| 1. |
- Bogg, Lennart, 1948-, et al.
(författare)
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An Economic Insight into Health Care in Six Chinese Counties : Equity in Crisis
- 2010
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Ingår i: International Health & Aid Policies. - : Cambridge University Press. - 9780521174268 ; , s. 123-137
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Bokkapitel (refereegranskat)abstract
- Objectives: To assess inequity in health care financing and utilisation, its associated socio-economic variables and consequences, with focus on the impact of alternative health financing systems. MethodsEconometric and multivariate analysis of cross-sectional and retrospective household survey data from six counties in three provinces in Central China. Findings:The old Cooperative Medical System (CMS) was associated with a five times less risk of financial difficulties, half the risk of care-induced debt (non-significant, 95%CI 0.2-1.1) and not one CMS participant having to forego care due to cost. CMS was associated with better health, three times less risk of illness with duration of at least one month. Other health insurance systems were associated with higher risk of illness, higher outpatient expenditure without evidence of reducing barriers to care. The elderly (60 years +) had a more than five times increased risk of illness for at least one month, (OR = 5.2, 95%CI = 3.2-8.3). The illness concentration index confirmed that the poor suffer from a higher prevalence of morbidity. The Le Grand index confirmed strong bias in utilisation favouring the rich. The Kakwani index confirmed an extremely high degree of regressivity in the financing of health services, (-0.73) for outpatient and (-0.94) for inpatient services. The New Cooperative Medical System (NCMS) differs from the old CMS in critical aspects.
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| 2. |
- Bogg, Lennart, et al.
(författare)
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The cost of coverage : rural health insurance in China
- 1996
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Ingår i: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 11:3, s. 238-52
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 3. |
- Dong, Hengjin, et al.
(författare)
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A description of outpatient drug use in rural China : evidence of differences due to insurance coverage
- 1999
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Ingår i: International Journal of Health Planning and Management. - 0749-6753 .- 1099-1751. ; 14:1, s. 41-56
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes the effects of health financing systems (insurance) on outpatient drug use in rural China. 1320 outpatients were interviewed (exit interview) in the randomly selected county, township and village health care facilities in five counties in three provinces of central China. The interview was face to face. Questions were asked by a trained interviewer and were answered by patient him/herself. The main finding was that health insurance appeared to influence drug use in outpatient services. The average number of drugs per visit was 2.56 and drug expenditures per visit was 16.9 yuan. Between insured and uninsured (out-of-pocket) groups, there were significant differences in the number of drugs and drug expenditures per visit. The insured had a lower number of drugs and a higher drug expenditure per visit than the uninsured, implying the use of more expensive drugs per visit than the uninsured. There were also significant differences in the number of drugs and drug expenditures per visit between the types of insurance. One third of the drugs were anti-infectives, most of which were penicillin, gentamycin, and sulfonamides. The results imply that uninsured patients do not receive the same care as the insured do even if they have the same needs. The fee-for-service financing for hospitals and health insurance have changed health providers' and consumers' behaviour and resulted in the increase of medical expenditure.
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| 4. |
- Dong, Hengjin, et al.
(författare)
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Association between health insurance and antibiotics prescribing in four counties in rural China
- 1999
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 48:1, s. 29-45
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Tidskriftsartikel (refereegranskat)abstract
- A cross-sectional study was carried out at county, township and village health care facilities in four counties in rural China in order to describe and compare the effects of health financing systems on antibiotic prescribing in outpatient care. A total of 1232 outpatients at the health care facilities was selected by multi-stage random sampling and were interviewed over 2 weeks. The results showed that health financing systems appeared to influence antibiotic prescribing in outpatient care, both in terms of frequency and of the types prescribed. The insured group had lower prescribing of antibiotics at township and village health care facilities, and for respiratory tract infections, but had higher prescribing of newer antibiotics at county and village health care facilities, for respiratory tract and g-i infections. Because there was a high patient compliance rate (94.3%) in this study the prescribing of antibiotics (supply side behavior) reflected the use of antibiotics (demand side behavior) to a great extent. Thus the results imply that antibiotics prescribing and using might be biased by the patient's health financing systems and antibiotic prescribing was the result of the interaction between physicians and patients.
