Health status in a transitional society: urban-rural disparities from a dynamic perspective in China

Background

The phenomenon of urban-rural segmentation has emerged and is remarkable, and the health disparities between rural and urban China should be stressed.

Methods

Based on data from the Chinese General Social Survey from 2005 to 2013, this study not only explored the net age, period, and cohort effects of self-rated health, but compared these effects between rural and urban China from a dynamic perspective through hierarchical age-period-cohort-cross-classified random effects model.

Results

Urban-rural disparities, as well as work status and gender disparities in health increased with age, in line with the cumulative advantage/disadvantage effects theory, while marital status disparities in health declining with age was in line with the age-as-leveler effects theory. The war cohort, famine cohort, later cultural revolution cohort, and early reform cohort had poorer health than did those in the early China cohort, economic recovery cohort, and later reform cohort. The economic crisis period, war cohort, baby boomer, and early cultural revolution cohort encountered larger urban-rural health disparities, while the early China cohort and early reform cohort experienced smaller urban-rural disparities in health.

Conclusions

Population health is closely related to social context and health care development. It is necessary to keep economic development stable and boost medical technology improvements and the construction of the health care system.

     

Public health and the reforms: the New Zealand experience

The main aim of a national public health service is to conserve and improve the population's health. The health service reforms introduced in 1992 proposed the establishment of a Public Health Commission, which was to be responsible for health monitoring, public health policy advice and the purchase of public health services. These reforms, implemented in 1993, while emphasising a purchaser-provider separation also earmarked a budget for public health activities to be administered by the Commission. Such protection of funding is unusual. Public health activities span a wide range of measures to protect and promote health as well as to prevent disease. Many of these measures have been, and will continue to be, carried out at a local level. The results of some of these measures are not usually seen in the short term. Improvement of the population's health also requires proactive measures which are outside the traditional health service. The demonstration of quantifiable benefits to the public's health from such measures may require an even longer term. It is mainly in this area of activity, however, that the achievements of the Commission will be judged. Beginning with a short summary of the history of public health services in New Zealand, this paper looks briefly at the events that led to the establishment of the Public Health Commission, before moving on to describe its achievements to date, the challenges it faces and its impact on public health service provision. Based on such observations and an analysis of the strengths and weaknesses of the Commission, the paper attempts an appraisal of the public health function in the reformed health service, a function that will almost certainly be observed with interest in other countries. Certain ways of improving the public health function are outlined in the conclusions.     

Sexual ideology and experience in a Papua New Guinea society.

Recent anthropological interest in sexuality has been closely related to symbolic constructions of gender in different societies. Most studies explore the cultural constitution of sexual meanings without addressing how sex is experienced by actors. Material from the Bumbita Arapesh of the East Sepik Province of Papua New Guinea reveals that the local cultural ideology of male sexual domination does not adequately describe actual sexual experiences of Bumbita men and women. Cultural ideology states that men control sexual encounters as a part of their masculine essence, yet in actual marriages women often take the initiative in limiting sexual practice following postpartum prohibitions. Contrary to cultural expectations, men exhibit anxiety concerning sexual relations in a marriage. The public assertion of sexual dominance and suppression of sexual intimacy compensate for a sense of vulnerability accompanying sexual experience. An analytical distinction between "cultural ideology" and "individual experience" helps clarify the climate of sexual relationships in a cultural context.     

输尿管移行细胞癌的治疗体会

目的提高输尿管移行细胞癌的诊治水平。方法对2001年7月～2010年10月收治输尿管移行细胞癌患者,经输尿管镜检查、活检病理检查,明确诊断。结果 15例均经病理检查证实为移行细胞癌。其中Ⅰ级3例,Ⅱ级10例,Ⅲ级2例。TNM分类法,T2期4例,T3期11例,T4期1例。16例患者获得随访,随访时间6个月～10年,死亡2例。2例患者术后12个月出现膀胱肿瘤,行膀胱部分切除术。术后定期膀胱灌注化疗。结论输尿管癌的预后取决于肿瘤的浸润程度和肿瘤的分期密切相关,尤其是分期更为重要。影像学联合输尿管镜组织活检是诊断输尿管癌的最佳途径。早期发现,及时明确诊断并且选择合理的手术方式对提高输尿管癌的生存率至关重要,同时术后需施行定期膀胱内灌注化疗及密切随访。     

New public management,physicians and populism: Turkey's experience with health reforms

