Who Benefits from Government Healthcare Subsidies? An Assessment of the Equity of Healthcare Benefits Distribution in China

Background

Improving the equitable distribution of government healthcare subsidies (GHS), particularly among low-income citizens, is a major goal of China’s healthcare sector reform in China.

Objectives

This study investigates the distribution of GHS in China between socioeconomic populations at two different points in time, examines the comparative distribution of healthcare benefits before and after healthcare reforms in Northwest China, compares the parity of distribution between urban and rural areas, and explores factors that influence equitable GHS distribution.

Methods

Benefit incidence analysis of GHS progressivity was performed, and concentration and Kakwani indices for outpatient, inpatient, and total healthcare were calculated. Two rounds of household surveys that used multistage stratified samples were conducted in 2003 (13,564 respondents) and 2008 (12,973 respondents). Data on socioeconomics, healthcare payments, and healthcare utilization were collected using household interviews.

Results

High-income individuals generally reap larger benefits from GHS, as reflected by positive concentration indices, which indicates a regressive system. Concentration indices for inpatient care were 0.2199 (95% confidence interval [CI], 0.0829 to 0.3568) and 0.4445 (95% CI, 0.3000 to 0.5890) in 2002 (urban vs. rural, respectively), and 0.3925 (95% CI, 0.2528 to 0.5322) and 0.4084 (95% CI, 0.2977 to 0.5190) in 2007. Outpatient healthcare subsidies showed different distribution patterns in urban and rural areas following the redesign of rural healthcare insurance programs (urban vs. rural: 0.1433 [95% CI, 0.0263 to 0.2603] and 0.3662 [95% CI, 0.2703 to 0.4622] in 2002, respectively; 0.3063 [95% CI, 0.1657 to 0.4469] and −0.0273 [95% CI, −0.1702 to 0.1156] in 2007).

Conclusions

Our study demonstrates an inequitable distribution of GHS in China from 2002 to 2007; however, the inequity was reduced, especially in rural outpatient services. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.     

Does ABA in the Xylem Control the Rate of Leaf Growth in Soil-Dried Maize and Sunflower Plants?

Maize (Zea mays L.) and sunflower (Helianthus annuus L.) plantswere grown in large volumes of soil and leaf growth rate wasmonitored on a daily basis. Half the plants were given a soildrying treatment and when they showed a significant restrictionof growth rate (compared to both their daily growth rate beforedrying and the average growth rate of well-watered plants onthe same day), leaf water relations were measured and xylemsap was extracted using several techniques. There was a significant negative log-linear relationship betweenthe rate of leaf growth and the concentration of ABA in thexylem for both species. There was no clear relationship betweenleaf growth rate and leaf water potential or turgor for eitherspecies. Assessment of different methods for sampling xylemsap suggests that exudates collected from stem stumps or samplescollected by pressurizing the whole root system are suitablefor estimating ABA concentration in xylem, at least with largeplants of maize or sunflower, provided the first few hundredcubic millimetres of collected sap are used for the assay. Centrifugationof sections of stems resulted in dilution of ABA in the xylemsap with sap squeezed from parenchyma tissue. This is because,at least in plants subjected to mild soil drying, the concentrationof the ABA in the xylem is far higher than that in the cellsap of stem tissue. Results support the proposal that ABA plays a major role asa chemical signal involved in the root-to-shoot communicationof the effects of soil drying. The non-hydraulic restrictionof leaf growth by a chemical signal can be explained by theextra root-sourced ABA in the xylem and may be an importantcomponent of the modification of growth and development whichresults from prolonged soil drought. Key words: Soil drying, ABA, leaf growth, Zea mays L., Helianthus annuus L.     

Dual Function of Transforming Growth Factor-β in the Control of Proliferation and Apoptosis of Cells of the Nervous System

Transforming growth factor- (TGF-) is an agent that gave the name to an extensive superfamily of congeneric cytokines playing important roles in numerous physiological and pathological processes. TGF- is involved in a few signal pathways controlling growth, differentiation, and death (apoptosis) of the nerve cells. Yet, it was found that the role of TGF- in each of these processes is dual: it can act either as their stimulator or as an inhibitor. This review describes examples and principal mechanisms of the dual functions of TGF- in its regulatory influences realized in the mammalian nervous system.     

