, Yingchun
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MEDICAL care ,QUANTITATIVE research ,MEDICAL care costs ,AGING ,HOSPITAL care ,RESEARCH funding ,DESCRIPTIVE statistics ,RETIREMENT ,LONGITUDINAL method ,MIDDLE age ,OLD age - Abstract
Background: As global ageing continues to increase and many countries face challenges from the growing demand for long-term care. Drawing on the experiences of developed countries, developing countries have explored their own suitable long-term care insurance and have shown strong potential for development and research prospects. However, due to their late start, relevant research is underrepresented in the global research network and still needs to be supplemented. The present study hopes to examine the effect of long-term care insurance on healthcare utilization among the middle-aged and elderly from an empirical perspective, using China as an example. Methods: Panel data from wave 3 (2015) and wave 4 (2018) of the nationally-representative China health and retirement longitudinal study were selected to obtain a sample of 661 processing participants and 16,065 control participants after matching the policy implementation time in the first pilot cities, and quantitative analysis was conducted using difference-in-differences propensity score matching estimator method to assess the net effect of long-term care insurance on health care utilization among the middle-aged and elderly adults. Results: In the matched frequency-weighted regression difference-in-differences estimator results, long-term care insurance had a negative effect on the number and costs of annual hospitalizations at the 5% significance level (key variable values of − 0.0568101 and − 1236.309, respectively) and a non-significant effect on outpatient service utilization (P > 0.05). Further exploration of the heterogeneous effect of it revealed that implementation had a more significant negative effect on hospitalization utilization for middle-aged and older people in the East and for those with higher levels of education or attended care. Conclusion: Long-term care insurance has played a role in controlling hospitalization costs but has not yet achieved the expected effect in controlling outpatient costs. The policy effects in terms of regional distribution and education level and care situation have been variable. The treatment plan of long-term care insurance needs to be improved, the supply of resources for long-term care services should be increased, and the promotion of long-term care insurance and health science should be given attention. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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14. Income loss and subsequent poor psychological well-being among the Chinese population during the early COVID-19 pandemic.
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Lai, Sha, Lu, Li, Shen, Chi, Yan, Alice, Lei, Yanjun, Zhou, Zhongliang, and Wang, Youfa
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WELL-being ,ANHEDONIA ,NET losses ,TIME ,CROSS-sectional method ,SELF-evaluation ,MULTIPLE regression analysis ,MENTAL health ,INCOME ,SURVEYS ,SLEEP disorders ,SOCIOECONOMIC factors ,SCALE analysis (Psychology) ,DESCRIPTIVE statistics ,ATTENTION ,RESEARCH funding ,FAMILY relations ,ANGER ,COVID-19 pandemic ,PSYCHOLOGICAL stress - Abstract
Background: The COVID-19 pandemic has had major ramifications for health and the economy at both the individual and collective levels. This study examined exogenous negative changes in household income and their implications on psychological well-being (PWB) among the Chinese population during the COVID-19 pandemic. Methods: Data were drawn from the early China COVID-19 Survey, a cross-sectional anonymous online survey administered to the general population in China. Self-reported PWB was measured using a 5-point Likert scale with five questions related to the participants' recent psychological state. Hierarchical multiple linear regression was employed to examine whether income loss during the COVID-19 pandemic was associated with poor psychological health. Results: This study included 8,428 adults, of which 90% had suffered from a moderate or severe loss of household income due to the early COVID-19 pandemic. Those who had experienced moderate or severe loss of income scored significantly lower on psychological well-being than those who did not experience income loss (19.96 or 18.07 vs. 21.46; P < 0.001); after controlling for confounders, income loss was negatively associated with PWB scores (moderate income loss: B = − 0.603, P < 0.001; severe income loss: B = − 1.261, P < 0.001). An interaction effect existed between the degree of income loss and pre-pandemic income groups. Specifically, participants in the middle-income group who had suffered severe income loss scored the lowest on PWB (B = − 1.529, P < 0.001). There was also a main effect on income loss, such that participants with varying degrees of income loss differed across five dimensions, including anhedonia, sleep problems, irritability or anger, difficulty with concentration, and repeated disturbing dreams related to COVID-19. Conclusions: Income loss during the pandemic has had detrimental consequences on psychological well-being, and the magnitude of the impact of income loss on psychological well-being varied according to previous income levels. Future policy efforts should be directed toward improving the psychological well-being of the economically vulnerable and helping them recover from lost income in the shortest time possible. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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15. The pathways from disadvantaged socioeconomic status in childhood to edentulism in mid-to-late adulthood over the life-course.
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Zhang, Xiaoning, Dai, Shuping, Jiang, Xue, Huang, Wenhao, Zhou, Qiong, and Wang, Sheng
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STRUCTURAL equation modeling ,HEALTH services accessibility ,FOOD security ,ORAL health ,EDENTULOUS mouth ,HUMAN life cycle ,SOCIOECONOMIC status ,OCCUPATIONS ,SOCIAL classes ,DESCRIPTIVE statistics ,RESEARCH funding ,FAMILY relations ,EDUCATIONAL attainment ,CHILDREN - Abstract
Background: This study aimed to examine the direct and indirect pathways from childhood socioeconomic status (SES) to the prevalence of edentulism in mid-to-late age Chinese individuals using structural equation modeling (SEM). Methods: This study analyzed data from 17,032 mid- to-late age Chinese individuals in the 2014 and 2015 China Health and Retirement Longitudinal Study (CHARLS). Childhood SES was determined based on the parents' education and occupation, financial situation of the family, primary residence, food availability, and medical convenience. Adulthood SES was established according to educational achievements of the individuals. Edentulism is defined as the loss of all natural teeth. SEM was used to examine the statistical significance of the association between childhood SES and edentulism, mediated by childhood health, adulthood SES, and adult health. Results: Childhood SES had significant indirect (β = -0.026, p < 0.01), and total (β = -0.040, p < 0.01) effects on edentulism. It was determined that 65% of the total effect of childhood SES on edentulism was indirect, and mainly mediated by adult SES. Also, the goodness-of-fit indices of the best-fitting model were acceptable. Conclusion: This study revealed that childhood health, adult health and adult SES are mediators that explain the relationship between childhood SES and edentulism. The global attention to alleviate the inequality in edentulism should focus on exploring recommendations and intervention strategies from childhood to adulthood, by considering adult SES, childhood and adult health. [ABSTRACT FROM AUTHOR]
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- 2023
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16. Targeting vulnerable groups of health poverty alleviation in rural China— what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population?
