The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China

Since 2003, the New Rural Cooperative Medical Scheme, a community-based health insurance, is gradually implemented in China, in order to increase the access of the poor to healthcare services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 randomly selected township hospitals of Weifang prefecture (Shandong province, China), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. Estimations highlight three main results. First, the New Rural Cooperative Medical Scheme has a positive impact on the utilization of township hospitals, mainly on inpatient services, but none effect on their financial structure. In addition, the positive impact on the volume of discharged patients is higher in poor areas rather than the non-poor, reflecting a decrease of the burden of hospitalization costs. Lastly, the marginal impact of the reform is decreasing over time.China, New Rural Cooperative Medical Scheme, Impact analysis, Township Hospitals.

An analysis of farmers' perception of the new cooperative medical system in Liaoning Province, China

<p>Abstract</p> <p>Background</p> <p>Since 2003, the number of pilot areas of the New Rural Cooperative Medical System (NRCMS) has increased in rural China. And the major efforts have been concentrated on the enrollment of prospective members. In this study, we examined the satisfaction of the rural residents with the NRCMS as well as factors affecting their attitudes towards the NRCMS.</p> <p>Methods</p> <p>The data for this study were collected from a survey involving twenty counties in Liaoning Province. Interviews and focus groups were conducted between 10^thJanuary and 20^thAugust 2008. A total of 2,780 people aged 18-72 were randomly selected and interviewed. Data were evaluated by nonparametric tests and ordinal regression models.</p> <p>Results</p> <p>71.6% of the study subjects were satisfied with the NRCMS. Single factor analysis showed that attitudes towards the NRCMS were influenced by gender, age, marital status, and self-rated health status. In the ordinal regression analysis, gender, age, and self-rated health status affect satisfaction (P < 0.05).</p> <p>Conclusions</p> <p>We found that a considerable proportion of farmers were satisfied with the NRCMS. Gender, age, and self-rated health status had significant effects on farmers' attitudes towards the NRCMS. The Chinese Central Government attempted to adopt active measures in the future to continuously improve the NRCMS, including initiating educational programs, building new medical facilities and increasing financial investment.</p

Integration of HIV Care with Primary Health Care Services: Effect on Patient Satisfaction and Stigma in Rural Kenya.

HIV departments within Kenyan health facilities are usually better staffed and equipped than departments offering non-HIV services. Integration of HIV services into primary care may address this issue of skewed resource allocation. Between 2008 and 2010, we piloted a system of integrating HIV services into primary care in rural Kenya. Before integration, we conducted a survey among returning adults ≥18-year old attending the HIV clinic. We then integrated HIV and primary care services. Three and twelve months after integration, we administered the same questionnaires to a sample of returning adults attending the integrated clinic. Changes in patient responses were assessed using truncated linear regression and logistic regression. At 12 months after integration, respondents were more likely to be satisfied with reception services (adjusted odds ratio, aOR 2.71, 95% CI 1.32-5.56), HIV education (aOR 3.28, 95% CI 1.92-6.83), and wait time (aOR 1.97 95% CI 1.03-3.76). Men's comfort with receiving care at an integrated clinic did not change (aOR = 0.46 95% CI 0.06-3.86). Women were more likely to express discomfort after integration (aOR 3.37 95% CI 1.33-8.52). Integration of HIV services into primary care services was associated with significant increases in patient satisfaction in certain domains, with no negative effect on satisfaction

AGRICULTURAL PROCESSING PLANTS IN NORTH DAKOTA: SOCIOECONOMIC IMPACTS

The socioeconomic impact of four agricultural processing plants on their respective North Dakota communities was investigated. The objectives were (1) to evaluate the impact of plant construction and operation on economic, demographic, public service, and fiscal structures of rural areas and (2) to develop a set of general principles and recommended actions for community leaders to follow when a new agricultural processing facility is being considered. The selected communities were Carrington (Foster County), Jamestown (Stutsman County), New Rockford (Eddy County), and Wapheton (Richland County). In-depth personal interviews of community leaders were conducted in each community. In addition, a representative from the agricultural processing plant was also interviewed. Subsequently, a random drop-off/pick-up survey was conducted in the communities. A total of 469 questionnaires (85 percent response rate) were completed by community residents. Improved job opportunities and enhanced incomes were seen as major benefits to the local communities with the addition of the agricultural processing plants. Except for a few management and engineering positions, most of the available jobs were filled by area residents. The addition of the plants did not result in a large in-migration of people to fill positions. The residents' incomes were enhanced by the payroll of the plants. The areas where the plants are located had experienced a declining population base for some time. The siting of these plants did not reverse this trend; however, the employment of the processing plants did help slow the depopulation trend. The availability of 'affordable' housing was a concern in most of the communities. Most of the plant workers wages ($9-13/hour) would not allow for purchasing a new or existing homes in these communities. In one community, there were vacant homes which had been forfeited to the city in-lieu of property taxes. These homes have since been sold and are contributing property taxes to the community. Availability of day care was an issue in all communities. Also, if the plants operated on a 24 hour schedule, extended hour day care was an issue. Two of the communities in which the processing plants operated 24 hours per day offered extended hour day care, but in both cases the demand for extended day care did not justify the additional expense. The short- and long-term implications of local tax abatements were an issue for all communities. Some felt that local governments were leveraging the community's fiscal resources too much, while others believed that the community needed to be more concerned with the longer-term implications of tax abatements. At any rate, the consensus was that residents needed to be kept informed regarding commitments being made to a project and the implications of those commitments. Community leader advice to other communities considering economic development projects could generally be categorized as 1) appropriateness of project and compatibility with community, 2) infrastructure planning and financing, 3) anticipating issues and needs, and 4) development approach and attitude.agricultural processing, community impact, economic development, Agribusiness,

