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Home care poverty is the inability of older people to access adequate home care services and their unmet needs for home care. With the increasing number of older adults (60 years old and above) with disability in China, the Chinese government pays more and more attention to home care. In this case, it is of great significance to explore whether older adults with the disability face home care poverty and its influencing factors. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018 were utilized. SPSS 22.0 was used as a data analysis tool to conduct descriptive statistics and multiple logistic regression analysis on the sample (n = 1932). The study found that in 2018, 48.0% of older adults with disability faced home care poverty. Multiple logistic regression results showed that degree of disability, age, rural and non-eastern regions, income poverty, family caregiver, and reluctant caregivers were positive factors that increased the risk of home care poverty in disabled older adults (p < 0.05). But care duration, care expenditure, social pensions insurance, community daily life care and community medical services are the positive factors to eliminate the home care poverty for older adults with disability (p < 0.05). In order to solve the problem of home care poverty of older adults with disability, based on the research conclusions, the study proposed to establish a long-term care insurance system, formulate supportive policies for family caregivers or their families, and establish a wide variety of community care services.

Background: Timely and effective removal of respiratory secretions is of great significance for tracheotomized patients. The purpose of this study is to investigate the effectiveness of capsaicin nebulization to stimulate cough to promote early clearance of respiratory secretions in tracheotomized patients after hemorrhagic stroke. Method: This study implemented a randomized controlled design. Sixty-three patients who were tracheotomized following a hemorrhagic stroke completed this randomized controlled trial. In the control group, 33 cases were given a routine care after tracheotomy. In the intervention group, 30 cases were given a capsaicin solution nebulization in addition to the routine care. The daily sputum output and the number of sputum suctioning were observed. The differences in sputum viscosity, cough function, and Clinical Pulmonary Infection Score (CPIS) were compared between the two groups before and after the intervention. Vital sign changes during capsaicin nebulization and suctioning were compared between the two groups in a pilot study. Results: The daily sputum output of the capsaicin intervention group was significantly higher than that of the control group (p < 0.05). The number of sputum suctioning of capsaicin group was less than that of the control group after intervention (p < 0.05). The CPIS score of the capsaicin group was lower than that of the control group (p < 0.05) after a 1-week intervention. Patients' heart rate, respiratory rate, and oxygen saturation during capsaicin nebulization were not statistically different from those during routine sputum suctioning (p > 0.05). Conclusions: Capsaicin atomization-induced cough can effectively promote sputum excretion of hemorrhagic stroke patients undergoing tracheotomy and has a good safety profile. The Clinical Trial registration number of this study is ChiCTR2000037772 (http://www.chictr.org.cns).

This article presents an explanation to the paradox of why increased household incomes in rural areas in China are accompanied by decreased motivation for consumption. The empirical analysis shows a reduction in rural residents' consumer spending with the exception of spending on medical treatment and education. This effect is stronger in poor families or families with school-aged children. The authors argue that motivation for consumption has been sinking in rural areas in China because income inequality among the rural populations has stimulated spending on improving human capital to promote individual security and social mobility as a chance to squeeze into the middle class.

Since the late 1970s, special education in the People's Republic of China has experienced significant reform and fast development. However, education for children with severe developmental disabilities, especially autism spectrum disorders (ASDs), is still the greatest challenge in the field. This paper aims to give readers an overview of what is happening to children with ASDs in China. We first address the issue of prevalence of ASDs, and then offer an introduction to the diagnostic process. After that, a review of disability-related legislation is provided, followed by a description of current treatment options and available educational services. Finally we introduce all extent service providers and their roles.

China's oldest old population is estimated to quadruple by 2050. Yet, poverty rate for the oldest old has been the highest among all age groups in China. This paper investigates the relationship between economic stress, quality of life, and mortality among the oldest-old in China. Both objective economic hardships and perceived economic strain are examined. We base our investigation on data drawn from the Chinese Longitudinal Healthy Longevity Survey conducted between 2000 and 2005. Our sample includes 10,972 men and women between the ages of 80 and 105 in 2000. The data show that about 16% of these oldest-old lived under economic stress in 2000. The risk factors that make one vulnerable to economic stress include age, being male, being widowed or never married, being a minority member, having no education, having no living children, and not having children as main source of income, and having no pension. Economic stress is negatively associated with indicators of quality of life, such as the quality of medical care and mental well-being. The poor quality of life contributes to the higher mortality rate for the oldest old who are under economic stress. Results also show that perceived economic strain increases the risk of mortality by 42% in rural areas, even after controlling for basic demographic characteristics, life style factors, and major health events. For the rural oldest-old, having children as a main source of income and having access to pension alleviates the negative impact of economic hardship on mortality hazard by 23 and 66% respectively. However, in urban areas, economic stress has no direct impact on the hazard of mortality.

