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Objective: Household is a fundamental unit in many fields. This study was to analyse consistency degree and people’s health service needs from the perspective of household.Methods: A multi-stage random sampling was conducted. A total of 7293 individuals in 2715 households were interviewed, and 1606 individuals in 803 empty-nest households were enrolled in this study. A questionnaire was used to ask each individual about their health service needs in empty nest households. The consistency degree was calculated based on their consistent answers to the questionnaire, and a correlation analyse was used to study the relationship of individuals’ health service needs in the same empty nest households. A family collective model was used to analyse household-based health service needs.Results: Individual’s needs consistency rates in empty nest households, such as diagnosis and treatment service(H1), follow-up service for chronic disease(H2), telemedicine care(H3), physical examination service(H4), health education service(H5), mental healthcare(H6), and Chinese traditional medicine service(H7) were 40.30%, 89.13%, 98.85%, 58.93%, 57.95%, 72.84%, and 63.40%, respectively. Service needs of H1, H3, H4, H5, H7 for individuals in the same empty nest households had significant correlations with each other (r=0.404, 0.177, 0.286, 0.265, 0.220, P<0.001). Health service needs from a perspective of household in rural China mainly included H1 (12.4%), H4 (44.2%), H5 (26.9%) and H7(18.9%). Conclusions: Individuals in the same household are highly consistent with each other in health service needs. Individuals could affect other members’ health service needs in their households, when one of them get illness, their spouse would likely to have same health service needs to avoid getting disease or to keep health. In this study, health service needs in empty nest households are mainly concerned with health promotion and maintenance services, which could be an indicator for primary care to improve the effectiveness of service delivery, such as family doctor and family-based health insurance system. Also, more focus should be paid on households that need great help on different health services.
Xueyan Cheng; Liang Zhang. Health Service Needs From a Household Perspective: an Empirical Study in Rural Empty Nest Households in China. 2021, 1 .
AMA StyleXueyan Cheng, Liang Zhang. Health Service Needs From a Household Perspective: an Empirical Study in Rural Empty Nest Households in China. . 2021; ():1.
Chicago/Turabian StyleXueyan Cheng; Liang Zhang. 2021. "Health Service Needs From a Household Perspective: an Empirical Study in Rural Empty Nest Households in China." , no. : 1.
Background Health workers are at high risk of job burnout. Primary care in China has recently expanded its scope of services to a broader range of public health services in addition to clinical care. This study aims to measure the prevalence of burnout and identify its associated factors among clinical care and public health service providers at primary care facilities. Methods A cross-sectional survey (2018) was conducted among 17,816 clinical care and public health service providers at 701 primary care facilities from six provinces. Burnout was measured by the Chinese version of the Maslach Burnout Inventory-General Scale, and multilevel linear regression analysis was conducted to identify burnout’s association with demographics, as well as occupational and organisational factors. Results Overall, half of the providers (50.09%) suffered from burnout. Both the presence of burnout and the proportion of severe burnout among public health service providers (58.06% and 5.25%) were higher than among clinical care providers (47.55% and 2.26%, respectively). Similar factors were associated with burnout between clinical care and public health service providers. Younger, male, lower-educated providers and providers with intermediate professional title, permanent contract or higher working hours were related to a higher level of burnout. Organisational environment, such as the presence of a performance-based salary system, affected job burnout. Conclusions Job burnout is prevalent among different types of primary care providers in China, indicating the need for actions that encompass the entirety of primary care. We recommend strengthening the synergy between clinical care and public health services and transforming the performance-based salary system into a more quality-based system that includes teamwork incentives.
Shan Lu; Liang Zhang; Niek Klazinga; Dionne Kringos. More public health service providers are experiencing job burnout than clinical care providers in primary care facilities in China. Human Resources for Health 2020, 18, 1 -11.
AMA StyleShan Lu, Liang Zhang, Niek Klazinga, Dionne Kringos. More public health service providers are experiencing job burnout than clinical care providers in primary care facilities in China. Human Resources for Health. 2020; 18 (1):1-11.
Chicago/Turabian StyleShan Lu; Liang Zhang; Niek Klazinga; Dionne Kringos. 2020. "More public health service providers are experiencing job burnout than clinical care providers in primary care facilities in China." Human Resources for Health 18, no. 1: 1-11.