Recent debates on the rise of right‐wing or neoliberal populism globally have prompted public health and health systems researchers to explore its implications in the healthcare systems. This case study of Turkey's recent health reform initiative, the Health Transformation Program, aims to contribute to this debate by examining the nexus among populism, professionalism and the contemporary market and managerial reforms, often described as New Public Management (NPM). Building on document analysis and secondary sources, this article introduces a framework to explore whether and how populist agendas grow up in the shadow of NPM policies. We aim to deepen our understanding of the governance settings that might be used in different ways by right‐wing populist leaders to advance their agendas. Our research reveals that the NPM reforms in Turkey have opened a ‘backdoor’ through which right‐wing populist agendas were supported and the position of the medical profession as an important stakeholder in the institutional settings was weakened. However, what mattered most in the reform process was not the policies themselves but the ways new managerialist policies were implemented. Our analysis makes blind spots of the NPM reforms and healthcare governance research visible and calls for greater attention to implementation processes.     

NHS reforms in the United Kingdom and learning from developing country experience

The NHS has been the object of much international interest from its inception and through its periodic reforms. However, UK policy-makers have expressed only limited and selective concern for health sector reforms in other countries. This paper seeks to identify key elements of the present process and content of reforms to the UK NHS and examine the extent to which international learning would be important in developing these reforms. Particular emphasis is placed on learning from developing country experience. The paper therefore considers the policy process in the UK, the focus on primary care, the shift from competitive to collaborative strategies in addition to prioritising and planning. Each is considered in relation to developing country experience and the opportunities for learning. The paper concludes by setting out four areas leading to an international opening in NHS policy processes: developing political space in policy making, developing mechanisms for international exchanges, understanding policy context, and broadening international experience and changing values. The notion of a one-way process in international policy learning is rejected: while the South can learn from the North, so too can the North from the South.     

Problems of primary health care in a newly developed society: Reflections on the Hong Kong experience

Hong Kong has emerged as a newly developed society in Asia and its modern scientific health care system has had a substantial expansion. Recently, the rise of medical costs has made the health authority come to stress the development of PHC. This paper focusses on three major aspects of the PHC development in Hong Kong: (1) public health and preventive care; (2) food supply and nutrition; and (3) first-contact medical care and referral network.It is argued that in a newly developed society, the emphasis on developing both the quality and the quantity of PHC in the scientific biomedical stream is justifiable. However, at least two kinds of problems need to be taken into consideration, i.e. the prevalence of traditional beliefs and practices and the ever-rising demands of the public for health services.     

原发性前列腺移行细胞癌的诊疗分析(附三例病例报告)

目的 探讨原发性前列腺移行细胞癌的诊断与治疗方法,为早期准确发现并治疗提供线索.方法 回顾性分析3例原发性前列腺移行细胞癌的临床资料.结果 3例病例均可诊断为原发性前列腺癌,2例发现时已是晚期病变,术前检查(血清前列腺特异性抗原、B超等)均未能准确提示其诊断.术后病理原发性前列腺癌诊断明确,术后1例失随访,1例早期病变应用吡柔比星灌注后随访17个月后情况良好.1例晚期术后2个月复查腰椎MRI发现骨转移.结论 本病早期诊断困难,确诊主要需行经直肠B超引导下前列腺穿刺活检或尿道镜检并取病理组织检查,因其预后较差,且容易病理漏诊或误诊,需排除多中心病变及混合肿瘤情况而选择治疗方式.     

Overview: health financing reforms in Africa

Three broad strategies for health financing reform include: 1) cost recovery through user fees to expand access and improve quality of health services along with means testing to increase equity; 2) reallocation of existing resources to improve efficiency and access; and 3) assessment of the efficiency and quality of private health providers for making better use of the private sector in expanding access to quality health services. Research on the extent to which cost recovery reforms have improved access showed mixed results. A 1993 survey of more than 50 user fee experiences in Africa showed that in roughly half the cases, utilization either remained the same or decreased, whereas in the other cases, utilization increased after fees were introduced. Pilot tests of alternative cost recovery methods in 1993 and 1994 in rural Niger provided strong evidence that some form of social financing or risk-sharing mechanism may have advantages over pure fee-for-service methods in rural Africa. The main reason user fees are believed to be inequitable is that new or increased prices may provide a stronger disincentive to the poor than to the better-off. Informal means testing in Niger suggested that even moderately effective means testing can play a positive role for other incentives to utilization by the poor. A study identified specific measures of structure, process, and outcomes to assess quality improvement in 18 rural primary health care facilities involved in the Niger cost recovery pilot tests. Reallocation of existing resources to improve cost-effectiveness represents the second principle type of health financing reform. Private providers also play a role in promoting access in Sub-Saharan countries. Public and private sector efficiency in Senegal was also examined. Household spending to promote efficiency suggested that people could allocate money for health care more efficiently. Finally, some policy research needs were identified.     

