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Objective: This paper investigates how the public–private partnership (PPP) functions in the care provision for older people in Guangdong, China, particularly for ageing‐in‐place programs. Methods: Three cities with diversified PPP forms of care provision for older people were chosen as case studies. Focus groups were conducted in these cities for the local authorities and care homes involved in the partnerships. Results: Three forms of PPP, including private sector involvement for the ownership, construction, and operation of the facilities delivering care services, were identified. The public–private co‐constructed and privately run model with greater private sector involvement may lead to higher quality care in one specific program. The publicly constructed and privately run program is widely used in many cities, advancing the expansion of ageing‐in‐place programs in more communities. These PPPs reflect flexible and practical collaboration between the public and private sectors at the local level in the Chinese context. Conclusions: PPP have accelerated the development of a better care system for older people, mainly in terms of more affordable and higher‐quality care options for the public. They are also a feasible solution for the local government due to more cost‐effective and sustainable care provisions than previous publicly provided programs. The specific forms adopted are primarily associated with the scale of home care provision for ageing‐in‐place and the local government's financial capacity. Despite increasing private sector involvement, the public sector retains its crucial role in delivering care services targeting ageing in China. [ABSTRACT FROM AUTHOR]

This study examines performance of provincial health‐care system in China, using a dynamic network data envelopment analysis (DEA) approach. We focus on efficiency improvements both within provincial health‐care system and within two separate internal sub‐divisions. The administration division engages in financial management while the medical care division provides medical care services. Then there are two main results. First, the average overall efficiency score of provincial health‐care system is 0.9316 from 2010 to 2017. Second, the productivity progress in administration division is lower than that in medical care division, and the technical advances contribute most of the productivity progress. The research gap and the innovation of this paper lie in three aspects: First, this paper opens the black box of health production function and use the network DEA to analyze Chinese provincial health‐care system and its inner two constructs. Second, this paper discusses the efficiency scores as well as dynamic changes in one model. Finally, this paper tries to reveal the regional heterogeneity of static efficiency as well as the dynamic efficiency changes. [ABSTRACT FROM AUTHOR]

This paper examines caregiving for sick older family members in the context of socio‐economic transformations in rural China, combining empirical investigation with normative inquiry. The empirical part of this paper is based on a case study, taken from fieldwork in a rural Chinese hospital, of a son who took care of his hospitalized mother. This empirical study highlighted family members' weiqu (sense of unfairness)—a mental status from experiencing mistreatment and oppression in family care, yet with constrained power to explicitly protest or make care‐related choices. Underpinning people's weiqu and constrained choice, as informed by the conception of structural injustice, is the impact of unjust social structures, organized by unfavourable norms, discriminatory social policies and institutions targeting rural populations. By restraining individual choices and capacities in supporting health care for aging populations, these unjust structures create additional difficulties for and discriminations against rural families and their older members. Some policy recommendations are proposed to mitigate structural injustice so as to empower families and promote care for older people in rural settings. [ABSTRACT FROM AUTHOR]

China's 2009 health care reform agenda has been referred to as one of the most ambitious health policy programmes in modern history. Significant investment has combined with new structures, incentives, and regulations that have aimed to improve access, as well as gain greater control over a health care market much criticised for putting profit before patients. A range of health services research has been undertaken to analyse these efforts. Sociological perspectives have also been documented yet up to now a review and synthesis combining these various contributions has not been undertaken. By drawing on the lens of McDonaldization, the paper presents a narrative review that analyses the extent to which China's 2009 reform agenda has increased efficiency, calculability, predictability, and control over service provision. The review identifies elements of McDonaldization within China's 2009 reform agenda, however, notable gaps remain. In response to the limits of McDonaldization as a lens for understanding China's health care reform, the paper calls for alternative perspectives that are better able to understand the sociocultural dynamics shaping service provision, as well as an interdisciplinary research agenda that is able to generate new insights and understanding regarding health care in China. [ABSTRACT FROM AUTHOR]

In 2014 the authors of this paper, evaluators from China and Canada, jointly interviewed 12 policymakers in China at the national and provincial levels. This paper describes the needs of policymakers and how they view the evaluation capacity-building needs of the health system. The learnings from the policymaker dialogues informed the evaluation capacity-building efforts at three pilot sites in China. This paper focuses on the evaluation capacities needed by policymakers and implementers specifically to address inequities in the health sector, unlike most publications that focus on evaluation capacities of researchers. [ABSTRACT FROM AUTHOR]

This paper describes an evaluation experiment conducted in China between 2013 and 2016 to use evaluative thinking and evaluation approaches to help build the salience of health equity as a performance measure for health systems. This project was informed by a realist evaluation approach that sought to understand the context, mechanisms, and outcomes underlying health inequities. This chapter describes a theory of change that includes descriptions of the key actors involved in the project, the mechanisms of impact, and short- and long-term outcomes. Key questions that could help assess the impact of this project are also discussed. This paper contributes to the literature on building evaluation capacity for health inequities. [ABSTRACT FROM AUTHOR]

