New Rural Cooperative Medical System Research Articles

To investigate the individual and household-level factors influencing the willingness to pay for cataract surgery among patients aged 50 years and older in rural China: a cross-sectional study

ObjectivesTo investigate the factors influencing the willingness to pay (WTP) for cataract surgery among patients aged 50 years and older in rural China at both individual and household levels.DesignA cross-sectional...

Clinical analysis of secondary glaucoma in Central China

To describe the epidemiology, clinical and social characteristics, management, and outcomes of patients with secondary glaucoma in Central China, a total of 1,129 cases (1,158 eyes) among 710 males (62.89%) and 419 females (37.11%) were analyzed. The mean age was 53.75 ± 17.11 years. The New Rural Cooperative Medical System (NCMS) played the most important role in reimbursement (60.32%) for secondary glaucoma-related medical expenses. The predominant occupation was “farmer” (53.41%). Neovascularization and trauma were the leading causes of secondary glaucoma. Cases of trauma-induced glaucoma decreased substantially during the coronavirus disease 2019 (COVID-19) pandemic. An education level of senior high school or above was uncommon. Ahmed glaucoma valve implantation was the most commonly performed surgery. At the final follow-up, the overall intraocular pressure (IOP) in patients with vascular disease- and trauma-related secondary glaucoma was 19.53 ± 10.20 mmHg, 20.26 ± 11.75 mmHg, and 16.90 ± 6.72 mmHg, while the mean visual acuity (VA) was 0.33 ± 0.32, 0.34 ± 0.36, and 0.43 ± 0.36. In 814 (70.29%) eyes, the VA was < 0.01. Effective preventive measures for at-risk populations, increased NCMS coverage and the promotion of higher education are necessary. These findings will help ophthalmologists detect secondary glaucoma early and manage it in a timely manner.

Developing a Rural Healthcare System

Background: Healthcare related welfare is a matter of resource allocation. In modern market economies, redistribution in Western societies is accomplished through state welfare systems to balance the inequality of market resource allocation. However, resource allocation in socialist countries has its own peculiarities. And the relationship between market transformation (social transformation) and resource allocation methods in post-socialist countries is an important academic topic. This paper examines the changes in the rural cooperative medical system（RCMS）in China in order to explore the changes in rural cooperative healthcare governance mechanisms during recent social transformation. Objectives: The main purpose of this paper is to place the rural cooperative health care system（RCMS）in a macroeconomic-political context and to compare the changes in cooperative health care resource allocation mechanisms across time. Methods: The article undertakes a narrative literature review approach and method. The review used the following sources: Web of Science and PubMed. The search used the keywords" rural cooperative medical care system", "community benefits", " public service-based welfare" and "governance",and limited to articles published between January 2019 and June 2022. The selection of articles was based on the inclusion/exclusion criteria (keywords defined and time span of publication). Results: From collectivized cooperative medical care System（RCMS） to today's New Rural Cooperative Medical System（NRCMS), its governance mechanism has changed and the nature of welfare has changed with it. It has also changed from community welfare, where organized grassroots communities supply medical services, to government-led public service-based welfare. Main Contribution to Evidence-Based Practice: The paper shows the process of change in China's rural cooperative healthcarel system（RCMS), mainly analyzing the change of healthcare welfare governance mechanism. Thus ,it provides a reference for governmental health policies development and for international researchers.

The impact of medical service on the return behavior: A city-level study in China.

Due to the constraints of the rural-urban household registration systems, the migrants of China currently receive varying degrees of medical services. The fact that many migrants choose to return to their hometowns due to the inequality in medical care has been a social phenomenon. Using data from the 2017 China Migrant Dynamic Survey (CMDS), this paper explores the effect of medical services on population migration. Probit regression analysis method was utilized to examine the relationship between medical service level (MSL) and medical service improvement (MSI) and return behavior (RB), as well as the interaction effect between MSL and MSI, and the moderating effect of health status (HS) and health education (HE). Multiple heterogeneity tests were performed. Grouping regressions were conducted using rural household registration (RHR), grouping regressions were conducted using new rural cooperative medical system (NRCMS), and multinomial Probit regressions were conducted using migration distance and age factors. The following findings were obtained. First, when MSL is low but MSI is high in the locality of household registration, the return probability of migrants will increase. MSL also has a positive interaction effect with MSI, and they jointly increase the return probability of migrants; Second, HS and HE have a positive moderating effect on the relationships between MSL and RB and between MSI and RB; Third, heterogeneity analysis indicates that the migrants with RHR or the migrants not covered by the NRCMS are more prone to return due to the reason of medical service. In addition, the analysis also shows that middle-aged and older people who return across provinces have the highest tendency to return due to medical services and young people have the lowest propensity to return across and within provinces. The study could help local governments change their public medical care policies and close the gap between medical services in different areas. As a result, it is necessary to understand population migration trends and promote New Urbanization Strategies.