Based on data gathered through a household survey of 1,474 urban residents in Beijing, this study examines Chinese help-seeking behaviors in times of psychological distress and perceived barriers to seeking professional help. The results demonstrate that most respondents rely on informal means of seeking help whereas mental health and medical services are underused. The Internet has become a preferred alternative help-seeking approach, particularly among the young educated migrant population. Respondents with higher socioeconomic status are more likely to utilize professional services. The tendency to seek help informally is associated with refusal to recognize the need of professional help, whereas embarrassment and stigma are significant factors in the use of alternative services, particularly the Internet. In addition to showing a general lack of trust in professional mental health services, the more psychologically distressed subgroup also expressed concerns about the affordability of professional treatment. (Contains 6 tables.)

The patients receiving treatment from a hospital need to interact with multiple entities when claiming reimbursements. The complexities of the medical service supply chain can be simplified with an electronic clearance management system that allows hospitals, medical insurance bureau, bank, and patients to interact in a seamless and cashless manner. This case describes the implementation of such a system for the medical insurance bureau of Xiamen. Although the architecture was simple, the implementation faced a number of challenges. Although there were both organizational and technical challenges, the problems of co-ordination and communication between the different teams tended to dominate the process of implementation. The project leader was faced with the decision of prioritizing the complex challenges, and finding out ways to overcome them. (Contains 1 table and 6 figures.)

In this study, the authors analyze the dynamic relationship between Chinese women's education, their utilization of newly available medical pregnancy care, and their infants' mortality risk. China has undergone enormous social, economic, and political changes over recent decades and is a novel context in which to examine the potential influence of social change and technological innovation on health disparities. The authors consider efficacy, or the ability to quickly absorb and effectively utilize new medical innovations, and argue that the social stratification of efficacy provides an important conceptual link between education and the greater likelihood of benefitting from medical innovations. Using the 2001 National Family Planning and Reproductive Health Survey data and multilevel, multiprocess models, the authors show that Chinese infants born to better educated mothers retained a survival advantage over the turbulent decades between 1970 and 2000. This occurs largely because educated mothers more actively sought prenatal care and professional delivery assistance use. (Contains 5 tables and 2 notes.)

It has been noted that workplace violence most frequently occurs in hospitals. The purpose of this study was to explore antecedents of workplace violence in south China. The authors conducted face-to-face, in-depth, semistructured interviews with 30 hospital staff who had experienced at least one incident of workplace violence from patients during the past 12 months at three general hospitals in south China. The interviews were tape-recorded, then transcribed, and analyzed. The authors' analyses identified five major antecedents of workplace violence. First, 93.0% of medical workplace violence was related to insufficient communication between hospital staff and patients. Second, inadequate medical service quality was found to be a factor in 56.7% of the incidences. Third, unsatisfactory treatment outcome was reported in 60.0%. Fourth, heavy workload accounted for 43.3%. Fifth, patient frustration due to high medical expenses was reported in 40.0% of cases. The authors recommended a reengineering of hospital service delivery to create a more supportive and safer working environment for prevention of workplace violence. (Contains 2 tables.)

This study aims to establish evidence-based data to explore the perceptions and experience of primary care physicians in the Pap smear screening provision for women with intellectual disabilities (ID), and to analyze the associated factors in the delivery of screening services to women with ID in Taiwan. Data obtained by a cross-sectional survey by a structured, self-administered questionnaire (12 perceptional issues), and were posted to all primary care settings (N = 168) which provided Pap smear tests for women with ID in Taichung and I-Lan counties in Taiwan, Republic of China during the period of 2009. The vital primary care physician of each healthcare setting was the main respondent of the questionnaire. Finally, there were 69 valid questionnaires returned, giving a response rate of 41.7%. The main findings showed that 72.5% medical care settings provide Pap smear services and 51.5% have practical experience on conducting the tests for women with ID. Among the respondents, nearly 90% primary care physicians expressed that women with ID need Pap smear test regularly. With regard to the associated factors in the delivery of Pap smear screening services to women with ID. The study found that experienced healthcare settings in Pap smear tests for women with ID were more likely to be in public healthcare settings, felt confident in providing screening tests, having a rapid screening program and having a reminding follow-up system. Those respondents felt necessity in Pap smear test for women with ID were more likely to express it is needed to set up a special screening clinic for this group of women. The present study suggests that women with ID need thoughtful, well-coordinated care from primary care physicians, to increase access to health care providers may be helpful in improving Pap screening tests for this population. (Contains 3 tables.)

