Early appraisal of China's huge and complex health-care reforms

Yip, Winnie; Hsiao, William C.; Chen, Wen; Hu, Shanlian; Ma, Jing; Maynard, Alan

doi:10.1016/s0140-6736(11)61880-1

Cited by 1,013 publications

(878 citation statements)

References 39 publications

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“…Misaligned economic incentive for health providers is the main contributor to the overprescribing of antibiotics in China. Although China has implemented a zero drug profit policy since 2009, which aimed at removing profits on drug sales of health facilities, the connection between drug companies and individual doctors still contributes to this problem [18,19]. Compared with more developed regions, healthcare providers in less developed regions had lower incomes, experienced relaxed regulations, and were more likely to profit from overprescribing antibiotics [7,15,20].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

Peng

Wang

et al. 2018

Global Health Action

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Background: Antimicrobial resistance (AMR) is a great threat to public health. The primary cause of AMR is human antibiotic misuse. Little is known about regional differences of antibiotic misuse behaviours in China. Objectives: To explore the antibiotic misuse behaviours among university students in western and eastern China and find out the regional differences. Methods: Participants were recruited from universities in less developed Guizhou Province and developed Zhejiang Province using a cluster random sampling method. A self-administered questionnaire was designed to collect data, and the χ2 test and logistic regression were adopted to assess the associations between region and antibiotic misuse behaviours. Results: A total of 2073 university students from Guizhou and 1922 from Zhejiang completed questionnaires. Students in Guizhou had lower household income, parents’ education, and urban residence proportion than those in Zhejiang. Compared with those in Zhejiang, students in Guizhou had higher antibiotic use prescribed by doctors (79.8% vs 56.2%) and self-medication with antibiotics (33.0% vs 16.1%). Students in Guizhou were more likely to buy over-the-counter antibiotics without prescriptions (73.9% vs 63.4%), ask for antibiotics from doctors (21.4% vs 15.6%), and use antibiotics prophylactically (29.9% vs 15.7%). Adjusted models showed that the less developed region was significantly associated with higher antibiotic misuse behaviours. Conclusions: Misuse of antibiotics by well-educated young adults was very high in two regions but most serious in the less developed one. Campaigns are urgently needed to promote appropriate antibiotic use especially in less developed regions.

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Section: Discussionmentioning

confidence: 99%

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

Peng

Wang

et al. 2018

Global Health Action

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“…step-by-step, to first implement affordable measure(s), and gradually add sophisticated measure(s) in the program possibly over a long time. In China, the recent healthcare reform with a huge investment (Yip et al, 2012) may well allow China to "Stand Up and Do Something" (UICC, http://www.worldcancerday.org) now to alleviate the country's significant contribution to the world burden of cervical cancer (IARC, http:// globocan.iarc.fr/factsheet.asp), particularly in low-income rural and mountain communities.…”

Section: Implementing Community-based Cancer Awareness Programs Is a mentioning

confidence: 99%

“…In the recent 3-year healthcare reform launched in 2009, China has pumped CN¥850 billion (US$125 billion) to act as the first phase toward achieving comprehensive universal health coverage by 2020 (Yip et al, 2012). This provides an excellent opportunity for medical communities to argue for a sustainable national program for cervicalcancer control as the reform prioritizes primary healthcare systems (Yip et al, 2012), which covers low-income settings where the incidence and mortality of cervical cancer are historically high in China.…”

Section: Introductionmentioning

confidence: 99%

“…This provides an excellent opportunity for medical communities to argue for a sustainable national program for cervicalcancer control as the reform prioritizes primary healthcare systems (Yip et al, 2012), which covers low-income settings where the incidence and mortality of cervical cancer are historically high in China. Before a national program for cervical cancer is established and HPV vaccines become available, however, should public health workers in low-income communities do something now?…”

Section: Introductionmentioning

confidence: 99%

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Implementing a Cervical Cancer Awareness Program in Low-income Settings in Western China: a Community-based Locally Affordable Intervention for Risk Reduction