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Wang, Nianshi, Xu, Jing, Ma, Meiyan, Shan, Linghan, Jiao, Mingli, Xia, Qi, Tian, Wanxin, Zhang, Xiyu, Liu, Limin, Hao, Yanhua, Gao, Lijun, Wu, Qunhong, and Li, Ye
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- 2020
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17. Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: evidence from two cross-sectional household surveys in Shaanxi Province
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Fan, Xiaojing, Kumar, Meghan Bruce, Zhou, Zhongliang, Lee, Ching-Hung, Wang, Duolao, Liu, Haixia, Dang, Shaonong, and Gao, Jianmin
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- 2020
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18. Measurement and decomposition of income-related inequality in self-rated health among the elderly in China
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Gu, Hai, Kou, Yun, You, Hua, Xu, Xinpeng, Yang, Nichao, Liu, Jing, Liu, Xiyan, Gu, Jinghong, and Li, Xiaolu
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- 2019
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19. Changes in inequality in utilization of preventive care services: evidence on China’s 2009 and 2015 health system reform
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Xu, Yongjian, Zhang, Tao, and Wang, Duolao
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- 2019
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20. The impact of urban–rural medical insurance integration on medical impoverishment: evidence from China
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Huo, Jinkang, Hu, Mingzheng, and Li, Shaojie
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- 2023
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21. Catastrophic health expenditure and its association with socioeconomic status in China: evidence from the 2011-2018 China Health and Retirement Longitudinal Study
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Li, Xi, Mohanty, Itismita, Zhai, Tiemin, Chai, Peipei, and Niyonsenga, Theo
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- 2023
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22. Trends in health service needs, utilization, and non-communicable chronic diseases burden of older adults in China: evidence from the 1993 to 2018 National Health Service Survey
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Wu, Nina, Xie, Xueqin, Cai, Min, Han, Youli, and Wu, Shiyong
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- 2023
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23. Inequality of opportunity in outpatient expenditure among the elderly with multimorbidity: evidence from China
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Zhang, Kangkang, You, Hua, Yu, Linxiang, Wu, Qifeng, and Xu, Xinpeng
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- 2023
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24. Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China
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Li, Zhong, Hung, Peiyin, Shi, Kewei, Fu, You, and Qian, Dongfu
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- 2023
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25. Trends in the distribution of socioeconomic inequalities in smoking and cessation: evidence among adults aged 18 ~ 59 from China Family Panel Studies data
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Huang, Ming Zhao, Liu, Tai Yi, Zhang, Zhong Min, Song, Fujian, and Chen, Ting
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- 2023
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26. Institutional differences and geographical disparity: the impact of medical insurance on the equity of health services utilization by the floating elderly population - evidence from China
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Han, Junqiang and Meng, Yingying
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- 2019
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27. The effect of the health poverty alleviation project on financial risk protection for rural residents: evidence from Chishui City, China
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Chen, Chu and Pan, Jay
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- 2019
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28. Exploring pathways to outpatients’ satisfaction with health care in Chinese public hospitals in urban and rural areas using patient-reported experiences
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Wang, Xuanxuan, Chen, Jiaying, Burström, Bo, and Burström, Kristina
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- 2019
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29. The influence of medical insurance on the use of basic public health services for the floating population: the mediating effect of social integration
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Yulin Li and Dongmei Dou
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Rural Population ,China ,Medical insurance ,Insurance, Health ,Urban Population ,Health Policy ,Research ,Public Health, Environmental and Occupational Health ,Health Services ,Humans ,Social Integration ,Public aspects of medicine ,RA1-1270 ,Basic public health services - Abstract
Background The accessibility and fairness of the floating population’s access to basic public health services have an important impact on improving the health level of the whole population. Existing studies have shown that medical insurance and social integration have an impact on basic public health services, but there are few studies on the specific influence path between the three. Therefore, the research purpose of this paper is to explore the effects of medical insurance for urban and rural residents and basic medical insurance for urban employees on the utilization of basic public health services, and to analyze the mediating effect of social integration. Methods The data in this paper are derived from the 2017 China Mobile Population Dynamic Monitoring Survey data, which collects information on 31 provinces (regions, cities) and Xinjiang Production and Construction Corps mobile population 169,989 people, all of whom come from China’s relatively concentrated mobile population inflow areas (NHC FPSCo. 2021. Floating Population Service Center of NHC). After deleting part of the missing data and replacing the mean value, 154,586 people were finally included in the analysis. The proportion is 90.9%. Based on the data of China’s floating population dynamic survey in 2017,we used Logistic regression method to analyze the effects of basic medical insurance for urban and rural residents, basic medical insurance for urban employees and social integration on the utilization of basic public health services. Then we used the Bootstrap method of structural equation model to analyze the mediating effect of social integration. Results Medical insurance for urban and rural residents (β = 0.236;95%CI:1.195 ~ 1.342) has positive impact on health education, it (β = 0,190;95%CI:1.150 ~ 1.272) also has positive impact on the establishment of residents’ health records. Social integration (including political participation (β = 0.312;95%CI:1.324 ~ 1.410),activity participation (β = 0.724;95%CI:2.009 ~ 2.119), identity (β = 0.421; 95%CI:1.387 ~ 1.675))has positive impact on health education, it ((β = 0.312;95%CI:1.324 ~ 1.410), (β = 0.404;95%CI:1.463 ~ 1.534), (β = 0.282;95%CI:1.191 ~ 1.477)) also has positive impact on the establishment of residents’ health records. In addition, BMIUE (β = 0.169;95%CI:1.150 ~ 1.219) has an impact on the establishment of residents’ health records. The direct effect of medical insurance on the utilization of public health services was 0.092 (95%CI: 0.093 ~ 0.103), social integration was a partial mediator, the mediating effect was 0.127 (95%CI: 0.108 ~ 0.127), and the mediating effect size was 57.73%. Conclusions Medical insurance can directly promote the floating population to use basic public health services, and can indirectly promote the improvement of public health service utilization level through social integration.