Benefits of aggregation in woodlice: a factor in the terrestrialization process?

In the animal kingdom, living in group is driven by a tradeoff between the costs and the benefits of this way of life. This review focuses especially on the benefits of aggregation and crowding in woodlice (Crustacea: Isopoda: Oniscidea). Indeed, woodlice are well known to live in groups. Their aggregation behavior, as described in the early works of Allee, is regarded as a mechanism to prevent desiccation to which woodlice are extremely sensitive. However, it is now clear that there are additional benefits to aggregation in woodlice. Hence, this review addresses not only the limitation of water loss as the main factor explaining aggregation patterns, but also alternative explanations as reduction of oxygen consumption, increase in body growth, biotic stimuli for reproduction, better access to mates, possible shared defenses against predators, promotion of coprophagy as a secondary food source, sheltering behavior and the acquisition of internal symbionts. In addition, we place woodlice in the context of a terrestrialization process and propose that woodlice—the only suborder of Crustacea almost entirely composed of strictly terrestrial species—are a model taxon for studying the evolution of sociality through the transition from water to land. Further, we discuss other ultimate causes of aggregation preserved in terrestrial isopods in light of those explained in aquatic isopods and under the concept of exaptation. This knowledge could help understand, in this and other taxa, how the spatial closeness between conspecifics may promote the colonization of new environments and nonphysiological responses to climatic constraints.     

Bacterial Activity and Bacterioplankton Diversity in the Eutrophic River Warnow��Direct Measurement of Bacterial Growth Efficiency and Its Effect on Carbon Utilization

The influence of bacterial activity and diversity on bacterial growth efficiency was investigated in a flatland river. Eutrophic River Warnow drains predominantly agricultural land and is heavily loaded with nutrients, dissolved and particulate organic matter (DOM and POM), especially humic substances. Although the water column bacterial community consists of many inactive or damaged cells, bacterioplankton sustained a high bacterial secondary production of 0.2?C14.5???g C L^?1 h^?1 and a high DNA synthesis (thymidine uptake) of 6.1?C15.5???g C L^?1 h^?1. The direct and short-term measurement of bacterial respiration (by optodes) revealed high respiration rates especially in summer leading to directly estimated bacterial growth efficiencies (BGE) of 2?C28%. These values are compared to calculations based only on bacterial production, which considerably overestimated BGEs. From all these data, River Warnow can be characterized as a strongly remineralizing system. River Warnow was dominated among others by Cytophaga/Flavobacteria and Actinobacteria which are typical for organic rich waters because of their ability to degrade high molecular weight compounds. However, community composition did not significantly affect BGE.     

Carbon Mineralization in Peatlands: Does the Soil Microbial Community Composition Matter?

Peat from four geographically separated peatlands (up to 1,500 km apart) with distinct vegetation across North America was sterilized and inoculated with microbial consortia from either the home site or from the other sites. This reciprocal inoculation microcosm experiment examined how different microbial communities adapted to various peat substrates and how this in turn influenced C-mineralization patterns. The experimental approach allows distinctions to be made as to whether microbial community structure, peat properties, or imposed environmental conditions are primary drivers of peat C mineralization. Two additional inocula collected from other freshwater environments (industrially polluted harbor and lake sediments) were also added to each peat type to investigate the response of clearly disparate microbial communities. We hypothesized that the peat properties, such as substrate quality and physical structure, would dictate microbial community composition and activity, thus inoculations from different sites into the same peat soil would lead to the establishment of very similar microbial communities both phylogenetically and functionally. Post-incubation, the bacterial communities in each site converged towards a similar community regardless of the inoculum source, with the exception of peat inoculated with polluted harbor sediment. Inoculum type had no effect on C mineralization rates compared with controls, except for the two disparate inocula, which had lower rates in all peat types. Variation in microbial community structure measured as nonmetric multidimensional scaling axes scores or richness did not correlate significantly with microbial activity. Overall, these findings suggest that abiotic variables (e.g., pH, aeration, moisture content, and temperature) are the dominant control on peatland microbial activity and community composition, and in natural peatlands the microbial community can quickly adapt to future environmental change.     

