ArticleLiterature Review

China's Public Health-care System: Facing the Challenges

Authors:
To read the full-text of this research, you can request a copy directly from the author.

Abstract

The severe acute respiratory syndrome (SARS) crisis in China revealed not only the failures of the Chinese health-care system but also some fundamental structural deficiencies. A decentralized and fragmented health system, such as the one found in China, is not well-suited to making a rapid and coordinated response to public health emergencies. The commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of the under-provision of public services, such as health surveillance and preventive care. For the past 25 years, the Chinese Government has kept economic development at the top of the policy agenda at the expense of public health, especially in terms of access to health care for the 800 million people living in rural areas. A significant increase in government investment in the public health infrastructure, though long overdue, is not sufficient to solve the problems of the health-care system. China needs to reorganize its public health system by strengthening both the vertical and horizontal connections between its various public health organizations. China's recent policy of establishing a matching-fund financed rural health insurance system presents an exciting opportunity to improve people's access to health care.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... The government funds in the public health sector declined, which led public health institutions to generate their own revenues (i.e. selling vaccines, providing more profitable services) [4]. Some infectious diseases such as Tuberculosis (TB), re-emerged as a result of poverty and health inequities [5][6][7]. ...
... Without consistent financial supports from central budgets, the PCIs were incentivized to become self-financing entities. Because of the stagnation or even decline of basic public health service provision, some infectious diseases such as TB re-emerged [4,18,19]. ...
... Although many studies proved that the causal association between the public health expenditure and infant or child mortality [9,10], some studies well summarized China's experience on public health in 1949-1984 [3,16] and lessons in 1985-2002 [4,17], some studies assessed the effects of NEPHSP on service coverage and equity [14,[40][41][42][43][44][45][46][47][48], very few studies described China's financing strategies and mechanisms for the NEPHSP [34,35,41,43]. This study could be an important contribution to the exiting literature on evaluation of public health equalization in China. ...
Article
Full-text available
Background In 2009, China launched a health reform to promote the equalization of national essential public health services package (NEPHSP). The present study aimed to describe the financing strategies and mechanisms to improve access to public health for all, identify the strengths and weaknesses of the different approaches, and showed evidence on equity improvement among different regions. Methods We reviewed the relevant literatures and identified 208 articles after screening and quality assessment and conducted six key informants’ interviews. Secondary data on national and local government health expenditures, NEPHSP coverage and health indicators in 2003–2014 were collected, descriptive and equity analyses were used. ResultsBefore 2009, the government subsidy to primary care institutions (PCIs) were mainly used for basic construction and a small part of personnel expenses. Since 2009, the new funds for NEPHSP have significantly expanded service coverage and population coverage. These funds have been allocated by central, provincial, municipal and county governments at different proportions in China’s tax distribution system. Due to the fiscal transfer payment, the Central Government allocated more subsides to less-developed western regions and all the funds were managed in a specific account. Several types of payment methods have been adopted including capitation, pay for performance (P4P), pay for service items, global budget and public health voucher, to address issues from both the supply and demand sides. The equalization of NEPHSP did well through the establishment of health records, systematic care of children and maternal women, etc. Our data showed that the gap between the eastern, central and western regions narrowed. However the coverage for migrants was still low and performance was needed improving in effectiveness of managing patients with chronic diseases. Conclusions The delivery of essential public health services was highly influenced by public fiscal policy, and the implementation of health reform since 2009 has led the public health development towards the right direction. However China still needs to increase the fiscal investments to expand service coverage as well as promote the quality of public health services and equality among regions. Independent scientific monitoring and evaluation are also needed.
... With reforms and open policy arriving by the beginning of the 1980s, the public health system shifted toward decentralization, privatization, and marketization with a reduced budget from the central government and increased investments from the market. The principal responsibility for healthcare financing and service delivery transferred from the national to the local level, from the government to the market (Liu, 2004), and access to welfare services increasingly depended on one's ability to pay. From 1978 to 1999, the national share of healthcare spending decreased sharply from 32 to 15% with the central government's reduced redistributive power (Liu, 2004). ...
... The principal responsibility for healthcare financing and service delivery transferred from the national to the local level, from the government to the market (Liu, 2004), and access to welfare services increasingly depended on one's ability to pay. From 1978 to 1999, the national share of healthcare spending decreased sharply from 32 to 15% with the central government's reduced redistributive power (Liu, 2004). ...
... In 1983, there were 3.71 doctors and 4.84 hospital beds per 1,000 people in urban areas, compared to 0.82 doctors and 1.48 hospital beds per 1,000 people in the countryside (Bhalla, 1990). In 1999, 49% of urban residents had some form of health insurance, compared to 7% of rural residents and a mere 3% of residents in western China's most impoverished rural provinces (Liu, 2004). According to official data, in 2004, there were 1.80 doctors and 3.51 hospital beds per 1,000 people in urban areas and just 0.67 doctors and 1.42 hospital beds per 1,000 people in the countryside. ...
Chapter
Severe acute respiratory syndrome (SARS) struck China at the end of 2002 and the epidemic lasted for more than six months. SARS was the first outbreak of a readily transmissible disease in the twenty-first century (WHO, 2003b). From the detection of the first case on November 16, 2002, in Guangdong Province in South China, to Beijing’s removal from the World Health Organization’s (WHO’s) SARS list on June 24, 2003, the fight against the infectious disease lasted for nearly eight months.
... Further confounding the problems of restructuring is that core systemic modifications are often undertaken by those with little understanding o f the epidemiological, political, or social ramifications associated with implementation (De la Jara & Bossert, 1995). Rather, changes are distinguished by the calamitous decentralization and/or privatization of public services resulting in the absence o f infrastructure necessary to support even the most basic of health care needs (Blumenthal & Hsiao, 2005;Homedes & Ugalde, 2005;Liu, 2004). ...
... Presuming authoritative stakeholders act in their own best interests, the environment in which health policies and programs are developed, implemented, and evaluated is daunting at best, devastating at worst (Blumenthal & Hsiao, 2005;Bommier & Stecklov, 2002;Bossert & Beauvais, 2002;Liu, 2004;Twaddle, 1996;Waitzkin et al., 2005). Given the results of socio-political and economic reform range from very good to very poor, many conclude that policy decisions often rest on erroneous casual assumptions, cultural ideology, and/or the political will of the most influential (Bossert & Beauvais, 2002;De la Jara & Bossert, 1995;Waitzkin et al., 2005). ...
... O f the possible consequences of external stakeholder influence over national healthcare policy development, the question o f whether or not emerging arrangements serve to fulfill public health objectives appears to be one of the most critical (Saltman, 2003;Segall, 2000). Rather, the adequacy o f policy decisions is often based on the availability of financial resources, the ability of the citizenry to pay out-of-pocket expenses, or by assessing actual or potential disparities resulting from implementation (Blumenthal & Hsiao, 2005;De Groote, De Paepe, & Unger, 2005;De Vos, Dewitte, & Van der Stuyft, 2004;Fiedler & Wright, 2003;Giffin, 1994;Liu, 2004;Segal, 2004). ...
... Core Health Service Capabilities: A resilient health system sustains baseline levels of routine healthcare delivery during a public health emergency [28][29][30][31][32][33][34][35]. Barriers to Healthcare Access: A resilient health system dismantles barriers to healthcare access so that the public accesses care during emergencies [36,37]. Maintaining Critical Infrastructure and Transportation: A resilient health system develops plans to weather interruptions in critical infrastructure and transportation [24,25,[38][39][40][41][42][43][44][45][46][47][48][49][50]. ...
... Maintaining Critical Infrastructure and Transportation: A resilient health system develops plans to weather interruptions in critical infrastructure and transportation [24,25,[38][39][40][41][42][43][44][45][46][47][48][49][50]. Timely and Flexible Access to Emergency/Crisis Financing: A resilient health system has timely, flexible access to financing so that it can better prepare for and respond to public health emergencies [24,29,36,37,[39][40][41][51][52][53][54][55][56][57][58][59]. Leadership and Command Structure: A resilient health system has a clear and flexible command structure that has been established prior to an event and is exercised frequently [24,29,57,[60][61][62][63][64][65]. ...
... There are some indicators in the JEE that do address the themes identified in the literature review, but only within the context of public health. For example, the literature suggests that health facilities need access to financing during emergencies to cover the added costs of preparing for and responding to emergencies [24,29,36,37,[39][40][41][51][52][53][54][55][56][57][58][59]. The JEE indicator on National, Legislation, Policy and Financing does address whether countries have the financing to fulfill their obligations under the IHR, which includes "regulations or administrative requirements, or other governmental instruments governing public health surveillance and response" [12]. ...
Article
Full-text available
Background: The 2014-2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods: We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization's Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results: We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions: An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.
... Penelitian yang dilakukan penulis ini menggambarkan tentang adanya komunikasi dalam inovasi pelayanan kesehatan publik yang dilakukan Polindes desa Tarumajaya, kecamatan Kertasari, kabupaten Bandung. Salah satu penelitan yang menggambarkan pentingnya pelayanan kesehatan publik dalam meningkatkan pembangunan kesehatan masyarakatnya, adalah penelitian Liu (2004) yang dilakukan di China. Liu (2004) mengungkapkan tentang krisis parah pernapasan akut (SARS) krisis di Cina yang disebabkan karena kegagalan sistem perawatan kesehatan Cina serta beberapa kekurangan struktural mendasar. ...
... Salah satu penelitan yang menggambarkan pentingnya pelayanan kesehatan publik dalam meningkatkan pembangunan kesehatan masyarakatnya, adalah penelitian Liu (2004) yang dilakukan di China. Liu (2004) mengungkapkan tentang krisis parah pernapasan akut (SARS) krisis di Cina yang disebabkan karena kegagalan sistem perawatan kesehatan Cina serta beberapa kekurangan struktural mendasar. Sistem kesehatan yang terdesentralisasi dan terfragmentasi, seperti yang ditemukan di Cina, tidak cocok untuk membuat tanggapan yang cepat dan terkoordinasi terhadap keadaan darurat kesehatan masyarakat. ...
