INCREASING THE AFFORDABILITY OF HEALTHCARE: COMPARING REFORMS IN CHINA AND THE UNITED STATES 提高医疗服务的可负担性：中美医改比较

This article discusses the conceptual and measurement aspects of health care affordability. It points out that China’s health care reforms need to tackle individual affordability while societal affordability is a critical issue in healthcare reform for the United States. The paper further compares and discusses the approaches adopted by the two countries to ensure healthcare affordability including, expanding insurance coverage and enhancing benefits design, as well as controlling medical costs. The author stated that the United States and China can benefit by learning from each other’s experiences gathered through a systematic monitoring and evaluation of what works and what does no

Microplastics in the environment and the analysis:fulfil knowledge gap of research size covering, methodology and analytical technologies

Microplastics (MPs) were initially detected in aquatic environments in the early 2000s. Subsequently, extensive research has been conducted to enhance our understanding of MPs. Nonetheless, information about small MPs remains limited because the majority of studies have concentrated on larger MPs (&gt; 200 μm), and more advanced technologies such as µFTIR imaging still struggle when trying to quantify the smallest of MPs. Additionally, methods are not harmonized, which leads to challenges when comparing data across studies. To address aspects of these questions, this PhD study aimed to analyze MPs down to 10 μm in Danish marine waters. The study also explored the impact of different methodologies on understanding of MPs in the environment. Finally, a novel FTIR detection technology was studied to evaluate its efficacy in detecting small MPs.The study conducted in Danish marine waters revealed that the abundance and mass concentration of MPs convey different information. The abundance of MPs ranged from 17 to 286 items m−3 with an average of 103±86 items m−3, while the mass concentration ranged from 0.6 to 84.1 μg m−3 with an average of 23.3±28.3 μg m−3. The most prevalent types of polymers were polyester, and the majority of the MPs were fragments and small MPs (&lt; 100 μm). Moreover, the study investigated the relationship between MP distribution and human activities, revealing high MP abundance around the Copenhagen-Malmö area, probably due to the population density of the area. In addition, the analysis of the carbonyl index of polyolefins showed significant oxidation of small MPs. A rough mass balance indicated that wastewater and stormwater may play a key role in MPs in introducing MPs to the marine environment.To explore how analytical methodology affect the quantification of MPs in the environment, two different methodologies were employed to analyze the same sample collected from the Danube River, Hungary. The results demonstrated that the analytical methodology used impacted the abundance and mass concentration of MPs. Further investigation revealed that each step in the methodology produced different outcomes, providing insights for future improvement.The study also introduced large area attenuated total reflectance (LAATR)-Fourier-transform infrared spectroscopy (FTIR) applying ZnSe and Ge ATR-units. The use of these units improved the ability to analyze MPs down to 1.3 μm, particularly when detecting small MPs. Moreover, it provided information on both hyperspectral images and the obtained spectra quality, and it assessed criteria for obtaining reliable results with this technique.In summary, this study filled knowledge gaps regarding small MPs in the marine environment, examined the relationship between MP distribution and human activity, and provided insights into the effect of the analytical methodology on MP quantification results. Additionally, the study introduced the application of LAATR-FTIR for detecting small MPs. <br/

The Contribution of Population Health and Demographic Change to Economic Growth in China and India

We find that a cross-country model of economic growth successfully tracks the growth takeoffs in China and India. The major drivers of the predicted takeoffs are improved health, increased openness to trade, and a rising labor force-to-population ratio due to fertility decline. We also explore the effect of the reallocation of labor from low-productivity agriculture to the higher productivity industry and service sectors. Including the money value of longevity improvements in a measure of full income reduces the gap between the magnitude of China's takeoff relative to India's due to the relative stagnation in life expectancy in China since 1980.aging, health, retirement

Willingness to Pay for Social Health Insurance among Informal Sector Workers in Wuhan, China: a Contingent Valuation Study

Background: Most of the about 140 million informal sector workers in urban China do not have health insurance. A 1998 central government policy leaves it to the discretion of municipal governments to offer informal sector workers in cities voluntary participation in a social health insurance for formal sector workers, the so-called 'basic health insurance' (BHI). Methods: We used the contingent valuation method to assess the maximum willingness to pay (WTP) for BHI among informal sector workers, including unregistered rural-to-urban migrants, in Wuhan City, China. We selected respondents in a two-stage self-weighted cluster sampling scheme. Results: On average, informal sector workers were willing to pay substantial amounts for BHI (30 Renminbi (RMB), 95% confidence interval (CI) 27-33) as well as substantial proportions of their incomes (4.6%, 95% CI 4.1-5.1%). Average WTP increased significantly when any one of the copayments of the BHI was removed in the valuation: to 51 RMB (95% CI 46-56) without reimbursement ceiling; to 43 RMB (95% CI 37-49) without deductible; and to 47 RMB (95% CI 40-54) without coinsurance. WTP was higher than estimates of the cost of BHI based on past health expenditure or on premium contributions of formal sector workers. Predicted coverage with BHI declined steeply with the premium contribution at low contribution levels. When we applied equity weighting in the aggregation of individual WTP values in order to adjust for inequity in the distribution of income, mean WTP for BHI increased with inequality aversion over a plausible range of the aversion parameter. Holding other factors constant in multiple regression analysis, for a 1% increase in income WTP for BHI with different copayments increased by 0.434-0.499% (all p < 0.0001), and for a 1% increase in past health care expenditure WTP increased by 0.076-0.148% (all p < 0.0004). Being male, a migrant, or without permanent employment significantly decreased WTP for BHI. Education was not a significant determinant of WTP for BHI. Conclusion: Our results suggest that Chinese municipal governments should allow informal sector workers to participate in the BHI. From a normative perspective, BHI for informal sector workers is likely to increase social welfare because average WTP for BHI is significantly higher than estimates of the average cost of BHI. We further find that informal sector workers do not value the BHI as a mechanism to recover the relatively frequent but small financial losses associated with common illnesses, but because it protects against the rare but large financial losses associated with catastrophic care. From a behavioural perspective, our results predict that at a price equal to the average premium contribution of formal sector workers 35% of informal sector workers will enrol in the BHI. Subsidies and changes in insurance attributes (e.g. including catastrophic care and portability) should be effective in increasing BHI coverage. In addition, coverage should expand with rising incomes among informal sector workers in China. Finally, adverse selection will be unlikely to be a large problem, if the BHI is offered to informal sector workers