The Three Assistances and One Alleviation Plan issued in 2006 is an expansion of the Western China Program issued in 2003. Voluntary services in agricultural, educational, and medical areas by college graduates are organized through the implementation of this policy. The plan aims to recruit 20,000 graduates per year and has provided more detailed incentive measures for volunteers upon the completion of their services. This policy reflects the collaborative efforts of various ministries of the state government in developing western China through the educational effort of building human talents.

A course has been created to examine the ways in which China and the West have approached human health and medicine. Though fundamentally different, these two systems are complementary in a number of ways. This course is a model for a global science course in an educational initiative that incorporates Asian themes into science and engineering courses. The course is designed around an active-learning platform that has as major components: team research projects, oral presentations, role play, and peer-review. The students investigate concepts of scientific proof, clinical efficacy, and the functional structure of two very different systems of health and medical care. (Contains 4 tables.)

It has been only in the past decade that autism has been widely recognized among Chinese service providers. As a result, there are few professionals who are trained to treat the disorder. Although efforts are currently under way to determine the prevalence of autism in China, to date there are no reliable data that indicate the magnitude of the problem. There are no formalized education programs for children with autism and only a handful of treatment programs in larger city hospitals and private schools. Treatments range from herbal medicines and acupuncture to sensory integration training and, in rare instances, applied behavior analysis (ABA). This article provides an update on what is taking place in China for autism treatment, and the challenges that lie ahead as the Chinese Ministry of Education struggles to address the needs of children identified with the disorder.

Chinese families (n=101) from two settings (urban and rural) responded to the Family Needs Survey describing life with a child with disabilities. Findings indicated that information was the most pressing need followed by financial help and help locating a doctor. Type of impairment and setting were related to need expression. (Author/DB)

This is part I of a two-part annotated bibliography of selected references on medical education in the People's Republic of China. The references date from 1925 to 1983. Most of the references are from the 1970's. (RH)

Reports on a faculty exchange program between Seton Hall University and the Hangzhou School of Nursing in Zhejiang, China. Discusses the differences in medical treatment and learning strategies between the two countries. (JOW)

The comprehensive medical care system being utilized in China is described. Topics discussed include: the availability of medical care, training of physicians, medical care costs, and the political and social implications of the Chinese system. Lessons the United States can learn from the Chinese experience are presented. (BT)

Few studies have analyzed the acceptance of home/community-based medical and elderly care services in China. Therefore, we conducted a cross-sectional study to describe the acceptance of five services among people aged ≥ 45 years in the China mainland, and their influencing factors. The data were obtained from the database China Health and Retirement Longitudinal Study 2018. For each service, a binary logistics regression was adopted. A total of 9719 people were included, of whom 20.12% received services. The numbers of recipients (acceptance rates) of the five services, namely, comprehensive aged care services, regular physical examinations, onsite visits, health management, and entertainment, were 107 (1.10%), 1640 (16.87%), 323 (3.32%), 156 (1.61%), and 245 (2.52%), respectively. About 4% of people had received two or more services. The elderly aged 65–74 and those who were satisfied with the local medical services had higher acceptance of services. Urban hukou having health insurance, two or more chronic diseases, provincial economic welfare, and social welfare were positively associated with the acceptance of regular physical examination services. It is suggested that the government should gradually improve satisfaction with local medical services, and pay more attention to the needs of elderly people aged 65–74 for all kinds of home/community-based medical and elderly care services. [ABSTRACT FROM AUTHOR]

