The Unmet Medical Demand among China’s Urban Residents

Our work aimed to build a reasonable proxy for unmet medical demands of China’s urban residents. We combined health demand modeling and stochastic frontier analysis to produce a frontier medical demand function, which allowed us to disentangle unmet medical demands from the unobservable effects. We estimated unmet medical demands by using China’s provincial dataset that covered 2005–2018. Our estimates showed that unmet medical demand at the national level was 12.6% in 2018, and regions with high medical prices confronted more unmet medical demands than regions with moderate or low medical prices during 2005–2018. Furthermore, medical prices and education were the main factors that affected unmet medical demand; therefore, policy making should pay more attention to reducing medical costs and promoting health education.

Drying of pineapple slices using combined low-pressure superheated steam and vacuum drying

A method of combining low-pressure superheated steam drying (LPSSD) and vacuum drying (VD) was proposed to improve the dried pineapple quality and increase the drying rate. It was found that the inversion temperature in low-pressure superheated steam drying of pineapple was 85.75 °C in terms of the first falling rate period. The combining drying (LPSSD–VD) reduced the maximum material temperature by 9.5 °C and 0.35 °C, and shortened the drying time by 50 min and 90 min compared with LPSSD and VD at the same drying temperature of 90 °C. The vitamin C retention rate of dried pineapple by LPSSD–VD was 29.33% and 15.94% higher than that of LPSSD and VD, respectively. The color of dried pineapple was also improved. Moreover, the sugar content of dried pineapple can be well controlled to meet the health demand of low sugar and ensure the taste of dried pineapple during LPSSD–VD process.

P009 Australian consultant pharmacists’ potential roles in sleep health care - Exploring a new avenue for improving the management of insomnia

Background Insomnia is a highly prevalent sleep disorder and the first-line recommended treatment is cognitive behavioural therapy. However, there is persistent use of pharmacotherapy, mainly, sedative-hypnotics. Consultant pharmacists can provide medication review services for patients on polypharmacy, and are therefore well placed to educate patients and provide sleep health/insomnia care with regards to pharmacotherapy and behavioural therapy use. Objectives To explore consultant pharmacists’ current sleep health-related practice and what their perspectives are around developing/implementing a consultant pharmacist-led behavioural service for insomnia. Methods Qualitative semi-structured interviews were conducted with a convenience-based sample of consultant pharmacists. Interviews were audio-recorded, transcribed and thematically analysed. Results Twenty-four consultant pharmacists were interviewed. Three themes were gauged: 1) Trivializing insomnia and sleep health, 2) Patients – an integral piece of the treatment puzzle, 3) Making it work. Participants commonly dealt with older patients and frequently encountered patients with sleep complaints/consuming sleep aids. Generally, it was believed that sleep health was considered a ‘non-priority’, with other comorbidities taking precedence in health provisions. While interested in expanding their sleep health/insomnia practice, participants expressed the need for appropriate education/training, funding and collaborative treatment configurations. Further, patients’ attitudes towards treatment approaches were regarded critical to future service developments. Conclusion Insomnia/sleep health concerns are growing. Primary health professionals need to scale up their sleep health care provisions to accommodate for this health demand. Consultant pharmacists are interested/willing to expand their sleep-related practice and provide evidence-based insomnia therapies, however factors such as education/training, service configuration support and patient attitudes should be addressed.

Health Demand: Empirical Study of Effective Urban Households Demand in Indonesia

BACKGROUND: Grossman's health demand model recognizes medical price as a determinant of the estimation model. This article aims to examine the role of medical expenses in health demand by utilizing the number of sick and disturbed days obtained from Susenas, a survey on the expenditure of household food and non-food consumption conducted by the Central Bureau of Statistics to measure health demand and health insurance as a medical price in a reduction model. Health insurance can replace medical expenses because those who have health insurance face relatively low medical costs and face lower medical prices than those without health insurance. METHODS: Using the Ordinary Least Squares (OLS) estimation technique, sebuah teknik estimasi model regresi for 6,642 households this was obtained through three stages: First, using 71,932 sample households of susenas that relied fully on the Susenas sampling method by BPS; Second, find households that have experienced health problems during the last 6 months; Third, find households that have health expenditures of 24,341. Furthermore, the estimation model is based on 6,642 households identified to be in urban areas using the Ordinary Least Squares (OLS) estimation method. FINDINGS: The health demand estimation model that can be used to determine the behavior of health demand among urban households is limited to households with formal primary school (SD) education levels. Taking advantage of certain wages, age, cigarette expenditure, and sports expenses, it was found that the number of sick days and felt disturbed in the household group that had health insurance was 5.68 days relatively greater than those without health insurance. However, expanding to higher education and older age was found to be 1.47 days and 1.57 days. Aging tends to decrease good health and health insurance tends to increase it. CONCLUSION: It was found that health stocks differed between insured households and households without health insurance in those with aging.

