Understanding medical corruption in China: a mixed-methods study.

Medical corruption is a significant obstacle to achieving health-related Sustainable Development Goals. However, the understanding of medical corruption is limited, especially in developing countries. As the largest developing country, China is also plagued by medical corruption. By employing a mixed-methods design and combining data from three resources, this study attempts to examine patterns of medical corruption in China, explore its key drivers and investigate the perceived effectiveness of recent anti-corruption interventions. Using extracted data from 3546 cases on the China Judgments Online website between 2013 and 2019, we found that bribery, embezzlement and insurance fraud accounted for 68.1%, 22.8% and 9.1% of all medical corruption cases, respectively. Bribery was the major form of medical corruption. Approximately 80% of bribe-takers were healthcare providers, and most bribe-givers were suppliers of pharmaceuticals, medical equipment and consumables. Using a nationally representative household survey, we further found that the prevalence of informal payments from patients remained at a low level between 2011 and 2018. In 2018, only 0.4% of outpatients and 1.4% of inpatients reported that they had ever given 'red envelopes' to physicians in the past. Finally, we conducted interviews with 17 key informants to explore drivers of medical corruption and investigated the perceived effectiveness of recent anti-corruption interventions in China. Interview results showed that financial pressure and weak oversight were two main reasons for corrupt behaviours. Interview results also suggested that the anti-corruption campaign since 2012, the national volume-based procurement, and the special campaign against medical insurance fraud had reduced opportunities for medical corruption, implying China's positive progress in combating medical corruption. These findings hold lessons for anti-corruption interventions in China as well as other developing countries.

How do Chinese people perceive their healthcare system? Trends and determinants of public satisfaction and perceived fairness, 2006-2019.

BACKGROUND: The public's perception of the health system provides valuable insights on health system performance and future directions of improvement. While China's health care reform was a response to people's discontent in the health care system due to the lack of accessibility and affordability, little is known on changes in public perception of China's health system. This paper examines trends in public perception of the health system between 2006 and 2019 and assesses determinants of public perception in China's health system. METHODS: Seven waves of the China Social Survey, a nationally representative survey, were used to examine trends in public satisfaction with health care and perceived fairness in health care. Chi-square tests were used to examine differences across waves. Logistic regression models were used to explore determinants of public perception, including variables on sociodemographic characteristics, health system characteristics, and patient experience. RESULTS: Satisfaction with health care increased from 57.76% to 77.26% between 2006 and 2019. Perceived fairness in health care increased from 49.79% to 72.03% during the same period. Both indicators showed that the major improvement occurred before 2013. Sociodemographic characteristics are weakly associated with public perception. Financial protection and perceived medical safety are strongly associated with public perception, while accessibility is weakly associated with public perception. Patient experience such as perceived affordability and quality in the last medical visit are strongly associated with public perception of the health care system, while the accessibility of the last medical visit shows no impacts. CONCLUSION: Public satisfaction on health care and perceived fairness in health care in China improved over 2006-2019. The main improvement occurred in accordance with huge financial investments in public health insurance before 2013. Financial protection and perceived quality play significant roles in determining public perception, whereas accessibility and sociodemographic characteristics have limited influence on people's perception of China's health system. To achieve higher satisfaction and a higher sense of fairness in health care, China's health system needs to continue its reforms on hospital incentives and integrated delivery system to control health expenditure and improve health care quality.

A Tale of Transition: Trends of Catastrophic Health Expenditure and Impoverishment in Urban China, 1986-2009.

From 1986 to 2009, China's health system reform first adopted a market-oriented approach and later reemphasized the role of the government starting from 2002. China's oscillating health care financing policies present us a unique opportunity to examine the consequences of government-led financing and market-oriented financing measures. This study uses the Urban Household Survey, a diary data in China that covers the period of 1986 to 2009, to examine the long-run trends in the incidence and intensity of catastrophic health expenditure and medical impoverishment. Four major findings emerge. First, the incidence and intensity of catastrophic health expenditure in urban Chinese households increased rapidly between 1986 and 2002, whereas they stabilized after 2002. Second, the incidence of medical impoverishment and its depth in the poverty gap remained stable before 2002 and decreased rapidly after 2002. Third, income and regional inequality in measures of catastrophic health expenditure widened from 1986 to 2002. They narrowed in the 2000s but remain wide. Fourth, income and regional inequality in medical impoverishment remained unchanged between 1986 and 2002 and narrowed substantially after 2002. All these results suggest that China's two cycles of health care reform generated significantly different outcomes in financial protection, holding lessons for the ongoing health care reform in China and other countries.