Growth schedule of Xanthium canadense: Does it optimize the timing of reproduction?

Summary The effects of nutrition on the timing of reproductive initiation of a short-day annual plant Xanthium canadense (cocklebur) were examined with the following hypotheses in mind: If the plant always follows an optimal growth schedule, low-nutrient plants will initiate reproductive growth earlier than high-nutrient plants. On the other hand, if the plant flowers in response to photoperiodic stimuli, both plants will initiate reproductive growth on the same day. The sand-culture experiment showed that high-nutrient plants flowered earlier than the low-nutrient plants, leading to rejection of the first hypothesis. The predicted optimal flowering time is 2 days later than the actual flowering time in high-nutrient plants and 10 days earlier in low-nutrient plants. These deviations from the optimal times reduced the reproductive yield by 0.1% and 2.3%, respectively. The ratio of the final reproductive yield to the vegetative mass at flower initiation was 1.10 in high-nutrient plants and 0.63 in low-nutrient plants. Since the expected ratio for the optimal growth schedule is 1.0, high-nutrient plants followed the opitmal growth schedule more closely than the low-nutrient plants. Cocklebur is a fast-growing annual which is common in relatively nutrient-rich environments. This study suggests that cocklebur adapts itself to such environments through its photoperiodic response.     

Spatial Variation in the Storages and Age-Related Dynamics of Forest Carbon Sequestration in Different Climate Zones—Evidence from Black Locust Plantations on the Loess Plateau of China

Knowledge about the long-term influences of climate change on the amount of potential carbon (C) sequestration in forest ecosystems, including age-related dynamics, remains unclear. This study used two similar age-sequences of black locust forests (Robinia pseudoacacia L.) in the semi-arid and semi-humid zones of China’s Loess Plateau to assess the variation in C stocks and age-related dynamics. Our results demonstrated that black locust forests of the semi-humid zone stored significantly more C than did forests in the semi-arid zone, across the chronosequence (p < 0.001). The C carrying capacity of the plantations was measured at 166.4 Mg C ha⁻¹ (1 Mg = 10⁶ g) in the semi-humid zone, while the semi-arid zone had a capacity of only 79.4 Mg C ha⁻¹. Soil organic C (SOC) increased continuously with stand age in the semi-arid zone (R² = 0.84, p = 0.010). However, in the semi-humid zone, SOC declined sharply by 47.8% after the initial stage (5 to 10 y). The C stock in trees increased continuously with stand age in the semi-humid zone (R² = 0.83, p = 0.011), yet in the semi-arid zone, it decreased dramatically from 43.0 Mg C ha⁻¹ to 28.4 Mg C ha⁻¹ during the old forest stage (38 to 56 y). The shift from being a net C sink to a net C source occurred at the initial stage in the semi-humid zone versus at the old forest stage in the semi-arid zone after reforestation. Surprisingly, with the exception of the initial and later stages (55 y), the patterns of C allocation among trees, soils, understory and litter were not statistically different between the two climate zones. Our results suggest that climate factors can alter the potential amount and age-related dynamics of forest C sequestration.     

Effect of Enhanced UV-B Radiation on Growth,Yield and Stable Carbon Isotope Composition in Glycine max Cultivars

Effects of enhanced ultraviolet-B (UV-B) radiation on growth, yield and stable carbon isotope composition (δ13C value) in ten cultivars of Glycine max (L.) Merr. were investigated under field conditions. Supplemental UV-B irradiation simulated a 20% stratospheric ozone depletion in Lanzhou on summer solstice day. UV-B radiation reduced biomass and yield in all soybean cultivars by 24.2% and 23.3%, respectively. However, the harvest index increased in 6 of ten soybean cultivars but reduced in 4 cultivars, the average increment was 1.39%. As compared with control, the decrease in δ13C value by UV-B was observed in most cultivars, except in cutlivar “8907-32” increase was found. There were also organ differences of stable carbon isotope composition under enhanced UV-B irradiation. δ13C of roots was the highest and of leaves was the lowest, δ13C value in stem was higher than in seeds. The results indicated that UV-B enhancement might change the metabolic process and the allocation of metabolite.     

