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学者姓名:周忠良

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Unequal distribution of health human resource in mainland China: what are the determinants from a comprehensive perspective? SSCI PubMed Scopus
期刊论文 | 2018 , 17 | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH
WoS CC Cited Count: 3 SCOPUS Cited Count: 4
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Background: The inequality of health human resource is a worldwide problem, and solving it also is one of the major goals of China's recent health system reform. Yet there is a huge disparity among cities in mainland China. The aim of this study is to analyze the distribution inequality of the health human resource in 322 prefecture-level cities of mainland China in 2014, and to reveal the facets and causes of the inequalities. Methods: The data for this study were acquired from the provincial and municipal Health Statistics Yearbook (2014) and Statistical Yearbook (2014), the municipal National Economic Bulletin (2014), and the official websites of municipal governments, involving 322 prefecture-level cities. Meanwhile, Concentration Index was used to measure the magnitude of the unequal distribution of health human resource. A decomposition analysis was employed to quantify the contribution of each determinant to the total inequality. Results: The overall concentration index of doctors and nurses in mainland China in 2014 was 0.1038 (95% CI = 0.0208, 0.1865) and 0.0785 (95% CI = 0.0018, 0.1561). Decomposition of the concentration index revealed that economic status was the primary contributor (58.5% and 57%) to the inequality of doctors and nurses, followed by the Southwest China (19.1% and 18.6%), urbanization level (-13.1% and -12.8%), and revenue (8.0% and 7.8%). Party secretaries with Master degree (7.0%, 6.8%), mayors who were 60 years old or above (6.3%, 6.1%) also were proved to be a major contributor to the inequality of health human resource. Conclusions: There was inequality of health human resource distribution which was pro-rich in mainland China in 2014. Economic status of the cities accounted for most of the existing inequality, followed by the Southwest China, urbanization level, revenue, party secretaries with Master degree, and mayors who were 60 years old or above in respective importance. Besides, the party secretaries and mayors also had certain influence on the allocation of health human resource. The tough issue of HHR inequality should be addressed by comprehensive measures from a multidisciplinary perspective.

Keyword :

Decomposition analysis Inequality Concentration index Health human resource

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GB/T 7714 Li, Dan , Zhou, Zhongliang , Si, Yafei et al. Unequal distribution of health human resource in mainland China: what are the determinants from a comprehensive perspective? [J]. | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH , 2018 , 17 .
MLA Li, Dan et al. "Unequal distribution of health human resource in mainland China: what are the determinants from a comprehensive perspective?" . | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH 17 (2018) .
APA Li, Dan , Zhou, Zhongliang , Si, Yafei , Xu, Yongjian , Shen, Chi , Wang, Yiyang et al. Unequal distribution of health human resource in mainland China: what are the determinants from a comprehensive perspective? . | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH , 2018 , 17 .
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Prevalences and trends of chronic diseases in Shaanxi Province, China: Evidence from representative cross-sectional surveys in 2003, 2008 and 2013 SSCI SCIE PubMed Scopus
期刊论文 | 2018 , 13 (8) | PLOS ONE
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Objectives Non-communicable diseases, which can refer to chronic diseases that are not caused by infectious agents and can endure for a long time, are currently regarded as a critical public health problem in China. This study aimed to estimate the prevalences of self-reported physician-diagnosed chronic diseases among urban and rural populations aged 15 years and older in Shaanxi Province, China, during 2003-2013 and explore how these changes differ by subpopulation. Methods Three independent cross-sectional surveys were implemented in 2003, 2008 and 2013 in Shaanxi Province. A multistage stratified cluster random sampling method was used in each wave to collect representative samples. In total, 10,568 residents in 2003, 15,453 in 2008 and 48,808 in 2013 were included in this analysis. Information on self-reported physician-diagnosed chronic diseases was collected using face-to-face interviews in each survey. Multilevel Poisson regression with robust error variance was employed to calculate the adjusted prevalence ratios to estimate the relative change in chronic conditions in 2008 and 2013, compared to that in 2003. Results In 2013, 23.9%/22.1% of urban/rural residents, respectively, reported having at least one chronic condition, which represents an increase from 17.0%/15.1%, respectively, in 2008 and 12.8%/10.9%, respectively, in 2003. Adjusted for socio-demographic characteristics, the prevalence of chronic diseases was significantly higher in 2013 than that in 2003. Among the chronic diseases studied, the prevalence of hypertension and diabetes has increased dramatically over a decade. The increase in chronic diseases occurred mainly among the middle-aged and elderly. Conclusions Chronic diseases are highly prevalent and continuously increasing in the adult population in Shaanxi Province from 2003 to 2013. Given its large aging population, China may face a greater chronic disease burden. A national chronic disease surveillance system and screening program should be established to acquire comprehensive information regarding the distribution and trends of chronic diseases.

