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Integrating pension service with medical service for the elderly:Necessity, dilemmas and solutions

Chinese Journal of Health Policy.2014;(6):63-68. doi:10.3969/j.issn.1674-2982.2014.06.011

Along with the degree of population ageing worse off continuously, the demand for medical service is growing. The current system of pension service and medical service are discrete and separate, and integrating pen-sion service with medical service is the best choice for China. However, there are some problems with the model for integrating pension service with medical service. These problems include the lack of funding, negative participation and imperfect methods of service delivery; high toll levels and single, rigid service contents; and bull management and policies hard to enforce. China should improve the service delivery model, identify service content according to the demand for service object, and improve the mechanism of government management.

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Analysis on the group purchasing organizations in the United States and its implications for Chinese drug procurement

Rong SHAO ; Jinping XIE ; Rong JIANG

Chinese Journal of Health Policy.2014;(6):35-40. doi:10.3969/j.issn.1674-2982.2014.06.007

In this paper, basic characteristics of group purchasing organizations ( GPOs) and its implications for US health care system are analyzed using a literature research method. The main contents include the development process, type, basic functions, drug procurement processes, fee sources, characteristics and influence for the hospi-tals, supplies, regulators of GPOs. We suggest that GPOs have helped US health care providers save a lot of money and played an important role in the healthcare supply chain. We also suggest that market mechanisms should be intro-duced widely concerning the model innovation and improvement of domestic drug procurement. At the same time, government and the market should be coordinated properly. Moreover, scientific evaluation methods should be set in consideration of drug quality, prices and its economic practicality.

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Comparative analysis of changes in provincial health expenditure since China health system re-form in 2009

Congcong WANG ; Quan WAN ; Yuhui ZHANG ; Peipei CHAI ; Feng GUO ; Qiang WEI ; Tiemin ZHAI ; Xiufeng WANG

Chinese Journal of Health Policy.2014;(6):22-27. doi:10.3969/j.issn.1674-2982.2014.06.005

Objective:To analyze the characteristics of health financing at the provincial level according to the total health expenditure since China health system reform began in 2009 and provide evidence for improving health fi-nancing policy. Methods:20 provinces were chosen and vertical and horizontal Comparative approach was used to an-alyze the data. Results:Total health expenditure increased for all regions, of which the biggest rate was Anhui prov-ince, about 82. 97%, while the largest increasing for government health care expenditure was Ningxia province, a-bout 108 . 71%. In 2012 , the provinces with social health expenditure share of total above 40% were allocated in the east region, and the number of provinces with out-of pocket payment share of total above 40% reduces to 5. Conclu-sion:Total health expenditure grew in all regions, but there were differences in the degree that this spending matched the economic level;The financing structure was optimized, but the characteristic of regional financing was different. Some provinces were under huge pressure to reduce out-of pocket payments. Suggestions: Under the premise of im-proving the funding level, financing structure adjustment must be focused, and public funding should play a bigger role and out-of pocket payments should be reduced.

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Public-interest-oriented indicator system for performance assessment in public hospitals

Xiaosen LI ; Li WEI ; Min FU ; Hongxing YU ; Lan YAO ; Ying LI ; Honghui CHEN ; Hongxing ZHANG ; Tao LI ; Zhiyong LIU

Chinese Journal of Health Policy.2014;(6):16-21. doi:10.3969/j.issn.1674-2982.2014.06.004

Objective: To develop an indicator system for assessing public hospital performance. Methods:Based on literature research and expert consultation, we formed an indicator system framework and indicators for as-sessing public hospital performance. Using Delphi expert consultation, focus group interviews, focus group discussion and individual in-depth interview qualitative research methods, we constructed a public hospital performance evalua-tion indicators. Results:There are four dimensions, 11 secondary indicators, 30 tertiary indicators in the indicator system, depending on the level of hospital, the indicators and weights are adjusted. Conclusion:The indicator system is suitable for public-interest-oriented performance assessment of public hospitals, and provides basis for the perform-ance assessment system.

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Obstacles and strategies on bottom-up cascading healthcare practice in China

Youde GUO ; Hong LIANG

Chinese Journal of Health Policy.2014;(6):6-9. doi:10.3969/j.issn.1674-2982.2014.06.002

In this paper, we describe mismatch, chaos, and disorder behavior during healthcare seeking. Such structural imbalances, scarcity and surplus make healthcare services less efficient. We give reasons for such phenomena in terms of long-term effects of health resource allocation policy-making and implementation, inherent de-fects within healthcare insurance, incomplete market development, and cultural issues. We then propose four policy strategies, including rational price mechanism, strict referral healthcare system, confidence in basic healthcare facili-ties, and proper healthcare cultures. These will restore orderly healthcare behavior and help realize expectations for the current healthcare reform in China.

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Effect of doctors' home-visiting on health related behaviors of patients with diabetes in rural areas：A sample survey in three counties in Shandong Province

Yang ZHAO ; Xiaoyun LIU ; Xiaojie SUN ; Qingyue MENG

Chinese Journal of Health Policy.2014;(6):73-78. doi:10.3969/j.issn.1674-2982.2014.06.013

Objective:This article discusses the status of the health behaviors of rural people with diabetes, to explore effect of doctors’ home-visiting on the behavior of patients with diabetes in rural areas, and to promote chronic disease management and public health service equalization in rural areas . Methods:Junan, Liangshan, and Pingyin counties in Shandong province were sampled using a multi-stage stratified sampling method, and data was collected from 401 questionnaires issued to people with diabetes. A chi-square test and multivariate logistic regression were used to analyze the determinants. Results:Only 52. 0% of diabetes patients received home-visiting from doctors in the surveyed rural areas. Doctors’ visiting works on medication behavior on time and appropriate exercise of patients with diabetes in rural areas was statistically significant, but did not work on measuring blood glucose and periodic review and other health-related behaviors. Conclusion:The rate of doctor home-visiting is low, and the effect is not obvious. More attention should be paid to the content and quality of doctors’ home visiting, and strong policies should support and guide it. According to the characteristics of the rural and patients behavior changing, it is necessary to take flexi-ble modes of health service, improve the diabetes management in rural areas, and promote the equalization of public health service.