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- 2022
30. The relationship between urbanization and depression in China: the mediating role of neighborhood social capital
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Wang, Ruoyu, Xue, Desheng, Liu, Ye, Chen, Hongsheng, and Qiu, Yingzhi
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- 2018
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31. Socioeconomic disparities in abdominal obesity over the life course in China
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Zhao, Panpan, Gu, Xiaoli, Qian, Dongfu, Yang, Fan, and for the Healthy Aging and Development Study Group in Nanjing Medical University, and for the Data Mining Group of Biomedical Big Data in Nanjing Medical University
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- 2018
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32. The comparison of healthcare utilization inequity between URRBMI and NCMS in rural China
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Zengwen Wang, Tianyi Pan, Yucheng Chen, Xiaodi Liu, and Hongwei Hu
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Adult ,Male ,Rural Population ,China ,medicine.medical_specialty ,Healthcare utilization ,Urban Population ,Horizontal inequity index ,Deductible ,Inequity ,03 medical and health sciences ,Ambulatory care ,Environmental health ,The integration of urban-rural medical insurance ,Urban Health Services ,medicine ,Humans ,Longitudinal Studies ,Healthcare Disparities ,Health policy ,Social policy ,Insurance, Health ,030505 public health ,Inpatient care ,Research ,Health Policy ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Health services research ,lcsh:RA1-1270 ,Patient Acceptance of Health Care ,Logistic Models ,Female ,Rural Health Services ,Business ,Rural area ,0305 other medical science - Abstract
Background The inequity of healthcare utilization in rural China is serious, and the urban-rural segmentation of the medical insurance system intensifies this problem. To guarantee that the rural population enjoys the same medical insurance benefits, China began to establish Urban and Rural Resident Basic Medical Insurance (URRBMI) nationwide in 2016. Against this backdrop, this paper aims to compare the healthcare utilization inequity between URRBMI and New Cooperative Medical Schemes (NCMS) and to analyze whether the inequity is reduced under URRBMI in rural China. Methods Using the data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which was conducted in 2015, a binary logistic regression model was applied to analyze the influence of income on healthcare utilization, and the decomposition of the concentration index was adopted to compare the Horizontal inequity index (HI index) of healthcare utilization among the individuals insured by URRBMI and NCMS. Results There is no statistically significant difference in healthcare utilization between URRBMI and NCMS, but in outpatient utilization, there are significant differences among different income groups in NCMS; high-income groups utilize more outpatient care. The Horizontal inequity indexes (HI indexes) in outpatient utilization for individuals insured by URRBMI and NCMS are 0.024 and 0.012, respectively, indicating a pro-rich inequity. Meanwhile, the HI indexes in inpatient utilization under the two groups are − 0.043 and − 0.028, respectively, meaning a pro-poor inequity. For both the outpatient and inpatient care, the inequity degree of URRBMI is larger than that of NCMS. Conclusions This paper shows that inequity still exists in rural areas after the integration of urban-rural medical insurance schemes, and there is still a certain gap between the actual and the expected goal of URRBMI. Specifically, compared to NCMS, the pro-rich inequity in outpatient care and the pro-poor inequity in inpatient care are more serious in URRBMI. More chronic diseases should be covered and moral hazard should be avoided in URRBMI. For the vulnerable groups, special policies such as reducing the deductible and covering these groups with catastrophic medical insurance could be considered.
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- 2019
33. Hukou-based rural–urban disparities in maternal health service utilization and delivery modes in two Chinese cities in Guangdong Province
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Menghan Shen, Yushan Wu, and Xin Xiang
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Maternal health ,Healthcare access ,Rural-urban inequality ,China ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Most existing research on rural–urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural–urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China. Methods Utilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015–2019) and 25,849 live births in City B (2018–2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable. Results While there is no statistically significant difference in rural and urban mothers’ probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively. Conclusions Rural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services.
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- 2021
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34. Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance
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Xian-zhi Fu
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Catastrophic health expenditure ,Impoverishment ,Medical insurance ,Propensity score ,China ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). Methods We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. Results From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. Conclusions In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.
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- 2021
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35. Tracking the effects of COVID-19 in rural China over time
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Huan Wang, Markus Zhang, Robin Li, Oliver Zhong, Hannah Johnstone, Huan Zhou, Hao Xue, Sean Sylvia, Matthew Boswell, Prashant Loyalka, and Scott Rozelle
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COVID-19 ,Rural community ,China ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time. Methods We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China’s overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February. Results There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas. Conclusions By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities.
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- 2021
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36. Analysis of factors affecting medical personnel seeking employment at primary health care institutions: developing human resources for primary health care.
