Health in china: From Mao to market reform

Hesketh, Thérèse; Wei, Xing

doi:10.1136/bmj.314.7093.1543

Cited by 82 publications

(68 citation statements)

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“…A cooperative medical system was developed in China in the 1950s to provide basic health care and preventive services (Hesketh & Wei, 1997). Widespread immunization campaigns were started at this time.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the growth rate of group A is similar to that estimated for HCV genotype 4 in Egypt (Pybus et al, 2003;Tanaka et al, 2004), which was spread rapidly during the twentieth century by extensive Egypt-wide anti-schistosomiasis injection campaigns (Frank et al, 2000). The growth rate of group B appears to be higher than that of HCV genotype 4 in Egypt.According to Chen et al (2002), the prevalence of anti-HCV in China is significantly higher among post-transfusional A cooperative medical system was developed in China in the 1950s to provide basic health care and preventive services (Hesketh & Wei, 1997). Widespread immunization campaigns were started at this time.…”

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confidence: 99%

“…However, medical schools and specialist hospital departments closed during the 'Cultural Revolution' during the years [1966][1967][1968][1969][1970][1971][1972][1973][1974][1975][1976]. Over a million non-professional health-care providers ('barefoot doctors') were provided with limited training and were responsible for the health care in the countryside (Brown et al, 1984;Hesketh & Wei, 1997). Under such circumstances there is potential for the transmission of bloodborne viruses such as HCV, particularly by unsafe injection and traditional Chinese acupuncture (Hsu, 1996).…”

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confidence: 99%

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Population genetic history of hepatitis C virus 1b infection in China

Nakano

Lü

et al. 2006

Journal of General Virology

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Subtype 1b is the most common strain of Hepatitis C virus (HCV) in China. Here, the molecular epidemiology and epidemic history of this strain were investigated by conducting phylogenetic and population genetic analyses of E1 and NS5B gene sequences sampled from nine Chinese cities. The phylogenetic analysis indicated the presence of two clusters of Chinese strains that did not include reference strains from other countries, suggesting that these clusters represent two independent chains of HCV transmission within China. The remaining Chinese isolates were more closely related to reference strains from other countries. The date of origin and past population dynamics of the two groups were investigated using a new population genetic method, the Bayesian skyline plot. The estimated dates of origin of both groups coincide with the period of the Chinese 'Cultural Revolution' during the years [1966][1967][1968][1969][1970][1971][1972][1973][1974][1975][1976]. Both groups grew at a rapid exponential rate between~1970 and~1990, after which transmission slowed considerably. Possible explanations for the groups' fast spread and subsequent slowdown are discussed, including parenteral transmission by unsafe injection, iatrogenic transmission by infected blood or blood products and improvements in blood safety since 1990. These results shed light on HCV transmission in China and may help to predict the future burden of HCV-related disease in the country. INTRODUCTIONHepatitis C virus (HCV) is a genetically diverse RNA virus with a single-stranded, positive-sense genome. The virus is classified into six major genotypes with closely related isolates within each genotype being grouped into subtypes (Simmonds et al., 1993;Robertson et al., 1998). Partial genome sequences, particularly those from the E1 and NS5B genes, are commonly used in HCV genotyping and evolutionary analysis (e.g. Simmonds et al., 1993;Smith et al., 1997). Different HCV genotypes and subtypes have different geographical distributions, transmission routes and rates of spread (Bukh et al., 1993;Smith et al., 1997;Pybus et al., 2001). 'Epidemic' subtypes, such as 1a, 1b and 3a, are typically found at high prevalences globally having spread rapidly during the twentieth century, probably via infected blood, blood products and injecting drug use. In contrast, 'endemic' strains of HCV are usually less prevalent, found in restricted geographical areas and represent long-term, low-level endemic infection in particular populations Pybus et al., 2001).Evolutionary analysis of sampled virus sequences has advanced considerably during the past decade and is now an important tool in molecular epidemiology. In addition to standard phylogenetic analysis, population genetic methods based on coalescent theory can be used to estimate epidemiological history from viral gene sequences. Coalescent 3These authors contributed equally to this work. , 2003Tanaka et al., 2002Tanaka et al., , 2004Tanaka et al., , 2005Nakano et al., 2004).It has been estimated that 2?5-4?9 % of China's...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Population genetic history of hepatitis C virus 1b infection in China

Nakano

Lü

et al. 2006

Journal of General Virology

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“…In 1950, the newly established government faced a situation racked by poverty and disease after long-term wars, malnutrition and endemic disease, and the industrial base was in ruins [3]. In politics, the government adopted systematically planned and strongly enforced organizational principles.…”

Section: Factors Affecting Successmentioning

confidence: 99%

Urban Health Insurance Reform in China

Xin¹,

Amsbary²,

Powell³

2014

Advances in Intelligent Systems Research

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Abstract:The healthcare system for urban employees in China was established in the early 1950s. The first stage (1950s-1980) mainly consisted of two parts, the Government Insurance Scheme (GIS) and the Labor Insurance Scheme (LIS). The GIS and LIS achieved remarkable success with limited resources, contributed to economic development and social stability, and won high praise from the World Health Organization. The second stage (1980s to date) aimed at controlling costs and expanded the risk pool to the city level, but experienced several problems, was not well received by the public, and drew negative government evaluations. This study examines underlying reasons and offers recommendations for improvement. Stage I: 1950s-1980The health insurance system for China's urban workers was first established in the early 1950s and consisted of two parts: the Government Insurance Scheme (GIS), which covered government employees, retirees, disabled veterans, and university teachers, staff and students; and the Labor Insurance Scheme (LIS), which covered state enterprise employees, retirees and their dependents. Only state-owned enterprises (SOE, enterprises owned and managed by central or provincial governments) with more than 100 employees were required to participate in the LIS; smaller state enterprises and industries owned by local governments participated on a voluntary basis. Both the GIS and LIS provided -longitudinal‖ insurance, i.e., individual government agency and SOE only insured their own employees and there was no linkage and reciprocity across them at the community level. Both approaches were financed by the government.The GIS and LIS provided comprehensive health care benefits. Beneficiaries received free outpatient, inpatient services and prescription drugs, which were often called -Free Medical Care.‖ Dependents of the LIS beneficiaries were provided with a 50 percent coinsurance for their medical service and drugs. Small collectively owned enterprises enrollees enjoyed similar benefits to those of rural workers. Each collective unit ran its own insurance programs. Their employees were usually covered but not necessarily their dependents. Often the employees had to pay for their medical expenses first and to obtain reimbursement later.China developed a three-tiered organization for the delivery of health care. The three-tier hospitals had similar functions but were different in scale and -target‖ groups. In Shanghai's case, the three levels were the municipal, district and street level. Each level covered a defined beneficiary population, and lower-level hospitals could refer patients to higher ones when it was unable to treat them due to a lack of necessary skills and/or equipment. In addition, most large work units had their own hospitals,

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“…2 Since the launch of economic reform in 1978, China's healthcare system has been transformed. Between 1978 and 1999, the central government's share of national healthcare spending was reduced from 32% to 15%, leading to predictable sequelae.…”

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confidence: 99%