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This paper examines the daily practices of caring for COVID-19 patients in Wuhan, China, in early 2020 and the challenges that nurses faced. The paper shows that the affective contagion, especially among patients, introduced unexpected challenges for nurses in caring for COVID-19-infected patients. Nurses had to contend with the challenges of treating both physical and psychological problems in patients simultaneously. As a result, it was necessary for nurses to adapt to the different rhythm of COVID-19 wards to address these challenges and do so through taking on a range of general and specific nursing tasks and playing a diverse range of roles on the wards, from garbage collector to "psychological counselor." Thus, the paper brings attention to the experiences and demands of providing nursing care in an emergency pandemic context, in particular the necessity of responding to both the physical and the psychological needs of patients. These insights could better prepare health services in China and elsewhere in the world for responding effectively to potential future pandemics. • The affective contagion introduced unexpected challenges for nurses in COVID-19 wards. • Nurses adapt to the different working rhythm in COVID-19 wards than in "normal" wards. • A hierarchy of necessity emerged in the context of caring for COVID-19 patients. [ABSTRACT FROM AUTHOR]

The association between digitalization and individual health has attracted increasing attention from both scholars and policymakers. Existing research, however, has not agreed on whether digitization can improve health or reduce health inequality. The purpose of this study is to clarify whether and how the development of digitalization may be related to health and health disparities. We rely on China Family Panel Studies (CFPS) surveys from 2012 to 2018 to obtain a sample of 82,471 observations to explore the impact of digitalization on self-rated health and health inequality and its transmission mechanisms. The hypotheses are tested by Ordinary Least Squares Modeling. As expected, digitalization is significantly and positively correlated with self-rated health. Furthermore, the development of digitalization has led to a notable decrease in health inequality. The influencing mechanisms of digitalization include income, healthcare consumption and health behaviors. Both dimensions of digitalization—internet development and digital finance—generate significant effects and the effects of internet development are greater. This study is the first to systematically investigate the impact of digitalization development on health and health inequality. Our findings provide evidence for the health promotion theory by clarifying the benefits of digitalization in improving residents' health and reducing health inequality. Therefore, utilizing the tools of digitalization efficiently could be a focus of policymakers aiming to accomplish the SDGs' health targets. • This paper contributes to assess the health outcomes of digitalization in China. • Developing digitalization has greatly improved self-rated health of residents. • Also, digitalization has reduced health inequality between residents. • Digitalization can affect health through income, health consumption and behaviors. • Digitalization is a useful tool for policymakers to reach the SDGs' health goals. [ABSTRACT FROM AUTHOR]

For Chinese policymakers, shouldering responsibility is often associated with high liability risk, thus resulting in low-level care for risky and stigmatized populations such as drug users. Therefore, it is crucial to explore ways to improve care access in such an uneasy policy environment. Based on long-term ethnographic fieldwork conducted in Yunnan province in southwestern China from 2013 to 2021, this paper traces the policy-making process of the Yunnan Province Methadone Oral Solution Take-Home Treatment Work Proposal. All stakeholders involved considered this policy attempt "impossible" at first, as the highly addictive methadone becomes an illegal drug once it is taken outside a clinical setting. By analyzing how a group of local government officials, together with medical practitioners and drug users, strive to legitimize and ultimately implement the policy, I argue that people's concern over liability risks strengthens the boundary between methadone as a "drug" and methadone as a "medicine," between methadone solution drinkers as "drug users" and as "patients," and between "inside the clinic" and "outside the clinic." By utilizing a culturalist approach to explore the possibility of care in such a context, this paper reveals that a " heqing heli hefa worthy-of-being-cared-for" discourse is crucial in that it acts as symbolic capital to dissolve the above boundaries embedded in the dominant political culture. Moreover, it is the key cultural logic of the "building" of care. The findings also illustrate how local policymakers negotiate and balance responsibility and liability to create a potential policy space for enabling care practices. Additionally, this study sheds light on the inclusion of care for the most stigmatized and marginalized populations, and has broad implications for policy-making in other contexts. • In the field of drug control, policies often delay and even exclude care for drug users. • Concerns over liability risks hamper users' access to take-home methadone service. • Liability risks affect people's categorizing of methadone as a medicine or a drug. • Privatization of compassion helps to mitigate liability risks. • Policymaking could also be a process of accumulating and building care. [ABSTRACT FROM AUTHOR]

