UNASSIGNED: The Chinese government proposes to establish a hierarchical diagnosis and treatment system, and attaches great importance to community health services. Under the background of population aging and the increase of older adults with disability, this study aimed to analyze the effect of spatial accessibility of community health services on the activities of daily living (ADL) among older adults in China.
UNASSIGNED: A research sample of 7,922 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018 was adopted. There were 2,806 participants in the treatment group and 5,116 participants in the control group. The propensity score matching method was adopted to match the treatment and control groups to calculate the values of average treatment effects on treated (ATT).
UNASSIGNED: The results of kernel density matching method showed that the factual ADL score of the treatment group was 10.912, the counterfactual ADL score of the control group was 10.694, and the ATT value was 0.218 (p < 0.01). The spatial accessibility of community health services could significantly improve the activities of daily living among older adults in China. Meanwhile, there was urban-rural heterogeneity in the impact of spatial accessibility of community health services on the activities of daily living of older adults in China. The effect value in urban samples (ATT = 0.371, p < 0.01) was higher than that in rural samples (ATT = 0.180, p < 0.01).
UNASSIGNED: Spatial accessibility of community health services could improve the activities of daily living among older adults in China. The Chinese government should take actions to improve the distribution of community health service resources.

BACKGROUND: Global digitalization significantly impacts public health by improving healthcare access for marginalized populations. In China, socioeconomic disparities and the Hukou system create significant barriers for the migrant population to access basic public health services (BPHS). This study aimed to assess how digital infrastructure construction (DIC) affects BPHS utilization among China\'s migrant populations, filling a gap in the literature regarding the relationship between digital advancements and health service accessibility.
METHODS: This research used micro-level data from the 2018 China Migrants Dynamic Survey and incorporated variables aligned with the Broadband China policy to employ a comprehensive empirical strategy. It included baseline regressions, robustness checks through propensity score matching and machine learning techniques, and heterogeneity analysis to explore the differential impacts of DIC based on gender, age, education level, and Hukou status.
RESULTS: The findings revealed that DIC significantly enhances the likelihood of migrants establishing health records and registering with family doctors, demonstrating quantifiable improvements in health service utilization. Heterogeneity analysis further indicated that the beneficial impacts of DIC were more pronounced among female migrants, those with higher education levels, younger populations, and urban Hukou holders.
CONCLUSIONS: DIC plays a crucial role in bridging the accessibility gap to BPHS for migrant populations in China, contributing to narrowing health disparities and advancing social equity. These results emphasize the significance of digital infrastructure in public health strategies and offer valuable insights for policymakers, healthcare providers, and researchers. Future research should prioritize longitudinal studies on the sustained effects of DIC and tailor digital health initiatives to meet the unique needs of migrant populations, promoting inclusive health policy planning and implementation.

BACKGROUND: Cervical cancer remains the second most common cause of death in women and poses a growing public health challenge. It is urgent to increase cervical cancer screening rates in Kenya as per the 2018 Kenya National Cancer Screening Guidelines. Addressing access to care may serve as a target to achieve this goal; however, how individual dimensions of access to care are associated with the utilization of cervical cancer screening services in low- and middle-income countries, including Kenya, remains unclear. This study aimed to examine how different aspects of access to care (affordability, availability, geographical access, and social influence) were associated with cervical cancer screening among Kenyan women of reproductive age.
METHODS: This cross-sectional study used data from the 2014 Kenya Demographic and Health Survey and the 2010 Kenya Service Provision Assessment. The final sample included 5,563 women aged 25-49 years. Logistic regression models were used to examine the association between different aspects of access to care and the uptake of cervical cancer screening.
RESULTS: Factors such as being in the poorest wealth quintile, lacking health insurance, having difficulty obtaining funds for treatment (affordability), limited availability of screening services at nearby facilities (availability), living in rural areas (geographical access), and having healthcare decisions made solely by husbands/partners or others (social influence) were associated with a decreased likelihood of the uptake of cervical cancer screening.
CONCLUSIONS: Increasing health insurance coverage, enhancing the availability of screening services at health facilities, expanding mobile screening health facilities in rural areas, and empowering women to make their own healthcare decisions are crucial steps for increasing cervical cancer screening uptake in Kenya.