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Comments and revision suggestions on banning tobacco advertisement items of the Advertise-ment Law Revised Draft of People’s Republic of China

Gonghuan YANG ; Jie YANG ; Jinrong HUANG

Chinese Journal of Health Policy.2014;(6):69-72. doi:10.3969/j.issn.1674-2982.2014.06.012

When revising Advertisement Law ( AL) of People's Republic of China, a basic principal is the comprehensive banning of direct or indirect tobacco advertising and implementing the WHO Framework Conven-tion on Tobacco Control ( FCTC) . After comparing the AL Revised Draft ( ALRD) with the AL, the Interim Man-agement Regulation for Tobacco Advertisements ( IMRTA) , and FCTC article 13 and its implementation guide-line, we found that ALRD did not ban all kinds of the tobacco advertising in all public places by using different channels, couldn’t clearly define the covert and false advertisements on tobacco, so that the epidemic of tobacco advertising cannot be curbed in China. In addition, this ALRD still permits the tobacco advertising in some places, and this does not satisfy the FCTC requirement. Therefore, China cannot honor its commitments as a re-sponsible big country. According to above analysis, we proposed some suggestions on comprehensive banning all the direct and indirect tobacco advertisements.

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Associations of environmental factors with health and mortality among Chinese elderly:A sam-ple survey in 22 provinces in China

Yi ZENG ; Danan GU ; Purser JAMA ; Hoenig HELEN ; Christakis NICHOLAS

Chinese Journal of Health Policy.2014;(6):53-62. doi:10.3969/j.issn.1674-2982.2014.06.010

We analyzed data from a nationally representative sample of 15,973 elderly residents from 866 coun-ties and cities in 2002 and followed up in 2005 with multilevel logistic regression models to investigate how social, eco-nomical environmental factors are associated with health outcomes and mortality risk. After control individual-level fac-tors, we found that air pollution increased the odds of disability in activities of daily living ( ADLs) , cognitive impair-ment, and health deficits index. More rainfall was protective, reducing the odds of ADL disability and cognitive impair-ment. Extremely low seasonal temperatures increased the odds of ADL disability and mortality. Extremely high seasonal temperatures increased the odds of cognitive impairment and health deficit index. Living in a mountain area decreased the odds of ADL disability and health deficits. The conclusion is that efforts to reduce pollution and improve socioeco-nomic conditions could significantly improve the health and survival of the elderly.

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Health care need and utilization among China’s aged population:Data from the National Health Services Survey 1998 to 2008

Kaihua GAO ; Juncheng QIAN ; Tuohong ZHANG

Chinese Journal of Health Policy.2014;(6):47-52. doi:10.3969/j.issn.1674-2982.2014.06.009

Objective:To explore trends in health care need and utilization among China’s aged population and provide a reference for policy-making on medical service provision for the aging population. Methods:The paper ana-lyzes prevalence, outpatient utilization, hospitalization, and medical expenses of the aging population using large comparable sample data from National Health Services Survey in 1998 , 2003 and 2008 . Results: From 1998 to 2008 , the two-week prevalence rate ranged from 29 . 0% to 43 . 2%; the prevalence rate of chronic diseases ranged from 50 . 2% to 59 . 5%; the two-week visiting rate ranged from 31 . 7% to 28 . 3%; and the hospitalization rate ranged from 7 . 9% to 13 . 8%. Conclusion:Chronic diseases have been the major health issues of the aging popula-tion. The financial burden greatly reduces the utilization of medical care among the aged population. A health system that can respond to the aged population quickly is much needed.

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Study on the essential medicines supply of medical institutions at county-level in Shaanxi Province

Lina WU ; Dehong WEI ; Chen CHEN ; Yuankui LI ; Qian SHEN ; Zhongliang ZHOU ; Bing LV ; Minghuan JIANG ; Xiao WANG ; Shimin YANG ; Yu FANG

Chinese Journal of Health Policy.2014;(6):41-46. doi:10.3969/j.issn.1674-2982.2014.06.008

Objective: To analyze the essential medicines supply of medical institutions at county-level in Shaanxi Province and to provide empirical evidences and suggestions to improve relevant policies. Methods:A strati-fied cluster random sampling method was used to choose the institution samples. A survey was conducted to study the supply of essential medicines in 2012. Indicators include the variety and amount of essential medicines procured, the medicine shortage condition, and the rate of winning the bid for essential medicine. Results:Essential medicines ac-counted for 69 . 1% of all medicines;and procurement of essential medicines accounted for 42 . 4% of all procurement spending on medicines. Of the top 25 chemical products of essential medicines, provincial supplementary medicines accounted for 33. 9%;and among the top 25 traditional Chinese medicines of essential medicines, the provincial sup-plementary medicines accounted for 51. 9%. All 27 medical institutions faced a shortage of medicines. There were 47 kinds of essential drugs in urgent need were out of bid. Conclusion:Essential medicine supply of medical institutions at county-level is in good condition;however, more attention needs to be paid to medicine shortage. We should take measurements to standardize the process of bidding for essential medicines and strengthen the management of medi-cine shortage in order to better meet patients’ needs.

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