... Cina perlu mengatur kembali sistem kesehatan publiknya dengan memperkuat koneksi vertikal dan horizontal antara berbagai organisasi kesehatan publiknya. Kebijakan baru-baru ini di Cina untuk membangun sistem asuransi kesehatan pedesaan yang dibiayai dengan dana pendamping memberikan peluang yang menarik untuk meningkatkan akses masyarakat terhadap perawatan kesehatan (Kuncoro, 2006;Liu, 2004) Penelitian tersebut memperlihatkan data bahwa diperlukan adanya peningkatan pelayanan kesehatan publik untuk meningkatkan akses masyarakat pedesaan yang tinggal di China. Peningkatan tersebut bisa dilakukan dalam investasi dan infratruktur kesehatan masyarakat yang ada dalam sistem kesehatan di China. ...
Article
Full-text available
The "one data" policy driven by the government through the Ministry of Health is believed to be able to innovate and give a new face to health services. Of course, the improvement of health services starts from the smallest and lowest layers, namely Polindes. Starting from this policy and the finding of relatively low public health service problems, the authors see a health service in Polindes, which contributes positively to improving the quality of public health services. The health service is the author's view of the communication perspective through the study of Communication in the Synergy of Public Health Services Polindes (Village Maternity Post) in Tarumajaya Village, Kertasari District, Bandung Regency. The method used in this research is a case study. The results of the study revealed that public health services in Polindes are inseparable from the communication process that exists in the village. The verbal communication process includes positive synergy between the communicator and the communicant. In this case, the communicators are village midwives, village officials, namely the village head and his staff, the sub-district health center, and the active role of the village cadres involved. In contrast, the communicant that was targeted was the community in the village of Tarumajaya. This positive synergy results in a marked increase in public services, namely by providing new facilities in the village, RTK (Birth Waiting Home). Kebijakan “one data” yang dimotori oleh pemerintah melalui Kementerian kesehatan diyakini mampu membuat inovasi dan memberikan wajah baru terhadap layanan kesehatan. Tentunya, perbaikan layanan kesehatan tersebut dimulai dari lapisan terkecil dan terbawah yakni Polindes. Berawal dari kebijakan tersebut dan masih ditemukannya masalah pelayanan kesehatan publik yang relatif rendah, penulis melihat sebuah layanan kesehatan di Polindes, yang memberikan kontribusi positif dalam peningkatan kualitas layanan kesehatan masyarakat. Pelayanan kesahatan tersebut penulis lihat dari perpektif komunikasi melaui penelitian Komunikasi dalam Sinergi Pelayanan Kesehatan Publik Polindes (Pos Bersalin Desa) di Desa Tarumajaya, Kecamatan Kertasari, Kabupaten Bandung ini dilakukan. Metode yang digunakan dalam penelitian ini adalah studi kasus. Hasil penelitian mengungkapkan bahwa pelayanan kesehatan publik di Polindes, tidak terlepas dari adanya proses komunikasi yang terjalin di desa tersebut. Proses komunikasi verbal tersebut meliputi sinergitas positif antara pihak komunikator dan komunikan. Dalam hal ini, komunikator tersebut adalah Bidan Desa, Aparat Desa yakni Kepala Desa beserta staffnya, Puskesmas tingkat kecamatan, serta peran aktif dari para kader desa yang terlibat. Sedangkan komunikan yang menjadi target adalah masyarakat di desa Tarumajaya. Sinergitas positif tersebut menghasilkan peningkatan pelayanan publik yang nyata, yaitu dengan adanya penyediaan fasilitas baru di desa, RTK (Rumah Tunggu Kelahiran).
... With reforms and open policy arriving by the beginning of the 1980s, the public health system shifted toward decentralization, privatization, and marketization with a reduced budget from the central government and increased investments from the market. The principal responsibility for healthcare financing and service delivery transferred from the national to the local level, from the government to the market (Liu, 2004), and access to welfare services increasingly depended on one's ability to pay. From 1978 to 1999, the national share of healthcare spending decreased sharply from 32 to 15% with the central government's reduced redistributive power (Liu, 2004). ...
... The principal responsibility for healthcare financing and service delivery transferred from the national to the local level, from the government to the market (Liu, 2004), and access to welfare services increasingly depended on one's ability to pay. From 1978 to 1999, the national share of healthcare spending decreased sharply from 32 to 15% with the central government's reduced redistributive power (Liu, 2004). ...
... In 1983, there were 3.71 doctors and 4.84 hospital beds per 1,000 people in urban areas, compared to 0.82 doctors and 1.48 hospital beds per 1,000 people in the countryside (Bhalla, 1990). In 1999, 49% of urban residents had some form of health insurance, compared to 7% of rural residents and a mere 3% of residents in western China's most impoverished rural provinces (Liu, 2004). According to official data, in 2004, there were 1.80 doctors and 3.51 hospital beds per 1,000 people in urban areas and just 0.67 doctors and 1.42 hospital beds per 1,000 people in the countryside. ...
Chapter
We know of plenty of examples where crises give rise to reform (such as the homeland security system after the 9/11 events in the USA and the emergency management system after the SARS crisis in China). We also know of crises that lead straight back to the status quo (such as the safety work management system after several extraordinarily serious safety accidents in China). This prompts an interesting question: What explains this variance in policy change? This book intends to answer this question in the context of China.
... Biopolitics in the captured literature is defined in the sense of states governing mortality in times of disease -through gaining authority to assign subjects into statuses of infected or uninfected (Lawson and Xu 2007), the 'moralization of health' through measures aimed at individuals, such as vaccine uptake (Hier), as well as 'the political regulation of corporality' and individuals' bodies through disease control measures (Ragozina 2020 Out of the four terms examined in this conceptual mapping scoping study, 'organizations' had the smallest number of articles captured in the search, a total of six. In most of these articles, analysis of the structure and functions of organizations involved within a public health response, such as non-governmental organizations (NGOs), government agencies, or components within agencies involved a form of organizational mapping of health systems (Liu 2004;Schwartz, Evans and Greenberg 2007), emergency response structures (Forestier, Cox and Horne 2016;Kim, Oh and Wang 2020;Liu et al. 2021), and the ways in which these structures have changed over time (Schwartz, Evans and Greenberg 2007;Kim, Oh and Wang 2020). This was akin to one of the definitions of governance proposed by Levi-Faur, that of governance as structure: for example, 'horizontal' or 'vertical' arrangements (Barbazza and Tello 2014), 'vertical integration' of health system components is also described as a type of 'organizational strategy' for reform (Liu 2004). ...
... In most of these articles, analysis of the structure and functions of organizations involved within a public health response, such as non-governmental organizations (NGOs), government agencies, or components within agencies involved a form of organizational mapping of health systems (Liu 2004;Schwartz, Evans and Greenberg 2007), emergency response structures (Forestier, Cox and Horne 2016;Kim, Oh and Wang 2020;Liu et al. 2021), and the ways in which these structures have changed over time (Schwartz, Evans and Greenberg 2007;Kim, Oh and Wang 2020). This was akin to one of the definitions of governance proposed by Levi-Faur, that of governance as structure: for example, 'horizontal' or 'vertical' arrangements (Barbazza and Tello 2014), 'vertical integration' of health system components is also described as a type of 'organizational strategy' for reform (Liu 2004). ...
Article
Full-text available
In recent years, the literature on public health interventions and health outcomes in the context of epidemic and pandemic response has grown immensely. However, relatively few of these studies have situated their findings within the institutional, political, organizational, and governmental (IPOG) context in which interventions and outcomes exist. This conceptual mapping scoping study synthesized the published literature on the impact of IPOG factors on epidemic and pandemic response and critically examined definitions and uses of the terms IPOG in this literature. This research involved a comprehensive search of four databases across the social, health, and biomedical sciences as well as multi-level eligibility screening conducted by two independent reviewers. Data on the temporal, geographic, and topical range of studies were extracted, then descriptive statistics were calculated to summarize these data. Hybrid inductive and deductive qualitative analysis of the full-text articles was conducted to critically analyze the definitions and uses of these terms in the literature. The searches retrieved 4,918 distinct articles; 65 met the inclusion criteria and were thus reviewed. These articles were published from 2004 to 2022, were mostly written about COVID-19 (61.5%), and most frequently engaged with the concept of governance (36.9%) in relation to epidemic and pandemic response. Emergent themes related to the variable use of the investigated terms, the significant increase in relevant literature published amidst the COVID-19 pandemic, as well as a lack of consistent definitions used across all four terms: institutions, politics, organizations, and governance. This study revealed opportunities for health systems researchers to further engage in interdisciplinary work with fields such as law and political science, to become more forthright in defining factors which shape responses to epidemics and pandemics, and to develop greater consistency in using these IPOG terms in order to lessen confusion among a rapidly growing body of literature.
... By 2011, this proportion has reached about 95% (National Bureau of Statistics, 2015). Correspondingly, the proportion of private healthcare expenditures has fallen sharply from 60% in 2001 to around 35% in 2011 (Liu, 2014). The government is working hard to expand insurance coverage and limit the patient's own costs. ...
... This is because township medical centers lack funds and medical quality is low. The problem at the policy level is that township health centers should continue to be part of the hospital system or be transformed into mobile clinics (Liu, 2014). Under the new reform system, they will accept government subsidies and provide basic public health services. ...
Article
Full-text available
Population ageing brings additional challenges to many countries around the world. As China became the first country in the world to have more than 1 billion people aged 60 and above in 2010, this has put forward higher requirements for the amount of medical resources, quality of medical services, reliability and fairness in China. Providing a comprehensive health care system is a major challenge for policymakers. The purpose of this article is to discuss the challenges facing policymakers in less developed countries. This paper selects the Chinese healthcare system as a case study for analysis. To explore the effectiveness of the Chinese government's measures to formulate relevant basic medical security policies, reform the medical insurance system and subsidy levels, and comprehensively cover medical insurance. The study found that while health insurance levels have grown significantly, there are still challenges in coordinating programs, and many management and financing issues have arisen in the sustainable development of hospital services. Finally, it will describe how policymakers can use the current health insurance system to address these challenges. This article will discuss in detail two specific challenges facing the health care reform process, one is the discussion on the coverage and segmentation of medical insurance, and the other is the analysis on the future reform of public hospitals.
... Since the foundation of the People's Republic of China, the Chinese government has been improving the fairness and accessibility of medical resources. However, many issues remain (30,31). To provide residents with systematic and continuous medical services, the hierarchical design of China's hospitals is highly robust. ...