Smog Avoidance Investment While Improving Air Quality: Health Demand or Risk Aversion? Evidence from Cities in China

Atmospheric pollution control policies have achieved remarkable progress in China since 2013, and the smog protective equipment market has experienced a great boom during the same period. From the perspectives of the health production efficiency hypothesis and the time discount rate hypothesis, this study investigates the relationship between household expenditures on air pollution avoidance and health care, and individuals’ self-assessed health based on network survey data from 17 cities in China. Using the treatment effect model to control the potential endogenous selection problems, we explain the paradox of the growing smog avoidance investment coexisting with improving air quality. First, smog avoidance investment and household medical expenditures do not have substitution effects, while the perception of pollution intensity, pollution protection knowledge, and future health preferences significantly promote smog avoidance investment and medical expenditures. Second, air pollution avoidance investment greatly increases the probability that urban residents rate their health as “good” and “very good”. The results indicate that the time preference hypothesis can explain the pollution avoidance investment behavior and health demands of Chinese urban residents well. The hidden social welfare loss caused by air pollution may still be underestimated, even though short-term avoidance costs are included in the evaluation of pollution impacts. It is necessary to optimize environmental regulations and policies to consistently improve the ecological environment.

Physician distribution across China’s cities: regional variations

Background Distribution of physicians is a key component of access to health care. Although there is extensive research on urban-rural disparities in physician distribution, limited attention has been directed to the heterogeneity across urban areas. This research depicts variations in physician density across over 600 cities in the context of China’s rapid urbanization. Methods Data came from National Census Surveys and China statistical yearbooks, 2000–2003, and 2010–2013. Cities were characterized in terms of not only administrative level but also geographic regions and urban agglomerations. We analyzed variations in physician supply by applying generalized estimating equations with an ordinal logistic linking function. Results Although overall physician density increased between 2003 and 2013, with population and socioeconomic attributes adjusted, physician density declined in urban China. On average, urban districts had a higher physician density than county-level cities, but there were regional variations. Cities in urban agglomerations and those outsides did not differ in physician density. Conclusion Despite the reduced inequality between 2003 and 2013, the growth in physician density did not appear to be commensurate with the changes in population health demand. Assessment in physician distribution needs to take into account heterogeneity in population and socioeconomic characteristics.

Adapting for the COVID-19 pandemic in Ecuador, a characterization of hospital strategies and patients

The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.

Identifying goals, roles and tasks of extended scope physiotherapy in Dutch primary care- an exploratory, qualitative multi-step study

Background Rising healthcare costs, an increasing general practitioner shortage and an aging population have made healthcare organization transformation a priority. To meet these challenges, traditional roles of non-medical members have been reconsidered. Within the domain of physiotherapy, there has been significant interest in Extended Scope Physiotherapy (ESP). Although studies have focused on the perceptions of different stakeholders in relation to ESP, there is a large variety in the interpretation of ESP. Aim: To identify a paradigm of ESP incorporating goals, roles and tasks, to provide a consistent approach for the implementation of ESP in primary care. Methods An exploratory, qualitative multi-step design was used containing a scoping review, focus groups and semi-structured interviews. The study population consisted of patients, physiotherapists, general practitioners and indirect stakeholders such as lecturers, health insurers and policymakers related to primary care physiotherapy. The main topics discussed in the focus groups and semi-structured interviews were the goals, skills and roles affiliated with ESP. The ‘framework’ method, developed by Ritchie & Spencer, was used as analytical approach to refine the framework. Results Two focus groups and twelve semi-structured interviews were conducted to explore stakeholder perspectives on ESP in Dutch primary care. A total of 11 physiotherapists, six general practitioners, five patients and four indirect stakeholders participated in the study. There was a lot of support for ‘decreasing healthcare costs’, ‘tackling increased health demand’ and ‘improving healthcare effectiveness’ as main goals of ESP. The most agreement was reached on ‘triaging’, ‘referring to specialists’ and ‘ordering diagnostic imaging’ as tasks fitting for ESP. Most stakeholders also supported ‘working in a multidisciplinary team’, ‘working as a consultant’ and ‘an ESP role separated from a physiotherapist role’ as roles of ESP. Conclusions Based on the scoping review, focus groups and interviews with direct and indirect stakeholders, it appears that there is sufficient support for ESP in the Netherlands. This study provides a clear presentation of how ESP can be conceptualized in primary care. A pilot focused on determining the feasibility of ESP in Dutch primary care will be the next step.