This paper focuses on C-K theory with its application to expand the scope of innovative solutions to transform health systems.The previous paper(Huttin,2024)provided a review of main design theories and a description ...This paper focuses on C-K theory with its application to expand the scope of innovative solutions to transform health systems.The previous paper(Huttin,2024)provided a review of main design theories and a description of the research process and interactions between investigators for physicians’choice models using random price generators.The selection of alternatives for that user case mainly related to medical policy problems(e.g.Huttin&Hausman,2021).However,such experimental studies require scaling up for bigger samples and therefore comprehensive user cases,to be useful for transformative tools in health system reforms.The use of C-K theory(Hatchuel&Weil,2002)may be a useful framework to generate data elements on economic and financial information,from conversation of care,and expand the dataspace,with innovative applications of the algorithms(as proposed in Prof.Huttin’s studies).The development of such economic models will impact the architecture of national or international accounting systems;therefore,they may require the design of ad hoc or satellite health accounts with such additional type of information.However,the architecture of health accounts is more driven by environmental communities who dominate methodological advances(e.g.agriculture,forestry management,etc.);modeling techniques in international health accounting generate specific tracers to integrate in aggregate indexes.Such development of the K space may be used for the health targets under the global agenda(e.g.SDGs).The statistical methods used to transform this K space,their selection process,and the identification of key parameters estimates will determine to a certain extent the transformation of health systems and will nurture the C concepts(e.g.more justice in reallocation of services and access to care).In global health,comparable national estimates are used(e.g.“Global Burden of Diseases”(GBD)and risk predictors for health risk evaluation).In relation to global pricing,the agenda refers to“Universal Health Coverage”(UHC),to accelerate access to affordable medical services in different regions of the world.Additional economic and financial information on populations with methodologies such as Hierarchical Bayesian Modeling(HBM)and its countervailing use(e.g.,physicians reversed conjoint models,Huttin,2017),with trained models on bigger samples and comprehensive user cases,contributes to structuring the pathway to transformative changes.展开更多
1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%o...1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].展开更多
Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of sk...Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.展开更多
The study evaluated the impact of digital health tools, task sharing, capacity building, and maternal health financing on Maternal, Newborn, and Child Health (MNCH) systems in Kisii, Kajiado, and Migori counties in Ke...The study evaluated the impact of digital health tools, task sharing, capacity building, and maternal health financing on Maternal, Newborn, and Child Health (MNCH) systems in Kisii, Kajiado, and Migori counties in Kenya, under the Tekeleza project1. It aimed to assess how these interventions influenced MNCH service uptake, outcomes, and referral systems, using a mixed-methods approach with data from healthcare providers, community health promoters, and mothers. Findings showed that digital tools like the LUCY App improved coordination and maternal care but highlighted the need for better app features and wider access. Task sharing in areas like sonography enhanced service delivery but required stronger stakeholder engagement. Capacity-building through training was crucial for skill development, though additional training on emerging health issues was needed. Financial interventions, such as the Linda Mama program, boosted service uptake, but reimbursement processes needed improvement. Strengthening referral systems between lower- and higher-level facilities was identified as essential for timely access to care. The study concludes that integrating digital tools, expanding task sharing, enhancing training, and reinforcing health financing and referral systems are critical for strengthening MNCH services in rural Kenya, with broader implications for similar low-resource settings.展开更多
Objective:To evaluate the health effects of sugary beverage consumption among adolescent students in Guangxi.Methods:In three cities of Guangxi(Nanning,Liuzhou,and Guilin),we investigated the consumption of sugary bev...Objective:To evaluate the health effects of sugary beverage consumption among adolescent students in Guangxi.Methods:In three cities of Guangxi(Nanning,Liuzhou,and Guilin),we investigated the consumption of sugary beverages by distributing a self-administered Functional Assessment Questionnaire of Life Health System and a Dietary Behavior Questionnaire(this paper analyzes only the part of sugary beverage consumption)to adolescent students in four schools,aiming to find out the general health status of the students and also to assess the effects of sugary beverages on the functional system health of adolescent students.Results:A total of 953 adolescent students between the ages of 14 and 24 were surveyed.Among them,46.17%consumed sugary beverages once a week;37.46%consumed them 2-3 times;11.52%consumed them more than 3 times;and 4.83%consumed them every day.The mean score of Functional Assessment Questionnaire of Life Health System was 32.There was a positive correlation between the frequency of consumption of sugary beverages and the overall systemic function assessment score(P<0.05),and the rank of the total score elevated by 0.314 times for each increase in the level of consumption.Compared to those who drink sugary beverages at least once a day,drinking them once a week showed a statistically significant difference(P<0.05).However,there was no statistically significant difference between drinking 2-3 times a week and more than 3 times a week(P>0.05).The correlation between consuming sugary beverages once a week and 2-3 times a week and endocrine system scores was also statistically significant(P<0.05).Conclusion:More than half of the students in the surveyed areas consumed sugary beverages two or more times a week,and the higher the frequency of consumption,the higher the scores of systemic function assessment.Health education on sugar reduction among adolescents should be strengthened.展开更多
Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto p...Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto public health emergencies under the International Health Regulations (2005), the actions of most countriesto combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This crosssectionalstudy aimed to examine the health system resilience of selected countries and analyze their strategiesand measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K.,and the U.S., based on the severity of the national epidemic, the geographical location, and the developmentlevel. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure theseverity of the impact of the pandemic in each country;WHO State Parties Self-Assessment Annual Reporting (SPAR)Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience;and research articles and press materials were summarized to identify the strategies and measures adopted bycountries during response to COVID-19. This study applied the resilient health systems framework to analyzehealth system resilience in the selected countries from five dimensions, including awareness, diversity, selfregulation,integration and adaptation.Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and theU.S. were above the global and regional averages;the SPAR Scores of Iran were above the global average whilethe GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. investedmore health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategyof extensive testing and identification of suspected patients. In terms of specific measures, all the five countriesadopted measures such as restrictions on entry and international travel, closure of schools and industries,lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied acrosscountries, based on the response strategies.Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparednessand response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries stilldo not build resilient health systems in response to public health emergencies. Health system strengtheningand health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach todeveloping resilient health systems.展开更多
Objective To systematic review and analyze the practices and effects of integrating post-abortion family planning （PAFP） services into existing health system worldwide in order to inform the future interventions to ...Objective To systematic review and analyze the practices and effects of integrating post-abortion family planning （PAFP） services into existing health system worldwide in order to inform the future interventions to deliver PAFP in China. Methods A systematic search for relevant published and unpublished literature was conducted. Based on a set of criteria, citation and full text were screened, related data were extracted. Findings of included studies were reviewed and analyzed using a textual narrative approach to synthesis. Results A total of 28 studies were included in the synthesis. The studies were published between 1995 and 2008 and covered 20 countries. Some countries were in the stage of piloting post-abortion care （PAC）/PAFP intervention, while others were either from piloting to scaling up or examined how well a pilot PAC/PAFP intervention and resulting improvements were able to be maintained over the long term in the same intervention site. Most studies examined initiatives that were implemented at public sectors from tertiary, secondary to primary health facilities, while a few were imple- mented at private sectors. Efforts of integrating PAFP into existing health system from health system perspectives such as funding the programs, training of trainer （TOT） training or on the job training of physicians and mid-level service provider, expan- sion the range of contraceptive methods available including a few free distribution of contraceptives, improving data collection including cost analysis in a few countries,service guidelines provided to health professionals, supportive supervision at program sites to ensure quality of care, and leadership from government to strengthen PAC/ PAFP service by revising or developing a new national policy. Effects of those intervention programs included that 2 studies decreased abortion rates, 7 studies improved modern contraceptive use, 1 study improved women＇s knowledge on sexual ＆ reproductive health, and 5 studies reported women＇s high satisfaction rate with receiving PAC/PAFP services. Conclusion Each study was conducted within a cultural legal social and religious framework. There might be no single set of best practices that can be put forward as a model to integrate PAFP into existing health system in China. These areas should be taken into account in our future intervention including government＇s optimization and complement to the regulations related to abortion, contraception and PAFP, capacity building for service provider, continuous efforts to improve the quality of PAFP service, and accessibility of multiple contraceptive methods for married as well as unmarried youth.展开更多
Background: The prevalence and incidence rate of tuberculosis remains high although the disease is known to be almost always curable provided the patient adheres to the treatment regimen. This study assessed the stren...Background: The prevalence and incidence rate of tuberculosis remains high although the disease is known to be almost always curable provided the patient adheres to the treatment regimen. This study assessed the strength of association between known patient and health system factors associated with first line tuberculosis treatment adherence. Methods: A quantitative cross sectional study. Retrospective chart reviews were conducted among 570 persons who had primary tuberculosis and received first line treatment at a health facility within the Nkangala district, Mpumalanga province and who had a treatment outcome recorded between 1st January 2009 and 31st December 2014. Adherence to first line tuberculosis treatment was defined as taking ≥80% of tuberculosis prescribed drugs within a period of 6 to 8 months. Stata software (logistic regressions model) was used to analyze results and find the strength of association between known factors and treatment adherence. Results: Out of the 570 study participants, 473 were adherent and 96 were not adherent. There was a statistically significant association between age 18 years and above (OR: 1.02, P-value: 0.027), sex (lower in males OR: 0.44, P-value: 0.001) and support (OR: 3.04, P-value: 0.05) and HIV (OR: 1, P-value: 0.634) and first line TB treatment adherence. Conclusion and Recommendation: >80% adherence to first line tuberculosis outcome is possible. The support given to people with tuberculosis will further enhance adherence to first line tuberculosis treatment.展开更多
Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age...Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age, 50% to 60% of adolescents and adults with pelvic pain, and up to 50% of women with infertility are pregnant from the condition. However, this proportion tends to be even greater due to the difficulty in diagnosing it: because it presents different symptoms, lack of information from health professionals, and a high-cost diagnostic test. Another aggravating factor is the average time from the onset of symptoms to the medical diagnosis, which even today ranges from five to ten years;this delay has consequences for disease progression, as it prevents early treatment, which is important for improving pain levels and physical and psychological well-being. Aware of these mishaps, it is therefore important to assess the difficulties faced by doctors in the diagnosis of endometriosis in the public health system, in Brazil, the Unified Health System (SUS). With this purpose, a cross sectional was carried out, developed in the virtual environment using traffic in Google forms, with the difficulties quantified in the Likert scale. Participating physicians pointed out a medium difficulty for patients with endometriosis to access the consultation (58%) and moderate difficulty (52%) to perform an ultrasound examination;also signaled great difficulty in performing magnetic resonance imaging (77%) and laparotomy (61%) in these patients. It is hoped that knowledge about the difficulties faced by physicians in the diagnosis of endometriosis in the SUS will give these physicians a voice and corroborate, even if minimally, so that there is more research that provokes the search for these difficulties, in order to improving the quality of life of these women.展开更多
