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To achieve universal health insurance coverage,China has launched three phases of health care system reforms.The first round of reforms was embarked on in the mid-1980s with the introduction of market incentives.The second round began in 1997 with the introduction of the Urban Employee Basic Medical Insurance （UEBMI） scheme which provided health insurance coverage to all urban workers in addition to a long-term/historical scheme for government workers.

Background: Quality of life is an important indicator for quality of care. This study aimed to determine the quality of life (QOL) and its predictors in Iranian women with breast cancer who undergo chemotherapy and radiotherapy to design effective interventions in improving patients' QOL. Methods: The cross-sectional study was conducted on 190 women with breast cancer who were referred to oncology centers for chemotherapy and radiotherapy in Arak city, the central part of Iran. The participants were recruited utilizing convenience sampling method in a period from April to July 2018. Data were collected using demographic and disease characteristics questionnaires, QOL-Cancer30, QOL-Breast Cancer 23, Illness Perception Questionnaire, and Supportive Care Needs Survey - Short Form 34. Multivariate linear regression was used to analyze data. Results: The mean (standard deviation) score of cancer QOL was 57.1 (25.8). On the other hand, the mean (standard deviation) scores of the symptom and functional domains of breast cancer QOL were 43.3 (17.9) and 44.3 (21.7), respectively. Predictive variables for cancer QOL were spouse education, insurance coverage, type of surgery, type of treatment, supportive care needs, and illness perception. Predictive variables for the domain of symptoms of breast cancer QOL included spouse education, income, supportive care needs, and illness perception, while for the functional domain of breast cancer QOL, the predictive variables were the type of surgery, spouse age, supportive care needs, and illness perception. Conclusion: Fulfilling supportive care needs, helping to understand the curative nature of cancer, as well as empowering complementary health insurances are among intervenable variables to improve QOL among women with breast cancer.

The United States spends greatly more per person on health care than any other country but the evidence shows that care is often poor and inappropriate. Despite expenditures of 1.7 trillion dollars in 2003, and growing substantially each year, services remain fragmented and poorly coordinated, and more than 46 million people are uninsured. Why can't America, with its vast array of resources, sophisticated technologies, superior medical research and educational institutions, and talented health care professionals, produce higher quality care and better outcomes?In The Truth about Health Care, David Mechanic explains how health care in America has evolved in ways that favor a myriad of economic, professional, and political interests over those of patients. While money has always had a place in medical care, \"big money\" and the quest for profits has become dominant, making meaningful reforms difficult to achieve. Mechanic acknowledges that railing against these influences, which are here to stay, can achieve only so much. Instead, he asks whether it is possible to convert what is best about health care in America into a well functioning system that better serves the entire population.Bringing decades of experience as an active health policy participant, researcher, teacher, and consultant to the public and private sectors, Mechanic examines the strengths and weaknesses of our system and how it has evolved. He pays special attention to areas often neglected in policy discussions, such as the loss of public trust in medicine, the tragic state of long-term care, and the relationship of mental health to health care.For anyone who has been frustrated by uncoordinated health networks, insurance denials, and other obstacles to obtaining appropriate care, this book will provide a refreshing and frank look at the system's current and future dilemmas. Mechanic's thoughtful roadmap describes how health plans, healthcare professionals, policymakers, and consumer groups can work together to improve access, quality, fairness, and health outcomes in America.About the Author:

Private voluntary health insurance already plays an important role in the health sector of many low and middle income countries.The book reviews the context under which private insurance could contribute to an improvement in the financial sustainability of the health sector, financial protection against the costs of illness, household income.

Background China has recently made efforts to integrate urban and rural basic medical insurance systems in order to ensure both urban and rural enrollees obtain unified benefits. However, whether the distribution of government healthcare subsides has become more equitable remains unknown. The purpose of this study was to analyze determinants of and inequality in net inpatient care benefits under the integration of urban-rural medical insurance systems in China. Methods Data were obtained from a nationally representative household survey, the Fifth National Health Services Survey (2013), conducted in Anhui province. A multiple regression model and concentration index (CI) was used to estimate related factors and inequality of inpatient care net benefits. Results Findings indicated that individuals received more inpatient care benefits when urban and rural social healthcare systems were integrated. Factors associated with net benefits included gender, age, marital status, retirement, educational level, history of chronic diseases, health status, willingness to seek inpatient care and per capita income. The rich were found to disproportionately benefit from inpatient care, and the CI of net benefits for integrated insurance enrollees was the lowest among all three available health insurance schemes. These findings indicate that the recent unification of urban-rural social health insurances reduces inequality in net benefits from government subsidies. Some socioeconomic factors, such as per capita income, 60 years of age and over, history of chronic disease and high educational level positively influence inequality. Conclusion In China, accelerating the integration of urban and rural medical insurance systems is an effective way to increase equity of benefit in urban and rural areas. Strategies aimed at reducing inpatient benefit inequality must address socioeconomic factors influencing healthcare outcomes.