Trends in access to health services, financial protection and satisfaction between 2010 and 2016: Has China achieved the goals of its health system reform?

Guided by the principle of universal health coverage, China began its complex health system reform in 2009. Using data from the China Family Panel Studies (CFPS), this study assesses trends in healthcare utilization, financial protection, and satisfaction between 2010 and 2016. We use difference-in-means tests and regression analysis to evaluate overall trends and compare subsample results by urban/rural residence and income quartiles to examine changes in inequity. Our results show that China has achieved substantial improvements in access to healthcare services and financial protection since the health system reform in 2009. First, China has experienced a substantial increase in both inpatient and outpatient care utilization between 2010 and 2016. Second, people receive better financial protection by measures of health insurance coverage, inpatient reimbursement rate, the likelihood of incurring catastrophic health expenditure, and the likelihood of medical impoverishment. Third, inequity in financial protection by income quartiles has significantly decreased, though poorer groups remain more vulnerable. However, we do not observe a concurrent increase in satisfaction towards the health system. We also find that people are more willing to seek medical services in hospitals rather than primary care institutions. All these results suggest that China's ongoing health system reform should pay more attention to establishing a tiered health delivery system, strengthening financial protection for the poor, and increasing responsiveness to rising expectations.

Prevention, management, and rehabilitation of stroke in low- and middle-income countries.

Although stroke incidence in high-income countries (HICs) decreased over the past four decades, it increased dramatically in low- and middle-income countries (LMICs). In this review, we describe the current status of primary prevention, treatment, and management of acute stroke and secondary prevention of and rehabilitation after stroke in LMICs. Although surveillance, screening, and accurate diagnosis are important for stroke prevention, LMICs face challenges in these areas due to lack of resources, awareness, and technical capacity. Maintaining a healthy lifestyle, such as no tobacco use, healthful diet, and physical activity are important strategies for both primary and secondary prevention of stroke. Controlling high blood pressure is also critically important in the general population and in the acute stage of hemorrhagic stroke. Additional primary prevention strategies include community-based education programs, polypill, prevention and management of atrial fibrillation, and digital health technology. For treatment of stroke during the acute stage, specific surgical procedures and medications are recommended, and inpatient stroke care units have been proven to provide high quality care. Patients with a chronic condition like stroke may require lifelong pharmaceutical treatment, lifestyle maintenance and self-management skills, and caregiver and family support, in order to achieve optimal health outcomes. Rehabilitation improves physical, speech, and cognitive functioning of disabled stroke patients. It is expected that home- or community-based services and tele-rehabilitation may hold special promise for stroke patients in LMICs.

Dummy molecularly imprinted polymer for selective screening of trace bisphenols in river.

Bisphenols (BPs) are potential endocrine-disrupting chemicals that may adversely affect human health and wildlife. The complexity of matrix encountered in real-world samples renders screening of trace BPs a formidable challenge. The present study highlighted the potential of molecularly imprinted solid-phase extraction (MISPE) for selective detection of trace bisphenols and their halogenated analogues in surface water. The template bleeding was observed at parts-per-billion levels, deteriorating the accuracy and precision of BPs quantification. To surmount this problem, a dummy MISPE strategy was proposed, in which bisphenol E (BPE) was selected as a dummy template for molecularly imprinted polymer (MIP) synthesis. Coupling this MISPE strategy with chromatographic analysis, a dummy MISPE-HPLC method was established. The linearity, precision, limit of detection (LOD) and recovery were then validated. The linearity of the calibration curve for each BP was observed over the range of 20-2000 ng L-1 (r > 0.998). LOD for each bisphenol was measured as low as 2.5-5.0 ng L-1. This technique was applied to simultaneous screening of BPs in the Qinghe River, and five bisphenols were found within the concentration range of 0-224 ng L-1 in river samples. The designed dummy MIP was superior to the commercial sorbents with regard to the selectivity, cross-reactivity, matrix removal efficiency and reusability. These merits enabled the applications of dummy MISPE for selective extraction and sensitive screening of BPs in environmental water samples. This method also provided a promising tool for monitoring the occurrence, distribution and fate of BPs in surface water.