Disparities in the utilization, expenditures, and quality of care by insurance types have been well documented. Such comparisons have yet to be investigated in end-of-life (EOL) settings in China, where public insurance covers over 95% of the Chinese population. This study examined the associations between health insurance and EOL care in the last six months of life: outpatient visits, emergency department (ED) visits, inpatient services, intensive care unit (ICU) admissions, expenditures, and place of death among the cancer patients. A total of 398 patients diagnosed with cancer who survived more than 6 months after diagnosis and died from July 2015 to June 2017 in urban Yichang, China, were included. Descriptive analysis and multivariate regression models were used to investigate the bivariate and independent associations, respectively, between health insurance with EOL healthcare utilization, expenditures and place of death. Urban Employee Basic Medical Insurance (UEBMI) beneficiaries visited EDs more frequently than Urban Resident-based Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS) beneficiaries (marginal effects [95% Confidence Interval]: 2.15 [1.81–2.48] and 1.92 [1.59–2.26], respectively). NRCMS and UEBMI beneficiaries had more hospitalizations than URBMI beneficiaries (1.01 [0.38–1.64] and 0.71 [0.20–1.22], respectively). Compared to URBMI beneficiaries, NRCMS beneficiaries and UEBMI beneficiaries had ¥15,722 and ¥43,241 higher expenditures. Similarly, UEBMI beneficiaries were most likely to die in hospitals, followed by NRCMS (UEBMI vs. NRCMS: 0.23 [0.11–0.36]) and URBMI (UEBMI vs. URBMI: 0.67 [0.57–0.78]) beneficiaries. The disproportionately lower utilization of EOL care among NRCMS and URBMI beneficiaries, compared to UEBMI beneficiaries, raised concerns regarding quality of EOL care and financial burdens of NRCMS and URBMI beneficiaries. Purposive hospice care intervention might be warranted to address EOL care for these beneficiaries in China.
Zhong Li; Peiyin Hung; Ruibo He; XiaoMing Tu; XiaoMing Li; Chengzhong Xu; Fangfang Lu; Pei Zhang; Liang Zhang. Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study. BMC Public Health 2020, 20, 1 -9.
AMA StyleZhong Li, Peiyin Hung, Ruibo He, XiaoMing Tu, XiaoMing Li, Chengzhong Xu, Fangfang Lu, Pei Zhang, Liang Zhang. Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study. BMC Public Health. 2020; 20 (1):1-9.
Chicago/Turabian StyleZhong Li; Peiyin Hung; Ruibo He; XiaoMing Tu; XiaoMing Li; Chengzhong Xu; Fangfang Lu; Pei Zhang; Liang Zhang. 2020. "Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study." BMC Public Health 20, no. 1: 1-9.
Background Comprehensive primary care practices, through preconception, preventive, curative, and rehabilitative care, have been a global priority in the promotion of health. However, the scope of primary care services has still been in decline in China. Studies on the factors for primary care service scope have centred on human resources and infrastructure; the role of direct government subsidies (DGS) on services scope of primary care facilities were left unanswered. This study aimed to explore the association between the DGS and services scope of primary care facilities in China. Methods A multi-stage, clustered cross-sectional survey using self-administrated questionnaire was conducted among primary care facilities of 36 districts/counties in China. A total of 770 primary care facilities were surveyed with 757 (98.3%) valid respondents. Of the 757 primary care facilities, 469 (62.0%) provided us detailed information of financial revenue and DGS from 2009 to 2016. Therefore, 469 primary care facilities from 31 counties/districts were included in this study. Sasabuchi-Lind-Mehlum tests and multivariate regression models were used to examine the inverted U-shaped relationship between the DGS and service scope. Results Of 469 PCFs, 332 (70.8%) were township health centres. Proportion of annul DGS to FR arose from 26.5% in 2009 to 50.5% in 2016. At the low proportion of DGS to financial revenue, an increase in DGS was associated with an increased service scope of primary care facilities, whereas the proportion of DGS to financial revenue over 42.5% might cause narrowed service scope (P = 0.023, 95% CI 11.59–51.74%); for the basic medical care dimension, the cut point is 42.6%. However, association between DGS and service scope of public health by primary care facilities is statistically insignificant. Conclusion While the DGS successfully achieved equalization of basic preventive and public health services, the disproportionate proportion of DGS to financial revenue is associated with narrowed service scope, which might cause underutilization of primary care and distorted incentive structure of primary care. Future improvements of DGS should focus on the incentive of broader basic medical services provision, such as clarifying service scope of primary care facilities and strategic procurement with a performance-based subsidies system to determine resource allocation.
Zhong Li; Peiyin Hung; Ruibo He; Liang Zhang. Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China. International Journal for Equity in Health 2020, 19, 1 -10.
AMA StyleZhong Li, Peiyin Hung, Ruibo He, Liang Zhang. Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China. International Journal for Equity in Health. 2020; 19 (1):1-10.
Chicago/Turabian StyleZhong Li; Peiyin Hung; Ruibo He; Liang Zhang. 2020. "Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China." International Journal for Equity in Health 19, no. 1: 1-10.
The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.
Wanchun Xu; Zijing Pan; Shan Lu; Liang Zhang. Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China. International Journal of Environmental Research and Public Health 2020, 17, 4531 .