Blockchain can be used to build a peer-to-peer, secure, and smart transaction system. As a horizontal technology that has changed several fields of industry, blockchain has tremendous potential to transform healthcare systems as well. In this article, a systematic review is conducted to critically evaluate 64 articles on blockchain-based healthcare systems, published between 2016 and January 2020 in 21 conferences, 33 journals, and ten online sources. The aim of this article is to answer three main questions. First, what are the applications of blockchain in the healthcare systems, and what are the structures and challenges of applying blockchain to a specific healthcare domain? Second, what are the technical, temporal, and spatial aspects of the currently developed blockchain applications for different healthcare domain? Third, what are the future research directions in designing and implementing blockchain-based healthcare systems? Statistical facts about the technical aspects of these 64 articles show that most of the proposed blockchain-based healthcare systems use private blockchain and Ethereum platforms; furthermore, the majority of the authors are affiliated with research institutions in the USA and China. We also discuss potential future research directions, e.g., integrating the blockchain in artificial intelligence based solutions, cloud-computing-based solutions, and parallel blockchain architecture. [ABSTRACT FROM AUTHOR]

Introduction: Residents' satisfaction with medical services has commonly been treated as both a medical and psychosocial process. The influence of psychosocial factors on residents' satisfaction with medical treatment is generally considered as important as that of medical factors. However, the effect of individual social capital on residents' satisfaction after medical treatment-an important psychosocial variable that may influence health status and access to medical services-has not received sufficient attention. Methods: This study used the questionnaire survey data of urban residents in eight Chinese cities in 2014 to investigate how individual social capital affects residents' satisfaction with medical services over the past year. Results: The results revealed a negative impact of individual social capital on residents' overall satisfaction with medical services. In addition, the use of individual social capital significantly improved residents' satisfaction with medical resources and significantly reduced residents' satisfaction with the medical system. Moreover, the negative impact of individual social capital on residents' overall satisfaction with medical services was greater for individuals with a lower likelihood of using this capital, which may lead to unequal allocation of medical resources and long-term life satisfaction. Discussion: The heterogeneous impact and mechanism of individual social capital on residents' satisfaction with medical services was confirmed under the premise of self-selection bias. [ABSTRACT FROM AUTHOR]

Equitable and high-quality medical services are more urgent in underdeveloped cities for the higher population ageing and demanding social justice. However, there is little attention paid to the multi-level medical services, particularly regarding the time indicators under the latest policies for underdeveloped cities. The improved efforts were hampered partly by single scenario of location optimization, ignoring the integrated optimization for both road infrastructure and institution location. Toward the healthy China 2030 and rural revitalization policy, this study systematically investigated medical services for underdeveloped cities by constructing a multi-level evaluation and multi-scenario optimization framework with Geographical Information System technology in a case study of Xuchang City in China. Following the time goals from the latest policies, the services of high-quality hospitals and primary health centers were multi-level evaluated by network analysis method and further optimized through multi-scenario involving different new multi-level medical facilities and roads. Driven by urban-rural inequalities, candidate facilities were first selected based on multi-source data and then determined by location‑allocation analysis method, while new roads were assumed by space syntax method. The improvement rose rapidly and finally slowly with the increasing number of candidates. Few new roads and facilities could be more suitable, and the priority was explored under the local economy and planning. The findings could provide valuable support for urban healthy development under the latest policies., (© 2024. The Author(s).)

Background: Price levels of medical services may vary across regions with different income levels, which would raise concerns about the equal access to medical services. This study aimed to estimate the spatial price index of medical services to measure price levels across 31 provincial regions in China., Methods: Price data were collected from medical service price schedule in each region. Two methods based on the Purchasing Power Parities were used to estimate the spatial price index and measure price differences across regions. The two-way fixed effects models were used to examine the association between medical service price levels and income levels, and further investigate the impacts of price differences on utilization of medical services and medical expenditure., Results: The consistent estimation results were given by two methods. Medical service price level in the highest-price region was found to be 74% higher than the lowest. There was a significant negative correlation between price levels and income levels, as well as price levels and the utilization of outpatient services. Moreover, we also found a 1% increase in medical service price level was significantly associated with a 0.34% and 0.24% increase in the medical service expense per outpatient visit and per inpatient respectively., Conclusions: Regions in China had significant gaps in medical service price levels. Policymakers should pay more attention to regional price differences and take great measures such as enhancing financial protection to ensure the equal access to medical services and better achieve the universal health coverage., (© 2024. The Author(s).)