Simayi¹,

Yang²,

Li³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Some 60 years after introduction of the Papanicolaou smear worldwide, cervical cancer remains a burden in developing countries where >85% of world new cases and deaths occur, suggesting a failure to establish comprehensive cervical-cancer control programs. Effective interventions are available to control cervical cancer but are not all affordable in low-income settings. Disease awareness saves lives by risk-reduction as witnessed in reducing mortality of HIV/AIDS and smoking-related cancers. Subjects and Methods: We initiated a community-based awareness program on cervical cancer in two low-income Muslim Uyghur townships in Kashi (Kashgar) Prefecture, Xinjiang, China in 2008. The education involved more than 5,000 women from two rural townships and awareness was then evaluated in 2010 and 2011, respectively, using a questionnaire with 10 basic knowledge questions on cervical cancer. Demographic information was also collected and included in an EpiData database. A 10-point scoring system was used to score the awareness. Results: The effectiveness and feasibility of the program were evaluated among 4,475 women aged 19-70 years, of whom >92% lived on/ below US$1.00/day. Women without prior education showed a poor average awareness rate of 6.4% (164/2,559). A onetime education intervention, however, sharply raised the awareness rate by 4-fold to 25.5% (493/1,916). Importantly, low income and illiteracy were two reliable factors affecting awareness before or after education intervention. Conclusions: Education intervention can significantly raise the awareness of cervical cancer in low-income women. Economic development and compulsory education are two important solutions in raising general disease awareness. We propose that implementing community-based awareness programs against cervical cancer is realistic, locally affordable and sustainable in low-income countries, which may save many lives over time and, importantly, will facilitate the integration of comprehensive programs when feasible. In this context, adopting this strategy may provide one good example of how to achieve "good health at low cost".

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“…Simultaneously, emerging middle-class expectations of healthcare services have increased, and misaligned economic incentives for doctors earning low salaries have challenged medical professionalism. 5 Cash gifts to providers (hongbao) are illegal, but prevalent. Consumers' high out-of-pocket expenses and questions about the quality of care have fuelled public anger and violence against healthcare providers.…”

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confidence: 99%

China's 50% caesarean delivery rate: is it too high?

Hellerstein

Feldman

Duan

2014

BJOG

119

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China has one of the highest rates of caesarean delivery in the world. Of the 16 million babies born in 2010, approximately half were by caesarean, with 107 330 in Shanghai alone. 1 Understanding the reasons underlying this practice preference in China may provide insight into factors influencing caesarean rates in other countries.After the 1949 Communist revolution in China, national health policy emphasised public health. Health care was centrally planned, and focused on the provision of preventive care, vaccination, and basic medical care to a predominantly rural Chinese population. Obstetric care provided basic prenatal care and prevention of complications of pre-eclampsia, perinatal infections, and postpartum haemorrhage through the training of birth attendants.China's population grew to nearly 1 billion by 1978. Fears of over-population prompted the 'later, longer, fewer' campaign, which decreased total fertility rates from 5.8 to 2.7. 2 In 1979 the 'One Child Family' policy limited Han couples (the majority ethnic group) to a single child.In the 1980s, China's economy evolved from a socialist model to a state-controlled market economy, which grew at over 9% each year for decades, accompanied by the increasing urbanisation of the population. The centralized commune healthcare system was dismantled and replaced with a decentralised fee-for-service model that left most Chinese poorly insured. By 2002, 81% of the rural poor had no healthcare coverage, and out-of-pocket expenses that were 20% in 1979 rose to 58% by 2002. To offset reduced government healthcare spending, hospitals were allowed to increase fees and mark-up charges on medications, changes that resulted in increased costs of care, misuse of services, and the over-prescription of medications. 3

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Early appraisal of China's huge and complex health-care reforms

Cited by 1,013 publications

References 39 publications

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

Implementing a Cervical Cancer Awareness Program in Low-income Settings in Western China: a Community-based Locally Affordable Intervention for Risk Reduction

China's 50% caesarean delivery rate: is it too high?

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