Factors and key problems influencing insured's poor perceptions of convenience of basic medical insurance: a mixed methods research of a northern city in China.

BACKGROUND: This study aimed to explore the factors that affect insured's perceptions of convenience of the basic medical insurance (PCBMI) in Harbin, China and to diagnose the key problems to further propose corresponding measures. The findings provide evidence-based support for the reform of convenience of the basic medical insurance system (BMIS) and the cultivation of public literacy. METHODS: We adopted a mixed methods design composing a multivariate regression model using the data from a cross-sectional questionnaire survey (n = 1045) of residents who were enrolled for BMIS in Harbin to identify the factors influencing the PCBMI. A quota sampling method was further adopted. Semi-structured interviews were then conducted with 30 important information providers selected by convenience sampling. Interpretative phenomenological analysis was employed to summarize and analyze the key problems. RESULTS: Overall, approximately 51% of respondents reported poor PCBMI. The logistic regression model showed that insured without outpatient experience within two weeks (OR = 2.522, 95% CI = 1.267-5.024), had poorer levels of understanding of basic medical insurance information (OR = 2.336, 95% CI = 1.612-3.386), lived in rural areas (OR = 1.819, 95% CI = 1.036-3.195), had low levels of annual out-of-pocket medical expenses (OR = 1.488, 95% CI = 1.129-1.961), and were more likely to give the PCBMI a worse evaluation than their counterparts. The results of the qualitative analysis showed that the key problem areas of the PCBMI were the design of the BMIS, the cognitive biases of the insured, publicity information about the BMIS, and the health system environment. CONCLUSIONS: This study found that in addition to the design of BMIS, the cognition of the insured, the BMIS information publicity and the health system environment are also the key problems hindering PCBMI. While optimizing system design and implementation, Chinese policymakers need to focus on the insured with low PCBMI characteristics. Moreover, it is necessary to focus on exploring effective BMIS information publicity methods, supporting public policy literacy and improving the health system environment.

Perceptions of the benefits of the basic medical insurance system among the insured: a mixed methods research of a northern city in China.

Background: The perceptions of the benefits of the basic medical insurance system among the insured not only reflect the system's performance but also the public's basic medical insurance policy literacy, valuable information for countries that have entered the stage of deepening reform. This study aims to examine the factors that affect the perceptions of the benefits of the basic medical insurance system in China, diagnose the key problems, and propose corresponding measures for improvement. Methods: A mixed method design was used. Data for the quantitative study were obtained from a cross-sectional questionnaire survey (n = 1,045) of residents of Harbin who had enrolled for basic medical insurance system. A quota sampling method was further adopted. A multivariate logistic regression model was then employed to identify the factors influencing the perceptions of the benefits of the basic medical insurance system, followed by semi-structured interviews with 30 conveniently selected key informants. Interpretative phenomenological analysis was used to analyze the interview data. Results: Approximately 44% of insured persons reported low perceptions of benefits. The logistic regression model showed that low perceptions of the benefits of the basic medical insurance system was positively correlated with the experience of daily drug purchases (OR = 1.967), perceptions of recognition with basic medical insurance system (OR = 1.948), perceptions of the financial burden of participation costs (OR = 1.887), perceptions of the convenience of using basic medical insurance for medical treatment (OR = 1.770), perceptions of the financial burden of daily drug purchases costs (OR = 1.721), perceptions of the financial burden of hospitalization costs (OR = 1.570), and type of basic medical insurance system (OR = 1.456). The results of the qualitative analysis showed that the key problem areas of perceptions of the benefits of the basic medical insurance system were: (I) system design of basic medical insurance; (II) intuitive cognition of the insured; (III) rational cognition of the insured; and (IV) the system environment. Conclusions: Improving the perceptions of the benefits of the basic medical insurance system of the insured requires joint efforts in improving system design and implementation, exploring effective publicity methods of basic medical insurance system information, supporting public policy literacy, and promoting the health system environment.

In vitro bioaccessibility of potentially toxic metals (PTMs) in Baoji urban soil (NW China) from different functional areas and its implication for health risk assessment.