AMA StyleWanchun Xu, Zijing Pan, Shan Lu, Liang Zhang. Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China. International Journal of Environmental Research and Public Health. 2020; 17 (12):4531.
Chicago/Turabian StyleWanchun Xu; Zijing Pan; Shan Lu; Liang Zhang. 2020. "Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China." International Journal of Environmental Research and Public Health 17, no. 12: 4531.
Background Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in rural China remain unclear. This study aims to explore the prevalence and associated factors of self-treatment among elders in rural China, trying to discover the vulnerable groups as well as the service gaps among the rural elders. Methods Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, an impoverished county in western China. Data were collected through a household–individual combined questionnaires. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 330 (individuals). Bivariate and multiple logistic regression analysis were performed in the whole sample group and four subgroups to obtain the prevalence ratios regarding the associated factors. Results In the present study, 35.2% of the elders with illness within the last 2 weeks reported self-treatment. The variables associated with self-treatment in the whole sample group were health status (OR 6.75, 95%CI 1.93–23.60), recent alcohol consumption (OR 0.42, 95%CI 0.21–0.83) and the utilisation of family practice services (OR 0.59, 95%CI 0.36–0.96); the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (OR 0.39, 95%CI 0.18–0.86) or drinking alcohol recently (OR 0.28, 95%CI 0.09–0.82) were less likely to self-treat, while the non-empty-nest elders who were no less than 75 years old (OR 3.10, 95%CI 1.33, 7.22) or at better health status (OR 9.20, 95%CI 1.73–48.75) were more likely to self-treat. Conclusion Self-treatment was prevalent among the elders in rural China. Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Older elders in the non-empty nest group were more likely to self-treat, while the empty-nest elders with self-care habits in traditional Chinese medicine were less likely to self-treat. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for identifying the potential service gaps and developing improvement strategies in the health care delivery system for the elderly in China.
Wanchun Xu; Zhong Li; Zijing Pan; Ruibo He; Liang Zhang. Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study. International Journal for Equity in Health 2020, 19, 32 -12.
AMA StyleWanchun Xu, Zhong Li, Zijing Pan, Ruibo He, Liang Zhang. Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study. International Journal for Equity in Health. 2020; 19 (1):32-12.
Chicago/Turabian StyleWanchun Xu; Zhong Li; Zijing Pan; Ruibo He; Liang Zhang. 2020. "Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study." International Journal for Equity in Health 19, no. 1: 32-12.
The health workers in rural primary care systems are at the increasing risk of job burnout. To explore the prevalence and associated factors of the job burnout among the primary healthcare worker in rural China, a cross-sectional survey was conducted among 15,627 participants in 459 township hospitals from six provinces. A combination of stratified multi-stage sampling and cluster sampling method, and a self-administrated questionnaire with the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS) were used in the investigation. Multilevel regression analyses were used to examine the potential associated factors on both individual and organisational levels. 47.6% of respondents were experiencing moderate burnout, and 3.3% were in severe burnout. Professionals working for over 40 h per week, at young age, with a college degree, and with professional titles at medium or high rank reported a higher degree of job burnout. At the institutional level, the high ratio of performance-based salary was associated with a higher level of depersonalization. Burnout has become prevalent among the primary healthcare workers in rural China, and multiple strategies are needed to reduce the work stress and some high-risk groups’ vulnerability to job burnout.
Wanchun Xu; Zijing Pan; Zhong Li; Shan Lu; Liang Zhang. Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis. International Journal of Environmental Research and Public Health 2020, 17, 727 .
AMA StyleWanchun Xu, Zijing Pan, Zhong Li, Shan Lu, Liang Zhang. Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis. International Journal of Environmental Research and Public Health. 2020; 17 (3):727.
Chicago/Turabian StyleWanchun Xu; Zijing Pan; Zhong Li; Shan Lu; Liang Zhang. 2020. "Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis." International Journal of Environmental Research and Public Health 17, no. 3: 727.
Background China poverty reduction policy (PRP) addresses two important elements: the targeted poverty reduction (TPA) project since 2015 in line with social assistance policy as national policy; and reducing inequality in health services utilization by making provision of medical financial assistance (MFA). Therefore, this study aims to assess the effects of the PRP in health services utilization (both inpatient and outpatient services) among the central and western rural poor of China. Methods The study conducted household survey and applied propensity score matching (PSM) method to assess the effects of the PRP on health services utilization among the rural poor of Central and Western China. A sensitivity test was also performed on the PSM results to test their robustness. Results Key findings showed 17.6% of respondents were the beneficial of PRP. The average treatment effects on the treated (ATT) of the PRP on the inpatient visits within one year was found significantly positive (P = 0.026). Conclusion There has been relationship between PRP with medical financial assistance and reduction of inequality in health services utilization by the poorer, in particular to accessing the inpatient services from the county or township hospitals of China. Policy makers should pay attention for making provision of improving responsiveness of supply, when subsidizing on the demand side.