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GB/T 7714 Lai, Sha , Gao, Jianmin , Zhou, Zhongliang et al. Prevalences and trends of chronic diseases in Shaanxi Province, China: Evidence from representative cross-sectional surveys in 2003, 2008 and 2013 [J]. | PLOS ONE , 2018 , 13 (8) .
MLA Lai, Sha et al. "Prevalences and trends of chronic diseases in Shaanxi Province, China: Evidence from representative cross-sectional surveys in 2003, 2008 and 2013" . | PLOS ONE 13 . 8 (2018) .
APA Lai, Sha , Gao, Jianmin , Zhou, Zhongliang , Yang, Xiaowei , Xu, Yongjian , Zhou, Zhiying et al. Prevalences and trends of chronic diseases in Shaanxi Province, China: Evidence from representative cross-sectional surveys in 2003, 2008 and 2013 . | PLOS ONE , 2018 , 13 (8) .
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Comparing the income-related inequity of tested prevalence and self-reported prevalence of hypertension in China SSCI PubMed Scopus
期刊论文 | 2018 , 17 | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH
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Background: Hypertension has become a global health challenge given its high prevalence and but low awareness and detection. Whether the actual prevalence of hypertension has been estimated is important, especially for the poor. This study aimed to measure tested prevalence and self-reported prevalence of hypertension and compare the inequity between them in China. Methods: Data were derived from China Health and Nutrition Survey (CHNS) conducted in 2011. By using the multistage, stratified, random sampling method, 12,168 respondents aged 18 or older were identified for analysis. Both tested prevalence (systolic blood pressure >= 140 mmHg or/and diastolic blood pressure >= 90 mmHg or /and current use any of antihypertensive medication) and self-reported prevalence (ever diagnosed with hypertension by a doctor) were used to measure the prevalence of hypertension. The concentration index was employed to measure the extent of inequality in tested prevalence and self-reported prevalence. A decomposition method, based on a Probit model, was used to analyze income-related horizontal inequity of tested prevalence and self-reported prevalence. Results: The tested prevalence and self-reported prevalence of total respondents were 28.8% [95% CI (28.0%, 29.6%)] and 15.7% [95% CI (15.0%, 16.3%)], and 26.4% [95% CI (25.1%, 27.6%)] and 19.0% [95% CI (17.9%, 20.1%)] in urban areas, and 30.3% [95% CI (29.3%, 31.4%)] and 13.5% [95% CI (12.7%, 14.3%)] in rural areas. The horizontal inequity indexes of mean tested prevalence and self-reported prevalence were - 0.0494 and 0.1203 of total respondents, - 0.0736 and 0. 0748 in urban area, and - 0.0177 and 0.0466 in rural area respectively, indicating pro-poor inequity in tested prevalence and pro-rich inequity in self-reported prevalence of hypertension. Economic status, education attainment and age were key factors of the pro-poor inequity in tested prevalence. Economic status, area and age were key factors to explain the poor-rich inequity in self-reported prevalence. Conclusions: This study revealed self-reported prevalence of hypertension was much lower than tested prevalence in China, while a larger gap between self-reported and tested prevalence was found in rural areas. Our study suggested social strategies aiming at narrowing economic gap and regional disparities, reducing educational inequity, and facilitating health conditions of the elderly should be implemented. Finally, awareness raising campaigns to test hypertension in rural area need be strengthened by health education programs and improving the access to public health service, especially for those who do not engage with regular health checkups.

