The public's perception of the health system provides valuable insights on health system performance and future directions of improvement. While China's health care reform was a response to people's ...discontent in the health care system due to the lack of accessibility and affordability, little is known on changes in public perception of China's health system. This paper examines trends in public perception of the health system between 2006 and 2019 and assesses determinants of public perception in China's health system.
Seven waves of the China Social Survey, a nationally representative survey, were used to examine trends in public satisfaction with health care and perceived fairness in health care. Chi-square tests were used to examine differences across waves. Logistic regression models were used to explore determinants of public perception, including variables on sociodemographic characteristics, health system characteristics, and patient experience.
Satisfaction with health care increased from 57.76% to 77.26% between 2006 and 2019. Perceived fairness in health care increased from 49.79% to 72.03% during the same period. Both indicators showed that the major improvement occurred before 2013. Sociodemographic characteristics are weakly associated with public perception. Financial protection and perceived medical safety are strongly associated with public perception, while accessibility is weakly associated with public perception. Patient experience such as perceived affordability and quality in the last medical visit are strongly associated with public perception of the health care system, while the accessibility of the last medical visit shows no impacts.
Public satisfaction on health care and perceived fairness in health care in China improved over 2006-2019. The main improvement occurred in accordance with huge financial investments in public health insurance before 2013. Financial protection and perceived quality play significant roles in determining public perception, whereas accessibility and sociodemographic characteristics have limited influence on people's perception of China's health system. To achieve higher satisfaction and a higher sense of fairness in health care, China's health system needs to continue its reforms on hospital incentives and integrated delivery system to control health expenditure and improve health care quality.
From 1986 to 2009, China's health system reform first adopted a market-oriented approach and later reemphasized the role of the government starting from 2002. China's oscillating health care ...financing policies present us a unique opportunity to examine the consequences of government-led financing and market-oriented financing measures. This study uses the Urban Household Survey, a diary data in China that covers the period of 1986 to 2009, to examine the long-run trends in the incidence and intensity of catastrophic health expenditure and medical impoverishment. Four major findings emerge. First, the incidence and intensity of catastrophic health expenditure in urban Chinese households increased rapidly between 1986 and 2002, whereas they stabilized after 2002. Second, the incidence of medical impoverishment and its depth in the poverty gap remained stable before 2002 and decreased rapidly after 2002. Third, income and regional inequality in measures of catastrophic health expenditure widened from 1986 to 2002. They narrowed in the 2000s but remain wide. Fourth, income and regional inequality in medical impoverishment remained unchanged between 1986 and 2002 and narrowed substantially after 2002. All these results suggest that China's two cycles of health care reform generated significantly different outcomes in financial protection, holding lessons for the ongoing health care reform in China and other countries.
Guided by the principle of universal health coverage, China began its complex health system reform in 2009. Using data from the China Family Panel Studies (CFPS), this study assesses trends in ...healthcare utilization, financial protection, and satisfaction between 2010 and 2016. We use difference-in-means tests and regression analysis to evaluate overall trends and compare subsample results by urban/rural residence and income quartiles to examine changes in inequity. Our results show that China has achieved substantial improvements in access to healthcare services and financial protection since the health system reform in 2009. First, China has experienced a substantial increase in both inpatient and outpatient care utilization between 2010 and 2016. Second, people receive better financial protection by measures of health insurance coverage, inpatient reimbursement rate, the likelihood of incurring catastrophic health expenditure, and the likelihood of medical impoverishment. Third, inequity in financial protection by income quartiles has significantly decreased, though poorer groups remain more vulnerable. However, we do not observe a concurrent increase in satisfaction towards the health system. We also find that people are more willing to seek medical services in hospitals rather than primary care institutions. All these results suggest that China's ongoing health system reform should pay more attention to establishing a tiered health delivery system, strengthening financial protection for the poor, and increasing responsiveness to rising expectations.
•China has achieved substantial improvements in access to healthcare services.•From 2010 to 2016, people received better financial protection in healthcare.•Inequity in financial protection by income quartiles has decreased.•We do not observe a concurrent increase in satisfaction towards the health system.
Although stroke incidence in high-income countries (HICs) decreased over the past four decades, it increased dramatically in low- and middle-income countries (LMICs). In this review, we describe the ...current status of primary prevention, treatment, and management of acute stroke and secondary prevention of and rehabilitation after stroke in LMICs. Although surveillance, screening, and accurate diagnosis are important for stroke prevention, LMICs face challenges in these areas due to lack of resources, awareness, and technical capacity. Maintaining a healthy lifestyle, such as no tobacco use, healthful diet, and physical activity are important strategies for both primary and secondary prevention of stroke. Controlling high blood pressure is also critically important in the general population and in the acute stage of hemorrhagic stroke. Additional primary prevention strategies include community-based education programs, polypill, prevention and management of atrial fibrillation, and digital health technology. For treatment of stroke during the acute stage, specific surgical procedures and medications are recommended, and inpatient stroke care units have been proven to provide high quality care. Patients with a chronic condition like stroke may require lifelong pharmaceutical treatment, lifestyle maintenance and self-management skills, and caregiver and family support, in order to achieve optimal health outcomes. Rehabilitation improves physical, speech, and cognitive functioning of disabled stroke patients. It is expected that home- or community-based services and tele-rehabilitation may hold special promise for stroke patients in LMICs.
•We described the surveillance, screening, and accurate diagnosis of stroke in LMICs.•Primary prevention includes healthy lifestyles, BP control, and sodium reduction.•Intravenous thrombolysis is the approved treatment of stroke during the acute stage.•Secondary prevention includes pharmaceutical treatment and lifestyle maintenance.•Rehabilitation improves patients' physical, speech, and cognitive functioning.
