Rural Cooperative Research Articles

Socio-economic inequalities in health service utilization among Chinese rural migrant workers with New Cooperative Medical Scheme: a multilevel regression approach

BackgroundWhile reducing inequity in health service utilization is an important goal of China’s health system, it has been widely acknowledged that a huge number of rural migrant workers cannot be effectually protected against risks with the New Rural Cooperative Medical Insurance (NCMS).MethodData of the 2016 China Labor-force Dynamic Survey and the Chinese Urban Statistical Yearbook were used. The multilevel regression approach was implemented with a nationally representative sample of rural migrant workers with NCMS. Our study adopted the concentration index and its decomposition method to quantify the inequality of their health service utilization.ResultThe multilevel model analysis indicated that impact variables for health service utilization were not concentrated, especially the contextual and individual characteristics. The concentration indices of the probability of two weeks outpatient and the probability of inpatient were -0.168 (95%CI:-0.236,-0.092) and -0.072 (95%CI:-1.085,-0.060), respectively. The horizontal inequality indices for the probability of two-week outpatient and the probability of inpatient were -0.012 and 0.053, respectively.ConclusionThe health service utilization of rural migrant workers with NCMS is insufficient. Our study highlighted that substantial inequalities in their health service utilization did exist. In addition, their need of health service utilization increased the pro-poor inequality. Based on the findings, our study offered notable implications on compensation policies and benefit packages to improve the equality among rural migrant workers with NCMS.

The deviation between the willingness and behavior of farmers to adopt electricity-saving tricycles and its influencing factors in Dazu District of China

This study aims to explore whether there is a deviation between farmers' willingness and behavior to adopt electricity-saving tricycles and to identify factors influencing the deviation. A total of 234 rural households in Dazu District of China were selected by using the stratified random sampling technique and interviewed face-to-face. The cross-analysis method was employed to analyze the deviation, and the binary logit model was used to investigate the influencing factors on the deviation. The results demonstrate that there is a deviation between farmers' adoption willingness and behavior. Of the 193 farmers who were willing to adopt electricity-saving tricycles, only 52 had actual adoption behaviors in their families. The inconsistency rate was more than 73%. The regression results indicate that age, whether the respondents are village cadres, and the terrain of the dwelling have positive effects on the deviation. The number of permanent residents, the diversity of income structure, the area of the dwelling, the cognition toward climate change and individual behaviors of energy use, and whether the respondents participate in rural cooperatives or not affect the deviation negatively. Our findings provide policy implications for government measures to guide the transition from the willingness to the actual adoption behavior of farmers.

Experience in Growth Monitoring and Promotion Integrated With Immunization Services in a City Corporation of Bangladesh

ObjectivesWe aim to share the experience of the USAID's Strengthening Multi-sectoral Nutrition Programming through Implementation Science Activity (MSNP), which has been integrating Growth Monitoring (GMP) and Expanded Program of Immunization (EPI) for children under two years in Khulna City Corporation (KCC), Ministry of Local Government Rural Development and Cooperatives (LGRD), Bangladesh.MethodsThe team analyzed the GMP and EPI service data, observed client-provider interactions (service delivery) (n = 3 nutrition counselors), conducted semi-structured interview with health assistants (n = 6) and informal discussion with mothers (n = 10) who visited the GMP/EPI service facilities from October 2021 to January 2022.ResultsBoth health assistants and nutrition counselors delivered GMP and EPI services, serving as key enablers of EPI-GMP integration. Reminder text messages were sent by MSNP project to mothers of children lost-for-follow-up to encourage their service return. From October 2021 to January 2022 GMP-EPI integrated services were provided to 1518 children (October: 32; November: 281; December: 583; January: 622).Major challenges included coordination gaps between service activities; space constraints to conduct GMP; overburdening of health assistants to fulfil EPI lost-to-follow-up targets during COVID-19 pandemic and priority for vaccination of COVID-19 to EPI; lack of awareness among caregivers of the importance of appropriate nutrition during the child's first 1000 days for healthy physical and mental development.ConclusionsAlthough this experience suggests integration of GMP into EPI can work, improvements are needed. The MSNP project will increase coordination among donors, Ministry of Health and LGRD, KCC and partner NGOs, service providers and mothers to ensure sustained and effective GMP-EPI integration; provide need-based infant and young child feeding counseling and train caregivers on community-based management of acute malnutrition, and strengthen service provision by providing supportive supervision to them.Funding SourcesUnited States Agency for International Development (USAID).

