Health Services In China Research Articles

Role of Usual Healthcare Combined with Telemedicine in the Management of High-Risk Pregnancy in Hangzhou, China.

Background Maternal health is an important part of basic public health services in China's medical reform. Effective management is an important guarantee of maternal health. Telemedicine has been widely used in maternal health management. Objective This study explores the role of usual healthcare combined with telemedicine in the management of high-risk pregnancy. Methods The study was a retrospective. Data were obtained from Hangzhou Maternity Hospital between October 2012 and September 2016, including 93465 pregnant women who were in usual high-risk pregnancy management (usual group) and 134884 pregnant women who were in telemedicine combined with usual high-risk pregnancy management (telemedicine group). The differences in high-risk scores and pregnancy outcomes between the usual and the telemedicine groups were compared. Results The high-risk factors were analyzed, and the results showed that the first fixed high-risk factor was scar uterus and the first dynamic high-risk factor was hepatitis B. Comparing the data of two groups, the number of prenatal visits increased significantly in the telemedicine group (p value <0.05). Although the critical proportion of high-risk women was 2.13% in the usual group and 5.88% in the telemedicine group, respectively (p value <0.01), maternal mortality decreased in the telemedicine group (p value <0.05). Conclusion The combination of telemedicine and usual healthcare can urge the pregnant women to carry out antenatal visits on time, which is one of the important factors to improve the outcome of high-risk pregnancy.

Assessment of the health status and health service perceptions of international migrants coming to Guangzhou, China, from high-, middle- and low-income countries

BackgroundChina, which used to be an export country for migrants, has become a new destination for international migrants due to its rapid economic growth. However, little empirical data is available on the health status of and health service access barriers faced by these international migrants.MethodsForeigners who visited the Guangzhou Municipal Exit-Entry Administration Office to extend their visas were invited to participate in the study. Quantitative data were collected using electronic questionnaire in 13 languages. The participants were characterised by the income level of their country of origin (high-, middle- and low-income countries (HICs, MICs and LICs, respectively)), and the key factors associated with their health status, medical insurance coverage and perceptions of health services in China were examined.ResultsOverall, 1146 participants from 119 countries participated in the study, 57.1, 25.1 and 17.8% of whom were from MICs, HICs and LICs, respectively. Over one fifth of the participants experienced health problems while staying in China, and about half had no health insurance. Although the participants from HICs were more likely than those from MICs and LICs to have medical insurance, they were also more likely to have health problems. Furthermore, 43.0, 45.0 and 12.0% of the participants thought that the health services in China were good, fair and poor, respectively. Among the participants, those from HICs were less likely to have positive feedback.ConclusionsOur study is the first to report a quantitative survey of the health status, health insurance coverage, and health service perceptions of a diverse and surging population of international migrants in China. The findings call for more in-depth studies on the challenges presented by the increasing global migration to the health system.

Association of influence factors and maternal health service in China: a structural equation modeling approach

目的 根据孕产期保健服务现状，分析影响孕产期保健服务质量的直接及间接因素。 方法 于2016年9－12月采用整群随机抽样的方法，从成都市22个区(市)县按照经济水平的高低分为高、中、低(一、二、三个圈层)3个层次中随机抽取9个区(市)县，在被抽取的9个区(市)县中随机抽取20个社区卫生服务中心，从20个社区卫生服务中心的孕期系统保健登记册上共随机抽取1 000名产妇进行调查。采用描述性统计分析方法及结构方程模型对孕产期服务质量影响因素进行分析。 结果 早孕建卡率为88.9%；产后访视项目齐全的占90.4%；孕产期系统保健管理率为78.6%，满意率为83.37%。结构方程模型结果显示，孕产期保健行为受到孕产期保健知识认知(β＝0.602，P<0.05)和医院级别的直接影响(β＝0.378，P<0.05)，同时医院级别及孕产期保健知识认知均可通过孕产期保健行为对孕产妇满意度产生间接作用，总作用分别为23.6%和37.6%；而孕产期保健行为和孕产妇满意度之间相关(β＝0.625，P<0.05)。 结论 成都市孕产期系统保健管理率有待进一步提高，针对孕产期保健知识认知及医院级别等有针对性的制定健康教育宣传，可以提高孕产期保健服务质量。

