Suchergebnisse

As China encourages urbanisation, a necessary process is the urbanisation of its people, granting local-urban hukou, or local citizenship, to migrant populations. But reforms encouraging urbanisation are dependent on migrant populations wanting to become formal, registered urban residents. What is the demand for hukou? Based on a unique probabilistically-sampled contingent valuation survey of over 900 migrants in Beijing and Changsha, we use migrants' willingness-to-pay for hukou as a measure of demand for urbanisation. We find that migrants in Beijing are willing to give up between 9% and 14% of their income over five years to gain local-urban hukou. Migrants in Changsha are much less willing to pay for hukou with a willingness-to-pay indistinguishable from zero, and rural migrants have a negative willingness-to-pay. This study contributes to the broader literature on the impact of China's hukou system by providing a unique test of migrant workers' willingness-to-pay for local citizenship.

Machine generated contents note: Foreword William C. Hsiao; Preface; Acknowledgements; Part I. Introduction: Analytic Framework, History, and Public Health: 1. China's healthcare industry: a system perspective Lawton Robert Burns and Gordon Liu; 2. History of China's healthcare system Lawton Robert Burns and Yanzhong Huang; 3. China's public health system and infrastructure Xiaofeng Liang and Lawton Robert Burns; Part II. Healthcare Reform: 4. Epidemiological transition and health system reforms in China Gordon Liu and Sam Krumholz; 5. China's healthcare reform: status and outlook Claudia Suessmuth-Dyckerhoff and Florian Then; 6. The challenge of non-communicable diseases (NCDs) in China: government responses and opportunities for reform Tsung-Mei Cheng; Part III. Healthcare Providers: 7. China's physician and nurse workforce Lawton Robert Burns; 8. China's hospital sector Jerry LaForgia and Winnie Yip; 9. United family healthcare (Chindex International): a case study Vanessa Folkerts and Roberta Lipson; 10. Providing and financing elder care in China John Whitman and Lawton Robert Burns; Part IV. Insurers and Reimbursement: 11. Health insurance in China Ambar LaForgia and Lawton Robert Burns; 12. Health insurance and chronic disease control: quasi-experimental evidence from hypertension in rural China Karen Eggleston, Kate Bundorf, Margaret Triyana, Yan Wang and Sen Zhou; 13. Drug pricing and health technology assessment in China and other Asian markets Gordon Liu, Nan Luo and Zhongyun Zhao; Part V. Product Manufacturers: 14. China's pharmaceutical sector Rachel Lee and Lawton Robert Burns; 15. China's medical technology sector James Deng and Lawton Robert Burns; 16. Life sciences investment and biotechnology in China Stephen Sammut and Lawton Robert Burns; Index

Strong economic growth has led to remarkable urbanization in China. Using the China Health and Nutrition Survey, this study provides the first empirical evidence documenting the impact of urbanization on rural health care and insurance. The primary finding is that urbanization leads to a significant and equitable increase in insurance coverage, which in turn plays a critical role in access to care. In addition, adverse selection exists in the demand for insurance. Income is also a significant determinant of insurance coverage. This study concludes that urbanization can help make substantial changes in rural health care and insurance status.

Abstract

Background
Contemporary data on the quantity and quality of medication use among older adults are lacking. This study examined recent trends in the number and appropriateness of prescription medication use among older adults in the United States.


Methods
Data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and March 2020 were used, and 6 336 adult participants aged 65 and older were included. We examined the number of prescription medication, prevalence of polypharmacy (≥5 prescription drugs), use of potentially inappropriate medication (PIM), and use of recommended medications (angiotensin-converting enzyme inhibitor [ACEI]/angiotensin receptor blockers [ARBs] plus beta-blockers among patients with heart failure and ACEI/ARBs among patients with albuminuria).


Results
There has been a slight increase in the prevalence of polypharmacy (39.3% in 2011–2012 to 43.8% in 2017–2020, p for trend = .32). Antihypertensive, antihyperlipidemic, antidiabetic medications, and antidepressants are the most commonly used medications. There was no substantial change in the use of PIM (17.0% to 14.7%). Less than 50% of older adults with heart failure received ACEI/ARBs plus beta-blockers (44.3% in 2017–2020) and approximately 50% of patients with albuminuria received ACEI/ARBs (54.0% in 2017–2020), with no improvement over the study period. Polypharmacy, older age, female, and lower socioeconomic status were generally associated with greater use of PIM but lower use of recommended medications.


Conclusions
The medication burden remained high among older adults in the United States and the appropriate utilization of medications did not improve in the recent decade. Our results underscore the need for greater attentions and interventions to the quality of medication use among older adults.