Is banana value chain in East Africa sustainable? Evidence from Ethiopia

Banana is an essential commercial fruit for smallholder farmers in East Africa including Ethiopia. It is also lifeblood of the majority of the farmers in Arba Minch district of Ethiopia. However, this sector is experiencing many constraints with limited investment on sustainable value chain management. Thus, this study aims to examine the sustainability performance assessment of the banana value chain by comparing and analyzing 25 attributes through triple bottom-line indicators. The critical aspects of the qualitative data were analyzed using Sustainability Assessment of Food and Agriculture Systems version 3.0 at Ethiopian context. The results show that banana product flow from the farmer and ends with the consumer through three market channels which link farmers directly with rural retailers, traveling traders, and farmer cooperatives. Largest volume of banana was sold through the traveling trader channel while the smallest volume was sold via the rural retailer channels. The banana payment flow begins from consumers and ends with input suppliers. Farmers have limited access to alternative markets for their banana products, but wholesalers have many connections and marketing options across the country. The results of the banana value chain sustainability assessment also reveal that the economic, social, and environmental indicators have moderate sustainability performance in the study area. The value of the Cronbach’s alpha coefficient was 0.7993 which shows that the five-point scale items of the experts’ judgment on the sustainability of banana value chain are consistent and reliable. The chain has several advantages in terms of profitability, emission of air pollutants, employment, and constraints in terms of coordination, profit margin, value share, market diversity, transportation, product and market information, safety and hygiene, and waste management. Thus, Government and non-governmental organizations give due attention towards the sustainable banana value chain. • Ethiopia is one of major banana producing country in East Africa. • The banana product flow starts from producers and ends with consumers. • Farmers have limited access to alternative markets for their Banana products in Ethiopia. • Banana value chain has moderate sustainability performance in Ethiopia.

English

Maize is the most important cereal crop in Ethiopia in terms of plantation area, production volume, and economic importance for food security. Despite the relative yield increment at the national level, maize production in the study area has been hindered by a couple of factors. This study was conducted to assess and evaluate maize production constraints in the Hawassa Zuria district. Primary data was collected from 60 randomly selected maize producers. Accordingly, socioeconomic factors such as sex (β = -2.02), educational level (β = 0.18), total livestock unit (TLU) (β = 0.27), and major income source (β for agriculture = 2.75 and β for private works = 3.05) could significantly influence maize production and productivity at 1% probability level. The institutional factors such as access to agricultural inputs, extension services, credit, irrigation, and membership in rural cooperatives; and agronomic factors such as fertilizer use, planting density, weeding frequency, tillage mechanisms, and pest and disease infestation were identified as the major challenges likely influencing maize production in the study area. Based on the study outcomes, policy recommendation is made such as improving the educational level, enhancing input access and empowering farmers to adopt and apply a full package of agronomic practices that help to improve soil fertility and thus crop productivity. As a result, addressing these constraints would be critical to improving food production. Key words: Agronomic factors, determinants, maize, multiple linear regression, production and productivity, policy recommendation.

Rural Financial Decision Support System Based on Database and Genetic Algorithm

With the development of society and economy, the rural financial institution system mainly includes cooperatives and political and commercial rural financial institutions, and they are supplemented by agricultural insurance, guarantee, securities and other nonfinancial organizations to improve their own functions. Rural credit cooperatives have higher investment and operation risks than other financial institutions. New-type rural financial institutions are more sensitive to the market environment, asset quality and profitability, and risk-taking ability. Internal and external risks continue to accumulate, and their potential is low. These risks pose serious obstacles to the development and growth of financial institutions such as rural banks and microfinance companies, and pose major challenges to the security and stability of rural areas and agriculture. Using database and genetic algorithm to study rural credit risk, profitability, and liquidity, in order to track the impact of each explanatory variable in the system on the explained variable, the impulse response function is used to analyze the impact of nonperforming loan ratio on asset profitability. The data are all close to 0, indicating that the influence between the two is more obvious. The intelligent decision-making system support system evaluates the market risk, credit risk, liquidity risk, and risk management and risk acceptance of rural financial institutions and explores effective countermeasures for their sustainable development.

