Despite of the potential role of service quality analysis from the beneficiaries’ perspectives in health system strengthening, its use has been limited in the developing world. More so, the analysis of socio-economic and demographic correlates of the perception differentials has been least addressed by the researchers. This study is an attempt to explore the perception of the urbanites regarding quality of health centres in Bhubaneswar, India and its socio-economic correlates. A cross-sectional study was carried out in which, data were collected from a sample of 180 respondents residing in six different types of residential localities of the city and an un-weighted hospital quality index was computed for analyzing the satisfaction level and its differentials, after carrying out the validity and reliability analyses of the index. Urbanites in this study were dissatisfied with many aspects of health care delivery in government health centres, like supply of medicines and availability of appropriate medical equipments. Although most of the respondents (78%) were quite satisfied with the private hospitals, there existed few lacunas to be bridged too. Overall satisfaction level was found to be associated with age (p=.134), migration status (p=.005), education (p=.000), residence type (p=.000), household size (p=.001) and income of the respondents (p=.000). A strong need of strengthening the government health centres was felt and so also taking measures to further improve private hospital quality in the city. There was also a need to address the disparity in health care service provision between slum and non-slum households, at an urgent basis.
Urban Health ; Urban Health Services ; India

In order to reduce the health inequalities within a society changes need to be made in broad health determinants and their distribution in the population. It has been expected that the Health impact assessment(HIA) and Healthy Cities can provide opportunities and useful means for changing social policy and environment related with the broad health determinants in developed countries. HIA is any combination of procedures or methods by which a proposed 4P(policy, plan, program, project) may be judged as to the effects it may have on the health of a population. Healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential. In Korea, social and academic interest regarding the HIA and Healthy Cities has been growing recently but the need of HIA and Healthy Cities in the perspective of reducing health inequality was not introduced adequately. So we reviewed the basic concepts and methods of the HIA and Healthy Cities, and its possible contribution to reducing health inequalities. We concluded that though the concepts and methods of the HIA and Healthy Cities are relatively new and still in need of improvement, they will be useful in approaching the issue of health inequality in Korea.
Health Planning/*methods ; Health Services Accessibility ; *Health Status Disparities ; Humans ; Korea ; *Urban Health ; Urban Population

BACKGROUNDGetting medical treatment is still difficult and expensive in western China. Improving the equity of basic health services is one of the tasks of the new healthcare reform in China. This study aimed to analyze the parallel and vertical equity of health service utilization of urban residents and then find its influencing factors.

METHODSIn August 2011, a household survey was conducted at 18 communities of Baoji City by multi-stage stratified random sampling. Based on the survey data, we calculated a concentration index of health service utilization for different income residents and a difference index of different ages. We then investigated the influencing factors of health service utilization by employing the Logistic regression model and log-linear regression model.

RESULTSThe two-week morbidity rate of sampled residents was 19.43%, the morbidity rate of chronic diseases was 21.68%, and the required hospitalization rate after medical diagnosis was 11.36%. Among out-patient service utilization, the two-week out-patient rate, number of two-week out-patients, and out-patient expense had good parallel and vertical equity, while out-patient compensation expense had poor parallel and vertical equity. The inpatient service utilization, hospitalization rate, number of inpatients, days stayed in the hospital, and inpatient expense had good parallel equity, while inpatient compensation expense had poor parallel equity. While the hospitalization rate and number of inpatients had vertical equity, the days stayed in hospital, inpatient expense, and inpatient compensation expense had vertical inequity.

CONCLUSIONSUrban residents' health was at a low level and there was not good health service utilization. There existed rather poor equity of out-patient compensation expense. The equity of inpatient service utilization was quite poor. Income difference and the type of medical insurance had great effects on the equity of health service utilization.

China ; Health Services ; utilization ; Healthcare Disparities ; Humans ; Multivariate Analysis ; Urban Health Services

The demand for knowledge of productive health and the current status of productive health services provided by relevant governmental institutions were qualitatively and quantitatively studied. The study identified the key factors that influenced the demand for the productive health services and results of the services. It also discussed the effective approaches to control, planning and sustainable development of the reproductive health services for the floating populations.
Attitude to Health ; China ; Health Services Accessibility ; Health Services Needs and Demand/*statistics & numerical data ; Questionnaires ; *Reproductive Health Services/supply & distribution ; Sampling Studies ; Transients and Migrants ; Travel ; Urban Health Services/*organization & administration ; Urban Health Services/standards ; Young Adult

OBJECTIVETo investigate the status of the clinical agency of detection, management, and health insurance for hypertensive patients in urban and rural communities of five provinces in China in 2010, in order to provide fundamental data for implementation and evaluation of community health management of hypertensive patients in basic public health service.

