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Long Q.,University of Helsinki | Zhang T.,Peking University | Xu L.,Center for Health Statistics and Information | Hemminki E.,Finnish National Institute for Health and Welfare
Tropical Medicine and International Health | Year: 2010

OBJECTIVE: To investigate factors influencing maternal health care utilisation in western rural China and its relation to income before (2002) and after (2007) introducing a new rural health insurance system (NCMS). METHODS: Data from cross-sectional household-based health surveys carried out in ten western rural provinces of China in 2003 and 2008 were used in the study. The study population comprised women giving birth in 2002 or 2007, with 917 and 809 births, respectively. Correlations between outcomes and explanatory variables were studied by logistic regression models and a log-linear model. RESULTS: Between 2002 and 2007, having no any pre-natal visit decreased from 25% to 12% (difference 13%, 95% CI 10-17%); facility-based delivery increased from 45% to 80% (difference 35%, 95% CI 29-37%); and differences in using pre-natal and delivery care between the income groups narrowed. In a logistic regression analysis, women with lower education, from minority groups, or high parity were less likely to use pre-natal and delivery care in 2007. The expenditure for facility-based delivery increased over the period, but the out-of-pocket expenditure for delivery as a percentage of the annual household income decreased. In 2007, it was 14% in the low-income group. NCMS participation was found positively correlated with lower out-of-pocket expenditure for facility-based delivery (coefficient-1.14 P < 0.05) in 2007. CONCLUSIONS: Facility-based delivery greatly increased between 2002 and 2007, coinciding with the introduction of the NCMS. The rural poor were still facing substantial payment for facility-based delivery, although NCMS participation reduced the out-of-pocket expenditure on average. © 2010 Blackwell Publishing Ltd.

Long Q.,University of Helsinki | Zhang Y.,Center for Health Statistics and Information | Wu Z.,Fudan University | Bogg L.,Karolinska Institutet | Hemminki E.,Finnish National Institute for Health and Welfare
Bulletin of the World Health Organization | Year: 2011

Objective To investigate changes in the expenditure of giving birth in health-care facilities in rural China during 1998-2007, to examine the financial burden on households, particularly poor ones, and to identify factors associated with out-of-pocket expenditure. Methods Cross-sectional data on births between 1998 and 2007 were obtained from national household surveys conducted in 2003 and 2008. Descriptive statistics and log-linear models were used to identify factors associated with out-of-pocket expenditure on delivery. Findings During 1998-2007, the proportion of facility-based deliveries increased from 55% to 90%. In 2007, 60% of births occurred at county-level or higher-level facilities. The Caesarean delivery rate increased from 6% to 26%. Total expenditure on a facility-based delivery increased by 152%, with a marked rise from 2002 onwards with the introduction of the New Cooperative Medical Scheme. In 2007, out-of-pocket expenditure on a facility-based delivery equalled 13% of the mean annual household income for low-income households. This proportion had decreased from 18% in 2002 and differences between income groups had narrowed. Regression models showed that Caesarean delivery and delivery at a higher-level facility were associated with higher expenditure in 2007. The New Cooperative Medical Scheme was associated with lower out-of-pocket expenditure on Caesarean delivery but not on vaginal delivery. Conclusion Expenditure on facility-based delivery greatly increased in rural China over 1998-2007 because of greater use of higher-level facilities, more Caesarean deliveries and the introduction of the New Cooperative Medical Scheme. The financial burden on the rural poor remained high.

Meng Q.,Shandong University | Yuan B.,Shandong University | Jia L.,Shandong University | Wang J.,Shandong University | And 2 more authors.
Health Policy and Planning | Year: 2011

Vulnerable groups are often not covered by health insurance schemes. Strategies to extend coverage in these groups will help to address inequity. We used the existing literature to summarize the options for expanding health insurance coverage, describe which countries have tried these strategies, and identify and describe evaluation studies.We included any report of a policy or strategy to expand health insurance coverage and any evaluation and economic modelling studies. Vulnerable populations were defined as children, the elderly, women, low-income individuals, rural population, racial or ethnic minorities, immigrants, and those with disability or chronic diseases. Forty-five databases were searched for relevant documents. The authors applied inclusion criteria, and extracted data using pre-coded forms, on contents of health insurance schemes or programmes, and used the framework approach to establish categories.Of the 21528 articles screened, 86 documents were finally included. Descriptions about the USA dominated (72), with only five from Africa, six from Asia and two from South America. We identified six main categories: (1) changing eligibility criteria of health insurance; (2) increasing public awareness; (3) making the premium more affordable; (4) innovative enrolment strategies; (5) improving health care delivery; and (6) improving management and organization of the insurance schemes. All six categories were found in the literature about schemes in the USA, and schemes often included components from each category. Strategies in developing countries were much more limited in their scope. Evaluation studies numbered 25, of which the majority were of time series design. All studies found that the expansion strategies were effective, as assessed by the author(s).In countries expanding coverage, the categories identified from the literature can help policy makers consider their options, implement strategies where it is common sense to do so and establish appropriate implementation monitoring. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2010; all rights reserved.

