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Jian Wang
Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China

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Journal article
Published: 06 July 2021 in Journal of Medical Internet Research
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Background All aging societies face the challenge of allocating limited resources for the highest value of use. The sharing economy provides one method to address the imbalance between the demand and supply of health services to the older adult population. With a substantial aging population, China’s practices in the sharing aging industry may set examples for other “getting old before getting rich” countries. Objective There is a gap in both the data and research on China’s aging industry sharing economy. This paper addresses these data and research lacunae by constructing a framework for the application of a sharing model in China’s aging industry, by assessing the current state of the aging industry sharing economy, by setting out the challenges to the sharing aging health care and service economy, and by making recommendations for the development of the aging industry sharing economy. Methods This paper constructs a sharing economy framework in the aging industry covering four aspects (people, facilities, capital, and information) to test the current state and future prospects of China’s aging industry sharing economy. Results In people sharing, we analyzed the sharing of emotional companionship, doctors, nurses, nursing attendants, and domestic helpers. We discussed facility sharing models from the point of land and housing, medical devices, and other items such as pensioner meals and shared medicine bins. We acknowledge that crowdfunding platforms have developed fast in China, but many older adult users faced problems in their operation. Information sharing is a developing field, which can optimize users’ experiences and should help older adults filter out misinformation, but China currently does not have adequate sharing information platforms for older adults. Conclusions We identified four major challenges in China’s aging industry sharing economy: poor adaptability to technology for older adults, mediocre quality of shared services, one-size-fits-all and the concept of the useless elderly, and shortage of qualified practitioners. We make recommendations for specific measures by governments, communities, and enterprises to improve the sharing economy in the aging industry.

ACS Style

Yaolin Hu; Jian Wang; Stephen Nicholas; Elizabeth Maitland. The Sharing Economy in China’s Aging Industry: Applications, Challenges, and Recommendations. Journal of Medical Internet Research 2021, 23, e27758 .

AMA Style

Yaolin Hu, Jian Wang, Stephen Nicholas, Elizabeth Maitland. The Sharing Economy in China’s Aging Industry: Applications, Challenges, and Recommendations. Journal of Medical Internet Research. 2021; 23 (7):e27758.

Chicago/Turabian Style

Yaolin Hu; Jian Wang; Stephen Nicholas; Elizabeth Maitland. 2021. "The Sharing Economy in China’s Aging Industry: Applications, Challenges, and Recommendations." Journal of Medical Internet Research 23, no. 7: e27758.

Journal article
Published: 17 June 2021 in Journal of Medical Internet Research
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By applying advanced health information technology to the health care field, health informatization helps optimize health resource allocation, improve health care services, and realize universal health coverage. COVID-19 has tested the status quo of China’s health informatization, revealing challenges to the health care system. This viewpoint evaluates the development, status quo, and practice of China’s health informatization, especially during COVID-19, and makes recommendations to address the health informatization challenges. We collected, assessed, and evaluated data on the development of China’s health informatization from five perspectives—health information infrastructure, information technology (IT) applications, financial and intellectual investment, health resource allocation, and standard system—and discussed the status quo of the internet plus health care service pattern during COVID-19. The main data sources included China’s policy documents and national plans on health informatization, commercial and public welfare sources and websites, public reports, institutional reports, and academic papers. In particular, we extracted data from the 2019 National Health Informatization Survey released by the National Health Commission in China. We found that China developed its health information infrastructure and IT applications, made significant financial and intellectual informatization investments, and improved health resource allocations. Tested during COVID-19, China’s current health informatization system, especially the internet plus health care system, has played a crucial role in monitoring and controlling the pandemic and allocating medical resources. However, an uneven distribution of health resources and insufficient financial and intellectual investment continue to challenge China’s health informatization. China’s rapid development of health informatization played a crucial role during COVID-19, providing a reference point for global pandemic prevention and control. To further promote health informatization, China’s health informatization needs to strengthen top-level design, increase investment and training, upgrade the health infrastructure and IT applications, and improve internet plus health care services.

ACS Style

Mian Huang; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Ziyue Guo. Development, Status Quo, and Challenges to China’s Health Informatization During COVID-19: Evaluation and Recommendations. Journal of Medical Internet Research 2021, 23, e27345 .

AMA Style

Mian Huang, Jian Wang, Stephen Nicholas, Elizabeth Maitland, Ziyue Guo. Development, Status Quo, and Challenges to China’s Health Informatization During COVID-19: Evaluation and Recommendations. Journal of Medical Internet Research. 2021; 23 (6):e27345.

Chicago/Turabian Style

Mian Huang; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Ziyue Guo. 2021. "Development, Status Quo, and Challenges to China’s Health Informatization During COVID-19: Evaluation and Recommendations." Journal of Medical Internet Research 23, no. 6: e27345.

Research paper
Published: 04 June 2021 in Human Vaccines & Immunotherapeutics
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Background: Over 26 million recovered COVID-19 patients will suffer from discrimination in work, education and social interactions. We analyzed the determinants of discrimination against recovered COVID-19 patients and suggest policy recommendations to reduce such discrimination. Methods: Twenty-seven Chinese cities were selected randomly based on their geographical location and GDP rank. One hundred adults were interviewed in each city with an equal number of men and women and three urban residents for every two rural residents. A multiple ordered logistic regression model was used to assess the associations between potential determinants and the COVID-19 discrimination level. Results: Of 2377 participants, 79.76% displayed discrimination toward recovered COVID-19 patients. The female discrimination level was 1.25 times that of males; the discrimination level increased with age; and was occupation-specific, with physicians’ (OR = 0.352) and students’ (OR = 0.553) discrimination level lower than that of farmers. The discrimination level of participants from the central regions was 1.828 times, and the eastern region 1.504 times, that of participants from western region. The participants’ discrimination level was lower when they scored higher in transmission knowledge, prevention knowledge and other COVID-19 knowledge, treatment methods and quarantine time. Conclusion: Sex, age, occupation, infections of relatives and friends, regions and scores on COVID-19 knowledge were determinants of discrimination level against recovered COVID-19 patients. In contrast with qualitative studies, our quantitative study recommends targeted education campaigns, focusing on physicians, women, older people and certain occupations. Only the COVID-19 vaccination program for the whole population will resolve the COVID-19 discrimination problem.