Background: Patient satisfaction has been seen as a key criterion when evaluating hospitals and is one of the main focuses of the current health‐care reform in China. This paper aimed to explore patient‐ and hospital‐level factors associated with inpatient satisfaction, which can provide policy implications for the evaluation and development of a patient‐oriented health‐care system. Methods: The paper analyses data from the 2017 China National Patient Survey which includes 20 300 inpatients from 131 tertiary hospitals across 31 provinces. Descriptive analysis and multivariable logistic regressions are conducted to identify key factors related to satisfaction. Results: Patient sociodemographic characteristics, including gender, age, income and insurance type, are found to be strongly associated with their satisfaction of inpatient experience. In terms of institutional characteristics, hospital type, size, staffing and financial performance are also significantly correlated with inpatient satisfaction. Patients are more satisfied with specialist hospitals and large hospitals measured by the number of beds and surgeries. Hospitals with higher nurse‐to‐bed ratio also receive more satisfaction. The financial performance of hospitals, however, is negatively associated with satisfaction. Conclusion: Patient satisfaction contains unique information on service quality and thus should be incorporated into the matrix of hospital evaluation. Meanwhile, differences in patient composition must be adjusted to make fair comparisons across hospitals. Moreover, future reform needs to put greater efforts in the design of comprehensive public insurance scheme, efficient hospital structure and an overall well‐functioning health‐care delivery system in order to better serve patients in China. [ABSTRACT FROM AUTHOR]

Presents abstracts of several articles on public administration and development. "Health Services and Space Utilisation in Urban and Rural Communities: A Case Study of Ile-Ife, Nigeria"; "Access to Health Services"; "Urban Design Practical in Socialist China."

In the medical practice in China, giving and taking "red envelopes" (monetary gifts) is a common phenomenon although few openly admit it. This paper, based on our empirical study including data collected from interviews and questionnaires with medical professionals and patients, attempts to explore why "red envelopes" have become a serious problem in the physician-patient relationship and how the situation can be improved. Previous studies show that scholars tend to correlate the spread of "red envelopes" in health care sector to the commercialization trend, the general erosion of traditional values, and the lowering of the moral level in the medical field. However, in this paper, the authors argue that medical professionals' choice of taking "red envelopes" is actually more a way to compensate for their problematic self-image and marred dignity in real practice. Medical professionals in China as a whole are in an embarrassing situation where the work pressure and income, and the sense of pride that used to be part of their profession are not comparable to each other. Under this circumstance, we believe that the effective way to deal with the "red envelopes" issue does not lie solely in introducing more stringent regulations or granting medical professionals higher payments, but rather in protecting and enhancing the professional dignity of all those working in healthcare. And on top of that, there must also be effort to cultivate a more favorable moral environment. [ABSTRACT FROM AUTHOR]

How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee-for-service to case-based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case-based payment in the Chinese health care system and applied a systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case-based payment. Some ethical problems of case-based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high-income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient-physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case-based payment is currently more ethically acceptable than fee-for-service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case-based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications. [ABSTRACT FROM AUTHOR]

In 2003, the New Rural Cooperative Medical Scheme (NCMS) was initiated in China to provide rural inhabitants with financial protection against health risks. The benefit package was extended to outpatient care in 2007. Using the China Health and Nutrition Survey of 2009, this paper examines the relationship between the households participating in the NCMS and the level and distribution of catastrophic health payments and health payment-induced poverty resulting from outpatient care. The study finds no significant difference in terms of catastrophic health payments and health payment-induced poverty before and after NCMS reimbursement. The out-of-pocket payments (OOP) are concentrated disproportionately among the poor even after the insurance reimbursement. This heavy burden of OOP payments has become a poverty trap for the poor. This study calls for a more comprehensive insurance and effective insurance package. [ABSTRACT FROM AUTHOR]

Trust is indispensable not only for interpersonal relationships and social life, but for good quality healthcare. As manifested in the increasing violence and tension in patient-physician relationships, China has been experiencing a widespread and profound crisis of patient-physician trust. And globally, the crisis of trust is an issue that every society, either developing or developed, has to face in one way or another. Yet, in spite of some pioneering works, the subject of patient-physician trust and mistrust - a crucial matter in healthcare especially because there are numerous ethical implications - has largely been marginalized in bioethics as a global discourse. Drawing lessons as well as inspirations from China, this paper demonstrates the necessity of a trust-oriented bioethics and presents some key theoretical, methodological and philosophical elements of such a bioethics. A trust-oriented bioethics moves beyond the current dominant bioethical paradigms through putting the subject of trust and mistrust in the central agenda of the field, learning from the social sciences, and reviving indigenous moral resources. In order for global bioethics to claim its relevance to the things that truly matter in social life and healthcare, trust should be as vital as such central norms like autonomy and justice and can serve as a potent theoretical framework. [ABSTRACT FROM AUTHOR]

To investigate the phenomenon of patient-physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust (particularly physicians' distrust of patients and their relatives) leads to increased levels of fear and self-protection by doctors which exacerbate difficulties in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism-the primacy of patient welfare-as well as the traditional Chinese ideal of "medicine as the art of humanity". Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures. [ABSTRACT FROM AUTHOR]