Background Social disparities in healthcare persist in the US despite the expansion of Medicaid under the Affordable Care Act. We investigated the causal impact of socioeconomic status on the quality of care in a setting with minimal confounding bias from race, insurance type, and access to care. Methods We designed a retrospective population-based study with a random 25% sample of adult Taiwan population enrolled in Taiwan’s National Health Insurance system from 2000 to 2016. Patient’s income levels were categorized into low-income group (<25th percentile) and high-income group (≥25th percentile). We used marginal structural modeling analysis to calculate the odds of hospital admissions for 11 ambulatory care sensitive conditions identified by the Agency for Healthcare Research and Quality and the odds of having an Elixhauser comorbidity index greater than zero for low-income patients. Results Among 2,844,334 patients, those in lower-income group had 1.28 greater odds (95% CI 1.24–1.33) of experiencing preventable hospitalizations, and 1.04 greater odds (95% CI 1.03–1.05) of having a comorbid condition in comparison to high-income group. Conclusions Income was shown to be a causal factor in a patient’s health and a determinant of the quality of care received even with equitable access to care under a universal health insurance system. Policies focusing on addressing income as an important upstream causal determinant of health to provide support to patients in lower socioeconomic status will be effective in improving health outcomes for this vulnerable social stratum.

Health insurance has become a crucial component of people’s lives as the occurrence of health problems rises. Unaffordable healthcare problems for individuals with little income might be a problem. In the case of a medical emergency, health insurance assists individuals in affording the costs of healthcare services and protects them financially against the possibility of debt. Security, privacy, and fraud risks may impact the numerous benefits of health insurance. In recent years, health insurance fraud has been a contentious topic due to the substantial losses it causes for individuals, commercial enterprises, and governments. Therefore, there is a need to develop mechanisms for identifying health insurance fraud incidents. Furthermore, a large quantity of highly sensitive electronic health insurance data are generated on a daily basis, which attracts fraudulent users. Motivated by these facts, we propose a smart healthcare insurance framework for fraud detection and prevention (SHINFDP) that leverages the capabilities of cutting-edge technologies including blockchain, 5G, cloud, and machine learning (ML) to enhance the health insurance process. The proposed framework is evaluated using mathematical modeling and an industrial focus group. In addition, a case study was demonstrated to illustrate the SHINFDP’s applicability in enhancing the security and effectiveness of health insurance. The findings indicate that the SHINFDP aids in the detection of healthcare fraud at early stages. Furthermore, the results of the focus group show that SHINFDP is adaptable and simple to comprehend. The case study further strengthens the findings and also describes the implications of the proposed solution in a real setting.

Different approaches to measure the hospital competition index might lead to inconsistent results of the effects of hospital competition on innovation adoption. The purpose of this study is to adopt a different approach to define market area and measure the level of competition to examine whether hospital competition has a positive effect on hospital behavior, taking quality indicator projects participation as an example. A total of 238 hospitals located in Taipei, Taichung, and Kaohsiung were recruited in this study. Competition index was used as the independent variable, and participation lists of Taiwan Clinical Performance Indicator and Taiwan Healthcare Indicator Series in 2012 were used as dependent variables. All data used in this study were retrieved from the 2012 national hospital profiles and the participation list of the 2 quality indicator projects in 2012; these profiles are issued by the Taiwan Ministry of Health and Welfare annually. Geopolitical boundaries and 4 kinds of fixed radiuses were used to define market area. Herfindahl-Hirschman Index and hospital density were used to measure the level of competition. A total of 12 competition indices were produced in this study by employing the geographic information system, while max-rescaled R² was used to evaluate and compare the models on goodness of fit. The results show that the effects of hospital competition on quality indicator projects participation were varied, which mean different indicators for market competition might reveal different conclusions. Furthermore, this study also found the Herfindahl-Hirschman Index at 5-km radius was the optimum competition index.

The medical services market is rapidly expanding around the world, following the experience of the industrialized Western economies. Cultural differences make existing assumptions about health care quality risky to export, leading to an increasing interest in understanding patient satisfaction with care within non-Western contexts. Within the Greater China region, both Western and traditional Chinese medicine coexist, yet there is a lack of research instruments that include distinct values of Chinese patients. This article reports the development of a measure of Chinese patient satisfaction with outpatient care. We describe the foundation of the scale in a qualitative report that includes 8 dimensions of Chinese patient satisfaction. A sample of 400 Chinese patients completed the final instrument. A quantitative analytical procedure leads to a 6-dimension and 27-item instrument to measure Chinese patients’ satisfaction with outpatient care. Our proposed instrument has good internal consistency supporting the use of the instrument in contexts where Chinese patients are being treated.

The third United Nations Sustainable Development Goal promotes health and well-being. Despite the existence of academic literature examining the relationship between health and income inequality, evidence on the role of healthcare systems in this inequality remains limited. This article aims to analyse the extent to which healthcare systems are associated with differences in economic inequality. To this end, a balanced panel of 27 European Union countries for the period 2005–2022 is used, applying t-tests for differences in means and linear regression models using S80/S20, Gini and Palma inequality measures. The main results show that countries with a Social Health Insurance System (SHIS) exhibit, on average, lower levels of income inequality, despite not being the highest spenders on healthcare. On the other hand, healthcare expenditure has a negative and statistically significant relationship with inequality, whereas in countries with a Mixed Healthcare System (MHS), this association is not statistically significant. A disaggregated analysis of public and private spending indicates that public expenditure is particularly relevant in SHIS countries being negatively associated with income inequality, whereas this relationship differs in countries with a National Health System (NHS). Thus, it is concluded that healthcare systems display significant differences in the relationship under study.