Article
Full-text available
The number of patients in a hospital is a direct indicator of patients' choice of hospital, which is a complex process affected by many factors. Based on the national medical system and patients' preference for high-grade hospitals in China, this study establishes a three-dimensional differential equation model for calculating the time variation of the number of visits to three grades of hospitals. We performed a qualitative analysis of the system. We carried out a subsequent numerical simulation to analyze the impact on the system when the rate of leapfrog treatment and the maximum capacity of doctors and treatments changed. The results show that the sustainability of China's three levels of hospitals mainly depends on the level of hospital development. The strength of comprehensive health improvement at specific levels is the key to increasing the service efficiency of medical resources.
... One view is that there exists "market failure" in the hospitals sector, and private hospitals will push up the medical service price and the shortage of prevention investment. For example, Liu (2004) pointed out that as the financing of hospitals in China became increasingly privatized, hospitals had become less interested in public health work. The other view is that the inefficiency and supply shortage of China's hospitals sector are due to the price regulation and vacancy of hospitals' independent management right. ...
Article
This paper investigates the treatment quality of the hospitals sector in China during 2009–2014. The treatment quality of a hospital is higher if relatively more medical services are provided with fewer deaths. Our research question is twofold: (i) Does the pressure of for-profit lower treatment quality by causing more deaths? (ii) Can government subsidy raise treatment quality by releasing the pressure from market competition? Our empirical results show that the treatment quality in China has been improving during the studied period. There are pieces of evidence that both marketization and government subsidies can boost the treatment quality of the hospitals sector. The co-existence of market force and government regulation is beneficial to the patients.
... En el largo plazo, las mencionadas enfermedades respiratorias terminan afectando otros órganos y, por ende, dando lugar a otras enfermedades. En términos de cobertura, también hay evidencia de fallas estructurales como en el brote de Síndrome Respiratorio Agudo Severo (SRAS) de 2003, donde la atención fue muestra de un sistema deciente, insuciente e inconexo (Liu, 2004). ...
Article
Full-text available
La configuración del modelo de desarrollo de China ha intentado tener un distanciamiento del modelo de Washington. Lo anterior quiso ser planteado desde una visión alternativa a los postulados estadounidenses, pero trajo consigo puntos de convergencia y similitudes en el entendimiento sesgado del desarrollo. China ostenta un prestigioso lugar en materia de producto interno bruto, pero sus indicadores humanos no reejan esta prosperidad como los económicos. El Consenso de Beijing es un recetario de tareas para alcanzar estándares y crecimiento económico, razón por la cual, no es un modelo de desarrollo. La deshumanización de la noción de desarrollo dentro del modelo chino repercute en que Beijing ha alcanzado un grado relevante de crecimiento macroeconómico, pero se distancia de variables imperantes para tener un desarrollo integral. Aunque el índice de desarrollo humano de China es alto, la medición de dicho indicador sigue estando ligada a cuestiones mayoritariamente económicas, y así, distanciándose de la esencia del desarrollo humano, como consecuencia del objetivo de alcanzar la calidad de vida de la población que es el fin último del desarrollo
... Combating communicable diseases depends on surveillance, preventive measures, outbreak investigation, and the establishment of control mechanisms [52]. Unfortunately, data from surveillance systems are often delayed, and reporting is inaccurate, making it difficult to use such data for the detection of outbreaks [53][54][55][56][57]. It is estimated that only 35% of communicable disease cases are reported to national health departments [58][59][60]. ...
Article
Full-text available
We investigate the use of sentiment dictionaries to estimate sentiment for large document collections. Our goal in this paper is a semiautomatic method for extending a general sentiment dictionary for a specific target domain in a way that minimizes manual effort. General sentiment dictionaries may not contain terms important to the target domain or may score terms in ways that are inappropriate for the target domain. We combine statistical term identification and term evaluation using Amazon Mechanical Turk to extend the EmoLex sentiment dictionary to a domain-specific study of dengue fever. The same approach can be applied to any term-based sentiment dictionary or target domain. We explain how terms are identified for inclusion or re-evaluation and how Mechanical Turk generates scores for the identified terms. Examples are provided that compare EmoLex sentiment estimates before and after it is extended. We conclude by describing how our sentiment estimates can be integrated into an epidemiology surveillance system that includes sentiment visualization and discussing the strengths and limitations of our work.
... Village doctors, as the primary health service providers in village clinics, play an important role in the rural healthcare system. [1][2][3][4] In China, the history of village doctors could be dated back to "barefoot doctors" of the 1960s', who received only short-time training and then provided primary medical and health services to villagers. Over decades, the team of village doctors has reached 0.901 million by 2017. ...
Article
Full-text available
To strengthen rural health services, the Chinese government has launched a series of policies to promote health workforce development. This study aims to understand the current status of village doctors and to explore the factors associated with village doctors' job satisfaction in western China. It also attempts to provide references for further building capacities of village doctors and promoting the development of rural health service policy.A multistage stratified sampling method was used to obtain data from a cross-sectional survey on village doctors across 2 provinces of western China during 2012 to 2013. Quantitative data were collected from village doctors face-to-face, through a self-administered questionnaire.Among the 370 respondents, 225 (60.8%) aged 25 to 44 years, and 268 (72.4%) were covered by health insurance. Their income and working time calculated by workloads were higher than their self-report results. Being healthy, working fewer years, and having government funding and facilities were the positive factors toward their job satisfaction. Village doctors working with government-funded village clinics or facilities were more likely to feel satisfied.Problems identified previously such as low income and lack of insurance, heavy workload and aging were not detected in our study. Instead, village doctors were better-paid and better-covered by social insurance than other local rural residents, with increased job satisfaction. Government policies should pay more attention to improving the quality of rural health services and the income and security system of village doctors, to maintain and increase their job satisfaction and work enthusiasm. Further experimental study could evaluate effects of government input to improve rural health human resources and system development.
... TB designated hospitals still largely rely on fee-for-services, and TB care providers' salaries are linked with the revenue generated for the hospital. It is not surprising, as many other studies in China have reported, that a perverse financial incentive is driving healthcare providers to prescribe more and more expensive health services [22][23][24][25][26]. The increase of total medical costs for inpatient care might be partly attributed to increasing the content care according to TB treatment clinical pathways. ...
Article
Full-text available
Objective: The China Center for Disease Control and Prevention (CDC) introduced an innovative financing model of tuberculosis (TB) care and control with the aim of standardizing TB treatment and reducing the financial burden associated with patients with TB. This is a study of the pilot implementation of new financing mechanism in Zhenjiang, between 2014-2015. We compared TB hospitalization rates and inpatient service costs before and after implementation to examine the factors associated with hospital admissions. Our goal is to provide evidence-based recommendations for improving TB service provision and cost control. Methods: We reviewed new policy documents on TB financing. We conducted a patient survey to investigate the utilization of inpatient services, and patients' out-of-pocket payment for inpatient care. We extracted total medical expenditures of inpatient services from inpatient records of TB designated hospitals. Findings: 63.6% (n = 159) of the surveyed patients with TB were admitted for treatment in 2015, which was higher than that in 2013 (54.8%, n = 144). The number of hospital admission was slightly lower in 2015 (1.16 per patient) than in 2013 (1.26 per patient), while the length of hospital stay was longer in 2015 (24 days) than in 2013 (16 days). In 2015, patients from families with low incomes were more likely to be admitted than those from higher income groups (OR = 3.06, 95% CI: 1.12-8.33). The average inpatient service cost in 2015 (3345 USD) was 1.7 times the cost in 2013 (1952 USD). It was found that 96.2% of patients with TB who were from low-income households spent more than 20% of their household income on inpatient care in 2013, versus 100% in 2015. Conclusion: The TB hospital admission rate and total inpatient service cost increased over the study period. The majority of patients with TB, particularly poor patient who used inpatient care, continue to suffer from heavy financial burden.
... There are obvious differences and similarities in the accountability of various types of hospitals. In terms of differences, as the government has comprehensive control over the decision-making authority of public hospitals, the government's accountability for public hospitals is achieved through bureaucratic or administrative direct accountability, such as direct appointment of hospital leadership, which is a "patriarchal" accountability approach in China's institutional environment [32]. As for private hospitals, which are less government-dependent, the government is more likely to adopt indirect mechanisms, such as economic methods, the mechanism of regulatory accountability, purchasing services and so on. ...
Article
Full-text available
Objectives: To qualitatively compare the influence of different ownership which is considered as a kind of institutional environment in public hospitals, private hospitals, and mixed-ownership hospitals on hospital governance structure and organizational behavior. Design: Qualitative descriptive study, using semi-structured, in-depth interviews and thematic template analysis, theoretically informed by critical realism. Participants: 27 key informants including national policymakers in charge of the health sector, influential researchers, local administrators responsible for implementing policies, and hospital managers who are experienced in institutional change. Results: Hospital ownership has a significant influence on hospitals in terms of decision-making power allocation, residual ownership allocation, market entry level, accountability, and social functions. These five aspects in hospital organizational structure incentivize hospitals to adapt to the internal and external environment of the hospital organization—such as market environment, governance, and financing arrangements—affect the behavior of the hospital organization, and ultimately affect the efficiency of hospital operation and quality of service. The incentives under the public system are relatively distorted. Private hospitals have poor performance in failing their social functions due to their insufficient development ability. Compared to them, mixed ownership hospitals have a better performance in terms of incentive mechanism and organizational development. Conclusion: Public hospitals should improve the governance environment and decision-making structure, so as to balance their implementation of social functions and achieve favorable organizational development. For private hospitals, in addition to the optimization of the policy environment, attempts should be made to strengthen their supervision. The development of mixed-ownership hospitals should be oriented towards socialized governance.
... Thus, the government should also strengthen the financial support for health care providers. 31 It is to be noted that, personal and work-related characteristics that are significantly related to lower quality of life, (e.g., female gender, lower salary, working at Central PHC center, being a dentistry assistant, having a longer PHC experience, etc.) necessitate further study to identify the cause(s) for lowered HRQoL among primary health care providers and to suggest the proper strategy that can be used by primary health care managers and policy makers at the Saudi MOH for developing and appropriately implementing successful plans to improve their HRQoL. ...
... 7 Unfortunately, data from surveillance systems are often delayed and reporting is inaccurate, making it difficult to use such data for the detection of outbreaks. [8][9][10][11][12] Moreover, it is estimated that only 35% of communicable disease cases are reported to national health departments. [13][14][15] Underreporting of these diseases negatively impacts the public health policy makers' abilities to decrease morbidity and mortality. ...