In China's healthcare sector, a popular and socio-culturally distinctive phenomenon known as guanxi jiuyi (medical guanxi), whereby patients draw on their guanxi (personal connections) with physicians when seeking healthcare, is thriving. Integrating anthropological investigation with normative inquiry, this paper examines medical guanxi through the lens of patient-physician trust and mistrust. The first-hand empirical data acquired - on the lived experiences and perspectives of both patients and physicians - is based on six months' fieldwork carried out in a county hospital in Guangdong, southern China, which included in-depth interviews with 20 patients and 20 medical professionals. Patients who emphasized the positive effects of guanxi on patient-physician trust believed that it facilitates access to experienced medical specialists, enhances clinical communication, and reduces the financial and medical risks of over diagnosis and overtreatment by physicians. At the same time, these findings reveal patients' strong sense of mistrust, not only towards individual health professionals but also to the medical profession and China's commercialized healthcare industry. While some health professionals in the study responded favourably to medical guanxi, most were opposed to it on the grounds that it undermines professional standards and equitable healthcare. We found that the practice of medical guanxi is not morally justifiable, chiefly because it reinforces the present high levels of patient-physician mistrust and erodes trust between patients and the medical profession as a whole. In China, both the medical profession and the state need to promote patient-physician trust based on medical professionalism and institutional norms, rather than on guanxi or individual relationships. [ABSTRACT FROM AUTHOR]

Focusing on the shared sense of victimization and disadvantage-ness by both patients and doctors/medical workers in cases of medical conflicts, this paper aims to examine the current patient-doctor tensions in the larger context of moral transformation in Chinese society since the 1980s. Although the decline of public trust in certain aspects is closely associated with the impact of commodification and commercialization of medical sector during the past two decades, other factors play important role as well. In the case of patient-doctor tension, mutual disrespect and mistrust also result from the ongoing process of individualization and the remaking of moral self, in which the individual demand for respect, dignity, and trust seem to have unexpectedly and ironically contributed to the rise of tensions and conflicts between patients and doctors as well as other medical workers. [ABSTRACT FROM AUTHOR]

Based on two years' ethnographic research on doctor-patient relations in urban China, this paper examines the causes of patients' mistrust of physicians. I identify the major factors at the societal, institutional, and interpersonal levels that lead to patients' mistrust of physicians. First, I set the context by describing the extent of mistrust at the societal level. Then, I investigate the institutional sources of mistrust. I argue that the financing mechanism of public hospitals and physicians' income structures are the most crucial factors in inducing patients' mistrust. Hospitals' heavy reliance on self-finance has basically caused public hospitals to run like private hospitals, resulting in blatant conflicts of interest between hospitals and patients. Related to this is physicians' reliance on bonuses and commissions as part of their regular incomes, which has inevitably resulted in overtreatment and, hence, mistrust from the patients. At the interpersonal level, I describe how individual physicians' attitudes toward and interaction with patients may also affect patients' sense of trust or mistrust in physicians. In conclusion, I discuss the ethical implications of the mistrust problem, and suggest changes at the institutional and interpersonal levels to mitigate the problem. [ABSTRACT FROM AUTHOR]

This paper discusses the development and implementation of structured guidelines that contained a fixed set of questions as part of a project in building evaluation capacity for addressing health inequities in the health sector in China. The ambition of the guidelines was to test whether a structured process of questions could aid teams that did not have a strong background in evaluation to complete equity-focused evaluations and also help raise the salience of health equity as an important goal of health systems reform among the participants of the project. The guidelines were informed by multiple perspectives that included the literature on social determinants of health, realist evaluation, and utilization/influence perspectives. One noteworthy aspect of this project was that the participants in this capacity-building project were local and national policymakers, practitioners, and university researchers. Our original goal was to test these guidelines in equity-focused policy interventions in three separate provinces of China. One key insight from this project was that there is a need to move away from a testing perspective to a developmental approach in formulating evaluation guidelines that can work across multiple organizational and country contexts and also closely reflect the needs of practitioners and policymakers in evaluation capacity-building efforts. [ABSTRACT FROM AUTHOR]

China's New Cooperative Medical Scheme (NCMS), established in 2003, is a universal health care insurance program for rural residents aimed to improve access to basic health care services and reduce financial risks of catastrophic illnesses in the rural population. It is a cornerstone of China's most recent health care reform efforts. The purpose of this paper is to share insights and learnings from two evaluations of NCMS payment reform. The evaluations were conducted by local researchers and evaluators who were deeply involved in the design and implementation of NCMS in their own region and have gone through a process of reflection of their own work to bring learnings to the broader health systems and evaluation communities in China. [ABSTRACT FROM AUTHOR]