Can China's New Rural Cooperative Medical System Improve Farmers' Subjective Well-Being?

The New Rural Cooperative Medical System (NRCMS) is one of the essential systems for ensuring public health in rural China. This paper investigates the effect of farmers' participation in the NRCMS on their subjective well-being and its mechanisms using data from the Chinese General Social Survey 2017. The results show that farmers' participation in the NRCMS significantly enhances their subjective well-being, and these results remain robust after regression with the instrumental variables method and propensity score matching method. Further analysis of the mechanisms suggests that participation in the NRCMS can enhance farmers' subjective well-being by increasing their consumption levels other than medical consumption. Moreover, medical consumption levels play a negative role in participating in the NRCMS on farmers' subjective well-being, which can be explained as the “masking effect.” The regression results of the subsamples show that the higher a farmer's income is, the less his or her participation in the NRCMS enhances subjective well-being. And the effect of participation in the NRCMS on farmers' subjective well-being is not significant if their health status is too high or too low.

A comparison of the effect of diurnal temperature range and apparent temperature on cardiovascular disease among farmers in Qingyang, Northwest China.

Climate change is increasing the incidence of extreme weather events which have a significant impact on public health. Cardiovascular diseases (CVDs) are the number one cause of death globally (40%). Apparent temperature (AT) and diurnal temperature range (DTR) have been extensively used to evaluate the effects of temperature on cardiovascular disease (CVD). However, the relevant information is quite limited from analysis and comparison of effects and differing pathogenesis of DTR and AT on CVD especially in less-developed, rural areas of China. This is the first attempt to analyze different effects between AT and DTR on CVD using distributed lag nonlinear modeling (DLNM) in rural area. Data on CVD hospital admission in Qingyang (Northwest China) in 2014-2017 originated from the New Rural Cooperative Medical System (NRCMS) of Gansu Province, and meteorological variables were provided by the Meteorological Science Data Sharing Service. Both AT and DTR had significant nonlinear and delayed impacts on hospital admissions for CVD. DTR had a stronger and more persistent effect on CVD incidence than AT. Females were more affected by high AT and low DTR than were males, while males were more vulnerable to low AT and high DTR. Temperature effects were not significantly different between people above and below 65years of age. These findings provide local public health authorities with reference concerning sensitive temperature indices for susceptible populations with a view to improve CVD preventive strategies in rural areas.

Efficiency Analysis of New Rural Cooperative Medical System in China: Implications for the COVID-19 Era.

The sudden outbreak of coronavirus disease 2019 (COVID-19) has caused a huge impact on the Chinese residents' health and economic level. In the pandemic background, the country and its institutions have introduced pandemic-related insurance to stabilize the national situation. At this stage, insurance has played an increasingly important role in social life. With the popularization of insurance, the idea of buying insurance to avoid risk has gradually become popular among people. Among them, the New Rural Cooperative Medical System (NRCMS) has been farmers' common choice. The NRCMS, a mutual aid system created by farmers spontaneously in the country, plays a great role in guaranteeing farmers access to basic health services, alleviating poverty caused by disease and returning to poverty due to disease, and promoting poverty alleviation and rural revitalization. Given this backdrop, we study the efficiency of the NRCMS that can effectively promote poverty alleviation and rural revitalization and ensure the people's happy life. Implementing the Data Envelopment Analysis (DEA), we find that technological progress is one of the main factors influencing the efficiency of the NRCMS. Therefore, it is important to improve the technology for providing the efficiency of the NRCMS and promoting the happiness of the society.