The healthcare system＇s approach considers the complexity and interactions between organized elements. In continuous processing, healthcare systems are affected by their constituent elements, themselves modified with...The healthcare system＇s approach considers the complexity and interactions between organized elements. In continuous processing, healthcare systems are affected by their constituent elements, themselves modified with each system change. To secure and optimize the system of care, collaboration between levels is necessary. Almost no documented experience to better coordination of levels of care in the Belgian system is available. To improve the quality of care, the system needs collaborative coordination between stakeholders. Good coordination improves the quality of patient care, it makes quality more efficient and optimal care. This coordination between care lines must be collaborative. Interactional communication is the founding element of inter-professional collaboration. A good self-esteem improves the relationship between actors in the health system and supports the initiatives and adaptability. It contributes therefore to an increase of the quality of care. The interactional Local Health System promotes cooperation in the relevant health network. Consultation and coordination between the actors involved and motivated bring care quality and operational solutions. This dynamic modality of exchanges appears fruitful as participants continue to meet and coordinate care, even after the official end of the action-research. The climate became conducive to solving real problems through the skills developed in the LHS.展开更多
Can Romania have a sustainable health system,so that the population can choose medical services at a state hospital or at a private hospital?A healthy state,with a healthy population,can ensure a viable balance with a...Can Romania have a sustainable health system,so that the population can choose medical services at a state hospital or at a private hospital?A healthy state,with a healthy population,can ensure a viable balance with a secure future.Each country ensures its health system through levers,policies,and well-defined sources of funding,determined by demographics,geographical position,culture,nationality,has the necessary sources to implement its own health system,whether it is public or private.The programs that can be implemented in the health system start from the quality of medical services,which must be provided so that each patient can be sure that medical needs are achievable.We have a people with diverse traditions,a beautiful culture,specialized doctors and yet the medical system is still fragile.Funding programs must help us start this health system,build many private hospitals,so from prevention to services specialized,surgical,to be able to bring in the country specialized medical staff to us but gone to many states of the world.Any change can lead us to what we want,the health of our population in the village,the city,the majority of the population,the identification of possibilities to revive the health system.The market of private health systems,diversified by international players,bank brokers,manages to bring important changes in the health system.From a technical point of view,health insurance has its originality in the impossibility of being able to predict the insured’s illness and the costs necessary for recovery.Any risk related to personal injury,illness,temporary incapacity for work,can be identified,assessed in the form of medical expenses,loss of income,as a result,disability,borne by both the individual and the family,due to the inability to insure a normal activity,daily existence.Insurance can be considered as a method of controlling the health risk.The current situation regarding the disease of the population whit COVID often makes us understand that we must be prepared at all times.The situation of the pandemic SARS-COV 19 found a timely solution through the private health system.展开更多
Regardless of the existing situations,economic crises,epidemics,or causes determined by the effects triggered in the foreign policy of the European Union states,health becomes a factor of maximum urgency in the state ...Regardless of the existing situations,economic crises,epidemics,or causes determined by the effects triggered in the foreign policy of the European Union states,health becomes a factor of maximum urgency in the state of a state,in order to have a healthy population.Ro mania now has both funding sources and revenues allocated to the establishment of the Single National Health Insurance Fund,major conditions for having an efficient health system.The National House of Health Insurance becomes the binder in the establishm ent and use of the Single National Health Fund,in the organization and coordination of projects for the development of the public and private health system,so that through the framework contract,legally constituted,we can look at the health system from needs up to the consumption of health services.No matter how much we analyze the health system in the country,it becomes efficient in the future,even if we have an aging population with pressing needs from a demographic point of view.Through a consist ent monitoring of the management in the health system and the attraction of medical personnel,after graduation,in hospital units,the balance of medical personnel vs.patient can become favorable.Family doctors must have the most important role in the h ealth system,in the existing conditions considering that the prevention and elimination of waiting time in hospitals are strictly related to the urgency of the medical services provided in time by them.Hospital units can reduce the degree of illness of t he population in the shortest possible time through monthly reporting of existing problems,including nosocomial infections.When there are well-established funding resources,the ways of their use and distribution are known,there are qualified medical pe rsonnel who can provide medical services to the population,upon returning to the country after specialization in other countries,we can clearly discuss that Romania has development levers of the public and private health system,in any condition.We must think that a transparent and prepared health system can therefore affect any country to have a healthy people,when the medical act is viewed through the lens of seriousness,humanity,professional values.展开更多
The first International Conference on Environment and Human Health Systems Engineering was held on July 8,2017 in Northwestern Polytechnical University（NPU）,Xi’an.This conference was jointly held by the School of L...The first International Conference on Environment and Human Health Systems Engineering was held on July 8,2017 in Northwestern Polytechnical University（NPU）,Xi’an.This conference was jointly held by the School of Life Sciences of NPU,the Office of International Cooperation of NPU and the China Aerospace Academy of Systems Science and Engineering（CAASSE）.展开更多