Health care funding reforms in Croatia: a case of mistaken priorities

This study provides an overview of funding mechanisms in Croatian health care and analyses them in terms of sustainability, efficiency and equity. The study presents an in depth investigation of problems facing funding health care in Croatia: high expenditure, inadequate financial resources, continuous deficits of the state insurance fund, lack of transparency in funding, an aging population, etc. Furthermore, the study provides a critical overview of reforms that have been implemented to counter those issues from 1990 to 2002. The study argues that the implemented reforms over relied on shifting health expenditure from public to private sources in addressing financial deficits in the system. The study argues that, instead, the reforms should have focused more on curbing rising expenditure in health care providers. Emphasis has been put on the extent to which the reforms affected the conceptual-social foundations of the system. Finally, the paper provides recommendations for policy makers in Croatia and presents an overview of Croatian experiences that might be of interest to researchers and policy makers internationally.     

过去20年的卫生政策:改革与反改革

本文探讨了过去20年来卫生改革的不同阶段特征。20世纪90年代初,改革的主要目标是赋予患者更多的选择权和在卫生体系中引入更激烈的竞争;1995—2000年,目标发生逆转,致力于卫生系统的整合和规制;进入2000年以来,政策热点转向强化患者权利。为了探寻这些改革策略背后隐藏的动机,文章分析了经济合作与发展组织成员国法国、德国、荷兰、新西兰、瑞典和英国的改革实例,旨在揭示执政政府的意识形态倾向是如何影响改革措施内容的。     

Older people living alone in Shanghai: A questionnaire survey of their life experience

Globally the number of older people living alone is increasing. Little is known about the life experience of older people living alone in Mainland China. This study aimed to explore older people's experience regarding different components of their lives. A cross‐sectional survey of 387 older people aged 60 years and above and living alone in two communities in Shanghai was conducted from April to July 2015. A structured questionnaire including 15‐item Geriatric Depression Scale, Activity of Daily Living Scale, UCLA Loneliness Scale version 3, Social Support Rate Scale and Older People's Quality of Life Questionnaire was used to assess the health status, loneliness, social support, quality of life and demographic information. A total of 15.7% of the participants rated their health as poor with 56.8% reporting chronic diseases and 26.9% reporting being depressed. A total of 71.1% of the participants reported a high level of functional ability. However, 54.3% and 21.7% of the participants reported a moderately and moderately high level of loneliness respectively. The median of SSRS was 30 and the mean of Older People's Quality of Life Questionnaire was 120.2, indicating a lower level of social support and quality of life. There were statistically significant differences in health, loneliness, social support and quality of life across the participants with different characteristics. Interventions to improve the health status, reduce loneliness, increase social support and maintain or improve quality of life of older people living alone in Shanghai could be developed and implemented. Potential interventions include providing frequent home care services, early detection of depression, encouraging more contacts from children and other family members, and providing support from other sources.     

Designing national quality reforms: a framework for action.

Healthcare systems worldwide strive to improve the quality of care they provide. Securing predictable systemic improvement is, however, a complex task. The imperative to be evidence-based is often constrained by the literature, which is of uneven scientific rigour and neither well-synthesized nor contextualised. This article provides a conceptual framework to guide the translation of the available evidence into policy and managerial decisions for improving quality. The framework has three aspects: a taxonomy to organize the available evidence of potential quality-enhancing interventions; a multi-tier approach to selecting and implementing interventions in a healthcare system; and a model to guide the adoption of professional, governmental and market levers for change.     

Hospital reforms in France under a Socialist government

French health care faced the dual crises of rising costs and excess physicians. No government, whether left or right, could avoid focusing reform on the extensive public hospital system. Many differences introduced by the Socialists after 1981 were rhetorical and relational--matters of "democratization" of governance and "control" of physicians. Paradoxically, the two major structural reforms, "departmentalization" and "global budgeting," were extensions of actions begun under preceding governments. Neither has come to fruition yet.