Purpose To measure and analyse national EQ-5D data and to provide norms for the Chinese general population by age, sex, educational level, income and employment status. Methods The EQ-5D instrument was included in the National Health Services Survey 2008 (n = 120,703) to measure health-related quality of life (HRQoL). All descriptive analyses by socio-economic status (educational level, income and employment status) and by clinical characteristics (discomfort during the past 2 weeks, diagnosed with chronic diseases during the past 6 months and hospitalised during the past 12 months) were stratified by sex and age group. Results Health status declines with advancing age, and women reported worse health status than men, which is in line with EQ-5D population health studies in other countries and previous population health studies in China. The EQ-5D instrument distinguished well for the known groups: positive association between socio-economic status and HRQoL was observed among the Chinese population. Persons with clinical characteristics had worse HRQoL than those without. Conclusions This study provides Chinese population HRQoL data measured by the EQ-5D instrument, based on a national representative sample. The main findings for different subgroups are consistent with results from EQ-5D population studies in other countries, and discriminative validity was supported.

In the 1990s, China introduced a “free” tuberculosis (TB) care policy under the national TB control program. Recently, as a part of a new TB diagnosis and treatment model, it has been recommended that the integrated model scale up. This paper examines whether or not TB designated hospitals in the selected project sites have provided TB care according to the national and local guidelines, and analyzes the actual practices and expenditures involved in completing TB treatment. It also explores the reasons why “free” TB care in China cannot be effectively implemented under the integrated model. This study was conducted in three counties of Zhenjiang city, Jiangsu province. Mixed methods were used, which comprised reviewing the national and local TB control guidelines, conducting TB patient surveys, collecting TB inpatient and outpatient hospital records, and conducting qualitative interviews with stakeholders. Descriptive statistics were used for quantitative data analysis across counties and in order to compare patients who received only outpatient care and those who received both outpatient and inpatient care. The chi-square test and analysis of variance were performed where necessary. Qualitative data were analyzed using the framework approach. Although the national TB care guidelines recommend outpatient care as a basis for TB treatment in China, we found high hospital admission rates for TB patients ranging from 39 % in Yangzhong county to 83 % in Dantu county. Almost all outpatient TB patients paid for lab tests and over 80 % paid for liver protection drugs and around 70 % paid for image examinations. These three components accounted for three-quarters of the total outpatient expenditure. For patients who received only outpatient care, the total expenditure upon completion of TB treatment was on average 1,135 Chinese yuan. For patients who received outpatient and inpatient care, the total expenditure upon completion of TB treatment was 11,117 Chinese yuan. The “free” TB care policy under the integrated model has not been effectively implemented in China. There has been substantial spending on non-recommended services, examinations, and drugs for TB treatment.

This study analyse how subjective well-being (SWB) in a Chinese population varies with subjective health status, age, sex, region and socio-economic characteristics. In the Household Health Survey 2010, face-to-face interviews were carried out in urban and rural counties in eastern, middle and western areas of China (n = 8,000, aged 15–102 years). To measure subjective health status, a global self-rated health question, the EQ-5D descriptive system, and a visual analogue scale of health status was included. To measure SWB, a validated Chinese version of a question on self-reported happiness, adopted from the World Values Survey, was included. SWB increased with socio-economic status (income and education), and was lower among unemployed individuals and divorced individuals. SWB also increased strongly with subjective health status. When health status was divided into different dimensions using the EQ-5D, the anxiety/depression dimension was the most important dimension for SWB. The reported SWB was also higher in rural counties than in urban counties in the same area, after controlling for socio-economic characteristics and subjective health status.

To obtain a nationally representative Chinese three-level EuroQol five-dimensional questionnaire value set based on the time trade-off (TTO) method. A multistage, stratified, clustered random nationally representative Chinese sample was used. The study design followed an adapted UK Measurement and Valuation of Health protocol. Each respondent valued 11 random states plus state 33333 and "unconscious" using the TTO method in face-to-face interviews. Three types of models were explored: ordinary least squares, general least squares, and weighted least squares models. In total, 5939 inhabitants aged 15 years and older were interviewed. Of these, 5503 satisfactorily interviewed participants were included in constructing models. An ordinary least squares model including 10 dummies without constant and N3 had a mean absolute error of 0.083 and a correlation coefficient of 0.899 between the predicted and mean values. Goodness-of-fit indices of two models based on split subsample were similar. TTO values were higher in our study compared with those in a study carried out in urban areas, which is mirrored by the higher values in rural areas. Several other aspects, in addition to the valuation procedure, might have influenced the results, such as factors beyond demographic factors such as view on life and death and believing in an afterlife, which need further investigation. Future studies using the three-level EuroQol five-dimensional questionnaire should consider using this value set based on a nationally representative sample of the Chinese population.

Tuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households. A number of studies have analyzed patient and household expenditure on TB care, but there does not appear to be any that have assessed the incidence, intensity and determinants of catastrophic health expenditure (CHE) relating to TB care in China. That will be the objective of this paper. The data used for this study were derived from the baseline survey of the China Government – Gates Foundation TB Phase II program. Our analysis included 747 TB cases. Catastrophic health expenditure for TB care was estimated using two approaches, with households defined as experiencing CHE if their annual expenditure on TB care: (a) exceeded 10 % of total household income; and (b) exceeded 40 % of their non-food expenditure (capacity to pay). Chi-square tests were used to identify associated factors and logistic regression analysis to identify the determinants of CHE. The incidence of CHE was 66.8 % using the household income measure and 54.7 % using non-food expenditure (capacity to pay). An inverse association was observed between CHE rates and household income level. Significant determinants of CHE were: age, household size, employment status, health insurance status, patient income as a percentage of total household income, hospitalization and status as a minimum living security household. Factors including gender, marital status and type of TB case had no significant associations with CHE. Catastrophic health expenditure incidence from TB care is high in China. An integrated policy expanding the free treatment package and ensuring universal coverage, especially the height of UHC for TB patients, is needed. Financial and social protection interventions are essential for identified at-risk groups.

Purpose To investigate the feasibility of deriving experience-based visual analogue scale (VAS) values for EQ-5D-3L health states using national general population health survey data in China. Methods The EQ-5D-3L was included in the National Health Services Survey (n = 120,709, aged 15–103 years) to measure health-related quality of life. The respondents reported their current health status on a VAS and completed the EQ-5D-3L questionnaire, enabling modelling of the association between the experience-based VAS values and self-reported problems on EQ-5D dimensions and severity levels. Results VAS values were generally negatively associated with problems reported on the EQ-5D dimensions, and the anxiety/depression dimension had the greatest impact on VAS values. A previously obtained value for dead allowed the values for all 243 EQ-5D-3L health states to be transformed to the 0–1 scale (0 = dead, 1 = full health). Conclusions This study presents the feasibility of deriving an experience-based VAS values for EQ-5D-3L health states in China. The analysis of these VAS data raises more fundamental issues concerning the universal nature of the classification system and the extent to which Chinese respondents utilise the same concepts of health as defined by this classification system.