Does the medical insurance system play a real role in reducing catastrophic economic burden in elderly patients with cardiovascular disease in China? Implication for accurately targeting vulnerable characteristics

BackgroundThe vulnerability of cardiovascular disease (CVD) patients’ health abilities, combined with the severity of the disease and the overlapping risk factors, leads such people to bear the economic burden of the disease due to the medical services. We estimated the economic burden of CVD and identified the weak link in the design of the medical insurance.MethodsData from 5610 middle-aged and elderly with CVD were drawn from the 2015 wave of “China Health and Retirement Longitudinal Study” (CHARLS). The recommended method of the “World Health Organization” (WHO) was adopted to calculate “catastrophic health expenditure” (CHE), “impoverishment by medical expenses” (IME), and applied the treatment-effect model to analyze the determinants of CHE.ResultsThe incidence of CHE was 19.9% for the elderly families with CVD members, which was 3.6% higher than for uninsured families (16.3%). Families with CVD combined with > 3 other chronic diseases (38.88%) were the riskiest factor for the high CHE in the new rural cooperative medical system (NCMS). Moreover, families with members > 75 years old (33.33%), having two chronic disease (30.74%), and families having disabled members (33.33%), hospitalization members (32.41%) were identified as the high risky determinants for the high CHE in NCMS.ConclusionsElderly with physical vulnerabilities were more prone to CHE. The medical insurance only reduced barriers to accessing health resources for elderly with CVD; however it lacked the policy inclination for high-utilization populations, and had poorly accurate identification of the vulnerable characteristics of CVD, which in turn affects the economic protection ability of the medical insurance. The dispersion between the multiple medical security schemes leads to the existence of blind spots in the economic risk protection of individuals and families.

Characteristics and implications of insurance-reimbursed inpatient care for gastric and oesophageal cancers in Anhui, China.

BackgroundThis study aimed to identify characteristics and trends in insurance-reimbursed inpatient care (NRIC) for gastric and oesophageal cancers and inform evaluation of medical systems reform.MethodsThe study extracted routinely collected records of claims for reimbursement from the New Rural Cooperative Medical System (NRCMS) in Anhui Province, China and performed descriptive and regression discontinuity analysis.ResultsFrom 2013 to 2017, NRIC in terms of person-time per million people (pmp) increased 5.60 and 20.62 times for gastric and oesophageal cancers, respectively. Total expense per episode for gastric and oesophageal cancers increased from 1130.25 and 22 697.99 yuan to 12 514.98 and 24 639.37 yuan, respectively. The ratio of out-of-pocket expenses per inpatient care episode to annual disposable income per capita was 0.43 for gastric cancer and 0.91 for oesophageal cancer and decreased by 0.17 and 0.47, respectively. Regression discontinuity modelling revealed that, when controlled for disposable income, illiteracy rate and months from start time, the treatment variable was significantly associated with person-times of NRIC pmp (β=0.613, p=0.000), length of stay per 105 people (β=−52.990, p=0.000) and total expenses per NRIC episode (β=2.431, p=0.000).ConclusionsThe study period witnessed substantial achievements in benefits to patients, inpatient care efficiency and equity. These achievements may be attributed mainly to the recent reforms launched in Anhui province, China.

Public Medical Insurance and Healthcare Utilization and Expenditures of Older with Chronic Diseases in Rural China: Evidence from NRCMS.

China’s rural older are the threat from chronic diseases, making it important to evaluate the effect of public health insurance on the health care utilization and expenditures with chronic diseases. In 2003, China initiated a public health insurance, which was called the New Rural Cooperative Medical System (NRCMS). NRCMS is a voluntary program, targeting rural residents with government subsidies and individual contribution. Using the two-stage residual inclusion approach (2SRI), we analyzed the impact of NRCMS on health-care service utilization and expenditure of rural older with chronic diseases by using the 2011 and 2013 China Health and Retirement Survey (CHARLS) data. The results showed NRCMS did not play an effective role on improving the medical services utilization of rural older with chronic diseases. Although NRCMS immediate reimbursement significantly reduced the outpatient service fee, the actual outpatient reimbursement is the opposite. In addition, NRCMS did not significantly decrease their hospitalization expense. Policy makers should pay attention to health management about chronic diseases in rural China, and some measures should be taken to deepen the medical security system reform and improve the public health service system.