ACS Style

Rugang Liu; Stephen Nicholas; Anli Leng; Dongfu Qian; Elizabeth Maitland; Jian Wang. The influencing factors of discrimination against recovered Coronavirus disease 2019 (COVID-19) patients in China: a national study. Human Vaccines & Immunotherapeutics 2021, 1 -9.

AMA Style

Rugang Liu, Stephen Nicholas, Anli Leng, Dongfu Qian, Elizabeth Maitland, Jian Wang. The influencing factors of discrimination against recovered Coronavirus disease 2019 (COVID-19) patients in China: a national study. Human Vaccines & Immunotherapeutics. 2021; ():1-9.

Chicago/Turabian Style

Rugang Liu; Stephen Nicholas; Anli Leng; Dongfu Qian; Elizabeth Maitland; Jian Wang. 2021. "The influencing factors of discrimination against recovered Coronavirus disease 2019 (COVID-19) patients in China: a national study." Human Vaccines & Immunotherapeutics , no. : 1-9.

Journal article
Published: 29 May 2021 in BMC Health Services Research
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Background Catastrophic health expenditures (CHE) are out-of-pocket payments (OOP) that exceed a predefined percentage or threshold of a household’s resources, usually 40 %, that can push households into poverty in China. We analyzed the trends in the incidence and intensity, and explored the determinants, of CHE, and proposed policy recommendation to address CHE. Methods A unique 5-year national urban-rural panel database was constructed from the China Family Panel Studies (CFPS) surveys. CHE incidence was measured by calculating headcount (percentage of households incurring CHE to the total household sample) and intensity was measured by overshoot (degree by which an average out of pocket health expenditure exceeds the threshold of the total sample). A linear probability model was employed to assess the trend in the net effect of the determinants of CHE incidence and a random effect logit model was used to analyse the role of the characteristics of the household head, the household and household health utilization on CHE incidence. Results CHE determinants vary across time and geographical location. From 2010 to 2018, the total, urban and rural CHE incidence all showed a decreasing tend, falling from 14.7 to 8.7 % for total households, 12.5–6.6 % in urban and 16.8–10.9 % in rural areas. CHE intensity decreased in rural (24.50–20.51 %) and urban (22.31–19.57 %) areas and for all households (23.61–20.15 %). Inpatient services were the most important determinant of the incidence of CHE. For urban households, the random effect logit model identified household head (age, education, self-rated health); household characteristics (members 65 + years, chronic diseases, family size and income status); and healthcare utilization (inpatient and outpatient usage) as determinants of CHE. For rural areas, the same variables were significant with the addition of household head’s sex and health insurance. Conclusions The incidence and intensity of CHE in China displayed a downward trend, but was higher in rural than urban areas. Costs of inpatient service usage should be a key intervention strategy to address CHE. The policy implications include improving the economic level of poor households, reforming health insurance and reinforcing pre-payment hospital insurance methods.

ACS Style

Cai Liu; Zhao-Min Liu; Stephen Nicholas; Jian Wang. Trends and determinants of catastrophic health expenditure in China 2010–2018: a national panel data analysis. BMC Health Services Research 2021, 21, 1 -12.

AMA Style

Cai Liu, Zhao-Min Liu, Stephen Nicholas, Jian Wang. Trends and determinants of catastrophic health expenditure in China 2010–2018: a national panel data analysis. BMC Health Services Research. 2021; 21 (1):1-12.

Chicago/Turabian Style

Cai Liu; Zhao-Min Liu; Stephen Nicholas; Jian Wang. 2021. "Trends and determinants of catastrophic health expenditure in China 2010–2018: a national panel data analysis." BMC Health Services Research 21, no. 1: 1-12.

Preprint content
Published: 25 May 2021
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Objective: To provide the first estimates of the cost of productivity losses attributed to diabetes age 20-69 years old in urban and rural areas of China. Methods: Construct through life table modelling, expectancy life of diabetes sufferers, including the years of potential life lost and working years of life lost. Using the human capital approach, we measured the productivity losses attributed to absenteeism, presenteeism, labor force dropout and premature deaths due to diabetes of the population aged 20-69 years in urban and rural areas in China. Results: In 2017, we estimated that there were 100.46 million diabetes lost hours, with the total cost of productivity losses US$613.60 billion, comprising US$326.40 billion from labor force dropout, US$186.34 billion from premature death, US$97.71 billion from absenteeism, and US$27.04 billion from presenteeism. Productivity loss was greater in urban (US$490.79 billion) than rural areas (US$122.81 billion), with urban presenteeism (US$2.54 billion) greater than rural presenteeism (US$608.55 million); urban absenteeism (US$79.10 billion) greater than rural absenteeism (US$18.61 billion); urban labour force dropout (US$261.24 billion) greater than rural labour force dropout (US$65.15 billion) and urban premature death (US$147.90 billion) greater than rural premature death (US$38.44 billion). Conclusions: Diabetes had a large and significant negatively impact on productivity in urban and rural in China, with a significant gap in the level of diabetes management in urban compared to rural regions. Productivity loss was significantly higher in urban than rural regions. Further investment is required in the prevention, diagnosis and control of diabetes in under-resourced health services in rural locations and also in urban areas, where most diabetes cases reside. Specifically, targeted and effective diabetes prevention and management actions are urgently required.

ACS Style

Hongying Hao; Lizheng Xu; Anli Leng; Jingjie Sun; Nicholas Stephen; Jian Wang. Productivity losses due to diabetes in urban and rural China. 2021, 1 .

