Suchergebnisse

International audience ; This chapter addresses the increasing role of digital healthcare in the overall Chinese healthcare system. As described in previous chapters, the healthcare system faces many issues, such as the confrontational relationship between doctors and patients, the poor access for populations in rural areas, the significant mark-up throughout distribution channels, a financially heavy burden for chronic diseases, poor quality of healthcare supply and inefficient hospital operation except Level 3 hospitals that have to deal with an over-demand. Many solutions have been proposed, such as the multiplication of healthcare suppliers, the establishment of general practitioners as gatekeepers for hospital admissions, the implementation of public health insurance schemes or the government support for reforms in favour of private health insurance and private healthcare providers. However, they have not proven sufficient to solve all problems yet. Digital healthcare is likely to play an increasing part in addressing these issues. One of the strengths of e-health is the quick and widespread adoption of mobile platforms. This may help solve access challenges, through online appointment registration systems, models of online-offline services, two-communication platforms between patients and physicians, sharing information through the Electronic Health Record (EHR) and Electronic Medical Record (EMR) systems, the generalized implementation of a DRG-based payment system, making patients more increasingly active actors in maintaining the health status, and improving the online drug market. On the flip side, this also raises many concerns regarding the confidentiality of personal medical data and the monopoly situation of some internet companies.

Cesarean deliveries are widely used in many high-and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008-2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of promoting programs such as care participation on cesarean delivery rates.

International audience ; China is currently experiencing an over-utilization of university hospitals and hospitals with high-tech equipment, usually located in main cities. Even though they have a large capacity, they are faced with congestion leading to long queues. In parallel, there is under-utilization of smaller institutions. The Ministry of Health estimates that 70% of patients treated in university hospitals of a higher level (Level 3) could have received adequate treatment in hospitals of a lower category, closer to their home. In 2009, the Chinese government published a large-scale development plan for the health sector, with over RMB 770 billion to be invested. Four years later, RMB 620 billion was already spent, with a public insurance scheme set-up and a network of Community Health Centres created. Yet, this key issue of the Chinese health system, that is, the concentration of demand on a small number of hospitals, still remains, eventually leading to a tense relationship between doctors and patients, and to increasingly common acts of violence. The origin of such violence as well as possible directions to restore trust, respect, and understanding between patients and medical staff is examined. The decentralization of quality care seems to be the key, but there are different ways to achieve this goal. Obviously, digital tools such as connected health object and other online services are likely to play a growing role in addressing this issue.

International audience ; China is the second largest pharmaceutical market in the world. This sector grew by 21.4% between 2002 and 2012. In OECD countries, spending on medical drugs accounted for approximately 17% of total health spending or 1.5% of gross domestic product (GDP) in 2009. That same year, spending on pharmaceutical products in China represented 43% of the total healthcare expenditure. Aware of the issue, the Chinese government has reacted. A limitation on the hospital mark-up on drugs has been implemented and a list of key drugs that are considered essential has been set up. Drugs on this list have to be accessible to everyone, with a regulated price to be kept as low as possible. To keep prices low, procurement is made through centralized bidding at provincial level, pharmaceutical companies delivering directly to medical facilities. Yet, in the field, the reality remains at times complex, with different ways to circumvent these constraints.

International audience ; Health insurance in China is the topic of this chapter. Up until the economic reforms of the 1980s, communities (a village or a group of villages) were managing the social welfare of their inhabitants. The system was extremely decentralized. With the collapse of the community medical system, existing public establishments were either replaced by private ones, or put into competition with them. As a result, the healthcare access system was no longer free of charge and became unaffordable to many. During the period of absence of a centralized public insurance system, this lack of access to treatment became a major problem; at first for the most vulnerable part of the population, and gradually for a greater and greater proportion of rural dwellers. As the question of healthcare costs causing widespread poverty became a pressing issue, different public health insurance programmes were implemented. Today, geographical inequity is still observed for these programmes. There is variability not only in terms of funding eligibility, types of illness or services to be covered, but also in terms of levels of benefits and payments methods. Concerning the private health insurance market, it was next to nothing in the early 2000s. Today, the rise of private health insurance schemes is supported by the Chinese government and is finding an audience among the emerging upper middle class.

