Cooperative Medical Service Research Articles

Development of China's health care system in the time of COVID‐19: Challenges, opportunities, and call for actions

Development of China's health care system in the time of COVID‐19: Challenges, opportunities, and call for actions

Economic analysis of new rural cooperative medical service financing model based on environment perspective

The purpose of this paper is to continuously to improve health security benefit of China’s New Rural Cooperative Medical System (CNRCMS). In the light of consumer’s choice theory and life-cycle theory, from the perspective of cost, efficiency and utility, this paper analyses the health effects of the typical financing models in different environments. The results show that different environmental conditions are significantly related to the adaptability of the rural social and economic development level to the fund-raising model. The conclusion is that improving the environment and establishing multiple health insurance mode are of great significance to reduce the financing cost and improve the health status of the CNRCMS.

Investigation of medication compliance in patients with pneumoconiosis complicated with chronic obstructive pulmonary disease at stable stage

Objective: To investigate the compliance of inhalation during stable phase of pneumoconiosis complicated with COPD and to explore the factors influencing compliance. Methods: The patients with pneumoconiosis complicated with COPD who were hospitalized in the four Department of occupational disease prevention and treatment in Hunan province from December 2016 to August 2017 were selected as the research subjects. The examination of Chest radiograph, HRCT and lung function was perfected, and CAT score and MRC score were carried out. The age, culture, smoking history, acute aggravation of 1 years, medical insurance and so on were collected, and follow-up was conducted after 6 months. Results: Of the 115 patients who had successfully followed up, 14 cases (12.17%) were persisted in medication, and 101 cases (87.83%) did not adhere to the medication. The smoking index median of the non adherence group was 30 (15, 40) , while that of the adherence group was 16 (6, 31) . The smoking index of the adherence group was lower than that of the non adherence group. The FEV1% in the unadhered group was 44.69+15.48, and the drug group was 37.12+16.98, the FEV(1)/FVC in the unadhered group was 52.43+9.19, and the drug group was 44.43+11.88, and the lung function of the drug group was worse than that of the unadhered group. The adherence rate of group COPD (group D) was higher than that of group A, B and C, and the difference between D group and B group was statistically significant. The adherence rate of pneumoconiosis stage Ⅲ was higher than that of pneumoconiosis stageⅡand pneumoconiosisⅠ. Conclusion: The compliance of long acting bronchodilator inhalation is low in stable phase of pneumoconiosis complicated with COPD. The poorer the lung function, the higher the compliance of inhalation. The compliance of pneumoconiosis patients with Medical insurance for industrial injury is higher than that of pneumoconiosis patients with New rural cooperative medical service.

New Rural Cooperative Medical Service Quality Evaluation Method Considering Uncertainty Decision-making Information

New Rural Cooperative Medical Service Quality Evaluation Method Considering Uncertainty Decision-making Information

Study on cooperative emergency medical service system and mobile app development

Emergency medical treatment is an important component of public health, and its service quality is directly related to people's health and safety. But in the traditional emergency medical service mode, the relevant departments are relatively isolated and dispersive, which results in vital information cannot be shared in real-time. This study argues the application architecture and framework of a new cooperative emergency medical service system (CEMSS). The system enables effective information communication among emergency command centre (ECC), ambulances and the hospital dispatching centre, and makes doctors in the ambulances with experts of the hospital related departments work in synergy. The mobile app based on Android operating system is developed to promote convenience and flexibility. The proposed system can help doctors shorten the treatment time, improve the service quality and reduce the damage for patients.

Study on cooperative emergency medical service system and mobile app development

Study on cooperative emergency medical service system and mobile app development

Current Status and Progress of Telemedicine in Korea and Other Countries.

ObjectivesThe purpose of this study was to review the current telemedicine of the Korea and the telemedicine of the other countries.MethodsThis study reviewed several documents on telemedicine and summarized the documents on the initiation of the telemedicine of the Korea, the recent regulations of the government, the analytical research results, and the telemedicine of foreign countries.ResultsOne of recent demonstration trials of telemedicine began in July 2015 in the Korea. The plan was to conduct an emergency telemedical treatment trial among the cooperative medical service centers until the end of February 2016. No telemedical services were provided at the level of local primary care clinics, and there was 1.2% provision at the hospital level. The Europe Union and the United States had more active telemedical services in comparison to the Korea.ConclusionsThe introduction and usage of telemedicine in the Korea was behind those of other countries. It is necessary to develop a proactive support policy for telemedicine through a government implemented trial.