Background: China's rural population is immense, and to ensure the well-being of rural residents through healthcare services, it is essential to analyze the resources of rural grassroots healthcare institutions in China. The objective is to examine the discrepancies and deficiencies in resources between rural grassroots healthcare institutions and the national average, providing a basis for future improvements and supplementation of rural healthcare resources., Methodology: The study analyzed data from 2020 to 2022 on the number of healthcare establishments, the capacity of hospital beds, the number of healthcare professionals, and the number of physicians in both rural and national settings. Additionally, it examined the medical service conditions and ratios of township health centers in rural areas to assess the resource gap between rural areas and the national average., Results: Healthcare establishments: On average, there were 2.2 fewer healthcare institutions per 10,000 persons in rural areas compared to the national average over three years. Hospital beds: On average, there were approximately 36 fewer hospital beds per 10,000 persons in rural areas compared to the national average over three years. Healthcare professionals and physicians: On average, there were about 48 fewer healthcare technical personnel and 10 fewer practicing (including assistant) physicians per 10,000 persons in rural areas compared to the national average over three years., Conclusion: Compared to the national average, there are significant discrepancies and deficiencies in grassroots healthcare resources in rural China. This underscores the necessity of increasing funding to progressively enhance the number of healthcare institutions in rural areas, expand the number of healthcare personnel, and elevate medical standards to better align with national benchmarks. Improving rural healthcare resources will strategically equip these institutions to cater to rural communities and effectively handle public health emergencies. Ensuring that the rural population in China has equal access to healthcare services as the rest of the country is crucial for promoting the well-being of rural residents and achieving health equity., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang.)

Cross-border services and support are becoming an increasingly important part of Hong Kong's social policy because an increasing number of its older citizens are choosing to live in mainland China. Unfortunately, with the recent outbreak of COVID-19, medical services for cross-border older adults have been blocked due to strict immigration controls. This article examines the effects of COVID-19 on these older adults, with a specific focus on the interruption of medical services and the remedial measures taken by the government and non-governmental organizations. It also discusses the prospect of delivering care for cross-border older people using telemedicine, which is considered one of the most important methods for overcoming space-distance and reducing the risk of cross-contamination caused by close contact. [ABSTRACT FROM AUTHOR]

Background: To evaluate the performance of medical service for patients with breast cancer in Henan Province, China, using diagnosis related groups (DRGs) indicators and to provide data to inform practices and policies for the prevention and control of breast cancer.Methods: The data were collected from the front pages of medical records (FPMR) of all hospitals above class II that admitted breast cancer patients in Henan Province between 2016 and 2019. Breast cancer patients were the subjects in our study. China DRGs (CN-DRGs) was used as a risk adjustment tool. Three indicators, including the case mix index (CMI), number of DRGs, and total weight, were used to evaluate the range of available services for patients with breast cancer, while indicators including the charge efficiency index (CEI), time efficiency index (TEI) and inpatient mortality of low-risk group cases (IMLRG) were used to evaluate medical service efficiency and medical safety.Results: Between 2016 and 2019, there were 103,760 patients with breast cancer. The total weight increased over the study period at an average annual rate of 21.71%. The TEI decreased over the study period by 15.60%. The CEI exhibited an increasing trend, but the average annual rate of increase was small (2.94%). The IMLRP was 0.02, 0, 0 and 0.01% in 2016, 2017, 2018 and 2019, respectively.Conclusion: The performance of medical service improved between 2016 and 2019 for breast cancer patients discharged from study hospitals in Henan Province. The main area of improvement was in the range of available services, but medical institutions must still make efforts to improve the efficiency of medical services and ensure medical safety. DRGs is an effective evaluation tool. [ABSTRACT FROM AUTHOR]

Facing the increasingly severe aging situation, China has started to implement the "integrated medical services and elderly care (IMSEC)" policy, which covers a variety of IMSEC models. However, there is currently little research on middle-aged and elderly people's choice preference for these IMSEC models and their associated factors. Through the face-to-face questionnaire method, the choice preference of middle-aged and elderly people aged 45 years and over in Zhejiang Province, China, to the IMSEC model is explored. Through the multinomial logistic regression model, the influencing factors of choice preference are analyzed. A total of 1034 people are included in 2022. Their choice preference for the 4 major types of IMSEC models are Home IMSEC model (48.07%), Community IMSEC model (23.79%), Institutional IMSEC model (21.76%), and Internet Plus IMSEC model (6.38%). "C1. Home elderly care and contracted with a family doctor" is the most chosen subtype, accounting for 34.53%. The rural elderly are more likely to choose "Home IMSEC model" (OR(95%CI) = 2.977(1.343-6.601)). Elderly people with relatively large life care needs are more likely to choose "Institutional IMSEC model" (OR(95%CI) = 1.114(1.042-1.190)). Moreover, age, education, and self-reported health status are also influencing factors of choice preference. The government should focus on promoting the development of the "Home IMSEC model" and increase the promotion of "Internet Plus IMSEC model." In addition, the life care service capacity and spiritual comfort capacity of IMSEC institutions, as well as the medical service capacity of the community, need to be enhanced., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Consent for PublicationThe authors declare no conflict of interest.

