Although much public scrutiny and academic attention has focused on the evaluations of system implementation since the beginning of New Rural Cooperative Medical System (NRCMS) in China, few studies have systematically evaluated the achievements of the stated policy goals. The purpose of this study is to examine to what extent the policy goals of NRCMS have been achieved. Using multistage sampling processes, two rounds of cross-sectional household surveys including 9787 and 7921 rural households were conducted in Eastern China in year 2000 and year 2008, respectively. A pre- and post-implementation comparison was used to evaluate the achievement of policy goals in three measures: impoverishment from major health hazards, household financial risk from medical expenses, and rural income inequity. Intention surveys were also applied to find out potential obstacles in the implementation of NRCMS. The rate of re-impoverishment from health hazard was reduced from 2.69 % ex ante to 2.12 % ex post, a decrease of 21.13 %. The severity of impoverishment fell from a previous 4.66 % to 3.02 %, a decline of 35.18 %. Economic risk of medical treatment population relative to the whole population fell from 2.62 ex ante to 2.03 ex post, a 22.52 % reduction. As indication of effect on improving income equity, the Gini coefficient fell from 0.4629 to 0.4541. The effects of NRCMS were significantly better than those of RCMS. Despite the preliminary achievements, our intention survey of key respondents identified that technical difficulties in actuarial funding and more sustainable reimbursement schedules has become the most challenging barriers in achieving the goals of NRCMS, while raising the insurance premium on NRCMS was no longer as big a barrier. With NRCMS, China has established a medical security system to reduce the financial burden of healthcare on rural residents. NRCMS has achieved some positive though limited effects; but technical difficulties in the implementation of NRCMS have become barriers to achieve the pre-set policy goals. Efforts should be made to improve the capacity building in the design of the reimbursement schemes for the implementers of NRCMS, such as identifying medical impoverishment, calculating actuarial funding levels for the risk pooling.

In the 12th Five-Year Plan, the Chinese government set the goal of increasing life expectancy by one year. The purpose of this study is to examine the impact of major causes of death on the life expectancy of the Chinese people between 1950 and 2010 and predict changing trends to identify major issues requiring future attention. A continuous database organised by population and death data on diseases by age group between 1950 and 2010 were created from A Province in Eastern China. The diseases were classified into four categories by the International Classification of Diseases-10 (ICD-10): infectious and parasitic diseases, chronic diseases, accidental injuries, and maternal diseases. Potential gains in life expectancy (PGLEs) were applied to reflect the impact on life expectancy caused by deaths from various diseases, by using the cause-eliminated life table. The PGLEs of infectious and parasitic diseases decreased from 15.59 years in 1950, to 0.07 year in 2010, and have remained low since 2000. However, the PGLEs of chronic diseases increased from 8.70 years in 1950, to 13.36 years in 2010, and indicated an increasing future trend. The two opposite trends exhibited a ‘scissors-like difference’. The proportion of accidental injuries and maternal diseases in the death spectrum was low. The PGLEs of accidental injuries decreased from 2.95 years in 1950, to 0.86 year in 2010, maintaining a low level, while the PGLEs of maternal diseases dropped from 0.56 to 0.002 year during the same period, approaching zero. The findings of this study provide useful information, which could contribute to a more effective allocation of public health programmes. In recent years, chronic diseases and accidental injuries have emerged as major factors influencing life expectancy. Primary and secondary prevention actions, such as public education, modification of behaviours, and introduction of safety measures should be emphasised in efforts to promote life expectancy. The morbidity and mortality rates of infectious, parasitic, and maternal diseases should be maintained at low levels.

Objectives: China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China.Methods: An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform.Results: After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β₃ = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β₃ = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β₃ = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β₃ = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β₃ = −1220.72, p = 0.22) and number of inpatients (β₃ = 75.42, p = 0.09).Conclusion: The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

This study aimed to investigate the hypertension-related knowledge, attitudes, behaviors (KAB), and socio-demographic determinants among community-dwellers who were at risk for hypertension in Shanghai, China. A cross-sectional survey was conducted in a district of Shanghai in 2017 using multi-stage cluster sampling, including 611 participants who were at risk for hypertension. Questionnaires were used to investigate KAB regarding hypertension prevention. Multivariable logistic regression was performed to examine the relationship between socio-demographic factors and hypertension-related KAB. The results indicated that more than 75% of the study population had accurate knowledge, but only 48.4% knew the Recommended Daily Intake of salt for adults; over 80% formed health beliefs, while less than 50% were keeping a healthy diet, maintaining regular physical activity and/or bodyweight control. Better knowledge was found in the below 60 age group (p < 0.01) and the 60–69 age group (p = 0.03) than in the ≥70 age group. The behaviors in females (p < 0.01) were better than in males and were better in those covered by the Urban Employee Basic Medical Insurance (p = 0.01) than in those with the New Rural Cooperative Medical Insurance. In conclusion, although the rates of accurate knowledge and belief of hypertension prevention were high in the study population, the rates of maintaining healthy behaviors were relatively low. Socio-demographic factors had important influences on hypertension-related KAB. Further health education and intervention of hypertension prevention was needed to improve their level of KAB and reduce their risk for hypertension among the target groups.

Purpose: This study aimed to develop a screening tool based on a risk scoring approach that could identify individuals at high risk for hypertension in Shanghai, China. Methods: A total of 3147 respondents from the 2013 Shanghai Chronic Disease and Risk Factor Surveillance were randomly divided into the derivation group and validation group. The coefficients obtained from multivariable logistic regression were used to assign a score to each variable category. The receiver operating characteristic (ROC) curve was used to find the optimal cut-off point and to evaluate the screening performance. Results: Age, family history of hypertension, having diabetes, having dyslipidemia, body mass index, and having abdominal obesity contributed to the risk score. The area under the ROC curve was 0.817 (95% CI: 0.797– 0.836). The optimal cut-off value of 20 had a sensitivity of 83.4%, and a specificity of 64.3%, demonstrating good performance. Conclusion: We developed a simple and valid screening tool to identify individuals at risk for hypertension. Early detection could be beneficial for high-risk groups to better manage their conditions and delay the progression of hypertension and related complications.