Under China's healthcare reforms, community health service centres (CHCs) have been established as the preferred primary care providers. Even with this change, there is still little attention paid to patients' usual source of care (USC) from CHCs in Northeastern China. The main purposes of this study were to explore the determinants of usual source of community health service and to examine the association between usual source of community health service and patients' experiences with primary care. A cross-sectional survey with 515 adult patients at CHCs in Jilin Province, China, was conducted between July 2016 and November 2016. The patients' experiences with primary care were assessed with the Primary Care Assessment Tool (PCAT). Patients with self-perceived poor health status (odds ratio = 1.984, 95% confidence interval = 1.145-3.437) and chronic disease (odds ratio = 2.207, 95% confidence interval = 1.203-4.051) were more likely to have a usual source of community health service than patients with selfperceived good health status or without chronic disease. Patients scored the highest on comprehensiveness of services available (Mean = 2.87) and the lowest on community orientation (Mean = 1.83) in all domains of the PCAT, with values ranging from 1 to 4. A multiple linear regression analysis revealed that patients with a usual source of community health service had significantly higher overall scores than those without (B = 0.205, p < .001). This study demonstrated the important role of CHCs in providing affordable health services for patients with chronic disease or poor health status. Moreover, patients who chose a CHC as a USC had better experiences with primary care compared with patients who did not choose a CHC as a USC. However, community-oriented services need to be improved, and efforts to improve patients' experiences should include policies that incentivise patients to adopt a CHC as their USC.
Background Even though China launched a series of measures to alleviate several financial burdens (including health insurance scheme, increased government investment, and so on), the economic burden of health expenditure has still not been alleviated. Out-of-pocket payments (OPPs) show not only a time correlation but also some degree of spatial correlation. The aims of the current study were thus to identify the spatial cluster of OPPs, to investigate the main factors affecting variation, and to explore the spatial spillover sources of China’s OPP. Methods Global and local spatial autocorrelation tests were validated to identify the spatial cluster of OPPs using the panel data of 31 provinces in China from 2005 to 2016. The Spatial Durbin Model, established in this paper, measured the spatial spillover effect of OPPs and analyzed the possible spillover sources (demand, supply, and socio-economic factors. Results OPPs were found to have a significant and positive spatial correlation. The results of the Spatial Durbin Model showed the direct and indirect effects of demand, supply, and socio- economic factors on China’s OPPs. Among the demand factors, the direct and indirect correlation (elasticity) coefficients were positive. Among the supply factors, the direct and indirect effects of the share of primary health beds on residents’ OPPs were negative. The ratio of health technicians in hospitals to those in primary health institutions on per capital OPPs had a significant indirect effect. Among the socio-economic factors, the direct effects of GDP, government health expenditure, and urbanization on OPPs were found to be positive. There were no significant indirect effects of socio-economic factors on OPPs. Conclusion This paper finds that China’s OPPs are not randomly distributed but, overall, present a positive spatial cluster, even though a series of measures have been launched to promote health equity. Socio-economic factors and those associated with demand were found to be the main influences of variation in OPPs, while demand was seen to be the driver of the positive spatial spillover of OPPs, whereby effective supply could inhibit these positive spillover effects. Electronic supplementary material The online version of this article (10.1186/s12913-019-4451-0) contains supplementary material, which is available to authorized users.
Through the analysis of the current situation of rural logistics development, we find that there are many problems in the development of rural logistics in China: imperfect infrastructure, incomplete use of information systems, the development of rural logistics can not be connected with the city, and the logistics system of rural development is chaotic; through the analysis, we find that China Post has a very strong advantage in rural logistics, according to economic development. The exhibition situation is divided into logistics services, specialization services, and then through the platform of Postal Music Network, new retail mode is introduced to let agricultural products come out and commodities go in. China Post through promotes the platform of Postal Music Network, and constantly improves the platform. Information system and logistics are seamlessly docked, so that rural e-commerce development can drive rural logistics, promote rural economic development, and further improve the quality of life of rural people.
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