ECCP Program in Connecticut of America and Its Enlightenment

Early Childhood Consultation Partnership program in Connecticut is an important part of American children mental health consultation project. This program provides children from birth to five years old with mental health consultation service, including Child-specific Services, Core Classroom Services, and Intensive Site Services. This paper mainly uses literature method to sort out content, operation and management in ECCP program, in order to inspire children's mental health services in China. Based on the experience of Connecticut, the authors suggest that China should pay more attention to children’s mental health and integrate all sources to establish a service for children’s mental health.

The effect of the latest health care reforms on the quality of community health services in China.

The Chinese government initiated a new round health care reform in 2009 to provide universal primary health care to the country's population. The aim of this study was to evaluate and compare the quality of community health services before and after the latest health care reforms in China. A series of nationwide surveys were conducted in 2008 and in 2011to assess the development of the community health services. A total of 2274 and 2501 community health centers, 38200 and 42200 prescriptions, and 12163 and 12386 outpatients visited community health centers (CHCs) were investigated in 2008 and in 2011, respectively. Multivariable regressions and Kruskal-Wallis tests were applied to analyze the differences before and after health care reforms. Quality of community health services has been improved significantly at the first stage of health care reforms in China. CHCs were larger and better equipped after health care reforms in terms of average building area and average number of medical equipment. Patient satisfaction increased, and patient payments per visit decreased after health care reforms. But there was no significant improvement in health human resource, and overuse of injections remains prevalent, pointing to the need for further reforms to improve quality of community health services, such as general practitioner cultivation and supervision over prescribing behaviors.

Inter-provincial inequality of public health services in China: the perspective of local officials\u2019 behavior

BackgroundAfter economic reform, China experienced rising public health services inequality between the eastern developed and mid-west undeveloped provinces. The fiscal transfer payment system which aims to shape the disparities was considered inefficient. However, there are only a few studies that address the political reason when analyzing the inter-provincial public health services inequality. And the previous studies did not consider a possible non-linear relationship between the fiscal transfer payments and the inter-provincial public health services equalization.MethodsThis paper argues that the local officials’ fanatical pursuit of local economic growth which driven by the Political Promotion Tournament and the polarized fiscal self-sufficiency (fiscal capacities) of local governments are responsible for the inter-provincial inequality of public health services and the inefficiency of fiscal transfer payments. By constructing panel threshold regression models with fiscal self-sufficiency of local governments as threshold variable, this study tries to empirically investigate the optimal level of the local governments’ self-sufficiency at which the fiscal transfer payments can effectively promote equalization.ResultsThreshold effects exist between fiscal transfer payments and inter-provincial public health services equalization. The effects on inter-provincial public health services equalization show trends that first increase and then decrease as the fiscal self-sufficiency of local governments increases. And there exist a range of fiscal self-sufficiency between 29.236 and 43.765% or between 28.575 and 45.746% for local governments where the fiscal transfer payments can effectively achieve equalization. Currently, the vast majority of provinces in China remain in the ineffective regime where the fiscal transfer payments are inefficient in shaping inequality.ConclusionsThis paper explains the reason of inequality in public health services and the inefficiency of fiscal transfer payment system from Chinese local officials’ behavior aspect, and try to find out an effective solution by focusing on the local government’s fiscal capacity. The effective way to narrow the inequality is to establish a flexible tax-sharing system to adjust local governments’ fiscal capacities and give local governments with low fiscal self-sufficiency more fiscal resources. The new policy measures recently launched by Chinese central government coincide with our recommendations.