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Jia, Huanhuan, Yu, Xihe, Jiang, Hairui, Yu, Jianxing, Cao, Peng, Gao, Shang, Shang, Panpan, and Qiang, Bayuzhen
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UNEMPLOYMENT & psychology ,HELP-seeking behavior ,PRIMARY health care ,EMPLOYMENT ,DESCRIPTIVE statistics ,DATA analysis software - Abstract
Background: The serious shortage of human resources for primary health care (PHC) is a common issue in health reforms worldwide. China has proposed that it is an effective way to encourage and guide qualified medical personnel to work in primary health care institutions (PHCIs). However, few studies have been conducted on the willingness and influencing factors of medical personnel to seek employment at PHCIs. Methods: Based on implicit theory and lexical approach, pre-investigation was conducted to collect the items that influence the medical personnel to seek employment at PHCIs from the perspective of guided objects. Through a three-phase investigation of 1160 doctors in 29 public hospitals in 9 cities, the items were categorized, and a structural equation model was established and verified to explore the interrelationship of influencing factors. Results: A total of 6 factors were rotated, including Sense of Gain (SG), Internal Organization Development (IOD), Remuneration and Development (RD), Condition of the City Where the PHCI Is Located (CCPL), Job Responsibilities (JR) and Family Support (FS). The results of the model showed that IOD, RD, JR and FS had a significantly positive effect on the SG. In addition, the FS, RD and JR significantly mediated the relationship between the internal and external environment of PHCIs and SG. The values of the fit index indicated an acceptable-fitting model. Conclusion: Family, remuneration, individual development, and job responsibility are closely related to the willingness of medical personnel to seek employment at PHCIs, and the internal and external environment of PHCIs is also an important factor. Therefore, the development of PHC providers can be promoted by paying attention to the family members of medical personnel, establishing a reasonable remuneration system, providing suitable development opportunities, arranging work rationally and improving the internal construction of PHCIs. [ABSTRACT FROM AUTHOR]
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- 2022
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37. It’s all about the money? A qualitative study of healthcare worker motivation in urban China
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Zhidong Xuan, Liang Fang, Guohong Li, Yaru Chen, Ross Millar, Jun Liu, and Meng Wang
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Semi-structured interview ,China ,Urban Population ,Attitude of Health Personnel ,Health Personnel ,Health workers ,RT ,Occupational Stress ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Health care ,Humans ,030212 general & internal medicine ,Trust relationships ,Qualitative Research ,Health policy ,Motivation ,Governance ,ComputingMilieux_THECOMPUTINGPROFESSION ,Salaries and Fringe Benefits ,business.industry ,Research ,030503 health policy & services ,Health Policy ,lcsh:Public aspects of medicine ,Administrative Personnel ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Renumeration ,Public relations ,Career Mobility ,Incentive ,Health Care Reform ,Human resource management ,Workforce ,Public service ,0305 other medical science ,business ,RA ,Delivery of Health Care ,Qualitative research ,Career development - Abstract
Background:\ud China’s healthcare reform programme continues to receive much attention. Central to these discussions has been how the various financial incentives underpinning reform efforts are negatively impacting on the healthcare workforce. Research continues to document these trends, however, qualitative analysis of how these incentives impact on the motivation of healthcare workers remains underdeveloped. Furthermore, the application of motivational theories to make sense of healthcare worker experiences has yet to be undertaken.\ud \ud Methods:\ud The purpose of our paper is to present a comparative case study account of healthcare worker motivation across urban China. It draws on semi structured interviews (n = 89) with a range of staff and organisations across three provinces. In doing so, the paper analyses how healthcare worker motivation is influenced by a variety of financial incentives; how motivation is influenced by the opportunities for career development; and how motivation is influenced by the day to day pressures of meeting patient expectations.\ud \ud Results:\ud The experience of healthcare workers in China highlights how a reliance on financial incentives has challenged their ability to maintain the values and ethos of public service. Our findings suggest greater attention needs to be paid to the motivating factors of improved income and career development. Further work is also needed to nurture and develop the motivation of healthcare workers through the building of trust between fellow workers, patients, and the public.\ud \ud Conclusions:\ud Through the analysis of healthcare worker motivation, our paper presents a number of ways China can improve its current healthcare reform efforts. It draws on the experience of other countries in calling for policy makers to support alternative approaches to healthcare reform that build on multiple channels of motivation to support healthcare workers.
- Published
- 2017
38. Sociodemographic disparities in the establishment of health records among 0.5 million migrants from 2014 to 2017 in China: a nationwide cross-sectional study.
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Wang, Jun, Zhu, Jingmin, Wang, Xueyao, Che, Yue, Bai, Yang, and Liu, Jue
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NOMADS ,HEALTH services accessibility ,CROSS-sectional method ,MULTIVARIATE analysis ,MEDICAL care ,HEALTH status indicators ,SOCIOECONOMIC factors ,MEDICAL records ,DESCRIPTIVE statistics - Abstract
Background: Migrants account for a large part of China's population. Many policies and inventions have been taken to improve access to public health services and the health of migrants. China's Basic Public Health Services(BPHS) are a series of public health services in this policy domain, which aims at promoting the access of public health sevices and improve health equity of residents. The establishment of health records is the fundamental service of BPHS. However, there is little known about the establishment of health records among migrants in China, which hinders the more efficient provision of health services for migrants, and health equity is difficult to achieve. Based on the research gap, this study aims at showing the sociodemographic disparities in the establishment rate of health records, and identifying priorities and recommendations for promoting health equity of migrants in China. Methods: This study used national data from China Migrants Dynamic Survey (CMDS) from 2014 to 2017 to evaluate the sociodemographic disparities in the establishment rate of health records and utilization of relevant public health services. The study included 539,926 respondents. Following the descriptive statistics of migrants, we showed the establishment rate of health records by sociodemographic characteristics and migrating related characteristics. Multivariate analysis was conducted to explore the associations between sociodemographic charicteristics, migrating related charicteristics and the establishment of health records. Results: The establishment rate of health records among migrants in the sampled years were 22.99, 38.44, 27.29% respectively, and 29.18% in general, and there existed heterogeneity in the establishment rate of health records by sociodemographic charicteristics and migrating related charicteristics. Female migrants who were older, from middle age, married or living with partner, with higher educational attainment, with urban household registration, migrated for longer time, migrated for the reason of studying or family issues, migrated in province were more likely to establish health records. Conclusion: There existed sociodemographic disparities in the establishment rate of health records and inequalities in the utilization of health records services among migrants in China. Migrating related characteristics also had impact on the establishment status. Policies should take both supply side and demand side of health services to improve the health equity of migrants, which means that relative departments should continue to invest in primary healthcare centers to improve their ability to provide services as well as migrants' health literacy. [ABSTRACT FROM AUTHOR]