AMA Style

Hongying Hao, Lizheng Xu, Anli Leng, Jingjie Sun, Nicholas Stephen, Jian Wang. Productivity losses due to diabetes in urban and rural China. . 2021; ():1.

Chicago/Turabian Style

Hongying Hao; Lizheng Xu; Anli Leng; Jingjie Sun; Nicholas Stephen; Jian Wang. 2021. "Productivity losses due to diabetes in urban and rural China." , no. : 1.

Journal article
Published: 11 May 2021 in Vaccines
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(1) Background: By April 2021, over 160 million Chinese have been vaccinated against coronavirus disease 2019 (COVID-19). This study analyzed the impact of vaccination on discrimination against recovered COVID-19 patients and the determinants of discrimination among intended vaccinated people. (2) Methods: A self-designed questionnaire was used to collect data on COVID-19 associated discrimination from nine provinces in China. Pearson chi-square tests and a multivariate ordered logistic regression analyzed the determinants of COVID-19-related discrimination. (3) Results: People who intended to be COVID-19 vaccinated displayed a high level of discrimination against recovered COVID-19 patients, with only 37.74% of the intended vaccinated without any prejudice and 34.11% displaying severe discrimination. However, vaccinations reduced COVID-19-related discrimination against recovered COVID-19 patients from 79.76% to 62.26%. Sex, age, education level, occupation, geographical region, respondents’ awareness of vaccine effectiveness and infection risk, and COVID-19 knowledge score had a significant influence on the COVID-19 related discrimination (p < 0.05). (4) Conclusions: Vaccination significantly reduced COVID-19 associated discrimination, but discrimination rates remained high. Among the intended vaccinated respondents, females, the older aged, people with high school and above education level, retirees, migrant workers, and residents in central China were identified as key targets for information campaigns to reduce COVID-19 related discrimination.

ACS Style

Lu Li; Jian Wang; Anli Leng; Stephen Nicholas; Elizabeth Maitland; Rugang Liu. Will COVID-19 Vaccinations End Discrimination against COVID-19 Patients in China? New Evidence on Recovered COVID-19 Patients. Vaccines 2021, 9, 490 .

AMA Style

Lu Li, Jian Wang, Anli Leng, Stephen Nicholas, Elizabeth Maitland, Rugang Liu. Will COVID-19 Vaccinations End Discrimination against COVID-19 Patients in China? New Evidence on Recovered COVID-19 Patients. Vaccines. 2021; 9 (5):490.

Chicago/Turabian Style

Lu Li; Jian Wang; Anli Leng; Stephen Nicholas; Elizabeth Maitland; Rugang Liu. 2021. "Will COVID-19 Vaccinations End Discrimination against COVID-19 Patients in China? New Evidence on Recovered COVID-19 Patients." Vaccines 9, no. 5: 490.

Journal article
Published: 02 May 2021 in Vaccines
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(1) Background: More coronavirus disease 2019 (COVID-19) vaccines are gradually being developed and marketed. Improving the vaccination intention will be the key to increasing the vaccination rate in the future; (2) Methods: A self-designed questionnaire was used to collect data on COVID-19 vaccination intentions, protection motivation and control variables. Pearson Chi-square test and multivariate ordered logistic regression models were specified to analyze the determinants of intention to receive COVID-19 vaccine; (3) Results: Although the vaccine was free, 17.75% of the 2377 respondents did not want, or were hesitant, to receive the COVID-19 vaccine. Respondents’ cognition of vaccine safety, external reward and response efficacy were positively related to COVID-19 vaccination intention, while age, income and response cost were negatively related to the intention to receive the COVID-19 vaccine. Professionals and people without medical insurance had the lowest intention to vaccinate; (4) Conclusions: The older aged, people without health insurance, those with higher incomes and professionals should be treated as the key intervention targets. Strengthening publicity and education about the safety and efficacy of COVID-19 vaccines, training vaccinated people and community leaders as propagandists for the vaccine, and improving the accessibility to the COVID-19 vaccine are recommended to improve COVID-19 vaccination intention.

ACS Style

Lu Li; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Anli Leng; Rugang Liu. The Intention to Receive the COVID-19 Vaccine in China: Insights from Protection Motivation Theory. Vaccines 2021, 9, 445 .

AMA Style

Lu Li, Jian Wang, Stephen Nicholas, Elizabeth Maitland, Anli Leng, Rugang Liu. The Intention to Receive the COVID-19 Vaccine in China: Insights from Protection Motivation Theory. Vaccines. 2021; 9 (5):445.

Chicago/Turabian Style

Lu Li; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Anli Leng; Rugang Liu. 2021. "The Intention to Receive the COVID-19 Vaccine in China: Insights from Protection Motivation Theory." Vaccines 9, no. 5: 445.

Preprint content
Published: 26 April 2021
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Background Knowing terminal cancer patients’ treatment preferences will improve patient-centered health care, better inform surrogates and medical staff of patient preferences and enhance the quality of end-of-life (EoL) care. In China, little is known about terminal cancer patients’ preferences. We aimed to examines the preferences for EoL care of terminal cancer patients. Methods Data on 183 terminal cancer patients aged over 50 years old was collected by discrete choice experiment (DCE). Each DCE scenario described six attributes: hospitalization days,life extension, quality of life (QoL), adverse treatment reactions, place of death preference and out-of-pocket payments.Patient preferences were derived using a mixed logit model and the marginal willingness to pay (WTP) were estimated from the regression coefficients. Results Patients’ preferences for moderate survive time, better quality of life, lower risk of adverse reaction, home death and lower payments were all statistically significant in driving choice between treatment models. Extending life and QoL were the most important attributes. Patients were willing to pay RMB256,895.45 to improve QoL from a bad level to a very good level, significantly higher than their willingness to pay for half additional life year (RMB233,446.16) and one additional life year (RMB182,298.76). This indicates that patients were not willing to blindly pursue life extension and neglect the QoL,but preferred to trade off life extension for QoL. The predicted uptake of optimal end-of-life care scenario was 91.04%. Conclusions Our study contributes to the development of patient-centered preferences for end-of-life care models that improve advanced terminal patient’s care and provide empirical evidence for physicians and surrogates to operationalize end-of-life care trade-offs.

