Background: Equity is one of the major goals of China's new medical reforms launched in 2009. This study aimed to analyze the disequilibrium in primary health care (PHC) workforce among various economic zones in China and to compare the fairness between urban and rural areas since the implementation of the new medical reforms.Method: According to China's 11th Five-Year Plan, China is divided into eight economic regions. The data of this study were obtained from China Statistical Yearbook 2009-2016. The Atkinson index was used to depict the trend of PHC workforce fairness; the Gini coefficient was used to compare the fairness of workforce distribution between urban and rural areas; the health resource agglomeration degree was used to analyze the distributional equity of the workforce in the eight regions; and the Theil Index was used to compare the fairness of urban and rural workforce distribution across eight regions.Result: The Atkinson index indicated that the equity of the entire PHC workforce allocation had generally improved during the new medical reforms; the Gini coefficient indicated that the fairness of the entire workforce allocation had improved in cities, but only the nurse allocation became fairer in rural areas. The agglomeration degree and the Theil index indicated that the fairness gaps across the eight regions were still large. These analyses differed from previous studies where China was divided into western, central and eastern regions. In what was previously defined as eastern region, the northeast was under-resourced, while the eastern coastal areas were observing a resource surplus. In western region, we found that the fairness in the northwest was significantly worse than southwest.Conclusion: In China, the distribution of healthcare workforce has been improved with continuous effort. The gaps in the distribution of PHC workforce across different economic regions and between urban and rural areas are still large, with different regions facing different problems. The government should consider the population and geographical factors in allocation of PHC workforce, especially nurses.

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Background Elder people aged ≥45 years often have more healthcare needs than the younger. But the Chinese elderly are less likely to see a doctor when ill. In this article, this phenomenon is abbreviated as “not see a doctor”. This study aimed to describe the reason distribution of“not see a doctor” among the Chinese elderly. Specifically,we examined the reasons why“not see a doctor” happened to the Chinese elderly with different characteristics. Methods In order to explore the associations between various predisposing, enabling and need factors and “not see a doctor” in China, this cross-sectional study used the data from the 2015 wave 4 of the China Health and Retirement Longitudinal Study (CHARLS). Using multivariate analyses, associations between “not see a doctor” and factors were accessed. Models were estimated using a binary model with negative log-log link function (cases versus controls) and multinomial logit analysis (reasons for “not see a doctor”). Results Adjusted by individual weight, the analysis included 16,277 people aged ≥45 years, of whom 11% reported “not see a doctor”. Overall, those with older age, other marital status (except married) and poorer health status were more likely to report “not see a doctor”. No significant associations were found between income and “not see a doctor”. The majority of cases report “no need” as the reason for their “not see a doctor”. Except reason “no need”, factor associated with the healthcare system—cost—accounted for the most case of “not see a doctor”. Those without health insurance are more likely not to see a doctor due to affordability issues. Conclusions This quantitative study suggests that “not see a doctor” is more likely to happen due to age and marital status issues, especially affordability issues. For China, it is important to enforce the policy of reducing of healthcare fees and increasing health insurance coverage.

To investigate the influence of the home environment, defined as family socioeconomic status (SES) (parent education level, household income), student resource-mediated SES (access to nutritional resources and cognitively stimulating experiences), reading ability, and difficulty with homework on quality of life in children and adolescents residing in urban and suburban areas in Hangzhou City, Zhejiang Province, China. This study included 3200 Grade 3–6 students from 8 elementary schools in Hangzhou City. Assessments included questionnaires that evaluated student quality of life, family SES, resource-mediated SES (dietary behavior and the home literacy environment), reading ability, and difficulty with homework. The effects of the home environment on student quality of life were analyzed by univariate analysis, multiple linear regression analysis, and structural equation modeling. Overall, 80.6% of students had a medium or better quality of life. Young age (Grade 3 or 4), female sex, household income of 10000–15000 RMB, high breakfast consumption, daily intake of fruit, a balanced diet, and good reading habits were positively correlated with student quality of life (P < 0.05), while overuse of electronic devices was negatively correlated with quality of life (P < 0.05). Dietary behaviors, home literacy environment, and student reading ability and difficulty with homework directly affected quality of life. Family SES indirectly affected student quality of life. Children and adolescents in China should have access to good nutrition and cognitively stimulating experiences to enhance their well-being and provide them with social and academic advantages.