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- 2021
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39. A nationwide cross-sectional study of 15,611 lesbian, gay and bisexual people in China: disclosure of sexual orientation and experiences of negative treatment in health care
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Yiu-tung Suen and Randolph Chun Ho Chan
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Sexual and gender minorities ,Sexuality ,China ,Social discrimination ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Lesbian, gay and bisexual (LGB) people often face individual- and system-level barriers in health care. However, LGB people’s experiences of health care in non-European and non-American settings have been scarcely studied. In China, while it has been estimated that there are at least 70 million gender and sexual minorities, there has been no larger-scale study on LGB people’s experiences of health care beyond a focus on gay men and HIV. This study is the first larger-scale quantitative study to investigate LGB people’s experiences of health care in China, where non-heterosexuality is officially silenced and the needs of non-heterosexual people are largely ignored by service providers. Methods An online survey was designed in joint partnership by academic, community groups and the United Nations Development Programme. Targeted and snowball sampling was adopted for participant recruitment. Such unique cross-sectoral partnership made this research possible in the authoritarian state of China where data collection on LGB people is extremely rare. For the analysis in this paper, a sample of 15,611 Chinese LGB people were included. Frequency and descriptive statistics were conducted to describe the LGB respondents’ demographic characteristics and their experiences in health care settings. Chi-square tests were conducted to test how experiences vary across LGB people with different demographic characteristics. Results More than three quarters of the respondents said they would be willing to disclose to their medical care providers their sexual orientation if asked. However, only 5.7% of the respondents said that medical care providers ever asked them about their sexual orientation. About 8.0% of the LGB people surveyed reported having experienced negative treatment in medical care settings. Six percent (5.7%) of the Chinese LGB people said in accessing mental health care services, they were recommended, coaxed into, or provided conversion therapy for sexual orientation, gender identity or gender expression. Conclusions There is a strong need to enhance LGB cultural competence among health care providers. Policymakers in China should also formulate laws, policies, regulations, clearly articulated codes of conduct, and transparent procedures and practices to ensure non-discrimination of LGB people in the health care system, with a particular focus on banning conversion therapy.
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- 2020
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40. Difference in bypass for inpatient care and its determinants between rural and urban residents in China
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Lu, Shan, Li, Yunxiao, Gao, Hongxia, and Zhang, Yan
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- 2022
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41. Gap analysis on hospitalized health service utilization in floating population covered by different medical insurances: case study from Jiangsu Province, China
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Yang Fan, Cai Xinzhao, and Bian Ying
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Adult ,Employment ,Male ,Rural Population ,China ,medicine.medical_specialty ,Urban Population ,Gap analysis ,Logistic regression ,Insurance Coverage ,Floating population ,Health insurance coverage ,Young Adult ,Health services ,Sex Factors ,Health care ,medicine ,Humans ,Inpatient health utilization ,Socioeconomics ,Reimbursement ,Health policy ,Transients and Migrants ,Insurance, Health ,business.industry ,lcsh:Public aspects of medicine ,Research ,Health Policy ,Public health ,Public Health, Environmental and Occupational Health ,Health services research ,lcsh:RA1-1270 ,Health Care Costs ,Health Services ,Patient Acceptance of Health Care ,Medical insurance ,Hospitalization ,Logistic Models ,Educational Status ,Female ,Health Expenditures ,Rural area ,business ,Jiangsu China ,Demography - Abstract
Objective By analyzing the gap of hospitalization service among floating population covered by different medical insurance in Jiangsu Province, this paper aimed to understand the current situation of hospitalized health service utilization (HHSU) among floating population, and to provide policy suggestions for improving HHSU of floating population with different health insurance. Methods The data of this study were obtained from “the National Dynamic Monitoring Survey of Floating Population in 2014”. A total of 12,000 samples of floating population in Jiangsu Province were selected. 57.15% for men and 42.85% for women; 46.95% for those under 30 years old, 39.67% for 30 to 45 years old, 13.38% for over the age of forty-five. Using descriptive statistical analysis, chi-square test, exploratory factor analysis, logistic regression and stepwise multiple linear regression, the paper analyzed the difference of HHSU of floating population with different medical insurance in 2014. This study divided basic medical insurance into 3 categories: MIUE (Medical Insurance of Urban Employee), other medical insurances (including new rural cooperative medical system and the medical insurance for urban residents) and no medical insurance. Results The hospitalization rate of floating population with MIUE (89.95%) was higher than the rate of floating population with other medical insurances (74.76%) and the gap is 15.19%. It was also higher than the rate of floating population with no medical insurance (67.57%) and the gap is 22.38%. (chi-square = 24.958, p = 0.000). 15.34% of floating population with MIUE spent more than 1600 dollars during hospitalization. It was lower than floating population with other medical insurances (16.19%) and no medical insurance (21.62%). The gaps respectively were 0.85 and 6.28% (chi-square = 10.000, p = 0.040). There existed significant differences among hospitalization medical expenses that floating population with different basic medical insurances spent. (chi-square = 225.206, p = 0.000) The type of basic medical insurance had statistical significance on whether the patients were hospitalized (p = 0.003) and whether they were hospitalized (p = 0.014). Logistic regression analysis results showed that “Social structure” (Education, Hukou, Insurance status and Work status) were significantly associated with Should be hospitalized but not and “Education” were significantly associated with Inpatient facilities selection. The stepwise multiple linear regression results presented that “Demography” and “Floating area” influenced In-hospital medical cost and “Social structure” and “Gender” influenced Reimbursement of in-hospital medical cost. Conclusion Medical insurance type affects the hospitalization health service utilization of floating population, including Should be hospitalized but not and Reimbursement of in-hospital medical cost.