Qi Zou; Xiaoqun He; Zhong Li; Wanchun Xu; Liang Zhang. The effects of poverty reduction policy on health services utilization among the rural poor: a quasi-experimental study in central and western rural China. International Journal for Equity in Health 2019, 18, 1 -11.
AMA StyleQi Zou, Xiaoqun He, Zhong Li, Wanchun Xu, Liang Zhang. The effects of poverty reduction policy on health services utilization among the rural poor: a quasi-experimental study in central and western rural China. International Journal for Equity in Health. 2019; 18 (1):1-11.
Chicago/Turabian StyleQi Zou; Xiaoqun He; Zhong Li; Wanchun Xu; Liang Zhang. 2019. "The effects of poverty reduction policy on health services utilization among the rural poor: a quasi-experimental study in central and western rural China." International Journal for Equity in Health 18, no. 1: 1-11.
Background Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in the current rural China remain unclear. This study aims to explore the determinants of self-treatment among elders in rural China, focusing on context-specific and multi-dimensional factors. Methods Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, Guizhou Province in western China. Data were collected through a self-administered questionnaire on the healthcare needs of residents. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 338 (individuals). Pearson’s chi-squared test and binary logistic regression analysis were performed among the whole sample group and four subgroups. Results Approximately 25.94% of the 1303 elders reported illness within the last 2 weeks, of whom 34.4% indicated self-treatment. The variables independently associated with a greater probability of self-treatment in the whole sample group were better health status, no recent alcohol consumption and no utilisation of family practice services; the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (TCM) and drinking alcohol recently were less likely to self-treat. Non-empty-nest elders who were no less than 75 years old and at better health status were more likely to self-treat. Conclusion Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Advanced age and self-care habits in TCM also play roles in some subgroups. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for developing improvement strategies of the family practice system in China.
Wanchun Xu; Zhong Li; Zijing Pan; Ruibo He; Liang Zhang. Exploring factors associated with self-treatment among different elder subgroups in rural China: a cross-sectional study. 2019, 1 .
AMA StyleWanchun Xu, Zhong Li, Zijing Pan, Ruibo He, Liang Zhang. Exploring factors associated with self-treatment among different elder subgroups in rural China: a cross-sectional study. . 2019; ():1.
Chicago/Turabian StyleWanchun Xu; Zhong Li; Zijing Pan; Ruibo He; Liang Zhang. 2019. "Exploring factors associated with self-treatment among different elder subgroups in rural China: a cross-sectional study." , no. : 1.
The weak primary healthcare system in China brings challenges to the national strategy of primary medical institutions providing general health needs for patients with non-communicable diseases (NCDs). It is necessary to explore the potential discrepancies in health status for patients with NCDs if they go to primary medical institutions rather than high-level hospitals. Data was obtained from Surveillance of Health-seeking Behavior in Hubei Province. Respondents were investigated six times to collect information on health service utilization and health-related quality of life (HRQoL). Ninety-two hypertension patients who went to medical institutions of the same level were included. HRQoL was measured by the Chinese version of EQ-5D-3L. A multilevel growth curve model was applied to analyze whether provider level could influence HRQoL. The utility score and visual analogue scale (VAS) of patients varied insignificantly over six months (p > 0.05). A growth curve model showed that comorbidity was the only factor significantly influencing utility score (p = 0.019). Time and comorbidity were the only influencing factors of VAS (p < 0.05). Our findings indicated that the level of healthcare provider had no significant impact on the health status of patients with NCDs. As such, this study concludes that the primary healthcare system in China is qualified to be the health gatekeeper for NCDs patients.
Yadong Niu; Ting Ye; Yan Zhang; Liang Zhang. Can Primary Medical Institutions Lead to Worse Health Status for Patients with Noncommunicable Diseases Compared with High-Level Hospitals? A Follow-Up Observation Study in China. International Journal of Environmental Research and Public Health 2019, 16, 1336 .
AMA StyleYadong Niu, Ting Ye, Yan Zhang, Liang Zhang. Can Primary Medical Institutions Lead to Worse Health Status for Patients with Noncommunicable Diseases Compared with High-Level Hospitals? A Follow-Up Observation Study in China. International Journal of Environmental Research and Public Health. 2019; 16 (8):1336.
Chicago/Turabian StyleYadong Niu; Ting Ye; Yan Zhang; Liang Zhang. 2019. "Can Primary Medical Institutions Lead to Worse Health Status for Patients with Noncommunicable Diseases Compared with High-Level Hospitals? A Follow-Up Observation Study in China." International Journal of Environmental Research and Public Health 16, no. 8: 1336.