Evidence map›Paper›PMID 25940189›Full record

ArticleHuman resources for health2015

How China's new health reform influences village doctors' income structure: evidence from a qualitative study in six counties in China.

Shengfa Zhang, Weijun Zhang, Huixuan Zhou, Huiwen Xu, Zhiyong Qu, Mengqi Guo, Fugang Wang, You Zhong, Linni Gu, Xiaoyun Liang and 3 more

Abstract read
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In one paragraph

Article in Human resources for health, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
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  8. Influential Factors of Burnout among Village Doctors in China: A Cross-Sectional Study.International journal of environmental research and public health · 2021
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  14. Increased Inequalities in Health Resource and Access to Health Care in Rural China.International journal of environmental research and public health · 2018
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Shengfa ZhangSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. zhangshengfa1988@hotmail.com.
Weijun ZhangSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. zwj@bnu.edu.cn.
Huixuan ZhouSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. chouhuixuan@live.cn.
Huiwen XuSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. xhw197@gmail.com.
Zhiyong QuSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. qzy@bnu.edu.cn.
Mengqi GuoSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. never_wf@126.com.
Fugang WangSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. sabeihu@163.com.
You ZhongSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. zy91216@163.com.
Linni GuSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. gulinni@bnu.edu.cn.
Xiaoyun LiangSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. liangxiaoyun@bnu.edu.cn.
Zhihong SaSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. zhihongsa@gmail.com.
Xiaohua WangSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. wxh@bnu.edu.cn.
Donghua TianSchool of Social Development and Public Policy, China Institute of Health, Beijing Normal University, 19 Xinjiekou Wai St., Beijing, 100875, China. tian65216@hotmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn 2009, health-care reform was launched to achieve universal health coverage in China. A good understanding of how China's health reforms are influencing village doctors' income structure will assist authorities to adjust related polices and ensure that village doctors employment conditions enable them to remain motivated and productive. This study aimed to investigate the village doctors' income structure and analyse how these health policies influenced it.

methodsBased on a review of the previous literature and qualitative study, village doctors' income structure was depicted and analysed. A qualitative study was conducted in six counties of six provinces in China from August 2013 to January 2014. Forty-nine village doctors participated in in-depth interviews designed to document their income structure and its influencing factors. The themes and subthemes of key factors influencing village doctors' income structure were analysed and determined by a thematic analysis approach and group discussion.

resultsSeveral policies launched during China's 2009 health-care reform had major impact on village doctors. The National Essential Medicines System cancelled drug mark-ups, removing their primary source of income. The government implemented a series of measures to compensate, including paying them to implement public health activities and provide services covered by social health insurance, but these have also changed the village doctors' role. Moreover, integrated management of village doctors' activities by township-level staff has reduced their independence, and different counties' economic status and health reform processes have also led to inconsistencies in village doctors' payment. These changes have dramatically reduced village doctors' income and employment satisfaction.

conclusionsThe health-care reform policies have had lasting impacts on village doctors' income structure since the policies' implementation in 2009. The village doctors have to rely on the salaries and subsidies from the government after the drug mark-up was cancelled. China's national health reforms are attempting to draw village doctors into the national health workforce, but the policies have impacted their income and independence. Further research into these concerns and monitoring of measures to adequately compensate village doctors should be undertaken. Reasonable compensation strategies should be established, and sufficient subsidies should be allocated in a timely manner.

Indexed as

Delivery of Health CareHealth Care ReformIncomeJob SatisfactionPhysiciansRural Health ServicesSalaries and Fringe BenefitsAdultChinaFemaleHealth PolicyHumansInsurance, HealthMaleMiddle AgedQualitative Research

Identifiers

PMID25940189
PMCPMC4440293

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.