Patient experiences with inpatient care in rural China.

OBJECTIVE: To describe patient experiences with hospital inpatient care among participants living in rural China and to examine their associations with sociodemographic characteristics, hospital type and province. DESIGN: Cross-sectional study using data from questionnaires administered to members of randomly selected households in 2010. We used linear and logistic regression to determine associations between patient ratings of care and key components of their experience and between patient ratings of care and sociodemographic characteristics, hospital type and province. SETTING: Households located in seven provinces in rural China. PARTICIPANTS: Household members >15 years who reported being admitted to the hospital within the last 365 days with valid data on our outcome measures (n = 443). MAIN OUTCOME MEASURES: Patient evaluations of health care experiences. RESULTS: Approximately 31% of participants rated their experiences 5.0 out of 5.0 (best), but 22% rated their experiences ≤3.0. Fifteen percent would not recommend the facility to family and friends. Five factors emerged, of which, 'communication with nurses' was most strongly and consistently associated with overall patient ratings. Multivariable models showed that ratings for township and county-level hospitals were significantly lower than above county-level hospitals. Variation also existed across the seven provinces. CONCLUSIONS: Findings suggest that patients on average have high ratings of hospital care, but a notable proportion of participants, particularly those receiving care in county-level hospitals, continue to be less than fully satisfied. As China further develops its health system, establishing routine monitoring of patients' experiences will be important to ensure the system is responsive to the population needs.

Health insurance benefit design and healthcare utilization in northern rural China.

BACKGROUND: Poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s. Although the Chinese government introduced the New Rural Cooperative Medical Schemes (NRCMS) in 2003, the associations between different health insurance benefit package designs and healthcare utilization remain largely unknown. Accordingly, we sought to examine the impact of health insurance benefit design on health care utilization. METHODS AND FINDINGS: We conducted a cross-sectional study using data from a household survey of 15,698 members of 4,209 randomly-selected households in 7 provinces, which were representative of the provinces along the north side of the Yellow River. Interviews were conducted face-to-face and in Mandarin. Our analytic sample included 9,762 respondents from 2,642 households. In each household, respondents indicated the type of health insurance benefit that the household had (coverage for inpatient care only or coverage for both inpatient and outpatient care) and the number of outpatient visits in the 30 days preceding the interview and the number of hospitalizations in the 365 days preceding the household interview. People who had both outpatient and inpatient coverage compared with inpatient coverage only had significantly more village-level outpatient visits, township-level outpatient visits, and total outpatient visits. Furthermore, the increased utilization of township and village-level outpatient care was experienced disproportionately by people who were poorer, whereas the increased inpatient utilization overall and at the county level was experienced disproportionately by people who were richer. CONCLUSION: The evidence from this study indicates that the design of health insurance benefits is an important policy tool that can affect the health services utilization and socioeconomic equity in service use at different levels. Without careful design, health insurance may not benefit those who are most in need of financial protection from health services expenses.

Hospital management in the context of health sector reform: a planning model in Ethiopia.

Through health sector reform in developing countries, Ministries of Health have sought to enhance health care through greater community governance and improved management effectiveness in their public hospitals. In this paper, we present a partnership-mentoring model for enhancing management capacity that has been piloted in Ethiopia and may be useful in other developing countries. The model included needs assessment and baseline evaluation using a hospital management indicator checklist, deployment of 24 Fellows (US and international hospital administrators) for 1 year to work as mentors with hospital management teams in 14 Ethiopian hospitals, continuing didactic and practical training in quality improvement methods for hospital management teams, and 24 management improvement projects to be completed during the year with plans for replication more broadly as appropriate. Surveys of Fellows and Ethiopian managers within the first quarter of onsite activity found high levels of trust in one another's abilities and intent to implement changes. The partnership-mentoring model promotes sustainability and may provide other countries with approaches for improving the quality of hospital care through improved hospital management.

Extended-care programs for weight management in rural communities: the treatment of obesity in underserved rural settings (TOURS) randomized trial.

BACKGROUND: Rural counties in the United States have higher rates of obesity, sedentary lifestyle, and associated chronic diseases than nonrural areas, yet the management of obesity in rural communities has received little attention from researchers. METHODS: Obese women from rural communities who completed an initial 6-month weight-loss program at Cooperative Extension Service offices in 6 medically underserved rural counties (n = 234) were randomized to extended care or to an education control group. The extended-care programs entailed problem-solving counseling delivered in 26 biweekly sessions via telephone or face to face. Control group participants received 26 biweekly newsletters containing weight-control advice. RESULTS: Mean weight at study entry was 96.4 kg. Mean weight loss during the initial 6-month intervention was 10.0 kg. One year after randomization, participants in the telephone and face-to-face extended-care programs regained less weight (mean [SE], 1.2 [0.7] and 1.2 [0.6] kg, respectively) than those in the education control group (3.7 [0.7] kg; P = .03 and .02, respectively). The beneficial effects of extended-care counseling were mediated by greater adherence to behavioral weight-management strategies, and cost analyses indicated that telephone counseling was less expensive than face-to-face intervention. CONCLUSIONS: Extended care delivered either by telephone or in face-to-face sessions improved the 1-year maintenance of lost weight compared with education alone. Telephone counseling constitutes an effective and cost-efficient option for long-term weight management. Delivering lifestyle interventions via the existing infrastructure of the Cooperative Extension Service represents a viable means of adapting research for rural communities with limited access to preventive health services. Trial Registration clinicaltrials.gov Identifier: NCT00201006.