The relationship of perceived organizational support to affective commitment, emotional exhaustion and turnover intention: a study of general practitioners in Shanghai community health centers in China

To understand the government incentive policy’s impact on the work attitudes of the general practitioners (GPs) in community health service center and relationship of perceived organizational support (POS) to affective commitment (AC), emotional exhaustion (EE) and general practitioners’ turnover intention (TI), this study used two waves of surveys and collected 1145 valid questionnaires from 45 community health centers in Pudong New Area of Shanghai. The analysis strategies include correlation analysis, variance analysis and structural equation modeling (SEM). The results show that POS, AC are positively correlated with TI (P<0.001); EE is negatively correlated with POS, AC and TI (P<0.001). According to the SEM analysis, the POS has indirect effect on TI, whose impact paths include POS->EE->TI, POS->AC->TI, and POS->EE->AC->TI; the overall impact effect is -0.196. The EE can affect TI directly and indirectly, with overall impact effect being 0.286. AC has direct influence on TI with impact effect being -0.533. The research results suggest that overall the government incentive policy has positive impact on the work attitudes of GPs, and POS has an indirect effect on TI, among which, EE and AC play mediating roles between POS and TI. EE can affect TI directly and indirectly; AC has direct impact on TI. Based on these results, implications and suggestions for managing and retaining the GPs in community health centers are discussed.Para compreender o impacto da política de incentivos nas atitudes de trabalho de médicos de clínica geral (CG) nos centros de saúde comunitários bem como a relação com o apoio organizacional percebido (AOP) com a implicação afetiva (IA), a exaustão emocional (EE) e a intenção de saída (IS) por parte dos clínicos gerais, este estudo usou duas ondas de inquéritos e recolheu 1145 respostas válidas provenientes de 45 centros de saúde comunitários no Novo Distrito de Pudong em Shangai. A estratégia de análise de dados inclui a análise de correlações, a análise de variação e os modelos de equações estruturais (SEM). Os resultados mostram que o AOP a a IA estão associados positivamente com a IS (p<.001); que a EE está correlacionada negativamente com o AOP, a IA e a IS (p<.001). De acordo com a análise SEM o AOP exerce um efeito indireto na IS, cujas vias de impacto incluem AOP->EE->IS, AOP->IA->IS, e AOP->EE->IS. O efeito total é de -0.196. A EE pode afetar a IS direta e indiretamente, com um efeito total de 0.286. A IA exerce um efeito direto na IS com uma magnitude de -0.533. Os resultados deste estudo sugerem que há uma correlação positiva entre a política de incentivos e o AOP por parte dos CG e que o AOP exerce um efeito indireto na IS, no qual a EE e a IA desempenham um papel mediador entre o AOP e a IS. A EE pode afetar a IS direta e indiretamente, a IA tem um efeito direto na IS. Com base nestes resultados, discutem-se as implicações para a gestão e a retenção dos CG nos centros de saúde comunitários

Proceeding: 3rd Java International Nursing Conference 2015 “Harmony of Caring and Healing Inquiry for Holistic Nursing Practice; Enhancing Quality of Care”, Semarang, 20-21 August 2015

This is the proceeding of the 3rd Java International Nursing Conference 2015 organized by School of Nursing, Faculty of Medicine, Diponegoro University, in collaboration with STIKES Kendal. The conference was held on 20-21 August 2015 in Semarang, Indonesia. The conference aims to enable educators, students, practitioners and researchers from nursing, medicine, midwifery and other health sciences to disseminate and discuss evidence of nursing education, research, and practices to improve the quality of care. This conference also provides participants opportunities to develop their professional networks, learn from other colleagues and meet leading personalities in nursing and health sciences. The 3rd JINC 2015 was comprised of keynote lectures and concurrent submitted oral presentations and poster sessions. The following themes have been chosen to be the focus of the conference: (a) Multicenter Science: Physiology, Biology, Chemistry, etc. in Holistic Nursing Practice, (b) Complementary Therapy in Nursing and Complementary, Alternative Medicine: Alternative Medicine (Herbal Medicine), Complementary Therapy (Cupping, Acupuncture, Yoga, Aromatherapy, Music Therapy, etc.), (c) Application of Inter-professional Collaboration and Education: Education Development in Holistic Nursing, Competencies of Holistic Nursing, Learning Methods and Assessments, and (d) Application of Holistic Nursing: Leadership & Management, Entrepreneurship in Holistic Nursing, Application of Holistic Nursing in Clinical and Community Settings

