BackgroundAgainst the achievement of nearly universal coverage for social health insurance for the elderly in China, a problem of inequity among different insurance schemes on health outcomes is still a big challenge for the health care system. Whether various health insurance schemes have divergent effects on health outcome is still a puzzle. Empirical evidence will be investigated in this study.MethodsThis study employs a nationally representative survey database, the National Survey of the Aged Population in Urban/Rural China, to compare the changes of health outcomes among the elderly before and after the reform. A one-way ANOVA is utilized to detect disparities in health care expenditures and health status among different health insurance schemes. Multiple Linear Regression is applied later to examine the further effects of different insurance plans on health outcomes while controlling for other social determinants.ResultsThe one-way ANOVA result illustrates that although the gaps in insurance reimbursements between the Urban Employee Basic Medical Insurance (UEBMI) and the other schemes, the New Rural Cooperative Medical Scheme (NCMS) and Urban Residents Basic Medical Insurance (URBMI) decreased, out-of-pocket spending accounts for a larger proportion of total health care expenditures, and the disparities among different insurances enlarged. Results of the Multiple Linear Regression suggest that UEBMI participants have better self-reported health status, physical functions and psychological wellbeing than URBMI and NCMS participants, and those uninsured. URBMI participants report better self-reported health than NCMS ones and uninsured people, while having worse psychological wellbeing compared with their NCMS counterparts.ConclusionsThis research contributes to a transformation in health insurance studies from an emphasis on the opportunity-oriented health equity measured by coverage and healthcare accessibility to concern with outcome-based equity composed of health expenditure and health status. The results indicate that fragmented health insurance schemes generate inequitable health care utilization and health outcomes for the elderly. This study re-emphasizes the importance of reforming health insurance systems based on their health outcome rather than entitlement, which will particularly benefit the most vulnerable older groups.

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Income does not capture all aspects of poverty that are associated with adverse health outcomes. Deprivation of non-monetary resources has an independent effect on general health above and beyond the effect of income poverty. Policies should move beyond endowment and take into account the multidimensionality of poverty, in order to address the problem of health inequality.

Articles you may be interested inTemperature-dependent structural stability and optical properties of ultrathin Hf-Al-O films grown by facingtarget reactive sputtering Chemical states and electrical properties of a high-k metal oxide/silicon interface with oxygen-gettering titaniummetal-overlayer Appl.The interface properties of the hafnium gate oxide films prepared by direct sputtering of hafnium in oxygen with rapid thermal annealing have been investigated in detail. X-ray photoelectron spectroscopy reveals that the interface silicate layer is a random mixture of Hf-O, Si-O, Hf-Si, and excess Hf and Si atoms. The contributions of these bonds to the composition of silicate layer are governed by the Si/Hf ratio. At low Si/Hf ratio ͑Ͻ2͒, the silicate layer is a mixture of SiO 4 and HfO 4 phases. At higher Si/Hf ratio ͑2-5͒, the contribution of the HfO 4 phase decreases and Hf-Si ͑silicide͒ bonds become important. At very high Si/Hf ratio ͑Ͼ9͒ and close to the substrate, Hf-Si dominates and the high strain Hf-Si bonds govern the electrical properties of the interface. These results explain the observed high interface trap density at the HfO 2 /Si interface and the soft breakdown behavior which is different from the silicon oxide film.

Objective: To assess the incidence of late onset (. 72 hours) infection and necrotising enterocolitis (NEC) in very low birthweight (VLBW) infants in two 36 month periods using two hand hygiene protocols: conventional handwashing (HW; first 36 month period); an alcohol hand rub and gloves technique (HR; second 36 month period). Method: VLBW infants admitted to the neonatal intensive care unit during the period December 1993-November 1999 were eligible. A new hand hygiene protocol using alcohol handrub and gloves was introduced in December 1996. Each patient's case record was reviewed retrospectively by two independent investigators using a standard data collection form. The incidence of NEC and systemic infections, including bacterial or fungal septicaemia, meningitis, and peritonitis, in the two periods were compared. Results: The HW and HR groups contained 161 and 176 VLBW infants respectively. The incidence of late onset systemic infection decreased from 13.5 to 4.8 episodes (including NEC)/1000 patient days after introduction of the HR regimen, representing a 2.8-fold reduction. Similarly, the incidence of Gram positive, Gram negative, and fungal infections decreased 2.5-fold, 2.6-fold, and 7-fold respectively. There was also a significant reduction in the incidence of NEC in the HR group (p , 0.0001). Subgroup analysis revealed that the incidence of methicillin resistant Staphylococcus aureus (MRSA) septicaemia was significantly decreased in the second 36 month period (p = 0.048). The clinical data suggest that infants in the HW group had significantly earlier onset of sepsis (p , 0.05) and required oxygen supplementation for longer (p , 0.05) than those in the HR group. Significantly more VLBW infants were discharged from the neonatal intensive care unit without ever being infected (p , 0.0001), and also significantly fewer infants had more than one episode of infection in the HR group (p , 0.0001). Conclusion: The introduction of the HR protocol was associated with a 2.8-fold reduction in the incidence of late onset systemic infection, and also a significant decrease in the incidence of MRSA septicaemia and NEC in VLBW infants. This decrease in infection rate was maintained throughout the second 36 month period. L ate onset neonatal infection is a serious complication of prematurity and a significant cause of morbidity and mortality.1-4 A recent survey of 15 major neonatal centres in the United States indicated that infants who developed late onset sepsis had a significantly longer hospital stay and higher mortality than patients who were not infected.