BackgroundThe New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes.MethodsA cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview.ResultsNRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2%) owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of household's capacity to pay) and medical impoverishment (household per capita income falling below the poverty line due to medical expense) was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness) were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved from impoverishment.ConclusionThe coverage of NRCMS among the rural population was high but not adequate to improve access to in-patient care and protect against financial catastrophe and household impoverishment due to health payment, especially for the poor and the chronically ill. Furthermore, MFA played almost no such role; therefore, the current schemes need to be improved.

ObjectiveThe study aimed to examine the effect of household and community characteristics on financial catastrophe and impoverishment due to health payment in Western and Central Rural China.MethodsA household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Independent variables included village characteristics, household income, chronic illness status, health care use and health spending. A composite contextual variable, named village deprivation, was derived from socio-economic status and availability of health care facilities in each village using factor analysis. Dependent variables were whether household health payment was more than 40% of household's capacity to pay (catastrophic health payment) and whether household per capita income was put under Chinese national poverty line (1067 Yuan income per year) after health spending (impoverishment). Mixed effects logistic regression was used to assess the effect of the independent variables on the two outcomes.ResultsHouseholds with low per capita income, having elderly, hospitalized or chronically ill members, and whose head was unemployed were more likely to incur financial catastrophe and impoverishment due to health expenditure. Both catastrophic and impoverishing health payments increased with increased village deprivation. However, the presence of a village health clinic had no effect on the two outcomes, nor did household enrollment in the New Rural Cooperative Medical Scheme (national health insurance).ConclusionsVillage deprivation independently increases the risk for financial hardship due to health payment after adjusting for known household-level factors. This suggests that policy makers need to view the individual, household and village as separate units for policy targeting.

This paper aims at investigating the change over time in the environmental awareness in rural Chinese communities and its correlation with environmental management measures implemented at the local level. We identify three main components of awareness, namely: perception, behavior, and attitude toward environmental management measures. Data were collected from two surveys in three villages in northern China in 2006 and 2015 that interviewed 125 and 129 respondents, respectively, and were analyzed employing an Analytic Hierarchy Process (AHP) approach. The results discussed in the paper show that environmental awareness increased between 2006-2015, and was mainly manifested in better environmental behavior and understanding of environmental status due an improvement in rural infrastructure and a greater amount of information provided to rural residents about the environment. Place of residence had a considerable influence on respondents' environmental awareness: residents in eco-villages had a higher environmental awareness than those living in common agricultural villages. This appears to indicate a positive nexus between the comprehensiveness of environmental management measures implemented locally, and environmental awareness. Also, the universality of environment issues reduced the importance of socioeconomic and demographic factors in determining the degree of environmental awareness. However, more attention should be paid to villagers' external behavior and inner feelings, such as their attitude to governmental management policies. These findings yield important policy implications that are relevant to the promotion of environmental awareness in China's rural communities, and the adoption of more effective environmental management measures.

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The concept of circular economy (CE) has recently gained momentum in the political, scientific, and economic debate, especially in China and Europe. As a result, organizations and scholars have started to establish different sets of principles for its adoption. For this reason, it is important to identify and assess the differences and similarities among existing sets of CE principles, and how organizations and individuals understand and translate them into practice. In this paper, we firstly present a brief review and analysis of the coherence among six existing sets of principles. Our analysis finds that, despite the mixed degree of coherence, all sets describe the necessity to implement CE principles at all levels of a company. We then present the results of an in-depth qualitative survey that investigates how 19 key informants representing small, medium, and multinational companies based in China understand and carry out the CE principles laid out by the BSI standard BS 8001:2017; how these principles can transform the culture and processes of these companies; and what are the opportunities and threats that such transformation can bring. Results describe a good awareness and knowledge of the CE principles and an optimistic outlook concerning their adoption. At the same time, numerous barriers and threats that the implementation of these principles might entail are presented. Overall, respondents confirm the complexity of implementing the principles of the CE in an integrated and consistent way in the management and strategies of Chinese companies and highlight the challenges that might arise during their implementation.