52 research outputs found
The role of health system governance in strengthening the rural health insurance system in China.
BACKGROUND: Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. METHODS: Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. RESULTS: We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. CONCLUSIONS: China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding mechanisms. However, this study demonstrates that health systems governance may be critical to enable the development and operation of such schemes. Given that many LMICs are expanding health financing system to cover populations in rural areas or the informal sectors, we argue that strengthening specific practices in each governance domain could inform the adaptation of these schemes to other settings
Beijing's diagnosis-related group payment reform pilot:Impact on quality of acute myocardial infarction care
Sex differences in non-communicable disease prevalence in China: a cross-sectional analysis of the China Health and Retirement Longitudinal Study in 2011
ObjectivesTo describe the sex differences in the prevalence of non-communicable diseases (NCDs) in adults aged 45 years or older in China.DesignCross-sectional study.SettingNationally representative sample of the Chinese population 2011.Participants8401 men and 8928 women over 45 years of age who participated in the first wave of the China Health and Retirement Longitudinal Study (CHARLS).Outcome measuresSelf-reported data on overall health and diagnosis of hypertension, dyslipidaemia, diabetes, heart disease, stroke, chronic lung disease, cancer or arthritis. Sex differences in NCDs were described using logistic regression to generate odds ratios (OR) with adjustment for sociodemographic factors and health-related behaviours. All analyses were stratified by age group for 45–64-year-old and ≥65-year-old participants.ResultsIn both age groups, men reported better overall health than women. The crude prevalence of heart disease, cancer and arthritis was higher while that of stroke and chronic lung disease was lower in women than in men. After adjustment, ORs (95% CI) for the 45–64 and ≥65 year age groups were 0.70 (0.58 to 0.84) and 0.66 (0.54 to 0.80), respectively, for arthritis for men compared with women. In contrast, ORs were 1.66 (1.09 to 2.52) and 2.12 (1.36 to 3.30) for stroke and 1.51 (1.21 to 1.89) and 1.43 (1.09 to 1.88) for chronic lung disease for men compared with women. ORs for heart disease (0.65 (0.52 to 0.80)) were lower in men than in women only in the 45–64 year age group.ConclusionsOdds of arthritis were lower while those of stroke and chronic lung disease were higher in men than in women in both age groups. However, odds of heart disease were lower in men than in women, but only in the group of individuals aged 45–64 years.</jats:sec
Performance evaluation of inpatient service in Beijing: a horizontal comparison with risk adjustment based on Diagnosis Related Groups
<p>Abstract</p> <p>Background</p> <p>The medical performance evaluation, which provides a basis for rational decision-making, is an important part of medical service research. Current progress with health services reform in China is far from satisfactory, without sufficient regulation. To achieve better progress, an effective tool for evaluating medical performance needs to be established. In view of this, this study attempted to develop such a tool appropriate for the Chinese context.</p> <p>Methods</p> <p>Data was collected from the front pages of medical records (FPMR) of all large general public hospitals (21 hospitals) in the third and fourth quarter of 2007. Locally developed Diagnosis Related Groups (DRGs) were introduced as a tool for risk adjustment and performance evaluation indicators were established: Charge Efficiency Index (CEI), Time Efficiency Index (TEI) and inpatient mortality of low-risk group cases (IMLRG), to reflect respectively work efficiency and medical service quality. Using these indicators, the inpatient services' performance was horizontally compared among hospitals. Case-mix Index (CMI) was used to adjust efficiency indices and then produce adjusted CEI (aCEI) and adjusted TEI (aTEI). Poisson distribution analysis was used to test the statistical significance of the IMLRG differences between different hospitals.</p> <p>Results</p> <p>Using the aCEI, aTEI and IMLRG scores for the 21 hospitals, Hospital A and C had relatively good overall performance because their medical charges were lower, LOS shorter and IMLRG smaller. The performance of Hospital P and Q was the worst due to their relatively high charge level, long LOS and high IMLRG. Various performance problems also existed in the other hospitals.</p> <p>Conclusion</p> <p>It is possible to develop an accurate and easy to run performance evaluation system using Case-Mix as the tool for risk adjustment, choosing indicators close to consumers and managers, and utilizing routine report forms as the basic information source. To keep such a system running effectively, it is necessary to improve the reliability of clinical information and the risk-adjustment ability of Case-Mix.</p
