Rural Central China Research Articles

The Prevalence and Influencing Factors of Child Sexual Abuse among School Students in Rural Central China: A Cross-Sectional Survey

Background: Child sexual abuse (CSA) is a global public health problem, which has a significant impact, and the situation is not optimistic. Objectives: The aim was to investigate the prevalence rate and influencing factors of CSA among school-aged children in rural central China. Participants and Setting: Participants were recruited from rural schools to reflect the prevalence rate of CSA in Hubei Province in China. A total of 3,940 (2,085 boys and 1,855 girls) school-aged rural children in central China participated in this study. Methods: The prevalence rate and influencing factors of CSA were tested through the utilization of anonymous and self-administered questionnaires, which collected the demographic information of the participants and the contact and non-contact types of CSA incidents. Results: The prevalence rate of CSA in the survey was 15.3%. Findings from multivariate analysis indicated that gender (OR=0.428, 95%CI: 0.355~0.517, reference: boy), study level at school (OR=1.597，95%CI: 1.414~1.805, reference: primary school) and whether the respondent was a left-behind child (OR=1.238，95%CI: 1.014~1.511, reference: non-left-behind child) were significantly associated with CSA. Conclusions: The prevalence rate of CSA among the participants was relatively high. Boys, senior high school students and left-behind children were more likely to be sexually abused. The provision of systematic sexual education to these high-risk groups will help reduce the prevalence of CSA.

Effect of a health management model based on the three-tier prevention and control system for cardiovascular and cerebrovascular diseases: a prospective cohort study in rural Central China (CENTRAL-HMM)

BackgroundCardiovascular and cerebrovascular diseases (CVDs) present a significant challenge in the realm of chronic disease management in China. The objective of this study is to assess the efficacy of a health management model rooted in a three-tier prevention and control system for CVDs.MethodsFrom August 2020 to September 2020, this study enrolled 2033 CVDs patients from 105 villages across three townships in central China. All participants underwent a 12-month health management involving monitoring, risk assessment, health education, and interventions. The primary endpoint focused on recurrence and exacerbation, while secondary outcomes encompassed health economic indicators, awareness of prevention and control knowledge, risk factor, lifestyle behavior. Data analysis was conducted using generalized estimating equation models.ResultsAfter 1 year of follow-up, the odds of recurrence and exacerbation decreased significantly compared to the baseline [odds ratio (OR) 0.30, 95% confidence interval (CI): 0.26, 0.35], accompanied by reduced hospitalization frequency [mean difference (MD) -0.61, 95% CI: -0.66, -0.56] and a monthly average reduction in medication costs (MD, -69.80, 95% CI: -104.55, -35.05). Moreover, patients’ awareness of CVDs prevention and treatment knowledge markedly improved (P < 0.01). Diastolic blood pressure, blood lipid and plasma glucose levels, anxiety and depression, lifestyle behavior all demonstrated significant enhancements from baseline levels (P < 0.01). Crucially, health management did not result in an increased abnormality rate of safety indicators.ConclusionsThe health management model, grounded in a three-level prevention and control system, showed potential applicability in reducing recurrence and exacerbation, easing healthcare economic burden, boosting awareness of prevention and treatment, and positively influencing risk factors. Additional multicenter and long-term studies are necessary to validate these findings and support broader implementation of this model.Trial registrationChinese Clinical Trial Registry (ChiCTR) ChiCTR2000032243 (24/04/2020) (https://www.chictr.org.cn/showproj.html?proj=52395).

Systematic Characterization of the Oligosaccharide Profile of Human Milk in Rural Areas of Central China: Quantitative Tracking of Human Milk Oligosaccharide Composition during 12 Months of Lactation.

This study investigates changes in human milk oligosaccharide (HMO) composition over a 12 month breastfeeding period in rural central China. The HMO profiles of 97 mothers were analyzed by graphitized carbon liquid chromatography-electrospray ionization-mass spectrometry. This method was simple to prepare samples and can simultaneously and absolutely quantify at least 20 neutral and acidic HMOs. All mothers were classified into four milk groups based on the presence or absence of specific α-1,2 and α-1,4-fucosylated HMOs. The main oligosaccharides in milk groups I and II were 2'-FL, LDFT, LNFP-I, and LNDFH-I, while LNT, 3-FL, LNFP-II, LNFP-V, LNDFH-II, and DFLNH-b were predominant in milk groups III and IV. Additionally, the lactation period was the primary factor affecting the concentration of individual HMOs. The concentrations of most HMOs decreased with lactation and stabilized after 180 days. However, the concentrations of 3-FL, LDFT, and LNDFH II increased gradually over the lactation period, and the concentration of 3'-SL decreased during early lactation (5-180 days) but increased during later lactation (180-365 days). Furthermore, Spearman correlation analysis revealed that maternal factors and infant factors may also affect the concentration of various HMOs. These findings provide fundamental insights for the development of a comprehensive human milk database.

