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      Elderly healthcare service at the community health centers in the Pearl River Delta region, China

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          Abstract

          Objective: The recent population census showed China had officially become a graying society. In the meantime, China also faces a growing burden of non-communicable diseases. Since 2009, a series of policies have been implemented to enhance primary care at the community level. This study describes the elderly care services provided in the differently organized community health centers (CHCs).

          Methods: It covered 13 CHCs of six cities located within the Pearl River Delta (PRD) region. In-depth interviews were conducted with a total of 59 health administrators, CHC managers, and CHC doctors regarding elderly care.

          Results: The study found that accessibility of healthcare for elders has been improved due to the development of health insurance schemes as well as preferential policy to encourage the CHC utilization by the elderly. All the CHCs provide health examinations and chronic disease management to the permanent elderly within their catchment district. However, some preventative care such as fall prevention, immunization and mental health management are not provided.

          Conclusion: Key barriers include low capacity of health service providers in the CHCs, and a lack of government investment in CHCs. Our report provides an empirical evidence for the health care reform in China.

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          Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference?

          Background As one of the most populous metropolitan areas in the Pearl River Delta of South China, Shenzhen attracts millions of migrant workers annually. The objectives of this study were to compare health needs, self-reported health and healthcare utilisation of insured and uninsured migrant workers in Shenzhen, China, where a new health insurance scheme targeting at migrant workers was initiated. Methods A cross-sectional survey using multi-staged sampling was conducted to collect data from migrant factory workers. Statistical tests included logistic regression analysis were used. Results Among 4634 subjects (96.54%) who responded to the survey, 55.11% were uninsured. Disease patterns were similar irrespective of insurance status. The uninsured were more likely to be female, single, younger and less educated unskilled labourers with a lower monthly income compared with the insured. Out of 1136 who reported illness in the previous two weeks, 62.15% did not visit a doctor. Of the 296 who were referred for inpatient care, 48.65% did not attend because of inability to pay. Amongst those who reported sickness, 548 were insured and 588 were uninsured. Those that were insured, and had easier access to care were more likely to make doctor visits than those who were uninsured. Conclusion Health care utilisation patterns differ between insured and uninsured workers and insurance status appears to be a significant factor. The health insurance system is inequitably distributed amongst migrant workers. Younger less educated women who are paid less are more likely to be uninsured and therefore to pay out of pocket for their care. For greater equity this group need to be included in the insurance schemes as they develop.
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            Mobility of primary health care workers in China

            Background Rural township health centres and urban community health centres play a crucial role in the delivery of primary health care in China. Over the past two-and-a-half decades, these health institutions have not been as well developed as high-level hospitals. The limited availability and low qualifications of human resources in health are among the main challenges facing lower-level health facilities. This paper aims to analyse the mobility of health workers in township and community health centres. Methods Data used in this paper come from a nationwide survey of health facilities in 2006. Ten provinces in different locations and of varying levels of economic development were selected. From these provinces, 119 rural township health centres and 89 urban community health centres were selected to participate in a questionnaire survey. Thirty key informants were selected from these health facilities to be interviewed. Results In 2005, 8.1% and 8.9% of health workers left township and community health centres, respectively. The health workers in rural township health centres had three to 13 years of work experience and typically had received a formal medical education. The majority of the mobile health workers moved to higher-level health facilities; very few moved to other rural township health centres. The rates of workers leaving township and community health centres increased between 2000 and 2005, with the main reasons for leaving being low salaries, limited opportunities for professional development and poor living conditions. Conclusion In China, primary health workers in township health centres and community health centres move to higher-level facilities due to low salaries, limited opportunities for promotion and poor living conditions. The government already has policies in place to counteract this migration, but it must step up enforcement if rural township health centres and urban community centres are to retain health professionals and recruit qualified health workers.
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              China’s primary health-care reform

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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Family Medicine and Community Health & American Chinese Medical Education Association (USA )
                xxx-xxx
                2305-6983
                March 2013
                February 2014
                : 1
                : 1
                : 30-36
                Affiliations
                [1] 1The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
                [2] 2School of public health, Guangzhou Medical University, Guangzhou, China
                [3] 3Bauhinia Foundation Research Centre, Hong Kong SAR, China
                Author notes
                CORRESPONDING AUTHOR: Xiaolin Wei, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China xiaolinwei@ 123456cuhk.edu.hk
                Funding: The study was funded by the Bauhinia Foundation Research Centre, Hong Kong (Ref No. 7050162), and the data analysis is supported by the primary care comparison study from the Research Grants Committee, Hong Kong (Ref No. CUHK 4002-SPPR-10). The funders had no role in study design, data collection, analysis, preparation of the manuscript.
                Article
                fmch20130105
                10.15212/FMCH.2013.0105
                e920662a-30d6-4d09-a3fe-66f35f58a8d3
                Copyright © 2013 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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                Self URI (journal page): http://fmch-journal.org/
                Categories
                Original Research

                General medicine,Medicine,Geriatric medicine,Occupational & Environmental medicine,Internal medicine,Health & Social care
                Community health center,China,Elderly care

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