The cost of coverage: rural health insurance in China.
(17/13273)
China has undergone great economic and social change since 1978 with far reaching implications for the health care system and ultimately for the health status of the population. The Chinese Medical Reform of the 1980s made cost recovery a primary objective. The urban population is mostly protected by generous government health insurance. A high share government budget is allocated to urban health care. Rural cooperative health insurance reached a peak in the mid-1970s when 90% of the rural population were covered. In the 1980s rural cooperative health insurance collapsed and present coverage is less than 8%. The decline has been accompanied by reports of growing equity problems in the financing of and access to health care. This article is the first in a four-year study of the impact on equity of the changes in Chinese health care financing. The article examines the relationship between rural cooperative health insurance as the explanatory variable and health care expenditure, curative vs. preventive expenditure and tertiary curative care expenditure as dependent variables using a natural experimental design with a 'twin' county as a control. The findings support the hypothesis that cooperative health insurance will induce higher growth of health care expenditure. The findings also support the hypothesis that cooperative health insurance will lead to a shift from preventive medicine to curative medicine and to a higher level of tertiary curative care expenditure. The empirical evidence from the Chinese counties is contradicting World Bank health financing policies. (+info)
Health human resource development in rural China.
(18/13273)
China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas. (+info)
Determinants of patient choice of medical provider: a case study in rural China.
(19/13273)
This study examines the factors that influence patient choice of medical provider in the three-tier health care system in rural China: village health posts, township health centres, and county (and higher level) hospitals. The model is estimated using a multinomial logit approach applied to a sample of 1877 cases of outpatient treatment from a household survey in Shunyi county of Beijing in 1993. This represents the first effort to identify and quantify the impact of individual factors on patient choice of provider in China. The results show that relative to self-pay patients, Government and Labour Health Insurance beneficiaries are more likely to use county hospitals, while patients covered by the rural Cooperative Medical System (CMS) are more likely to use village-level facilities. In addition, high-income patients are more likely to visit county hospitals than low-income patients. The results also reveal that disease patterns have a significant impact on patient choice of provider, implying that the ongoing process of health transition will lead people to use the higher quality services offered at the county hospitals. We discuss the implications of the results for organizing health care finance and delivery in rural China to achieve efficiency and equity. (+info)
Eradication of schistosomiasis in Guangxi, China. Part 3. Community diagnosis of the worst-affected areas and maintenance strategies for the future.
(20/13273)
Reported are the results of a community-based assessment of maintenance of schistosomiasis eradication in Guangxi, a large autonomous region of China with a population of 44 million. Eradication of the disease was achieved in 1989 in Guangxi but maintenance costs are rising. We focused on three counties that had the most intense transmission in the past: Binyang, Jingxi, and Yishan. Four instruments were used: in-depth interviews, focus group discussions, a knowledge, attitudes and practices survey, and subsequent community feedback. In the past, schistosomiasis had serious consequences in Guangxi, decreasing work capacity and restricting marriage and occupational mobility. Since its eradication there have been clear benefits in terms of increased agricultural output and improved farming conditions. Personal habits and traditional manual farming activities in Guangxi would continue to expose a large proportion of the population to environmental risk if the disease were to return. Ignorance about control programme achievements is increasing and is related to youth and inexperience. There was a universal desire in the study counties for more local education about the history of the programme and about the risk of schistosomiasis returning. Snail surveillance is considered important, but people are not willing to volunteer for such work. Our study methods were novel for Guangxi and community feedback was helpful. Snail checking procedures have been modified to make them more efficient and no snails have been found since 1992. The animal and human stool examinations have ceased and vigilance now concentrates on snails and children (skin tests). The long-term strategy is to make the population invulnerable to future schistosomiasis transmission if the snail vectors return. This means continuing education and making the former endemic counties a high priority for water and sanitation improvements. (+info)
The prevalence of low back pain in adults: a methodological review of the literature.
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The prevalence of low back pain (LBP) has been reported in the literature for different populations. Methodological differences among studies and lack of methodological rigor have made it difficult to draw conclusions from these studies. A systematic review was done for adult community prevalence studies of LBP published from 1981 to 1998. The technique of capture-recapture was performed to estimate the completeness of the search strategy used. Established guidelines and a methodological scoring system were used to critically appraise the studies. Thirteen studies were deemed methodologically acceptable. Differences in the duration of LBP used in the studies appeared to affect the prevalence rates reported and explain much of the variation seen. It was estimated that the point prevalence rate in North America is 5.6%. Further studies using superior methods are needed, however, before this estimate can be used with confidence to make health care policies and decisions relating to physical therapy. (+info)
Rapid economic growth and 'the four Ds' of disruption, deprivation, disease and death: public health lessons from nineteenth-century Britain for twenty-first-century China?
(22/13273)
Rapid economic growth has always entailed serious disruption: environmental, ideological, and political. As a result the relationship between economic growth and public health is complex since such disruption always threatens to spill over into deprivation, disease and death. The populations of most current high-income, high-life expectancy countries of 'the West' endured several decades of severely compromised health when they first experienced industrialization in the last century Although health technologies have moved on, the social, administrative and political disruption accompanying economic growth can still impede the delivery of health improvements. The case history of 19th-century laissez-faire Britain is explored in some detail to demonstrate the importance of these social and political forces, particularly the relative vigour and participatory nature of local government, linking to recent work on the importance of social capital in development. For a country like China today, paradoxically, there is nothing that needs such careful planning as a 'free market' economy. (+info)
Two cultures, two levels of AIDS risk.
(23/13273)
On the basis of a field survey the authors discuss strategy for reducing the relatively high incidence of HIV infection and AIDS among China's self-employed. (+info)
Cancer screening practices among primary care physicians serving Chinese Americans in San Francisco.
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Previous research has reported a lack of regular cancer screening among Chinese Americans. The overall objectives of this study were to use a mail survey of primary care physicians who served Chinese Americans in San Francisco to investigate: a) the attitudes, beliefs, and practices regarding breast, cervical, and colon cancer screening and b) factors influencing the use of these cancer screening tests. The sampling frame for our mail survey consisted of: a) primary care physicians affiliated with the Chinese Community Health Plan and b) primary care physicians with a Chinese surname listed in the Yellow Pages of the 1995 San Francisco Telephone Directory. A 5-minute, self-administered questionnaire was developed and mailed to 80 physicians, and 51 primary care physicians completed the survey. A majority reported performing regular clinical breast examinations (84%) and teaching their patients to do self-breast examinations (84%). However, the rate of performing Pap smears was only 61% and the rate of ordering annual mammograms for patients aged 50 and older was 63%. The rates of ordering annual fecal occult blood testing and sigmoidoscopy at regular intervals of three to five years among patients aged 50 and older were 69% and 20%, respectively. Barriers (patient-specific, provider-specific, and practice logistics) to using cancer screening tests were identified. The data presented in this study provide a basis for developing interventions to increase performance of regular cancer screening among primary care physicians serving Chinese Americans. Cancer screening rates may be improved by targeting the barriers to screening identified among these physicians. Strategies to help physicians overcome these barriers are discussed. (+info)