A public health system generally refers to public utilities oriented toward protecting and improving health. It is intended to protect the health of the general public. Since the founding of the People’s Republic of ...A public health system generally refers to public utilities oriented toward protecting and improving health. It is intended to protect the health of the general public. Since the founding of the People’s Republic of China, China has constructed the largest healthcare system in the world. The 20th National Congress of the Communist Party of China(CPC), stressed that China will improve its public health system. Looking back at the history of China’s public health system from its inception to the reform and development and then improvement, it can be found that its development has always revolved around the theoretical logic of unifying rights and obligations and the practical logic of balancing the protection of the right to health and the regulation of state power. The fundamental goal is to protect the right to health of the people. The increasing health risks in modern society have changed require that efforts be made to construct a crisscrossing legal framework for public health, improve early-warning and emergency response mechanisms for public health emergencies,and integrate the health concept into all policies to further improve the public health system.展开更多
Objective: to analyze the effect of Newman's health system nursing intervention in the elderly patients with chronic schizophrenia. Methods: a total of 62 elderly patients with chronic schizophrenia who received r...Objective: to analyze the effect of Newman's health system nursing intervention in the elderly patients with chronic schizophrenia. Methods: a total of 62 elderly patients with chronic schizophrenia who received rehabilitation care in our hospital from June 2019 to June 2020 were randomly selected for the study. According to the length of hospitalization, the patients were divided into 2 groups with 31 cases in each group. Among them, the reference group carries on the daily nursing to the patient, the research group adopts the Newman health system to carry on the nursing to the patient, compares the effect of two kinds of plans. Results: in terms of the symptoms shown by the patients, the scores between the groups before and after the care were the same, while the behavioral performance scores of the research group were lower and the degree of rehabilitation was higher. There was a significant difference between the two indexes (P < 0.05). Conclusion: Newman health system nursing intervention is an effective model in promoting the rehabilitation of elderly patients with chronic schizophrenia, and has application value.展开更多
EDITOR＇S NOTE： In an interview given of late to our staff reporter, Gao Qiang, Chinese Minister of Health, spoke on the achievements made by China in medical and health work during the Tenth Five-Year Plan period （...EDITOR＇S NOTE： In an interview given of late to our staff reporter, Gao Qiang, Chinese Minister of Health, spoke on the achievements made by China in medical and health work during the Tenth Five-Year Plan period （2001-2005）, the soaring medical costs that have invoked much public complaint, ways of carrying to depth the reform of the medical service system, development of the rural cooperative medical system and community-based medical services in cities, as well as prevention and control of AIDS. Following is a transcript of the interview.展开更多
The main purpose of the National Nutrition and Health Systematic Survey for children 0-17 years of age in China(CNHSC)was to collect basic data on the nutrition,development,and health status for children in different ...The main purpose of the National Nutrition and Health Systematic Survey for children 0-17 years of age in China(CNHSC)was to collect basic data on the nutrition,development,and health status for children in different regions across China using evidence-based,reliable,and cost-effective approaches.Children and their parents or guardians from seven regions(south,southwest,north,northwest,eastern,central,and northeast China)in China were recruited.A multi-stage stratified randomized sampling method was used.Two provinces were randomly sampled from each of the seven regions,from which one urban district and one rural country were also randomly sampled,resulting in a total of 28 survey counties/districts.Dietary surveys,health examinations,laboratory testing,and questionnaires were used to collect dietary intake,nutritional status,child development,and health status information.Nutrition,health,and lifestyle assessment of children and their parents was determined using the Knowledge Attitude Practice(KAP)survey.Greater than 100,000 children(38,000 children<6 years of age and 66,000 children6-17 years of age)completed the survey.The survey provided comprehensive data on child nutrition and health status for future studies and will serve as the basis for an integrated nutrition and health improvement strategies proposal for children in China.展开更多
Over the past 70 years,there was a rapid epidemiological transition in disease burden in China,from infectious disease to non-communicable diseases(NCDs),which requires long-term prevention and management.Rapid growth...Over the past 70 years,there was a rapid epidemiological transition in disease burden in China,from infectious disease to non-communicable diseases(NCDs),which requires long-term prevention and management.Rapid growth in mobile phone use,internet connectivity and digital health technology,presents new opportunities for improvement in NCD healthcare delivery and population-based outcomes.Although there were a growing number of research to evaluate the feasibility and effectiveness of the mobile health(mHealth)interventions for NCD management,the extent to which mHealth contributes towards the health system strengthening in China remains unknown.In this paper,we provided a high-level overview of mHealth in China and its role for Chinese health system strengthening.We conclude with several recommendations for the future of mHealth research in China based on existing evidence identified.展开更多
The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak...The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak of COVID-19 second wave in India, the health system of country was virtually at the brink of collapse. Therefore, to identify the factors that resulted into breakdown and the challenges, Indian healthcare system faced during the second wave of COVID-19 pandemic, this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization (WHO). Applying integrated review approach, we found that the factors such as poor infrastructure, inadequate financing, lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India. Although health system in India faced these challenges from the very beginning, but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic. To sum-up given the likely future challenges of pandemic, while healthcare should be prioritized with adequate financing, strong capacity-building measures and integration of public and private sectors in India. Likewise fiscal stimulus, risk assessment, data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.展开更多