Method for identifying rural PLES and its applications

The quantitative identification of rural land functions serves as a basis for rural land planning, coordinated spatial development, and control capacity improvement and is significant for rural transformation and sustainable development. This paper constructs an analysis framework to identify and evaluate “production-living-ecological” space (PLES) in rural areas of central and western China. On the Loess Plateau, which was taken as the study area, a combination of qualitative and quantitative analysis was completed to determine framework indicators and their thresholds. Resource and environmental carrying capacity and land suitability were measured through GIS spatial analysis under different land functional orientations. This sought to recognize production space (PS), living space (LS), and ecological space (ES) in rural areas, reveal their distribution patterns on the Loess Plateau, and determine alternative areas for future land use. The results indicate that the PS and LS of the Loess Plateau rural land show a relatively low resource and environmental carrying capacity but vary significantly in different functional regions. The space distribution of PS and LS with higher carrying capacity shows obvious consistency. Although the Loess Plateau has vast sustainable land for development, the intensity of development should be carefully controlled. Additionally, significant regional differences remain in rural PLES, so reasonable future rural land planning should be formulated according to the PLES pattern. This study provides a scientific basis for promoting coordinated development of Loess Plateau rural areas and implementing a rural revitalization strategy. It is also a reference for identifying PLES and its coordinated spatial development in rural central and western China.

Interaction of Passive Smoking and Diet Habits on Vitamin D Deficiency among Women of Reproductive Age in Rural Central China.

Maternal dietary undernutrition is known to be associated with the risk of vitamin D (VD) deficiency. However, whether the risk of VD deficiency in women of reproductive age is influenced by the interaction between passive smoking and inadequate nutrition remains unknown. The aim of this study is to explore the interaction between passive smoking and dietary undernutrition on the risk of VD deficiency. A population-based case-control study including 1151 non-pregnant women of reproductive age between 18 and 40 years old was conducted in Henan Province, China from 2009 to 2010. Blood samples and information on exposure factors were collected. The prevalence of VD deficiency was estimated based on a result of serum 25-hydroxyvitamin D [25(OH)D] &lt; 26.0 ng/mL. A multivariate logistic regression analysis was performed to explore the risk of VD deficiency. The prevalence of VD deficiency was 61.5%. After adjusting for potential confounding factors, the interactions between passive smoking and no nutritional supplementation, passive smoking and insufficient egg intake, and passive smoking and insufficient milk dairy products intake were associated with the risk of VD deficiency, and the adjusted ORs were 3.40 (95% CI 2.26-5.13), 2.87 (95% CI 2.20-4.10), and 2.18 (95% CI 1.33-3.58), respectively. The interaction coefficients were calculated to be 2.35, 2.79, and 1.70, respectively, indicating there were significant interaction effects, as all of the coefficients were higher than 1. Our findings present that the risk of VD deficiency was potentially influenced by interactions between passive smoking and inadequate nutrition. Passive smoking might strengthen the effect of inadequate nutrition on the risk of VD deficiency among rural women of reproductive age. More attention should be paid to the health education and nutritional status improvement of women of reproductive age, especially in rural areas of developing countries.

More use or cleaner use? Income growth and rural household energy-related carbon emissions in central China

Rural household income growth may have two counteracting effects on energy-related carbon emissions, by stimulating total energy consumption and by changing the energy structure towards low-carbon energy sources. This study aims to provide more insight into this relationship for the case of rural central China, a region where coal-fired electricity dominates modern energy consumption. Based on survey data collected in 2019, energy-related carbon emissions (ECE) and energy-related carbon intensity (ECI) per unit of energy are calculated. A mediation effect model is employed to distinguish between energy structure changes and total electricity consumption as mediating factors in the income growth – carbon emission relationship. We argue that whether biomass fuels are treated as either carbon-intensive or as carbon neutral has major consequences for the analysis. When biomass fuel is treated as carbon-intensive, income-related changes in energy structure and electricity consumption have opposite effects on ECE, but both are conducive to the reduction of ECI. When biomass fuel is treated as carbon-neutral, the positive effect of growth in coal-fired electricity consumption on ECE is much larger than the negative effect of the change in energy structure. Based on these findings, we present several recommendations for balancing two main targets of China's rural revitalization vitalization policy, i.e. rural household income growth and the transition towards low-carbon energy sources in China.