The article examines the role and challenges of scientific self-governance and standardization in inter-continental clinical research partnerships in stem cell medicine. The paper shows that – due to a high level of regulatory diversity – the enactment of internationally recognized standards in multi-country stem cell trials is a complex and highly situation-specific achievement. Standardization is imposed on a background of regulatory, institutional and epistemic-cultural heterogeneity, and implemented exclusively in the context of select clinical projects. Based on ethnographic data from the first trans-continental clinical trial infrastructure in stem cell medicine between China and the USA, the article demonstrates that locally evolved and international forms of experimental clinical research practices often co-exist in the same medical institutions. Researchers switch back and forth between these schemas, depending on the purposes of their research, the partners they work with, the geographic scale of research projects, and the contrasting demands for regulatory review, that result from these differences. Drawing on Birch's analysis of the role of standardization in international forms of capital production in the biosciences, the article argues that the integration of local knowledge institutions into the global bioeconomy does not necessarily result in the shutting down of localized forms of value production. In emerging fields of medical research, that are regulated in highly divergent ways across geographical regions, the coexistence of distinct modes of clinical translation allows also for the production of multiple forms of economic value, at varying spatial scales. This is especially so in countries with lenient regulations. As this paper shows, the long-standing absence of a regulatory framework for clinical stem cell applications in China, permits the situation-specific adoption of internationally recognized standards in some contexts, while enabling the continuation of localized forms of value production in others. [ABSTRACT FROM AUTHOR]

Individuals in developing countries often engage in paid and unpaid work till late in life due to low household savings and limited welfare provisions. Yet, physical disabilities associated with aging can limit their ability to work. While work can be beneficial for economic and psychological well-being, this paper investigates whether engagement in paid and unpaid work mediates the impact of physical disabilities on quality of life for older adults. We exploit the different levels of health services and social security in rural and urban China and India to examine the effect of public provisions in the process. We use nationally representative data of individuals aged 50 and above from the World Health Organization Study on Global Ageing and Adult Health Wave 1, conducted in 2008–10 in China and in 2007–08 in India. Using a causal mediation analysis framework, we find that paid work plays a minor role in mediating the effect of physical disabilities on quality of life in all societies, and the mediated effect is smaller in urban China than in other societies. Unpaid work is beneficial only in urban China, and it does not mediate the impact of physical disabilities on quality of life elsewhere. The findings indicate that promoting productive engagement alone, without improving basic public provisions, will have limited impact on improving quality of life of the aging population in developing countries. • In developing countries, both paid and unpaid work is common out of necessity. • Older adults bear a double burden of paid and unpaid work in rural China and India. • Productive aging has limited impact on quality of life in developing countries. • Impact of productive aging on quality of life varies with public provisions. • Physical disabilities associated with aging is less consequential in urban China. [ABSTRACT FROM AUTHOR]

Drawing on 40 in-depth interviews with Chinese breast cancer patients who participated in the breast cancer biobank at a hospital in Beijing, China, this paper explores these patients' perceptions of privacy. The analysis indicates that these patients primarily perceived privacy as informational privacy; they were concerned about the disclosure of contact information, cancer diagnosis, and genetic testing results; further, their views on disclosing different kinds of personal information were dynamic and heterogeneous in various relationships and contexts, which differs from the stereotypical beliefs of privacy in China. This paper provides situated understanding of why these patients had such privacy perceptions and what strategies they adopted to cope with their privacy. It then discusses the international similarities and differences in the disclosure of cancer and genetic testing results. • Established stereotypical beliefs regarding Chinese privacy are inappropriate. • The Chinese breast cancer patients in this study perceive privacy as informational privacy. • Privacy boundaries are mutable in various contexts and relations. • The patients in this study demonstrate that cancer secrecy and stigma persist in China. [ABSTRACT FROM AUTHOR]

