The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China

Background  

The New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes.     

Evaluation of the new rural cooperative medical system in China: is it working or not?

Background  

To prove the possibility of implementing the New Rural Cooperative Medical System (NRCMS) at different levels with a premium funding according to their economic level in developed and less developed areas in Guangdong province, and study the insurable inpatients in different types of regions, taking into account limitations of indemnities and loss ratios.     

The attitude of farmers to the New Rural Cooperative Medical Scheme in Northwest China one year after its introduction: a cross-sectional study

Aim

The implementation of the Chinese New Rural Cooperative Medical Scheme (NRCMS) spread fast since a county pilot trial in 2003. The purpose of this survey is to guide policy-makers on how to improve the current national NRCMS policy.

Subject and methods

Cross-sectional survey of 1,978 farmers in 50 villages in Huxian Shaanxi Province on their attitudes towards the NRCMS administered door-to-door in 2005.

Results

Most farmers hold a positive attitude towards the NRCMS. However, they do not trust the scheme management. Farmers place more trust in village doctors rather than village cadres for fund collection. More than two thirds of farmers seek care in county hospitals directly, bypassing village clinics and township hospitals. Not all hospitals and doctors fully comply with the NRCMS rules, and supplier-induced demand is still widespread. More than half of farmers worry that the NRCMS is not sustainable. Importantly, the survey showed a high enrolment rate of 92% (95% CI, 91; 93) in a voluntary insurance scheme.

Conclusion

A number of remedial actions in health financing, planning and management to counteract the identified issues are proposed.     

Current level and determinants of inappropriate admissions to township hospitals under the new rural cooperative medical system in China: a cross-sectional study

Background

The increased funding and reimbursement for the New Rural Cooperative Medical System (NRCMS) have provided residents in rural China with better access to inpatient services. This research aims to examine the level of inappropriate admissions to township hospitals under NRCMS, and the determinants that influence inappropriate admissions.

Methods

A total of 2,044 medical records in 10 township hospitals were collected from five counties in Midwestern China by stratified cluster sampling and evaluated using the Appropriateness Evaluation Protocol (AEP), which was developed by a Delphi expert consultation of 32 experts. A two-level logistic regression model by MLwiN 2.30 was used to examine the determinants of inappropriate admissions.

Results

Township hospitals had an average inappropriate admission rate of 26.5%. The highest rate of inappropriate admission was among patients aged more than 59 years old (30.1%). Inappropriate admissions mostly occurred for respiratory and circulatory diseases. Township hospital similarity and clustering were observed. Two-level logistic regression analysis showed that age, treating department, and disease were determinants of inappropriate admission.

Conclusions

Township hospitals have a high rate of inappropriate admissions. Explicit diagnostic criteria and a standardized supervision system should be developed to reduce this.

     

A case control study of differences in non-work injury and accidents among sawmill workers in rural compared to urban British Columbia, Canada

Background  

Using a cohort of British Columbian male sawmill workers, we conducted a nested case-control study of the impact of rural compared to urban residence as well as rural/urban migration patterns in relation to hospitalization for non-work injury. We postulate that for many types of non-work injuries, rates will be higher in rural communities than in urban ones and that rates will also be higher for workers who migrate from urban to rural communities.     

Utility of a thematic network in primary health care: a controlled interventional study in a rural area

Background  

UniNet is an Internet-based thematic network for a virtual community of users (VCU). It supports a virtual multidisciplinary community for physicians, focused on the improvement of clinical practice. This is a study of the effects of a thematic network such as UniNet on primary care medicine in a rural area, specifically as a platform of communication between specialists at the hospital and doctors in the rural area.     

Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital

Background  

The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger.     

Geocoding rural addresses in a community contaminated by PFOA: a comparison of methods

Background  

Location is often an important component of exposure assessment, and positional errors in geocoding may result in exposure misclassification. In rural areas, successful geocoding to a street address is limited by rural route boxes. Communities have assigned physical street addresses to rural route boxes as part of E911 readdressing projects for improved emergency response. Our study compared automated and E911 methods for recovering and geocoding valid street addresses and assessed the impact of positional errors on exposure classification.     