Article
Full-text available
Despite the improvement in health conditions across the world, communicable diseases remain among the leading mortality causes in many countries. Combating communicable diseases depends on surveillance, preventive measures, outbreak investigation, and the establishment of control mechanisms. Delays in obtaining country-level data of confirmed communicable disease cases, such as dengue fever, are prompting new efforts for short- to medium-term data. News articles highlight dengue infections, and they can reveal how public health messages, expert findings, and uncertainties are communicated to the public. In this article, we analyze dengue news articles in Asian countries, with a focus in India, for each month in 2014. We investigate how the reports cluster together, and uncover how dengue cases, public health messages, and research findings are communicated in the press. Our main contributions are to 1) uncover underlying topics from news articles that discuss dengue in Asian countries in 2014; 2) construct topic evolution graphs through the year; and 3) analyze the life cycle of dengue news articles in India, then relate them to rainfall, monthly reported dengue cases, and the Breteau Index. We show that the five main topics discussed in the newspapers in Asia in 2014 correspond to 1) prevention; 2) reported dengue cases; 3) politics; 4) prevention relative to other diseases; and 5) emergency plans. We identify that rainfall has 0.92 correlation with the reported dengue cases extracted from news articles. Based on our findings, we conclude that the proposed method facilitates the effective discovery of evolutionary dengue themes and patterns.
... Input-based provider payments are essential to the accessibility and equity of primary health care in China. China once had a strong primary health system that was a model for other nations, but there was a shift from rural to urban facilities and from primary care-based services to public hospital-centered care after 1978 (Liu, 2004;Eggleston et al., 2008;Blumenthal and Hsiao, 2015;World Bank Group et al., 2016). Effective primary health care is very important to cope with a series of new and serious challenges, including industrialization, urbanization, an aging population, and changes in the spectrum of diseases. ...
Article
Full-text available
Aim: To provide a framework for provider payment reform for primary care physicians in China. Background: Primary health care is central to health system reform and payment incentives have significant consequences for the equity and efficiency of it. Methods: This paper describes the special payments system for public primary health institutions and the subsequent internal salary remuneration to primary care physicians in China. Based on an analysis of the major challenges, we suggest a reform framework including the pattern of governance, and payments to primary health institutions and employed physicians. Findings: A mixed system of input-based and output-based payments to institutions would probably be appropriate under a long-term and relational contract with the government. It was also advised that internal remuneration is provided by a basic salary plus a bonus based on performance, and an extra-regional allowance. We hope that the results can be used to shift the passive budgeting of in-house staff within the public primary health institutions toward strategic purchasing.
... At the same time, because of the new medical materials, equipment, and treatment methods, the consumption of cutting-edge technology increases medical costs.37 How to control the high medical and health costs has become a key issue in the reform of China's medical and health system.38 Our findings showed that during the 10 years from 2010 to2019, the main reasons for the admission of patients with NDDs showed different trends: infection, abnormal blood pressure and the imbalance of electrolyte and water homoeostasis decreased. ...
Article
Background As the Chinese population continues to age, the incidence of neurodegenerative diseases (NDDs) has increased dramatically, which results in heavy medical and economic burden for families and society. Objective The objective of this study was to evaluate NDDs in a southern Chinese hospital over a 10‐year period and examine trends in demographics, outcome, length of stay, and cost. Methods Retrospective medical records of patients from January 2010 to December 2019 were collected, including 7231 patients with NDDs (as case group) and 9663 patients without any NDDs (as control group). The information of social demographic data, admission source, reasons for admission, outcomes, length of stay (LOS), and cost were extracted and analyzed. Result The average hospitalization age of the patients with NDDs is over 65 years (peak age 70–89 years). Compared to the control group, the case group had a longer LOS and a higher cost and the numbers of patients with NDDs increased yearly from 2010 to 2019. The LOS shortened while the cost increased. Clinical features affected LOS and cost. Patients suffering from infection, abnormal blood pressure and the imbalance of water‐electrolyte homeostasis as main reasons for admission were decreased; however, heart disease, cerebrovascular accident and mental diseases were significantly increased, the overall change trend of fracture/trauma remained stable. The rate of discharge to home care and mortality declined; discharge to other medical or community facilities increased over ten years. Conclusion The majority of NDDs patients tended to be older. During the last 10 years from 2010 to 2019, the numbers of NDDs patients increased yearly, the trend of LOS became shortening and the cost gradually increasing. The main reasons of admission and outcomes of hospital showed different trends.
... 9 By then only five percent of people were covered by the Cooperative Medical System, and markets were increasingly dictating the distribution and organization of health services. 15 Inequalities in access to health services were exacerbated by these trends as public health resources were redirected away from rural areas and economic development progressed more rapidly in urban areas. ...
Article
Full-text available
Public health education in China and India has a long history that has been both deeply responsive to the unique needs and medical traditions of each country, and sensitive to global influences. The history of public health education in China reaches back several centuries, with substantial input from American and European organizations during the Republican Era, 1911-1949. In India, centuries-old health care traditions were influenced during the colonial period by the British Empire prior to independence in 1947. Political upheaval in both countries during the 1940s further impacted the public health systems as well as public health education. The primary goal of this review is to outline public health education in India and Mainland China, with a focus on describing the historical systems and structures that have promoted the development of formalized public health education. We examine current challenges, and analyze opportunities for improvement. Health reforms in China and India need to consider new and modern models for public health education, perhaps in independent faculties of public health, to reinvigorate public health education and strengthen the position of public health in addressing the health challenges of the 21st century.
... Firstly, the enrollment unit of both the UR-BMI and the NCMS is the household instead of the individual. If migrants choose to join the UR-BMI in the cities where they work, their left-behind families are no longer eligible to enroll in the NCMS, and the left-behind family members, mainly the elderly or the children, are high risk groups which need health care the most (Liu, 2004). Therefore, the use of the household as the enrollment unit of both the UR-BMI and the NCMS prevents migrants from taking part in the UR-BMI with the rear secure. ...
Article
Although the Chinese government has established a public health insurance system covering both rural and urban areas, the rural–urban migrants seem to have been neglected. To have a clear sense of the current status of migrants in the public health insurance system and to find ways to increase their enrollment to medical insurance, this paper attempts to construct a conceptual classification framework of China’s health insurance system. This was done by reviewing the development of China’s health insurance system and identifying barriers to entry for migrants. The finding suggests that migrants’ limited access to health insurance owes more to their reluctance than to system exclusions. The job and residential stability of migrants are critical factors to building the classification framework to account for supply and demand factors in the formulation of China’s health insurance policy.
... Over the past few decades, the country has experienced unprecedented economic growth, accompanied by dramatic increase in income inequality (Li and Zhu 2006). Although a high rate of improvement in HRPI has occurred in China since the 1990s (Liu 2004), the everincreasing share of personal health and medical expenditure still poses a challenge for the government (Zhang and Kanbur 2005). It is hence paramount to examine whether the effects of economic development on health are modified by inequality or health infrastructure. ...
Article
Full-text available
Objectives: To document the association between economic development, income inequality, and health-related public infrastructure, and health outcomes among Chinese adults in midlife and older age. Methods: We use a series of multi-level regression models with individual-level baseline data from the China Health and Retirement Longitudinal Survey (CHARLS). Provincial-level data are obtained both from official statistics and from CHARLS itself. Multi-level models are estimated with different subjective and objective health outcomes. Results: Economic growth is associated with better self-rated health, but also with obesity. Better health infrastructure tends to be negatively associated with health outcomes, indicating the likely presence of reverse causality. No supportive evidence is found for the hypothesis that income inequality leads to worse health outcomes. Conclusions: Our study shows that on top of individual characteristics, provincial variations in economic development, income inequality, and health infrastructure are associated with a range of health outcomes for Chinese midlife and older adults. Economic development in China might also bring adverse health outcomes for this age group; as such specific policy responses need to be developed.
... China's most recent HSR was a response to deep inequity resulting from three decades of marketization and de facto privatization of the health sector. It was the culmination of many years of debate (Tang et al. 2014a) after acknowledged inaction on the heavy burden of healthcare on household expenditure (Blumenthal and Hsiao 2005;Huang 2011;Liu 2004;Liu et al. 2003;Tang et al. 2008). It comprises initiatives in five main areas: ...
Chapter
Full-text available
The health of China’s population improved dramatically during the first 30 years of the People’s Republic, established in 1949. By the mid-1970s, China was already undergoing the epidemiologic transition, years ahead of other nations of similar economic status, and by 1980, life expectancy (67 years) exceeded that of most similarly low-income nations by 7 years. Almost 30 years later, China’s 2009 health reforms were a response to deep inequity in access to affordable, quality healthcare resulting from three decades of marketization, including de facto privatization of the health sector, along with decentralized accountability and, to a large degree, financing of public health services. The reforms are built on earlier, equity-enhancing initiatives, particularly the reintroduction of social health insurance since 2003, and are planned to continue until 2020, with gradual achievement of overarching objectives on universal and equitable access to health services. The second phase of reform commenced in early 2012. China’s health reforms remain encouragingly specific but not prescriptive on strategy; set in the decentralized governance structure, they avoid the issue of reliance on local government support for the national equity objective, leaving the detailed design of health service financing, human resource distribution and accountability, essential drug lists and application of clinical care pathways, etc. to local health authorities answerable to local government, not the Ministry of Health. Community engagement in government processes, including in provision of healthcare, remains limited. This chapter uses the documentation and literature on health reform in China to provide a comprehensive overview of the current situation of the health sector and its reform in the People’s Republic.
... These problems were aggravated after the epidemic of SARS in 2003. Some scholars argued that it was the market-oriented reform that deteriorated the situation (Liu, 2004;Wang, 2004;Li, Chen, & Powers, 2012). Seemingly, this round of reform led the Chinese healthcare system to the other extreme with too much emphasis on market forces, which inevitably resulted in an indifferent society. ...
Article
Full-text available
The human rights-based approach is widely employed in achieving distributive justice in health care. In the light of a common understanding of the approach, protecting the right to health as a human right relies heavily on addressing state accountability. However, the corresponding measures are put forward unevenly on the national level and generally achieve less than expected. Deficiencies, such as inefficient utilization and the free-rider problem, are increasingly obvious along with the aging population. In the context of the Chinese healthcare system, the paper suggests that drawing attention to the importance of individual responsibility is beneficial to improve the performance of the human rights-based approach in reforming healthcare systems towards more justice. Furthermore, raising the issue of individual responsibility can help to achieve equilibrium between the protection of individual rights and the sustainability of the healthcare system.