This paper provides an analytical framework for explaining the practice of diagnostic disclosure by drawing on theoretical developments regarding the question of "culture in action." Based on ethnographic and interview data collected from fieldwork at a major cancer hospital in China from 2015 to 2019, this paper explains how doctors and family members make decisions about diagnostic disclosure. We argue that it is important to understand the practice of diagnostic disclosure as motivated by the actors' values on the one hand, and constrained and enabled by the actors' skills on the other hand. It is also necessary to distinguish between personal and public values, as well as medical and interpersonal skills. Based on these distinctions, we will be better equipped to explain why diagnostic disclosure has encountered difficulties in family-centered societies, such as China. • Decisions about diagnostic disclosure can be explain by theories of "culture in action". • Diagnostic disclosure is motivated by actors' values, as well as constrained and enabled by skills. • It is necessary to distinguish between different levels and kinds of values and skills. [ABSTRACT FROM AUTHOR]

China's recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between China's health insurance and out-of-pocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low- and medium-income individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that China's health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system. [ABSTRACT FROM AUTHOR]

Ex post moral hazard, the additional healthcare utilization induced by health insurance, can be decomposed into an efficient portion generated by the income effect and an inefficient portion caused by the substitution effect, which has been discussed theoretically, but few studies have provided evidence of the efficient moral hazard. In 2016, the Chinese government launched the consolidation of urban and rural resident health insurance at the national level. After the consolidation, insurance benefits for nearly 800 million rural residents got improved. This paper uses a nationally-representative sample of 30,972 individuals from the China Health and Retirement Longitudinal Study (2011–2018) and adopts a 2-step empirical approach with the difference-in-differences method and the fuzzy regression discontinuity design to estimate the efficient moral hazard in the consolidation among rural residents. We find that the price shock contained in the consolidation increases inpatient care utilization, and the corresponding price elasticity is between −0.68 and −0.62. Further analysis shows that the efficient moral hazard resulting in welfare gains accounts for 43.33%–66.36% of the additional healthcare utilization. These findings highlight the necessity of evaluating the efficient moral hazard when analyzing the cost-benefit of health insurance reform. • We provide rare evidence of the efficient moral hazard effect in health insurance. • We focus on low-income groups from developing countries. • We use a 2-step empirical approach to estimate the efficient moral hazard effect. • The efficient moral hazard generated by income effect accounts for 43.33%–66.36%. [ABSTRACT FROM AUTHOR]

Using nationally representative longitudinal data from 2010 to 2016 in China, this paper aims to systematically investigate the dynamic relationship between socioeconomic status (SES) and obesity in the Chinese adult population. We apply maximum likelihood estimations of dynamic panel models with fixed effects to evaluate the causal directions between SES and obesity, thus providing empirical evidence of the relative importance of the "social determination" hypothesis (SES determines obesity), the "health selection" hypothesis (obesity influences SES) and the "indirect selection" hypothesis (some third factors cause obesity and SES). All analyses were conducted for women and men separately. Our analyses mostly support the contention that after two years, there are no significant causal effects of either lagged SES on Body Mass Index (BMI) or BMI on SES, after controlling for time-invariant unobserved confounders. While there is weak evidence of social determination among men, non-manual workers tend to have a higher BMI than those who are unemployed. We conclude that the indirect selection hypothesis may be the most important explanation in understanding the relationship between SES and obesity in China. • The paper studies the causation between socioeconomic status and BMI in China. • We use maximum likelihood estimation for dynamic panel models with fixed effects. • Neither social determination nor health selection hypothesis is supported. • The association between SES and BMI may be due to earlier unobserved confounders. [ABSTRACT FROM AUTHOR]

Both the ageing of the Chinese population and elderly mobility impact on the Chinese social infrastructure, triggering challenges to maintain elderly wellbeing. This paper reflects on the notion that seasonal mobility promotes wellbeing, and explores how two crucial factors, namely, forced migration and health conditions, influence the relations between seasonal retirement mobility and wellbeing. This study analyses amenity-led seasonal retired mobilities to Sanya as a case study, and adopts and develops a conceptual framework for relations between mobility and wellbeing in terms of daily activity, sociality, and context through seasonal mobility. Qualitative methods including participant observation, non-participant observation, in-depth interviews, and mobile ethnography were used to collect data. This revealed the heterogeneity of health conditions, and the constrained mobilities of seasonal retirees. Health and willingness for mobility are shown as significant factors in influencing the relations between mobility and wellbeing, which are in turn complicated and dynamic. Seasonal mobilities bring about difficulties for retirees particularly in terms of their efforts to reconstruct their previous life and self-continuities. However, it is argued that these retirees can merely maintain temporary and superficial wellbeing due to constant health concerns and uncertainties over potential temporary or permanent return to their places of origin. Those with serious health problems have more limitations, sacrificing other aspects of wellbeing for physical health. Practical implications from state, destination, and individual levels to better facilitate seasonal mobility and promote wellbeing are provided. [ABSTRACT FROM AUTHOR]