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| 5. |
- Dong, Hengjin, et al.
(författare)
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Drug policy in China : pharmaceutical distribution in rural areas.
- 1999
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 48:6, s. 777-786
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Tidskriftsartikel (refereegranskat)abstract
- In 1978, China decided to reform its economy and since then has gradually opened up to the world. The economy has grown rapidly at an average of 9.8% per year from 1978 to 1994. Medical expenditure, especially for drugs, has grown even more rapidly. The increase in medical expenditure can be attributed to changing disease patterns, a higher proportion of older people in the population and fee-for-service incentives for hospitals. Due to the changing economic system and higher cost of health care, the Chinese government has reformed its health care system, including its health and drug policy. The drug policy reform has led to more comprehensive policy elements, including registration, production, distribution, utilization and administration. As a part of drug policy reform, the drug distribution network has also been changed, from a centrally controlled supply system (push system) to a market-oriented demand system (pull system). Hospitals can now purchase drugs directly from drug companies, factories and retailers, leading to increased price competition. Patients have easier access to drugs as more drugs are available on the market. At the same time, this has also entailed negative effects. The old drug administrative system is not suitable for the new drug distribution network. It is easy for people to get drugs on the market and this can lead to overuse and misuse. Marketing factors have influenced drug distribution so strongly that there is a risk of fake or low quality drugs being distributed. The government has taken some measures to fight these negative effects. This paper describes the drug policy reform in China, particularly the distribution of drugs to health care facilities.
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| 6. |
- Dong, Hengjin
(författare)
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Health financing systems and drug use in rural China
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aims to study the association between health-care financing systems and health-care consumers' drug use and health providers' prescribing in six Chinese counties. In a cross-sectional study, a multistage sampling procedure was used to select provinces, counties, townships and villages. A simple random sampling method was used to select health facilities. A quota sampling method was used to select outpatients and a systematic sampling method to select providers. Face-to-face outpatient interviews and health provider survey were carried out in 1995. Outpatients were interviewed by trained interviewers using questionnaires. Health provider were asked to fill out self-administered questionnaires. The findings of this study suggest that there is an association between health-financing systems and patients' drug use, care-seeking behaviour, and health providers' prescribing. The uninsured patients had a significantly higher average number of drugs per visit. and were prescribed antibiotics to a significantly higher degree than the insured, a small proportion of them using newer antibiotics. The insured patients, however, had significantly higher average medical (drug) costs than the uninsured. Most health providers were of the opinion that the patients' insurance was related to their prescribing of treatment, that a bonus in relation to the revenue from drug prescriptions provided an incentive for providers to over-prescribe, and that the insured patients had a better access to expensive drugs and were to a greater extent referred to specialised health facilities. Health providers' choice and use of drugs were influenced by the market factors. In 1994, more insured patients than uninsured were hospitalised at the suggestion of a doctor. A logistic regression analysis showed that only 'out-of-pocket' payment influenced the proportion of hospitalised patients and that the influence was negative. The fee-for-service- based insurance led to a higher growth of health care cost, to a shift from preventive to curative medicine and to a higher level of tertiary Curative care cost. It also induced a higher per capita consumption of drugs. It was found that the uninsured patients received more drugs at lower drug Costs per visit than the insured. This implies that they received cheaper drugs than the insured. The insured patients, however, had a better access to expensive drugs and treatment. This implies that the uninsured patients do not have the same access to health care for similar needs. The findings from the health provider Survey and from tile patient interviews and prescription analyses in the same health facilities are consistent. In conclusion, the health-care financing systems appear to influence patients' drug use and health providers' prescribing. Insured patients have significantly higher average medical (drug) costs per visit, and better access to expensive drugs and treatment such as hospitalization than uninsured. Health providers' prescribing are influenced by patients' insurance status and financial abilities, bonus payment mechanism, and market factors. The fee-for-service-based insurance leads to a higher growth of health care cost, to a shift from preventive to curative medicine and to a higher level of tertiary curative care cost. It also induces a higher per capita consumption of drugs. Efficiency and equity in access to health care are the two important aspects of China's new health policy. In order to realize the new policy China should finance health services by different benefit packages within social insurance financed by general tax, employers and individuals in tile urban and also in the rural areas.
