Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data

In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.China, New Rural Cooperative Medical Scheme, Technical efficiency, data envelopment analysis, Township Hospitals.

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.

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 is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.China;New Rural Cooperative Medical Scheme;Impact analysis;Township Hospitals.

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 is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.China;New Rural Cooperative Medical Scheme;Impact analysis;Township Hospitals.

Curative Activities of Township Hospitals in Weifang Prefecture, China: An Analysis of Environmental and Supply-Side Determinants

Township hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized.Health insurance, China, Healthcare services, Hausman-Taylor, Fixed-effects vector decomposition

Curative Activities of Township Hospitals in Weifang Prefecture, China: An Analysis of Environmental and Supply-Side Determinants

International audienceTownship hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized.Les hôpitaux municipaux, qui sont un maillon essentiel du système de santé rural Chinois, ont été affectés par les réformes économiques successives depuis les années 1980 et ont ainsi vu leur fréquentation s’affaiblir. À partir d’observations longitudinales sur neuf années (2000-2008) et 24 hôpitaux municipaux sélectionnés de façon aléatoire dans la préfecture de Weifang (Province du Shandong, Chine), cet article analyse les facteurs d’environnement et d’offre qui influencent le volume des activités curatives des hôpitaux municipaux, mesurépar le volume de consultations externes et d’hospitalisations. Afin d’estimer l’effet de variables invariantes dans le temps, deux estimateurs sont utilisés : Hausman-Taylor et Fixed-Effect Vector Decomposition. Les résultats des estimations des deux estimateurs sont similaires. Ils montrent que le système d’assurance mutualiste graduellement introduit à partir de 2003 influence positivement l’activité des hôpitaux municipaux, même s’il subsiste des barrières financières à l’accès aux soins de santé coûteux. L’analyse souligne aussi queles liens de référencement entre les différents niveaux de structures de santé devraient être renforcés et que la taille des hôpitaux municipaux, qui semble surestimée, doit être adaptée en fonction des facteurs environnementaux

Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data

In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.China;New Rural Cooperative Medical Scheme;Technical efficiency;data envelopment analysis;Township Hospitals.

Should we welcome robot teachers?

Abstract Current uses of robots in classrooms are reviewed and used to characterise four scenarios: (s1) Robot as Classroom Teacher; (s2) Robot as Companion and Peer; (s3) Robot as Care-eliciting Companion; and (s4) Telepresence Robot Teacher. The main ethical concerns associated with robot teachers are identified as: privacy; attachment, deception, and loss of human contact; and control and accountability. These are discussed in terms of the four identified scenarios. It is argued that classroom robots are likely to impact children’s’ privacy, especially when they masquerade as their friends and companions, when sensors are used to measure children’s responses, and when records are kept. Social robots designed to appear as if they understand and care for humans necessarily involve some deception (itself a complex notion), and could increase the risk of reduced human contact. Children could form attachments to robot companions (s2 and s3), or robot teachers (s1) and this could have a deleterious effect on their social development. There are also concerns about the ability, and use of robots to control or make decisions about children’s behaviour in the classroom. It is concluded that there are good reasons not to welcome fully fledged robot teachers (s1), and that robot companions (s2 and 3) should be given a cautious welcome at best. The limited circumstances in which robots could be used in the classroom to improve the human condition by offering otherwise unavailable educational experiences are discussed

Gymnemic acids inhibit hyphal growth and virulence in Candida albicans

Candida albicans is an opportunistic and polymorphic fungal pathogen that causes mucosal, disseminated and invasive infections in humans. Transition from the yeast form to the hyphal form is one of the key virulence factors in C. albicans contributing to macrophage evasion, tissue invasion and biofilm formation. Nontoxic small molecules that inhibit C. albicans yeast-to-hypha conversion and hyphal growth could represent a valuable source for understanding pathogenic fungal morphogenesis, identifying drug targets and serving as templates for the development of novel antifungal agents. Here, we have identified the triterpenoid saponin family of gymnemic acids (GAs) as inhibitor of C. albicans morphogenesis. GAs were isolated and purified from Gymnema sylvestre leaves, the Ayurvedic traditional medicinal plant used to treat diabetes. Purified GAs had no effect on the growth and viability of C. albicans yeast cells but inhibited its yeast-to-hypha conversion under several hypha-inducing conditions, including the presence of serum. Moreover, GAs promoted the conversion of C. albicans hyphae into yeast cells under hypha inducing conditions. They also inhibited conidial germination and hyphal growth of Aspergillus sp. Finally, GAs inhibited the formation of invasive hyphae from C. albicans-infected Caenorhabditis elegans worms and rescued them from killing by C. albicans. Hence, GAs could be useful for various antifungal applications due to their traditional use in herbal medicine

The Intestinal Microbiota Plays a Role in Salmonella-Induced Colitis Independent of Pathogen Colonization

The intestinal microbiota is composed of hundreds of species of bacteria, fungi and protozoa and is critical for numerous biological processes, such as nutrient acquisition, vitamin production, and colonization resistance against bacterial pathogens. We studied the role of the intestinal microbiota on host resistance to Salmonella enterica serovar Typhimurium-induced colitis. Using multiple antibiotic treatments in 129S1/SvImJ mice, we showed that disruption of the intestinal microbiota alters host susceptibility to infection. Although all antibiotic treatments caused similar increases in pathogen colonization, the development of enterocolitis was seen only when streptomycin or vancomycin was used; no significant pathology was observed with the use of metronidazole. Interestingly, metronidazole-treated and infected C57BL/6 mice developed severe pathology. We hypothesized that the intestinal microbiota confers resistance to infectious colitis without affecting the ability of S. Typhimurium to colonize the intestine. Indeed, different antibiotic treatments caused distinct shifts in the intestinal microbiota prior to infection. Through fluorescence in situ hybridization, terminal restriction fragment length polymorphism, and real-time PCR, we showed that there is a strong correlation between the intestinal microbiota composition before infection and susceptibility to Salmonella-induced colitis. Members of the Bacteroidetes phylum were present at significantly higher levels in mice resistant to colitis. Further analysis revealed that Porphyromonadaceae levels were also increased in these mice. Conversely, there was a positive correlation between the abundance of Lactobacillus sp. and predisposition to colitis. Our data suggests that different members of the microbiota might be associated with S. Typhimurium colonization and colitis. Dissecting the mechanisms involved in resistance to infection and inflammation will be critical for the development of therapeutic and preventative measures against enteric pathogens