Aims. This paper reviews the role of cardiac nursing in China and the potential of this professional group to take an important role in secondary and tertiary prevention initiatives. Background. China is undergoing unprecedented economic growth, yet globalisation of Chinese society has caused an increase in the prevalence of chronic conditions, particularly cardiovascular disease. Studies recognise that health providers and members of the public are not fully aware of the risks associated with cardiovascular disease and consequently are not equipped to deal with this looming epidemic. Design. Position paper. Method. This position paper summarises and discusses the burden of cardiovascular disease in China within the context of evidence for nurse-coordinated interventions. Barriers and facilitators to developing the nursing role in contemporary China are discussed. Conclusions. A key strategy for promoting the role of nurse-led programmes in China is increasing research skills among Chinese nurses to promote independent, collaborative interdisciplinary research. Promoting doctoral education in China, increasing the status of nursing in interdisciplinary teams, collaborating with cardiovascular nurses internationally and increasing the public's awareness of cardiovascular disease are critical steps in promoting nurse-led programmes to improve the health and well-being of the community. Relevance to clinical practice. Given the positive relationship between knowledge and skill levels of nurses and clinical outcomes, China's investment in the education and training of its nursing workforce is critical in improving practice and outcomes in cardiovascular disease. [ABSTRACT FROM AUTHOR]

Aim. This paper describes a study identifying the impact of key aspects of Chinese culture on the responses of mid-aged Chinese-Australians to their advanced cancer in order to make recommendations about their care within the health system. Background. Studies conducted in the 1960s and 1970s focused on understanding people's psychological responses to their experiences of terminal illness, but the issue of culture was not addressed. In recent years, a few studies have been conducted with Chinese-Australians, but were limited to issues related to their information needs and the disclosure of a cancer diagnosis. There is a lack of understanding of the impact of Chinese culture on the experiences of these patients. Method. A grounded theory approach was used to generate a substantive theory to explain how mid-aged Chinese-Australians respond to advancing cancer. Eleven participants were recruited and data were collected from face-to-face interviews, telephone contacts, observation and researcher fieldnotes. Data generation occurred between 1997 and 1999. Findings. Four modes of response to advanced cancer were identified: acute crisis, combat, despondency and waiting for death. This paper deals particularly with the combat mode which incorporated five culturally specific strategies used by participants in their struggle against advanced cancer. These were traditional Chinese medicine, traditional Chinese beliefs on the use of food for health maintenance, qi gong (a form of exercise), feng shui (which involves paying attention to spatial organization) and the worship of ancestors and gods. Deeply entrenched within these responses is the influence of Chinese culture, rooted in the beliefs and practices of traditional Chinese medicine and the philosophy of harmony and balance of yin and yang and qi. Conclusion. Healthcare professionals need to be aware of the cultural practices and beliefs of the different ethnic groups for whom they care, and of the importance of accommodation to and negotiation about these cultural practices. [ABSTRACT FROM AUTHOR]

woo h. & twinn s. (2004) Journal of Advanced Nursing 45(6), 595–602 Health needs of Hong Kong Chinese pregnant adolescents The outcomes of adolescent pregnancy have been associated with health risks such as obstetric complications and depression, and educational risks such as school dropout and reduced employment opportunities. These outcomes arise from a range of needs including perceived health needs, which are the focus of this paper. This paper reports a study to identify the perceived needs of Hong Kong Chinese adolescents following confirmation of an unintended pregnancy. An exploratory qualitative approach was used with a purposive sample of 10 Hong Kong Chinese pregnant adolescents. The study was undertaken during their stay in a non-government organization maternal shelter. Semi-structured interviews were used to explore adolescents’ perceptions of their psychological, social and health needs and the extent to which each of these needs was met. Six major categories were identified within the context of need, of which three were related to health needs: acceptance of the pregnancy; psychological reactions to the pregnancy; and use of contraception and health advice. The findings contribute to an understanding of the perceived health needs of Chinese adolescents, in particular those that are culturally determined. Implications for nursing practice indicate the significance of comprehensive health assessments and health promotion strategies to help adolescents increase their knowledge about sexual health and contraception. [ABSTRACT FROM AUTHOR]

The article presents a commentary on the study which reveals a need to enhance the nursing role in improving health outcomes of cardiovascular disease in China. It notes that the authors of the paper did not propose how the obstacles for changes in cardiac nursing will occur in China. Moreover, it asserts that nurses in China should examine the factors that influence nursing philosophy such as role and authority, and researchers should try to investigate in altering some of these factors.

This paper examines interrelationships between health status, access and utilization. Indicators for each of these are measured for China and India. It is shown that China, both during Mao and Deng periods, scores over India in the provision of health services to the rural population. Differences in economic inequalities, organization of health services and motivation account for this. Contrary to the prevailing view there is no conclusive evidence that the post-Mao reforms have lowered the access of rural people to health services. The decline of barefoot doctors has been accompanied by an increase in private medical practitioners, and a decline in rural health insurance has coincided with new and alternative experiments in this domain. [ABSTRACT FROM AUTHOR]