METHODSFrom Jiangsu, Shandong, Hebei, Sichuan and Gansu provinces, cities and districts (counties) were selected according to economic development level and 10 survey sites were finally determined. In each survey site, 3-4 communities or townships were selected by cluster sampling methods in 2010. A total of 8326 eligible hypertensive patients (4363 in urban and 3963 in rural) were included. The urban-rural difference of clinical agency and health insurance was compared for hypertensive patients.

RESULTSIn urban areas, 43.74% (1867/4268) hypertensive patients were first diagnosed at hospitals of district level or above, 25.07% (1070/4268) at community health service centers (CHSC), and 20.20% (862/4268) at community health service stations (CHSS), respectively; 30.72% (1274/4147) and 31.11% (1290/4147) patients chose CHSC and CHSS for their follow-up visiting, respectively; 60.23% (3073/5102) antihypertensive medication was obtained from pharmacies. In rural areas, 54.58% (2133/3908) hypertensive patients were first diagnosed at village clinics, 22.36% (874/3908) at township hospitals, and 18.86% (737/3908) at hospitals of county level or above; 70.49% (2695/3823) patients chose village clinics for their follow-up visiting; 46.23% (2116/4577) antihypertensive medication was obtained from village clinics, and 36.29% (1661/4577) from pharmacies. The main reasons for choosing clinical agency for both urban and rural patients were convenience (45.79%, 6276/13 706) and low cost (11.78%, 1614/13 706). The proportions of reimbursements for hospitalization expenses and total medical expenses for hypertensive patients in urban in the past year were 66.67% and 34.78%, respectively, which were much higher than those in rural (35.71% and 9.50%) (Z value was -12.13 and -17.56, P < 0.01).

CONCLUSIONCommunity-based hypertension detection and routine blood pressure measurement during clinical visiting should be further strengthened to improve early diagnosis of hypertension. The development of community-based clinical agency should be able to provide convenient and low cost health service for hypertensive patients to improve treatment, follow-up and control of hypertension.

Adult ; Aged ; China ; Cities ; Community Health Services ; Female ; Humans ; Hypertension ; diagnosis ; therapy ; Insurance, Health ; Male ; Middle Aged ; Public Health ; Rural Health Services ; Urban Health Services

OBJECTIVETo understand the satisfaction level and it's related factors of urban residents towards community-based preventive and health care service in Beijing.

METHODSThe community-based preventive and health care services were sorted as child immunization program, infectious disease prevention and control, and pregnant and maternal care. Based on the proportion of three categories service recipients accounted for the total number. A total of 431 service recipients were randomly and proportionally sampled from registered names. Then the service satisfaction household survey was carried out with standard questionnaire, and non-conditional logistic regression was conducted on the analysis of satisfaction and its related factors.

RESULTSGeneral satisfaction score was 3.93, with the satisfaction ratio of 71.9% (310/431). The satisfaction level of child immunization program and pregnant and maternal care was high, but that of infectious disease prevention and control was lower among three categories service recipients, with the satisfaction score of 3.99, 3.96 and 3.79, and the satisfaction ratio of 75.7% (165/218), 76.2% (77/101) and 60.7% (68/112) respectively. Initial impression (OR = 7.9, P = 0.008), service convenience (OR = 11.0, P<0.01), environment (OR = 23.4, P<0.01), skill (OR = 29.5, P<0.01), attitude (OR = 6.6, P = 0.020), privacy respect (OR = 88.1, P<0.01), equipment (OR = 25.7, P<0.01) and price (OR = 4.4, P = 0.013 ) were influencing factors.

CONCLUSIONThe general satisfaction should be considered high. While the apparatus and equipment should be renewed, the service environment should be improved. The service skill and attitude should improve more, and the residents' privacy should be respected. The preventive and health care services of infectious disease prevention and control should be strengthened.