Keyword :

Tested prevalence Self-reported prevalence Income-related health inequality Horizontal inequity China Hypertension Decomposition

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GB/T 7714 Su, Min , Si, Yafei , Zhou, Zhongliang et al. Comparing the income-related inequity of tested prevalence and self-reported prevalence of hypertension in China [J]. | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH , 2018 , 17 .
MLA Su, Min et al. "Comparing the income-related inequity of tested prevalence and self-reported prevalence of hypertension in China" . | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH 17 (2018) .
APA Su, Min , Si, Yafei , Zhou, Zhongliang , Shen, Chi , Dong, Wanyue , Fan, Xiaojing et al. Comparing the income-related inequity of tested prevalence and self-reported prevalence of hypertension in China . | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH , 2018 , 17 .
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Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China SSCI SCIE PubMed Scopus
期刊论文 | 2018 , 13 (3) | PLOS ONE
SCOPUS Cited Count: 2
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Introduction In 2009, China officially launched the New Health Care Reform (NHCR). One important purpose of the reform was to reduce financial burden of health care through health insurance expansion and health care provider regulations. This study aimed to provide evidence on the effect of the NHCR reform on catastrophic health expenditure (CHE) by comparing the occurrence and inequality of CHE among households with chronic diseases patients before and after the reform. Methods This study used the subset of data from the 2008 and 2013 National Health Services Survey conducted in Shaanxi Province. Our sample included households with chronic diseases patients and excluded observations with key variables missing. The final sample size was 1942 households in 2008 and 7704 households in 2013. We defined CHE occurrence following the definition of the World Health Organization (WHO). The income-related inequality in CHE was measured by the concentration index. A multi-level logistic regression model was used in the study to explore the influence of the NHCR on CHE occurrence, controlling for important covariates. Results From 2008 to 2013, the occurrence rate of CHE in rural areas declined from 29.15% to 23.62%. However, the CHE rate in urban areas increased from 19.18% to 24.95%. The interaction term between year and rural/urban location was statistically significant, confirming that the influence of the NHCR on the CHE occurrence rates were heterogeneous between rural and urban areas. As for the CHE inequality, the concentration index in rural areas decreased from -0.4572 to -0.5499 with a p-value less than 0.05. This implied that the CHE occurrence inequality was increased after the implementation of the NHCR. Conclusion Our study suggested that the implementation of the NHCR might not have been effective in reducing the CHE occurrence for households with chronic disease patients. Although the occurrence of CHE of rural households had decreased, the occurrence of CHE in urban areas was higher than before. In addition, the income inequality of CHE occurrence was greater in 2013 compared to that in 2008 in rural areas. Although the reform resulted in higher insurance coverage and higher government expenditure in health care, the financial burden of health care on households did not necessarily improve. Further efforts on developing the current health insurance system and optimizing the hierarchical health care system are required to improve the protection against CHE.

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GB/T 7714 Xu, Yongjian , Ma, Jie , Wu, Na et al. Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China [J]. | PLOS ONE , 2018 , 13 (3) .
MLA Xu, Yongjian et al. "Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China" . | PLOS ONE 13 . 3 (2018) .
APA Xu, Yongjian , Ma, Jie , Wu, Na , Fan, Xiaojing , Zhang, Tao , Zhou, Zhongliang et al. Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China . | PLOS ONE , 2018 , 13 (3) .
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Financial transfers from adult children and depressive symptoms among mid-aged and elderly residents in China - evidence from the China health and retirement longitudinal study SSCI SCIE PubMed Scopus
期刊论文 | 2018 , 18 | BMC PUBLIC HEALTH
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Background: Although the awareness of mental health problems in late life is rising, the association between financial transfers to the older generations from children and mental health at older ages in China has received little attention. This study examines the association between financial transfers from children and depressive symptoms among the mid-aged and elderly residents (from 45 years of age and older) in China. Methods: We used the data from the China Health and Retirement Longitudinal Study (CHARLS, 2013) (n= 10,935) This included data on financial transfers from all non-co-resident children to their parents, and the individual scores on depressive symptoms as measured by the 10-item Center for Epidemiologic Studies-Depression Scale (CESD-10). A two-level - individual and community levels - mixed linear model was deployed to explore their association. Results: Financial transfers from children to parents was the major component of inter-generational financial transfers in Chinese families. A higher financial support from non-co-resident children was signivicantly and positively related to fewer depressive symptoms (coef. = - 0.195,P-value< 0.001) among both the mid-aged and elderly parents. Conclusions: Financial transfers from non-co-resident children are associated with depressive symptoms among mid-aged and elderly residents in the China situation. Taxation and other policy measures should encourage and facilitate these type of financial transfers and prevent a decrease of support from children to parents.

