The outbreak of a novel coronavirus disease
BackgroundChina is in the process of integrating the new cooperative medical scheme (NCMS) and the urban residents’ basic medical insurance system (URBMI) into the urban and rural residents’ basic medical insurance system (URRBMI). However, how to integrate the financing policies of NCMS and URBMI has not been described in detail. This paper attempts to illustrate the differences between the financing mechanisms of NCMS and URBMI, to analyze financing inequity between urban and rural residents and to identify financing mechanisms for integrating urban and rural residents’ medical insurance systems.MethodsFinancing data for NCMS and URBMI (from 2008 to 2015) was collected from the China health statistics yearbook, the China health and family planning statistics yearbook, the National Handbook of NCMS Information, the China human resources and social security statistics yearbook, and the China social security yearbook. “Ability to pay” was introduced to measure inequity in health financing. Individual contributions to NCMS and URBMI as a function of per capita disposable income was used to analyze equity in health financing between rural and urban residents.ResultsURBMI had a financing mechanism that was similar to that used by NCMS in that public finance accounted for more than three quarters of the pooling funds. The scale of financing for NCMS was less than 5% of the per capita net income of rural residents and less than 2% of the per capita disposable income of urban residents for URBMI. Individual contributions to the NCMS and URBMI funds were less than 1% of their disposable and net incomes. Inequity in health financing between urban and rural residents in China was not improved as expected with the introduction of NCMS and URBMI. The role of the central government and local governments in financing NCMS and URBMI was oscillating in the past decade.ConclusionsThe scale of financing for URRBMI is insufficient for the increasing demands for medical services from the insured. The pooling fund should be increased so that it can better adjust to China’s rapidly aging population and epidemiological transitions as well as protect the insured from poverty due to illness. Individual contributions to the URBMI and NCMS funds were small in terms of contributors’ incomes. The role of the central government and local governments in financing URRBMI was not clearly identified. Individual contributions to the URRBMI fund should be increased to ensure the sustainable development of URRBMI. Compulsory enrollment should be required so that URRBMI improves the social medical insurance system in China.
Studies examining the trends in public trust in physicians have provided a considerable amount of valuable policy implications for policymakers compared with cross-sectional studies on this topic in many countries. This study investigated changes in public trust in physicians in China based on two cross-sectional national surveys conducted in 2011 and 2016 and identified the determinants of these changes. The results indicated 83.4% of respondents in 2011 reported trust or strong trust in physicians in China, which decreased to 64.2% by 2016. The results of ordinal logistic regression demonstrated that public trust in physicians in China had decreased significantly from 2011 to 2016 (P< 0.001) after adjusting for other independent variables. Self-reported health status, self-rated happiness, and self-identified social class were all associated positively with public trust in physicians in China. The results also confirmed that decreasing public satisfaction with the most recent treatment experience was the major determinant of decreasing public trust in physicians in China. The findings of this study suggest that decreasing public trust in physicians deserves considerable attention from national policymakers and that improving satisfaction with treatment experiences would be the most effective strategy for enhancing public trust in physicians in China.
Background The outbreak of COVID 19in December 2019 spread quickly and overwhelmed the local healthcare system of the epicenter. A total of 346 medical assistance teams with 42,600 reserve medics were mobilized from around the country for emergency assistance. This study aims to examine the incidence of mental health symptoms and predictors of Post-Traumatic Stress Disorders (PTSD) symptoms among the reserve medics working in Wuhan, the capital city of Hubei Province. Methods An anonymous survey was conducted from April 4–6, 2020 among the medics upon their returning home. A total of 225 surveys were returned with a response rate of 83%. The survey consisted of questionnaires about the medics' demographic information, social relations, mental health status (e.g. IES-R and DASS-21) and other work-related information. Mann-Whitney U Test, Kruskal-Wallis Test and hierarchical logistic regression models were used to examine the predictors of PTSD symptoms. Results During the stay in Wuhan, the medics experienced high levels of depression (46.7%), anxiety (35.6%) and stress symptoms (16.0%). Upon returning home, the overall prevalence of clinically concerned PTSD symptoms was as high as 31.6%. Further analyses revealed that PTSD symptoms and its subscales were significantly associated with age, collegial relationship and mental health status during their service. Conclusion The reserve medics reported a high prevalence of depression, anxiety and stress as well as clinically concerned PTSD symptoms. Comprehensive screening and intervention programs should be in place to help reserve medics cope with mental health challenges and build resilience during the COVID 19 pandemic.
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