Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

Construction of Industrialization Development Model for"1+4+X"Community-Based Elderly Care in Gannan Old Revolutionary Base Area in the Context of Population Aging

In the context of controlling population development in a planned way,China entered an aging society in the early 21 st century.In this context,how to meet the needs of the elderly care and form an effective elderly care model has become a key problem to be solved urgently by local government departments.With the continuous advancement of the elderly care policy,the community-based elderly care has gradually become the mainstream and is in the stage of vigorous promotion.Taking the Gannan old revolutionary base area in Jiangxi Province as an example,this study puts forward"1+4+X"community-based elderly care model based on the policy system of community-based elderly care,the physical and mental health of the elderly,the material space and the construction of evaluation system,and explores how to promote the application of this community model efficiently in the form of industrialization,so as to drive the economic growth of the Gannan old revolutionary base area,promote the employment development and improve the community-based elderly care service.

Aging Characteristics and Layout Planning of Old-age Care Facilities in the Downtown Area of Nanchang City

Compared to the situation of population aging and the elderly aging, the development of oldage undertaking in Nanchang is still undeveloped in that the old-age care industry lags behind the urban renewal speed and the objective needs of aging. Apart from discussions on the composition of elderly population and the status quo of aging, this paper took the institutional old-age care in the downtown area of Nanchang for example, explored problems in the current institutional old-age care facilities through field investigation, and proposed suggestions for the layout planning of old-age care facilities in the study area.

Evaluation Items for Community-Based Health Care Focusing on Social Aspects: A Literature Review

The progressive aging of society has become a global concern, and is expected to lead to the development of effective, sustainable, person-centered, integrated community-based care systems. However, there is insufficient evidence regarding effective integrated community-based care. In particular, few studies have focused on social aspects of the community environment related to elderly health. This study aimed to consider social aspects as evaluation items, focusing particularly on social determinants from the perspective of community-dwelling people, to explore truly effective integrated community-based care to improve elderly health. The definition of social determinants means social cohesion in social and community contexts. A literature review of English articles published in peer-reviewed journals up to October 2019 was conducted using PubMed, MEDLINE, and CINAHL with the following search terms: “social cohesion,” “elderly health,” “mental health” and “community.” Identified articles were screened based on title and abstract, and selected articles were subjected to full-text assessment and critical review. All references cited in the selected articles were also reviewed. The following inclusion criteria were used: 1) studies targeting community-dwelling elderly people or community-dwelling people including elderly people as participants;2) studies with clear descriptions of social factors in the Methods section;and 3) studies with clear descriptions of health-related items in the Methods section. From the 21 articles analyzed, of which 9 articles defined social determinants as social cohesion in social and community context, 37 items were extracted as social aspects at the community level that reflect the perspective of residents. These items can be developed as evaluation items for community-based health care outcomes through consensus among community health care providers and further investigation.

Analysis of home care-based multi-level old-age service system

With the deepening of China＇s aging, China＇s social pension problem more obvious each day, and gradually become the focus of attention of the whole society. On the one hand, China entered the aging society, old-age needs to grow exponentially. The sixth national census shows that in our country, the population aged 60 and 13.26% of the total population over the total number of 179 million, 65 years and older the proportion of 8.87% of the total population, the absolute number of nearly 120 million. Hundreds of millions of older age groups will produce a growing demand for care services, which is the original old-age service system and the whole economic and social development is a huge pressure. On the other hand, with the economic and social transformation, the traditional model of family pension has been unable to adapt to the profound changes in modem employment, family structure, the concept of retirement, since most parts of China, ＂old before getting ricE＂ the situation, how to solve the elderly the pension problem is related to the overall situation of China＇s economic and social development, related to the overall situation of building a harmonious society in China. Under current national conditions, the emphasis on the development of a single individual body to meet the growing demand for pension service is not realistic, we must mobilize the enthusiasm of all aspects of the element, multi-service integration of resources subject to their commitment to a different responsibilities and tasks provide a full range of care services according to different types, different levels of the actual needs of the older age groups. On the aging problem is that the whole community to face, you need to multi-government body, families, communities, institutions combine effectively starting from the actual needs of the elderly population, according to the financial assistance, life care, spiritual consolation three set the specific needs of services, through a government-led, home-based care services, community care services for the core and supplementary services for institutions focused on pension and other means to provide a full range of pension services.