ACS Style

Anli Leng; Elizabeth Maitland; Siyuan Wang; Stephen Nicholas; Kuixu Lan; Jian Wang. Preferences for End-of-life Care among Terminal Cancer Patients in China: A Discrete Choice Experiment. 2021, 1 .

AMA Style

Anli Leng, Elizabeth Maitland, Siyuan Wang, Stephen Nicholas, Kuixu Lan, Jian Wang. Preferences for End-of-life Care among Terminal Cancer Patients in China: A Discrete Choice Experiment. . 2021; ():1.

Chicago/Turabian Style

Anli Leng; Elizabeth Maitland; Siyuan Wang; Stephen Nicholas; Kuixu Lan; Jian Wang. 2021. "Preferences for End-of-life Care among Terminal Cancer Patients in China: A Discrete Choice Experiment." , no. : 1.

Public health
Published: 24 March 2021 in GeoHealth
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To control and prevent the risk of diabetes, diabetes studies have identified the need to better understand and evaluate the associations between influencing indicators and the prevalence of diabetes. One constraint has been that influencing indicators have been selected mainly based on subjective judgment and tested using traditional statistical modeling methods. We proposed a framework new to diabetes studies using data‐driven and spatial methods to identify the most significant influential determinants of diabetes automatically and estimated their relationships. We used data from diabetes mellitus patients' health insurance records in Shandong province, China, and collected influencing indicators of diabetes prevalence at the county level in the sociodemographic, economic, education, and geographical environment domains. We specified a framework to identify automatically the most influential determinants of diabetes, and then established the relationship between these selected influencing indicators and diabetes prevalence. Our autocorrelation results showed that the diabetes prevalence in 12 Shandong cities was significantly clustered (Moran's I = 0.328, p < 0.01). In total, 17 significant influencing indicators were selected by executing binary linear regressions and lasso regressions. The spatial error regressions in different subgroups were subject to different diabetes indicators. Some positive indicators existed significantly like per capita fruit production and other indicators correlated with diabetes prevalence negatively like the proportion of green space. Diabetes prevalence was mainly subjected to the joint effects of influencing indicators. This framework can help public health officials to inform the implementation of improved treatment and policies to attenuate diabetes diseases.

ACS Style

Yizhuo Li; Teng Fei; Jian Wang; Stephen Nicholas; Jun Li; Lizheng Xu; Yanran Huang; Hanqi Li. Influencing Indicators and Spatial Variation of Diabetes Mellitus Prevalence in Shandong, China: A Framework for Using Data‐Driven and Spatial Methods. GeoHealth 2021, 5, 1 .

AMA Style

Yizhuo Li, Teng Fei, Jian Wang, Stephen Nicholas, Jun Li, Lizheng Xu, Yanran Huang, Hanqi Li. Influencing Indicators and Spatial Variation of Diabetes Mellitus Prevalence in Shandong, China: A Framework for Using Data‐Driven and Spatial Methods. GeoHealth. 2021; 5 (3):1.

Chicago/Turabian Style

Yizhuo Li; Teng Fei; Jian Wang; Stephen Nicholas; Jun Li; Lizheng Xu; Yanran Huang; Hanqi Li. 2021. "Influencing Indicators and Spatial Variation of Diabetes Mellitus Prevalence in Shandong, China: A Framework for Using Data‐Driven and Spatial Methods." GeoHealth 5, no. 3: 1.

Journal article
Published: 21 March 2021 in Vaccines
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(1) Background: China will provide free coronavirus disease 2019 (COVID-19) vaccinations for the entire population. This study analyzed the COVID-19 vaccination willingness rate (VWR) and its determinants under China’s free vaccination policy compared to a paid vaccine. (2) Methods: Data on 2377 respondents were collected through a nationwide questionnaire survey. Multivariate ordered logistic regression models were specified to explore the correlation between the VWR and its determinants. (3) Results: China’s free vaccination policy for COVID-19 increased the VWR from 73.62% to 82.25% of the respondents. Concerns about the safety and side-effects were the primary reason for participants’ unwillingness to be vaccinated against COVID-19. Age, medical insurance and vaccine safety were significant determinants of the COVID-19 VWR for both the paid and free vaccine. Income, occupation and vaccine effectiveness were significant determinants of the COVID-19 VWR for the free vaccine. (4) Conclusions: Free vaccinations increased the COVID-19 VWR significantly. People over the age of 58 and without medical insurance should be treated as the target intervention population for improving the COVID-19 VWR. Contrary to previous research, high-income groups and professional workers should be intervention targets to improve the COVID-19 VWR. Strengthening nationwide publicity and education on COVID-19 vaccine safety and effectiveness are recommended policies for decision-makers.

ACS Style

Rugang Liu; Yuxun Zhang; Stephen Nicholas; Anli Leng; Elizabeth Maitland; Jian Wang. COVID-19 Vaccination Willingness among Chinese Adults under the Free Vaccination Policy. Vaccines 2021, 9, 292 .

AMA Style

Rugang Liu, Yuxun Zhang, Stephen Nicholas, Anli Leng, Elizabeth Maitland, Jian Wang. COVID-19 Vaccination Willingness among Chinese Adults under the Free Vaccination Policy. Vaccines. 2021; 9 (3):292.

Chicago/Turabian Style

Rugang Liu; Yuxun Zhang; Stephen Nicholas; Anli Leng; Elizabeth Maitland; Jian Wang. 2021. "COVID-19 Vaccination Willingness among Chinese Adults under the Free Vaccination Policy." Vaccines 9, no. 3: 292.