Targeting vulnerable groups of health poverty alleviation in rural China\u2014 what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population?

BackgroundIn light of the health poverty alleviation policy, we explore whether the New Rural Cooperative Medical System (NRCMS) has effectively reduced the economic burden of medical expenses on rural middle-aged and elderly people and other impoverished vulnerable groups. The study aims to provide evidence that can be used to improve the medical insurance system.MethodsData were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The method of calculating the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME) was adopted from the World Health Organization (WHO). The treatment effect model was used to identify the determinants of CHE for rural middle-aged and elderly people.ResultsThe incidence of CHE in rural China for middle-aged and elderly people is 21.8%, and the IME is 8.0%. The households that had enrolled in the NRCMS suffered higher CHE (21.9%) and IME (8.0%), than those that had not enrolled (CHE: 20.6% and IME: 7.7%). The NRCMS did not provide sufficient economic protection from CHE for households with three or more chronic diseases, inpatients, or households with members aged over 65 years. Key risk factors for the CHE included education levels, households with inpatients, households with members aged over 65 years, and households with disabilities.ConclusionsAlthough the NRCMS has reduced barriers to the usage of household health services by reducing people’s out-of-pocket payments, it has not effectively reduced the risk of these households falling into poverty. Our research identifies the characteristics of vulnerable groups that the NRCMS does not provide enough support for, and which puts them at a greater risk of falling into poverty due to health impoverishment.

Analysis of the effect of serious illness medical insurance on relieving the economic burden of rural residents in China: a case study in Jinzhai County

BackgroundIn 2003, China established a New Rural Cooperative Medical System (NRCMS) for rural residents to alleviate the burden of medical expenses among rural residents. However, its reimbursement for high medical costs was insufficient. Therefore, China gradually established the Serious Illness Insurance System (SIMIS) based on NRCMS. After receiving payment through NRCMS, patients in rural areas who met the requirements of SIMIS policy would receive a second payment for their high medical expenses. This study aimed to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County.MethodsThe study used the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province, from 2013 to 2016. We adopted descriptive and regression discontinuity (RD) methods to analyze the payment effect of SIMIS. The RD analysis targeted patients (n = 7353) whose annual serious illness expenses were between CNY 10,000 (1414 USD) and CNY 30,000 (4242 USD), whereas the descriptive analysis was used for data of the patients compensated by SIMIS (n = 2720).ResultsThe results of RD showed that the actual medical insurance payment proportion increased by about 2.5% (lwald = 0.025, P < 0.01), inside medical insurance self-payment proportion increased by about 2% (lwald = 0.020, P < 0.10), and outside medical insurance self-payment proportion decreased by about 1.6% (lwald = − 0.016, P < 0.05). The descriptive results showed that patients with serious illnesses mostly chose to go to a hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out-of-pocket medical expenses were still high.ConclusionThe medical technology level of Jinzhai County could not meet the needs of patients with seriously illnesses, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of the rural residents was insufficient. The high out-of-pocket expenses increased the possibility that only people with good economic conditions could benefit from the reimbursement of SIMIS, resulting in inequity.

Does New Rural Cooperative Medical Insurance Improve the Health of Rural Residents

Since 2012, China’s provinces have gradually introduced a serious illness insurance（SII）in the new rural cooperative medical system（NCMS）. Based on the micro-household survey data and the multiple difference method, this paper empirically studies the impact of major illness insurance on the health and medical expenditure of rural residents on the basis of correcting the heterogeneity of self-assessed health reports. The results confirm that more generous medical insurance has increased the improvement of rural residents’ health by 10%-20%, and this effect is still significant in the third year after the implementation of the policy. SII has also stimulated a substantial increase in the medical expenditure of rural residents, resulting in a 5% increase in per capita household medical expenditure and 29% increase in individual hospitalization expenditure, respectively. But these effects differ among different populations. From the perspective of the health improvement effect, rural middle and upper income families are the biggest beneficiaries. From the perspective of the incentive effect of medical expenditure, the incentive effect of SII increases with the increase of family incomes. The results of the conditional quantile DID model show that SII has significantly stimulated the expense of the group with higher medical expenses, and the group with less medical expenditure has not been influenced by SII. A series of robustness tests prove the robustness of our results. The conclusions of this study provide an empirical basis for further improving the basic medical insurance system in China.