Competent Alternative Model for the Peasants' Medical Expenditures in China: A Case of New Rural Cooperative Medical Service System (Nrcms) in Zhejiang Province

The New Rural Cooperative Medical Service System (NRCMS) in China has been established to ensure improved medical care support for all categories of Chinese peasants to offset their burden of excessive medical care expenditures. The primary aim of this paper is to identify an appropriate alternative modelling approach for the patients’ medical expenditures. Data were collected from Jiaojiang city through cluster and multistage random sampling procedure, which was comprised of 4,630 enrolled rural people under NRCMS. The paper presented the fi rst comparison of common econometric medical expenditures modelling approaches. Major fi ndings reveal that the Generalized Linear Model (GLM) predictive accuracy appears to be better than the Finite Mixture Model (FMM) and GLM (log link) was the best performer among all approaches. It may be attributed due to the structural difference of medical expenditures between China and other developing countries compared to the developed countries. This suggests that the Chinese government may fi nd an alternative to choose GLM approach among others to minimize the peasants’ medical expenditures under NRCMS.

Effects of comprehensive rehabilitation on stable chronic obstructive pulmonary disease patients in rural communities

Objective To explore the effects of comprehensive rehabilitation on patients with stable chronic obstructive pulmonary disease (COPD) in rural communities. Methods Between June 2010 and June 2012, 212 stable COPD patients were randomly divided into management group (n=107) and control group (n=105). All patients received conventional treatment. In addition, 107 stable COPD patients relying on new rural cooperative medical service station in management group underwent community comprehensive rehabilitation including training in respiratory function, exercise training, nutrition intervention and psychological care. Effect of lung function, symptoms (times of acute attack & hospitalization) and quality-of-life (QOL) rated by SF-36 questionnaire between two groups were recorded at Month 6. Results The score changes of QOL had significant inter-group differences between 2 groups for PCS (scores for physical component summary) and MCS (scores for mental component summary) (11.4±8.2 vs.1.6±1.2, 5.5±3.5 vs.2.2±0.9, all P<0.01). In the scores for physical component summary, the score change of physical function, physiological function, body pain and general health were significantly different between two groups (6.7±4.3 vs.1.2±0.8, 10.9±6.3 vs.1.9±1.5, 6.4±4.7 vs. 3.6±2.7, 3.2±2.7 vs.1.6±1.1, P<0.01). In the scores for mental component summary, the score change of vitality, emotional function, social function and mental health were significantly different between two groups (4.9±3.2 vs.1.9±1.4, 2.7±2.1 vs.1.6±1.1, 11.6±9.2 vs.3.6±2.3, 6.7±4.3 vs.1.4±0.9, P<0.01). The times of acute attack and hospitalization were obviously lower than those of the control group. No significant inter-group difference existed in lung function. Conclusion Comprehensive rehabilitation may improve the QOL in stable COPD patients in rural communities and reduce their times of acute attack. Key words: Pulmonary disease, chronic obstructive; Intervention studies; Treatment outcome

Study of coping style and the economic burden of disease in the patients of cerebral ischemic stroke

Objective To explore coping style and the economic burden of disease in the patients of cerebral ischemic stroke and to find new psychological nursing measures. Methods Questionnaire and homemade scale was used, 233 cases with cerebral ischemic stroke in Xuzhou Medical School Affiliated Hospital neurology department were collected and were divided into four groups( social insurance group, own expense group, residence health insurance group, and new cooperative medical service insurance group). Data were classified and analyzed by SPSS 16.0 software. Results Face factors, avoid factors, yield factors and total score in the coping style were significantly different in the four groups ( F = 32. 11,9. 23,22. 12,5. 82 ; P 0. 05 ). Conclusions Social insurance system as a society' s important support affects coping style in the patients of cerebral ischemic stroke. Key words: Cerebral ischemic stroke; Coping style; Financial burden of disease