Oral health service utilization patterns among preschool children in Beijing, China

BackgroundThe utilization of oral health services in children remains at a relatively low level in China. However, little is known about the utilization patterns and related factors. The objective of this study was to explore the patterns of oral health service utilization and to determine the related factors among preschool children in Beijing, China, based on the Andersen behavioral model.MethodsA cross-sectional study of 1425 preschool children aged 2 to 6 years was carried out in five kindergartens in Beijing, China. A questionnaire investigation of parents/caregivers was performed to collect information on oral health service utilization. Oral health needs were evaluated through oral health examinations. Chi-square tests, t-tests, multivariate logistic regression and negative binomial regression were used in this study to identify the variables associated with oral health service utilization.ResultsIn total, 648 (45.5%) children had utilized oral health services in the past 12 months, while 24.3% had utilized preventive oral health services. Routine checkups and receiving preventive measures accounted for 63.2% of the children who utilized oral health services in the past 12 months. Children were more likely to have utilized oral health services in the past 12 months if they attended kindergartens with regular oral health care resources, if their oral health status as perceived by their parents/parents was “fair” or “poor”, if they had more decayed, missing and filled teeth (dmft) and if they had experienced more dental pain. In addition, children with more dental pain and more access to oral health services, whose oral health status was perceived by parents/caregivers as worse tended to have utilized oral health services more frequently in the past 12 months.ConclusionsIn conclusion, we found a strong association between access to regular oral health care resources and oral health service utilization among preschool children. Children whose oral health status was perceived by parents/caregivers as worse and who had more dental pain were more likely to have utilized oral health services in China.

Patient satisfaction with prescribed medicines in community health services in China: A cross-sectional survey 6years after the implementation of the national essential medicines policy.

The National essential medicines policy (NEMP) is promoted by the World Health Organization for affordable medicines that can meet the basic needs of communities. Patient acceptance is essential for achieving the policy goals of the NEMP. This study aimed to assess patient satisfaction with prescribed medicines in community health services under the NEMP context in China. A stratified random sampling strategy was adopted to select 1,037 participants in 40 community health centres from four provinces in China. Patient satisfaction was rated on a five-point Likert scale (from 1="very dissatisfied" to 5="very satisfied") covering four domains: availability, affordability, effectiveness and safety. The results showed that the participants expressed a moderate degree of satisfaction, with a rating in the range of 66-82 out of a total of 100. Older people, those covered by insurance and those with a lower level of education tended to have higher ratings. While eastern (wealthy) residents were more likely to be concerned with "effectiveness," western (poor) residents were more likely to be concerned with "affordability." Awareness of the NEMP was negatively associated with patient satisfaction after control for other factors.

Inequality of public health and its role in spatial accessibility to medical facilities in China

Due to the close links between quality of life standards and level of regional development, it is important to gain an improved understanding of the factors that contribute to unequal spatial accessibility of medical and health services in China. This study analyzed 2859 counties using the average shortest distance traveled from settlements to medical facilities to calculate spatial accessibility. The Theil index at three levels (three partitions, eight economic zones and provinces) was used to assess the inequality between regions. Then, a method of spatial autocorrelation was used to assess the spatial agglomeration characteristics of spatial accessibility. To explore the underlying reasons for the imbalance in spatial accessibility, a total of eight indicators in three aspects (nature, society, and economy) were collected and geographically weighted regression (GWR) was employed to investigate spatial heterogeneity. We observed marked disparities in spatial accessibility to medical facilities at the national level. In particular, there appears to be improved spatial accessibility and lesser regional inequality in eastern and central regions as opposed to western Chinese regions; in coastal regions instead of inland regions; and in municipalities such as Beijing, Tianjin, and Shanghai, but not in other provinces and autonomous regions. Besides, significant global autocorrelation and obvious clusters were revealed in a spatial pattern analysis. A wide range of hot-spot areas (clusters of poor spatial accessibility) mainly concentrated in Tibet and other areas with complex terrain and lagging social and economic development. A number of cold-spot areas (clusters of good spatial accessibility) mostly scattered in built-up areas especially municipalities and well-developed urban agglomeration such as the Yangtze River Delta, the Pearl River Delta, and the Wuhan 1 + 8 city circle. Furthermore, the relationships between influencing factors and spatial accessibility were also investigated. The influence of altitude on spatial accessibility gradually decreased from the West to the East, while the influence of slope decreased from the South to the North with prominent provinces of Qinghai and Gansu. Population density exerted a higher impact on the distance in the southwest region whereas the urbanization rate influenced the northeast and southeast coastal region more intensively. In contrast, the pattern of educational level was relatively discrete. The influencing pattern of economic factors in both per area GDP and tertiary industry output share of accessibility showed apparent regional characteristics in the southeast coastal areas, as well as in the northwestern and northeastern parts. Outcomes from this study can be used to provide important information to aid policy making, while also facilitating future research aimed at improving the understanding of equality and sustainable development of medical facilities.

