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The phenomenon of elderly patients staying in hospital emergency department observation units for extended time in urban China poses a challenge to China’s healthcare system and presents a social problem of inequality. In this paper, we analyse statistics collected from 16 major public hospitals in Beijing to assess the extent and intensity of the problem and examine interviews of medical professionals to understand the mechanisms linking the issue to the Chinese healthcare system. We study the issue with the literature on market transition theory and on China’s recent healthcare reforms and view this age-based inequality as an outcome of the economic and social transformations in China. We make a few policy recommendations including using age-specific bed turnover and mortality rates for evaluating performance, employing three different release-status dependent mortality rates of emergency department patients for the evaluation of hospitals, and improving the capacity of post-acute, ambulatory care and geriatric care services in urban China. [ABSTRACT FROM AUTHOR]

Background: Fear of physicians is associated with a variety of negative relationship and clinical outcomes. Culturally competent communication has been suggested as a way for physicians to reduce patient fear. Previous research has not, however, assessed whether patients’ perceptions of physicians’ cultural competence are associated with the level of felt fear. This study assessed associations between patients’ fear of physicians and their perceptions of physicians’ cultural competence in healthcare interactions. Method: In this cross-sectional study, a purposive sample of 306 patients were recruited from the patient base of a local clinic system with three locations, one rural, one suburban, and one urban in Appalachian Ohio. Using validated paper-and-pencil questionnaires, we assessed patients’ perceptions of physicians’ cultural competence in four domains (macro cultural issues, proxemics/chronemics, language issues, and patient-centeredness) as well as fear of physicians. Results: Fear of physicians was associated with perceptions that physicians’ accommodated cultural differences related to issues of personal space and time and with perceptions of physicians’ provision of patient-centered care. Other domains of intercultural competence indicated negative association, but were not significant. Conclusions: The findings of this study provide evidence that some forms of physician accommodation of cultural difference are associated with reduced fear of physicians. These findings have implications for promoting physicians' cultural competence in healthcare interactions. These implications, with a focus on patient-physician communication are discussed. [ABSTRACT FROM AUTHOR]

To explore the preferable way of use and design of a work ability prognosis support tool for insurance physicians (IPs) and labour experts (LEs), based on a prediction model for future changes in work ability among individuals applying for a work disability benefit. We conducted three focus groups with professionals of the Dutch Social Security Institute (17 IPs and 7 LEs). Data were audio recorded and qualitatively analysed according to the main principles of thematic analysis. Clarity and ease of use were mentioned as important features of the tool. Most professionals preferred to make their own judgement during the work disability assessment interview with the claimant and afterwards verify their evaluation with the tool. Concerning preferences on the design of the tool, dividing work disability claimants into categories based on the outcome of the prediction model was experienced as the most straightforward and clear way of presenting the results. Professionals expected that this encourages them to use the tool and act accordingly. The tool should be easy to access and interpret, to increase the chance that professionals will use it. This way it can optimally help professionals making accurate prognoses of future changes in work ability. A work ability prognosis support tool based on a prediction model for changes in work ability at one-year follow-up can help occupational health professionals in making accurate prognosis of individuals applying for a work disability benefit. To be used in occupational health practice, these tools should have a simple and easy-to-use design. Graphical risk presentation can be used to provide intuitive meaning to numerical information and support users' understanding. Taking professionals' preferences into account when developing these tools encourages professionals to use the tools and act accordingly. [ABSTRACT FROM AUTHOR]

Tobacco use is the leading preventable cause of death in the United States. Analyzing the ability for different mechanisms to reduce smoking rates can provide healthcare systems with information to establish the most effective smoking cessation efforts. Health insurance provides individuals with direct mechanisms to curb smoking behavior, such as access to smoking cessation resources. Gaining insurance may additionally indirectly influence smoking cessation by altering risk perceptions. Behavioral economic theory suggests that gaining health insurance may reduce current smokers' rate of discounting on the future, which could increase smoking cessation. This article aimed to evaluate the impact of insurance status (i.e., gaining any private (n = 681), gaining only public (n = 647), or remaining uninsured (n = 5,056)) as well as the impact of having a discussion with a healthcare provider about quitting smoking on smoking cessation among current adult smokers who were uninsured at the beginning of their data collection. Data for this study came from the Medical Expenditure Panel Survey 2003 to 2014 database. The study found that while individuals gaining public insurance was not statistically associated with smoking cessation, individuals who gained private insurance were more likely to stop smoking than individuals who remained uninsured (OR: 1.330; 95% CI: 1.019,1.737; p = 0.036). Having a discussion with a healthcare provider about quitting smoking was not associated with smoking cessation. These findings indicate that gaining private insurance may impact smoking behavior through mechanisms other than direct access to physician services. [ABSTRACT FROM AUTHOR]