Research on Primary Care and health Aging in China and India

Abstracts
Healthy Aging in Asia book.  Comparative Diabetics project, China and India
Karen Eggleston, Stanford University
How are health systems in Asia promoting evidence-based policies for healthy aging? What strategies have been tried to prevent non-communicable chronic diseases (NCDs), screen for early detection, raise quality of care, improve medication adherence, reduce unnecessary hospitalizations and increase “value for money” in health spending?
The chapters of this book contribute to the literature on how diverse economies of Asia are preparing for older population age structures and transforming health systems to support patients who will live with chronic disease for decades. Fifteen concise chapters cover multiple aspects of policy initiatives for healthy aging and economic research on diabetes and hypertension control in health systems as diverse as cities such as Singapore and Hong Kong to large economies such as Japan, India, and China. Topics include precision health and personalized medicine in Japan; China’s evolving family doctor system and its national demonstration areas for chronic disease control; cancer disparities and public- private roles in Taiwan; and policies for healthy aging in Korea and India. Several chapters draw on research led by the Stanford Asia Health Policy Program on the net value of chronic disease management programs throughout Asia, starting with analysis of detailed longitudinal, patient-level data on diabetes management as a lens for understanding the net value of medical spending for patients with complicated chronic diseases across diverse health systems.

Research on Avoidable Admission of Diabetes Based on the Qualitative and Quantitative Transformation Model
Qin Jiang, China National Health Development Research Center

How does the Rural-Oriented Tuition-Waived Medical Education Programme Work? Evidence from Shaanxi, China
Jinlin Liu, Xi’an Jiatong University
Background: Attracting and recruiting health workers to work in rural areas is still a great challenge in China. The rural-oriented tuition-waived medical education (RTME) programme has been initiated and implemented in China since 2010, which aims to enroll the medical students mainly from rural areas to work in township hospitals for 6 years after they graduate. Taking Shaanxi as an example, this study aims to examine the effect of the RTME programme on rural-oriented tuition-waived medical students’ (RTMSs) attitudes towards working in rural areas.
Methods: Two cross-sectional surveys were conducted in 2015 and 2019. The first questionnaire survey in 2015 was conducted among RTMSs from the first group of students enrolled in the RTME programme in Shaanxi. The second survey was key informant interviews which include government personnel, township hospital directors, and two RTMSs working in township hospitals. Quantitative and qualitative analysis methods were used.
Results: All the RTMSs of the first group have broken the initial contracts they signed when they were enrolled in 2010, which is basically consistent with the results of the first questionnaire survey in 2015. Of the 230 valid responses in the 2015 survey, 92.6% expressed their intentions of breaking the contract for working in rural township hospitals for 6 years after their graduation. Meanwhile, after the contract expired, only 1.3% intended to remain in the rural areas, 66.5% had no intention of remaining, and 32.2% were unsure. The factors related to a positive attitude among the RTMSs towards working in rural areas (no intention of breaking the contract) included being female, having a mother educated at the level of primary school or below, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the policy. The factors related to a positive attitude of the RTMSs towards remaining in rural areas included being female, having a rural origin, having no regular family monthly income, having a father whose occupation was farmer, having a mother educated at the level of postsecondary or above, having the RTMSs be the final arbiter of the policy choice, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the educational scheme.
Conclusions: Related policy makers and health workforce managers may benefit from the findings of this study. Appropriate strategies should be implemented to stimulate the RTMSs’ intrinsic motivation and improve their willingness to work in rural areas and to better achieve the objectives of RTME policy. Meanwhile, measures to increase the retention of RTMSs should also be advanced.

Changes in Sleep Duration Associated with Retirement Transitions: the Role of Nap
Rize Jing and Hai Fang, Peking University
In this study, we analyzed the impact of retirement on sleep duration for old people and this is a very interesting study for the aging population in China.

Study on the Influence Factors of the Disability Evolution and Status Duration of the Rural Elderly in China
Weihong Zeng, Xi’an Jiatong University
With the development of aging and urbanization in China, social security problem for elderly people in rural areas is becoming more and more prominent. The rural elderly disabled population increase along with the deepening of the degree of disability. It is necessary to research on the characteristics of the disability trajectory and the duration of the specific level of disability status for rural elderly, in order to establish the effective long term care policy system. Using a 6-wave longitudinal survey data from 2001-2015 “Survey on the Welfare of Elderly in Anhui Province, China”, this paper analyzed the disability trajectory and the duration of the different levels of disability status for rural elderly, meanwhile, explored influence factors for the trajectory and duration time. Finally, the policy suggestions were provided based on the study findings.

Utilization of Mixed Method to Evaluate the Impact of National NCD Demonstration Site in China
Juan Zhang, School of Public Health, Peking Union Medical College (PUMC) & China Academy of Medical Science
Background By the end of 2014, 265 districts/counties out of 2853 districts/counties across China has been nominated as National Demonstration Site or Shifanqu. We aimed to evaluate the implementation and impact of National NCD Demonstration Site.
Methods We utilized both sociological and epidemiological methods to collect both qualitative and quantitative data in November and December of 2016 for process evaluation and outcome evaluation. In the meantime, case study was conducted. Semi-structured interview and focus group was organized to collect the process of intervention activities, involvement of non-health sectors, and leadership of local government. A cross-sectional survey was conducted among 4,000 adults aged 18 and above residing in 10 Shifanqu out of 265 across China. Demographic information, participation and attitudes toward intervention activities, awareness and lifestyle-related NCD, early detection of Cancer, management of blood pressure and glucose were collected.
Results The 265 Shifanqu were well implemented to meet the requirement of accreditation, in particular, health education and health promotion, China Health Lifestyle for All initiative, surveillance and safeguard measures. A government-led and inter-section coordination and communication mechanism has been established, with more than 16 non-health departments actively involved in the implementation. About 28.7% of residents living in the National Demonstration Area for comprehensive prevention and control of non-communicable disease were aware of the key messages related to chronic disease, 72.1% consumed vegetables every day, 53.6% consumed fruits every day, and 86.9% walked at least 10 minutes per day. Over 70% of patients with hypertension or diabetes reported that they were managed by the Community Health Centers, and above 50% of them were managed by the Community Health Centers as the national policy required.
Conclusion The implementation of National Demonstration Site has become a platform for the control and prevention of non-communicable diseases locally, and can be an important carrier of chronic disease prevention and control in China.

Initiatives on Hypertension Control in Shandong Province
Wang Yan, Shandong Provincial Health Department, P.R.China
As a province with a population of 100 million in North China, Shandong province has a relatively high prevalence of hypertension and its complications. The prevalence rate of hypertension among people aged between 18 and 69 is 23%. There are 16.5 million patients with diagnosed hypertension. There are 560,000 new cases of STEMI and stroke every year. Over the past decade, in order to control hypertension, Shandong province has implemented a series of intervention measures, including promoting salt reduction and blood pressure self-tests, providing free or low-price essential drugs such as anti-hypertensives, and implementing programs for early screening of cardiovascular and cerebrovascular diseases, among other initiatives. Most of these efforts appear to have achieved their intended effects, but there is still room for improvement in hypertension prevention and control. Building on the basis of this previous work, Shandong province will launch new targeted policies and measures aiming to promote blood pressure control among the population through lifestyle management and standardized drug treatment.