Motivated by current debates over the relationship between epidemic and trust, this paper estimates the short-term effects of the Covid-19 pandemic on general trust, political trust, and trust in physicians in China. Using an individual-level national longitude dataset, results from the Difference-in-Difference estimation show that greater exposure to Covid-19 risks significantly decreased general and political trust among the Chinese population, except for the younger generation (age 8–22). Higher exposure to Covid-19 in malleable ages of trust formation (age 8–22) may worsen individuals' general trust but improve their trust in local officials and physicians. Results from heterogeneity tests reveal that Covid-19 exacerbated general trust among the vulnerable groups, whereas their political trust was stable. • Short- and middle-term social implications of Covid-19 are estimated. • General and political trust is decreased except for the younger generation. • Trust in officials and physicians among the cohort aged 8–22 increases. • Heterogeneous effects can be observed and are exacerbated among vulnerable groups. [ABSTRACT FROM AUTHOR]

This paper investigates whether childhood conditions affect survival and health, both directly and indirectly through the mediating variable of adulthood socioeconomic status, among Chinese elderly. Using data from the 2008–2009 and 2011–2012 waves of the Chinese Longitudinal Healthy Longevity Survey, we apply structural equation models to estimate these effects. We find that favorable childhood conditions exert a negative direct impact on survival probability at senior ages, possibly resulting from mortality selection. Our results also support the pathways model, which indicates that advantageous childhood conditions improve socioeconomic status in adulthood and thus indirectly promote longevity and health at advanced ages. Combining the direct and indirect effects, the total effects of childhood advantages on survival and health are positive. We further demonstrate that direct and indirect effects of childhood conditions are stronger for women than they are for men. Our findings suggest that public policies that target childhood wellbeing may have far-reaching protective impacts on health among seniors. [ABSTRACT FROM AUTHOR]

With a goal of improving health system quality and efficiency, reforms of China's health system over the past decade have sought to strengthen primary healthcare in lower-level clinics and health centers. Despite these wide-ranging reforms and initiatives, population-based studies have documented dramatic declines in patients' use of primary care facilities during this period. In this paper, we explore the determinants of this trend in China's rural areas using detailed longitudinal data following a nationally-representative sample of rural households and village clinics from 2011 to 2018. We estimate that between 2011 and 2018, the probability that individuals sought care at village clinics when ill dropped by 44%. At the same time, the utilization of outpatient services in county hospitals increased by 56% and patient self-treatment increased by 20%. Detailed Kitagawa-Oaxaca-Blinder decompositions suggest four primary drivers of this trend: the shifting burden of disease in rural areas, changes in how patients choose to seek care given different disease conditions, declining drug inventory in village clinics, and the decreasing importance of remoteness as a determinant of healthcare seeking behavior. Our results highlight the deteriorating role of village clinics in the rural healthcare system and the increasing importance of self-treatment and higher-tier primary care services. • Recent policies in China have sought to strengthen primary care. • Despite this, rural primary care utilization in villages has continued to decline. • Utilization of village clinics has shifted to self-treatment and upper-tier facilities. • Decomposition analysis show four main factors driving this trend. • Results highlight a deteriorating role of village clinics in the health system. [ABSTRACT FROM AUTHOR]

Informal payment for medical services is a common phenomenon in China. Patients make informal payments, in cash or in kind, to physicians in addition to official charges billed for medical services. This paper assesses the associations between patients' perceptions of the physician as an agent for the patient's interests (physician agency problem) and informal payment behavior. Using data of 24,000 and 6700 rural households respectively from the Health Development of Rural China Program database (collected in 2008) and Ningxia data source (collected in 2015), we find that patients' concern about physician agency problems is significantly associated with informal payments. The data shows that patients are more likely to make informal payments when they show low trust towards their physicians. For example, in the surgical cases, among patients who strongly distrusted the physicians, 17.9% (95% confidence interval [CI]:]: 13.5, 22.3) initiated informal payments, compared to 8.0% (95% CI: 5.1, 10.9) who expressed "strong trust" in their physicians. Poor communication was also significantly associated with an increase in the informal payment rate. For example, in the non-surgical setting, among the patients who rated the physicians' explaining skills as "poor," 5.9% (95% CI: 5.0, 6.9) of them made informal payments, significantly higher than the patients who rated "excellent" (of whom 1.8% made informal payments 95% CI, 0.9, 2.7). In this study, we provide an explanation for this finding: patients may initiate informal payments to physicians in order to mitigate the physician agency problem. It suggests that to mitigate informal payments, improving alignment between doctors' incentives and patients' interests would be essential. • Informal payments were directly related to patients' concerns about physicians' behavior. • Patients were more likely to make informal payments when they showed low trust towards their physicians. • Poor communication between patients and physicians was related to informal payment rate. • Informal payment might be viewed as an effort by the patients to align the physicians. [ABSTRACT FROM AUTHOR]