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| 7. |
- Dong, Hengjin, et al.
(författare)
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The impact of expanded health system reform on governmental contributions and individual copayments in the new Chinese rural cooperative medical system
- 2016
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 31:1, s. 36-48
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Tidskriftsartikel (refereegranskat)abstract
- In 2002, the Chinese central government created a new rural cooperative medical system (NCMS), ensuring that both central and local governments partner with rural residents to reduce their copayments, thus making healthcare more affordable. Yet, significant gaps in health status and healthcare utilization persisted between urban and rural communities. Therefore, in 2009, healthcare reform was expanded, with (i) increased government financing and (ii) sharply reduced individual copayments for outpatient and inpatient care. Analyzing data from China's Ministry of Health, the Rural Cooperative Information Network, and Statistical Yearbooks, our findings suggest that healthcare reform has reached its preliminary objectives-government financing has grown significantly in most rural provinces, especially those in poorer western and central China, and copayments in most rural provinces have been reduced. Significant intraprovincial inequality of support remains. The central government contributes more money for poor provinces than for rich ones; however, NCMS schemes operate at the county level, which vary significantly in their level of economic development and per capital gross domestic products (GDP) within a province. Data reveal that the compensation ratios for both outpatient and inpatient care are not adjusted to compensate for a rural county's level of economic development or per capita GDP. Consequently, a greater financial burden for healthcare persists among persons in the poorest rural regions. A recommendation for next step in healthcare reform is to pool resources at prefectural/municipal level and also adjust central government contributions according to the GDP level at prefectural/municipal level.
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| 8. |
- Xu, Biao, et al.
(författare)
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DOTS in China : Removing barriers or moving barriers?
- 2006
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Ingår i: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 21:5, s. 365-72
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Tidskriftsartikel (refereegranskat)abstract
- In 1992, China initiated its modern National TB Control Programme (NTP) with DOTS strategy through a project funded by a World Bank loan. Key motives for the revised NTP-DOTS were to reduce financial barriers to patients by removing fee charges for diagnosis and treatment, and to address regressive suppliers' incentives for appropriate referrals. This study aims to assess to what extent China's NTP subsidies are achieving the objective of removing financial barriers to care in terms of patients' expenditure. One county with NTP-DOTS - Jianhu - and one county without - Funing - were selected. A cohort of 493 tuberculosis patients newly diagnosed in 2002 was interviewed by questionnaire. The main outcome measure was tuberculosis patients' expenditure on medical care and transportation/accommodation from the onset of symptoms to treatment completion. During the follow-up period, Funing started implementing NTP-DOTS, which offered a possibility of longitudinal comparison both between counties and within county. Ninety-four per cent (465/493) of subjects were followed-up. The mean total patient's expenditure on TB medical care and transportation/accommodation before TB diagnosis was higher in Jianhu than in Funing (715 vs. 256CNY), whereas it was higher in Funing (835 vs. 157CNY) after diagnosis. After implementing NTP-DOTS in Funing, expenditure after diagnosis decreased slightly whereas expenditure before diagnosis increased remarkably. We found that the market incentive structures in the reformed health system appear to have a stronger regressive effect and may result in prolonged delays before effective treatment can be given. We believe that doctors adapt to new incentive structures, with bonus income being linked to the hospitals' fee-for-service revenue, and find new ways of keeping revenue at the old levels, which reduce or eliminate the intended effect of the subsidies. TB patients suffer a heavy economic burden even in counties where NTP-DOTS treatment is subsidized. The total patient expenditure was reduced only marginally, but shifted substantially from after diagnosis to before diagnosis. The shift could imply delays in diagnosis and treatment with an increased risk of infection transmission.