... The emergence of several novel strains of influenza and respiratory viruses over the past decade has challenged public health systems [1,2]. Computational models can be useful tools when planning for epidemics, especially those caused by novel pathogens for which there is little evidence for the effectiveness of interventions. ...
Article
Computer models can be useful in planning interventions against novel strains of influenza. However such models sometimes make unsubstantiated assumptions about the relative infectivity of asymptomatic and symptomatic cases, or conversely assume there is no impact at all. Using household-level data from known-index studies of virologically confirmed influenza A infection, the relationship between an individual's infectiousness and their symptoms was quantified using a discrete-generation transmission model and Bayesian Markov chain Monte Carlo methods. It was found that the presence of particular respiratory symptoms in an index case does not influence transmission probabilities, with the exception of child-to-child transmission where the donor has phlegm or a phlegmy cough.
... In recent years, global major public health incidents have occurred frequently, and those characteristics, such as suddenness, unpredictability, and disruption of social stability, have attracted widespread attention from both scholars and practitioners (Xiao et al., 2021;Zhang, 2021). Liu (2004) argued that the public health crisis like SARS exposed the fragility of the public health system in China, making it difficult to respond to public health emergencies promptly and coordinately. Mahony and Clarke (2013) analyze the contemporary context of public crises, calling on society to give more attention and support facilities to public governance. ...
Article
Full-text available
Public opinion guidance plays a crucial role in the management of major public health incidents, and thus, exploring its mechanism is conducive to the comprehensive governance of social security. This study conducts a case study on the anti-pandemic public opinion guidance and analyzes the public opinion representation and the internal mechanism of public opinion guidance in the context of the COVID-19 in China. The findings suggest that the public opinion on the COVID-19 manifested a three-stage progressive and stable tendency and witnessed the strength of China, specifically, benefiting from the systematic and complete integration and release mechanism for anti-pandemic information, the three-dimensional mechanism for the dissemination of knowledge related to pandemic prevention and health, the innovative disclosure mechanism for precise information, and diversified channels for international public opinion guidance. The guidance mechanism proposed in this study provides significant suggestions for the public opinion guidance of global major public health incidents in future.
... Economic development and an increase in the aging population have heightened the demand for medical resources [10]. While China is in a period of rapid economic development, her large population, the polarization of the rich and the poor, the increase in the aging population, and the uneven distribution of medical resources have created complex problems in China's medical industry [11,12]. Rational allocation of medical resources and nding ways to improve treatment e ciency are two of the most pressing issues right now. ...
Preprint
Full-text available
Background: Due to economic development and an increase in the aging population, the demand for medical resources is increasing. A good doctor-patient relationship (DPR) can optimize patients’ medical experience and improve treatment efficiency. The DPR, however, is currently in crisis in China. To explore ways to improve DPR, this study assessed the views on the status of the DPR, medical services, and the general situation of medical work among medical personnel (MP) and the general population (GP). Methods: This cross-sectional study, conducted between December 2019 and March 2020, targeted the MP and the GP in Nanjing City, Jiangsu Province, and Zhengzhou City, Henan Province. The MP and the GP answered a self-administered questionnaire through Questionnaire Star and WeChat apps. Wilcoxon's Sign Rank Test, Chi-square test, and frequency distributions and percentages were used to process the data. Results: Only 11.04% of the MP and 14.89% of the GP believed that the current DPR was harmonious. Moreover, 54.55% of the MP and 71.12% of the GP believed that the medical industry was a service industry. While 14.29% of the MP and 64.44% of the GP thought medical stuff earned high salaries, 19.48% of the MP and 47.11% of the GP wanted their children to be in the medical industry. The recognition of the current status of the DPR did not affect the GP’s preference for their children's practice (p<0.05). Most MP hoped to improve salaries (40.26%), followed by safety (17.53%) and social status (12.99%); only 8.44% of the MP wanted to improve the DPR. Conclusion: The MP’s and GP’s views on the current status of DPR, the importance of medical service attitudes, and the general sense of the medical industry were similar. However, there was a significant difference in the perception of the nature of medical services and the income of the people employed in the medical industry between the two groups. Balancing the expectations of patients in the medical industry and increasing public awareness of the actual situation in the medical industry may be a feasible way to improve the DPR.
... The accessibility and affordability of health services were deemed suboptimal due to insufficient government funding, profit-oriented health services, and inadequate insurance coverage (Liu, 2004), which are believed to be important contributors to WPV. This is consistent with previous studies suggesting that China's widespread profit-generating medical practices have eroded patient trust, with poor provider-patient relationship being the key influencing factor (Hesketh et al., 2012;Phillips, 2016;Tucker et al., 2015;Wu et al., 2014;Yang et al., 2019). ...
Article
Workplace violence (WPV) in the health sector is a global public health issue. The magnitude of WPV is a particular concern in China’s health system. To examine the potential causes of WPV, we analyzed 3,045 qualitative responses to an open-ended question in a survey with health workers in the Zhejiang province, China. We adapted a four-level socio-ecological framework (societal/systemic, community/organizational, interpersonal, and individual) to thematically analyze the data. Ten sub-themes emerged. Within the societal/systemic level, we identified three sub-themes: (a) lack of legislation against WPV, (b) suboptimal accessibility and affordability of health services due to maldistributed health resources, commercialized health services, and inadequate health insurance, and (c) unregulated mass media reports. Within the community/organizational level, three sub-themes emerged: (a) lack of supportive health facility leadership, (b) inaction by government authorities, and (c) inefficient law enforcement agencies. Within the interpersonal level, two sub-themes were identified: (a) poor provider–patient communication and (b) distrust between health workers and patients. Finally, we identified the personal characteristics of health workers (e.g., competence and professionalism) and patients (e.g., sociodemographic background and expectations/satisfaction) as two individual-level sub-themes.
... The healthcare system is designed to satisfy people's medical needs, such as diagnosis and treatment and chronic disease management [50]. Public health is the collective action for sustained population-wide health improvement, such as health surveillance and preventive care [53,54]. With the advancement of social media, telemedicine has played an important role in providing health services in China, which should be considered when studying health service needs [55]. ...
Article
Full-text available
This study aimed to explore the health service needs of empty nest families from a household perspective. A multistage random sampling strategy was conducted to select 1606 individuals in 803 empty nest households in this study. A questionnaire was used to ask each individual about their health service needs in each household. The consistency rate was calculated based on their consistent answers to the questionnaire. We used a collective household model to analyze individuals’ public health service needs on the family level. According to the results, individuals’ consistency rates of health service needs in empty nest households, such as diagnosis and treatment service (H1), chronic disease management service (H2), telemedicine care (H3), physical examination service (H4), health education service (H5), mental healthcare (H6), and traditional Chinese medicine service (H7) were 40.30%, 89.13%, 98.85%, 58.93%, 57.95%, 72.84%, and 63.40%, respectively. Therefore, family-level health service needs could be studied from a family level. Health service needs of H1, H3, H4, H5, and H7 for individuals in empty nest households have significant correlations with each other (r = 0.404, 0.177, 0.286, 0.265, 0.220, p < 0.001). This will be helpful for health management in primary care in rural China; the concordance will alleviate the pressure of primary care and increase the effectiveness of doctor–patient communication. Health service needs in empty nest households who took individuals’ public needs as household needs (n = 746) included the H4 (43.3%) and H5 (24.9%) and were always with a male householder (94.0%) or at least one had chronic diseases (82.4%). Health service needs in empty nest households that considered one member’s needs as household needs (n = 46) included the H1 (56.5%), H4 (65.2%), H5 (63.0%), and H7 (45.7%), and the member would be the householder of the family (90.5%) or had a disease within two weeks (100.0%). In conclusion, family members’ roles and health status play an important role in health service needs in empty nest households. Additionally, physical examination and health education services are the two health services that are most needed by empty nest households, and are suitable for delivering within a household unit.
... (72,73) Los ensayos fueron la tipología documental utilizada exclusivamente por autores de origen anglosajón. Entre sus intereses están los cambios y los retos originados a partir de las reformas en el sistema de salud chino (74) y estadounidense, (75) además de críticas a las características de los servicios rurales, (76) la ruralidad como un determinante social en salud (77) y la importancia de contextualizarla en términos de persona y territorio. (78) Por último, entre los relatos de experiencia seleccionados el principal propósito fue señalar las características de macroproyectos enfocados a la atención en salud en comunidades rurales. ...
Article
Introduction: Rurality and health systems represent globally a field of forces marked by the survival of rurality and the inequity and inequality conditions in the access to health services. Objective: Identify the research methods used in the international context to analyze health services in rural populations. Methods: It was carried out an study of systematic review that included research reports related with the topic published until December, 2014. The selection process of the studies was conducted in four stages: identification, sieving, elegibility and inclusion. 253 references were recovered and those show the methodological diversity of approaches in the access to health services in rural populations. Conclusions: It is needed a different view to rurality for creating efficient public policies that are in accordance with the contexts and needs of communities that demand health services.
... However, the inequality of the distribution of health care resources in China is the biggest obstacle [8]. To change this phenomenon, China needs to strengthen both the vertical and horizontal connections between its public health service organizations [9,10]. The integrated care-with a fullfeatured, hierarchical and resource-sharing structure has been proposed [11]. ...
Preprint
Full-text available
Background: Multiple countries' experiences have illustrated that integrated care is an ideal choice regarding improving the quality of health care. In China, the central government has enacted a large number of policies to promote the development of integrated care in recent years. Yet, no existing research has examined how these policies to support the development of integrated care. In this paper we seek to address that gap. Methods: Document content analysis method was used in this paper. Data were collected by carrying out a review of integrated care policies (N=21) published from January 2015 to December 2020. The policy documents of integrated care issued by central governments are retrieved through the Internet. IHSDNSs (Integrated Health Service Delivery Networks)’s essential attributes framework was used to guide data analysis. Results: The most commonly referenced principal domains of integrated care in China were model of care, there were 45 references to the organization and management, financial allocation and incentives was the least often referenced source of information. The main purpose of reference to information was to support the reform of integrated care decision-making. Conclusions: A whole range of policies on integrated care were issued in a relatively short time. These policies propose a macro conceptual and operational framework for the development of integrated care. The development of integrated care has been mainly driven by the policy stimulus in China. However, the concrete measures still need clear negotiation and management by the local municipalities. Future policy should improve complementary policies such as financial allocation and financial incentive policy.