Keyword :

CHARLS Mid-aged and elderly residents Multilevel model China Depressive symptoms Inter-generational transfer

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GB/T 7714 Wu, Yue , Dong, Wanyue , Xu, Yongjian et al. Financial transfers from adult children and depressive symptoms among mid-aged and elderly residents in China - evidence from the China health and retirement longitudinal study [J]. | BMC PUBLIC HEALTH , 2018 , 18 .
MLA Wu, Yue et al. "Financial transfers from adult children and depressive symptoms among mid-aged and elderly residents in China - evidence from the China health and retirement longitudinal study" . | BMC PUBLIC HEALTH 18 (2018) .
APA Wu, Yue , Dong, Wanyue , Xu, Yongjian , Fan, Xiaojing , Su, Min , Gao, Jianmin et al. Financial transfers from adult children and depressive symptoms among mid-aged and elderly residents in China - evidence from the China health and retirement longitudinal study . | BMC PUBLIC HEALTH , 2018 , 18 .
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Socio-Economic Inequalities in Tobacco Consumption of the Older Adults in China: A Decomposition Method SSCI SCIE PubMed Scopus
期刊论文 | 2018 , 15 (7) | INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
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Background: In China, tobacco consumption is a leading risk factor for non-communicable diseases, and understanding the pattern of socio-economic inequalities of tobacco consumption will, thus, help to develop targeted policies of public health control. Methods: Data came from the China Health and Retirement Longitudinal Study in 2013, involving 17,663 respondents aged 45 and above. Tobacco use prevalence and tobacco use quantities were defined for further analysis. Using the concentration index (CI) and its decomposition, socio-economic inequalities of tobacco consumption grouped by gender were estimated. Results: The concentration index of tobacco use prevalence was 0.044 (men 0.041; women -0.039). The concentration index of tobacco use quantities among smokers was 0.039 (men 0.033; women 0.038). The majority of the inequality could be explained by educational attainment, age, area, and economic quantiles. Conclusions: Tobacco consumption was more common among richer compared to poorer people in China. Gender, educational attainments, age, areas, and economic quantiles were strong predictors of tobacco consumption in China. Public health policies need to be targeted towards men in higher economic quantiles with lower educational attainment, and divorced or widowed women, especially in urban areas of China.

Keyword :

concentration index tobacco consumption inequality decomposition China

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GB/T 7714 Si, Yafei , Zhou, Zhongliang , Su, Min et al. Socio-Economic Inequalities in Tobacco Consumption of the Older Adults in China: A Decomposition Method [J]. | INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH , 2018 , 15 (7) .
MLA Si, Yafei et al. "Socio-Economic Inequalities in Tobacco Consumption of the Older Adults in China: A Decomposition Method" . | INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 15 . 7 (2018) .
APA Si, Yafei , Zhou, Zhongliang , Su, Min , Wang, Xiao , Li, Dan , Wang, Dan et al. Socio-Economic Inequalities in Tobacco Consumption of the Older Adults in China: A Decomposition Method . | INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH , 2018 , 15 (7) .
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Research on the horizontal equity of inpatient benefits among NCMS enrollees in China: evidence from Shaanxi Province SSCI SCIE PubMed Scopus
期刊论文 | 2018 , 18 | BMC HEALTH SERVICES RESEARCH
WoS CC Cited Count: 1
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Background: Equity is an important goal for countries in formulating relevant health policies, and research on the equity of health services is more important for China, where the gap between the rich and poor is widening. The aims of this study are to explore to what extent the benefit equity of New Rural Cooperative Medical System enrollees has been achieved and to determine the geographical disparities in Shaanxi province and thus provide suggestions for future policy formulations. Methods: Data were obtained from the fifth Health Service Survey of Shaanxi province in 2013. A two-step mode was used to analyse the influencing factors of the inpatient benefit rate and inpatient compensation fee. Concentration indexes and concentration curves were applied to measure the inequity of the inpatient benefit rate and inpatient compensation fee. The decomposition method was employed to explore the source of inequity and horizontal inequity. Results: Based on a sample of 38,032 enrollees, our results showed that there were pro-rich inequities in the inpatient benefit rate and compensation fee. The concentration index of the inpatient benefit rate and compensation fee in 2013 were 0.064 and 0.174, respectively. The economic level (224.62%), self-evaluated health status (- 25.89%) and occupation status (- 12.32%) were the primary three contributors to the inequity of the inpatient benefit rate, and the economic level (106.16%) and age (- 2.88%) were the first two contributors to the inequity of the compensation fee. There were regional differences in the sources of inequities. Moreover, pro-rich horizontal inequity remained after standardizing health care needs. Conclusions: Our results indicated that there were pro-rich inequities in the inpatient benefit rate and compensation fee in the New Rural Cooperative Medical System. The economic levels of enrollees accounted for most of the existing inequity, followed by self-evaluated health scores and age. Efforts should be made to strengthen policies and programmes in the New Rural Cooperative Medical System to achieve basic health services equity, such as implementing hierarchical medical treatments and reducing extra inpatient benefits for the rich.