Effect of the Form of Mineral Nitrogen on the Growth and Heterotrophic Fixation of 14С-Bicarbonate in Chlamydomonas reinhardtii

Russian Journal of Plant Physiology - The earlier-detected effect of the mineral nitrogen form in the nutrient medium (ammonium or nitrate) on the quantity of ribosomes in the cells of...     

The Islands in the South China Sea: How Does Their Presence Limit the Extent of the High Seas and the Area and the Maritime Zones of the Mainland Coasts?

A number of small islands (the Paracel Islands, Pratas Island, the Spratly Islands, and Scarborough Reef) may have a considerable influence on the extent of maritime zones in the South China Sea. The maritime zones of these islands can limit the extent of the high seas and the Area in the South China Sea and the extent of the maritime zones of the mainland coasts. To assess the impact of the islands, it is necessary to establish whether they can generate the full suite of maritime zones. Under international law, some islands do not have an entitlement to an exclusive economic zone and continental shelf. Where islands can generate these maritime zones, a second issue arises, namely, how to delimit these zones with those of the mainland coasts bordering the South China Sea.     

Does it Pay to Care?: Exploring the Costs and Benefits of Parental Care in the Hibiscus Harlequin Bug Tectocoris diophthalmus (Heteroptera: Scutelleridae)

Knowledge of the selective pressures favouring parental care can inform our understanding of the evolutionary origins and transitions of sociality in insects. Here, we report upon investigations designed to estimate the costs and benefits of parental care in the egg‐guarding hibiscus harlequin bug Tectocoris diophthalmus (Heteroptera: Scutelleridae). We found that the presence of a guarding female had no effect on hatching success under benign laboratory conditions. In the wild, however, guarding decreased the likelihood of total clutch failure, and produced a fourfold greater egg‐hatching rate relative to unguarded clutches. Females guarded against generalist invertebrate egg predators, including conspecific nymphs, but were ineffective against hymenopteran egg parasitoids. Females continued to feed during the guarding period and exhibited no signs of weight loss or increased mortality due to this behaviour. We did not observe the production of subsequent clutches in any experimental females; therefore, the lifetime fecundity costs of providing parental care in T. diophthalmus remain indeterminate. Overall, maternal egg guarding appears to function as a relatively low cost–low benefit strategy that increases hatching success by protecting against predation – but not parasitism.     

Revisiting the Effect of Capture Heterogeneity on Survival Estimates in Capture-Mark-Recapture Studies: Does It Matter?

Recently developed capture-mark-recapture methods allow us to account for capture heterogeneity among individuals in the form of discrete mixtures and continuous individual random effects. In this article, we used simulations and two case studies to evaluate the effectiveness of continuously distributed individual random effects at removing potential bias due to capture heterogeneity, and to evaluate in what situation the added complexity of these models is justified. Simulations and case studies showed that ignoring individual capture heterogeneity generally led to a small negative bias in survival estimates and that individual random effects effectively removed this bias. As expected, accounting for capture heterogeneity also led to slightly less precise survival estimates. Our case studies also showed that accounting for capture heterogeneity increased in importance towards the end of study. Though ignoring capture heterogeneity led to a small bias in survival estimates, such bias may greatly impact management decisions. We advocate reducing potential heterogeneity at the sampling design stage. Where this is insufficient, we recommend modelling individual capture heterogeneity in situations such as when a large proportion of the individuals has a low detection probability (e.g. in the presence of floaters) and situations where the most recent survival estimates are of great interest (e.g. in applied conservation).     

Carbon storage and potentials of the broad-leaved forest in alpine region of the Qinghai-Xizang Plateau,China北大核心CSCD