National Essential Public Health Services Programs over the Past Decade Research Report One：Significance and Experiences of Implementing National Essential Public Health Services Programs

The National Essential Public Health Services Programs (NEPHSP) is a systematic and overall basic public service system arrangement made by the Chinese government at the national level aiming at the main health problems existing in urban and rural residents and targeting at key population key diseases and the whole population. Year of 2019 is the tenth anniversary of the NEPHSP implementation. This article summarized the significance of implementing NEPHSP based on a 10-year evaluation of NEPHSP from four aspects: universal health coverage, Healthy China 2030 strategy, China&apos;s deepening health system reform and major institutional innovation. At the same time, several main experiences of successful projects were summarized, including the following five aspects: establishing and improving a strong project organization and management system, steadily increasing strength of financial support, following the principle of gradual implementation of projects, advocating and encouraging local exploration in accordance with local conditions, and adhering to clear reward and punishment performance appraisal. From the historical perspective, this paper summarized the implementation of the great project led by the Chinese government in order to introduce the Chinese way, Chinese practice and Chinese experience of primary health care work in the new era at home and abroad

Does microplastic analysis method affect our understanding of microplastics in the environment?

Two analytical methods – both in active use at different laboratories – were tested and compared against each other to investigate how the procedure influences microplastic (MP) detection with micro Fourier Transform Infrared Spectroscopy (μFTIR) imaging. A representative composite water sample collected from the Danube River was divided into 12 subsamples, and processed following two different methods, which differed in MP isolation procedures, the optical substrate utilized for the chemical imaging, and the detection limit of the spectroscopic instruments. The first instrument had a nominal pixel resolution of 5.5 μm, while the second had a nominal resolution of 25 μm. These two methods led to different MP abundance, MP mass estimates, but not MP characteristics. Only looking at MPs &gt; 50 μm, the first method showed a higher MP abundance, namely 418–2571 MP m−3 with MP mass estimates of 703–1900 μg m−3, while the second method yielded 16.7–72.1 MP m−3 with mass estimates of 222–439 μg m−3. Looking deeper into the steps of the methods showed that the MP isolation procedure contributed slightly to the difference in the result. However, the variability between individual samples was larger than the difference caused by the methods. Somewhat sample-dependent, the use of two different substrates (zinc selenide windows versus Anodisc filters) caused a substantial difference between results. This was due to a higher tendency for particles to agglomerate on the Anodisc filters, and an ‘IR-halo’ around particles on ZnSe windows when scanning with μFTIR. Finally, the μFTIR settings and nominal resolution caused significant differences in identifying MP size and mass estimate, which showed that the smaller the pixel size, the more accurately the particle boundary can be defined. These findings contributed to explaining disagreements between studies and addressed the importance of harmonization of methods.</p

Primary productivity dynamics in the summer Arctic Ocean confirms broad regulation of the electron requirement for carbon fixation by light-phytoplankton community interaction

© 2019 Zhu, Suggett, Liu, He, Lin, Le, Ishizaka, Goes and Hao. Predicting conversion of photosynthetic electron transport to inorganic carbon uptake rates (the so-called electron requirement for carbon fixation, KC) is central to the broad scale deployment of Fast Repetition Rate fluorometry (FRRf) for primary productivity studies. However, reconciling variability of KC over space and time to produce robust algorithms remains challenging, given the large number of factors that influence KC. We have previously shown that light appears to be a proximal driver of Kc in several ocean regions and we therefore examined whether and how light similarly regulated KC variability in the Arctic Ocean, during a summer cruise in 2016. Sampling transited ice-free and ice-covered waters, with temperature, salinity and Chl-a concentrations all higher for the ice-free than ice covered surface waters. Micro- and pico-phytoplankton generally dominated the ice-free and ice-covered waters, respectively. Values of KC, determined from parallel measures of daily integrated electron transport rates and 14C-uptake, were overall lower for the ice-covered vs. ice-free stations. As in our previous studies, KC was strongly linearly correlated to daily PAR (r = 0.68, n = 46, p < 0.001) and this relationship could be further improved (r = 0.84, n = 46, p < 0.001) by separating samples into ice-free (micro-phytoplankton dominated) vs. ice-covered (Nano- and Pico-phytoplankton dominated water. We subsequently contrasted the PAR-KC relationship form the Arctic waters with the previous relationships from the Ariake Bay and East China Sea and revealed that these various PAR-KC relationships can be systematically explained across regions by phytoplankton community size structures. Specifically, the value of the linear slope describing PAR-KC decreases as water bodies have an increasing fraction of larger phytoplankton. We propose that this synoptic trend reflects how phytoplankton community structure integrates past and immediate environmental histories and hence may be a better broad-scale predictor of KC than specific environmental factors such as temperature and nutrients. We provide a novel algorithm that may enable broad-scale retrieval of CO2 uptake from FRRf with knowledge of light and phytoplankton community size information