Delayed treatment of tuberculosis patients in rural areas of Yogyakarta province,Indonesia

Background  

In year 2000, the entire population in Indonesia was 201 million and 57.6 percent of that was living in rural areas. This paper reports analyses that address to what extent the rural structure influence the way TB patients seek care prior to diagnosis by a DOTS facility.     

Physical activity and sedentary behaviours among rural adults in suixi,china: a cross-sectional study

Background  

Modernisation and urbanisation have led to lifestyle changes and increasing risks for chronic diseases in China. Physical activity and sedentary behaviours among rural populations need to be better understood, as the rural areas are undergoing rapid transitions. This study assessed levels of physical activity and sedentary behaviours of farming and non-farming adults in rural Suixi, described activity differences between farming and non-farming seasons, and examined correlates of leisure-time physical activity (LTPA) and TV viewing.     

Rural to urban migration and changes in cardiovascular risk factors in Tanzania: a prospective cohort study

Background  

High levels of rural to urban migration are a feature of most African countries. Our aim was to investigate changes, and their determinants, in cardiovascular risk factors on rural to urban migration in Tanzania.     

Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years

Background  

The burden of non-communicable chronic diseases, such as hypertension and diabetes, increases in sub-Saharan Africa. However, the majority of the rural population does still not have access to adequate care. The objective of this study is to examine the effectiveness of integrating care for hypertension and type 2 diabetes by task shifting to non-physician clinician (NPC) facilities in eight rural health districts in Cameroon.     

Extreme temperatures and mortality in the North of Spain

Objective  

To study the relationship between mortality and temperature in Cantabria, a Spanish region that includes both rural and urban areas.     

Culturally-adapted and audio-technology assisted HIV/AIDS awareness and education program in rural Nigeria: a cohort study

Background  

HIV-awareness programs tailored toward the needs of rural communities are needed. We sought to quantify change in HIV knowledge in three rural Nigerian villages following an integrated culturally adapted and technology assisted educational intervention.     

Role of educational level in the relationship between Body Mass Index (BMI) and health-related quality of life (HRQL) among rural Spanish women

Background  

The impact of obesity on health-related quality of life (HRQL) has been little explored in rural areas. The goal of this study is to ascertain the association between obesity and HRQL among Spanish women living in a rural area, and the influence of their educational level.     

Chinese urban–rural disparity in pandemic (H1N1) 2009 vaccination coverage rate and associated determinants: a cross-sectional telephone survey

Objectives

The present study aimed to examine the differences in pandemic (H1N1) 2009 vaccination coverage rate between urban and rural areas in China, and to explore factors associated with any urban–rural differences.

Study design

Cross-sectional study.

Methods

Data were derived from a cross-sectional telephone survey performed in seven urban and two rural areas soon after the pandemic peak in China, concerning pandemic (H1N1) 2009 vaccination and associated knowledge, attitudes and practices among the general population in China. A total of 10 669 participants aged 18 years and above participated in the study.

Results

Vaccination amongst rural residents was less than urban residents (8.9% vs 11.2%, P = 0.002). Among those who have not been immunized, 82.2% of rural respondents showed a willingness to get vaccinated against A/H1N1, significantly higher than that of urban respondents (55.3%). The major barrier to vaccination was reported as ‘not being informed to get vaccination’, of which there was a greater proportion in rural than urban population (71.9% vs 68.8%, P = 0.009). The analysis revealed a number of factors which contribute to this disparity: previous experience of vaccination against flu, degree of awareness of the free vaccination policy, and sociodemographic differences between urban and rural areas.

Conclusions

Significant discrepancies existed in the pandemic (H1N1) 2009 vaccination coverage rate and associated determinants, as well as the intention to get vaccinated between urban and rural residents. To improve the effectiveness of similar vaccination programmes in the future, campaigns for rural people need to be specifically tailored to address disparities in uptake.     

Smoking habits and health-related quality of life in a rural Japanese population

Purpose  

To investigate the association between smoking and health-related quality of life (HRQOL) in a rural Japanese population.     

Incidence and pattern of injuries among residents of a rural area in South-Western Nigeria: a community-based study

Background  

Despite the high incidence of infectious diseases in developing countries, injuries still contribute significantly to the health burden. There are few reports of rural, community-based injury surveys in Nigeria. This study describes the incidence and pattern of injuries among the residents of a rural area in South-Western Nigeria.