Preprint content
Published: 05 February 2021
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BACKGROUND All aging societies face the challenge of allocating limited resources for the highest value of use. The sharing economy provides one method to address the imbalance between the demand and supply of health services to the older adult population. With a substantial aging population, China’s practices in the sharing aging industry may set examples for other “getting old before getting rich” countries. OBJECTIVE There is a gap in both the data and research on China’s aging industry sharing economy. This paper addresses these data and research lacunae by constructing a framework for the application of a sharing model in China’s aging industry, by assessing the current state of the aging industry sharing economy, by setting out the challenges to the sharing aging health care and service economy, and by making recommendations for the development of the aging industry sharing economy. METHODS This paper constructs a sharing economy framework in the aging industry covering four aspects (people, facilities, capital, and information) to test the current state and future prospects of China’s aging industry sharing economy. RESULTS In people sharing, we analyzed the sharing of emotional companionship, doctors, nurses, nursing attendants, and domestic helpers. We discussed facility sharing models from the point of land and housing, medical devices, and other items such as pensioner meals and shared medicine bins. We acknowledge that crowdfunding platforms have developed fast in China, but many older adult users faced problems in their operation. Information sharing is a developing field, which can optimize users’ experiences and should help older adults filter out misinformation, but China currently does not have adequate sharing information platforms for older adults. CONCLUSIONS We identified four major challenges in China’s aging industry sharing economy: poor adaptability to technology for older adults, mediocre quality of shared services, one-size-fits-all and the concept of the useless elderly, and shortage of qualified practitioners. We make recommendations for specific measures by governments, communities, and enterprises to improve the sharing economy in the aging industry.

ACS Style

Yaolin Hu; Jian Wang; Stephen Nicholas; Elizabeth Maitland. The Sharing Economy in China’s Aging Industry: Applications, Challenges, and Recommendations (Preprint). 2021, 1 .

AMA Style

Yaolin Hu, Jian Wang, Stephen Nicholas, Elizabeth Maitland. The Sharing Economy in China’s Aging Industry: Applications, Challenges, and Recommendations (Preprint). . 2021; ():1.

Chicago/Turabian Style

Yaolin Hu; Jian Wang; Stephen Nicholas; Elizabeth Maitland. 2021. "The Sharing Economy in China’s Aging Industry: Applications, Challenges, and Recommendations (Preprint)." , no. : 1.

Preprint content
Published: 24 January 2021
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UNSTRUCTURED By applying advanced health information technology to the health care field, health informatization helps optimize health resource allocation, improve health care services, and realize universal health coverage. COVID-19 has tested the status quo of China’s health informatization, revealing challenges to the health care system. This viewpoint evaluates the development, status quo, and practice of China’s health informatization, especially during COVID-19, and makes recommendations to address the health informatization challenges. We collected, assessed, and evaluated data on the development of China’s health informatization from five perspectives—health information infrastructure, information technology (IT) applications, financial and intellectual investment, health resource allocation, and standard system—and discussed the status quo of the internet plus health care service pattern during COVID-19. The main data sources included China’s policy documents and national plans on health informatization, commercial and public welfare sources and websites, public reports, institutional reports, and academic papers. In particular, we extracted data from the 2019 National Health Informatization Survey released by the National Health Commission in China. We found that China developed its health information infrastructure and IT applications, made significant financial and intellectual informatization investments, and improved health resource allocations. Tested during COVID-19, China’s current health informatization system, especially the internet plus health care system, has played a crucial role in monitoring and controlling the pandemic and allocating medical resources. However, an uneven distribution of health resources and insufficient financial and intellectual investment continue to challenge China’s health informatization. China’s rapid development of health informatization played a crucial role during COVID-19, providing a reference point for global pandemic prevention and control. To further promote health informatization, China’s health informatization needs to strengthen top-level design, increase investment and training, upgrade the health infrastructure and IT applications, and improve internet plus health care services.

ACS Style

Mian Huang; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Ziyue Guo. Development, Status Quo, and Challenges to China’s Health Informatization During COVID-19: Evaluation and Recommendations (Preprint). 2021, 1 .

AMA Style

Mian Huang, Jian Wang, Stephen Nicholas, Elizabeth Maitland, Ziyue Guo. Development, Status Quo, and Challenges to China’s Health Informatization During COVID-19: Evaluation and Recommendations (Preprint). . 2021; ():1.

Chicago/Turabian Style

Mian Huang; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Ziyue Guo. 2021. "Development, Status Quo, and Challenges to China’s Health Informatization During COVID-19: Evaluation and Recommendations (Preprint)." , no. : 1.

Preprint content
Published: 04 January 2021
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Background: Catastrophic health expenditures (CHE) push households into poverty in China. We analyze the trends in incidence and intensity, and explore the determinants of CHE, and propose policy recommendation to address CHE.Methods: A unique 5-year national urban-rural panel database was constructed from China Family Panel Studies (CFPS) surveys. CHE incidence was measured by calculating headcount (percentage of households incurring CHE to the total household sample) and intensity was measured by overshoot (degree by which an average out of pocket health expenditure exceeds the threshold of the total sample). A linear probability model was employed to assess the trend in net effect of the determinants of CHE incidence and a random effect logit model was used to analyse the role of the characteristics of the household head, the household and household health utilization on CHE incidence.Results: CHE determinants vary across time and geographical location. From 2010 to 2018, the total, urban and rural CHE incidence all showed a decreasing tendency, falling from 14.7% to 8.7% for total households, 12.5% to 6.6% in urban and 16.8% to 10.9% in rural areas. CHE intensity decreased in rural (24.50% to 20.51%) and urban (22.31% to 19.57%) areas and for all households (23.61% to 20.15%). Inpatient services were the most important determinant of the incidence of CHE. For urban households, the random effect logit model identified household head (age, education, self-rated health); household characteristics (members 65+ years, chronic diseases, family size and income status); and healthcare utilization (inpatient and outpatient usage) as determinants of CHE. For rural areas, the same variables were significant with the addition of household head’s sex and health insurance.Conclusion: The incidence and intensity of CHE in China displayed a downward trend, but was higher in rural than urban areas. Costs of inpatient service usage should be a key point on intervention strategies to address CHE. The policy implications include improving the economic level of poor households, reforming health insurance and reinforcing pre-payment hospital insurance methods.