... Economic development and an increase in the aging population have heightened the demand for medical resources [16]. While China is in a period of rapid economic development, her large population, the polarization of the rich and the poor, the increase in the aging population, and the uneven distribution of medical resources have created complex problems in China's medical industry [17,18]. Rational allocation of medical resources and finding ways to improve treatment efficiency are two of the most pressing issues right now. ...
Article
Full-text available
Background Due to economic development and an increase in the aging population, the demand for medical resources is increasing. A good doctor-patient relationship (DPR) can optimize patients’ medical experience and improve treatment efficiency. The DPR, however, is currently in crisis in China. To explore ways to improve DPR, this study assessed the views on the status of the DPR, medical services, and the general situation of medical work among medical personnel (MP) and the general population (GP). Methods This cross-sectional study, conducted between December 2019 and March 2020, targeted the MP and the GP in Nanjing City, Jiangsu Province, and Zhengzhou City, Henan Province. A total of 154 MP and 329 GP answered a self-administered questionnaire through Questionnaire Star and WeChat apps. Wilcoxon’s Sign Rank Test, Chi-square test, and frequency distributions and percentages were used to process the data. Results Only 11.04% of the MP and 14.89% of the GP believed that the current DPR was harmonious. Moreover, 54.55% of the MP and 71.12% of the GP believed that the medical industry was a service industry. While 14.29% of the MP and 64.44% of the GP thought medical staff earned high salaries, 19.48% of the MP and 47.11% of the GP wanted their children to be in the medical industry. The recognition of the current status of the DPR did not affect the GP’s preference for their children’s practice ( p < 0.05). Most MPs hoped to improve salaries (40.26%), followed by safety (17.53%) and social status (12.99%); only 8.44% of the MP wanted to improve the DPR. Conclusion The MP’s and GP’s views on the current status of DPR, the importance of medical service attitudes, and the general sense of the medical industry were similar. However, there was a significant difference in the perception of the nature of medical services and the income of the people employed in the medical industry between the two groups. Balancing the expectations of patients in the medical industry and increasing public awareness of the actual situation in the medical industry may be a feasible way to improve the DPR.
... While scenarios comparable to the COVID-19 pandemic have been simulated [9], national response plans in many countries still tend to neglect the primary care sector [10]. Furthermore, primary care in Austria and Germany is mostly delivered in small, decentralized units run by self-employed general practitioners (GPs), which may hinder a rapid and coordinated pandemic response [11]. ...
Preprint
Full-text available
Background Coronavirus disease 2019 (COVID-19) represents a significant challenge to health care systems around the world. A well-functioning primary care system is crucial in epidemic situations as it plays an important role in the development of a system-wide response. Methods 2,187 Austrian and German GPs answered an internet suvey on preparedness, testing, staff protection, perception of risk, self-confidence, a decrease in the number of patient contacts, and efforts to control the spread of the virus in the practice during the early phase of the COVID-pandemic (3rd to 30th April). Results The completion rate of the questionnaire was high (90.9%). GPs gave low ratings to their preparedness for a pandemic, testing of suspected cases and efforts to protect staff. The provision of information to GPs and the perception of risk were rated as moderate. On the other hand, the participants rated their self-confidence, a decrease in patient contacts and their efforts to control the spread of the disease highly. Conclusion Primary care is an important resource for dealing with a pandemic like COVID-19. The workforce is confident and willing to take an active role, but needs to be provided with the appropriate surrounding conditions. This will require that certain conditions are met. Registration Trial registration at the German Clinical Trials Register: DRKS00021231 Primary Funding Source The study was financed by the cooperating University Institutes without any external financial support.
... While scenarios comparable to the COVID-19 pandemic have been simulated [9], national response plans in many countries still tend to neglect the primary care sector [10]. Furthermore, primary care in Austria and Germany is mostly delivered in small, decentralized units run by self-employed general practitioners (GPs), which may hinder a rapid and coordinated pandemic response [11]. ...
Article
Full-text available
Background Coronavirus disease 2019 (COVID-19) represents a significant challenge to health care systems around the world. A well-functioning primary care system is crucial in epidemic situations as it plays an important role in the development of a system-wide response. Methods 2,187 Austrian and German GPs answered an internet survey on preparedness, testing, staff protection, perception of risk, self-confidence, a decrease in the number of patient contacts, and efforts to control the spread of the virus in the practice during the early phase of the COVID-pandemic (3rd to 30th April). Results The completion rate of the questionnaire was high (90.9%). GPs gave low ratings to their preparedness for a pandemic, testing of suspected cases and efforts to protect staff. The provision of information to GPs and the perception of risk were rated as moderate. On the other hand, the participants rated their self-confidence, a decrease in patient contacts and their efforts to control the spread of the disease highly. Conclusion Primary care is an important resource for dealing with a pandemic like COVID-19. The workforce is confident and willing to take an active role, but needs to be provided with the appropriate surrounding conditions. This will require that certain conditions are met. Registration Trial registration at the German Clinical Trials Register: DRKS00021231 .
... As a consequence of the decentralization of health care system, a series of problems have emerged. Within the current system, horizontal communication is weak and the vertical control cannot be maintained, leading to varying performances, 7 and most of them are unsatisfying. At the same time, marketization and commercialization bring up concerns regarding affordability, accessibility, and equity. ...
Article
The purposes of this article are to explore the challenges the Chinese health care system will be facing in the next decade. The recent outbreak of coronavirus disease (COVID-19) having infected more than 90 000 persons in China (Source: World Health Organization, WHO Coronavirus Disease Dashboard) again reveals the weaknesses of the fragmental health care system. Over the past 3 decades, increasing out-of-pocket spending on health care, increasing mortality rate of chronic disease, growing disparities between rural and urban populations, the defectiveness of disease surveillance system, and disease outbreak response system have been pressing Chinese authorities for action. As this country has experienced an unprecedented economic growth along with an unparalleled development of health care system in the past 3 decades, the challenges ahead are unavoidably numerous and complex.
... The occurrence of infectious diseases is not only related to the source of infection, the route of transmission and the susceptible population, but is also affected by natural and social factors. Since the 1980s, China has undergone tremendous social changes [1,2], and the incidence of infectious diseases has changed considerably as a result of improvements in sanitary conditions and the nutritional status of the population, advances in diagnostic and therapeutic techniques, and the increased application of vaccines and drugs. By the year 2000, the incidence of infectious diseases in China had dropped significantly [3]. ...
Article
Background: Since the 1980s, China has undergone significant social change and the incidence of infectious diseases has also changed considerably. Here, we report the epidemiological features and changes in notifiable infectious diseases in China from 1986 to 2016 to explore the factors contributing to the successful control of infectious diseases and the challenges faced in the prevention and control of infectious diseases. Methods: The data of notifiable infectious diseases in China from 1986 to 2016 were collected from the monthly analysis report of the National Infectious Disease Surveillance System. Joinpoint regression models were used to examine incidence and mortality trends from 1986 to 2016. IBM SPSS Statistics version 22.0, Excel 2010 and R x64 3.5.2 were used for data analysis. Results: A total of 132 858 005 cases of notifiable infectious diseases were reported over these 31 years, with an average yearly incidence of 342.14/100 000. There were 284 694 deaths with an average yearly mortality rate of 0.73/100 000. The overall incidence and overall mortality of notifiable infectious diseases both showed a "U" distribution (ie, a decrease, stable, an increase, stable again). The top five diseases in terms of incidence were hand, foot and mouth disease, viral hepatitis, tuberculosis, other infectious causes of diarrhea and dysentery, accounting for 78.0% of all reported cases. The top five causes of death were HIV/AIDS, rabies, tuberculosis, viral hepatitis and epidemic encephalitis B, which accounted for 76.07% of all mortalities. The diseases with the top five fatality rates were rabies, H5N1, H7N9, HIV/AIDS and plague, with rates of 91.06%, 66.07%, 38.51%, 25.19% and 10.31%, respectively. Conclusions: This analysis will benefit the future monitoring of infectious diseases and public health measures in China.
... These issues include a lack of system-wide integration for the management of chronic diseases and over-utilization of tertiary health facilities due to factors such as the mistrust of primary care providers, who often have fewer years of formal medical training compared with hospital-based practitioners. [13][14][15] More than half of people with diabetes in China are unaware of their diagnosis, and even among those who are aware of their diagnosis, the level of control and management of diabetes is often inadequate. 4 5 Suboptimal diagnosis, treatment, and control of diabetes in China, aside from contributing to significant mortality and morbidity, also represent a major economic burden due to lost productivity 16 and inefficient healthcare expenditures. ...
Article
Objective: This study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults. Design and setting: Data from the China Health and Retirement Longitudinal Study, a nationally-representative panel survey of people aged 45 and over in China. Participants: Among participants with valid diabetes-related and hypertension-related medical history and biomarkers (n=8207), participants with diabetes (n=1318) were identified using biomarkers and self-reported medical history. Individual models were run using complete case analysis. Results: Among 1318 individuals with diabetes in 2011, 59.8% were unaware of their disease status. Diagnosis rates were significantly higher among participants with more generous public health insurance coverage (OR 3.58; 95% CI 2.15 to 5.98) and among those with other comorbidities such as dyslipidemia (OR 2.88; 95% CI 2.03 to 4.09). After adjusting for demographics, individuals with more generous public health insurance coverage did not have better glucose control at 4 years follow-up (OR 0.55; 95% CI 0.26 to 1.18) or fewer inpatient hospital admissions at 4 years (OR 1.29; 95% CI 0.72 to 2.33) and 7 years follow-up (OR 1.12; 95% CI 0.62 to 2.05). Individuals living in counties with better county-level primary care did not have better glucose control at 4 years follow-up (OR 0.69; 95% CI 0.01 to 33.36), although they did have fewer inpatient hospital admissions at 4 years follow-up (OR 0.03; 95% CI 0.00 to 0.95). Diabetes diagnosis was a significant independent predictor of both better glucose control at 4 years follow-up (OR 13.33; 95% CI 8.56 to 20.77) and increased inpatient hospital stays at 4 years (OR 1.72; 95% CI 1.20 to 2.47) and 7 years (OR 1.82; 95% CI 1.28 to 2.58) follow-up. Conclusions: These findings suggest that participants with diabetes are often diagnosed concurrently with other comorbid disease conditions or after diabetes-related complications have already developed, thus leading to worse health outcomes in subsequent years despite improvements in health associated with better primary care. These findings suggest the importance of strengthening primary care and insurance coverage among older adults to focus on diagnosing and treating diabetes early, in order to prevent avoidable health complications and promote healthy aging.