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- 2019
42. Temporal trends and variation in out-of-pocket expenditures and patient cost sharing: evidence from a Chinese national survey 2011–2015.
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Qin, Vicky Mengqi, Zhang, Yuting, Chia, Kee Seng, McPake, Barbara, Zhao, Yang, Hulse, Emily S. G., Legido-Quigley, Helena, and Lee, John Tayu
- Subjects
DRUGS & economics ,CHINESE people ,PSYCHOLOGY ,AGE distribution ,SELF-evaluation ,MEDICAL care costs ,POPULATION geography ,SOCIOECONOMIC factors ,SURVEYS ,COMPARATIVE studies ,HEALTH insurance ,DESCRIPTIVE statistics ,HOSPITAL care ,USER charges ,OUTPATIENT services in hospitals ,LONGITUDINAL method - Abstract
Objectives: This study aims to examine: (1) temporal trends in the percentage of cost-sharing and amount of out-of-pocket expenditure (OOPE) from 2011 to 2015; (2) factors associated with cost-sharing and OOPE; and (3) the relationships between province-level economic development and cost-sharing and OOPE in China. Setting: A total of 10,316 adults aged ≥45 years from China followed-up from 2011 to 2015 were included in the analysis. We measured two main outcome variables: (1) patient cost sharing, measured by the percentage of OOPE as total healthcare expenditure, and (2) absolute amount of OOPE. Results: Based on self-reported data, we did not find substantial differences in the percentage of cost sharing, but a significant increase in the absolute amount of OOPE among the middle-aged and older Chinese between 2011 and 2015. The percentage of cost-sharing was considerably higher for outpatient than inpatient care, and the majority paid more than 80% of the total cost for prescription drugs. Provinces with higher GDP per capita tend to have lower cost-sharing and a higher OOPE than their counterparts, but the relationship for OOPE became insignificant after adjusting for individual factors. Conclusion: Reducing out-of-pocket expenditure and patient cost sharing is required to improve financial protection from illness, especially for those with those with chronic conditions and reside in less developed regions in China. Ongoing monitoring of financial protection using data from various sources is warranted. [ABSTRACT FROM AUTHOR]
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- 2021
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43. Correction to: Inter-provincial inequality of public health services in China: the perspective of local officials' behavior
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Lei Hua, Yuxuan Rao, Xiaoyi Luo, Tianxiang Chen, and Ying Wang
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Value (ethics) ,Financing, Government ,medicine.medical_specialty ,Fiscal self-sufficiency of local governments ,China ,Inequality ,media_common.quotation_subject ,Inter-provincial public health services inequality ,Federal Government ,Public administration ,03 medical and health sciences ,0302 clinical medicine ,Fiscal transfer payments ,Political science ,medicine ,Political promotion tournament ,Humans ,030212 general & internal medicine ,Healthcare Disparities ,Health policy ,Social policy ,media_common ,Local Government ,030505 public health ,Public health services equalization ,lcsh:Public aspects of medicine ,Health Policy ,Public health ,Research ,Politics ,Perspective (graphical) ,Public Health, Environmental and Occupational Health ,Health services research ,Correction ,lcsh:RA1-1270 ,United States ,Socioeconomic Factors ,Local officials ,Health Expenditures ,0305 other medical science - Abstract
Background After economic reform, China experienced rising public health services inequality between the eastern developed and mid-west undeveloped provinces. The fiscal transfer payment system which aims to shape the disparities was considered inefficient. However, there are only a few studies that address the political reason when analyzing the inter-provincial public health services inequality. And the previous studies did not consider a possible non-linear relationship between the fiscal transfer payments and the inter-provincial public health services equalization. Methods This paper argues that the local officials’ fanatical pursuit of local economic growth which driven by the Political Promotion Tournament and the polarized fiscal self-sufficiency (fiscal capacities) of local governments are responsible for the inter-provincial inequality of public health services and the inefficiency of fiscal transfer payments. By constructing panel threshold regression models with fiscal self-sufficiency of local governments as threshold variable, this study tries to empirically investigate the optimal level of the local governments’ self-sufficiency at which the fiscal transfer payments can effectively promote equalization. Results Threshold effects exist between fiscal transfer payments and inter-provincial public health services equalization. The effects on inter-provincial public health services equalization show trends that first increase and then decrease as the fiscal self-sufficiency of local governments increases. And there exist a range of fiscal self-sufficiency between 29.236 and 43.765% or between 28.575 and 45.746% for local governments where the fiscal transfer payments can effectively achieve equalization. Currently, the vast majority of provinces in China remain in the ineffective regime where the fiscal transfer payments are inefficient in shaping inequality. Conclusions This paper explains the reason of inequality in public health services and the inefficiency of fiscal transfer payment system from Chinese local officials’ behavior aspect, and try to find out an effective solution by focusing on the local government’s fiscal capacity. The effective way to narrow the inequality is to establish a flexible tax-sharing system to adjust local governments’ fiscal capacities and give local governments with low fiscal self-sufficiency more fiscal resources. The new policy measures recently launched by Chinese central government coincide with our recommendations.