Thyroid-disrupting effects caused by exposure to alternative flame retardants from groundwater contamination in rural central China

Accumulating evidence reveals that exposure to alternative flame retardants (AFRs) results in defective thyroid functions. AFRs are detectable in various environmental media in developed cities in China. However, few studies have reported the contamination levels of AFR in groundwater in rural areas, indicating an urgent need to investigate exposure of AFRs and perform health risk assessment for populations that use groundwater as the main source of drinking water. This study investigated the concentrations of AFRs in groundwater in rural areas of central China. Moreover, Nthy-ori-3-1 cells were used to determine the thyroid cytotoxicities and thyroid–interfering effects of a single AFR as well as the mixtures of AFRs based on the AFR contamination levels in real-world. The results revealed that all classes of AFRs were detectable in rural areas in central China. Dechlorane plus, hexabromocyclododecane, bromophenols (BPs), novel brominated flame retardants (NBFRs) and organophosphate flame retardants (OPFRs) exhibited spatial contamination patterns, with an average concentrations (median) of 157.89 ± 88.61 (185.47) pg/L, 0.09 ± 0.29 (not detectable) ng/L, 5.20 ± 5.92 (3.43) ng/L, 3338.11 ± 3758.78 (2836.72) pg/L, and 79.35 ± 97.19 (53.62) ng/L, respectively. The half maximal effective concentrations (EC50) of BPs, OPFRs, and NBFRs ranged 98.4–4012 μM, 42.0–2506 μM, and 10.1–203.7 μM, respectively. Several AFRs exhibited more cytotoxic effects than did traditional brominated flame retardants. It is intriguing that several single AFRs and mixtures at environmentally-relevant exposure levels promoted the viability of Nthy-ori-3-1 cells. Taken together, our study demonstrates that AFRs are present in the groundwater in rural areas in central China and AFRs exhibit thyroid disrupting effects.

Selling under stigma: The relational gender dynamics of becoming biolaborers in China

Existing studies have examined how economic and cultural factors affect individuals selling organs and human tissues. But how social interactions and community relationships shape individuals' decisions and experiences has received much less attention. This research focuses on the intersection between economic disparities and gendered lineage structures to explain why and how people engage in bodily commodification. Drawing on oral history interviews with 32 former plasma sellers in central rural China, I find that villagers entered collection stations in two ways: 1) individual recruitment through which migrant men and married women on the margin of local lineage hierarchies in richer villages sold plasma as individuals and 2) familial recruitment through which multiple men of dominant lineage groups in poorer villages sold plasma in groups. While individual sellers struggled with self-blame and shame, familial sellers were shielded from gendered stigma as their communities adapted lineage rules to align plasma sale with masculinity. The results highlight the utility of a relational framework of gender in highlighting commodification as a dynamic social process shaped by participants’ power locations in relation to not only each other but also the local patriarchal order.

Changes in everyday life of rural China: a perspective of mobilities

This article aims to examine how rural everyday life has changed in the Chinese context in response to the process of urbanisation. Drawing on a mobilities perspective, changes in everyday life are represented by spatial mobilities and the impacts of social mobilities on them are assessed at a household level. Employing rural survey data for 2007 and 2017 conducted in Jianghan Plain, China, results reveal that everyday life in central rural China has undergone an uneven development and is significantly impacted by social mobilities. As one of the main agricultural production regions in China, the livelihood strategies in the study area have been shifting from full-time farming to part-time farming and non-farm. The effects of the process of social mobilities on working, consuming and leisure mobilities are also unevenly distributed. Our findings suggest that the perspective of everyday life deserves further investigation for its important role in exploring the human–land relationship in a rural context. And the mobilities paradigm can provide an alternative insight into rural restructuring and its social effects.

Household Water Access, Dietary Diversity and Nutritional Status among Preschoolers in Poor, Rural Areas of Central and Western China.