Dilemmas of Access to Healthcare in China

Introduction China's compliance with international standards pertaining to human rights in health warrants particular attention, not only because of the global implications of China's handling of health issues such as SARS, HIV and avian flu, but also because of the effects on the well-being of the Chinese people. China has committed itself to compliance with international human rights standards on the right to the highest attainable standard of physical and mental (1) Yet China's performance conflicted with factors largely unrelated to the normative consensus underlying human rights to health. Instead, questions of Institutional Capacity loom large in assessments of the potential for successful reforms in public access to healthcare. China's public health system has long been presented as a model for developing economies. While the barefoot doctor model of the Maoist period was heavily mythologised, the PRC did succeed in bringing basic levels of healthcare to an unprecedented number of people. However, the modernisation policies of the 1980s and the attendant social and political consequences of income disparities, declining public budgets and official corruption eroded significantly the standards of public healthcare. (2) Obstacles to public access to healthcare continue, born of market policies and accompanying costs of medicines, equipment and treatment. (3) The HIV and SARS crises revealed in stark detail the extent to which policies and practices on public health remain subject to imperatives of political expediency and suggest that the fundamental human right to health remains compromised. (4) Government efforts in the areas of health education and the prevention, reporting and treatment of disease involve individual members of society not merely as passive recipients of the exercise of government authority but as active stewards of their own physical well-being. Yet such involvement--as well as collaboration between public and private sectors--has been obstructed by abuses such as government censorship of information on public health conditions, (5) corruption (6) and popular stigmatisation of disease. (7) These dilemmas reflect the depth of operational challenges facing China's current effort to reform its healthcare delivery systems. China's capacity to remedy these problems will dictate to a significant extent the success of recent health policy reforms. China's New Health Care Reform Plan China's State Council passed a landmark Health Care Reform Plan in January 2009. This was the culmination of a policy process begun in 2006 that included extensive interagency consultation as well as public discussion. (8) The Plan builds on efforts to expand the system of rural cooperative medical service units begun in 2002 and expanded in 2003 following the SARS outbreak. Following a report by the State Council Development Research Centre in 2005 that criticised health sector reforms and noted the increase of patient contributions to medical fees from 20 per cent in 1978 to 52 per cent in 2005, the State Council established a joint working committee to draft a new health reform plan. Statistics from the Ministry of Health show that personal spending on medical services doubled from 21.2 per cent in 1980 to 45.2 per cent in 2007, while government funding dropped to 20.3 per cent from 36.2 per cent in 1980. (9) The healthcare plan is aimed in part at providing state subsidies for personal medical expenses. Comprehensive medical insurance was enacted for urban residents in 2007, and the rural cooperative system was expanded continuously between 2006 and 2008. In the fall of 2008, the draft Health Care Reform Plan was released for public debate. The plan was endorsed by the State Council in January 2009 (10) and taken up in Premier Wen Jiabao's Government Work Report to the Second Session of the 11th NPC in March. (11) The Plan was published for implementation in April. …

Investigation on the current situation of rural cooperative medical service in three township hospitals in Cili county of Hunan province

目的 了解农村乡卫生院合作医疗现状,分析影响现状的因素,提出改进的建议.方法 对湖南省慈利县3个乡的3所乡卫生院医务人员和就诊农村居民进行问卷调查.结果 乡卫生院医务人员工作待遇差,教育水平低,农村居民对乡卫生院医务人员的技术水平满意度不高.结论 建议从提高乡卫生院医务人员水平入手,逐步改善农村居民的医疗现状。

Health Care in the People's Republic of China: A Blend of Traditional and Modern

The People's Republic of China originally developed a unique health services system that embodies decentralization, continuity with traditional medicine, integration with the local political structure, and mass participation. In order to provide health services for over one billion people. China concentrated on training barefoot doctors, assistant doctors, midwives, and public health workers. Also, training programs attempted to integrate Chinese traditional medicine with Western medicine. However, economic reforms initiated during the 1980s currently are transforming the health care system. The rural cooperative medical service is being replaced by private hospitals and clinics and health insurance systems. In the future, China will have to balance increased specialization and technology with the delivery of health services to a largely rural population. This will be a difficult task for a nation in the process of economic reform.

An Introduction to China's Health Care System

The Chinese health care system was originally a highly centralized one. It had great success in improving the people's health. The county-township-village three-tier health care system has contributed much to rural primary health care, and has set an example of primary health care to the developing nations. In the 1980s, this system experienced transformations along with the changes of the country's administrative system and economic policy. The transformations are characterized by the disintegration of the rural cooperative medical service, by the decentralization of township hospitals from county to township governments, by official permission for private practice, by the implementation of the personal responsibility system in health institutions, by the health security reform, and by the development of health insurance in rural areas. The long-existing health administrative problems which were aggravated in the last decade are the rural-urban differences in resource allocation and the large proportion of people without health security. With the increase of medical service prices in recent years due to the inflation of the whole economy, it is believed that the cost of health care will create an economic burden to the low-income, fee-for-service paying individuals and will further affect the health of the population. In the process of the national economic reform, it is an important and difficult task for the health administrators to adjust the health care system promptly and properly. Only by continuously carrying forward good traditions, correcting mistakes and consistently persisting in health reform, can China further raise its health care to a new, prosperous stage.

