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      Determinants of basic public health services provision by village doctors in China: using non-communicable diseases management as an example

      research-article
      Author(s): , , ,
      Publication date (Electronic):
      Journal: BMC Health Services Research
      Publisher: BioMed Central
      Keywords: Village doctors, Equity, Primary health care

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          Abstract

          Background

          To ensure equity and accessibility of public health care in rural areas, the Chinese central government has launched a series of policies to motivate village doctors to provide basic public health services. Using chronic disease management and prevention as an example, this study aims to identify factors associated with village doctors’ basic public health services provision and to formulate targeted interventions in rural China.

          Methods

          Data was obtained from a survey of village doctors in three provinces in China in 2014. Using a multistage sampling process, data was collected through the self-administered questionnaire. The data was then analyzed using multilevel logistic regression models.

          Results

          The high-level basic public health services for chronic diseases (BPHS) provision rate was 85.2 % among the 1149 village doctors whom were included in the analysis. Among individual level variables, more education, more training opportunities, receiving more public health care subsidy (OR = 3.856, 95 % CI: 1.937–7.678, and OR = 4.027, 95 % CI: 1.722–9.420), being under integrated management (OR = 1.978, 95 % CI: 1.132–3.458), and being a New Cooperative Medical Scheme insurance program-contracted provider (OR = 2.099, 95 % CI: 1.187–3.712) were associated with the higher BPHS provision by village doctors. Among county level factors, Foreign Direct Investment Index showed a significant negative correlation with BPHS provision, while the government funding for BPHS showed no correlation (P > 0.100).

          Conclusion

          Increasing public health care subsidies received by individual village doctors, availability and attendance of training opportunities, and integrated management and NCMS contracting of village clinics are important factors in increasing BPHS provision in rural areas.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12913-016-1276-y) contains supplementary material, which is available to authorized users.

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          Most cited references47

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          A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt

          Lenka Benova, Oona Campbell, George Ploubidis (2015)
          Background The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care. Methods Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private). Results While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources. Conclusions Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0652-8) contains supplementary material, which is available to authorized users.
          Article 0 comments Cited 249 times – based on 0 reviews     Review now
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            Extending health insurance to the rural population: an impact evaluation of China's new cooperative medical scheme.

            Adam Wagstaff, Magnus Lindelow, Gao Jun … (2009)
            In 2003, China launched a heavily subsidized voluntary health insurance program for rural residents. We combine differences-in-differences with matching methods to obtain impact estimates, using data collected from program administrators, health facilities and households. The scheme has increased outpatient and inpatient utilization, and has reduced the cost of deliveries. But it has not reduced out-of-pocket expenses per outpatient visit or inpatient spell. Out-of-pocket payments overall have not been reduced. We find heterogeneity across income groups and implementing counties. The program has increased ownership of expensive equipment among central township health centers but has had no impact on cost per case.
            Article 0 comments Cited 197 times – based on 0 reviews     Review now
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              Reform of how health care is paid for in China: challenges and opportunities.

              Shanlian Hu, Shenglan Tang, Yuanli Liu … (2008)
              China's current strategy to improve how health services are paid for is headed in the right direction, but much more remains to be done. The problems to be resolved, reflecting the setbacks of recent decades, are substantial: high levels of out-of-pocket payments and cost escalation, stalled progress in providing adequate health insurance for all, widespread inefficiencies in health facilities, uneven quality, extensive inequality, and perverse incentives for hospitals and doctors. China's leadership is taking bold steps to accelerate improvement, including increasing government spending on health and committing to reaching 100% insurance coverage by 2010. China's efforts are part of a worldwide transformation in the financing of health care that will dominate global health in the 21st century. The prospects that China will complete this transformation successfully in the next two decades are good, although success is not guaranteed. The real test, as other countries have experienced, will come when tougher reforms have to be introduced.
              Article 0 comments Cited 158 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tongtong Li: litongtongpku@163.com
                Trudy Lei: tl2635@cumc.columbia.edu
                Zheng Xie: xiezheng@bjmu.edu.cn
                Tuohong Zhang: tzhang@bjmu.edu.cn
                Journal
                Journal ID (nlm-ta): BMC Health Serv Res
                Journal ID (iso-abbrev): BMC Health Serv Res
                Title: BMC Health Services Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6963
                Publication date (Electronic): 4 February 2016
                Publication date PMC-release: 4 February 2016
                Publication date Collection: 2015
                Volume: 16
                Electronic Location Identifier: 42
                Affiliations
                [ ]School of Public Health of Peking University, 38 Xueyuan Road, Haidian District, Beijing, P. R. China
                [ ]School of Public Health of Columbia University, New York, USA
                Article
                Publisher ID: 1276
                DOI: 10.1186/s12913-016-1276-y
                PMC ID: 4743421
                PubMed ID: 26846921
                SO-VID: 68b901ae-b575-4ae1-9701-ade44a9cc60b
                Copyright © © Li et al. 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 5 August 2015
                Date accepted : 22 January 2016
                Funding
                Funded by: the National Natural Science Foundation of China (NSFC)
                Award ID: 71403006
                Award Recipient :
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2016

                ScienceOpen disciplines: Health & Social care
                Keywords: village doctors,equity,primary health care
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: village doctors, equity, primary health care

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