Construction of Xi'an ecological old-age care community in the new urbanization

The new urbanization is an important carrier of ecological civilization construction, and ecological old-age care is the concrete manifestation of the perfect combination of the two, the proper meaning of the new urbanization connotation and an inevitable trend of its development. Based on the analysis of the connotation and relationship between the new urbanization and ecological old-age care, together with the current situation and existing problems of the current nursing institutions and ecological old-age care in Xi'an area, this paper discusses the major issues that should be noticed when constructing the ecological old-age care community in Xi'an and three main construction modes.

The Experience and Enlightenment of the Development of Old-age Care Services in Russia

Through the analysis of the history and current situation of Russia＇s old-age care services system, this paper analyzes and studies the old-age care services system in Russia. By means of law and social policy, Russia can promote the active participation of the elderly in politics, economy, culture and other activities to promote the positive image of the elderly. The active aging policy in Russia and the development trend of the old-age care service to promote the social adaptation and re-employment of the elderly are of positive significance to the development of our country＇s old-age care service.

Do Community-Based Programs Help to Improve HIV Treatment and Health Outcomes? A Review of the Literature

Increased availability of antiretroviral treatment for HIV makes the goal of universal access attainable. However, in most resource constrained settings where existing health systems are?largely dysfunctional, major barriers to achieving this goal remain. While treatments with antiretroviral drugs (ART) are the focal point of HIV management, it is increasingly recognized that ART alone will not be sufficient to adequately deal with the lifelong consequences of the disease. In addition, the current global economic downturn will continue to impact on funding for HIV care and support, making the search for sustainable solutions more urgent. This article reviews the current evidence base on the impact of community-based programs on HIV/AIDS treatment and general health outcomes, as well as their contribution to ensuring sustained care for HIV-positive people. Our findings suggest that these programs overall have a positive impact on various dimensions of HIV treatment and care, and make a significant contribution to health and HIV outcomes. The authors argue that better use of community platforms for HIV treatment and care programs could be critical for attaining desired goals and should be prioritized at all levels of program design, implementation, and monitoring and evaluation.

Cultural Sensitivity of a Community-Based Falls Prevention Program Targeting Older Arab American

Falls are a frequent and costly cause of injuries and functional decline in the elderly. Tai Chi is a cost-effective strategy for preventing falls in older adults. Many senior centers have introduced Tai Chi programs to increase mobility and decrease the risk of falls. However, the practice has yet to be widely disseminated to ethnic minorities who are not culturally connected to Tai Chi. This paper describes implementation barriers and recruitment and retention challenges of Arab American participants in a Tai Chi intervention-based health promotion program, including issues related to community organization and staffing, recruitment and retention, need for building relationships, need for translation and interpreters, and cultural barriers & misconceptions. Understanding and paying adequate attention to these challenges may help facilitate in planning other health promotion interventions targeting Arab American population.

Community-Based Health Insurance： An Evolutionary Approach to Achieving Universal Coverage in Low-Income Countries

The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect. We use existing evidence to describe the evolution of community-based health insurance in low-income countries through the three stages of basic model, enhanced model, and nationwide model. We have concluded that community-based health insurance development is a potential strategy to meet the urgent need for health financing in low-income countries. With careful planning and implementation, it is possible to adopt such evolutionary approach to achieve universal coverage by extending tax-based financing/social insurance characteristics to community-based health insurance schemes.

Improvement of the Legal System for Addressing the Issue of Elderly Care in China in the Context of Population Aging

Rapid population aging is a social reality facing China at present,and the issue of elderly care has become a hot topic of social concern.Legislation to address the issue of elderly care in the context of population aging should follow systematic concepts to achieve“vertical and horizontal integration.”In terms of content,it is necessary to formulate specific legal approaches around“the elderly and children,”with a focus on guaranteeing the livelihood and protection of the rights of the elderly while taking into account childbirth,employment and other issues.the laws should not only safeguard the social participation and labor rights of the elderly,but also effectively respond to the social challenges brought about by the aging of the population.It is also necessary to optimize the family planning policy to ease the burden of child-raising,improve the population structure and promote the long-term balanced development of the population,thus fundamentally solving the problem of population aging.the effort to improve the legal system to deal with the issue of elderly care in the context of population aging will better advance Chinese modernization.

