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In 2003, China launched a heavily subsidized voluntary health insurance program for rural residents. We analyze factors affecting enrollment and combine differences-in-differences with matching methods to obtain impact estimates. We use data collected from program administrators, health facilities and households. Enrollment is lower among poor households, and higher among households with chronically sick members. The scheme has increased outpatient and inpatient utilization (by 20-30%), but has had no impact on out-of-pocket spending or on utilization among the poor. The program has increased ownership of expensive equipment among central township health centers but has had no impact on cost per case.

Inbound tourist arrivals into China have been declining in recent years, possibly in response to increasing levels of urban air pollution. To examine Westerners' contemporary views on China as a travel destination, with a particular focus on air pollution, this research surveyed 600 US and Australian residents. An online panel survey collected data on cognitive and affective destination image, cognitive and affective risk perceptions, intention to visit China and key demographic variables. The findings show that, while China's cognitive image attributes were perceived positively, potential travelers expressed negative views about travel risks in China in general and about air quality in particular. Importantly, feelings towards the risk of air quality had a significant negative impact on destination image as well as intention to visit China. The research contributes to theory by highlighting the importance of considering affective risk perceptions in destination image studies. While some market segments seemed less sensitive to air pollution than others, this paper concludes that unless China proactively addresses the problem of air pollution, for example by seeking to stimulate positive feelings, international arrivals may continue to be compromised.

ObjectiveVerbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems.MethodsA literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification.FindingsA revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach.ConclusionsThe revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.