ACS Style

Cai Liu; Zhao Min Liu; Stephen Nicholas; Jian Wang. Trends and Determinants of Catastrophic Health Expenditure in China 2010-2018: A National Panel Data Analysis. 2021, 1 .

AMA Style

Cai Liu, Zhao Min Liu, Stephen Nicholas, Jian Wang. Trends and Determinants of Catastrophic Health Expenditure in China 2010-2018: A National Panel Data Analysis. . 2021; ():1.

Chicago/Turabian Style

Cai Liu; Zhao Min Liu; Stephen Nicholas; Jian Wang. 2021. "Trends and Determinants of Catastrophic Health Expenditure in China 2010-2018: A National Panel Data Analysis." , no. : 1.

Journal article
Published: 11 December 2020 in International Journal of Environmental Research and Public Health
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(1) Background: The management of multiple chronic diseases challenges China’s health system, but current research has neglected how multimorbidity is associated with poor health-related quality of life (HRQOL) and high health service demands by middle-aged and older adults. (2) Methods: A cross-sectional study was conducted in Shandong province, China in 2018 across three age groups: Middle-aged (45 to 59 years), young-old (60 to 74 years), and old-old (75 or above years). The information about socio-economic, health-related behaviors, HRQOL, and health service utilization was collected via face-to-face structured questionnaires. The EQ-5D-3L instrument, comprising a health description system and a visual analog scale (VAS), was used to measure participants’ HRQOL, and χ2 tests and the one-way ANOVA test were used to analyze differences in socio-demographic factors and HRQOL among the different age groups. Logistic regression models estimated the associations between lifestyle factors, health service utilization, and multimorbidity across age groups. (3) Results: There were 17,867 adults aged 45 or above in our sample, with 9259 (51.82%) female and 65.60% living in rural areas. Compared with the middle-aged adults, the young-old and old-old were more likely to be single and to have a lower level of education and income, with the old-old having lower levels than the young-old (P < 0.001). We found that 2465 (13.80%) suffered multimorbidities of whom 75.21% were older persons (aged 60 or above). As age increased, both the mean values of EQ-5D utility and the VAS scale decreased, displaying an inverse trend to the increase in the number of chronic diseases (P < 0.05). Ex-smokers and physical check-ups for middle or young-old respondents and overweight/obesity for all participants (P < 0.05) were positively correlated with multimorbidity. Drinking within the past month for all participants (P < 0.001), and daily tooth-brushing for middle (P < 0.05) and young-old participants (P < 0.001), were negatively associated with multimorbidity. Multimorbidities increased service utilization including outpatient and inpatient visits and taking self-medicine; and the probability of health utilization was the lowest for the old-old multimorbid patients (P < 0.001). (4) Conclusions: The prevalence and decline in HRQOL of multimorbid middle-aged and older-aged people were severe in Shandong province. Old patients also faced limited access to health services. We recommend early prevention and intervention to address the prevalence of middle-aged and old-aged multimorbidity. Further, the government should set-up special treatment channels for multiple chronic disease sufferers, improve medical insurance policies for the older-aged groups, and set-up multiple chronic disease insurance to effectively alleviate the costs of medical utilization caused by economic pressure for outpatients and inpatients with chronic diseases.

ACS Style

Qinfeng Zhao; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Jingjie Sun; Chen Jiao; Lizheng Xu; Anli Leng. Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province. International Journal of Environmental Research and Public Health 2020, 17, 9261 .

AMA Style

Qinfeng Zhao, Jian Wang, Stephen Nicholas, Elizabeth Maitland, Jingjie Sun, Chen Jiao, Lizheng Xu, Anli Leng. Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province. International Journal of Environmental Research and Public Health. 2020; 17 (24):9261.

Chicago/Turabian Style

Qinfeng Zhao; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Jingjie Sun; Chen Jiao; Lizheng Xu; Anli Leng. 2020. "Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province." International Journal of Environmental Research and Public Health 17, no. 24: 9261.

Journal article
Published: 05 December 2020 in Vaccine
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Vaccinations are an effective choice to stop disease outbreaks, including COVID-19. There is little research on individuals' COVID-19 vaccination decision-making. We aimed to determine individual preferences for COVID-19 vaccinations in China, and to assess the factors influencing vaccination decision-making to facilitate vaccination coverage. A D-efficient discrete choice experiment was conducted across six Chinese provinces selected by the stratified random sampling method. Vaccine choice sets were constructed using seven attributes: vaccine effectiveness, side-effects, accessibility, number of doses, vaccination sites, duration of vaccine protection, and proportion of acquaintances vaccinated. Conditional logit and latent class models were used to identify preferences. Although all seven attributes were proved to significantly influence respondents’ vaccination decision, vaccine effectiveness, side-effects and proportion of acquaintances vaccinated were the most important. We also found a higher probability of vaccinating when the vaccine was more effective; risks of serious side effects were small; vaccinations were free and voluntary; the fewer the number of doses; the longer the protection duration; and the higher the proportion of acquaintances vaccinated. Higher local vaccine coverage created altruistic herd incentives to vaccinate rather than free-rider problems. The predicted vaccination uptake of the optimal vaccination scenario in our study was 84.77%. Preference heterogeneity was substantial. Individuals who were older, had a lower education level, lower income, higher trust in the vaccine and higher perceived risk of infection, displayed a higher probability to vaccinate. Preference heterogeneity among individuals should lead health authorities to address the diversity of expectations about COVID-19 vaccinations. To maximize COVID-19 vaccine uptake, health authorities should promote vaccine effectiveness; pro-actively communicate the absence or presence of vaccine side effects; and ensure rapid and wide media communication about local vaccine coverage.