Issues of health care financing in the People's Republic of China

The major issue of health care financing in China is how to allocate limited resources to provide effective health care services for a population of about 900 million. There are three major types of health care insurance coverage in China: (1) public expenses medical insurance, (2) labor medical insurance and (3) cooperative medical service. The strategies for cost containment in China include the visit fee. referral system, herbal medicine and hospital payment system. The role of the central government is minimum in direct subsidies. The central government emphasizes the maximum community participation and involvement in health services. The general implications of the Chinese experiences may be useful concepts to be considered by developing countries.

BAREFOOT DOCTORS IN CHINA

The term barefoot doctors was 1st used in the Chiangchen People's Commune on the outskirts of Shanghai when a mobile service team formed by urban medical workers began to provide medical services in rural areas in 1965. They trained some young peasants to function as ''barefoot doctors.'' Barefoot doctors are now reaching almost every village, and currently they are the backbone of the rural cooperative medical service. This ''barefoot doctor'' service is operated by the peasants on a collective and mutual aid basis. Training barefoot doctors and running the cooperative medical service well are important to the development of China's rural health work with greater, faster, better, and more economical results. Part-time doctors who combine farm work with medical duties meet the needs of a developing country like China. The ''barefoot doctors'' participate in an inital training program which lasts from 3 to 6 months. After a period of practice, they receive additional training, including training groups by group and individual training by qualified doctors. The additional training is given year after year. The barefoot doctors are required to study both therapeutics and prophylaxis, both Western and traditional Chinese medicine. In addition, women barefoot doctors learn midwifery, maternal and child care, and the use of contraceptives along with other methods of family planning. The barefoot doctors in China's rural areas are important in implementing the policy of prevention 1st. Under the guidance of the commune hospitals, they devote much of their time to preventive medicine tasks.

海外の中小企業衛生対策を語る : 第2回中小企業衛生問題研究会全国集会

The author reported the outline of occupational health services to employees of small plants in U.S.A and in Europe, which he had recently inspected, at the 2nd general meeting of the Society for the Study of Occupational Health Problems of Small Plants in Osaka 1964. In both Europe and U.S.A., the health and medical services are lacking in small plants in general. Pilot experiments or programs of providing health and medical service to employees in small plants have been attempted in U.S.A. and in England. The patterns of the program are different according to the socio-economical and political conditions as well as the health and medical service system as of the state or the community. 1) Individual Program: It is the basic needs for the health service to employees in small as well as large plants to provide an individual health unit, e.g. medical equipment and medical personnael, in the plant. Otherwise, this program has frequently been miscarried mainly due to economical reason of the medical personnel. 2) Cooperative Program : The provision of a cooperative medical equipment or "Industrial Health Center" to a group of small plants is more favourable and effective to get the medical personnel and the well-equiped facilities. Slough Industrial Health Center and Harlow I.H.C. in England are worthy to be praised as well-arranged models of the cooperative health and medical service to small plants, which includes Central Clinic, mobile redressing service, health examination, inspection and research of work place, etc. These pilot experiments have shown that the assistance and the sponsor of the state, the community or the voluntary agencies should be the prerequisite to success of these programs, especially by means of a high initial investment. 3) Community Program: It is more effective and necessary to draw out the resources available in the community; hospitals, general physicians, nurses, institutes, volunteary agencies, especially official agencies. For instance, the cooperative activities of Bureau of Industrial Hygiene and the public health nurses of the health centers of Detroit Department of the Health are showing effective guidance and recommendations to improve the health services to employees in small plants. Besides, the part-time sevice of localgeneral physicians and their medical treatment in the offices should constitute the "backbone" of the health service to employees in small plants. On the other hand, criticisms to these programs, especially to so-called cooperative program for small plants, should not be overlooked, that is, these programs consist mainly of personal, rather clinical, medical services. For the health of employees the improvement of the unhealthy working conditions and the amelioration of the unhygienic environment in small plants should be the most essential needs, and the official inspection of factories and the recommendations to keep the legal hygienic standard should also not be neglected. Besides, the authour added a short description of the industrial health services in Czechoslovak, which have a tight correlation with the national socialized heath and medical service scheme, and of the initiative of Labour Union on Safety and Health in work places in the Socialist Republic.