China ; Community Health Services ; Consumer Behavior ; Humans ; Quality Assurance, Health Care ; Surveys and Questionnaires ; Urban Population

BACKGROUND: The majority of primary care consultations in Malaysia occur in the general practice clinics. To date, there is no comprehensive documentation of the morbidity and practice activities in this setting. OBJECTIVES: We reported the reasons for encounter, diagnoses and process of care in urban general practice and the influence of payment system on the morbidity and practice activities. METHODS: 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this study. General practitioners in these clinics completed a 2-page questionnaire for each of the 30 consecutive patients. The questionnaire requested for the following information: demographic data, reasons for encounter, important physical findings, diagnoses, investigations ordered, outpatient procedures performed, medical certificate given, medication prescribed and referral made. The morbidity (reasons for encounter and diagnoses) was coded using ICPC-2 and the medication data was coded using MIMS Classification Index. RESULTS: During 3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses (96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and diagnoses are in the following ICPC Chapters: Respiratory, General and unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies of selected aspects of the process of care (rate per 100 encounters) were: laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9, referral 2.4, and medication prescription 244. Consultation for chronic diseases and acute infections were influenced more by demographic variables (age, employment) rather than payment system. Cash-paying patients were more likely to receive laboratory investigations and injections. CONCLUSION: This study demonstrated the breadth of clinical care in the general practice. Relatively fewer patients consulted specifically for preventive care and treatment of chronic diseases. The frequencies of outpatient procedures and referrals appeared to be low. Payment system results in important differences in patient mix and influences some types of practice activities.
*Family Practice ; *Financing, Personal ; Malaysia ; *Morbidity ; *Process Assessment (Health Care) ; *Urban Health Services

OBJECTIVES: The Fourth Plenary Session of the 19th Central Committee of the Communist Party of China put forward the idea of "promoting the equalization of basic public services". The utilization of basic public health services by the floating population is an important indicator to measure the equalization of basic public health services. This study aims to understand the intergenerational differences in the utilization of basic public health services between the older generation and the new generation of floating population, and to analyze the influential factors. METHODS: We employed the personal questionnaire (A) of the national health and family planning dynamic monitoring survey on floating population in 2017. Pearson Chi-square test, bi-grouping logistic regression, and Poisson regression were applied to analyze the basic situation of the floating population and the intergenerational differences in the use of basic public health services between the new and old generations. RESULTS: The proportions of the new generation and the old generation who had established the residents' health records in the inflow area were 36.42% and 34.96%, respectively, with the significant difference ( CONCLUSIONS Although the coverage of basic public health services for the two generations of floating population is obviously different, the utilization of basic public health services of the floating population is still at a low level both in the new generation and in the old generation. There is an urgent need to improve the utilization of public health services for the whole floating population according to the characteristics of generations.
China/epidemiology* ; Educational Status ; Health Services ; Humans ; Rural Population ; Urban Population

PURPOSE: This study focused on analysing costs per visiting nursing care based on nursing activities in a public health center. METHOD: The Easley-Storfjell Instrument(1997) was used for a prospective descriptive analysis of self-records for workload data from 10 visiting nurses during 4 weeks on all nursing activities. In addition, analysis of the 478 visiting nursing records and cost data from 5 home visiting departments in public health centers during one year of 2003 was done. RESULT: The workload of visiting nurses by the type of model was identified as follows: Type I showed that caseloads made up 32.9 % of all nurse activities, and type II showed that the caseloads made up 45.8 %. Second, The cost per visit in type I was 33,088 won and 31,323 won in type II. Third, the estimated budgets were 1,902,436 won to 12,057,696 won for the type I model. and 4,151,316 won to 17,432,712 won for the type II model for one year. CONCLUSION: This study's results will contribute to baseline data used to establish on infrastructure for visiting nursing program and visiting nursing agencies based on the budget of visiting nursing services.
Community Health Nursing/*economics ; Costs and Cost Analysis ; Humans ; Korea ; Public Health Nursing/*economics ; Urban Health Services/*economics

OBJECTIVETo provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms.

METHODSA cross-sectional study, adopting Aday and Andersen' s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed.

RESULTSThe percentage of self-reported symptoms of RTIs in urban and rural women was 35.6 and 46.8, respectively; the proportion of women with RTIs who utilised health services was 27.5% and 26.7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self-medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs.

CONCLUSIONThe prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women' s ability for self-care. Regular medical check-ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women' s social stigma related to RTIs, giving women social and moral support.

Adult ; China ; Cross-Sectional Studies ; Female ; Genital Diseases, Female ; therapy ; Health Services Needs and Demand ; Humans ; Infection ; therapy ; Middle Aged ; Rural Health ; Urban Health ; Women's Health Services ; utilization