- Published
- 2018
44. Institutional differences and geographical disparity: the impact of medical insurance on the equity of health services utilization by the floating elderly population - evidence from China
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Junqiang Han and Yingying Meng
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Medical insurance ,Health service ,Inequity ,The floating population ,China ,The basic medical insurance system for urban employees ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The Chinese government has now achieved universal coverage of medical insurance through two systems: the Basic Medical Insurance System for Urban Employees (BMISUE) and the Basic Medical Insurance System for Urban and Rural Residents (BMISURR). This paper aims to identify the impact of China’s current medical insurance system on equity in the use of health services by the floating elderly population from two aspects: institutional differences and geographical disparity. Methods The data used in the study are from the China Migrants Dynamic Survey (CMDS) conducted by the National Health and Wellness Council of China. This study uses the Logit model to estimate the impact of the medical insurance system on the utilization of health services and the Propensity Score Matching (PSM) method to further test the robustness of the results. Results The study found that the type of medical insurance does not affect health services utilization by the floating elderly population in China. However, for those participating in the same medical insurance, participation in different regions will significantly affect the use of health service resources. For the BMISURR, when the place of the insurance is the same as the place of residence, the proportion of the floating elderly population that will see a doctor when they are sick will increase by 4.80%. For the BMISUE, when the place of the insurance is the same as the place of residence, the proportion of the floating elderly population that will see a doctor when they are sick will increase by 10.30%. Conclusions The difference between the place of insurance and the place of residence results in the unbalanced utilization of health services by the floating elderly population participating in the same medical insurance system.
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- 2019
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45. The effect of the health poverty alleviation project on financial risk protection for rural residents: evidence from Chishui City, China
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Chu Chen and Jay Pan
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Poverty ,Health policy ,Policy analysis ,Financial risk sharing ,Illness burden ,China ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Illness is the leading cause (44%) of poverty in China. Since 2016, The health poverty alleviation project, an integral component of the Targeted Poverty Alleviation in China, was implemented in 2016 to strengthen financial risk protection against illness for financially backward segments of the population. However, the effects of the health poverty alleviation project on financial risk protection have not been explored in the literature, this paper aims to bridge the gap. Methods Using panel data on 63,426 rural households in Chishui City, China, from 2014 to 2017, the difference-in-differences with propensity score matching method was employed. Results The health poverty alleviation project reduces out-of-pocket payments by 15% on average and decreases the probability of catastrophic health expenditure (annual out-of-pocket payments exceeding 10% of annual household income) and impoverishing health spending occurrence (out-of-pocket payments are forcing a household into poverty or into deeper poverty) by 7.7 and 11.7%, respectively. Additionally, the project increases the number of annual hospitalizations per household by 0.035. Conclusion Our study demonstrates that the health poverty alleviation project significantly improves financial risk protection by reducing out-of-pocket payments and decreasing the probability of incurring catastrophic or impoverishing levels of health expenditure. Our study has implications for the poverty reduction policies and reform of the Chinese health financing system.
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- 2019
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46. Measurement and decomposition of income-related inequality in self-rated health among the elderly in China
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Hai Gu, Yun Kou, Hua You, Xinpeng Xu, Nichao Yang, Jing Liu, Xiyan Liu, Jinghong Gu, and Xiaolu Li
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Corrected concentration index ,Decomposition ,Elderly ,Income-related inequality ,Self-rated health ,China ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Population ageing in China has brought increasing attention to the health inequalities of the elderly. The purpose of this paper is to measure income-related health inequality among the elderly in China and decompose its causes. Methods The data are from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2013, which contains 6176 individuals aged 60 years and above. A multiple linear regression model was used to analyze the influencing factors of self-rated health (SRH) among the elder people. Furthermore, the corrected concentration index were used to measure income-related health inequality. Wagstaff-type decomposition analysis was employed to explore the cause of inequality. The measurement and decomposition of health inequality was also performed separately in the male and female subgroups. Results Most elderly declared their health status as “fair” (51.33%) or “poor” (21.88%). Income, gender, residence, region, health insurance and other factors had significant association with SRH (P
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- 2019
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47. Policy disparities in response to the first wave of COVID-19 between China and Germany.
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Zhang, Yuyao, Shi, Leiyu, Chen, Haiqian, Wang, Xiaohan, and Sun, Gang
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HEALTH policy ,HEALTH services accessibility ,COVID-19 ,PREVENTION of communicable diseases ,HEALTH status indicators ,PUBLIC health ,WORLD health ,MEDICAL emergencies ,RISK assessment ,STATISTICAL models ,STAY-at-home orders ,COVID-19 pandemic ,INSURANCE - Abstract
Objective: Our research summarized policy disparities in response to the first wave of COVID-19 between China and Germany. We look forward to providing policy experience for other countries still in severe epidemics. Methods: We analyzed data provided by National Health Commission of the People's Republic of China and Johns Hopkins University Coronavirus Resource Center for the period 10 January 2020 to 25 May 252,020. We used generalized linear model to evaluate the associations between the main control policies and the number of confirmed cases and the policy disparities in response to the first wave of COVID-19 between China and Germany. Results: The generalized linear models show that the following factors influence the cumulative number of confirmed cases in China: the Joint Prevention and Control Mechanism; locking down the worst-hit areas; the highest level response to public health emergencies; the expansion of medical insurance coverage to suspected patients; makeshift hospitals; residential closed management; counterpart assistance. The following factors influence the cumulative number of confirmed cases in Germany: the Novel Coronavirus Crisis Command; large gathering cancelled; real-time COVID-19 risk assessment; the medical emergency plan; schools closure; restrictions on the import of overseas epidemics; the no-contact protocol. Conclusions: There are two differences between China and Germany in non-pharmaceutical interventions: China adopted the blocking strategy, and Germany adopted the first mitigation and then blocking strategy; China's goal is to eliminate the virus, and Germany's goal is to protect high-risk groups to reduce losses. At the same time, the policies implemented by the two countries have similarities: strict blockade is a key measure to control the source of infection, and improving medical response capabilities is an important way to reduce mortality. [ABSTRACT FROM AUTHOR]
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- 2021
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48. Measurement and determinants of catastrophic health expenditure among elderly households in China using longitudinal data from the CHARLS.