This paper examines the impact of China's public long-term care insurance (LTCI) pilots on the well-being of older adults and their families. Using panel data from the Chinese Longitudinal Healthy Longevity Survey, we exploit the rollout of the LTCI pilots across different cities during 2015–2017 and identify the effect of LTCI using a difference-in-differences approach. We find that the implementation of LTCI has reduced the likelihood of older adults reporting unmet activity of daily living (ADL)–related need for care, the intensity of informal care, and the amounts of ADL-related care expenditures and out-of-pocket medical expenditures. LTCI coverage was also associated with an improvement in self-reported health and a reduction in one-year mortality risk of older adults with baseline need for care. From a policy perspective, these findings suggest that the introduction of LTCI may benefit all members of the household, both care recipient and caregivers, which has important implications for the development of LTCI in China and other middle-income and developing countries. • Study impacts of China's long-term care insurance (LTCI) on well-being of older adults. • We exploit the rollout of the LTCI pilots across different cities during 2015–2017. • LTCI reduced older adults' unmet activity of daily living (ADL)–related need for care. • LTCI reduced informal care intensity, ADL-related care expenses, and medical expenses. • LTCI was associated with better self-reported health and lower mortality risk. [ABSTRACT FROM AUTHOR]

There is an increasing interest in using ordinal data collection methods, such as the best-worst scaling (BWS), to develop preference-based tariffs (value sets) for health-related quality of life instruments, yet the evidence on their performance is limited. This paper proposed to use an anchored BWS technique (in which the state of "death" served as an anchoring state) to directly develop a utility weight that lies on a scale anchored at 0 = death and 1 = full health for the Simplified Chinese version of the Short Form 6 Dimension version 2 (SF-6Dv2). An online panel from the general population of Mainland China completed an online survey between 20th July and 19th August, 2019 and 463 respondents were included in the main analysis. The Conditional Logit (CL) model, which assumes a homogeneous preference, as well as a Hierarchical Bayes (HB) model, which accounts for preference heterogeneity, were used to analyze the BWS data. The model performances were evaluated based on monotonicity and model-fit statistics. The majority of respondents indicated that the BWS questions were easy to understand and complete. Initial analyses suggested that the best and worst choices should not be pooled together. Based on model fit statistics of separated estimations and previous literature on health state valuation studies using BWS, the best choices were used for developing the final algorithm. The HB estimates were found to have better model performance than the CL estimates. This study provides an essential insight into using an anchored BWS approach in health state valuation. Furthermore, it demonstrates the advantage of using HB compared to the traditional CL model in producing preference values. • An anchored best-worst scaling technique has been used to develop preference weights directly. • Accounting for individual heterogeneity leads to a better model fit. • Incorporating respondents' views of attribute importance can improve model performance. • A Chinese online-panel-based scoring algorithm for SF-6Dv2 is developed. [ABSTRACT FROM AUTHOR]

This study investigates whether adult children's education has a protective effect on parental survival, using data from all waves (2010–2018) of the China Family Panel Studies. We exploited the exogenous temporal and geographical variations in the enforcement of the 1986 compulsory schooling laws in China to construct an instrumental variable (IV) for adult children's education. The IV estimates indicated that the law-induced higher education of adult children led to sizeable improvements in the likelihood of paternal survival, although it had no significant effect on maternal survival. The protective effect on paternal survival was mainly driven by better-educated daughters, while sons' education had only a modest positive effect on maternal survival. Further evidence suggested that such heterogeneity by the gender of adult children might mainly come through more informal caregiving from better-educated daughters to older fathers with a limited role played by financial support from adult children. • This paper studies the effect of adult children's education on parental survival. • We exploited variations in the enforcement of China's compulsory schooling laws. • Adult children's education increased paternal survival, but not maternal survival. • Daughters' better education was the main drive of increased paternal survival. • Gender differences might be explained by greater informal caregiving in daughters. [ABSTRACT FROM AUTHOR]