Keyword :

Benefit equity Inpatient Decomposition of the concentration index Concentration index New rural cooperative medical system

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GB/T 7714 Yan, Jue , Ren, Yangling , Zhou, Zhongliang et al. Research on the horizontal equity of inpatient benefits among NCMS enrollees in China: evidence from Shaanxi Province [J]. | BMC HEALTH SERVICES RESEARCH , 2018 , 18 .
MLA Yan, Jue et al. "Research on the horizontal equity of inpatient benefits among NCMS enrollees in China: evidence from Shaanxi Province" . | BMC HEALTH SERVICES RESEARCH 18 (2018) .
APA Yan, Jue , Ren, Yangling , Zhou, Zhongliang , Xu, Tiange , Wang, Xiao , Du, Leilei et al. Research on the horizontal equity of inpatient benefits among NCMS enrollees in China: evidence from Shaanxi Province . | BMC HEALTH SERVICES RESEARCH , 2018 , 18 .
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Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-Evidence from Shaanxi province SSCI SCIE PubMed Scopus
期刊论文 | 2018 , 13 (9) | PLOS ONE
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Background So far limited evidence exist comparing the difference between urban and rural elder residents in relation to how living arrangements correlates to health-related quality of life (HRQOL) of the elderly. Objective This study aims to compare the HRQOL of the elderly with four living arrangements: living with spouse only (LS), living alone (LA), living with a spouse and adult children(LSC) and the single elderly living with adult children (SLC) in urban and rural areas of China. Methods The data were drawn from the 2013 wave of Chinese National Health Service Survey in Shaanxi Province, which included 11,729 elderly people. The Chinese version of the EQ-5D-3L questionnaire was used to measure the HRQOL. Tobit regression model and logistic regression models were employed to estimate the associations between living arrangements and the HRQOL of the elderly. Results The EQ-5D utility scores of the urban elderly with four different living arrangements (LS, LA, LSC and SLC) were 0.9141, 0.8392, 0.8176 and 0.9080, which were almost all higher than their rural counterparts. After controlling other confounding variables, tobit regression estimates showed that the EQ-5D utility scores of the single elderly either living alone or living with adult children were lower than the elderly living with a spouse in urban areas. In rural areas only the single elderly living with adult children were more disadvantaged. Additionally the logistic regression results showed living-alone elderly had worse psychological health and the single elderly living with adult children had worse physical health. Conclusion The findings suggest that the urban elderly have better HRQOL than the rural elderly and the elderly with different living arrangements in urban and rural area have different HRQOL. More attention should be given to the poor mental health of the elderly living alone and the worse physical health of the single elderly living with adult children.

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GB/T 7714 Zhou, Zhiying , Zhou, Zhongliang , Gao, Jianmin et al. Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-Evidence from Shaanxi province [J]. | PLOS ONE , 2018 , 13 (9) .
MLA Zhou, Zhiying et al. "Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-Evidence from Shaanxi province" . | PLOS ONE 13 . 9 (2018) .
APA Zhou, Zhiying , Zhou, Zhongliang , Gao, Jianmin , Lai, Sha , Chen, Gang . Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-Evidence from Shaanxi province . | PLOS ONE , 2018 , 13 (9) .
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Effect of China's maternal health policy on improving rural hospital delivery: Evidence from two cross-sectional surveys SSCI SCIE PubMed Scopus
期刊论文 | 2018 , 8 | SCIENTIFIC REPORTS
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This population-based cross-sectional study aims to explore the effect of China's Rural Hospital Delivery Subsidy (RHDS) policy on the utilization of women's hospital delivery between rural and urban areas. A total of 2398 women were drawn from the Fourth and Fifth National Health Service Surveys, from the Shaanxi province. A generalized linear mixed model was used to analyze the influence of the RHDS policy on the hospital delivery rate. Concentration index and decomposition methods were used to explore the equity of hospital delivery utilization. Prior to introduction of the RHDS policy, the difference in hospital delivery rates was -0.09 (95% CL: -0.16, -0.01) between rural and urban women when adjusting the influence of socioeconomic factors on hospital delivery; after implementation of the policy, the difference was reduced to 0.02 (95% CL: -0.01, 0.06). The horizontal inequity index was reduced from 0.084 to 0.009 for rural women and from 0.070 to 0.011 for urban women. China's Rural Hospital Delivery Subsidy policy had some positive effect on reducing the gap between rural and urban women's hospital delivery rate and inequity. However, there is still a pro-rich inequity of hospital delivery utilization for both rural and urban women.