Application of Wireless Network in Hospital Information Construction

The rapid development and wide application of wireless network technology have brought unprecedented opportunities to the reform of medical and health services in China. Many hospitals in China have widely applied wireless network technology to informatization construction of hospitals, mainly including wireless room inspection, wireless infusion, wireless nursing, telemedicine, and warehouse management. This has the advantages of being flexible, convenient, effective, and reliable, which is conducive to the comprehensive integration of hospital data and information, reducing the work pressure of medical personnel, improving medical diagnosis and quality of care, and promoting the development of China’s medical and health services. Wireless networks have made outstanding contributions in controlling medical defects and improving economic efficiency while improving work efficiency and reducing costs. However, there are still certain security risks in wireless networks. Only the safe and rational use of wireless network technology can ensure the hospital’s information security.

Physical restraints: An ethical dilemma in mental health services in China

Given that physical restraints cause adverse effects to patients and nurses, their wide and frequent use has resulted in various clinical and ethical controversies in mental health services. The rate of physical restraints is significantly higher in China than in other countries. Some western and domestic media blamed relevant institutions for compromising the basic rights of psychiatric patients. Therefore, this study aims to collect and synthesize the relevant ethical evidence and to provide corresponding guidance for the nursing practice based on the current situation of the mainland of China. This study synthesized the ethical issue according to the ethical principle of autonomy, justice, beneficence, and non-maleficence. Given the current situation where the nursing workforce is limited and the mental health service is under-developed in China, applying physical restraints in the psychiatric inpatients to guarantee the safety of patients and nurses is crucial. In regard to respect the basic rights of psychiatric patients, it is recommended to protect the their autonomy, and eliminate the adverse effects of physical restraint. This goal would be achieved by ensuring the informed consent, providing humane care, and regulating the implementation of physical restraints.

An automated management system for the community health service in China

Objective To explore a useful tool for health administrative departments to manage the community health service (CHS). Methods On the basis of existing health laws and regulations in China, we describe the design of an automated management system for the CHS with a supervision system and an evaluation system using computer technology and corresponding design software. Results Four changes to the management of the CHS were made: repetitive work became automated, complicated work became simplified, nonregular services decreased, and obscure instructions became clear and specific. Conclusion The automated management system will promote the development of CHS management.

Commonweal of the medical and health services in China: a multi-perspective review

Through analyzing documents of healthcare departments, this paper explored the public benefit nature of the medical and health sector from such aspects as culture, philosophy, management, ethics, economy, politics and society. Furthermore, it analyzed the commonweal in the healthcare reform documents, including the commonweal in public health and medical services, basic medical care and health services, public hospitals and medical and health services. Public hospitals were cited as examples for an in-depth review of the profound connotation of commonweal in the medical and healthcare sector. Key words: Medical and health service; Commonweal; Multi-perspective; Connotation; Review

Integrated mental health services in China: challenges and planning for the future.