Objectives: To examine differences in health system responsiveness across different sectors in China and to compare to other Asian countries. Methods: The World Health Survey was implemented in a nationally representa...Objectives: To examine differences in health system responsiveness across different sectors in China and to compare to other Asian countries. Methods: The World Health Survey was implemented in a nationally representative sample in China and 10 additional Asian countries from 2002-2003. Face-to-face interviews were conducted to gather health care utilization and health systems responsiveness data. Results: Overall health system responsiveness in China was better for the inpatient than the outpatient health system. Differences were seen by domain, with prompt attention and respectful treatment performing better than the other domains. Differences in responsiveness were seen by socio- demographic characteristics, with women and younger respondents rating inpatient systems, whereas men and higher educated respondents rated outpatient systems, more responsive. Conclusions: As populations age, health care systems will come under more pressures – responsiveness can be used by governments to guide policy and system improvement efforts when resources are limited. In China, reforms might prioritize outpatient system responsiveness.展开更多
文摘This paper focuses on C-K theory with its application to expand the scope of innovative solutions to transform health systems.The previous paper(Huttin,2024)provided a review of main design theories and a description of the research process and interactions between investigators for physicians’choice models using random price generators.The selection of alternatives for that user case mainly related to medical policy problems(e.g.Huttin&Hausman,2021).However,such experimental studies require scaling up for bigger samples and therefore comprehensive user cases,to be useful for transformative tools in health system reforms.The use of C-K theory(Hatchuel&Weil,2002)may be a useful framework to generate data elements on economic and financial information,from conversation of care,and expand the dataspace,with innovative applications of the algorithms(as proposed in Prof.Huttin’s studies).The development of such economic models will impact the architecture of national or international accounting systems;therefore,they may require the design of ad hoc or satellite health accounts with such additional type of information.However,the architecture of health accounts is more driven by environmental communities who dominate methodological advances(e.g.agriculture,forestry management,etc.);modeling techniques in international health accounting generate specific tracers to integrate in aggregate indexes.Such development of the K space may be used for the health targets under the global agenda(e.g.SDGs).The statistical methods used to transform this K space,their selection process,and the identification of key parameters estimates will determine to a certain extent the transformation of health systems and will nurture the C concepts(e.g.more justice in reallocation of services and access to care).In global health,comparable national estimates are used(e.g.“Global Burden of Diseases”(GBD)and risk predictors for health risk evaluation).In relation to global pricing,the agenda refers to“Universal Health Coverage”(UHC),to accelerate access to affordable medical services in different regions of the world.Additional economic and financial information on populations with methodologies such as Hierarchical Bayesian Modeling(HBM)and its countervailing use(e.g.,physicians reversed conjoint models,Huttin,2017),with trained models on bigger samples and comprehensive user cases,contributes to structuring the pathway to transformative changes.
文摘1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].
文摘Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.
文摘The study evaluated the impact of digital health tools, task sharing, capacity building, and maternal health financing on Maternal, Newborn, and Child Health (MNCH) systems in Kisii, Kajiado, and Migori counties in Kenya, under the Tekeleza project1. It aimed to assess how these interventions influenced MNCH service uptake, outcomes, and referral systems, using a mixed-methods approach with data from healthcare providers, community health promoters, and mothers. Findings showed that digital tools like the LUCY App improved coordination and maternal care but highlighted the need for better app features and wider access. Task sharing in areas like sonography enhanced service delivery but required stronger stakeholder engagement. Capacity-building through training was crucial for skill development, though additional training on emerging health issues was needed. Financial interventions, such as the Linda Mama program, boosted service uptake, but reimbursement processes needed improvement. Strengthening referral systems between lower- and higher-level facilities was identified as essential for timely access to care. The study concludes that integrating digital tools, expanding task sharing, enhancing training, and reinforcing health financing and referral systems are critical for strengthening MNCH services in rural Kenya, with broader implications for similar low-resource settings.
文摘Objective:To evaluate the health effects of sugary beverage consumption among adolescent students in Guangxi.Methods:In three cities of Guangxi(Nanning,Liuzhou,and Guilin),we investigated the consumption of sugary beverages by distributing a self-administered Functional Assessment Questionnaire of Life Health System and a Dietary Behavior Questionnaire(this paper analyzes only the part of sugary beverage consumption)to adolescent students in four schools,aiming to find out the general health status of the students and also to assess the effects of sugary beverages on the functional system health of adolescent students.Results:A total of 953 adolescent students between the ages of 14 and 24 were surveyed.Among them,46.17%consumed sugary beverages once a week;37.46%consumed them 2-3 times;11.52%consumed them more than 3 times;and 4.83%consumed them every day.The mean score of Functional Assessment Questionnaire of Life Health System was 32.There was a positive correlation between the frequency of consumption of sugary beverages and the overall systemic function assessment score(P<0.05),and the rank of the total score elevated by 0.314 times for each increase in the level of consumption.Compared to those who drink sugary beverages at least once a day,drinking them once a week showed a statistically significant difference(P<0.05).However,there was no statistically significant difference between drinking 2-3 times a week and more than 3 times a week(P>0.05).The correlation between consuming sugary beverages once a week and 2-3 times a week and endocrine system scores was also statistically significant(P<0.05).Conclusion:More than half of the students in the surveyed areas consumed sugary beverages two or more times a week,and the higher the frequency of consumption,the higher the scores of systemic function assessment.Health education on sugar reduction among adolescents should be strengthened.