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GB/T 7714 Fan, Xiaojing , Xu, Yongjian , Stewart, Martyn et al. Effect of China's maternal health policy on improving rural hospital delivery: Evidence from two cross-sectional surveys [J]. | SCIENTIFIC REPORTS , 2018 , 8 .
MLA Fan, Xiaojing et al. "Effect of China's maternal health policy on improving rural hospital delivery: Evidence from two cross-sectional surveys" . | SCIENTIFIC REPORTS 8 (2018) .
APA Fan, Xiaojing , Xu, Yongjian , Stewart, Martyn , Zhou, Zhongliang , Dang, Shaonong , Wang, Duolao et al. Effect of China's maternal health policy on improving rural hospital delivery: Evidence from two cross-sectional surveys . | SCIENTIFIC REPORTS , 2018 , 8 .
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The distribution of benefits under China's new rural cooperative medical system: evidence from western rural China SSCI PubMed Scopus
期刊论文 | 2018 , 17 | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH
WoS CC Cited Count: 1 SCOPUS Cited Count: 1
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Background: China's New Cooperative Medical Scheme (NCMS) enables insured citizens to enjoy the same benefit package by paying a flat-rate premium. However, it still remains uncertain whether economically disadvantaged enrollees receive insurance benefits that at least match those of non-disadvantaged enrollees. This article, therefore, estimates the distribution of benefits under the NCMS across economic groups and compares the magnitude of economic-related inequity changes in the NCMS benefits. Methods: Data were drawn from two-wave large-scale representative and comparable cross-sectional household health survey datasets conducted in Shaanxi Province in 2008 and 2013. In total, 9506 (2008) and 38,010 (2013) NCMS enrollees were included. The benefits from the NCMS are measured in two ways: via the probability of receiving reimbursements and via the absolute amount of the obtained reimbursements. Two-part models were used to estimate the benefit distribution and to adjust benefits for health care needs. Concentration curve, dominance test of the concentration curve, and concentration index (CI) were used to estimate the overall degree of economic-related inequality. The degree of horizontal inequity was estimated via indirectly standardized measures based on the "equal treatment for equal needs" concept. Results: Our results indicate that economically affluent groups were more likely to receive reimbursements from the NCMS, and these reimbursements were also higher. Positive need-adjusted CIs for the probability of receiving reimbursements (CIs: 0.2027/0.1056 in 2008/2013) and the absolute amount of reimbursements (CIs: 0.3002/0.1660 in 2008/2013) further suggest the existence of clear pro-rich horizontal inequities in the benefits distribution under the NCMS. Encouragingly, a decreasing trend could be observed from 2008 to 2013, which suggests that horizontal inequities in NCMS benefits that favored the rich decreased over the investigated period, while the level of insurance benefits improved. Conclusions: Our study suggests that the benefits of NCMS are concentrated toward economically affluent groups. Although any trade-off between policy feasibility and equity has become a challenge for the formulation of social health insurance funding and benefit packages in developing countries, inequality can be gradually reduced through continuous adjustment of the medical insurance scheme, thus effectively targeting economically disadvantaged enrollees.

Keyword :

New cooperative medical scheme Health insurance China Benefit Equity

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GB/T 7714 Lai, Sha , Shen, Chi , Xu, Yongjian et al. The distribution of benefits under China's new rural cooperative medical system: evidence from western rural China [J]. | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH , 2018 , 17 .
MLA Lai, Sha et al. "The distribution of benefits under China's new rural cooperative medical system: evidence from western rural China" . | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH 17 (2018) .
APA Lai, Sha , Shen, Chi , Xu, Yongjian , Yang, Xiaowei , Si, Yafei , Gao, Jianmin et al. The distribution of benefits under China's new rural cooperative medical system: evidence from western rural China . | INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH , 2018 , 17 .
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