... Economic development and an increase in the aging population have heightened the demand for medical resources [16]. While China is in a period of rapid economic development, her large population, the polarization of the rich and the poor, the increase in the aging population, and the uneven distribution of medical resources have created complex problems in China's medical industry [17,18]. Rational allocation of medical resources and nding ways to improve treatment e ciency are two of the most pressing issues right now. ...
Preprint
Full-text available
Background: Due to economic development and an increase in the aging population, the demand for medical resources is increasing. A good doctor-patient relationship (DPR) can optimize patients’ medical experience and improve treatment efficiency. The DPR, however, is currently in crisis in China. To explore ways to improve DPR, this study assessed the views on the status of the DPR, medical services, and the general situation of medical work among medical personnel (MP) and the general population (GP). Methods: This cross-sectional study, conducted between December 2019 and March 2020, targeted the MP and the GP in Nanjing City, Jiangsu Province, and Zhengzhou City, Henan Province. A total of 154 MP and 329 GP answered a self-administered questionnaire through Questionnaire Star and WeChat apps. Wilcoxon's Sign Rank Test, Chi-square test, and frequency distributions and percentages were used to process the data. Results: Only 11.04% of the MP and 14.89% of the GP believed that the current DPR was harmonious. Moreover, 54.55% of the MP and 71.12% of the GP believed that the medical industry was a service industry. While 14.29% of the MP and 64.44% of the GP thought medical staff earned high salaries, 19.48% of the MP and 47.11% of the GP wanted their children to be in the medical industry. The recognition of the current status of the DPR did not affect the GP’s preference for their children's practice (p<0.05). Most MPs hoped to improve salaries (40.26%), followed by safety (17.53%) and social status (12.99%); only 8.44% of the MP wanted to improve the DPR. Conclusion: The MP’s and GP’s views on the current status of DPR, the importance of medical service attitudes, and the general sense of the medical industry were similar. However, there was a significant difference in the perception of the nature of medical services and the income of the people employed in the medical industry between the two groups. Balancing the expectations of patients in the medical industry and increasing public awareness of the actual situation in the medical industry may be a feasible way to improve the DPR.
... Economic development and an increase in the aging population have heightened the demand for medical resources [16]. While China is in a period of rapid economic development, her large population, the polarization of the rich and the poor, the increase in the aging population, and the uneven distribution of medical resources have created complex problems in China's medical industry [17,18]. Rational allocation of medical resources and nding ways to improve treatment e ciency are two of the most pressing issues right now. ...
Preprint
Full-text available
Background: Due to economic development and an increase in the aging population, the demand for medical resources is increasing. A good doctor-patient relationship (DPR) can optimize patients’ medical experience and improve treatment efficiency. The DPR, however, is currently in crisis in China. To explore ways to improve DPR, this study assessed the views on the status of the DPR, medical services, and the general situation of medical work among medical personnel (MP) and the general population (GP). Methods: This cross-sectional study, conducted between December 2019 and March 2020, targeted the MP and the GP in Nanjing City, Jiangsu Province, and Zhengzhou City, Henan Province. A total of 154 MP and 329 GP answered a self-administered questionnaire through Questionnaire Star and WeChat apps. Wilcoxon's Sign Rank Test, Chi-square test, and frequency distributions and percentages were used to process the data. Results: Only 11.04% of the MP and 14.89% of the GP believed that the current DPR was harmonious. Moreover, 54.55% of the MP and 71.12% of the GP believed that the medical industry was a service industry. While 14.29% of the MP and 64.44% of the GP thought medical stuff earned high salaries, 19.48% of the MP and 47.11% of the GP wanted their children to be in the medical industry. The recognition of the current status of the DPR did not affect the GP’s preference for their children's practice (p<0.05). Most MP hoped to improve salaries (40.26%), followed by safety (17.53%) and social status (12.99%); only 8.44% of the MP wanted to improve the DPR. Conclusion: The MP’s and GP’s views on the current status of DPR, the importance of medical service attitudes, and the general sense of the medical industry were similar. However, there was a significant difference in the perception of the nature of medical services and the income of the people employed in the medical industry between the two groups. Balancing the expectations of patients in the medical industry and increasing public awareness of the actual situation in the medical industry may be a feasible way to improve the DPR.
... Economic development and an increase in the aging population have heightened the demand for medical resources [16]. While China is in a period of rapid economic development, her large population, the polarization of the rich and the poor, the increase in the aging population, and the uneven distribution of medical resources have created complex problems in China's medical industry [17,18]. Rational allocation of medical resources and nding ways to improve treatment e ciency are two of the most pressing issues right now. ...
Preprint
Full-text available
Background: Due to economic development and an increase in the aging population, the demand for medical resources is increasing. A good doctor-patient relationship (DPR) can optimize patients’ medical experience and improve treatment efficiency. The DPR, however, is currently in crisis in China. To explore ways to improve DPR, this study assessed the views on the status of the DPR, medical services, and the general situation of medical work among medical personnel (MP) and the general population (GP). Methods: This cross-sectional study, conducted between December 2019 and March 2020, targeted the MP and the GP in Nanjing City, Jiangsu Province, and Zhengzhou City, Henan Province. A total of 154 MP and 329 GP answered a self-administered questionnaire through Questionnaire Star and WeChat apps. Wilcoxon's Sign Rank Test, Chi-square test, and frequency distributions and percentages were used to process the data. Results: Only 11.04% of the MP and 14.89% of the GP believed that the current DPR was harmonious. Moreover, 54.55% of the MP and 71.12% of the GP believed that the medical industry was a service industry. While 14.29% of the MP and 64.44% of the GP thought medical stuff earned high salaries, 19.48% of the MP and 47.11% of the GP wanted their children to be in the medical industry. The recognition of the current status of the DPR did not affect the GP’s preference for their children's practice (p<0.05). Most MP hoped to improve salaries (40.26%), followed by safety (17.53%) and social status (12.99%); only 8.44% of the MP wanted to improve the DPR. Conclusion: The MP’s and GP’s views on the current status of DPR, the importance of medical service attitudes, and the general sense of the medical industry were similar. However, there was a significant difference in the perception of the nature of medical services and the income of the people employed in the medical industry between the two groups. Balancing the expectations of patients in the medical industry and increasing public awareness of the actual situation in the medical industry may be a feasible way to improve the DPR.
Article
Full-text available
The study aimed to investigate the impact of motivation factors on an individual’s decision to choose Jordan as their primary tourism destination in the Middle East. The decision to choose Jordan as a medical destination will be analyzed based on factors, including government support; push engagement, and image perception. To this end, the study will gather data from 300 online individuals who have traveled to the Middle East for medical purposes. A qualitative approach will be adopted to provide insight into an individual’s preference for Jordan as the primary medical destination. A Partial Least Squares Structural Equation Modeling method was adopted, which allows for the creation of relations with different variables. The study’s findings indicate that people from rural areas in the Middle East preferred Jordan as a medical destination. Also, more women than men traveled to Jordan for medical purposes. Finally, more single people than married persons choose medical assistance in Jordan. Future studies are needed to ascertain how factors such as quality and cost influenced medical tourism into Jordan. AcknowledgmentsI would like to thank the Business School at Al Ahliyya Amman University, Jordan. Specifically, many thanks go to the departments of marketing.
Article
Objectives: To report the proportion and determinants of repeat induced abortions in China. Methods: Cross-sectional data were collected of 79 954 women who received an induced abortion from 297 hospitals across 30 Chinese provinces in 2013, using a stratified cluster sampling design. Logistic and Poisson regression models were fitted to identify characteristics associated with repeat abortion. Putative factors included age, household registration (hukou) status, marital status, education, occupation, reproductive history, and current contraceptive practices. Results: Of all abortions, 65.2% were repeat induced abortions. The proportion of repeat abortions varied substantially across provinces, from 36.9% in Qinghai to 85% in Hubei. The strongest factors associated with repeat induced abortion were being older than 40 years (adjusted odds ratio [ORadj ] 7.0, 95% confidence interval [CI] 6.2-7.9), divorced or widowed (ORadj 2.1, 95% CI 1.6-2.7), and using oral contraceptives (ORadj 2.1, 95% CI 1.9-2.3). Conclusion: A high proportion of repeat induced abortion was observed across many Chinese provinces, highlighting the need to reduce the incidence of unwanted pregnancy. Several sociodemographic and clinical factors were found to be significantly associated with repeat abortions and should be considered in post-abortion family planning services.
Conference Paper
In the digital age, the structure of global economy has been transformed; the healthcare system has also changed. By reviewing the history and statistical data of China healthcare system, and evaluating them in a global realm, this paper reveals the fact that medical system development in China still falls behind the world average level, which doesn’t coordinate with its economic and urbanization development. The main reasons are deficiency of financial expenditure, medical institutions and health care workers, which is hard to be improved within a short time. Therefore, local governments have adopted Smart Healthcare System to meet the people’s demand in health care. Cases include Smart healthcare card, new health insurance policy and the cloud hospital were introduced, Following by the review However, this paper also indicates the limitations of these smart methods, and presents a holistic medical service system-planning framework. From predictive urban planning to responsive urban governance, the whole process of smart healthcare system could be realized by big data analysis and local legislation establishment, therefore making planning decisions more rational and feasible.
Chapter
Health care systems ideally include universal access to comprehensive prepaid medical care along with health promotion and disease prevention. National health insurance and national health services of various models have evolved in the developed world and increasingly in developing countries as well. Some models, such as the Bismarckian social security model and the Bereidge National Health Service model, or National Health insurance such as in pioneered in Canada, are used by a number of countries. The common features are based on principles of national responsibility and solidarity for health, social solidarity for providing funding and searching for effective ways of providing care. Various universal systems of health coverage exist in all industrialized countries, except in the United States which has a mix of public and private insurance but with high percentages of uninsured and poorly insured. Health reform is a continuing process as all countries aspire to assure health care for all. Aging populations, increasing costs, advancing and increasing technology all require nations to modify and adapt organization and financing systems of health care, health protection and promotion.