Feng X.L.,Peking University | Xu L.,Center for Health Statistics and Information | Guo Y.,Peking University | Ronsmans C.,London School of Hygiene and Tropical Medicine
Bulletin of the World Health Organization | Year: 2011

Objective To assess trends in hospital births in China during 1988-2008 in an effort to determine if efforts to overcome financial barriers to giving birth in hospital have reduced the access gap between the rich and the poor. Methods Cross-sectional data obtained from four National Health Service Surveys were used to determine trends in hospital births during 1988-2008. Crude and adjusted annual rates were calculated by means of Poisson regression and were used to define trends across socioeconomic regions and households in different income quintiles. Findings In 2008 women throughout China were giving birth in hospital almost universally except in region IV, the most remote rural region, where the percentage of hospital births was only 60.8. Hospital births in this region had increased steadily before 2002, but after that year the upward trend slowed down. During 1988-2001 the average yearly increase had been 21%, but in 2002-2008 it dropped to 10% (P = 0.0031). Inequalities between socioeconomic regions were greater than among individual households belonging to different income strata. By 2008 the difference between low- and high-income households in the proportion of hospital births had become very small (96.1% and 87.7% of high- and low-income households, respectively, gave birth in hospital that year). Conclusion Most Chinese women now give birth in hospital, but the poorest rural region is still lagging behind. A more active and comprehensive approach will be needed to increase hospital births in these remote, hard-to-reach populations.

Jian W.,Peking University | Chan K.Y.,Peking University | Reidpath D.D.,Monash University | Xu L.,Center for Health Statistics and Information
Health Affairs | Year: 2010

Reducing the gap in health outcomes between rural and urban areas in China has been a focus of the central government's health reform efforts since 2002. Drawing on national survey data from 2003 and 2008, this paper analyzes changes in the rural-urban gap for patients with chronic diseases. Overall, there were substantial improvements at the national level in insurance coverage and the use of hospital services for both urban and rural residents with chronic diseases. There was also an overall reduction in the rural-urban gap in the use of inpatient services. But the gains were uneven. For example, although rural Chinese with chronic disease could more easily start inpatient treatment in 2008 than they could in 2003, because of the higher hospital copayments required under insurance coverage for rural citizens, they were more than twice as likely to drop out of treatment as were Chinese in urban areas. The strongest evidence of the narrowing of the rural-urban gap came from central China, while the evidence is mixed for western and eastern China. Our analysis suggests that different approaches will be required to narrow the rural-urban health service gap in different regions of China. ©2010 Project HOPE- The People-to-People Health Foundation, Inc.

Sun X.,Shandong University | Lucas H.,University of Sussex | Meng Q.,Shandong University | Zhang Y.,Center for Health Statistics and Information
Quality of Life Research | Year: 2011

Purpose This study aimed to compare health-related quality of life (HRQOL) for elderly men and women in three mutually exclusive living arrangements: Living alone, living only with spouse, and non-empty-nesters. It also examined whether such living arrangements and other factors relating to social interaction have an independent influence on HRQOL after controlling for other variables. Methods The data were drawn from China's 4th National Household Health Survey (NHHS) conducted in 2008. The final sample included 9,711 urban elderly people of 60 years and above. The EQ-5D inventory was used to measure health-related quality of life. Results The proportions of non-empty-nested men and women both changed following a 'U'-shaped curve with the increasing age. Controlling for other variables not including social interaction indicators, "living alone" was a significant predictor of reporting problems on Mobility, Pain/Discomfort and Anxiety/Depression. After introducing social interaction indicators, urban older adults 'having close contact with neighbors every week' had lower odds of problems on all five EQ-5D indicators, those 'having close contact with friends and relatives' had lower odds of problems on Mobility, Pain/Discomfort and Anxiety/ Depression, and those 'taking part in social activities every week' had lower odds of problems on all dimensions but Anxiety/Depression. In addition, after introducing social interaction indicators, the odds of reported problems on the three dimensions increased obviously. Conclusions This study suggests that the most vulnerable urban older adults are those who live entirely on their own. Frequent social interaction may buffer the negative effect of living alone on HRQOL of older adults. Policies that attempt to build harmonious neighborhoods, extend older adults' social network and encourage them to take part in social activities should be considered by the policy-makers in the future. © Springer Science+Business Media B.V. 2010.