A Study on Role of Customer Relationship Managemen in Rural Cooperative Bank in Madurai District

In India, the banking business is become more and more complex and tremendously changes from the liberalization and globalization. Rural development is the process of improving the quality of life and economic well being of people living in rural areas. In past decades, the government has taken initial steps of accelerating the rural areas development and welfare activities. The opening of new bank, the customer creation is very important one and develops to maintain the relationship is difficult. Customer relationship management is helpful to remove these difficulty in various aspect of services provided to the people. CRM facilitates the cooperative banks to provide one to one services and also maintain the transactions security of the customers. The main purpose of CRM in cooperative banking sector is to create and keep customer and view the entire banking transactions as consisting of highly integrated effort to create and satisfy the customer needs. A customer satisfaction is silent advertiser of cooperative banks product. In this study, the researcher has analyze the customer satisfaction of cooperative banking services in rural areas and what they are expecting form cooperative banks etc. It helps to bring out the results related to benefit cooperative banks to build better CRM services to rural areas. CRM facilitates the cooperative banks to provide one to one services and also maintain the transactions security of the customers.

The spatiotemporal correlation of PM2.5 concentration on esophageal cancer hospitalization rate in Fujian province of China.

This paper aimed to explore the correlation between PM2.5 concentration and hospitalization rate of esophageal cancer in Fujian province, and tried to find out the accurate lag effect between PM2.5 and hospitalization rate in 70 counties from the linear and nonlinear aspects. We extracted inpatients data of esophageal cancer from the New Rural Cooperative Medical Scheme (NRCMS) database and air pollutant PM2.5 grid data published by the atmospheric composition analysis group. The study showed that the hospitalization rate of esophageal cancer presented spatial aggregation in 70 counties of Fujian province. Southeast urban agglomerations had high hospitalization rates, while central and western regions had low hospitalization rates. The study found that the spatial distribution of the hospitalization rate of esophageal cancer in 2016 was not consistent with that of the PM2.5 concentration in the same year. The concentration of PM2.5 in 2003 and 2004 had the strongest correlation with the hospitalization rate of esophageal cancer in 2016, with Pearson correlation coefficient r value of - 0.365 and Geodetector q-statistic value of 0.148 (p < 0.05). Our findings showed that there existed a 13-year lag period of air pollutant PM2.5 on the esophageal cancer hospitalization rate, which can provide helpful guidance in the early screening strategy of esophageal cancer in Fujian. The research progress of this paper will help to understand the lag period of the impact of air pollutants on the hospitalization rate of esophageal cancer, provide valuable information for the prevention and treatment strategy of esophageal cancer in Fujian province, and provide relevant experience for alike regions.

A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trial

The prevalence of uncontrolled hypertension is high and increasing in low-income and middle-income countries. We tested the effectiveness of a multifaceted intervention for blood pressure control in rural China led by village doctors (community health workers on the front line of primary health care). In this open, cluster randomised trial (China Rural Hypertension Control Project), 326 villages that had a regular village doctor and participated in the China New Rural Cooperative Medical Scheme were randomly assigned (1:1) to either village doctor-led multifaceted intervention or enhanced usual care (control), with stratification by provinces, counties, and townships. We recruited individuals aged 40 years or older with an untreated blood pressure of 140/90 mm Hg or higher (≥130/80 mm Hg among those with a history of cardiovascular disease, diabetes, or chronic kidney disease) or a treated blood pressure of 130/80 mm Hg or higher. In the intervention group, trained village doctors initiated and titrated antihypertensive medications according to a standard protocol with supervision from primary care physicians. Village doctors also conducted health coaching on home blood pressure monitoring, lifestyle changes, and medication adherence. The primary outcome (reported here) was the proportion of patients with a blood pressure of less than 130/80 mm Hg at 18 months. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03527719, and is ongoing. Between May 8 and November 28, 2018, we enrolled 33 995 individuals from 163 intervention and 163 control villages. At 18 months, 8865 (57·0%) of 15 414 patients in the intervention group and 2895 (19·9%) of 14 500 patients in the control group had a blood pressure of less than 130/80 mm Hg, with a group difference of 37·0% (95% CI 34·9 to 39·1%; p<0·0001). Mean systolic blood pressure decreased by -26·3 mm Hg (95% CI -27·1 to -25·4) from baseline to 18 months in the intervention group and by -11·8 mm Hg (-12·6 to -11·0) in the control group, with a group difference of -14·5 mm Hg (95% CI -15·7 to -13·3 mm Hg; p<0·0001). Mean diastolic blood pressure decreased by -14·6 mm Hg (-15·1 to -14·2) from baseline to 18 months in the intervention group and by -7·5 mm Hg (-7·9 to -7·2) in the control group, with a group difference of -7·1 mm Hg (-7·7 to -6·5 mm Hg; p<0·0001). No treatment-related serious adverse events were reported in either group. Compared with enhanced usual care, village doctor-led intervention resulted in statistically significant improvements in blood pressure control among rural residents in China. This feasible, effective, and sustainable implementation strategy could be scaled up in rural China and other low-income and middle-income countries for hypertension control. Ministry of Science and Technology of China.