Construction of Urban Mixed-age Community: Opportunities, Challenges and Countermeasures: A Case Study of“Fangjia Hutong”in Beijing

In the context of China’s economic development and population aging,the innovation and exploration of the old-age care model has emerged as a new community transformation and development direction.Given the differing needs and characteristics of individuals across the lifespan,it is evident that a design approach that incorporates mixed-age integration and mutual-help communities is a viable strategy for enhancing intergenerational exchanges.This entails the creation of a diverse and open community that is conducive to habitation for individuals of all ages,encompassing the full spectrum of needs,from those of young children to the elderly.Such a community must be designed and constructed with the population in mind,from the initial planning and design stages to the operational phase.This encompasses a comprehensive range of services,including food,clothing,housing,transportation,and medical care and recreation.

Gerontological nursing and community-care in Taiwan and its enlightening value

By learning from the management experience in gerontological nursing,community-based and long-term care in Taiw an area.,this article proposed that nursing care should be based on patients' demand-orientation,and cultural inheritance of humanity and kindness,development of palliative care,and enhancement in community cooperation so as to improve management level and service quality in gerontological nursing and community-based care,and diversity in geriatric nursing culture.

Reducing childhood obesity through coordinated care:Development of a park prescription program

Major hindrances to controlling the current childhood obesity epidemic include access to prevention and/or treatment programs that are affordable,provide minimal barriers for participation,and are available to the general public.Moreover,successful childhood obesity prevention efforts will require coordinated partnerships in multiple sectors such as government,health care,school/afterschool,and the community but very few documented sustainable programs currently exist.Effective,community-based health and wellness programs with a focus on maintaining healthy weight via physical activity and healthy eating have the potential to be a powerful referral resource for pediatricians and other healthcare professionals who have young patients who are overweight/obese.The Miami Dade County Department of Parks,Recreation and Open Spaces in partnership with the University of Miami UHealth Systems have created a "Park Prescription Program(Parks Rx4Health^(TM))" that formally coordinates pediatricians,families,parents,caregivers,and child/adolescents to provide daily obesity-prevention activities.This Parks Rx4Health^(TM)program that we describe here allows UHealth pediatricians to seamlessly refer their overweight and obese patients to Fit2Play^(TM),an evidence-based,park-based afterschool health and wellness program.Measurable outcomes that include body mass index,blood pressure,fitness,and nutrition knowledge are being collected at baseline and at 3-and 6-mo after referral to document patient progress.Results are then shared with the referring physician so they can follow up with the patient if necessary.Identifying successful models that integrate primary care,public health,and community-based efforts is important to accelerating progress in preventing childhood obesity.Effective,community-based health and wellness programs with a focus on physical activity and nutrition education could be a powerful referral resource for pediatricians who have obese patients.

Socially Excluded Children： Listening to the Experiences of the Inmates of the Institutional Care

Children without parents are not only among the most vulnerable members of society--their care and protection also present a major child-care policy challenge. In spite of this, they are all but doomed to have their special needs ignored and their rights abused in many cases. Children without a biological family, who are cared for in some forms, also run the risk of a life which holds fewer possibilities for healthy development and a supportive environment than that of their peers with families. The range of threats is wide, from extreme neglect （lack of access to education, medical care, a balanced diet, etc.） to social stigmatization and marginalization and the fact that the loss of a family represents a serious trauma that stays with a person throughout his/her life and can potentially be seriously damaging if the person has not had any support in coping with it in childhood. The present study is conducted among the inmates （children） admitted in the ashrams （orphanages） who come from underprivileged socio-economic backgrounds. Information was collected from two orphanages of Sambalpur district situated in the western part of Odisha. These are Dhankauda Kanyaashram （for girls） and Dhankauda Balashram （for boys）. The paper examines a wide range of care interventions for orphans, including family care, institutional care, community-based care, and rights-based care. A lack of direction, inadequate care, ignorance, and discrimination can make the trauma experienced by orphans more intense and ultimately ensure that they really do not succeed.

Community-based elderly care services in China: an analysis based on the 2018 wave of the CLHLS Survey

Community-based elderly care services play an important role in dealing with popu-lation aging.Based data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey,we found that overall there was high demand for community-based elderly care services,but insufficient supply,resulting in unmet needs.The greatest demand was for medical care and nursing services and these were gener-ally more accessible compared to other services.The imbalance between available supply and elderly demand was greatest for personal care and psychological con-sulting services.Additionally,there were obvious imbalances of supply and demand for particular groups of the elderly population.In terms of demand,the young-old living in eastern and western China or urban areas had stronger demand for com-munity-based elderly care services.Elderly people with serious disabilities or low income,or living in rural areas and towns had more demand for home visit medical services,while the elderly with the ability to care for themselves or high incomes needed more social and entertainment services.With respect to inadequate supply,the demands for community-based elderly care services of the low-income elderly living in rural areas and towns or in western China were more likely to be unmet.Our results indicated that appropriate services should be provided by government agencies and institutions to meet the needs of various groups.It is also important to increase accessibility to community-based elderly care services as well as to guaran-tee an equitable distribution of supply.

