Access to Care by Older Rural People in a Post-Reform Chinese Hospital: an Ethical Evaluation of Anthropological Findings

Fitzgerald

Nie

2020

IJERPH

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This paper examines the experiences of seeking healthcare for rural Chinese older people, a population who experiences the multiple threats of socio-economic deprivation, marginalization, and lack of access to medical care, yet have been relatively overlooked within the existing scholarly literature. Based on ethnographical data collected from six-month fieldwork conducted in a rural primary hospital in Southern China, this paper identifies a widespread discouraging, dispiriting attitude regarding healthcare-seeking for rural older members despite the ongoing efforts of institutional reforms with a particular focus on addressing access to health services amongst rural populations. Such an attitude was expressed by older people’s families as well as the public in their narratives by devaluing older members’ health care demands as “unworthy of care and treatment” (“buzhide zhi” in Chinese). It was also internalized by older people, based on which they deployed a family-oriented health-seeking model and strategically downgraded their expectation on receiving medical care. Moreover, underpinning this discouragement and devaluation, as well as making them culturally legitimate, is the social expectation of rural older people to be enduring and restrained with health-seeking. Simultaneously, this paper highlights the sourc2e of institutional and structural impediments, as they intersect with unfavorable socio-cultural values that normalize discouragement and devaluation.

Section: Introductionmentioning

confidence: 94%

“Unworthy of Care and Treatment”: Cultural Devaluation and Structural Constraints to Healthcare-Seeking for Older People in Rural China

Fitzgerald

Nie

2020

IJERPH

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“…The public hospitals became underfunded, and health provides increasingly reliant on revenues generated by fees for high-tech interventions and (often excessive) prescriptions [8]. Meanwhile, as much for the aged of expenditures were devoted to the development of larger hospitals in urban areas, rural hospitals suffered from severe staff and compromised quality of medical care facilities [9]. These institutional changes resulted in heightened financial barriers of accessing hospital care that further disadvantaged rural older people who were of lower socioeconomic status.…”

Section: The Social Cultural and Structural Backdrop Of Aunt Chen's mentioning

confidence: 99%

Discouragement Towards Seeking Health Care of Older People in Rural China: The Influence of Culture and Structural Constraints

International Perspectives in Values-Based Mental Health Practice

2020

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This chapter portrays a discouraged, dispiriting attitude towards health-seeking of rural older people in China. Based on the case of health-seeking of Aunt Chens’s family collected from a 6-month’s field work in a rural Chinese hospital, this chapter depicts how discouragement and discrimination operate in older members’ health-seeking experiences, throughout which older people’s health care was devalued as worthless socioeconomic burden. Underpinning discouragement and devaluation is the cultural value that encourages older people to be enduring with suffering and restricted with health-seeking. Simultaneously, this chapter traces various sources of institutional and social structural impediments, as they intersect with unfavourable cultural values that normalise discouragement and decimation.

“…44,45 Despite the state's efforts to reform the health system over the past decade, it is still unclear to what extent these efforts have alleviated the burden of medical expenditure shouldered by rural residents. 42,46 The final impediment to elder healthcare relates to the structural constraints imposed by the Chinese hukou system (household registration policy). 47 The hukou system assigns all Chinese residents to one of two household categories -rural or urban -based on their employment.…”

Section: Structural Causes Of Family Vulnerabilitymentioning

confidence: 99%

Family vulnerability for sick older adults: An empirical ethics study

Nie

2020

Nurs Ethics

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Background: In China, the conventional family-based ageing care model is under pressure from social transitions, raising the question of whether and to what extent families are still capable of dealing with the care of the aged. Objective: This article examines the vulnerability and inadequacy of families to bear responsibility for the care of the aged against a backdrop of socioeconomic transformation and diminishing institutional support in rural China. Research design: This article adopts an empirical ethical approach that integrates empirical investigation with ethical inquiry. Participants and research context: The empirical component of this article focuses on the lived experiences of caring for a wife and mother with dementia in one rural Chinese family, collected from a 6-month fieldwork study conducted at one primary hospital. Ethical considerations: Approval was obtained from the university ethics committee. Findings: The empirical study highlights a conflicted family process of managing and negotiating care that indicates the inadequacies and limited ability of families to deal with aged care tasks. In addition, inadequate structures and institutional deficiencies exacerbate the vulnerability of rural families and their inability to offer adequate care. Conclusion: Acknowledging the vulnerability of families as ageing care providers, this article calls for a socially supported family care model for rural older people in China and also proposes policy recommendations.