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Evaluation the health system performance in China: Using criteria from World Health Organization(WHO) framework
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2017 (English)Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Introduction: World Health Organization (WHO) framework has developed three instinct goals for assessing health system performance: population health, responsiveness to healthcare and fairness in health financing. Since year 1977, structure of health system has been changed a lot in China. Transition of disease pattern along with aging population, Chinese government has taken a series of health reforms to reduce the pace for developing non-communicable diseases (NCDs), improving interaction between patients and healthcare provides as well as protecting people from catastrophic health expenditures.

Aim: The aim for this study was to assess the Chinese health system performance based on WHO framework--- Described the health status among the elderly from making certain of protective and risk factors; examined the differences when the elderly with different chronic conditions sought for healthcare; and compared the main types of healthcare payments with regards to fairness financing.

Methods: Using national weighted data collected from adults older than 50 years. Chisquare and post-hoc tests were applied for checking the distribution of socioeconomic and health behavior factors among different chronic conditions. Factor analysis was employed for deriving potential factor(s) in health responsiveness field. Composite scores were compared among health conditions by inpatient and outpatient sides. Kakwani indexes and curves were obtained from concentration index/ curves and Gini coefficient/ATP for progressivity analysis in healthcare financing. The data source in this study was from WHO Study on global AGEing and adult health (SAGE) Wave 1.

Results: More than half of the elderly were in chronic conditions, in which, around 44% people had suffered from multimorbidity. Different socioeconomic status as well as health behavior factors were considered in developing NCDs. Health system responsiveness scores did not have statistical significant differences among the elderly with different chronic conditions. Out-of-pocket payment was always in regressive pattern, and got lowest value in single morbidity group. Even though mandatory insurance had covered more than 70% of the elderly in China, but due to the relative lower proportion reimbursement for chronic diseases, people still had to pay a lot for seeking healthcare and the poorer people bore more financial burden.

Conclusion: A health system which allows majority of people could afford for health services is still a big challenge in China especially under population aging and epidemiological transition background. Health system should be developed in order to meet the needs of elderly with different chronic conditions.

Place, publisher, year, edition, pages
2017. , p. 27
Series
Centre for Public Health Report Series, ISSN 1651-341X ; 2017:45
Keyword [en]
Non-communicable diseases, the elderly, socioeconomic status, health system responsiveness, fairness financing, kakwani index
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-143272OAI: oai:DiVA.org:umu-143272DiVA, id: diva2:1168001
External cooperation
WHO SAGE - Paul Kowal
Educational program
Master's Programme in Public Health
Presentation
2017-10-10, Anna-Lena room at the unit Epidemiology and Global Health, Umeå University, Umeå, 15:00 (English)
Supervisors
Examiners
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2017-12-19Bibliographically approved

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