Qian J.,Center for Health Statistics and Information | Cai M.,Center for Health Statistics and Information | Gao J.,Center for Health Statistics and Information | Tang S.,Research and Training in Tropical Diseases | And 2 more authors.
Bulletin of the World Health Organization | Year: 2010

Objective: China has about 350 million smokers, more commonly men. Using data from National Health Service Surveys conducted in 1993, 1998 and 2003, we (i) estimated trends in smoking prevalence and cessation according to sociodemographic variables and (ii) analysed cessation rates, quitting intentions, reasons for quitting and reasons for relapsing. Methods: Data were collected from approximately 57 000 households and 200 000 individuals in each survey year. Household members > 15 years of age were interviewed about their smoking habits, quitting intentions and attitudes towards smoking. We present descriptive data stratified by age, sex, income level and rural versus urban residence. Findings: In China, current smoking in those > 15 years old declined 60-49% in men and 5-3.2% in women over 1993-2003. The decline was more marked in urban areas. However, heavy smoking (≥ 20 cigarettes daily) increased substantially overall and doubled in men. The average age of uptake also dropped by about 3 years. In 2003, 7.9% of smokers reported intending to quit, and 6% of people who had ever smoked reported having quit. Of former smokers, 40.6% quit because of illness, 26.9% to prevent disease and 10.9% for financial reasons. Conclusion: Smoking prevalence declined in China over the study period, perhaps due to the combined effect of smoking cessation, reduced uptake in women and selective mortality among men over 40 years of age. However, heavy smoking increased. People in China rarely quit or intend to quit smoking, except at older ages. Further tobacco control efforts are urgently needed, especially in rural areas.

Sun S.,Karolinska Institutet | Chen J.,Nanjing Medical University | Johannesson M.,Stockholm School of Economics | Kind P.,University of York | And 3 more authors.
Health and Place | Year: 2011

Purpose: To measure, describe and analyse regional differences in health-related quality of life measured by EQ-5D in China. Data were obtained via face-to-face interviews on a national representative sample (n=120,703, 15-103 years). The EQ-5D instrument was used to measure health status. Results: Rural areas had worse health status than urban areas. Health status was worst in western areas and best in eastern areas, and such disparities were profounder in rural areas. In urban areas, health status was best in middle-sized cities. In rural areas, health status increased with the economic development level of a county. Conclusion: Our study enhances understanding of the urban-rural differences and east-middle-west differences in health and sheds light on inequalities in health status between different city categories in the urban areas and county categories in the rural areas. © 2011 Elsevier Ltd.

Yuefeng L.,Center for Health Statistics and Information | Keqin R.,Center for Health Statistics and Information | Xiaowei R.,Lanzhou University
BMC Public Health | Year: 2012

Background: When an individual is ill or symptomatic, they have the options of seeking professional health care, self-treating or doing nothing. In China, some studies suggest that the number of individuals opting to self-treat has been rapidly increasing in recent years. Therefore, the aim of this study was to analyze the trends of and factors related to self-treatment in China. Methods. Self-treatment was measured based the concept and data of the China National Health Survey (CNHS), which covers 802,454 individuals. We used CNHS data from 1993, 1998, 2003, and 2008, and a Multinomial Logit Selection Model to estimate the factors influencing the decision to self-treat. Results: The prevalences of self-treatment with a recall period of two-weeks were significantly higher in urban compared with rural areas (31.2% vs 14.9% in 1993, 43.5% vs 21.4% in 1998, 47.2% vs 31.4% in 2003, 31.0% vs 25.3% in 2008) in China. Economic (per capita income, TV, sanitary water) and individual (education, profession, family members, exercise) factors, as well as accessibility to drugs had a positive association with the probability of self-treating. Different illness symptoms, severity, and duration show a negative association with the probability of self-treating, showing a degree of rationality in decision-making. Different insurance systems were also found to have an effect on self-treatment decision-making. Conclusions: Self-treatment and professional medical services have shared the incremental medical needs of residents in recent years in China. Self-perceived illness status, economic circumstances, and education play important roles in health care decision-making. © 2012 Yuefeng et al.; licensee BioMed Central Ltd.

Long Q.,Chongqing Medical University | Xu L.,Center for Health Statistics and Information | Bekedam H.,World Health Organization | Tang S.,Duke University
International Journal for Equity in Health | Year: 2013

Background: China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000-2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Methods. Health expenditures data came from the China National Health Accounts study in 1990-2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Results: Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). Conclusions: The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick members, particularly in the less developed region, is getting worse. It needs effective measures on cost control including healthcare provider payment reform and well developed health insurance schemes to offer better financial protection for the vulnerable Chinese seeking essential healthcare. © 2013 Long et al.; licensee BioMed Central Ltd.

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