Poor child feeding and childhood malnutrition are major public health problems in rural central and western China, with little evidence about their environmental determinants. This study aimed to investigate whether household water access is associated with dietary diversity and nutritional outcomes. We analyzed the cross-sectional data of 3727 children aged 6 to 59 months in rural central and western China, applying multivariate linear and logistic models to estimate the effect of water access on children’s anthropometric indices, hemoglobin, and dietary diversity. We found that unimproved water access was linked to a lower likelihood of achieving dietary diversity (OR = 0.65, 95% CI 0.44 to 0.98, p = 0.039); lower height-for-age z-score (β = −0.34, 95% CI −0.49 to −0.19, p < 0.001) and hemoglobin concentration (β = −2.78, 95% CI −5.16 to −0.41, p = 0.022); higher odds of stunting (OR = 1.50, 95% CI 1.01 to 2.25, p = 0.047) and anemia (OR = 1.34, 95% CI 1.02 to 1.77, p = 0.037). The associations between water access and nutritional outcomes were not explained by dietary diversity and were stronger in children who did not receive iron supplementation. These findings provide evidence for designing water-based nutritional interventions in China.

Reperfusion strategy and in-hospital outcomes for ST elevation myocardial infarction in secondary and tertiary hospitals in predominantly rural central China: a multicentre, prospective and observational study

ObjectivesTo assess differences in reperfusion treatment and outcomes between secondary and tertiary hospitals in predominantly rural central China.DesignMulticentre, prospective and observational study.SettingSixty-six (50 secondary and 16 tertiary) hospitals in Henan...

Prevalence of Malnutrition and Associated Factors of Stunting among 6-23-Month-Old Infants in Central Rural China in 2019.

This study aimed to evaluate the prevalence of malnutrition and to investigate the associated factors of stunting among 6–23-month-old infants in poor rural areas of central China. The China Nutrition Improvement Project on Children in Poor Areas was conducted in 56 national-level poor counties of seven provinces in 2019. We performed a multivariate binary logistic regression analysis to determine the associated factors of stunting. This cross-sectional study included 17,193 infants. The overall prevalence of stunting was the highest (3.9%), followed by overweight (3.0%), underweight (2.1%), wasting (2.0%), and obesity (0.5%). Girls [OR = 0.55, 95% CI (0.46, 0.65)], infants meeting requirements of minimum diversity diet [OR = 0.81, 95% CI (0.67, 0.98)], and mothers with middle-school or high-school education and above decreased the prevalence of stunting. Infants with diarrhea in two weeks [OR = 1.26,95% CI (0.98, 1.62)] were at higher odds of stunting. The malnutrition status in the study areas was improved, and vulnerable infants were found to need additional and earlier monitoring to detect and fundamentally prevent undernutrition.

Health service underutilization and its associated factors for chronic diseases patients in poverty-stricken areas in China: a multilevel analysis

BackgroundUnderutilization of health services among chronic non-communicable disease sufferers, especially for hypertension (HBP) and diabetes mellitus (DM), was considered as a significant contributing factor to substantial cases in terms of both avoidable morbidity and mortality. However, evidence on health services underutilization and its associated factors in poverty-stricken areas remain scarce based on previous literature. This study aims to describe health services underutilization for people diagnosed with chronic diseases in impoverished regions and to identify its associated factors, which are expected to provide practical implications for the implementations of interventions tailored to the specific needs of disadvantaged residents in rural China to achieve effective utilization of health services in a timely manner.MethodsData were collected from a cross-sectional survey conducted through face-to-face interviews among 2413 patients from six counties in rural central China in 2019. The Anderson behavioral model was adopted to explore the associated factors. A two-level logistic model was employed to investigate the association strengths reflected by adjusted odds ratios (AOR) and 95% confidence intervals in forest plots.ResultsOn average, 17.58% of the respondents with HBP and 14.87% with DM had experienced health services underutilization during 1 month before the survey. Multilevel logistic regression indicated that predisposing factors (age), enabling factors (income and a regular source of care), and need factors (self-reported health score) were the common predictors of health service underutilization both for hypertensive and diabetic patients in impoverished areas, among which obtaining a regular source of care was found to be relatively determinant as a protective factor for health services underutilization after controlling for other covariates.ConclusionsOur results suggested that the implementation of a series of comprehensive strategies should be addressed throughout policy-making procedures to improve the provision of regular source of care as a significant determinant for reducing health services underutilization, thus ultimately achieving equal utilization of health services in impoverished regions, especially among chronic disease patients. Our findings are expected to provide practical implications for other developing countries confronted with similar challenges resulting from underdeveloped healthcare systems and aging population structures.