ACS Style

Anli Leng; Elizabeth Maitland; Siyuan Wang; Stephen Nicholas; Rugang Liu; Jian Wang. Individual preferences for COVID-19 vaccination in China. Vaccine 2020, 39, 247 -254.

AMA Style

Anli Leng, Elizabeth Maitland, Siyuan Wang, Stephen Nicholas, Rugang Liu, Jian Wang. Individual preferences for COVID-19 vaccination in China. Vaccine. 2020; 39 (2):247-254.

Chicago/Turabian Style

Anli Leng; Elizabeth Maitland; Siyuan Wang; Stephen Nicholas; Rugang Liu; Jian Wang. 2020. "Individual preferences for COVID-19 vaccination in China." Vaccine 39, no. 2: 247-254.

Journal article
Published: 28 November 2020 in International Journal of Environmental Research and Public Health
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(1) Background: The association between multimorbidity and mental health is well established. However, the role of gender in different populations remains unclear. Currently, China is facing an increased prevalence of multimorbidity, especially in its disease-causing poverty population. The present study explores the gender-based differences in the relationship between multimorbidity and mental health using data from the rural, disease-causing poverty, older-age population in Shandong province, China, as a case study. (2) Methods: The data were obtained from the survey on the health and welfare of disease-causing poverty households in rural Shandong province. We identified 936 rural participants who were over 60 years old from disease-causing poverty households. The mental health status was measured using the Kessler Psychological Distress Scale (K10) instrument. Using a multivariable linear regression model, including the interaction of gender and multimorbidity, gender differences in the association between multimorbidity and mental health were explored. (3) Results: Multimorbidity was a serious health problem in rural, disease-causing poverty, older-age households, with the prevalence of multimorbidity estimated as 40% for women and 35.4% for men. There was a strong association between multimorbidity and mental health, which was moderated by gender. Women had higher K10 scores than men, and the mean K10 score was highest in women with three or more chronic diseases. Compared with men, women with multimorbidity had a higher risk of mental health problems. (4) Conclusions: The prevalence of multimorbidity in older-age rural disease-causing poverty subpopulations is a severe public health problem in China. The association between multimorbidity and mental health differed by gender, where multimorbid women suffered an increased mental health risk compared with men. Gender differences should be addressed when delivering effective physical and mental healthcare support to disease-causing poverty, older-age, rural households.

ACS Style

Chen Jiao; Anli Leng; Stephen Nicholas; Elizabeth Maitland; Jian Wang; Qinfeng Zhao; Lizheng Xu; Chaofan Gong. Multimorbidity and Mental Health: The Role of Gender among Disease-Causing Poverty, Rural, Aged Households in China. International Journal of Environmental Research and Public Health 2020, 17, 8855 .

AMA Style

Chen Jiao, Anli Leng, Stephen Nicholas, Elizabeth Maitland, Jian Wang, Qinfeng Zhao, Lizheng Xu, Chaofan Gong. Multimorbidity and Mental Health: The Role of Gender among Disease-Causing Poverty, Rural, Aged Households in China. International Journal of Environmental Research and Public Health. 2020; 17 (23):8855.

Chicago/Turabian Style

Chen Jiao; Anli Leng; Stephen Nicholas; Elizabeth Maitland; Jian Wang; Qinfeng Zhao; Lizheng Xu; Chaofan Gong. 2020. "Multimorbidity and Mental Health: The Role of Gender among Disease-Causing Poverty, Rural, Aged Households in China." International Journal of Environmental Research and Public Health 17, no. 23: 8855.

Journal article
Published: 24 September 2020 in Health Economics Review
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Background Health care systems in many countries are characterized by limited availability of provider performance data that can be used to design and implement welfare improving reforms in the health sector. We question whether a simple mystery shopper scheme can be an effective measure to improve primary care quality in such settings. Methods Using a randomized treatment-control design, we conducted a field experiment in primary care clinics in a Chinese city. We investigate whether informing physicians of a forthcoming mystery shopper audit influences their prescribing behavior. The intervention effects are estimated using conditional fixed-effects logistic regression. The estimated coefficients are interpreted as marginal utilities in a choice model. Results Our findings suggest that the mystery shopper intervention reduced the probability of prescribing overall. Moreover, the intervention had heterogeneous effects on different types of drugs. Conclusions This study provides new evidence suggesting that announced performance auditing of primary care providers could directly affect physician behavior even when it is not combined with pay-for-performance, or measures such as reminders, feedback or educational interventions.

ACS Style

Roland Cheo; Ge Ge; Geir Godager; Rugang Liu; Jian Wang; QiQi Wang. The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment. Health Economics Review 2020, 10, 1 -19.

AMA Style

Roland Cheo, Ge Ge, Geir Godager, Rugang Liu, Jian Wang, QiQi Wang. The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment. Health Economics Review. 2020; 10 (1):1-19.

Chicago/Turabian Style

Roland Cheo; Ge Ge; Geir Godager; Rugang Liu; Jian Wang; QiQi Wang. 2020. "The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment." Health Economics Review 10, no. 1: 1-19.

Journal article
Published: 14 September 2020 in Vaccines
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Understanding behavioral factors differences in the preferences for vaccinations can improve predictions of vaccine uptake rates and identify effective policy interventions to increase the demand for vaccinations. In this study, 353 adults in Shandong province in China were interviewed about their preferences for hepatitis B virus (HBV) vaccination. A discrete choice experiment (DCE) was employed to analyze the preference for HBV vaccinations, and a mixed logit model was used to estimate respondent preferences for vaccination attributes included in the DCE. While the protection rate against hepatitis B (HB), duration of protection, risk of side-effects, and vaccination cost were shown to influence adults’ preferences for HBV vaccination, adults valued “99% hepatitis B protection” above other attributes, followed by “20 years’ protection duration” and “1 in 150,000 risk of side-effects”. Individuals with lower time discount rates, non-overconfidence, or higher risk aversion were more likely to choose a vaccine. Lower risk aversion individuals showed a higher preference for lower risk of side-effects. Lower time discount rate individuals showed a higher preference for longer protection duration. Non-overconfidence individuals showed a higher preference for higher hepatitis B protection and cost. Interventions should be targeted to the behavioral determinants impeding vaccination.

