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Equity is the core of primary care. The issue of equity in health has become urgent and China has attached increasing attention to it. With rapid economic development and great change of the policy on medical insurance, the pattern of equity in health has changed a lot. Reform of healthcare in Zhejiang province is at the forefront of China; studies on Zhejiang are of great significance to the whole country. This paper aims to measure the equity in health from the perspectives of health needs and health seeking behavior, and provides suggestions for decision making.
A household survey was conducted in August 2016. A sample of 1000 households, 2807 individuals in Zhejiang was obtained with the multi-stage stratified cluster sampling method. Descriptive analysis and Chi-square test were adopted in the analysis. The value of concentration index was used to measure the equity.
This study finds that the poor have more urgent health needs and poorer health situation compared with the rich. The utilization of outpatient services was almost equal, whilst the utilization of hospitalization was pro-rich (the rich use more).Individuals with employer-based medical insurance use more outpatient services than those with rural and urban medical insurance. Compared to the rich, there were more people in the poorer income groups who didn't use inpatient services due to financial difficulties.
The issue of equity in health has attracted broad attention in the world, and China is no exception. We measured and analyzed the equity of health needs and absent rate of health services. We find that the poor have more urgent health needs and high absent rate of inpatient services compared with the rich. Income level and medical insurance may well explain the equity of outpatient and inequity of hospitalization. In view of the pro-rich inequity of hospitalization, more financial protection should be provided for the poor.
China, with the largest aging population which is fast increasing, faces great challenges. Increasingly, researchers are looking at the relationship between whole life conditions from birth to death and health status in old age using a life-course approach. Few researchers have paid attention to developing countries like China where early life conditions were worse than those in western countries in the early twentieth century. China has had a complex social and political history in the twentieth century. This study investigates trajectories of aging and the effects of childhood and adulthood Socioeconomic Status (SES) encompassing education, job and family condition, on oldest-elders physical health in China.
The data used in this study was from all seven waves (1998-2014) of the Chinese Longitudinal Healthy Longevity Survey and covered 6,483 respondents aged 80 to105 years in baseline. Measuring the limitation in activities of daily living represents physical health. Group-based trajectory modeling is used to identify groups of individuals with statistically similar developmental characteristics or trajectories. Multinomial logistic regression is used to compare the differences among trajectory groups.
Three-group models best fit the data for males and females. Along with increasing age, there was an increase in the limitation in activities of daily living. Some groups changed gradually, while others rose rapidly. Some childhood and adulthood socioeconomic status characteristics influenced trajectory-group membership. For both genders, group one and two had similar childhood socioeconomic status, while higher adulthood socioeconomic status like jobs were associated with less favorable health status. For group three of males suffering the hardest childhood in regard to education, had stable health status instead.
Diversity exists among aging procedure. Childhood and adulthood socioeconomic status influence health conditions of the oldest-elders in complex ways. Education is a remarkably positive factor significantly contributing to better health status.
Multiple drug resistance (MDR) intra-abdominal infections (IAIs) are associated with noteworthy direct and societal costs. Compared to previous studies, the present one takes both resistance rate and total medical costs (TMCs) into consideration, focusing on the impact of MDR on TMCs in IAIs, as well as further estimating the additional costs at a national level.
All inpatients discharged between 1 January 2014, and 31 December 2015 from a teaching hospital were included. Due to limits in budget and the large number of inpatients, the randombetween (bottom, top) function was applied to randomly select 40 percent of patients per year. Subsequently, we manually screened out 254 patients with IAIs, according to the International Classification of Disease (tenth revision) and electronic medical records. Eventually, 101 IAIs patients were included, in which 37 were infected by non-MDR bacteria and 64 by MDR bacteria. The Kruskal-wallis non-parametric test and multiple linear regression were employed to analyze the effect of single and multiple variables on TMCs.
Compared to patients with non-MDR infections, those with MDR were associated with significantly higher TMCs, higher antimicrobial costs, increased insurance, combination antimicrobial therapy, higher usage of antimicrobial agents, greater number of pathogens, longer length of stay, and longer intensive care unit stays. In addition, the average TMCs among patients with MDR were CNY131,801.17 (1USD was equal to CNY 6.227 in 2015), which were CNY 90,200.99 higher than those with non-MDR infections. If our results are generalizable to the whole country, the total attributable TMCs are estimated to be CNY37.06 billion, and the societal costs of CNY111.18 billion in 2015.
This real-world data analysis demonstrated the significant excessive burden MDR infections are posing to the current Chinese healthcare system in terms of both TMCs and healthcare resource utilization. Enhanced antimicrobial stewardship in China is necessary to curb the distribution of MDR bacteria.
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