Aims Our objective was to explore the vegetation carbon storages and their variations in the broad-leaved forests in the alpine region of the Qinghai-Xizang Plateau that includes Qinghai Province and Xizang Autonomous Region. Methods Based on forest resource inventory data and field sampling, this paper studied the carbon storage, its sequestration rate, and the potentials in the broad-leaved forests in the alpine region of the Qinghai-Xizang Plateau. Important findings The vegetation carbon storage in the broad-leaved forest accounted for 310.70 Tg in 2011, with the highest value in the broad-leaved mixed forest and the lowest in Populus forest among the six broad-leaved forests that include Quercus, Betula, Populus, other hard broad-leaved species, other soft broad-leaved species, and the broadleaved mixed forest. The carbon density of the broad-leaved forest was 89.04 Mg•hm2, with the highest value in other hard broad-leaved species forest and the lowest in other soft broad-leaved species forest. The carbon storage and carbon density in different layers of the forests followed a sequence of overstory layer > understory layer > litter layer > grass layer > dead wood layer, which all increased with forest age. In addition, the carbon storage of broad-leaved forest increased from 304.26 Tg in 2001 to 310.70 Tg in 2011. The mean annual carbon sequestration and its rate were 0.64 Tg•a1 and 0.19 Mg•hm2•a1, respectively. The maximum and minimum of the carbon sequestration rate were respectively found in other soft broad-leaved species forest and other hard broad-leaved species forest, with the highest value in the mature forest and the lowest in the young forest. Moreover, the carbon sequestration potential in the tree layer of broad-leaved forest reached 19.09 Mg•hm2 in 2011, with the highest value found in Quercus forest and the lowest in Betula forest. The carbon storage increased gradually during three inventory periods, indicating that the broad-leaved forest was well protected to maintain a healthy growth by the forest protection project of Qinghai Province and Xizang Autonomous Region.     

Does Phospholipid Methylation Play a Role in the Primary Mechanism of Action of Nerve Growth Factor?

Nerve growth factor (NGF)-untreated (naive) and neurite-bearing NGF-treated (\"primed\") PC12 rat pheochromocytoma cells were used as model system to study the role of phospholipid methylation in the NGF mechanism of action. The neurite-bearing cultures were deprived of NGF for 3 h before experimentation. Under both experimental conditions, the cells were labelled with [methyl-3H]methionine and then challenged with NGF for time periods ranging from 5 s to 30 min. Methylated phospholipids were extracted and then resolved and identified by TLC as phosphatidyl mono-, di-, and trimethyl ethanolamine. Quantification of the amount of radioactivity incorporated into each of the phospholipids indicated that NGF does not significantly alter phospholipid methylation either in naive or in neurite-bearing cells. Furthermore, using a methyltransferase inhibitor, it was found that neurite outgrowth still occurs when phospholipid methylation is almost completely blocked. These results indicate that phospholipid methylation does not play a primary role in the mechanism of action of NGF.     

Does Marriage Really Matter to Health? Intra- and Inter-Country Evidence from China,Japan, Taiwan,and the Republic of Korea

Background

The health benefits of marriage have been demonstrated mainly by studies on Western populations. This study aims to test whether the benefits are also valid in East Asian populations.

Methodology/Principal Findings

Individuals (n = 8,538) from China, Japan, Taiwan, and the Republic of Korea were sampled from the 2006 East Asian Social Survey. The association between self-rated health status and two marriage-related independent variables was analyzed using multivariate logistic regression models. In a two-level analysis for individuals from all countries, married individuals were more likely to report very good or good health compared to their never-married counterparts [odds ratio (OR) 1.56; 95% confidence interval (95% CI) 1.16−2.10]. However, the addition of marital satisfaction disintegrated the significant association of marriage with self-rated health. Married individuals in satisfying marriages were more likely to report very good or good health compared with never-married individuals (OR 1.85; 95% CI 1.37−2.50). In contrast, married individuals in dissatisfying marriages were as likely to report very good or good health as never-married individuals (OR 0.78; 95% CI 0.50−1.24). In a one-level analysis for each country, the importance of marital satisfaction varied greatly across countries. Unlike in other countries, in Japan, married individuals in dissatisfying marriages were about half as likely to report very good or good health as never-married individuals (OR 0.51, 95% CI 0.31−0.83), thereby showing no significant benefits from marriage with regard to self-rated health.

Conclusion/Significance

The present study of East Asian countries suggests that marital satisfaction is of greater importance in determining self-rated health than marriage itself, and that the importance of marital satisfaction varies across countries. Further research is required to better understand the relationship between marital satisfaction and self-rated health in different socio-cultural settings, and to establish effective social policies aiming at improving public health.