Previous literature on parental migration and children's health outcomes mainly focuses on subjective measures and often omits the selectivity issue. Taking advantage of a unique nationally representative longitudinal dataset from the China Health and Nutrition Survey, this paper uses anemia status as an objective measure of children's health outcomes and examines the different effects of parents' current migration status, migration history, and migration duration. The results show that father's migration does not harm children's physical health, especially for children in rural areas, for whom father's migration decreases the likelihood of being anemic; while mother's migration increases the likelihood of being anemic. Importantly, children with return migrant mothers are less likely to experience anemia. We also find that the longer the father migrated, the better the child's health, but mother's longer migration duration is more detrimental. Our findings highlight the gender dimension in the migration story and indicate that policymakers should encourage the return migration of migrant mothers. • Mother's migration impacts children's anemia status more than father's migration. • Mother's current migration increases the risk of anemia for children. • Mother's previous migration experience decreases the risk of anemia for children. • The duration of parental migration has a significant impact on children's health. • Rural children whose mothers migrated are particularly disadvantaged. [ABSTRACT FROM AUTHOR]

It is widely recognized that China has experienced the largest internal migration in its history and that these internal migrants are largely excluded from urban services, posing major challenges to their health outcomes. This paper attempts to address this issue from a socio-ecological lens, examining John W. Berry's conceptual framework of acculturation on internal migrants' health in China. We employed the National Migrant Dynamic Monitoring Survey (MDMS; 2014) data, with around 16,000 samples from eight cities. Our results showed that compared to their hometown culture, where migrants can successfully integrate into the mainstream culture of the destination area, mental health stress can be prevented and self-assessed health status is improved. Well-integrated migrants showed the best self-reported health (SRH) and mental health status, while segregated or marginalized migrants received lower health scores. It was interesting to see that the origin culture only protected SRH whereas the local culture could promote both mental health and SRH. This evidence may be alarming. Local government must respect origin cultures when carrying out social integration policy. In addition, macro-migration policies should encourage local mobility within the same cultural areas to minimize the negative effects of migration. • Applied John W. Berry's framework to urban-to-urban and rural-to-urban migration. • Attitude towards host culture and origin culture impacts internal migrants' health. • Cultural distance is linked with the selection of acculturation strategy. • Local governments should respect migrants' origin culture in policy development. [ABSTRACT FROM AUTHOR]

Performing diagnostic tests is a fundamental information-gathering activity in diagnostic process. However, little attention has been paid to the interactional process where a diagnostic test is advised and received, especially in Chinese medical settings. Decision making over prescribing diagnostic tests consists of clinicians' advice and patients' acceptance or resistance/rejection. Drawing on audio-recordings of clinician-patient encounters in Chinese outpatient clinics as data and conversation analysis as a method, we discuss how patient resistance to clinicians' diagnostic test-taking advice is displayed and managed over sequences of interaction. Two types of advice deliveries have been identified: advice either with no diagnostic utterances or with indeterminate diagnostic utterances. We find that patients demonstrate their resistance towards the former type of advice in two ways: questioning clinicians' decisions and proposing an alternative plan. Displaying resistance to the latter type of advice, patients have been found to recurrently resort to one way: proffering additional information about personal experience. Confronted with resistance, clinicians generally proceed to justify decisions by either asserting their epistemic primacy in determining a test or lowering certainty in the original speculative diagnosis. Towards persistent resistance, clinicians mainly employ two techniques to impose acceptance onto patients: repeating the initial advice and terminating forcefully current sequence. This study adds to a growing body of research on resistance in medical settings and contributes to our understanding of the decision making over medical investigations in Chinese outpatient clinic interaction. • We explore decision making over diagnostic tests in Chinese outpatient clinics. • This paper uses the methodology of Conversation analysis. • Two types of diagnostic test-taking advice is noted. • Resistance to diagnostic test-taking advice and resistance management are examined. [ABSTRACT FROM AUTHOR]