Purpose: In China, the coronavirus disease 2019 (COVID-19) pandemic has been under control and entered the normal prevention and control stage. For medical college students, many studies have analyzed their knowledge, risk perception, and prevention behaviors of COVID-19, but only a few pieces of research explore the content structure of COVID-19 risk perception and the influencing factors. This study measured the students' risk perception of COVID-19 and its dimensions and analyzed the influencing factors of risk perception among them.Methods: The online questionnaire survey was conducted at Hangzhou Medical College in Zhejiang Province among undergraduates and junior college students. A scale was formulated to precisely measure and analyze the COVID-19 risk perception among medical college students. The factors affecting the COVID-19 risk perception in medical college students were analyzed using the multivariate linear regression model.Results: A total of 810 medical students participated in the survey. Results show that COVID-19 risk perception among medical college students was divided into four dimensions: perceived health threat, perceived severity, perceived controllability, and perceived infection possibility. The results showed that income, education, major, and COVID-19 knowledge were the important factors affecting the COVID-19 risk perception of medical college students. Related factors have different influences on the various dimensions of COVID-19 risk perception. COVID-19 knowledge was significantly related to all dimensions of risk perception.Conclusion: This study evaluates the content structure of medical college students' risk perception of COVID-19 precisely and related influencing factors. It is necessary to grasp the risk perception, prevention, and control behaviors of medical college students of different backgrounds, education levels, and majors. Further knowledge training should be conducted for students majoring in clinical medicine, especially the pandemic prevention and control measure training to enhance their sense of security at work.

Medical resource allocation is an increasingly crucial issue. It is vital to understand residents’ (people living in the local area) evaluation of it. This study explores residents’ evaluation of medical resource allocation and its determinants with the dimensions of medical resource adequacy, balance, publicness, and accessibility. We used data from the China General Social Survey (CGSS). Binary logistic regression models were constructed from the four dimensions separately, and we compared the differences among them. The study’s results showed that accessibility and publicness are the highest and lowest dimensions of residents’ evaluation, respectively. The high evaluation of social equity may be a positive contributor to a higher evaluation of publicness and accessibility. The central region residents had the lowest evaluation of adequacy (OR = 0.697, p = 0.010) and balance (OR = 0.642, p = 0.008). To sum up, perceived social equity, social trust, and social class are crucial factors. Based on the results, the government should strengthen the supervision of the medical market, increase financial support for the health field in the central region, and establish a multi-level medical security system that may help optimize the allocation.

There is relatively little published on the socioeconomic distribution of chronic disease burden in older people. This study aims to quantify income-related inequalities in chronic disease situation among ≥45-year-old people in China. Data were collected from the 2015 China Health and Retirement Longitudinal Study. Self-reported chronic conditions included 14 diseases (ie, heart problem, diabetes). Multivariate Generalized Quasi-Poisson Regression was used to evaluate associations between prevalence and personal income. Prevalence of hypertension was highest among people above ≥ 75 (male participants 44.41%, female participants 47.53%). Heart problem prevalence increased with age. Chronic disease prevalence among population aged 45 to 59 years was greatly affected by income. Prevalence ratios (PRs) were highest for heart problems in 45 to 59 middle-income male participants and for memory-related diseases in 45 to 59 middle-income female participants. Significant inequalities in chronic conditions prevalence persist into old age, particularly among 45- to 59-year-old people. Opposite to developed countries, the prevalence of some chronic disease (ie, heart problem) is higher in richer populations in China. These findings pose the policy challenge of needing to prevent such inequalities in older years.

PurposeThis paper aims to evaluate the prevalence of self-medication and its associated factors among the Chinese elderly. Also, according to whether the elderly communicate with doctors (no matter before or after self-medication), we aimed to categorize self-medication and explore the associated factors.MethodsIt was a cross-sectional study. Data were derived from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). According to whether communicate with doctors or not, self-medication was reclassified as “self-medicate and NOT communicating with a doctor,” and “self-medicate and communicate with a doctor.” A binary logistic regression was used to identify which elderly were more likely to self-medicate, and a multinomial logistic regression was applied to explore the associated influencing factors of self-medication classifications.ResultsA total of 17,445 individuals aged ≥45 years were enrolled. The prevalence of self-medication was 58.60%. Self-medication was strongly associated with sex, education level, pension, self-reported general health status, chronic illness, satisfaction with local medical services, and three province-level socioeconomic welfare variables. About 19.64% of self-medication populations had communicated with a doctor. Higher education level and younger age were significantly associated with a higher probability of “self-medication and communication with a doctor.”ConclusionThe prevalence of self-medication among the Chinese elderly is increasing over the year. Health education on appropriate medication use targeting elder adults with low education levels is highly recommended. The typology of self-medication and its factors are new research entry points and could be meaningful for future studies.