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| 9. |
- Yan, Weirong, et al.
(författare)
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ISS - An Electronic Syndromic Surveillance System for Infectious Disease in Rural China
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:4, s. e62749-
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Tidskriftsartikel (refereegranskat)abstract
- Background: syndromic surveillance system has great advantages in promoting the early detection of epidemics and reducing the necessities of disease confirmation, and it is especially effective for surveillance in resource poor settings. However, most current syndromic surveillance systems are established in developed countries, and there are very few reports on the development of an electronic syndromic surveillance system in resource-constrained settings. Objective: this study describes the design and pilot implementation of an electronic surveillance system (ISS) for the early detection of infectious disease epidemics in rural China, complementing the conventional case report surveillance system. Methods: ISS was developed based on an existing platform 'Crisis Information Sharing Platform' (CRISP), combining with modern communication and GIS technology. ISS has four interconnected functions: 1) work group and communication group; 2) data source and collection; 3) data visualization; and 4) outbreak detection and alerting. Results: As of Jan. 31st 2012, ISS has been installed and pilot tested for six months in four counties in rural China. 95 health facilities, 14 pharmacies and 24 primary schools participated in the pilot study, entering respectively 74256, 79701, and 2330 daily records into the central database. More than 90% of surveillance units at the study sites are able to send daily information into the system. In the paper, we also presented the pilot data from health facilities in the two counties, which showed the ISS system had the potential to identify the change of disease patterns at the community level. Conclusions: The ISS platform may facilitate the early detection of infectious disease epidemic as it provides near real-time syndromic data collection, interactive visualization, and automated aberration detection. However, several constraints and challenges were encountered during the pilot implementation of ISS in rural China.
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| 10. |
- Ye, Chiyu, et al.
(författare)
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A preliminary analysis of the effect of the new rural cooperative medical scheme on inpatient care at a county hospital
- 2013
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 13:519, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Background: China in 2009 committed to reach universal health coverage by promoting three forms of health insurance; NCMS for the rural population, UEBMI for formally employed urban residents and URBMI for other urban residents. NCMS has expanded to near universal coverage in rural China since launching in 2003. The objective of this study aimed to assess the effect of NCMS on inpatient care utilization from 2003 to 2012 at Longyou county hospital, Zhejiang province.Methods: The research was conducted at Longyou county, Zhejiang province. All registered inpatient admissions from January 1, 2003, to June 30, 2012, were included in the study. The PLSQL Developer software was used toselect the interesting variables in the hospital information database and saved in an Excel 2003 file. The interesting variables included the patients’ general information (name, gender, age, payment method), discharge diagnosis, length of hospital stay, and expenditure (total expenditure and out-of-pocket payment). Two common diseases (coronary arteriosclerotic disease and pneumonia) were selected as tracer conditions.Results: 292,400 rural residents were enrolled in the Longyou county NCMS by 2011, 95.4% of the eligible population. A total of 145,744 inpatient admissions were registered from 1 January 2003 to 30 June 2012. The proportion ofinpatients covered by NCMS increased from 30.3% in 2004 to 54.2% in 2012 while the proportion of inpatients covered by UEBMI increased from 7.7% in 2003 to 14.7% in 2012. The average expenditure for UEBMI insured inpatients washigher than the average for NCMS insured inpatients, although the gap was narrowing. The average length of hospitalstay increased every year for all inpatients, but was higher for UEBMI inpatients than for NCMS insured inpatients. For both tracer conditions the results were similar to the above findings.Conclusions: NCMS has improved coverage height for its enrollees and resulted in increased cost of care per inpatient admission at the county hospital. However, wide differences persist between the two insurance systems in coverage height. Both systems are associated with increasing lengths of stay and rising cost per inpatient admission. We found that around 30% of inpatients were not covered by any of the two public health insurance systems, which calls for further studies.
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