ACS Style

Na Guo; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Dawei Zhu. Behavioral Differences in the Preference for Hepatitis B Virus Vaccination: A Discrete Choice Experiment. Vaccines 2020, 8, 527 .

AMA Style

Na Guo, Jian Wang, Stephen Nicholas, Elizabeth Maitland, Dawei Zhu. Behavioral Differences in the Preference for Hepatitis B Virus Vaccination: A Discrete Choice Experiment. Vaccines. 2020; 8 (3):527.

Chicago/Turabian Style

Na Guo; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Dawei Zhu. 2020. "Behavioral Differences in the Preference for Hepatitis B Virus Vaccination: A Discrete Choice Experiment." Vaccines 8, no. 3: 527.

Journal article
Published: 10 August 2020 in BMC Public Health
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Background Migrant workers are a susceptible population to the hepatitis b virus (HBV) and a vulnerable spot in China’s immunization procedures. There is no free HBV immunization program for migrant workers in China, so understanding migrant workers’ motivation to receive the HBV vaccine is the first step in designing effective immunization policies. Methods A fully specified protection motivation theory (PMT) model of HBV vaccination intention among migrant workers was specified. Data were collected through a cross-sectional survey of 406 migrant workers in three migrant-dense industries in Tianjin, China. Principal component factor analysis was used to produce PMT factors and nested binary logistic regression modeling was applied to assess the associations between protection motivation and HBV vaccination intention of migrant workers. Results The nested binary logistic regression model suggested that the severity factor and self-efficacy factor were positively related to HBV vaccination intention (OR = 2.15, 95% CI: 1.25–3.71; OR = 2.75, 95% CI: 1.62–4.66) while the response costs was negatively related to the HBV vaccination motivation (OR = 0.50, 95% CI: 0.29–0.83). The socio-demographic variables showed that younger, married and good self-rated health status participants were statistically associated with the intention of taking the HBV vaccine. Sex, education level and income group were not significantly associated with vaccination intention. The migrant-industry variables showed that migrant location had a strong effect on migrant workers’ vaccination intention. Conclusion Socio-demographic, migrant-industry variables and PMT factors (severity, self-efficacy and response costs) were statistically associated with migrant workers’ intention to vaccinate. Our results suggest that health policy makers should provide more information to migrants on HBV severity; inform migrant workers on where, when and how to get the HBV vaccine; tap into work organizations as a location for vaccinations; and identify migrant worker subgroups for targeted interventions.

ACS Style

Cai Liu; Stephen Nicholas; Jian Wang. The association between protection motivation and hepatitis b vaccination intention among migrant workers in Tianjin, China: a cross-sectional study. BMC Public Health 2020, 20, 1 -10.

AMA Style

Cai Liu, Stephen Nicholas, Jian Wang. The association between protection motivation and hepatitis b vaccination intention among migrant workers in Tianjin, China: a cross-sectional study. BMC Public Health. 2020; 20 (1):1-10.

Chicago/Turabian Style

Cai Liu; Stephen Nicholas; Jian Wang. 2020. "The association between protection motivation and hepatitis b vaccination intention among migrant workers in Tianjin, China: a cross-sectional study." BMC Public Health 20, no. 1: 1-10.

Preprint content
Published: 29 July 2020
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Background: Migrant workers are a susceptible population to the hepatitis b virus (HBV) and a vulnerable spot in China’s immunization procedures. There is no free HBV immunization program for migrant workers in China, so understanding migrant workers’ motivation to receive the HBV vaccine is the first step in designing effective immunization policies.Methods: A fully specified protection motivation theory (PMT) model of HBV vaccination intention among migrant workers was specified. Data were collected through a cross-sectional survey of 406 migrant workers in three migrant-dense industries in Tianjin, China. Principal component factor analysis was used to produce PMT factors and nested binary logistic regression modeling was applied to assess the associations between protection motivation and HBV vaccination intention of migrant workers.Results: The nested binary logistic regression model suggested that the severity factor and self-efficacy factor were positively related to HBV vaccination intention (OR=2.15, 95% CI: 1.25-3.71; OR=2.75, 95% CI: 1.62-4.66) while the response costs was negatively related to the HBV vaccination motivation (OR=0.50, 95% CI: 0.29-0.83). The socio-demographic variables showed that younger, married and good self-rated health status participants were statistically associated with the intention of taking the HBV vaccine. Sex, education level and income group were not significantly associated with vaccination intention. The migrant-industry variables showed that migrant location had a strong effect on migrant workers’ vaccination intention.Conclusion: Socio-demographic, migrant-industry variables and PMT factors (severity, self-efficacy and response costs) were statistically associated with migrant workers’ intention to vaccinate. Our results suggest that health policy makers should provide more information to migrants on HBV severity; inform migrant workers on where, when and how to get the HBV vaccine; tap into work organizations as a location for vaccinations; and identify migrant worker subgroups for targeted interventions.

ACS Style

Cai Liu; Stephen Nicholas; Wang Jian. The association between protection motivation and hepatitis b vaccination intention among migrant workers in Tianjin, China: a cross-sectional study. 2020, 1 .

AMA Style

Cai Liu, Stephen Nicholas, Wang Jian. The association between protection motivation and hepatitis b vaccination intention among migrant workers in Tianjin, China: a cross-sectional study. . 2020; ():1.

Chicago/Turabian Style

Cai Liu; Stephen Nicholas; Wang Jian. 2020. "The association between protection motivation and hepatitis b vaccination intention among migrant workers in Tianjin, China: a cross-sectional study." , no. : 1.