Local Public Services in Wisconsin: Alternatives for Municipalities with a Focus on Privatization

Both rural and urban municipal officials, faced with increased local resistance to higher taxes, increasing expenditure needs, weakening financial support from higher levels of government, and the growing pressure to "do more with less" have accelerated their search for alternative ways of delivering local public services. The downsizing of government has been brought to the forefront of public discussion in part due to the general conservative shift at the federal and state level and the need to maintain a balanced budget at the local level. Related private sector trends downsizing middle management as a means to become "leaner and meaner," reducing duplication and waste, and increasing earnings, profit levels, and returns to investors. At the same time many local public officials are faced with rising costs to maintain an aging infrastructure, accommodating the needs of special populations, satisfying rules and regulations imposed by higher levels of government, funding new investments to meet the demands of a growing economy in some instances, or maintaining critical services in the face declining economies. In short, the rules of the game for effective management of local governments have changed.

Basic medical insurance impact on medical services in Guangdong province

Medical care has long been the main concern of people's livelihood in modern countries, particularly in Guangdong Province, which has a resident population of more than 100 million. This dissertation's historical context is the Guangdong Province medical system reform of 2009, with a primary focus on the effect of the medical insurance system on medical services following the 2018 merger of the two types of basic medical insurance into a single basic medical insurance for urban and rural residents. This dissertation begins by outlining the basic medical insurance system in Guangdong. Following a descriptive methodology, it examines the effects of two basic medical insurance plans on the use of medical services. This includes the use of outpatient and inpatient services, customer satisfaction, and the causes of unmet medical requirements. Third, this dissertation examines the effects of medical insurance from the perspective of medical service providers, paying particular attention to changes in the number of designated medical facilities and the number of their employees. Forth, it examines the supervision and expense control functions of medical insurance, as well as the oversight functions for the system of tiered medical service. In addition, it also examines the game of stakeholders in the implementation of basic medical insurance, in order to provide as a guide for bettering policy. The result demonstrate that basic medical insurance has objectively encouraged the use of medical services while lowering the cost of those utilizing medical services in Guangdong. The use of insurance is being monitored. Although the self-paid component of medical costs is kept at around 25%, self-paid medical costs are nevertheless rising as a result of the rise in total medical costs.Os cuidados médicos têm sido uma preocupação principal da subsistência das pessoas nos países modernos, em particular na Província de Guangdong, que tem uma população residente de mais de 100 milhões de pessoas. O contexto histórico desta tese é a reforma do sistema médico da província de Guangdong de 2009, com um foco principal no efeito do sistema de seguro médico nos serviços médicos após a fusão dos dois tipos de seguro médico básico em 2018 num único seguro médico básico para residentes urbanos e rurais. Esta tese começa por apresentar o sistema de seguro médico básico em Guangdong. Após a descrição da metodologia, examina os efeitos dos dois planos de seguro médico básico sobre uso dos serviços médicos. Inclui a utilização de serviços ambulatórios e de internamento, a satisfação do cliente, e as causas das necessidades médicas não satisfeitas. Terceiro, esta tese examina os efeitos de seguro médico a partir da perspectiva dos prestadores de serviço médico, prestando atenção particular às alterações no número de facilidades médicas designadas e no número dos seus empregados. Quarto, examina as funções de supervisão e controlo de despesas do seguro médico, bem como as funções de supervisão do sistema de serviço médico por níveis. Além disso, também examina o jogo dos interessados na implementação do seguro médico básico, a fim de fornecer como guia para melhorar a política. O resultado demonstra que o seguro médico básico tem encorajado objectivamente a utilização dos serviços médicos enquanto baixa o custo daqueles que utilizam serviços médicos em Guangdong. A utilização do seguro está a ser monitorada. Embora a parte auto-paga dos custos médicos seja mantida em cerca de 25%, os custos médicos auto-pagos estão a aumentar como resultado do aumento dos custos médicos totais

Residential Status and Satisfaction with China’s Public Health Services

This thesis examined the joint effect of hukou (household registration) status and residence location on people’s satisfaction with public health services in China. It also examines the role of education level, media use (official and unofficial), perception of equality, self–rated social status, self–rated health status, public health insurance participation in the relationship between residential status and satisfaction with public health services. This thesis found that hukou status and residence location have significantly joint effect on satisfaction. Satisfaction score is the highest among those with rural residence and rural hukou, followed by urban individuals with rural hukou, with urban individuals with urban hukou having the lowest satisfaction score. Official media and self-rated social status significantly suppress the effect of residential status on satisfaction while unofficial media, perception of equality and self-rated health status significantly mediate the effect. Findings from this study provide a better understanding of inequalities in health services across hukou status and residence location and provide insights on how to utilize information on public satisfaction appropriately in formulating and evaluating health policies. The expectations–experience competing effect model used in this thesis is not fully supported by the data. More research is needed to examine whether hukou status and residence location influence expectations of health service. In addition, factors other than higher expectations might explain urban residents’ lower levels of satisfaction with public health services needs to be identified