The crisis of medical response caused by catastrophic events might significantly affect emergency response, and might even initiate more serious social crisis. Therefore, early identification and timely blocking the formation of crisis in the early phase after a major disaster will improve the efficiency of medical response in a major disaster and avoid serious consequences. In the present paper, we described the emergency strategy to crisis management of medical response after a major disaster. Major catastrophic events often lead to various crises, including excess demand, the crisis of response in barrier and the structural crisis in response. The corresponding emergency response strategies include: (i) shunt of catastrophic medical surge; (ii) scalability of medical surge capacity; (iii) matching of the structural elements of response; (iv) maintaining the functions of support system for medical response and maximising the operation of the integrated response system; and (v) selection of appropriate care 'standard' in extreme situations of overload of disaster medical surge. In conclusion, under the impact of a major catastrophic event, medical response is often complex and the medical surge beyond the convention- al response capacity and it is easy to be in crisis. In addition to the current consensus of disaster response, three additional aspects should be considered. First, all relevant society forces led by the government and military should be linkages. Second, a powerful medical response system must be based on a strong support system. Third, countermeasures of medical surge should be applied flexibly to the special and specific disaster environment, to promote the effective medical response force. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various articles in the issue on topics including socio-political, cultural and healthcare context of patient-physician mistrust; and implications of patient–physician trust and mistrust in the Chinese context.

Purpose: The utility efficiency of medical devices is important, especially for countries such as China, which have a large population and shortage of medical care resources. Radiotherapy devices are among the most valuable and specialized equipment categories and carry enormous treatment loads. In this study, a novel method is proposed to improve the efficiency of a radiotherapy device (linac). Although scheduling management with accurate prediction of the entire treatment time included in each appointment, arrange a reasonable time duration for appointments and save time between patient shifts effectively. Tasks belonging to the treatment and non‐treatment groups can be assigned more flexibly based on the availability of time. Material and methods: Data from 1665 patients, including patient positioning time (PT) and treatment time (TT), were collected in collaboration with the Radiotherapy Center of the Department of Oncology at the Second Affiliated Hospital of Kunming Medical University from November 2020 to August 2021. The features related to PT and TT were extracted and used to train the machine learning‐based model to predict PT and TT in independent patients. The prediction results were subsequently applied to a minute‐based scheduling tool. Conclusion: Artificial intelligence is a promising approach to solve abstract problems with a specialized knowledge background. The results of this study show encouraging prediction outcomes in relation to effective scheduling management and could improve the efficiency of the linac. This successful trial broadens the meaning of medical data and potential future research directions in radiotherapy. [ABSTRACT FROM AUTHOR]

Despite their recent deterioration, village clinics have historically been an important source of health care for the poor and elderly in rural China. In this paper, we examine the current role of village clinics, the patients who use them and some of the services they provide. We focus specifically on the role of village clinics in meeting the health-care needs of the rural poor and elderly. We find that although clinics are continuing to decline financially, they remain a source of care for the rural elderly and poor. We estimate that the elderly are 10-15 percent more likely than young individuals to seek care at a clinic. We show that clinics provide many unique services to support the rural elderly (and the elderly poor), such as in-home patient care, the option for patients to pay on credit, and free and discounted services. [ABSTRACT FROM AUTHOR]

ABSTRACT The paper looks in detail at patients that were treated at one of the most discussed companies operating in the field of untried stem cell treatments, Beike Biotech of Shenzhen, China. Our data show that patients who had been treated at Beike Biotech view themselves as proactively pursuing treatment choices that are not available in their home countries. These patients typically come from a broad variety of countries: China, the United Kingdom, the United States, South Africa and Australia. Among the patients we interviewed there seemed to be both an awareness of the general risks involved in such experimental treatments and a readiness to accept those risks weighed against the possible benefits. We interpret this evidence as possibly reflecting the emergence of risk-taking patients as 'consumers' of medical options as well as the drive of patients to seek treatment options in the global arena, rather than being hindered by the ethical and regulatory constraints of their home countries. Further, we found that these patients tend to operate in more or less stable networks and groups in which they interact and cooperate closely and develop opinions and assessments of available treatment options for their ailments. These patients also perform a multiple role as patients, research subjects, and research funders because they are required to pay their way into treatment and research activities. This new social dynamics of patienthood has important implications for the ethical governance of stem cell treatments. [ABSTRACT FROM AUTHOR]

This paper analyzes economic–social interaction in China in connection with the country's change of economic system. I define an economic system in terms of a multi-dimensional vector of broad institutional characteristics, and I emphasize that important features of the social development are closely related to specific changes in these various dimensions. I classify China's options for future social improvements into three broad categories: (i) policies that improve the stability and distribution of factor income; (ii) government-created wedges between factor income and disposable income; and (iii) improvements in the quantity, quality and distribution of human services, such as education and healthcare. [ABSTRACT FROM AUTHOR]

Based on a survey conducted by our research team at the Chinese Academy of Social Sciences, the present paper reports on the development of China's new rural cooperative medical system set up in late 2002. The new rural cooperative medical system is different from the old system in that it is organized, guided and supported by the government but that rural residents voluntarily participate in its administration. It is financed by individuals, collectives and the government. The new cooperative medical system focuses on serious disease planning and mutual aid and fraternity between rural residents in health care. The results of our survey indicate that the new rural medical system has been successful up to now but that it also has some problems. China needs to pay more attention to overcoming the difficulties and challenges it faces in terms of future medical needs so that a mechanism for its sustainable development can be established. [ABSTRACT FROM AUTHOR]