The Effect of the Full Coverage of Essential Medicines Policy on Utilization and Accessibility of Primary Healthcare Service for Rural Seniors: A Time Series Study in Qidong, China.

Background: Since 2015, in order to handle the increasing prevalence of age-related diseases and escalating health expenditures arising from the aging population, the full coverage of essential medicines (FCEMs) policy for rural seniors has been implemented in primary healthcare institutions of Qidong County of Jiangsu, China. The purpose of this study is to examine the long-term effects of the introduction of FCEMs’ policy on the utilization and accessibility of primary healthcare service for elderly beneficiaries. Methods: The retrospective study was conducted in Qidong County in the Jiangsu province, China. A 47-month longitudinal dataset involving 91,444 health insurance claims records of inpatients aged 70 and older in primary healthcare institutions was analyzed. Changes in health service utilization (average length of stay), patient copayments (out-of-pocket expenses), New Rural Cooperative Medical System (NRCMS) reimbursement rate and daily hospitalization costs per patient were analyzed using interrupted time series analysis. Augment Dicky-Fuller unit root method was used to test the stationarity of the series alongside the Durbin Watson method to test autocorrelation. Results: Average length of stay increased at 0.372 bed-days per month before the implementation of FCEMs policy, whereas the increasing trend was slowed down at 0.003 bed-days per month after the implementation of FCEMs policy (p < 0.001). The average out-of-pocket expenses increased by 38.035 RMB monthly in pre-implementation of the policy period, but it decreased at the rate of 5.180 RMB per month after the implementation of the FCEMs policy (p = 0.006). The NRCMS reimbursement rate increased at 0.066% per month in pre-implementation of policy and the increasing trend was sharper at 0.349% in post-implementation of policy (p = 0.135). The daily hospitalization costs per patient decreased by 6.263 RMB (p = 0.030) per month, whereas it increased at the rate of 3.119 RMB (p = 0.002) per month afterwards. Conclusions: Based on interrupted time series analyses, we concluded that FCEMs policy was associated with positive changes of average LOS and average OOP expenses. The FCEMs policy has alleviated the financial burden of the rural seniors and slightly improved the efficiency of primary health service utilization. However, it had no positive effect on daily hospitalization costs. Therefore, in the general framework of FCEMs policy, the Chinese health policy-maker should take necessary supporting measures to curb climbing hospitalization expenditures and promote the rational drug use in primary healthcare institutions.

Medical system and nutrition improvement for the rural elderly

BackgroundInsufficient nutrition intake has negatively influenced the health of the elderly in rural China where the problem of population aging is serious. The present study aims to explore whether the medical system, called the New Rural Cooperative Medical System (NRCMS), can improve the rural elderly’s nutrition intake and the mechanism behind it.MethodsThe difference in differences (DID) model and the propensity score matching-difference in differences (PSM-DID) model are both performed to investigate the impact of the medical system on nutrition improvement for the rural elderly. Two thousand seven hundred eighty rural elderly samples tracked in 2000 and 2006 from the China Health and Nutrition Survey are analyzed. Indices for the elderly’s nutrition intake includes daily average intake of energy, fat, protein, and carbohydrate.ResultsThe results show that participation in the NRCMS can significantly increase the rural elderly’s total energy intake, carbohydrate intake, and protein intake by 206.688 kcal, 36.379 g, and 6.979 g, respectively. A more significant impact of the NRCMS on nutrition intake is observed in the central and near-western where economic development is lagging behind. Also, compared to people of 18–60 age group, such impact is statistically more significant in the elderly for the carbohydrate intake.ConclusionsThe NRCMS can improve the rural elderly’s nutrition intake in China. As the population ages rapidly in rural China, the present study provides recommendations on how to improve nutrition and health status of the elderly from the aspect of the medical system.