Effects of social capital on farmers’ choices of climate change adaptation behavior in Dazu District, China

ABSTRACT This study explores the effects of social capital on farmers’ choices of climate change adaptation behavior in Dazu District, China. A total of 228 questionnaires were obtained from randomly sampled households. Social capital was divided into social networks, participation, reciprocity and trust. The adaptation behaviors in the study area were identified as crop adjustment, environmental improvement, financial management, and livelihood diversification. A boosted regression tree model was used to analyze the effects of different dimensions of social capital on farmers’ choices of climate change adaptation behavior. The results show that most farmers in Dazu District of Chongqing have adopted crop adjustment adaptation behavior. The social capital and socioeconomic characteristics of farmers have different impacts on different adaptation behaviors. Among social capital, the largest influence on climate change adaptation behavior is the degree of trust in the information of agricultural technology extension service centers, and the lowest influence is participation in rural cooperatives. In terms of socioeconomic characteristics, the largest impact on climate change adaptation behavior is agricultural income share, and the lowest impact is gender. The findings of this study can provide empirical support for governments to formulate effective policies to improve farmers’ climate change adaptation capabilities.

The Data Analytics of Finance Impact on the Rural Development Combining Financial Constraint and Economic Growth Theory.

In order to solve the predicament of rural economic development, China's rural areas have spontaneously formed a rural financial system with rural characteristics. With the deepening reform of rural finance, Rural Commercial Bank was restructured on the basis of rural credit cooperatives in the past. It can be said that Rural Commercial Bank is a rural financial institution born in rural areas. Therefore, the development of the local rural commercial bank and the development of the local rural economy have been integrated, and the core force in rural finance is the Rural Commercial Bank. It is precisely because of the core position of China's rural commercial banks in rural, when Chinese scholars conduct research on rural finance, they often choose rural commercial banks as the research object. Based on this, when the article studies the impact of rural finance on the rural economy, it also chooses rural commercial banks as the research object. Finance that the rural commercial banks are used as the starting point to carry out the research work on their local rural finance. This article takes D County Rural Commercial Bank as an example to introduce and analyze the development status and development process of D county's rural finance. Using the method of empirical research, this paper studies the impact of the development of agricultural-related business of rural commercial banks on the rural economy. In addition, according to the empirical research results, a set of financial innovation countermeasures to promote rural economic development is proposed. Through the research on the influence of rural financial institutions in D county on the rural economy, it can be seen that providing new directions and new methods for the development of China's rural economy from the perspective of finance. It provides a reference for promoting the stable and effective development of the domestic rural economy. The survey shows that rural deposits have maintained a rapid upward trend. The total amount increased rapidly from 2.219 billion yuan in 2012 to 6.039 billion yuan in 2018, with an average annual increase of 637 million yuan.

Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis

ObjectiveTo evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress. MethodsThis was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress. ResultsSignificant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity (P ​= ​0.032) and psychological distress (P ​< ​0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50–59 years (P ​= ​0.035), 60–69 years (P ​= ​0.007), and 70 years or older (P ​= ​0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY (P ​< ​0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) (P ​= ​0.030) or New Rural Cooperative Medical Scheme (NRCMS) (P ​= ​0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years (P ​= ​0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer (P ​= ​0.009), the surgery group (P ​< ​0.001) and adjuvant therapy group (P ​< ​0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups. ConclusionsThe research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.