This paper presents research results from the evaluation of the Medical Financial Assistance (MFA) program, supported by the World Bank, to extremely poor rural residents. It is found that MFA can help to improve the ability of the poor to make use of medical services, and especially their ability to receive services from township clinics. The present study also shows that adoption of the MFA mechanism helps to reduce the impact of disease on the economies of poor families, and prevents the poor afflicted with serious illnesses from being marginalized. However, as the beneficiaries often suffer from serious, complicated and lasting illnesses, the financial assistance is often insignificant in relation to medical expenses. Furthermore, the MFA plays no significant role in restoring a patient's income-earning ability. [ABSTRACT FROM AUTHOR]

Context China has a long tradition of education and medicine. However, limited economic conditions and a huge population mean that further development of medical education in China must be tailored to meet the country's needs. Objectives The aim of this paper is to describe current medical education practice in China with reference to the general and historical purposes of education in China and how they have affected and continue to affect student learning. Reference is also made to both Western medicine and traditional Chinese medicine. Methods It is argued that traditional educational practices in China have encouraged rote learning and that creativity is not cultivated. This affects the way many Chinese students learn medicine. Since 1949, the Chinese medical education system has developed according to its own needs. The current system for training medical students is complex, with medical school curricula lasting 3−8 years. However, medical education reform is taking place and new teaching methods are being introduced in some schools. Discussion Medical education is important to China's large population. The undergraduate medical education system is being streamlined and national standards are being established. Innovations in medical education have recently been encouraged and supported, including the adoption of problem-based learning. It is important that the momentum is kept up so that the health care of a fifth of the world's population is assured. [ABSTRACT FROM AUTHOR]

Aim: This paper reports a study that leads to understanding challenges facing nurse educators implementing mandatory continuing nursing education in The People’s Republic of China. Background: Mandatory continuing nursing education was instituted to maintain and develop registered nurses’ competence in the context of healthcare reform in China in 1996. However, there is an increasing complaint of credit-focused and teacher-centred learning in Chinese literature. Despite an increasing appeal to improve the learning situation, little consensus has been reached. By examining nurse educators’ perceived challenges and their coping strategies in implementing mandatory continuing nursing education, this study illuminates the possibilities for reform in mandatory continuing nursing education. Methods: Data were collected through in-depth interactive dialogues between the researcher and five nurse educators in five healthcare organizations in China, utilizing Gadamer’s philosophical hermeneutics. Findings: Three themes were found in this study described as finding a way to support nurses’ competence within a constrained situation, reconciling credit requirements and representing all stakeholders’ interests. Conclusions: A tension between the mandatory continuing nursing education policy and the context of implementing the policy can contribute to credit-focused and teacher-centred learning. Regular policy review and educational support for nurse educators are crucial aspects to improve mandatory continuing nursing education. [ABSTRACT FROM AUTHOR]

With the promotion and wider acceptance of the concept of ‘normalization’ and ‘community integration’, an increased number of adults with learning disabilities are living in the community and facing more social and health care problems. The authors describe the introduction of new guardianship laws in Hong Kong with the creation of a Guardianship Board to safeguard the interests of all those who are mentally unable to make decisions about their personal, medical or financial affairs. Some case vignettes are provided to illustrate its functions and roles. By sharing the Hong Kong experience, it is hoped that this paper can raise awareness of circumstances in countries that are planning to develop or reform their guardianship practices for people with learning disabilities. [ABSTRACT FROM AUTHOR]

The Internet is promising to play a prominent role in health care in the future, but there is an imbalance in its use between the East and the West, between genders, the rich and poor, the educated and uneducated and the urban and rural. This paper looks at the use of the Internet from the perspective of these subgroups across the world, and outlines some of the problems facing disadvantaged groups in particular older people and their caregivers in China. Older people and their predominantly family caregivers have limited access to computers which is compounded by lack of access to good health care. However, it is suggested that this will become a growth area as older people and their caregivers may well bypass traditional care for tele-health care and Internet information-based systems. [ABSTRACT FROM AUTHOR]

* The significance of primary health care to the health of individuals and communities has been well established but the development of primary health care and nursing practice within the context of primary health care remains varied in different countries and settings.* This paper focuses on developments in nursing practice in primary health care in Hong Kong, using three community-based research projects to identify the opportunities and challenges created for nurses working in these settings. The projects were established in response to identified health needs and to target cancer education, HIV/AIDS and chronic health problems.* Opportunities include the development of professional autonomy, innovative approaches to clinical practice, and developing skills in working with a diverse range of professionals and communities. Challenges include managing uncertainty and the development of evaluation systems to demonstrate health gains from nursing interventions. [ABSTRACT FROM AUTHOR]