Abstract In healthcare service systems, patients are not always served in the order they arrive, but are ranked with respect to their relative "importance" and "urgency" to the service system. We consider such a system where elective admission requests backlogged on a list wait to be assigned inpatient beds. To consolidate the performance of Classified Diagnose and Treatment in China, determining an optimal admission priority assignment policy for all waiting patients is vital. It is a complicated multi-criteria decision making (MCDM) problem involving both qualitative and quantitative criteria. Evaluating the admission priority of each patient is based on vague information or uncertain data in which significant dependence and feedback between the evaluation dimensions and criteria may exist. This paper applies a hybrid MCDM model that integrates the 2-tuple DEMATEL technique and the fuzzy VIKOR method to the elective admission control problem. It makes use of the modified 2-tuple DEMATEL to determine the relative weights of the evaluation criteria and the fuzzy VIKOR method to assess the alternatives (waiting patients) over the criteria. An empirical case in West China Hospital is presented to demonstrate the applicability of the proposed approach. Sensitivity analysis of the results by the proposed hybrid MCDM model and comparative analysis with other different approaches are presented. The results show that the proposed model is effective and provides insightful implications for hospital managers to refer. [ABSTRACT FROM AUTHOR]

Urban areas usually display better health care services than rural areas, but data about suburban areas in China are lacking. Hence, this cross-sectional study compared the utilization of community basic medical services in Shanghai urban and suburban areas between 2009 and 2014. These data were used to improve the efficiency of community health service utilization and to provide a reference for solving the main health problems of the residents in urban and suburban areas of Shanghai. Using a two-stage random sampling method, questionnaires were completed by 73 community health service centers that were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistics, principal component analysis, and forecast analysis were used to complete a gap analysis of basic health services utilization quality between urban and suburban areas. During the 6-year study period, there was an increasing trend toward greater efficiency of basic medical service provision, benefits of basic medical service provision, effectiveness of common chronic disease management, overall satisfaction of community residents, and two-way referral effects. In addition to the implementation effect of hypertension management and two-way referral, the remaining indicators showed a superior effect in urban areas compared with the suburbs (P<0.001). In addition, among the seven principal components, four principal component scores were better in urban areas than in suburban areas (P = <0.001, 0.004, 0.036, and 0.022). The urban comprehensive score also exceeded that of the suburbs (P<0.001). In summary, over the 6-year period, there was a rapidly increasing trend in basic medical service utilization. Comprehensive satisfaction clearly improved as well. Nevertheless, there was an imbalance in health service utilization between urban and suburban areas. There is a need for the health administrative department to address this imbalance between urban and suburban institutions and to provide the required support to underdeveloped areas to improve resident satisfaction. [ABSTRACT FROM AUTHOR]

This study aimed to locate the contributing factors of Catastrophic Health Expenditure (CHE), evaluate their impacts, and try to propose strategies for reducing the possibilities of CHE in the context of China’s current public health insurance system. The financial data of all hospitalization cases from a sample hospital in 2013 were gathered and used to determine the pattern of household medical costs. A simulation model was constructed based on China’s current public health insurance system to evaluate the financial burden for medical service on Chinese patients, as well as to calculate the possibilities of CHE. Then, by adjusting several parameters, suggestions were made for China’s health insurance system in order to reduce CHE. It’s found with China’s current public health insurance system, the financial aid that a patient may receive depends on whether he is from an urban or rural area and whether he is employed. Due to the different insurance policies and the wide income gap between urban and rural areas, rural residents are much more financially vulnerable during health crisis. The possibility of CHE can be more than 50% for low-income rural families. The CHE ratio can be dramatically lowered by applying different policies for different household income groups. It’s concluded the financial burden for medical services of Chinese patients is quite large currently, especially for those from rural areas. By referencing different healthcare policies in the world, applying different health insurance policies for different income groups can dramatically reduce the possibility of CHE in China. [ABSTRACT FROM AUTHOR]