BACKGROUND: Forced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population.
METHODS: Adhering to a qualitative research paradigm, the study centers on stakeholders\' perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach.
RESULTS: The study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants.
CONCLUSIONS: This research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers\' capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.

BACKGROUND: The incidence of rabies exposure is high and increasing in China, leading to an urgent demand of rabies post-exposure prophylaxis (PEP) clinics for the injured. However, the spatial accessibility and inequality of rabies-exposed patients to rabies PEP clinics is less known in China.
METHODS: Based on rabies exposure data, PEP clinic data, and resident travel origin-destination (OD) matrix data in Guangzhou City, China, we first described the incidence of rabies exposure in Guangzhou from 2020 to 2022. Then, the Gaussian two-step floating catchment area method (2SFCA) was used to analyze the spatial accessibility of rabies-exposed patients to rabies PEP clinics in Guangzhou, and the Gini coefficient and Moran\'s I statistics were utilized to evaluate the inequality and clustering of accessibility scores.
RESULTS: From 2020 to 2022, a total of 524,160 cases of rabies exposure were reported in Guangzhou, and the incidence showed a significant increasing trend, with an average annual incidence of 932.0/100,000. Spatial accessibility analysis revealed that the overall spatial accessibility scores for three scenarios (threshold of driving duration [d0] = 30 min, 45 min, and 60 min) were 0.30 (95% CI: 0.07, 0.87), 0.28 (95% CI: 0.11, 0.53) and 0.28 (95% CI: 0.14, 0.44), respectively. Conghua, Huangpu, Zengcheng and Nansha districts had the higher accessibility scores, while Haizhu, Liwan, and Yuexiu districts exhibited lower spatial accessibility scores. The Gini coefficient and Moran\'s I statistics showed that there were certain inequality and clustering in the accessibility to rabies PEP clinics in Guangzhou.
CONCLUSIONS: This study clarifies the heterogeneity of spatial accessibility to rabies PEP clinics, and provide valuable insights for resource allocation to achieve the WHO target of zero human dog-mediated rabies deaths by 2030.

Rare diseases affect over 300 million people worldwide and are gaining recognition as a global health priority. Their inclusion in the UN Sustainable Development Goals, the UN Resolution on Addressing the Challenges of Persons Living with a Rare Disease, and the anticipated WHO Global Network for Rare Diseases and WHO Resolution on Rare Diseases, which is yet to be announced, emphasise their significance. People with rare diseases often face unmet health needs, including access to screening, diagnosis, therapy, and comprehensive health care. These challenges highlight the need for awareness and targeted interventions, including comprehensive education, especially in primary care. The majority of rare disease research, clinical services, and health systems are addressed with specialist care. WHO Member States have committed to focusing on primary health care in both universal health coverage and health-related Sustainable Development Goals. Recognising this opportunity, the International Rare Diseases Research Consortium (IRDiRC) assembled a global, multistakeholder task force to identify key barriers and opportunities for empowering primary health-care providers in addressing rare disease challenges.

A study on infertility in China found that while 543 health care institutions are approved for assisted reproductive technology (ART), only 10.1% offer all ART services, with a significant skew toward the eastern regions, highlighting the accessibility challenges faced by rural and remote populations; this study recommends government measures including travel subsidies and education initiatives to improve ART access for economically disadvantaged individuals.