Effect of insurance-reimbursed inpatient cancer care in Anhui Province: a retrospective study

BackgroundChina's Anhui Province has made great efforts reforming its health systems (eg, reimbursement for medical care for major diseases, clinical path management, and dual referrals), but little is known about the effect of these reforms. This study reveals important evidence in this regard using inpatient cancer care as an indicator of the effect of these reforms on health. MethodsThe study used descriptive analysis of reimbursement records for inpatient cancer care in Anhui Province from 2013 to 2017, extracted from the New Rural Cooperative Medical System (NRCMS) database, a medical insurance scheme that covers more than 98% of rural residents. FindingsThe study extracted 329 901 inpatient cancer care reimbursement records. From 2013 to 2017, overall coverage of NRCMS-reimbursed inpatient cancer care increased by 14·20 times; per 100 000 people, these increases were 2·22 to 78·42 for lung cancer, 9·09 to 55·74 for stomach cancer, 1·33 to 26·74 for oesophageal cancer, and 0·69 to 45·62 for colorectal cancer. The ratio of per case out-of-pocket expense to annual per capita dispensable income was reduced from 0·51 to 0·32 on average, and from 0·49 to 0·36 for lung cancer, 0·53 to 0·31 for stomach cancer, 0·52 to 0·32 for oesophageal cancer, and 1·02 to 0·55 for colorectal cancer. Both overall and cancer-specific inpatient cancer care expenditure increased at first, which was then followed by a decease. The proportion of cost on operation, nursing, and consultation increased from 1·61% to 10·74% in total expense for all inpatient cancer care and a similar trend was observable for all specific cancers. Overall length of stay decreased from 13·36 to 9·55 days. The Gini coefficient of expenses increased from 0·49 to 0·39 for all inpatient cancer care, and changed from 0·43 to 0·35 for lung cancer, 0·53 to 0·43 for stomach cancer, 0·47 to 0·38 for oesophageal cancer, and 0·51 to 0·41 for colorectal cancer. InterpretationHealth reformation in Anhui Province has resulted in a substantial improvement in coverage of NRCMS-reimbursed inpatient cancer care, economic burden due to inpatient cancer care, and service quality, efficiency, and equity. FundingNatural Science Foundation of China.

Self-motivated medical care-seeking behaviors and disease progression in a community-based cohort of chronic hepatitis B virus-infected patients in China

BackgroundTo determine the treatment behaviors among a community-based cohort of chronic hepatitis B virus (HBV)-infected persons and to examine the disease progression among non-antiviral-treated HBV-infected cases after 5 years of follow-up.MethodsWe conducted a community-based prospective study on people with chronic HBV infection in mainland China from 2009 to 2014. In 2009, we recruited participants who were identified as HBV infected in 2006 in a national sero-survey. A face-to-face follow-up investigation was completed in 2014, and the personal information, the clinical diagnosis provided at the last hospital visit, the HBV antiviral treatment history, and the insurance type was collected for each patient for analysis. Multivariable logistic regression was used to identify factors that are associated with active medical care- seeking and antiviral treatments.ResultsAmong the 2422 chronic HBV-infected patients recruited in 2009, 1784 (73.7%) were followed-up to 2014, and 638 (35.8%) had sought medical care in hospitals; among them, 140 (21.9%) received antiviral treatments. The lowest medical care-seeking rate (26%) was in participants over 50-year old. We determined that the frequency of medical care-seeking was higher among those participants living in urban areas (aRR = 1.3, 95% CI:1.0–1.6), those in 0–19-year old (aRR = 1.5, 95% CI:1.1–2.1), 20–39-year old (aRR = 2.2, 95% CI:1.7–3.0) and 40–49-year old (aRR = 1.5, 95% CI:1.1–2.0), and persons with insurance of the type Urban residents’ basic medical insurance (URBMI) or Commercial health insurance (CHI) (aRR = 2.5, 95% CI:1.7–3.6) and New Rural Cooperative Medical System (NRCMS) (aRR = 1.9, 95% CI:1.4–2.6). Patients were more likely to receive antiviral treatment if they were 20–39-year old (aRR = 0.4, 95% CI:0.3–0.7), had insurance of the type URBMI or CHI (aRR = 2.6, 95% CI:1.1–6.3) or NRCMS (aRR = 3.0, 95% CI:1.3–6.9) and were treated at prefecture and above-level hospitals (aRR = 2.0, 95% CI:1.4–3.0). Among non-antiviral-treated HBV-infected cases, we found the annual rates for HBsAg sero-clearance, progress to cirrhosis and HCC were 1.0, 0.6 and 0.2%, respectively.ConclusionThe rates of medical care-seeking and antiviral treatment were low among community-based chronic HBV-infected persons, thus we recommend improving the insurance policies for HBV-infected persons to increase the antiviral treatment rate, and conducting extensive education to promote HBV-infected patients actively seeking medical care from hospitals.