Article
Research on medical practice that uses big data has attracted considerable attention recently. In this paper, we focused on a large set of patient referral data gathered in Fujian province, China, between 2009 and 2011. We built a directed weighted patient referral network. By using four metrics from network science, namely, the power-law distribution, global rich-club coefficient, local rich-club coefficient, and assortativity coefficient, we identified a significant rich-club phenomenon in this network. In addition, the community detection was also carried out to find the relationship between rich members and non-rich members. The findings indicate an oligopoly in which Class-III hospitals occupy an overwhelmingly dominant position over the competition. Also, the characteristic ‘significant regional clustering’ was inferred from the results.
Thesis
Demographic worldwide trends shows the survival of rurality, characterized by a dynamic of poverty, precarious living conditions and regional inequality. On Colombian context, these trends is added with the limited access to health services. Therefore, to make an approach to the dynamics of access to health services for rural populations, It make a study mixed composed by two methodological moments, first, documentary research, allowed to demonstrate the main indicators of condition assessment access to health services and theoretical approaches of this problem in different contexts to Colombian. The second moment, exploratory, descriptive and cross-sectional determined the conditions of use of health services in an institution of the public hospital network on Boyacá during the years 2008-2012. This research showed that it requires a differentiated look rurality to develop public policy, to be consistent with the context and needs of the communities that require health services.
Chapter
Health-related sectors have become increasingly strategic for the structural change that the Chinese government is pursuing. After a brief sketch of the institutional setting, the chapter first illustrates the main health policies, that is the major reforms that China has undertaken with respect to the provision of healthcare and to the financing of healthcare services. Then, the analysis summarises main policies for the health industry, that is the strategic guidelines and the specific interventions targeting health-related manufacturing sectors, with specific reference to the biotechnology industry, traditional Chinese medicine (TCM) and the pharmaceutical sector. The chapter ends with a zoom on the latter, with a specific focus on the restructuring process which has characterised the industry in the last decades by means of mergers and acquisitions.
Article
In low- and middle-income countries, social health insurance schemes are the main focus of efforts to achieve universal health coverage (UHC) by promoting access to health care and financial protection. Problems with financial protection in China are caused mainly by health insurance fragmentation and a rapid rise in medical expenditure. In this context, China implemented a policy of direct settlement of intra-provincial medical reimbursement in 2014. We evaluated the impact of the policy on financial protection with a population aged 45 and above based on the China Health and Retirement Longitudinal Study from 2011 to 2018. We estimated the policy effects using the difference-in-differences method, based on coarsened exact matching. We found that the policy significantly reduced the catastrophic health expenditures (CHEs) rate by approximately 10% in the population, whether middle-aged or elderly. Subgroup analyses indicated that middle-aged and elderly people living in western China and with lower household incomes received greater protection from the policy. The CHEs rate for the two age groups in western China was reduced by 16.26% and 20.12%, respectively. The CHEs rate was reduced by 24.51% and 17.32% for middle-aged individuals in the lowest and second household income quartiles, respectively, and by 21.31% for older adults in the second household income quartile. The new rural cooperative medical scheme exerted a smaller protective effect than urban medical insurance among the participants aged 60 and older. We found that in addition to optimizing health insurance schemes, more health care reform measures, such as adopting more efficient payment methods and rationalizing medical expenditures, should be combined to help reduce health inequities and accelerate progress toward achieving UHC and the Sustainable Development Goals.
Article
Full-text available
Beginning in 1978, China implemented economic reforms to transform the economy to a free-market system. We compared the effect of the reforms on the growth of children in urban and rural areas. Using data from five large cross-sectional surveys conducted between 1975 and 1992, we examined the trends in height for age of children two to five years of age in urban and rural areas. Mean height for age was expressed as the height in centimeters adjusted to a reference value of 99.1 cm for a 42-month-old boy. Height increased before and during the economic reforms. In 1975, the average height of children in periurban rural areas was about 3.5 cm less than that of children in urban areas. Between 1975 and 1985, the average height of children in periurban rural areas increased by 2.0 cm, as compared with 1.3 cm in urban children. Between 1987 and 1992, the average height of both urban and rural children increased, but the net increase for rural children was only one fifth that for urban children (0.5 vs. 2.5 cm). In a 1990 survey of seven provinces, the rural mean height was 92.5 cm, as compared with the urban mean of 96.9 cm and the reference value of 99.1 cm; 38 percent of rural children had moderate stunting of growth and 15 percent had severe stunting, as compared with 10 percent and 3 percent of urban children, respectively. Differences in height between rural and urban children were greater in provinces in which the average height of children was lower. Despite an overall improvement in child growth during the economic reforms in China, the improvement has not been equitable, as judged by increased differences in height between rural and urban children and increased disparities within rural area.
Chapter
China's outstanding health achievements before the 1980s and rapid economic growth over the past decade are well documented. Less well known, however, is the impact of the transition from a socialist to a market economy on overall health development and equity in health and health care. This chapter presents an analysis of inequities in health in China, covering inter-regional and gender inequities in adult life expectancy at an individual and an ecological level. It addresses the overarching question of whether economic growth has yielded improved health status for all, or only for some. The chapter ends with a consideration of the policy implications of their findings.
Article
I t is the nature of epidemics to be unpredictable. People want answers to some important questions: How serious is severe acute respiratory syndrome (SARS)? Will SARS be contained in Toronto, or Singapore, or China? How far will it spread and how rapidly? What can the global community do to prevent
Article
As a result of China's transition to a socialist market economy, its rural health services have undergone many of the changes commonly associated with health sector reform. These have included a decreased reliance on state funding, decentralisation of public health services, increased autonomy of health facilities, increased freedom of movement of health workers, and decreased political control. These changes have been associated with growing inequality in access to health services, increases in the cost of medical care, and the deterioration of preventive programmes in some poor areas. This paper argues that the government's strategy for addressing these problems has overemphasised the identification of new sources of revenue and has paid inadequate attention to factors that influence provider behaviour. The strategy also does not address contextual issues such as public sector employment practices and systems of local government finance. Other countries can learn from China's experience by taking a systematic approach to the formulation and implementation of strategies for health sector reform.
Article
Why do health systems matter? -- How well do health systems perform? -- Health services: well chosen, well organizad? -- What resources are needed? -- Who pays for health system? -- How is the public interest protected?
Article
China's rural people, who comprise 80 per cent of its population, have in the past been served by grossly inadequate numbers of health-care personnel. Rural medical services were massively expanded as a result of the Great Proletarian Cultural Revolution, which began in 1965. As part of this expansion, agricultural workers are trained to meet rural needs for environmental sanitation, health education, immunization, first aid, and some aspects of primary care and post-illness follow-up; there are now said to be over a million such "bare-foot doctors." Their formal training period is brief, and continued on-the-job education is stressed. Analogous health workers include "worker doctors" in China's factories and "Red Guard doctors," who are housewives serving as physicians' assistants in urban neighborhood health stations. The development of these categories of workers and their training illustrate some of the principles on which current Chinese health services are based.
Article
In the late 1970s China launched its agricultural reforms which initiated a decade of continued economic growth and significant transformation of the Chinese society. The agricultural reforms altered the peasants' incentives, weakened community organization and lessened the central government's control over local communities. These changes largely caused the collapse of the widely acclaimed rural cooperative medical system in China. Consequently China experienced a decreased supply of rural health workers, increased burden of illnesses, disintegration of the three tier medical system, reduced primary health care, and an increased demand for hospital medical services. More than ten years have elapsed since China changed its agricultural economic system and China is still struggling to find an equitable, efficient and sustainable way of financing and organizing its rural health services. The Chinese experiences provided several important lessons for other nations: there is a need to understand the limits of the market forces and to redefine the role of the government in rural health care under a market economy; community participation in and control of local health financing schemes is essential in developing a sustainable rural health system; the rural health system needs to be dynamic, rather than static, to keep pace with changing demand and needs of the population.
Article
This paper examines the changes in equality of health and health care in China during its transition from a command economy to market economy. Data from three national surveys in 1985, 1986, and 1993 are combined with complementary studies and analysis of major underlying economic and health care factors to compare changes in health status of urban and rural Chinese during the period of economic transition. Empirical evidence suggests a widening gap in health status between urban and rural residents in the transitional period, correlated with increasing gaps in income and health care utilization. These trends are associated with changes in health care financing and organization, including dramatic reduction of insurance cover for the rural population and relaxed public health. The Chinese experience demonstrates that health development does not automatically follow economic growth. China moves toward the 21st century with increasing inequality plaguing the health component of its social safety net system.
Article
This paper analyzes the distortion effects of the hospital pricing policies in China. To help maintain equitable access to hospital services, the Chinese government regulates prices of hospital services, and provides subsidies to public hospitals. Comparing the regulated fees of selected hospital services with their average unit costs indicates that the average cost-recovery rate of the fees is only 50%. The fees for 90% of the services are less than their average unit costs, while the fees for the high-tech services exceed their costs. Moreover, the State Price Commission allowed a drug profit margin of 15-20% over the wholesale price. The distorted fee schedule affects the behaviour of hospitals. Empirical evidence revealed problems of violation of price regulations (charging a fee exceeding the regulated fee), over-provision of profitable high-tech services and over-prescription of drugs. The Chinese experience shows that low regulated fees cannot reduce the economic burden on patients, and that distorted medical fees can result in distorted service provision and low efficiency of medical resources. Strategies to correct for the price distortions are discussed.
Financing health care: issues and options for China World Bank
  • World Bank
Mortality data of the Chinese population]. Beijing: the Chinese Population Press
  • Y Huang
  • Y Liu
A decade of China's economic reform: challenges for the future Center for Strategic and International Studies
  • P Hartland-Thunberg
Guidelines for reforming the rural healthcare system]. Beijing: State Council
  • State Council
SARS – a global threat, a global response. (EU Council of Health Ministers' Meeting.) Available from: http://www.who.int
  • Gh Brundtland
Guidelines for reforming the urban health and pharmaceutical sectors]. Beijing: State Council
  • State Council
The health impact of economic development and reform
  • S Hu
The national rural health conference was convened in Beijing
  • HB Yin