Public Participation and Governance Performance in Gender-Imbalanced Central Rural China: The Roles of Trust and Risk Perception

The study investigates the impact of public participation on governance performance in a risk society. A trust-based participatory paradigm is proposed as a viable framework. Using data from a 2018 survey of family planning services in Hubei, China, this study develops hypotheses drawn from causal mechanisms of participatory governance. A structural equation modeling (SEM) approach is employed to disentangle the direct effect of public participation on governance performance from its indirect effect through trust. Moderated multiple regressions (MMR) are conducted to identify the moderating effect of risk perception. The results indicate that public participation is associated with higher perceived quality of family planning services and decreases son preference through the serial mediation effects of trust and perceived quality. Risk perception of gender imbalance magnifies the positive effect of civic autonomy on perceived quality. This paper extends previous research on the governance of gender imbalance and contributes to the literature on the relationship between public participation, trust, risk perception, and governance performance in authoritarian countries.

A Qualitative Study of HIV/AIDS Social Policy Implementation in Rural Central China: Recipient Perspectives

Social assistance policy initiatives are crucial to improve the socio-economic conditions of people living with HIV/AIDS (PLWHA). Little is known about the implementation of HIV/AIDS social assistance policies in China, as well as the effects on recipients of the subsidies associated with these policies. This qualitative study examined HIV/AIDS social assistance policy implementation in rural Central China, a region heavily affected by HIV/AIDS. Using thematic analysis, we analyzed data from 15 interviews with PLWHA in Fuyang City, Anhui. The findings reveal the predominant role that social assistance policies played in mitigating the deleterious impacts of HIV/AIDS on PLWHA. These policies provided living subsidies and greatly reduced the economic burdens through medical and educational assistance plans. Our findings also highlight challenges with implementation of the policy, including access and coverage issues, inadequate subsidies, stigma, and issues related to recipients&amp;rsquo; privacy. This study provides recommendations to improve social assistance policies that mitigate the negative impacts of HIV/AIDS on vulnerable households.

Job satisfaction and associated factors among health care staff in township health centers——a cross-sectional survey in rural Central China

ABSTRACT Township health centers play a cornerstone role in the primary healthcare in China while it’s development is largely limited by the brain drain. Job satisfaction is closely related to brain drain, investigating the relevant factors of job satisfaction can provide strategies to reduce brain drain. This research was conducted in Huangpi, China. Convenience sampling methods and self-administereded questionnaires were used. We collected 1370 valid samples, with an effective rate of 97.72%. Descriptive statistics are used to describe sociodemographic information. The Pearson Chi-square statistical was used to test the binary association between job satisfaction and another categorical variable. All the sociodemographic information was applied to the binary logistic regression model using the stepwise selection method. The mean age was 36.98 (SD = 9.84), factors that affect job satisfaction include educational background (x2 = 7.99, p< 0.05), marital status (x2 = 8.96, p< 0.05, monthly income (x2 = 51.43, p< 0.01), hire form (x2 = 7.64, p< 0.05), hours worked per week (x2 = 33.48, p< 0.01), parent had a stable job (x2 = 10.65, p< 0.01). Government and management should consider the impact of current policies on job satisfaction. Increasing the welfare of healthcare staff and promoting equity are potential strategies for improving low levels of job satisfaction.

Accessibility of Rural Life Space on the Jianghan Plain, China: The Role of Livelihood.

This article aims to contribute to the relationship between accessibility of rural life space and rural livelihood capital and transitions in rural central China. Employing data produced from a household survey, we developed a composite index for accessibility of rural life space incorporating spatial and temporal attributes of a household’s daily activities and then explored the mediation effect of rural livelihood capital and transitions on accessibility. Results revealed a pattern of diversification in terms of life space accessibility undertaken for daily activities across households. Both livelihood capital and transitions had significant mediation effects on the relationship between socio-economic characteristics of rural households and accessibility of rural life space. The effects of livelihood capital on livelihood transitions also influenced the path on rural households’ accessibility of rural life space. One of the implications of this article is to link rural transformation to the context of urbanization and rural access issues from a perspective of daily activity, and then to figure out the best method for rural development policy and service planning.

Sleep Disturbance in Older Adults With or Without Mild Cognitive Impairment and Its Associated Factors Residing in Rural Area, China.