Eager to build an integrated community-based mental health system, in 2004 China started the '686 Programme', whose purpose was to integrate hospital and community services for patients with serious mental illness. In 2015, the National Mental Health Working Plan (2015-2020) proposed an ambitious strategy for implementing this project. The goal of this review is to assess potential opportunities for and barriers to successful implementation of a community-based mental health system that integrates hospital and community mental health services into the general healthcare system. We examine 7066 sources in both English and Chinese: the academic peer-reviewed literature, the grey literature on mental health policies, and documents from government and policymaking agencies. Although China has proposed a number of innovative programmes to address its mental health burden, several of these proposals have yet to be fully activated, particularly those that focus on integrated care. Integrating mental health services into China's general healthcare system holds great promise for increased access to and quality improvement in mental health services, as well as decreased stigma and more effective management of physical and mental health comorbidities. This article examines the challenges to integrating mental health services into China's general healthcare system, especially in the primary care sphere, including: accurately estimating mental health needs, integrating mental and physical healthcare, increasing workforce development and training, resolving interprofessional issues, financing and funding, developing an affordable and sustainable mental health system, and delivering care to specific subpopulations to meet the needs of China's diverse populace. As China's political commitment to expanding its mental health system is rapidly evolving, we offer suggestions for future directions in addressing China's mental health needs.

Depression as seen through the eyes of rural Chinese women: Implications for help-seeking and the future of mental health care in China

BackgroundAs part of a larger epidemiological study of depression among rural Chinese women, we sought to understand their explanatory models of depression. We explored how participants describe depression, to what cause they attribute depression, and what sources of treatment they would recommend. MethodsParticipants first were assessed with the Center for Epidemiological-Depression scale (CES-D), with a cut-point of 16 or greater indicative of depression. The Short Explanatory Model Interview (SEMI), a semi-structured questionnaire, was our primary tool for exploring participants’ explanatory models relating to a vignette describing a rural Chinese woman with depression. ResultsAmong the 416 women who consented and completed the SEMI, 277(66.6%) reported that the woman in the vignette had something wrong with her health. Among these, only 8(2.9%) women provided a specific psychiatric name for the condition, while 150(54.2%) provided non-specific psychiatric disease names or affective symptoms, and 78(28.2%)of the sample provided physical disease names. Participants attributed causes largely to internal factors (41.5%) or external factors (36.8%). In terms of help-seeking, 101(36.4%) said the woman in the vignette should see a doctor, 70(25.3%) indicated that she should solve the problem herself, and 42(15.2%) recommended seeking support from family members and friends. We did not find any differences in recognition, causal attribution, and help-seeking suggestions between women with a CES-D ≥ 16 and those with CES-D < 16. LimitationsThe use of a vignette to prompt discussion was not the same as talking about real-life personal situations. ConclusionOur results point to potential challenges and opportunities that lay ahead as China develops mental health services in its vast rural areas among women who may be at risk for developing depression. We found that our participants often attributed their symptoms to internal or external social causes, and preferred not speaking with family members and friends. Our findings suggest that rural Chinese women may be reticent to recognize or describe categorical concepts such as “depression” as a health problem, and they invite further consideration about how best to develop new health services in China's rural regions.

A study on satisfaction with publicly financed health services in China

BackgroundWith implementation of Chinese universal healthcare, the performance of urban and rural residents’ healthcare and the degree of satisfaction with publicly financed health services have become a hot issue in assessing health reforms in China. An evaluation model of health services in community and evaluation indexes of health-system performance have been put forward in related researches. This study examines variation in satisfaction with publicly financed health services among urban and rural residents in five Chinese cities and assesses their determinants.MethodsThe data are derived from a survey of 1198 urban and rural residents from five nationally representative regions concerning their perceptions of satisfaction with China’s publicly financed health services. The respondents assessed their degree of satisfaction with publicly financed health services on a 5-point Likert scale. It is a kind of questionaire scale that features the answers for 1–5 points labeled very unsatisfied, unsatisfied, neither unsatisfied nor satisfied, satisfied and very satisfied linking to each factor or variable, where a score of 1 reflects the lowest degree of satisfaction and a score of 5 represents the highest degree. The logistic regression methods are used to identify the variables into its determining components.ResultsThe overall satisfaction degree representing satisfaction of all factors (variables) is 3.02, which is at the middle level of a 1–5 Likert scale, inferring respondents’ neutral attitude to publicly financed health services. According to the correlation test, the factors with characteristic root greater than 0.5 are chosen to take the factor analysis and 12 extracted factors can explain 77.97% of original 18 variables’ total variance. Regression analysis based on the survey data finds that health records, vaccinations, pediatric care, elder care, and mental health management are the main factors accounting for degree of satisfaction with publicly financed health services for both urban and rural residents.ConclusionsWhat can be done to increase the degree of satisfaction with health services needs to be considered based on our findings. Regression analysis based on the survey data finds that health records, vaccinations, pediatric care, elder care, and mental health management are the main factors accounting for degree of satisfaction with publicly financed health services for both urban and rural residents. Therefore, with improvements in health records, timely vaccination, elder care for women or elder, pediatric care and major psychosis management, degree of satisfaction with publicly financed health services are likely to grow.