Old-age Care Modes and Facility Planning Based on the Concept of “Continuum of Care”

Through the comparative analysis on the theories and practical experience of the development of old-age care (OAC) in both China and other countries,and based on the interview and questionnaire survey in Zhejiang Province and Hangzhou City,this paper proposes the research and analysis framework for the old-age service system,i.e.,"OAC mode-OAC service system-OAC facility system." The paper argues that,oriented by OAC mode of "taking community-and home-based care as the main body and institution-based care as supplement," China should build an OAC facility system and planning thoughts that take "continuum of care" as concept and long-term care system as core.Taking Zhejiang Province and Hangzhou City as examples,the paper conducts the optimization research on current OAC facilities planning in terms of hierarchical system,scale,and differentiation,so as to formulate more systematic and operable planning standards for OAC facilities.

Research on the Renewal Strategy of Social Space for the Elderly in Colleges and Universities from the Perspective of Multi Generations:Take a University in the North as an Example

Under the background of population aging,while the living environment of the elderly is improved,it is necessary to pay attention to their spiritual needs and build an elderly-friendly and livable social environment.In this paper,through field investigation and research on social behavior and space,the social behavior and needs of the elderly in a university in the north were analyzed,and based on the social characteristics and psychological needs of the elderly and students in the university,the construction of a dynamic space with multi-generational shared space as the core was proposed to develop a social platform that integrates virtual and reality,so as to provide reference for the updating of social space in college communities in the future.

Study on the application Of long-term nursing insurance In community pension Of Shanghai

In twenty-first Century. the speed of population aging in China was accelerated, the growth of the disabled populationaccelerated and the demand for the existing long-term care service was challenging. It is imminent to establish a system that can meet the long-term care needs of the disabled population, As a pilot city of long-term care insurance. Shanghai has a Fund for the long-term care insurance system. To compare and analyze the related elements of raising, service content and payment, combined with the experience ol long-term nursing insurance in foreign countries, and considering its application in community pension, it has certain reference significance for the design of long-term nursing insurance system in China.

Challenges in the provision of community aged care in China

Objective:Population ageing in China is a significant challenge for the Chinese government,the society and Chinese people.The dramatic process of population ageing together with social and economic diversity in China has created issues in the availability,equality and sustainability of social and financial support for older people.The aims of this review are to identify the social and economic challenges to the traditional caregiving system in China,and to examine possible solutions to improve the care of older people in China using the framework of ageing in place.Methods:Electronic literature searches were conducted in May and June 2013 using PubMed,CNKI,and MEDLINE.Statistical data and reports were retrieved from the United Nations,the World Health Organisation,the World Bank and National Bureau of Statistics of China.Government policy documents were found through government websites and formal publications.Results:Family-centred care for older people in China is recognised as a cultural tradition in the Chinese community.However,driven by large-scale social,political and economic changes,this model of caring for older people has dynamically changed over the last 50 years.Traditionally the family has been the most important source of social support for older people followed by neighbour support and support from friends.Today family obligations of caring are still centred in a cultural and practical context;however,support from family and children has weakened incrementally.Community-based aged services are absent in most areas,while older people and their families have to pay out-of-pocket expenses for non-residential services.There is a severe shortage of aged care or nursing home resources in China and those that exist are of low quality and expensive.The staff who work in these facilities rarely have any formal training in aged care.In addition,a market approach to the funding of residential aged care has the potential to create a moral hazard due to the poor regulatory control of aged care in China.While the building of residential aged care homes is seen as the solution to the care of older people in China,older people prefer to age in their own homes and expect the restoration of the family care tradition as well as more government support for them to“age in place”.This approach has the potential to be more cost effective than expensive aged care facilities.Conclusion:Given older people’s preferences,ageing in place,with the provision of community services and family support,potentially provides a fair and financially viable approach to promote healthy ageing and supportive care in China.Further studies are required to identify 1)how ageing in place can be supported by a national strategy,2)the financial arrangements required to fund such an approach,and 3)how to train high quality community-based professionals in both rural and urban areas to support the care of older people.