To evaluate the prevalence of sleep disturbance in older adults with or without mild cognitive impairment (MCI) and associated factors among residents in rural central China. A cross-sectional survey was conducted in adults in rural areas of the Hunan province aged≥60 years. Study participants (N = 1213) included 479 individuals meeting the criteria for MCI and 734 with normal cognitive abilities. The participants completed the Athens Insomnia Scale, Stress Resilience Quotient Scale, Affect Balance Scale and Activities of Daily Living (ADL) Scale. Chi-square test, Wilcoxon rank sum analyses and multiple logistic regression were used in this study. A total of 60.33% of participants with MCI demonstrated sleep disturbance (60.33%, 95% CI: 0.559-0.649), which was significantly higher than in the non-MCI group (43.73%, 95% CI: 0.759-0.838). Multiple logistic regression conducted separately in the populations of older adults with or without MCI showed that age, drinking habits, affect balance and activities of daily life were correlates of self-reported sleep disturbance in rural older adults with MCI (B = -5.469), whereas age, ADL, living arrangement and resilience were the main influencing factors in older adults without MCI (B = 2.991). Sleep disturbance is more common in older adults with MCI than without MCI in rural areas of China. The factors influencing sleep disturbances vary between older adults with or without MCI, with age and ADL representing common factors influencing sleep disturbance in both groups. Interventions focusing on the age, drinking habits, affect balance and ADL may improve sleep quality in MCI older adults.

Rationale and design of the Henan ST elevation myocardial infarction (STEMI) registry: a regional STEMI project in predominantly rural central China

BackgroundCardiovascular disease including ST elevation myocardial infarction (STEMI) is increasing and the leading cause of death in China. There has been limited data available to characterize STEMI management and outcomes in rural areas of China. The Henan STEMI Registry is a regional STEMI project with the objectives to timely obtain real-world knowledge about STEMI patients in secondary and tertiary hospitals and to provide a platform for care quality improvement efforts in predominantly rural central China.MethodsThe Henan STEMI Registry is a multicentre, prospective and observational study for STEMI patients. The registry includes 66 participating hospitals (50 secondary hospitals; 16 tertiary hospitals) that cover 15 prefectures and one city direct-controlled by the province in Henan province. Patients were consecutively enrolled with a primary diagnosis of STEMI within 30 days of symptom onset. Clinical treatments, outcomes and cost are collected by local investigators and captured electronically, with a standardized set of variables and standard definitions, and rigorous data quality control. Post-discharge patient follow-up to 1 year is planned. As of August 2018, the Henan STEMI Registry has enrolled 5479 patients of STEMI.DiscussionThe Henan STEMI Registry represents the largest Chinese regional platform for clinical research and care quality improvement for STEMI. The board inclusion of secondary hospitals in Henan province will allow for the exploration of STEMI in predominantly rural central China.Trial registration[NCT02641262] [29 December, 2015].

Impact of Critical Illness Insurance on the Burden of High-Cost Rural Residents in Central China: An Interrupted Time Series Study.

Critical illness insurance (CII) in China was introduced to protect high-cost groups from health expenditure shocks for the purpose of mutual aid. This study aimed to evaluate the impact of CII on the burden of high-cost groups in central rural China. Data were extracted from the basic medical insurance (BMI) hospitalization database of Xiantao City from January 2010 to December 2016. A total of 77,757 hospitalization records were included in our analysis. The out-of-pocket (OOP) expenses and reimbursement ratio (RR) were the two main outcome variables. Interrupted time series analysis with a segmented regression approach was adopted. Level and slope changes were reported to reflect short- and long-term effects, respectively. Results indicated that the number of high-cost inpatient visits, the average monthly hospitalization expenses, and OOP expenses per high-cost inpatient visit were increased after CII introduction. By contrast, the RR from BMI and non-reimbursable expenses ratio were decreased. The OOP expenses and RR covered by CII were higher than those uncovered. We estimated a significant level decrease in OOP expenses (p < 0.01) and rise in RR (p < 0.01), whereas the slope decreases of OOP expenses (p = 0.19) and rise of RR (p = 0.11) after the CII were non-significant. We concluded that the short-term effect of the CII policy is significant and contributes to decreasing OOP expenses and raising RR for high-cost groups, whereas the long-term effect is non-significant. These findings can be explained by increasing hospitalization expenses, many non-reimbursable expenses, low coverage for high-cost groups, and the unsustainability of the financing methods.