BACKGROUND: PCSK9 inhibitors are a novel class of lipid-lowering drugs that have demonstrated favorable efficacy and safety. Evolocumab and alirocumab have been added to China\'s National Reimbursement Drug List through the National Drug Price Negotiation (NDPN) policy. This study aims to evaluate the impact of the NDPN policy on the utilization and accessibility of these two PCSK9 inhibitors.
METHODS: The procurement data of evolocumab and alirocumab were collected from 1,519 hospitals between January 2021 and December 2022. We determined the monthly availability, utilization, cost per daily defined dose (DDDc), and affordability of the two medicines. Single-group interrupted time series (ITS) analysis was performed to assess the impact of the NDPN policy on each drug, and multiple-group ITS analysis was performed to compare the differences between them.
RESULTS: The NDPN policy led to a significant and sudden increase in the availability and utilization of PCSK9 inhibitors, along with a decrease in their DDDc. In the year following the policy implementation, there was an increase in the availability, utilization, and spending, and the DDDc remained stable. The affordability of PCSK9 inhibitors in China have been significantly improved, with a 92.97% reduction in out-of-pocket costs. The availability of both PCSK9 inhibitors was similar, and the DDDc of alirocumab was only $0.23 higher after the intervention. The market share of evolocumab consistently exceeded that of alirocumab. Regional disparities in utilization were observed, with higher utilization in the eastern region and a correlation with per capita disposable income.
CONCLUSIONS: The NDPN policy has successfully improved the accessibility and utilization of PCSK9 inhibitors in China. However, regional disparities in utilization indicate the need for further interventions to ensure equitable medicine access.

OBJECTIVE: This study investigates the relationship between hukou conversion and the psychological integration of rural older migrants, exploring the mediating role of accessibility to health resources.
METHODS: The 3,963 valid samples of rural older migrants included in the study were sourced from the 2017 China Migrants Dynamic Survey (CMDS). The study established a multiple linear regression model for estimation and utilized inverse probability-weighted regression adjustment (IPWRA) method to correct for the selection bias of hukou conversion.
RESULTS: Compared to older migrants with rural hukou, merit-based (β = 0.384, 95% CI: 0.265 to 0.504), family-based (β = 0.371, 95% CI: 0.178 to 0.565) and policy-based (β = 0.306, 95% CI: 0.124 to 0.487) converters have significantly higher psychological integration. These findings remain robust even after addressing the potential issue of endogenous selection bias using the IPWRA method. Bootstrap mediating effect tests indicate that hukou conversion can indirectly affect psychological integration through the mediator role of health resources accessibility.
CONCLUSIONS: Accessibility of health resources mediates the association between hukou conversion and psychological integration. Policymakers should enhance the implementation of hukou conversion, strengthen the health resource guarantee system, and achieve a deeper psychological integration among rural older migrants.

BACKGROUND: Many ethnic minorities in Hong Kong seek medical tourism after encountering inequalities in access to local healthcare because of language barriers and cultural-religious differences. The present study explored the ethnic minorities\' lived experiences of medical tourism and issues arising from cross-border health-seeking relevant to this specific population.
METHODS: Qualitative in-depth interviews with 25 ethnic minority informants from five South Asian countries in 2019.
RESULTS: The 19 informants out of the 25 have sought assistance from their international networks for home remedies, medical advice and treatments of traditional/Western medicines, for they are more costly or unavailable in Hong Kong and for issues related to racial discrimination, language barriers, transnationalism engagement, cultural insensitivity, and dissatisfaction with healthcare services in Hong Kong.
CONCLUSIONS: Medical tourism can relieve the host country\'s caring responsibilities from healthcare services, so the government might no longer be hard-pressed to fix the failing healthcare system. Consequently, it could cause public health concerns, such as having patients bear the risks of exposure to new pathogens, the extra cost from postoperative complications, gaps in medical documentation and continuum of care, etc. It also triggers global inequities in health care, exacerbating unequal distribution of resources among the affordable and non-affordable groups.
CONCLUSIONS: Ethnic minorities in Hong Kong sought cross-border healthcare because of structural and cultural-religious issues. The surge of medical tourism from rich and developed countries to poor and developing countries may infringe upon the rights of residents in destination countries. To mitigate such negative impacts, policymakers of host countries should improve hospital infrastructure, as well as train and recruit more culturally sensitive healthcare workers to promote universal health coverage. Healthcare professionals should also strive to enhance their cultural competence to foster effective intercultural communication for ethnic minority groups.