Bisphenols (BPs) are potential endocrine-disrupting chemicals that may adversely affect human health and wildlife. The complexity of matrix encountered in real-world samples renders screening of ...trace BPs a formidable challenge. The present study highlighted the potential of molecularly imprinted solid-phase extraction (MISPE) for selective detection of trace bisphenols and their halogenated analogues in surface water. The template bleeding was observed at parts-per-billion levels, deteriorating the accuracy and precision of BPs quantification. To surmount this problem, a dummy MISPE strategy was proposed, in which bisphenol E (BPE) was selected as a dummy template for molecularly imprinted polymer (MIP) synthesis. Coupling this MISPE strategy with chromatographic analysis, a dummy MISPE-HPLC method was established. The linearity, precision, limit of detection (LOD) and recovery were then validated. The linearity of the calibration curve for each BP was observed over the range of 20-2000 ng L-1 (r 0.998). LOD for each bisphenol was measured as low as 2.5-5.0 ng L-1. This technique was applied to simultaneous screening of BPs in the Qinghe River, and five bisphenols were found within the concentration range of 0-224 ng L-1 in river samples. The designed dummy MIP was superior to the commercial sorbents with regard to the selectivity, cross-reactivity, matrix removal efficiency and reusability. These merits enabled the applications of dummy MISPE for selective extraction and sensitive screening of BPs in environmental water samples. This method also provided a promising tool for monitoring the occurrence, distribution and fate of BPs in surface water.
Abstract
Medical corruption is a significant obstacle to achieving health-related Sustainable Development Goals. However, the understanding of medical corruption is limited, especially in developing ...countries. As the largest developing country, China is also plagued by medical corruption. By employing a mixed-methods design and combining data from three resources, this study attempts to examine patterns of medical corruption in China, explore its key drivers and investigate the perceived effectiveness of recent anti-corruption interventions. Using extracted data from 3546 cases on the China Judgments Online website between 2013 and 2019, we found that bribery, embezzlement and insurance fraud accounted for 68.1%, 22.8% and 9.1% of all medical corruption cases, respectively. Bribery was the major form of medical corruption. Approximately 80% of bribe-takers were healthcare providers, and most bribe-givers were suppliers of pharmaceuticals, medical equipment and consumables. Using a nationally representative household survey, we further found that the prevalence of informal payments from patients remained at a low level between 2011 and 2018. In 2018, only 0.4% of outpatients and 1.4% of inpatients reported that they had ever given ‘red envelopes’ to physicians in the past. Finally, we conducted interviews with 17 key informants to explore drivers of medical corruption and investigated the perceived effectiveness of recent anti-corruption interventions in China. Interview results showed that financial pressure and weak oversight were two main reasons for corrupt behaviours. Interview results also suggested that the anti-corruption campaign since 2012, the national volume-based procurement, and the special campaign against medical insurance fraud had reduced opportunities for medical corruption, implying China’s positive progress in combating medical corruption. These findings hold lessons for anti-corruption interventions in China as well as other developing countries.
Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high ...income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.
Conductive coordination polymers (CPs) have potential in a wide range of applications because of their inherent structural and functional diversity. Three electrically conductive CPs (CuxC6S6, x=3, 4 ...or 5.5) derived from the same organic linker (benzenehexathiol) and metal node (copper(I)) were synthesized and studied. CuxC6S6 materials are organic–inorganic hybrid copper sulfides comprising a π‐π stacking structure and cooper sulfur networks. Charge‐transport pathways within the network facilitate conductivity and offer control of the Fermi level through modulation of the oxidation level of the non‐innocent redox‐active ligand. Two CuxC6S6 (x=4 or 5.5) CPs display high electrical conductivity and they feature a tunable structural topology and electronic structure. Cu4C6S6 and Cu5.5C6S6 act as degenerate semiconductors. Moreover, Cu5.5C6S6 is a p‐type thermoelectric material with a ZT value of 0.12 at 390 K, which is a record‐breaking performance for p‐type CPs.
A family of electrically conductive coordination polymers (CuxC6S6; x=3, 4 or 5.5) are reported. The hybrid structures of the polymers offer charge‐transport paths and enable a shift of the Fermi level by modulating the oxidation level of the non‐innocent redox‐active ligand. As a result, their band structures range from metal to degenerate semiconductors in which Cu5.5C6S6 demonstrates appreciable thermoelectric performance.
We experimentally demonstrate the implementation of 10 Gbps high-speed mid-infrared (MIR) free-space optical (FSO) communication, by means of our developed robust high-speed MIR transmitter and ...receiver modules. Such modules can enable frequency down- and up-conversion between 1550 nm and 3594 nm based on difference frequency generation (DFG) in MgO-doped periodically poled LiNbO
(MgO: PPLN). The MIR transmitter generates 5.34 dBm power at 3594 nm for input powers of 33 dBm at 1550 nm and 37 dBm at 1083 nm. The MIR receiver regenerates -24.5 dBm power at 1550 nm for input powers of -1.2 dBm at 3594 nm and 36.7 dBm at 1083 nm. The eye diagram of regenerated 1550 nm signal is clear, and both for the on-off keying (OOK) and differential phase shift keying (DPSK) modulation, the power penalties compared with back to back (BTB) signals are lower than 3.5 dB measured at bit error ratio (BER) of 1E-6. According to our analyses, the system supports variable data rate, wavelength, and modulation format. Furthermore, the optical and electrical components are well integrated and fixed in MIR transmitter and receiver modules, which exhibit long-term stability and can be applied to field experiments.
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