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Liu, Shiai, Coyte, Peter C., Fu, Mingqi, and Zhang, Qilin
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FAMILIES ,HEALTH policy ,CONFIDENCE intervals ,MEDICAL care costs ,DISEASE incidence ,POPULATION geography ,CATASTROPHIC illness ,SEVERITY of illness index ,DESCRIPTIVE statistics ,HOSPITAL care ,HEALTH & social status ,STATISTICAL models ,LOGISTIC regression analysis ,MEDICAL appointments ,PEOPLE with disabilities ,PUBLIC welfare ,MEDICAID ,POLICY sciences ,LONGITUDINAL method ,OUTPATIENT services in hospitals ,MIDDLE age ,EVALUATION - Abstract
Background: Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen's model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. Results: The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011–2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. Conclusions: Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures. [ABSTRACT FROM AUTHOR]
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- 2021
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49. Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016.
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Tian, Fan and Pan, Jay
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CHILDBIRTH ,CONFIDENCE intervals ,HEALTH care rationing ,HEALTH services accessibility ,HEALTH status indicators ,HOLISTIC medicine ,HEALTH policy ,MATERNAL mortality ,POPULATION geography ,HEALTH & social status ,DESCRIPTIVE statistics - Abstract
Background: Driven by the government's firm commitment to promoting maternal health, maternal mortality ratio (MMR) in China has achieved a remarkable reduction over the past 25 years. Paralleled with the decline of MMR has been the expansion of hospital bed supply as well as substantial reduction in hospital bed distribution inequalities, which were thought to be significant contributors to the reduction in MMR. However, evidences on the impact of hospital bed supply as well as how its distribution inequality has affected MMR remains scarce in China. Addressing this uncertainty is essential to understand whether efforts made on the expansion of healthcare resource supply as well as on improving its distribution inequality from a geographical perspective has the potential to produce measurable population health improvements. Methods: Panel data of 31 provinces in China between 2004 and 2016 were extracted from the national statistical data, including China Statistical Yearbooks, China Health Statistical Yearbooks and other national publications. We firstly described the changes in hospital bed density as well as its distribution inequality from a geographical perspective. Then, a linear mixed model was employed to evaluate the impact of hospital bed supply as well as its distribution inequality on MMR at the provincial level. Results: The MMR decreased substantially from 48.3 to 19.9 deaths per 100,000 live births between 2004 and 2016. The average hospital bed density increased from 2.28 per 1000 population in 2004 to 4.54 per 1000 population in 2016, with the average Gini coefficient reducing from 0.32 to 0.25. As indicated by the adjusted mixed-effects regressions, hospital bed density had a negative association with MMR (β = − 0.112, 95% CI: − 0.210--0.013) while every 0.1-unit reduction of Gini coefficient suggested 14.50% decline in MMR on average (β = 1.354, 95% CI: 0.123–2.584). Based on the mediation analysis, the association between hospital bed density or Gini coefficient with MMR was found to be significantly mediated by facility birth rate, especially during the period from 2004 to 2009. Conclusions: This study provided empirical evidences on China's impressive success in the aspect of reducing MMR which could be attributed to the expansion of hospital beds as well as the improvement in its distribution inequality from a geographical perspective. Such findings were expected to provide evidence-based implications for long-term policy-making procedures in order to achieve rational healthcare resource allocations as well as promoting the equity and accessibility to obtaining health care from a holistic perspective. Constant efforts should be made on improving the equity in healthcare resource allocations in order to achieve the penetration of universal healthcare coverage. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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50. Effects of asymmetric medical insurance subsidy on hospitals competition under non-price regulation
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Chan Wang and Pu-yan Nie
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medicine.medical_specialty ,China ,National Health Programs ,Self-insurance ,Competition (economics) ,03 medical and health sciences ,0502 economics and business ,medicine ,Healthcare Financing ,Humans ,050207 economics ,L51 ,Economics, Hospital ,health care economics and organizations ,Health policy ,Game theory ,Social policy ,Insurance, Health ,Medical Assistance ,Public economics ,I11 ,030503 health policy & services ,Public health ,Health Policy ,Research ,05 social sciences ,I13 ,Health services research ,Public Health, Environmental and Occupational Health ,Quality competition ,Management efficiency ,Subsidy ,Medical insurance subsidy ,Hospitals ,Key person insurance ,Fees and Charges ,Government ,Health Care Reform ,Business ,0305 other medical science ,Delivery of Health Care - Abstract
Background Poor medical care and high fees are two major problems in the world health care system. As a result, health care insurance system reform is a major issue in developing countries, such as China. Governments should take the effect of health care insurance system reform on the competition of hospitals into account when they practice a reform. This article aims to capture the influences of asymmetric medical insurance subsidy and the importance of medical quality to patients on hospitals competition under non-price regulation. Methods We establish a three-stage duopoly model with quantity and quality competition. In the model, qualitative difference and asymmetric medical insurance subsidy among hospitals are considered. The government decides subsidy (or reimbursement) ratios in the first stage. Hospitals choose the quality in the second stage and then support the quantity in the third stage. We obtain our conclusions by mathematical model analyses and all the results are achieved by backward induction. Results The importance of medical quality to patients has stronger influence on the small hospital, while subsidy has greater effect on the large hospital. Meanwhile, the importance of medical quality to patients strengthens competition, but subsidy effect weakens it. Besides, subsidy ratios difference affects the relationship between subsidy and hospital competition. Furthermore, we capture the optimal reimbursement ratio based on social welfare maximization. More importantly, this paper finds that the higher management efficiency of the medical insurance investment funds is, the higher the best subsidy ratio is. Conclusions This paper states that subsidy is a two-edged sword. On one hand, subsidy stimulates medical demand. On the other hand, subsidy raises price and inhibits hospital competition. Therefore, government must set an appropriate subsidy ratio difference between large and small hospitals to maximize the total social welfare. For a developing country with limited medical resources and great difference in hospitals such as China, adjusting the reimbursement ratios between different level hospitals and increasing medical quality are two reasonable methods for the sustainable development of its health system.
- Published
- 2016
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