BackgroundAlthough the community health service system is now established in China, the utilisation of the community health service institutions is low due to the lack of a gate-keeping role of the primary health service providers and referrals among the three-tiered health service institutions. In addition to this, patients who can afford to pay, often seek best services in big hospitals to guarantee the quality of care. Thus, the need of guiding the patients to the community health services and increasing the utilisation of the community health service institutions is becoming an urgent problem, which hinders the future development of community health services. This study focuses on the question of how to increase the utilisation of Chinese community health centres (HCs).MethodsA cross-sectional Base-line Survey of Chinese City Community Health Service System Building using the multi-staged cluster sampling was conducted to collect data from all HCs in 28 key contact cities. Relevant indicators of totally 1790 HCs were analysed. The statistical methods included ANONVA and logistic regression.Results and ConclusionsThe analysis suggested several key factors for increasing the outpatient workload (OW) at the HCs: establishing an adequate referral system among the different levels of the health system; enhancing the qualification of health personnel and increasing the compensation by the health insurance for services provided at HCs. Other key factors with a positive effect on the OW included: the government ownership of the HCs, the scale of the institutions, the medical equipment used, the mix of health services provided, and the women in childbearing age in the residence.
Background: Workplace violence against healthcare workers is a global issue that is on the rise, with Chinese healthcare workers facing growing challenges with hospital violence. Attacks on medical staff have increased in recent years with no clear resolution. Prior research focused on policies to improve the doctor-patient relationship and better protect clinicians, but few studies addressed the patient perspective. This paper examines patients' choices when facing a medical dispute and identifies groups who are more likely to respond to conflict with violence or other serious actions.Methods: Patient survey responses were collected in 12 leading public hospitals in five Chinese provinces with 5556 participants. The survey asked sociodemographic information, patients' attitudes (e.g., general optimism, trust in their physicians, perceived healthcare quality), and their primary response to a medical dispute. From least to most severe, the options range from "complaining within the family" to "violence." We used t-tests and Chi-square tests to explore the relationships between reactions and patient characteristics. We also performed multivariable logistic regressions to determine the impact of sociodemographics and provider trust on the seriousness of responses. Results: The primary response of a third of respondents was complaining to hospital or health department officials (32.5%). Seeking legal help (26.3%) and direct negotiation with doctors (19.6%) were other frequent responses. More serious responses included 83 stating violence (1.5%), 9.7% expressing a desire to expose the issue to the news media, and 7.4% resorting to seeking third-party assistance. Patients who were more likely to report "violence" were male (OR = 1.81, p < .05), high-income earners (OR = 3.71, p < .05), or reported lower life satisfaction (OR = 1.40, p < .05). Higher trust scores were associated with a lower likelihood of a serious response, including violence (OR = 0.80, p < .01).
Objective We investigated the level of physician trust in China and how it is influenced by various demographic factors. MethodsWe surveyed 12 public hospitals from which inpatients were randomly selected using hospitalization ID and outpatients were selected using census sampling to participate in the interview. Trust in physicians was measured using the Chinese version of Wake Forest Physician Trust Scale. Mixed-effects and logistic models were employed to study correlates of trust. ResultsThe distribution of scale mean was left skewed, which implied a subpopulation bearing low levels of trust towards physicians. Respondents who were male, young, outpatients, unsatisfied with their life status, had high levels of education and income, and paid less attention to their health were prone to be less satisfied with their physicians. ConclusionsThe level of physician trust in China is lower compared to studies in western countries. We also found demographic factors related with significantly lower physician trust, which may help policymakers identify potential target subpopulations and be more specific with their efforts to improve patient-physician relationships.
BackgroundChina has become the world‘s second largest healthcare market based on a recent report by the World Health Organization. Eventhough China achieved universal health insurance coverage in 2011, representing the largest expansion of insurance coverage in human history achieved; health inequality remains endemic in China. Lessons from the effect of market crisis on health equity in Europe and other places has reignited interest in exploring the potential healthcare market aberrations that can trigger distributive injustice in healthcare resource allocation among China’s provinces. Recently, many healthcare investors in China have become more concerned about capital preservation, and are responding by abandoning long term investments strategies in healthcare. This investment withdrawal en mass is perceived to be influenced by herding tendencies and can trigger or consolidate endemic health inequality.MethodsOur study simultaneously employs four testing models (two state spaced models and two return dispersion models) to establish the existence of procyclical (herding) behavior among the stocks and its health equity implications. These are applied to a large set of data to compare and contrast results of herd formation among investors in fourteen healthcare sectors in China.ResultsThe study reveals that apart from the cross sectional standard deviation (CSSD) model, the remaining two models and our augmented state space model yields significant evidence of herding in all subsectors of the healthcare market. We also find that the herding effect is more prominent during down movements of the market.ConclusionHerding behavior may lead to contemporaneous loss of investor confidence and capital withdrawal and thereby deprive the healthcare sector of the much needed capital for expansion. Thus there may be obvious delay in efforts to bridge the gap in access to healthcare facilities, medical support services, medical supplies, pharmaceuticals, biotechnology, diagnostic substances, medical laboratory and advanced medical equipment across China. Moreover, a potential crash in the healthcare market is possible in the healthcare sector as a result of persistent herding tendencies among investors and that may have more damaging consequences for health inequality in China.
