Mingshan Lu

From A National, Centrally Planned Health System To A System Based On The Market: Lessons From China

No other country has undergone health care reforms as dramatic as Chinas. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper adds to the literature by examining Chinas health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from Chinas reform process.

Rural and Urban Disparity in Health Services Utilization in China

Objectives:To describe patterns in physician and hospital utilization among rural and urban populations in China and to determine factors associated with any differences. Methods:In 2003, the Third National Health Services Survey in China was conducted to collect information about health services utilization from randomly selected residents. Of the 193,689 respondents to the survey (response rate, 77.8%), 6429 urban and 16,044 rural respondents who were age 18 or older and reported an illness within the last 2 weeks before the survey were analyzed. Generalized estimating equations with a log link were used to assess the relationship between rural/urban residence and physician visit/hospitalization to adjust for respondents clustered at the household level. Results:About half of respondents did not see a physician when they were ill. Rural respondents used physicians more than urban respondents (52.0% vs. 43.0%, P < 0.001) and used hospitals less (7.6% vs. 11.1%, P < 0.001). Factor associated with increased physician utilization included residing in rural areas among majority Chinese (ie, Han) [rate ratio (RR), 1.21; 95% confidence interval (95% CI), 1.16–1.26], residing <3 km away from the medical center (RR, 1.16; 95% CI, 1.12–1.21), or being uninsured (RR, 1.38; 95% CI, 1.30–1.46). Rural minority Chinese visited physicians significantly less than urban minority Chinese (RR, 0.90; 95% CI, 0.83–0.98). Hospital utilization was significantly lower among rural males (RR, 0.84; 95% CI, 0.72–0.98), rural seniors (age, ≥65; RR, 0.64; 95% CI, 0.53–0.77), rural respondents with low education (RR, 0.70; 95% CI, 0.57–0.86 for illiterate), or rural insured respondents (RR, 0.86; 95% CI, 0.69–0.99) than hospitalization among urban counterparts. Conclusions:Three national approaches should be considered in reforming the healthcare system in China: universal insurance coverage, higher amounts of insurance coverage, and increasing the populations level of education. In addition, access issues in remote areas and by rural minority Chinese population should be addressed.

A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women

BackgroundThe Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive systematic review, without geographic, language or date limitations, to update current knowledge on the effectiveness of existing intervention strategies to enhance breast and cervical screening uptake in Asian women.MethodsThis study systematically reviewed studies published as of January 2010 to synthesize knowledge about effectiveness of cancer screening interventions targeting Asian women. Fifteen multidisciplinary peer-reviewed and grey literature databases were searched to identify relevant studies.ResultsThe results of our systematic review were reported in accordance with the PRISMA Statement. Of 37 selected intervention studies, only 18 studies included valid outcome measures (i.e. self-reported or recorded receipt of mammograms or Pap smear). 11 of the 18 intervention studies with valid outcome measures used multiple intervention strategies to target individuals in a specific Asian ethnic group. This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions. The effectiveness of community-based or workplace-based group education programs increases when additional supports, such as assistance in scheduling/attending screening and mobile screening services are provided. Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake. Media campaigns and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake. Intervention effectiveness appears to vary with ethnic population, methods of program delivery, and study setting.ConclusionsDespite some limitations, our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors, such as type of intervention and study population characteristics. While some studies demonstrated the effectiveness of certain intervention programs, the cost effectiveness and long-term sustainability of these programs remain questionable. When adopting an intervention program, it is important to consider the impacts of social-and cultural factors specific to the Asian population on cancer screening uptake. Future research is needed to develop new interventions and tools, and adopt vigorous study design and evaluation methodologies to increase cancer screening among Asian women to promote population health and health equity.

Assessing record linkage between health care and Vital Statistics databases using deterministic methods

BackgroundWe assessed the linkage and correct linkage rate using deterministic record linkage among three commonly used Canadian databases, namely, the population registry, hospital discharge data and Vital Statistics registry.MethodsThree combinations of four personal identifiers (surname, first name, sex and date of birth) were used to determine the optimal combination. The correct linkage rate was assessed using a unique personal health number available in all three databases.ResultsAmong the three combinations, the combination of surname, sex, and date of birth had the highest linkage rate of 88.0% and 93.1%, and the second highest correct linkage rate of 96.9% and 98.9% between the population registry and Vital Statistics registry, and between the hospital discharge data and Vital Statistics registry in 2001, respectively. Adding the first name to the combination of the three identifiers above increased correct linkage by less than 1%, but at the cost of lowering the linkage rate almost by 10%.ConclusionOur findings suggest that the combination of surname, sex and date of birth appears to be optimal using deterministic linkage. The linkage and correct linkage rates appear to vary by age and the type of database, but not by sex.

Direct economic burden of hepatitis B virus related diseases: evidence from Shandong, China.

BackgroundAlthough the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to investigate the direct economic burden of acute and chronic hepatitis B, cirrhosis and liver cancer caused by HBV-related disease.MethodsFrom April 2010 to November 2010, we conducted a survey of inpatients with HBV-related diseases and who were hospitalized for seven or more days in one of the seven tertiary and six secondary hospitals in Shandong, China. Patients were recorded consecutively within a three-to-five month time period from each sampled hospital; an in-person survey was conducted to collect demographic and socio-economic information, as well as direct medical and nonmedical expenses during the last month and last year prior to the current hospitalization. Direct medical costs included total outpatient, inpatient, and self-treatment expenditures; direct nonmedical costs included spending on nutritional supplements, transportation, and nursing. Direct medical costs during the current hospitalization were also obtained from the hospital financial database. The direct economic cost was calculated as the sum of direct medical and nonmedical costs. Our results call for the importance of implementing clinical guideline, improving system accountability, and helping secondary and smaller hospitals to improve efficiency. This has important policy implication for the on-going hospital reform in China.ResultsOur data based on inpatients with HBV-related diseases suggested that the direct cost in US dollars for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer was

Male and Female Adult Population Health Status in China: A Cross-Sectional National Survey

2954,

Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China

10834,

Comparing public and private hospitals in China: Evidence from Guangdong

4552,

Child health insurance coverage: a survey among temporary and permanent residents in Shanghai

7400.28,

Systematic review of risk adjustment models of hospital length of stay (LOS).

6936 and