In order to better understand both the conceptual and operational aspects of bioaccessibility and phytobioavailability of PTMs (Co, Cr, Cu, Li, Mn, Ni, Pb, Zn) in different urban soils, a total of 30 soil samples from agricultural region, entertainment district, education area, traffic area, residential area and industrial area (IA) in Baoji urban city (NW China) were collected and the bioaccessibility and phytobioavailability were measured by multi-in vitro models of PBET, SBET, citric acid leaching and Tessier sequential extraction procedure, respectively. The suitable in vitro measurement of bioaccessibility and phytobioavailability for each PTM was selected and would be reliably applied for health risk assessment. The results indicated that the bioaccessibility and phytobioavailability for each PTM evaluated by in vitro models depended on PTM total concentration and anthropologic activity influence. The health risks associated with bioaccessibility of PTMs exposure showed that the carcinogenic and non-carcinogenic risks in all areas for children and adults were below the threshold or acceptable risk levels except lead exposure on children in IA, indicating there were more health risks to the children in than that in other functional areas. It was worth that the highest observation of Pb in IA would strongly correlate with lead-acid battery industries, which the emissions would influence on the occurrences of Pb distributing in the other functional areas, which were supported from the analysis results of XPS. Therefore, the continuous monitoring and attention to the health risk of inhabitants in different functional areas should be paid.

Prioritising local action for water quality improvement using citizen science; a study across three major metropolitan areas of China.

Streams in urban areas are prone to degradation. While urbanization-induced poor water quality is a widely observed and well documented phenomenon, the mechanism to pinpoint local drivers of urban stream degradation, and their relative influence on water quality, is still lacking. Utilizing data from the citizen science project FreshWater Watch, we use a machine learning approach to identify key indicators, potential drivers, and potential controls to water quality across the metropolitan areas of Shanghai, Guangzhou and Hong Kong. Partial dependencies were examined to establish the direction of relationships between predictors and water quality. A random forest classification model indicated that predictors of stream water colour (drivers related to artificial land coverage and agricultural land use coverage) and potential controls related to the presence of bankside vegetation were found to be important in identifying basins with degraded water quality conditions, based on individual measurements of turbidity and nutrient (N-NO3 and P-PO4) concentrations.

Combining citizen science and land use data to identify drivers of eutrophication in the Huangpu River system.

In recent years, the massive land use changes and urbanization of Shanghai City have coincided with a growing eutrophication and an overall degradation of Huangpu River, with related risks to the city's drinking water supply and economic development. However, there is only limited information to evaluate the spatial and temporal changes to the Huangpu River and its many tributaries. In the present study, 400 citizen scientists were trained to monitor water quality and environmental conditions on a monthly basis over three years in the lower (high urbanized) Huangpu River catchment. Their data were integrated with high resolution land cover data using GIS techniques to characterize water quality dynamics of the Huangpu River system with respect to main environmental drivers. Environmental driver analysis indicated that up-catchment conditions dominate river dynamics while typical urban impacts (first flush, impermeable land cover…) have only limited influence. According to these results, the city's investments to improve wastewater treatment and mitigate lower river impacts need to be extended throughout the catchment to reduce nutrient concentrations that are near or above thresholds for rivers and streams. The positive impact of in-stream vegetation pointed to the possibilities that local scale ecological remediation activities to reduce runoff could be viable approaches to improve river conditions throughout the catchment.

Spatial multicriteria decision analysis of flood risks in aging-dam management in China: a framework and case study.

Approximately 30,000 dams in China are aging and are considered to be high-level risks. Developing a framework for analyzing spatial multicriteria flood risk is crucial to ranking management scenarios for these dams, especially in densely populated areas. Based on the theories of spatial multicriteria decision analysis, this report generalizes a framework consisting of scenario definition, problem structuring, criteria construction, spatial quantification of criteria, criteria weighting, decision rules, sensitivity analyses, and scenario appraisal. The framework is presented in detail by using a case study to rank dam rehabilitation, decommissioning and existing-condition scenarios. The results show that there was a serious inundation, and that a dam rehabilitation scenario could reduce the multicriteria flood risk by 0.25 in the most affected areas; this indicates a mean risk decrease of less than 23%. Although increased risk (<0.20) was found for some residential and commercial buildings, if the dam were to be decommissioned, the mean risk would not be greater than the current existing risk, indicating that the dam rehabilitation scenario had a higher rank for decreasing the flood risk than the decommissioning scenario, but that dam rehabilitation alone might be of little help in abating flood risk. With adjustments and improvement to the specific methods (according to the circumstances and available data) this framework may be applied to other sites.