Fiscal Decentralization, Local Competitions and Sustainability of Medical Insurance Funds：Evidence from China

Local governments are responsible for the management of social medical insurance for urban and rural residents in China. Under the background of fiscal decentralization between the central government and local governments, the strengthening of supervision on medical insurance funds by local governments leads to a reduction in the expenditure of the medical insurance fund, which contributes to its sustainability. By employing the provincial level panel data during 2004–2014, we used a fixed effect model and a spatial autoregression model to investigate whether fiscal decentralization has had a negative influence on the expenditure of China’s new rural cooperative medical system (NCMS) fund. We found that fiscal decentralization has had a significant influence over its per capita expenditure. Our results also indicate that higher fiscal decentralization leads to higher financial aid in the NCMS provided by local governments. Additionally, the expenditure of the NCMS and the local financial aid are influenced by nearby governments. Our results suggest that appropriate fiscal decentralization, which helps to maintain the sustainability of social medical insurance funds, should be encouraged.

The prevalence and related factors associated with psychosocial distress among 420 hospitalised lung cancer patients in China: A case study.

Previous studies have reported high prevalence of psychosocial distress among lung cancer patients in Western countries, but the prevalence of distress in Chinese patients is not established. The study objectives were to report the prevalence of and factors associated with psychosocial distress in a sample of hospitalised patients in China and to implement distress screening in one thoracic specialty department. In this cross-sectional study, adult patients completed a self-reported demographic and clinical questionnaire and the distress thermometer with the problem list. Distress was dichotomised (high vs. low) and compared. Regression analyses were used to determine which variables were associated with psychosocial distress. One hundred eighty-six of 420 patients (38.6%) reported distress ≥4/10. They were unemployed, had New Rural Cooperative Medical System (NRCMS) insurance and Stage IV cancer. NRCMS insurance contributed to the likelihood of high distress and worry. Patients reported significant psychosocial distress during hospitalisation related to practical, emotional and physical problems. In this case study, staff reported they screened consecutive patients but there were no available referrals after discharge. We concluded it may be premature to screen patients for distress prior to instituting resources to establish services. To do otherwise is premature in ensuring patients' relief.

The short-term effects of air pollutants on hospitalizations for respiratory disease in Hefei, China.

Previous studies have shown that ambient air pollution is associated with respiratory morbidity. However, the effects of air pollutants on health have rarely been studied in China. Our study aimed to estimate the short-term effects of particulate air pollutants on hospitalizations for three types of respiratory disease: pneumonia, chronic obstructive pulmonary disease (COPD), and asthma. We collected data on daily admissions for patients with each disease from the New Rural Cooperative Medical System (NRCMS) in Hefei, China. Daily records of air pollutants and meteorological data from January 2014 to March 2016 were also obtained. Distributed lag nonlinear models were employed in the analysis to evaluate the association between daily air pollutants and admissions. The highest effect of each pollutant on COPD hospital admission was observed with PM2.5 at lag 12 (RR = 1.068, 95% CI 1.017 to 1.121) and PM10 at lag 10 (RR = 1.031, 95% CI 1.002 to 1.060), for an increase of 10μg/m3 in concentrations of the pollutants. The short-term effects of PM10 on asthma hospital admissions peaked at lag 12 (RR = 1.057, 95% CI 1.010 to 1.107). According to our stratified analysis, we found that the effects on COPD admission were more pronounced in the warm season than in the cold season, and the elderly (≥ 65years) and females were more vulnerable to air pollution.