基金supported by the National Natural Science Foundationof China (No. 72042014).
文摘Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto public health emergencies under the International Health Regulations (2005), the actions of most countriesto combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This crosssectionalstudy aimed to examine the health system resilience of selected countries and analyze their strategiesand measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K.,and the U.S., based on the severity of the national epidemic, the geographical location, and the developmentlevel. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure theseverity of the impact of the pandemic in each country;WHO State Parties Self-Assessment Annual Reporting (SPAR)Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience;and research articles and press materials were summarized to identify the strategies and measures adopted bycountries during response to COVID-19. This study applied the resilient health systems framework to analyzehealth system resilience in the selected countries from five dimensions, including awareness, diversity, selfregulation,integration and adaptation.Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and theU.S. were above the global and regional averages;the SPAR Scores of Iran were above the global average whilethe GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. investedmore health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategyof extensive testing and identification of suspected patients. In terms of specific measures, all the five countriesadopted measures such as restrictions on entry and international travel, closure of schools and industries,lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied acrosscountries, based on the response strategies.Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparednessand response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries stilldo not build resilient health systems in response to public health emergencies. Health system strengtheningand health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach todeveloping resilient health systems.
基金funded by the European Commission’s Seventh Framework Program[FP7/2007-2013]under grant agreement No.282490
文摘Objective To systematic review and analyze the practices and effects of integrating post-abortion family planning （PAFP） services into existing health system worldwide in order to inform the future interventions to deliver PAFP in China. Methods A systematic search for relevant published and unpublished literature was conducted. Based on a set of criteria, citation and full text were screened, related data were extracted. Findings of included studies were reviewed and analyzed using a textual narrative approach to synthesis. Results A total of 28 studies were included in the synthesis. The studies were published between 1995 and 2008 and covered 20 countries. Some countries were in the stage of piloting post-abortion care （PAC）/PAFP intervention, while others were either from piloting to scaling up or examined how well a pilot PAC/PAFP intervention and resulting improvements were able to be maintained over the long term in the same intervention site. Most studies examined initiatives that were implemented at public sectors from tertiary, secondary to primary health facilities, while a few were imple- mented at private sectors. Efforts of integrating PAFP into existing health system from health system perspectives such as funding the programs, training of trainer （TOT） training or on the job training of physicians and mid-level service provider, expan- sion the range of contraceptive methods available including a few free distribution of contraceptives, improving data collection including cost analysis in a few countries,service guidelines provided to health professionals, supportive supervision at program sites to ensure quality of care, and leadership from government to strengthen PAC/ PAFP service by revising or developing a new national policy. Effects of those intervention programs included that 2 studies decreased abortion rates, 7 studies improved modern contraceptive use, 1 study improved women＇s knowledge on sexual ＆ reproductive health, and 5 studies reported women＇s high satisfaction rate with receiving PAC/PAFP services. Conclusion Each study was conducted within a cultural legal social and religious framework. There might be no single set of best practices that can be put forward as a model to integrate PAFP into existing health system in China. These areas should be taken into account in our future intervention including government＇s optimization and complement to the regulations related to abortion, contraception and PAFP, capacity building for service provider, continuous efforts to improve the quality of PAFP service, and accessibility of multiple contraceptive methods for married as well as unmarried youth.
文摘Background: The prevalence and incidence rate of tuberculosis remains high although the disease is known to be almost always curable provided the patient adheres to the treatment regimen. This study assessed the strength of association between known patient and health system factors associated with first line tuberculosis treatment adherence. Methods: A quantitative cross sectional study. Retrospective chart reviews were conducted among 570 persons who had primary tuberculosis and received first line treatment at a health facility within the Nkangala district, Mpumalanga province and who had a treatment outcome recorded between 1st January 2009 and 31st December 2014. Adherence to first line tuberculosis treatment was defined as taking ≥80% of tuberculosis prescribed drugs within a period of 6 to 8 months. Stata software (logistic regressions model) was used to analyze results and find the strength of association between known factors and treatment adherence. Results: Out of the 570 study participants, 473 were adherent and 96 were not adherent. There was a statistically significant association between age 18 years and above (OR: 1.02, P-value: 0.027), sex (lower in males OR: 0.44, P-value: 0.001) and support (OR: 3.04, P-value: 0.05) and HIV (OR: 1, P-value: 0.634) and first line TB treatment adherence. Conclusion and Recommendation: >80% adherence to first line tuberculosis outcome is possible. The support given to people with tuberculosis will further enhance adherence to first line tuberculosis treatment.
文摘Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age, 50% to 60% of adolescents and adults with pelvic pain, and up to 50% of women with infertility are pregnant from the condition. However, this proportion tends to be even greater due to the difficulty in diagnosing it: because it presents different symptoms, lack of information from health professionals, and a high-cost diagnostic test. Another aggravating factor is the average time from the onset of symptoms to the medical diagnosis, which even today ranges from five to ten years;this delay has consequences for disease progression, as it prevents early treatment, which is important for improving pain levels and physical and psychological well-being. Aware of these mishaps, it is therefore important to assess the difficulties faced by doctors in the diagnosis of endometriosis in the public health system, in Brazil, the Unified Health System (SUS). With this purpose, a cross sectional was carried out, developed in the virtual environment using traffic in Google forms, with the difficulties quantified in the Likert scale. Participating physicians pointed out a medium difficulty for patients with endometriosis to access the consultation (58%) and moderate difficulty (52%) to perform an ultrasound examination;also signaled great difficulty in performing magnetic resonance imaging (77%) and laparotomy (61%) in these patients. It is hoped that knowledge about the difficulties faced by physicians in the diagnosis of endometriosis in the SUS will give these physicians a voice and corroborate, even if minimally, so that there is more research that provokes the search for these difficulties, in order to improving the quality of life of these women.