This paper examines how the Chinese state's prenatal health care campaigns of the early 1950s attempted to redefine women's social and political roles. The replacement of local midwifing practices with a uniform birthing method in order to radically reduce infant and mother mortality entailed complex ramifications regarding the relationship of women vis-a-vis the state. Campaigns involved demonizing "traditional" midwifing, promoting a statistical vision of female reproductivity and children as national resources, and the isolation of individual mothers as directly responsible to the state for managing reproduction for the national interest. In sum, a physiological definition of gender was used to open women's bodies to state management. Utopic visions of painless childbirth and of the socialist nation as a giant new family were used to promote participation in grassroots campaigns, but the sources also point to forms of local resistance to the micro-level reorganization of power these campaigns intended. [ABSTRACT FROM AUTHOR]

Background: The increasing incidence of cancer in China has posed considerable challenges for cancer care delivery systems. This study aimed to determine the general population's preferences for cancer care, to provide evidence for building a people‐centered integrated cancer care system. Methods: We conducted a discrete choice experiment that involved 1,200 participants in Shandong Province. Individuals were asked to choose between cancer care scenarios based on the type and level of hospitals, with various out‐of‐pocket costs, waiting time, and contact working in the hospitals. Individual preferences, willingness to pay, and uptake rate were estimated using a mixed‐logit model. Results: This study included 848 respondents (70.67%). Respondents preferred county hospitals with shorter hospitalization waiting times and contact working in hospitals. Compared to the reference levels, the three highest willingness to pay values were related to waiting time for hospitalization (¥97,857.69–¥145411.70–¥212,992.10/$14512.70–$21565.16–$31587.61), followed by the county‐level hospital (¥32,545.13/$4826.58). The preferences of the different groups of respondents were diverse. Based on a county‐level general hospital with contact in the hospital, 50% out‐of‐pocket costs and a waiting time of 15 days, the probability of seeking baseline care was 0.37. Reducing the waiting time from 15 to 7, 3, and 0 days, increases the probability of choosing a county‐level hospital from 0.37 to 0.58, 0.64, and 0.70, respectively. Conclusions: This study suggests that there is a substantial interest in attending county‐level hospitals and that reducing hospitalization waiting time is the most effective measure to increase the probability of seeking cancer care in county‐level hospitals. [ABSTRACT FROM AUTHOR]

This paper is based on a comparative study examining how Chinese and white families manage the care of a chronically ill child. The circumstances of their lives that shape their experience of iliness are explored. It is argued that the ideologies which underpin Western health cate practices, in this case, the 'ideology of normalisation', often differ from the perspectives held by non-Western immigrants, and others who do not have access to the ideology. The discrepancies in viewpoints between patients and practitioners can lead to a different set of goals in the treatment encounter, with the possibility of misunderstandings in the clinical context. The 'ideology of normalisation' is used to show how professional ideologies serve as a means of separating out families into those who comply and those who do not. In other words, the ideology, and the moral discourse on normalisation, permit professionals to evaluate families and to categorise them. This categorisation has consequences for patient care, they might be refused treatment. Yet, this ideology is not based merely on 'value-free professional theories', but is located within the moral order. The socio-political, economic and historical factors that underpin the ideology are discussed. [ABSTRACT FROM AUTHOR]

an editorial is presented on research and study presented by the medical care industry in China regarding inflammation of airways and respiratory diseases. It talks about the research emphasising of the medical care provided for patients with chronic obstructive pulmonary disease (COPD) and asthma in China. It tells about the manuscripts submitted by Chinese respirologists in the industry.

Evaluating the efficiency of healthcare services accurately can help in analyzing the rationality of inputs and outputs in such services. Considering the consistency and equity of assessment criteria, this study conducts the stochastic multicriteria acceptability analysis (SMAA‐2) with a directional distance function to evaluate the efficiency of healthcare services in 31 provincial administrative regions of mainland China, as observed in 2018. We use SMAA‐DDF to explore all the projection directions to the efficient frontier instead of a certain projection direction. We measure the maximum and average efficiencies for each of the 31 provincial healthcare services. Our empirical findings show that only seven provinces achieve optimal healthcare service efficiency; the eastern area performed the best, followed by the central, western, and northeast areas. Furthermore, the path along the projection directions is provided to help inefficient provinces improve their efficiency and obtain the best possible positions. [ABSTRACT FROM AUTHOR]

One of the unintended effects of China's health care reforms is the emergence of unregistered practitioners. We discuss reasons for their development and their role in the urban health care provision system under consideration of general developments in health care provision and health governance - thereby drawing scientific attention to a by far under-researched topic. We analyse the basic characteristics and strategies of clinic-based unregistered practitioners in Guangzhou and examine their perception and utilisation by rural-to-urban migrants. The research design followed a qualitative dominant mixed methods research approach, which included expert interviews with representatives of administration, indepth interviews with practitioners and migrants, a quantitative survey with 450 migrants and field observations. According to our results, gaps in the formal health care system - especially lack of access of marginalised population groups and inadequate responsiveness - poor enforcement of regulation and corrupt executive personnel are responsible for their emergence and prevalence. [ABSTRACT FROM AUTHOR]