Large hospitals in China are overcrowded, while primary care tends to be underutilized, resulting in inefficient allocation of resources. This paper examines the impacts of a policy change in a mandatory public employee health insurance program in China designed to encourage the utilization of primary care by reducing patient cost-sharing. We use a unique administrative insurance claim dataset from the Urban Employee Basic Medical Insurance (UEBMI) scheme between 2013 and 2015. The sample includes 40,024 individuals. We conduct an event-study analysis controlling for individual fixed effects and find that the change in cost-sharing increased primary care utilization, decreased non-primary care utilization, and increased total outpatient utilization without impacting total spending. In addition, the policy change did not affect the likelihood of having avoidable inpatient admissions. Further, patients with hypertension or diabetes increased their primary care utilization even when using additional coverage for patients with chronic diseases, the cost-sharing rates for which did not change during the period of our study, rather than their standard UEBMI benefits. This study provides evidence that changes in cost-sharing can affect healthcare utilization, suggesting that supply-side incentives can play an important role in building a primary care–based integrated healthcare delivery system in China. • A change in cost-sharing for primary care increased primary care utilization. • The policy change also led to a decrease in non-primary care utilization. • Incentives can help build a primary care–based integrated healthcare system. [ABSTRACT FROM AUTHOR]

In China, a large number of men are being squeezed out of the marriage market due to a shortage of marriageable women. Previous research has largely discussed the consequences of gender imbalances and focused on the behavior of marriage-squeezed men that threatens public safety. No empirical studies explored the impact of the social environment on risky behaviors of marriage-squeezed men. The main objective of this paper is to examine whether social discrimination is associated with marriage-squeezed men's engagement in the behaviors that threaten their own wellbeing and community safety. Using individual-level data collected in Chaohu City, Anhui, this study employed binary logistic regression and linear regression to examine the impacts of discrimination on alcohol use disorder and suicidal ideation, respectively. Ordinary least squares regression was performed to predict the effects of discrimination on gambling and verbal conflict based on village-level data collected in 380 villages across 18 provinces in China. The results showed that self-reported discrimination was positively associated with incidence of alcohol use disorder and suicidal ideation among marriage-squeezed men; villagers' discrimination was also positively associated with the number of marriage-squeezed men in the village who often gambled or were in conflict with others. Evidence suggests that social discrimination is one important mechanism that triggers marriage-squeezed men to engage in risky behaviors that threaten self- and community safety. Commonly held stereotypes about rural bachelors is one of the reasons that causes marriage-squeezed men to pose a threat to public safety. It is necessary to develop and implement policies aimed at creating a friendly and tolerant social environment for marriage-squeezed men. • Defines bachelors' risky behaviors at two levels; self- and community safety. • Highlights impact of social environment on risky behaviors. • Marriage-squeezed men suffer discrimination, especially in central and western China. • Marriage-squeezed men experience a higher incidence of certain risky behaviors. • Social discrimination is positively related to risky behaviors. [ABSTRACT FROM AUTHOR]

China piloted a publicly funded Long-term Care Nursing Insurance (LTCNI) with an aim to improve access to long-term care (LTC) for older people in China in 2012. Existing studies showed that the scheme has been successful in meeting some goals, but little is known on how the availability, price and quality of the local care providers affect access to care. Using an Agent-based Modelling approach, this paper simulates the effects of the LTCNI on access to care by considering quality, costs and availability of the local care providers. Our simulation is based on Qingdao city—the first city in China that piloted the LTCNI. We found considerable discrepancies in terms of access to services among the LTCNI beneficiaries. The poor are more likely to choose nursing home care with low costs albeit these services may be of poor quality. The demand for home-based services is high, but these services are not distributed according to population needs and are not available in some districts with high concentration of older people. Consequently, a large proportion of disabled older people have no access to home-based services. We urge policy makers to improve the benefit package of the LTCNI, especially for the poor. We also suggest that more resources should be directed to promote and improve the availability of home-based services in areas with a large number of older people. • Evaluate the effects of Long-term Care Nursing Insurance (LTCNI) on access. • Use an innovative Agent-based Modelling approach. • Considerable discrepancies are observed for access to care among the beneficiaries. • The poor are more likely to choose nursing home with low costs and poor quality. • Important to promote home-based care in areas with high LTC demand. [ABSTRACT FROM AUTHOR]