文摘The healthcare system＇s approach considers the complexity and interactions between organized elements. In continuous processing, healthcare systems are affected by their constituent elements, themselves modified with each system change. To secure and optimize the system of care, collaboration between levels is necessary. Almost no documented experience to better coordination of levels of care in the Belgian system is available. To improve the quality of care, the system needs collaborative coordination between stakeholders. Good coordination improves the quality of patient care, it makes quality more efficient and optimal care. This coordination between care lines must be collaborative. Interactional communication is the founding element of inter-professional collaboration. A good self-esteem improves the relationship between actors in the health system and supports the initiatives and adaptability. It contributes therefore to an increase of the quality of care. The interactional Local Health System promotes cooperation in the relevant health network. Consultation and coordination between the actors involved and motivated bring care quality and operational solutions. This dynamic modality of exchanges appears fruitful as participants continue to meet and coordinate care, even after the official end of the action-research. The climate became conducive to solving real problems through the skills developed in the LHS.
文摘Can Romania have a sustainable health system,so that the population can choose medical services at a state hospital or at a private hospital?A healthy state,with a healthy population,can ensure a viable balance with a secure future.Each country ensures its health system through levers,policies,and well-defined sources of funding,determined by demographics,geographical position,culture,nationality,has the necessary sources to implement its own health system,whether it is public or private.The programs that can be implemented in the health system start from the quality of medical services,which must be provided so that each patient can be sure that medical needs are achievable.We have a people with diverse traditions,a beautiful culture,specialized doctors and yet the medical system is still fragile.Funding programs must help us start this health system,build many private hospitals,so from prevention to services specialized,surgical,to be able to bring in the country specialized medical staff to us but gone to many states of the world.Any change can lead us to what we want,the health of our population in the village,the city,the majority of the population,the identification of possibilities to revive the health system.The market of private health systems,diversified by international players,bank brokers,manages to bring important changes in the health system.From a technical point of view,health insurance has its originality in the impossibility of being able to predict the insured’s illness and the costs necessary for recovery.Any risk related to personal injury,illness,temporary incapacity for work,can be identified,assessed in the form of medical expenses,loss of income,as a result,disability,borne by both the individual and the family,due to the inability to insure a normal activity,daily existence.Insurance can be considered as a method of controlling the health risk.The current situation regarding the disease of the population whit COVID often makes us understand that we must be prepared at all times.The situation of the pandemic SARS-COV 19 found a timely solution through the private health system.
文摘Regardless of the existing situations,economic crises,epidemics,or causes determined by the effects triggered in the foreign policy of the European Union states,health becomes a factor of maximum urgency in the state of a state,in order to have a healthy population.Ro mania now has both funding sources and revenues allocated to the establishment of the Single National Health Insurance Fund,major conditions for having an efficient health system.The National House of Health Insurance becomes the binder in the establishm ent and use of the Single National Health Fund,in the organization and coordination of projects for the development of the public and private health system,so that through the framework contract,legally constituted,we can look at the health system from needs up to the consumption of health services.No matter how much we analyze the health system in the country,it becomes efficient in the future,even if we have an aging population with pressing needs from a demographic point of view.Through a consist ent monitoring of the management in the health system and the attraction of medical personnel,after graduation,in hospital units,the balance of medical personnel vs.patient can become favorable.Family doctors must have the most important role in the h ealth system,in the existing conditions considering that the prevention and elimination of waiting time in hospitals are strictly related to the urgency of the medical services provided in time by them.Hospital units can reduce the degree of illness of t he population in the shortest possible time through monthly reporting of existing problems,including nosocomial infections.When there are well-established funding resources,the ways of their use and distribution are known,there are qualified medical pe rsonnel who can provide medical services to the population,upon returning to the country after specialization in other countries,we can clearly discuss that Romania has development levers of the public and private health system,in any condition.We must think that a transparent and prepared health system can therefore affect any country to have a healthy people,when the medical act is viewed through the lens of seriousness,humanity,professional values.
文摘The first International Conference on Environment and Human Health Systems Engineering was held on July 8,2017 in Northwestern Polytechnical University（NPU）,Xi’an.This conference was jointly held by the School of Life Sciences of NPU,the Office of International Cooperation of NPU and the China Aerospace Academy of Systems Science and Engineering（CAASSE）.