Investing in health capital: Does medical insurance matter?

Health capital investment is a component of human capital and can increase labor productivity in the economy. This study analyzes the returns on health investment based on the perspective of medical insurance. China’s basic medical insurance system provides a suitable institutional setting, which comprises three schemes: Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical Scheme. Using the China Health and Retirement Longitudinal Study and various econometric models, we find that medical insurance significantly impacts health outcomes of Chinese population aged 45 years and more. The result differs by the types of medical insurance, health indicators, and age groups. Furthermore, the convenience of obtaining medical insurance benefits, rarely mentioned in academic literature, is a significant factor affecting population health. From the perspective of health capital investment, investment in medical insurance must target younger groups.

Inequity in Health Services Utilization in Economically Underdeveloped Regions of Northeast China.

BackgroundThe Chinese health system has long been committed to eliminating inequalities in health services utilization. However, few studies have analyzed or measured these inequalities in economically underdeveloped regions in China.MethodsA total of 6,627 respondents from 3,000 households in Heilongjiang Province were extracted from the Sixth National Health Services Survey. We measured horizontal inequity in both 2-week outpatient rate and annual inpatient rate, and then identified the factors contributing to inequality.ResultsThe horizontal inequity indices of the 2-week outpatient and annual impatient rates in Heilongjiang Province were 0.0586 and 0.1276, respectively. Household income, health status, place of residence, basic medical insurance, and commercial health insurance were found to be the main factors affecting inequality in health services utilization. The contributions of household income to these two indices were 184.03 and 253.47%, respectively. Health status factors, including suffering from chronic disease, limitations in daily activities, and poor self-rated health, played positive roles in reducing inequality in these two indices. The contributions of place of residence to these two indices were 27.21 and −28.45%, respectively. Urban Employee Basic Medical Insurance made a pro-rich contribution to these two indices: 56.25 and 81.48%, respectively. Urban and Rural Resident Basic Medical Insurance, Urban Resident Basic Medical Insurance, New Rural Cooperative Medical Scheme, and other basic medical insurance made a pro-poor contribution to these two indices: −73.51 and −54.87%, respectively. Commercial health insurance made a pro-rich contribution to these two indices: 20.79 and 7.40%, respectively. Meanwhile, critical illness insurance made a slightly pro-poor contribution to these two indices: −4.60 and −0.90%, respectively.ConclusionsThe findings showed that the “equal treatment in equal need” principle was not met in the health services utilization context in Heilongjiang Province. To address this issue, the government could make policy changes to protect low-income populations from underused health services, and work to improve basic medical insurance, critical illness insurance, and social security systems.

The Reimbursement Rate of New Rural Cooperative Medical Scheme and Self-Rated Health Among Rural Middle-Aged and Elderly.

ObjectivesThe ultimate goal of the New Rural Cooperative Medical Scheme (NRCMS) is to improve physical and psychological health and aim to provide equitable, affordable, cost-effective healthcare services for all rural people. One of our major concerns from the perspective of policy outcome is whether middle-aged and elderly can benefit from the insurance to improve self-rated health. The main objectives of this study are to answer the questions that the reimbursement rate of the NRCMS is a possible explanation of why and how rural middle-aged and elderly shift from non-medical service inputs to medical service to produce health based on a family production theory.MethodsData were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, which involved 1,030 rural adults aged 45 years and older, and ordinal logistic regression estimator and two-step regression were used to examine these assumptions. Our approach controlled for the health status of those people at the same administrative level of the hospital.ResultsOur study shows some interesting results. First, the reimbursement rate of NRCMS predicted a higher level of SRH among rural middle-aged and elderly, but that all of the indirect effect of it on SRH could be explained in total by satisfaction of local medical services utilization (ab = 0.0492). Second, the results further showed that the odds ratio of satisfaction from affordable, convenient, high-quality medical services is 2.402 times (p < 0.01) greater for those with higher reimbursement levels than for their counterparts with lower reimbursement. Third, the odds ratios of inpatient care visit, outpatient care visit, and physical examination among policyholders of NRCMS are also 1.116, 1.628, and 1.08 times greater, respectively, than their counterparts who are not satisfied with these local medical services.ConclusionsOur results concluded that generous insurance reimbursement can reduce the price of healthcare and costs of utilization that both had a dramatic effect on SRH among middle-aged and elderly when their demand for medical treatment is incurred. The government should focus on the healthcare cost, utilization, and health benefit calculations of health insurance policy options at the stage of rapid aging in rural China.