Background: China’s universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China. Methods: Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic payments and seeking-care choices for UMIS beneficiaries were selected to measure the affordability and medical service flow of patients after the implementation of UMIS. Results: China’s UMIS was established in 2008. After that, the trending increase of the expenditure of the UMIS was higher than that of increase in revenue compared to previous years. Up to 2014, the UMIS had covered 97.5% of the entire population in China. After introduction of the UMIS, there were significant increases in licensed physicians, nurses, and hospital beds per 1000 individuals. In addition, hospital outpatient visits and inpatient visits per year increased compared to the pre-UMIS period. The average fatality rate of inpatients in the overall hospital and general hospital and the average fatality rate due to acute myocardial infarction (AMI) in general hospitals was significantly decreased. In contrast, no significant and prospective changes were observed in rural physicians per 1000 individuals, inpatient visits and inpatient fatality rate in the community centers and township hospitals compared to the pre-UMIS period. After 2008, the rates of catastrophic payments for UMIS inpatients at different income levels were declining at three levels of hospitals. Whichever income level, the rate of catastrophic payments for inpatients of Urban Employee’s Basic Medical Insurance was the lowest. For the low-income patients, a single hospitalization at a tertiary hospital can lead to catastrophic payments. It is needless to say what the economic burden could be if patients required multiple hospitalizations within a year. UMIS beneficiaries showed the intention of growth to seek hospitalization services in tertiary hospitals. Conclusions: Introduction of the UMIS contributed to an increase in available medical services and the use thereof, and a decrease in fatality rate. The affordability of UMIS beneficiaries for medical expenses was successfully ameliorated. The differences in patients’ affordability are mainly manifested in different medical insurance schemes and different seeking-care choices. The ability of the poor patients covered by UMIS to resist catastrophic medical payments is still relatively weak. Therefore, the current UMIS should reform the insurance payment model to promote the integration of medical services and the formation of a tiered treatment system. UMIS also should establish supplementary medical insurance packages for the poor. [ABSTRACT FROM AUTHOR]

Objective: To understand whether the increased outpatient service provision (OSP) brings in enough additional income (excluding income from essential medicine) for primary hospitals (INCOME) to compensate for reduced costs of medicine. Methods: The two outcomes, annual OSP and INCOME for the period of 2008–2012, were collected from 34,506 primary hospitals in 2,675 counties in 31 provinces in China by the national surveillance system. The data had a four-level hierarchical structure; time points were nested within primary hospital, hospitals within county, and counties within province. We fitted bivariate five-level random effects regression models to examine correlations between OSP and INCOME in terms of their mean values and dose-response effects of the essential medicine policy (EMP). We adjusted for the effects of time period and selected hospital resources. Findings: The estimated correlation coefficients between the two outcomes’ mean values were strongly positive among provinces (r = 0.910), moderately positive among counties (r = 0.380), and none among hospitals (r = 0.002) and time (r = 0.007). The correlation between their policy effects was weakly positive among provinces (r = 0.234), but none at the county and hospital levels. However, there were markedly negative correlation coefficients between the mean and policy effects at -0.328 for OSP and -0.541 for INCOME at the hospital level. Conclusion: There was no evidence to suggest an association between the two outcomes in terms of their mean values and dose-response effects of EMP at the hospital level. This indicated that increased OSP did not bring enough additional INCOME. Sustainable mechanisms to compensate primary hospitals are needed. [ABSTRACT FROM AUTHOR]

Background and aim: The doctor–patient relationship has been a major focus of society. Hospitals’ efforts to improve the quality of their medical services have been to reduce the probability of doctor–patient conflicts. In this study, we aimed to determine the gap between expectations and perceptions of service quality according to patients to provide reference data for creating strategies to improve health care quality. Methods: Twenty–seven hospitals in 15 provinces (municipalities directly beneath the central government) were selected for our survey; we sent out 1,589 questionnaires, of which 1,520 were collected (response rate 95.65%) and 1,303 were valid (85.72% effective recovery rate). Paired t-tests were used to analyze whether there were significant differences between patients' expectations and perceived service quality. A binary logistic regression analysis was used to determine whether there were significant differences in the gap between expectation and perception of service quality according to patients' demographic characteristics. Results: There was a significant difference between the expected and perceived service quality (p < 0.05) according to patients both before and after receiving medical services. Furthermore, the service quality gap of each service dimension was negative. Specifically, the gaps in service quality were as follows: economy, responsiveness, empathy, assurance, reliability, and tangibles. Overall, we can conclude that patients’ perceptions of service quality are lower than their expectations. Conclusions: According to the study results, the quality of health care services as perceived by patients was lower than expected. Hospitals should make adjustments according to the actual situation and should strive to constantly improve the quality of medical services for patients. [ABSTRACT FROM AUTHOR]