BackgroundFor decades the development of community health services has been emphasized in China to cope with the growing burden of chronic diseases by providing basic medical services. This survey aims at investigating factors associated with the use of Community Health Centers (CHCs) for the management of hypertensive patients in Chengdu, China.MethodsWe used a systematic sampling method to select 2,030 patients with hypertension or diabetes registered in 29 CHCs in Chengdu in 2007. Researchers interviewed patients who consented to participate at their home. This paper reports findings from the survey of 1,716 hypertensive patients with completed questionnaires. Univariate analyses and multiple logistic regression analyses were conducted to explore factors influencing the use of CHCs for the management of hypertensive patients.Results81.4% of hypertensive patients regularly used CHCs for hypertension monitoring and treatment in Chengdu. Univariate analyses indicated that use of CHCs was associated with the education level, occupation, types of medical insurance, Body Mass Index(BMI), patients' knowledge on hypertension, awareness of CHCs functions, satisfaction of the service of CHCs. Multiple regression analyses found that use of CHCs was positively associated with the following factors: the Urban Resident Basic Medical Insurance(URBMI), knowledge on blood pressure, awareness of the sites in CHCs to measure blood pressure, awareness of having to take life-long antihypertensive medicine once the treatment started, awareness of the health records registration in CHCs, regular follow up, improved convenience of seeing doctor. Patients with professional job were less likely to use the services of CHCs.ConclusionsThe use of CHCs for hypertension management could be increased by improving residents' knowledge on the monitoring and treatment of hypertension, and the awareness of CHCs functions. The CHCs could play an important role in providing medical care to low-income, unemployed and other disadvantaged patients with hypertension.
This study examined effects of the treatment-before-deposit policy on Chinese patients' trust in physicians and perceived service quality. This study included 3313 patients recruited from 12 hospitals in China. The research team used cross-sectional survey to examine Chinese patients' experience with the treatment-before-deposit policy, perceived service quality, and trust in their physicians. Using mediation analysis, we estimated direct and indirect effects of the treatment-before-deposit policy on patients' perceived service quality and trust in their physicians. Patients who benefitted from the treatment-before-deposit policy reported greater service quality and higher trust in their physicians. The impacts of whether patients benefitted from the policy on trust in physicians were fully mediated by perceived service quality with statistically significant indirect effect. The results support the hypothesis that the treatment-before-deposit policy improves patients' perceived service quality and trust in physicians.
Traditional clinical mode of enhanced external counterpulsation is not targeted for different diseases. Specialized strategies in the treatment of enhanced external counterpulsation for coronary heart disease and cerebral ischemic stroke are supposed to be distinguished. The goal of treatment for coronary heart disease is diastolic blood pressure/systolic blood pressure = Q ≥ 1.2 after counterpulsation, while the goal of treatment for cerebral ischemic stroke is the improvement of mean arterial pressure. A computational lumped parameter model was established for the simulation of hemodynamic effect of enhanced external counterpulsation on two diseases. Vessel collapse was considered during the simulation of counterpulsation. Based on different pressurized and decompressed rate, pressurized moment, pressure duration, and pressure amplitude, different counterpulsation modes were applied to the model and the immediate hemodynamic effects were compared. Results showed that the pressure duration and pressure amplitude had most influence on two diseases. For cerebral ischemic stroke, the longer pressure duration and the higher pressure amplitude of thighs, the higher mean arterial pressure; while for coronary heart disease, the value of Q was highest when the pressure end moment was 0.6 s during a 0.88-s cardiac cycle, and Q had a linear increase in the pressure amplitude of buttocks, but little change with the increase of calves and thighs pressure amplitude. For patients with coronary heart disease, the pressure duration was not supposed to be too long to avoid the increase of systolic blood pressure, and the improvement of pressure amplitude of buttocks could promise a positive treatment effect for coronary heart disease. While for patients with cerebral ischemic stroke, both the long pressure duration of each part and the high pressure amplitude of thighs could result in the systolic blood pressure and diastolic blood pressure have a certain increase, thus promoting the maximum mean arterial pressure and a best treatment. Graphical abstract The specialized treatment strategies of EECP for cardiovascular and cerebrovascular disease.
To understand key factors that drive China’s green fodder supply, this study estimates a Nerlovian partial-adjustment model, using provincial-level panel data spanning two decades (1997–2016). Based on a set of explanatory variables selected by the LASSO (Least Absolute Shrinkage and Selection Operator) method, estimation of the Nerlovian model by the system-GMM (Generalized Method of Moments) method yields three key findings. First, while farmers’ previous cultivation decisions on green fodder supply strongly predict their current decisions, without the influence of other drivers, China’s green fodder supply tends to decline over time. Second, among the identified drivers, government policy plays the most significant role—the availability of subsidies for cultivation of green fodder crops raises the sown area of green fodder crops by more than 30 percent. In contrast, farmer’s sown-area decision is only modestly responsive to price incentives. Finally, while the stock of fixed capital inputs (e.g., number of combine harvesters) and natural disasters (e.g., floods) both affect green fodder supply, their impacts are small.
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