Predicting trend of early childhood caries in mainland China: a combined meta-analytic and mathematical modelling approach based on epidemiological surveys

Early childhood caries (ECC) is the most common chronic disease in young children. A reliable predictive model for ECC prevalence is needed in China as a decision supportive tool for planning health resources. In this study, we first established the autoregressive integrated moving average (ARIMA) model and grey predictive model (GM) based on the estimated national prevalence of ECC with meta-analysis from the published articles. The pooled data from 1988 to 2010 were used to establish the model, while the data from 2011 to 2013 were used to validate the models. The fitting and prediction accuracy of the two models were evaluated by mean absolute error (MAE) and mean absolute percentage error (MAPE). Then, we forecasted the annual prevalence from 2014 to 2018, which was 55.8%, 53.5%, 54.0%, 52.9%, 51.2% by ARIMA model and 52.8%, 52.0%, 51.2%, 50.4%, 49.6% by GM. The declining trend in ECC prevalence may be attributed to the socioeconomic developments and improved public health service in China. In conclusion, both ARIMA and GM models can be well applied to forecast and analyze the trend of ECC; the fitting and testing errors generated by the ARIMA model were lower than those obtained from GM.

Perspectives of Individuals With Mental Illness on Community Mental Health Services in China: A Qualitative Exploration.

Little is known about the perspectives of individuals with mental illness on community mental health services (CMHS) in China. The current study aimed to explore these perspectives. Semi-structured interviews were completed with a purposive sample of 25 individuals with mental illness recruited from three communities in Guangzhou City, China. The Colaizzi method was used for data analysis. Three main themes were identified: (a) patients' perceptions of CMHS, (b) patients' barriers to accessing CMHS, and (c) patients' expectations of CMHS. The identified issues should be taken into consideration in improving CMHS. CMHS staff, including nurses, should make patients more aware of CMHS. To increase CMHS use and make it more responsive to patients' expectations, staff should try to resolve patients' stigma and desire to return to society. [Journal of Psychosocial Nursing and Mental Health Services, 55(7), 30-37.].

Perceived impacts of the national essential medicines system: a cross-sectional survey of health workers in urban community health services in China

ObjectivesThis study aimed to investigate the perceptions of primary care workers about the impacts of the national essential medicines policy (NEMP).SettingA cross-sectional questionnaire survey was undertaken in 42 urban community...

BEYOND TRADITIONAL VALUES: MENTAL HEALTH IN LATER LIFE IN CHINA AND HONG KONG

According to the World Bank, China has the fastest aging population in human history. Strongly influenced by filial piety, there has been a culture of honoring an older person as a ‘treasure at home’ However due to various factors including rapid urbanization and associated policies, empty nest households are becoming more prevalent in Mainland China. In Hong Kong, traditional values are eroding, reinforced by a decline in the social status of older adults as a result of relatively low levels of education and lack of gainful employment. Moreover, social stigma and ‘face saving’ are prevalent in Chinese cultures. Mental illness is considered shameful. Negative stereotypes affect intervention models. This presentation examines the development of mental health services in China as well as the unique challenges faced by the different regions, including the paucity of community services in the Mainland and the sustainability of health/ community care in Hong Kong.