Helical Luttinger liquid on the edge of a 2-dimensional topological antiferromagnet
Boundary helical Luttinger liquid (HLL) with broken bulk time-reversal
symmetry belongs to a unique topological class which may occur in
antiferromagnets (AFM). Here, we search for signatures of HLL on the edge of a
recently discovered topological AFM, MnBi2Te4 even-layer. Using scanning
superconducting quantum interference device, we directly image helical edge
current in the AFM ground state appearing at its charge neutral point. Such
helical edge state accompanies an insulating bulk which is topologically
distinct from the ferromagnetic Chern insulator phase as revealed in a magnetic
field driven quantum phase transition. The edge conductance of the AFM order
follows a power-law as a function of temperature and source-drain bias which
serves as strong evidence for HLL. Such HLL scaling is robust at finite fields
below the quantum critical point. The observed HLL in a layered AFM
semiconductor represents a highly tunable topological matter compatible with
future spintronics and quantum computation
Electronically phase separated nano-network in antiferromagnetic insulating LaMnO3/PrMnO3/CaMnO3 tricolor superlattice
Strongly correlated materials often exhibit an electronic phase separation
(EPS) phenomena whose domain pattern is random in nature. The ability to
control the spatial arrangement of the electronic phases at microscopic scales
is highly desirable for tailoring their macroscopic properties and/or designing
novel electronic devices. Here we report the formation of EPS nanoscale network
in a mono-atomically stacked LaMnO3/CaMnO3/PrMnO3 superlattice grown on SrTiO3
(STO) (001) substrate, which is known to have an antiferromagnetic (AFM)
insulating ground state. The EPS nano-network is a consequence of an internal
strain relaxation triggered by the structural domain formation of the
underlying STO substrate at low temperatures. The same nanoscale network
pattern can be reproduced upon temperature cycling allowing us to employ
different local imaging techniques to directly compare the magnetic and
transport state of a single EPS domain. Our results confirm the one-to-one
correspondence between ferromagnetic (AFM) to metallic (insulating) state in
manganite. It also represents a significant step in a paradigm shift from
passively characterizing EPS in strongly correlated systems to actively
engaging in its manipulation
Is occupation a good predictor of self-rated health in China?
China's rapidly changing economic landscape has led to widening social inequalities. Occupational status in terms of occupational type and prestige may reflect these socio-structural shifts of social position and be more predictive of self-rated health status than income and education, which may only reflect more gradual acquisitions of social status over time. The goals of this study were to understand the role of occupational status in predicting self-rated health, which is well known to be associated with long-term mortality, as well as compare the occupational status to the other major socioeconomic indicators of income and education.Data from the 2010 baseline surveys of the China Family Panel Studies, which utilized multi-stage probability sampling with implicit stratification was used. Logistic regression was used to examine the relationship of various socioeconomic indicators (i.e. occupational status, income, and education) with self-rated health as the primary outcome of interest. A series of models considered the associations of occupational category or occupational prestige with self-rated health.The final sample consisted of 14,367 employed adults aged 18-60, which was nationally representative of working adults in China. We found that occupation was not a major predictor of self-rated health in China when age, ethnicity, location, marital status, physical and mental health status were controlled for, with the exception of women working in lower grade management and professional jobs (OR = 1.82, 95% CI: 1.03-3.22). In comparison, income followed by education exhibited greater association with self-rated health. The highest income group had the least probability to report poor health (In men: OR = 0.30, 95% CI: 0.21-0.43. In women: OR = 0.44, 95% CI: 0.26-0.73). People educated with junior high school had better self-rated health than those with primary and below education level (In men: OR = 0.62, 95% CI: 0.50-0.75. In women: OR = 0.53, 95% CI: 0.42-0.68). Income, education and occupation were correlated with each other.Within the context of rapid societal changes in China, income and its implications for greater healthcare access and benefits had the greatest association with self-rated health followed by education. Occupational status was not associated. Occupational categories and prestige should be better adapted to reflect China's unique sociopolitical and historical context
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