Background: Price differences of medical services across regions may affect equity in health financing. This study aimed to estimate the spatial price index of medical services to measure price levels across regions in the Yangtze River Delta, China., Methods: Gini-Éltetö-Köves-Szulc method and minimum spanning tree method based on the purchasing power parities were used in this study., Results: According to the Gini-Éltetö-Köves-Szulc method, Shanghai and Anhui province had price levels that are 127.55% and 103.45% respectively of the price level in Zhejiang province, whereas in Jiangsu medical services were priced at 92.71% of that in Zhejiang province. The spatial price index of medical services in the Yangtze River Delta based on the minimum spanning tree method provided similar results., Conclusions: Regions in the Yangtze River Delta had significant gaps in medical services price levels. And the price levels tended to not correlate with socioeconomic levels. It is necessary to promote the regional coordination of medical services price and better achieve equity in health., (© 2023. The Author(s).)

Background: In July 2017, the first affiliated hospital of Sun Yat-sen university carried out the world's first case of ischemia-free liver transplantation (IFLT). This study aimed to evaluate the performance of medical services pre- and post-IFLT implementation in the organ transplant department of this hospital based on diagnosis-related groups, so as to provide a data basis for the clinical practice of the organ transplant specialty., Methods: The first pages of medical records of inpatients in the organ transplant department from 2016 to 2019 were collected. The China version Diagnosis-related groups (DRGs) were used as a risk adjustment tool to compare the income structure, service availability, service efficiency and service safety of the organ transplant department between the pre- and post-IFLT implementation periods., Results: Income structure of the organ transplant department was more optimized in the post-IFLT period compared with that in the pre-IFLT period. Medical service performance parameters of the organ transplant department in the post-IFLT period were better than those in the pre-IFLT period. Specifically, case mix index values were 2.65 and 2.89 in the pre- and post-IFLT periods, respectively ( p  = 0.173). Proportions of organ transplantation cases were 14.16 and 18.27%, respectively ( p  < 0.001). Compared with that in the pre-IFLT period, the average postoperative hospital stay of liver transplants decreased by 11.40% (30.17 vs. 26.73 days, p  = 0.006), and the average postoperative hospital stay of renal transplants decreased by 7.61% (25.23 vs.23.31 days, p  = 0.092). Cost efficiency index decreased significantly compared with that in the pre-IFLT period ( p  < 0.001), while time efficiency index fluctuated around 0.83 in the pre- and post-IFLT periods ( p  = 0.725). Moreover, the average postoperative hospital stay of IFLT cases was significantly shorter than that of conventional liver transplant cases ( p  = 0.001)., Conclusion: The application of IFLT technology could contribute to improving the medical service performance of the organ transplant department. Meanwhile, the DRGs tool may help transplant departments to coordinate the future delivery planning of medical service., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lu, Lin, Xiong, Pang, Zhang, Xin, Li, Shen, Chen and Zhang.)

The level of medical services is the link between the two strategic goals of "healthy China" and "common prosperity," and government participation plays an important adjustment role in it, so it is of great theoretical and practical significance to study its inner logic. In this paper, we firstly analyze the mechanism of medical service level to promote the development of common prosperity and the role of government in it; secondly, we construct a panel dynamic regression model and a threshold regression model to verify the relationship between the three. It is found that the contribution of both equity and efficiency of health care services to the achievement of common wealth is non-linear, and the degree of government participation plays an important adjustment role, with single and double threshold effects between them and the level of common prosperity, respectively. In the process of participating in the medical service market, the government should clearly position itself, actively play the demand-led role of the market, encourage private capital to provide quality medical services, and purposefully optimize the financial expenditure structure according to the local actual situation. There are many ways in which the government can be involved in health care, and there will be differences between China and other countries around the world. These are all worthy of further discussion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chen and Zhang.)