International audience ; China is currently experiencing an over-utilization of university hospitals and hospitals with high-tech equipment, usually located in main cities. Even though they have a large capacity, they are faced with congestion leading to long queues. In parallel, there is under-utilization of smaller institutions. The Ministry of Health estimates that 70% of patients treated in university hospitals of a higher level (Level 3) could have received adequate treatment in hospitals of a lower category, closer to their home. In 2009, the Chinese government published a large-scale development plan for the health sector, with over RMB 770 billion to be invested. Four years later, RMB 620 billion was already spent, with a public insurance scheme set-up and a network of Community Health Centres created. Yet, this key issue of the Chinese health system, that is, the concentration of demand on a small number of hospitals, still remains, eventually leading to a tense relationship between doctors and patients, and to increasingly common acts of violence. The origin of such violence as well as possible directions to restore trust, respect, and understanding between patients and medical staff is examined. The decentralization of quality care seems to be the key, but there are different ways to achieve this goal. Obviously, digital tools such as connected health object and other online services are likely to play a growing role in addressing this issue.

Cesarean deliveries are widely used in many high-and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008-2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of promoting programs such as care participation on cesarean delivery rates.

China's public health system has gone through a number of development stages. This paper aims at showing how, from its inception as a hierarchical system, the healthcare system then lost its structure, to finally give birth to a focalised system where the first point of entry in the treatment process has become the hospital, in particular the healthcare establishments that offer the most reliable standards of care. These days, the widely-acknowledged inefficiencies of the healthcare system have led to a climate of violence between medical staff and their patients, caused by the overwhelming demand that hospitals must bear, the ambiguous status of public establishments, financial benefits and other perks for medical staff, as well as the medical staff's civil servant status, and the implications thereof. Policies to foster the development of primary health centres are struggling to gain traction, while digital healthcare offers promising solutions and is developing fast. (China Perspec/GIGA)

How can healthcare access for Chinese migrants be improved? Migrant workers face two types of healthcare-access exclusion in the workplace: a financial one (via income) and a legislative one (from the "hukou"). We use 2006 data from a survey of rural migrant workers conducted in five of the most economically-advanced cities. We estimate a fixed-effect probit model, and control for the non-exogeneity of health insurance. The empirical findings support the hypothesis of a return to the hometown for migrant workers with poor health. Apart from residency permits and income, the social integration of migrant workers is also found to be a decisive factor in healthcare access. Policies tackling migrant healthcare exclusion should thus involve organisations working at the local level, such as residents' committees.

How can healthcare access for Chinese migrants be improved? Migrant workers face two types of healthcare-access exclusion in the workplace: a financial one (via income) and a legislative one (from the "hukou"). We use 2006 data from a survey of rural migrant workers conducted in five of the most economically-advanced cities. We estimate a fixed-effect probit model, and control for the non-exogeneity of health insurance. The empirical findings support the hypothesis of a return to the hometown for migrant workers with poor health. Apart from residency permits and income, the social integration of migrant workers is also found to be a decisive factor in healthcare access. Policies tackling migrant healthcare exclusion should thus involve organisations working at the local level, such as residents' committees.

How can healthcare access for Chinese migrants be improved? Migrant workers face two types of healthcare-access exclusion in the workplace: one is financial (because of their income) and the other is social (because of the lack of social networks in the city). We use 2006 data from a survey of rural migrant workers conducted in five of the most economically-advanced cities. The empirical findings support the hypothesis of a return to the hometown for migrant workers with poor health. Apart from residency permits and income, the social integration of migrant workers is also found to be a decisive factor in healthcare access. (China Perspect/GIGA)