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Dividing China into seven regions reveals rural income and consumption divergence for both 1980–2005 and 2000–05. But while real rural consumption growth averaged 7.7 percent over 1985–2005 in the eastern coastal region, it averaged 6.5 percent uniformly in the interior. In evaluating well-being, such rapid improvement in all regions arguably overshadows negative connotations of divergence. Twenty years of household survey data reveal dramatic increases in rural household savings, as rural consumption improved more slowly than income in some periods. This raises questions about the suitability of consumption as a basis for measuring well-being and its distribution. Increased savings appear to be transient, as some households save while others dissave to purchase durables and afford lumpy services like education and healthcare—supplies of which became more plentiful in the 1990s. The paper argues that more meaningful measures of regional disparities come from differences in regional poverty headcounts. It also suggests that higher regional inequality and accompanying interregional migration indicate that inequality plays an important positive role in inducing economic actors voluntarily to move to more productive locations and activities as a mechanism for ensuring sustainable improvements in individual well-being. [ABSTRACT FROM AUTHOR]

Objective: This study explored treatment experiences and social support among individuals with eating disorders (EDs) in mainland China. Method: Subscribers of a Chinese online social media platform (WeChat) focused on EDs were invited to complete a screening questionnaire that included the Eating Disorder Diagnostic Scale for the DSM‐5. Of the 116 questionnaire responses, 31 met inclusion criteria for follow‐up interviews. Individuals who never sought treatment were not eligible for follow‐up interviews, but provided brief explanations about why they did not seek treatment. All eligible participants (n = 31) completed a semi‐structured interview about their experiences with ED treatment and social support. Qualitative data from the interviews and survey responses regarding not seeking treatment were subjected to inductive data‐driven thematic analysis with deductive coding to illuminate treatment and social support experiences or reasons for not seeking treatment. Results: Themes emerged from interviews revealed positive inpatient treatment experiences for anorexia nervosa, but negative outpatient treatment experiences, unaffordable care, and ineffective psychopharmacological treatments. Parents, friends, and partners were sources of social support, but participants largely felt misunderstood or blamed by these same entities. Shame, not recognizing ED as an illness, and financial constraints were listed as the primary reasons for not seeking treatment. Discussion: The importance of hearing patients' perspectives, improving ED literacy in China, increasing knowledge of culturally specific manifestations of EDs, and developing culturally responsive services and dissemination of treatment resources are emphasized. [ABSTRACT FROM AUTHOR]

Aim: To determine the efficacy of Internet‐based interventions in decreasing the prevalence of postpartum depression in perinatal women. Design: This review was conducted according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Methods: We performed a systematic meta‐analysis of randomized controlled trials on the efficacy of Internet‐based interventions for postpartum depression. Studies (2008–2018) were identified through a search conducted on PubMed, EMBASE and the Cochrane Library. Risk ratios or weighted mean differences with 95% confidence intervals were calculated using a fixed‐effects model or a random‐effects model. Stata software 11.0 was used to perform the meta‐analysis. Results: Most of the seven eligible studies were randomized controlled trials. The random‐effects model indicated that Internet‐based interventions significantly improved postpartum depression (d = 0.642, N = 7). Attrition rates ranged from 4.5%–86.9% and from 0%–87.1% for the intervention and control groups, respectively. [ABSTRACT FROM AUTHOR]

The role of the government in health care provision remains a contested issue worldwide. Public hospitals dominate China's health care industry. However, in the early 2000s, the eastern China city of Suqian privatized all its hospitals and relaxed entry barriers for private hospitals. We assess the impact of the pro‐market reform on hospital performance using a differences‐in‐differences approach. We find that the pro‐market reform decreased medical price and expenditure, improved self‐reported health outcomes, and reduced search time and cost for patients. We show that after the reform, Suqian residents had greater trust in doctors than did residents from other cities. [ABSTRACT FROM AUTHOR]

An editorial is presented on the improving quality of the manuscripts submitted from China on respirology, inflammation of the airway and the medical care industry in China.

Strengthening the nursing workforce is core to health system reform in China. Patient experiences of hospital care have been recognized as important in this endeavor. Studies exploring the relationships between nursing workforce and patient experiences of hospital care, however, are scarce. The aim of this cross‐sectional study was to examine the associations between nurse education level, nurse staffing, and hospitalized patients' experiences of hospital care. Participants were 1,582 nurses responsible for direct care and 1,305 hospitalized patients from 23 hospitals in Guangdong province, China in 2014. Education level of nurses was measured by the proportion of nurses holding a baccalaureate or higher degree. Nurse staffing was measured by the unit nurse‐patient ratio. The Hospital Consumer Assessment of Health care Providers and Systems Scale was used to measure patient experiences of hospital care. Structural equation modeling demonstrated that a higher proportion of nurses holding a baccalaureate or higher degree was related directly to better patient perceptions of communication with nurses, responsiveness of nurses, pain management, and physical environment, and related indirectly to overall hospital ratings and recommendation of the hospital. A higher nurse‐patient staffing ratio was associated directly with better patient perceptions of communication with nurses, education about new medications given in hospital, and physical environment, and indirectly with overall ratings and recommendation of the hospital. Our findings add new evidence in the Chinese societal context about the relationship between the nursing workforce and patient experiences of hospital care. Upgrading nurse education level and increasing nurse staffing could potentially improve patient experiences of hospital care. [ABSTRACT FROM AUTHOR]