A Study on the Funds and Investment Management of the Dehradun Urban Co-Operative Bank in Uttarakhand

Cooperative credit can be broken down into Urban Co-operative Banks (UCBs) and Rural Cooperative Banks. Rural cooperatives play a big part in the credit delivery system in rural areas. Urban Cooperative Banks (UCBs) try to get savings from middle and low-income people and give them money to people who need it. People who work for UCBs and rural cooperative credit banks are regulated by the Reserve Bank of India and NABARD, respectively. Both are regulated by the State Government in regard to certain types of work they do.The research demonstrates that in the majority of situations, the bank handles money and investments more effectively and efficiently. On the other hand, the bank’s high cost deposits are on the higher side, which will have a stronger impact on the bank’s profit and profitability in the long run. To provide more contemporary banking services and to attract new consumers, the bank should place a premium on providing high-quality services. Delivering high-quality services and transitioning from conventional to digital banking will undoubtedly bring value to the bank. Developing an appropriate plan to address difficulties such as NPA management, increasing competition from new generation banks, small and payment banks, would undoubtedly increase the bank’s operating efficiency.

SWOT analysis of e‐commerce development of rural tourism farmers' professional cooperatives in the era of big data

In the era of big data, strategy is an indicator that determines business growth and directly guides the sustainable development of business. This paper aims to study the construction of the SWOT (S stands for strength, W stands for weakness, O stands for opportunity, and T stands for threat.) structure analysis model of e-commerce tourism development strategy based on the experience of big data. Through empirical analysis, it explores the factors that affect the development strategy of e-commerce business, and proposes practical measures and development directions. Based on big data theory, this paper uses SWOT analysis to analyze the e-commerce development strategy of China's rural tourism cooperatives in detail, and uses the analytic hierarchy process to analyze the green development direction of e-commerce tourism enterprises. The experimental results of this paper show that the order of enterprise development strategy selection in the context of big data for tourism electronics is: SO strategy, ST strategy, WO strategy and WT strategy.

Characterizing Potentially Preventable Hospitalizations of High-Cost Patients in Rural China.

IntroductionHigh-cost patients are characterized by repeated hospitalizations, and inpatient cost accounts for a large proportion of their total health care spending. This study aimed to assess the occurrence and costs of potentially preventable hospitalizations and explore contributing factors among high-cost patients in rural China.MethodsWe examined a population-based sample of patients using the 2016 New Rural Cooperative Medical Scheme in Dangyang city, China. Eighteen thousand forty-three high-cost patients were identified. A validated tool and logistic regression analysis were used to determine preventable hospitalizations and their patient-level and supply-side factors.ResultsHigh-cost patients were older (average age of 54 years) than non-high-cost patients (50 years) and more likely to come from poverty-stricken families. The occurrence of preventable hospitalization was 21.65% among high-cost patients. The proportion of preventable inpatient cost in total inpatient and outpatient expenditure among high-cost patients (5.81%) was lower than that of non-high-cost patients (7.88%) but accounted for 75.87% of the overall preventable inpatient cost. High-cost patients with more hospitalizations were more likely to experience preventable hospitalization, and those with heart failure, COPD, diabetes and mixed conditions were at a higher risk of preventable hospitalization, while those with more outpatient visits were less likely to show preventable hospitalization.ConclusionsThe occurrence of preventable hospitalization among high-cost patients in rural China was sizeable. The preventable inpatient cost of the overall population was concentrated among high-cost patients. Interventions such as improving preventive care and disease management targeting high-cost patients within counties may improve patients' health outcomes and quality of life and reduce overall preventable inpatient cost.

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.

Multimorbidity and catastrophic health expenditure among patients with diabetes in China: a nationwide population-based study

IntroductionMultimorbidity is common among patients with diabetes and can lead to catastrophic health expenditure (CHE) for their families. This study aims to investigate the prevalence of multimorbidity and CHE among...