基金a phased result of the key project of the National Social Science Fund titled “Review and Analysis of the Research of Jurisprudence in China in the Past 70 Years”(project approval No. 19AFX002)the student research project of Southwest University of Political Science and Law titled “Law on the Promotion of Basic Medical and Health Care and New Progress in the Protection of the Right to Health”(project approval No. 2021XZXSZC)。
文摘A public health system generally refers to public utilities oriented toward protecting and improving health. It is intended to protect the health of the general public. Since the founding of the People’s Republic of China, China has constructed the largest healthcare system in the world. The 20th National Congress of the Communist Party of China(CPC), stressed that China will improve its public health system. Looking back at the history of China’s public health system from its inception to the reform and development and then improvement, it can be found that its development has always revolved around the theoretical logic of unifying rights and obligations and the practical logic of balancing the protection of the right to health and the regulation of state power. The fundamental goal is to protect the right to health of the people. The increasing health risks in modern society have changed require that efforts be made to construct a crisscrossing legal framework for public health, improve early-warning and emergency response mechanisms for public health emergencies,and integrate the health concept into all policies to further improve the public health system.
文摘Objective: to analyze the effect of Newman's health system nursing intervention in the elderly patients with chronic schizophrenia. Methods: a total of 62 elderly patients with chronic schizophrenia who received rehabilitation care in our hospital from June 2019 to June 2020 were randomly selected for the study. According to the length of hospitalization, the patients were divided into 2 groups with 31 cases in each group. Among them, the reference group carries on the daily nursing to the patient, the research group adopts the Newman health system to carry on the nursing to the patient, compares the effect of two kinds of plans. Results: in terms of the symptoms shown by the patients, the scores between the groups before and after the care were the same, while the behavioral performance scores of the research group were lower and the degree of rehabilitation was higher. There was a significant difference between the two indexes (P < 0.05). Conclusion: Newman health system nursing intervention is an effective model in promoting the rehabilitation of elderly patients with chronic schizophrenia, and has application value.
文摘EDITOR＇S NOTE： In an interview given of late to our staff reporter, Gao Qiang, Chinese Minister of Health, spoke on the achievements made by China in medical and health work during the Tenth Five-Year Plan period （2001-2005）, the soaring medical costs that have invoked much public complaint, ways of carrying to depth the reform of the medical service system, development of the rural cooperative medical system and community-based medical services in cities, as well as prevention and control of AIDS. Following is a transcript of the interview.
基金supported by the National Special Program for Science&Technology Basic Resources Investigation of China[Grant No.2017FY101100,2017FY101101,2017FY101102,2017FY101103,2017FY101104,2017FY101105,2017FY101106,and 2017FY101107]。
文摘The main purpose of the National Nutrition and Health Systematic Survey for children 0-17 years of age in China(CNHSC)was to collect basic data on the nutrition,development,and health status for children in different regions across China using evidence-based,reliable,and cost-effective approaches.Children and their parents or guardians from seven regions(south,southwest,north,northwest,eastern,central,and northeast China)in China were recruited.A multi-stage stratified randomized sampling method was used.Two provinces were randomly sampled from each of the seven regions,from which one urban district and one rural country were also randomly sampled,resulting in a total of 28 survey counties/districts.Dietary surveys,health examinations,laboratory testing,and questionnaires were used to collect dietary intake,nutritional status,child development,and health status information.Nutrition,health,and lifestyle assessment of children and their parents was determined using the Knowledge Attitude Practice(KAP)survey.Greater than 100,000 children(38,000 children<6 years of age and 66,000 children6-17 years of age)completed the survey.The survey provided comprehensive data on child nutrition and health status for future studies and will serve as the basis for an integrated nutrition and health improvement strategies proposal for children in China.
基金The George Institute for Global Health postgraduate scholarship to conduct this study.
文摘Over the past 70 years,there was a rapid epidemiological transition in disease burden in China,from infectious disease to non-communicable diseases(NCDs),which requires long-term prevention and management.Rapid growth in mobile phone use,internet connectivity and digital health technology,presents new opportunities for improvement in NCD healthcare delivery and population-based outcomes.Although there were a growing number of research to evaluate the feasibility and effectiveness of the mobile health(mHealth)interventions for NCD management,the extent to which mHealth contributes towards the health system strengthening in China remains unknown.In this paper,we provided a high-level overview of mHealth in China and its role for Chinese health system strengthening.We conclude with several recommendations for the future of mHealth research in China based on existing evidence identified.
文摘The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak of COVID-19 second wave in India, the health system of country was virtually at the brink of collapse. Therefore, to identify the factors that resulted into breakdown and the challenges, Indian healthcare system faced during the second wave of COVID-19 pandemic, this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization (WHO). Applying integrated review approach, we found that the factors such as poor infrastructure, inadequate financing, lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India. Although health system in India faced these challenges from the very beginning, but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic. To sum-up given the likely future challenges of pandemic, while healthcare should be prioritized with adequate financing, strong capacity-building measures and integration of public and private sectors in India. Likewise fiscal stimulus, risk assessment, data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.
文摘Objectives: To examine differences in health system responsiveness across different sectors in China and to compare to other Asian countries. Methods: The World Health Survey was implemented in a nationally representative sample in China and 10 additional Asian countries from 2002-2003. Face-to-face interviews were conducted to gather health care utilization and health systems responsiveness data. Results: Overall health system responsiveness in China was better for the inpatient than the outpatient health system. Differences were seen by domain, with prompt attention and respectful treatment performing better than the other domains. Differences in responsiveness were seen by socio- demographic characteristics, with women and younger respondents rating inpatient systems, whereas men and higher educated respondents rated outpatient systems, more responsive. Conclusions: As populations age, health care systems will come under more pressures – responsiveness can be used by governments to guide policy and system improvement efforts when resources are limited. In China, reforms might prioritize outpatient system responsiveness.
