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BACKGROUND: E-health has the potential to promote health accessibility, performance and cost-saving. However, the adoption and penetration of e-health in underprivileged areas remains insufficient. We aim to investigate patients' and doctors' perception, acceptance, and utilization of e-health in a rural, spatially isolated and poverty-stricken county in southwestern China. METHODS: A retrospective analysis based on a cross-sectional survey of patients and doctors in 2016 was conducted. Participants were recruited through convenience and purposive sampling, and questionnaires were self-designed and validated by investigators. The utilization, intention to use and preference of four e-health services were evaluated, including e-appointment, e-consultation, online drug purchase, and telemedicine. Predictors of utilization and intention to use e-health services were investigated by multivariable logistic regression. RESULTS: A total of 485 patients were included. The utilization rate of any type of e-health services was 29.9%, ranging from 6% in telemedicine to 18% in e-consultation. Additionally, 13.9%-30.3% of respondents as non-users revealed their willingness to use such services. Users and potential users of e-health services were inclined to specialized care from county, city or province hospitals, and they were most concerned with the quality, ease of use and price of e-health service. Patients' utilization and intention to use e-health could be associated with education and income level, cohabitants, working location, previous medical utilization, and access to digital device and internet. There remained 53.9%-78.3% of respondents reluctant to use e-health services, mainly due to perceived inability to use them. Of 212 doctors, 58% and 28% had provided online consultation and telemedicine before, and over 80% of county-hospital doctors (including actual providers) indicated their willingness to provide such services. Reliability, quality and ease of use were doctors' major concerns regarding e-health. Doctors' actual provision of e-health was predicted by their professional title, number of years in work, satisfaction with the wage incentive system, and self-rated health. Nevertheless, their willingness to adopt was only associated with the possession of smartphone. CONCLUSIONS: E-health is still in its infancy in western and rural China, where health resources are most scarce, and where e-health could prove most beneficial. Our study reveals the wide gaps between patients' low usage and their certain willingness to use e-health, as well as gaps between patients' moderate attention to use and physician's high preparedness to adopt e-health. Patients' and doctors' perceptions, needs, expectations, and concerns should be recognized and considered to promote the development of e-health in these underprivileged regions.

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OBJECTIVE: Primary health care (PHC) is widely perceived to be the backbone of health care systems. Since the outbreak of COVID-19, PHC has not only provided primary medical services, but also served as a grassroots network for public health. Our research explored the accessibility, availability, and affordability of primary health care from a spatial perspective, to understand the social determinants affecting access to it in Hong Kong. METHOD: This constitutes a descriptive study from the perspective of spatial analysis. The nearest neighbor method was used to measure the geographic accessibility of PHC based on the road network. The 2SFCA method was used to measure spatial availability and affordability to primary health care, while the SARAR model, Spatial Error model, and Spatial Lag model were then constructed to explain potential factors influencing accessibility and availability of PHC. RESULTS: In terms of accessibility, 95% of residents in Hong Kong can reach a PHC institution within 15 minutes; in terms of availability, 83% of residents can receive PHC service within a month; while in terms of affordability, only 32% of residents can afford PHC services with the support of medical insurance and medical voucher. In Hong Kong, education status and household income show a significant impact on accessibility and availability of PHC. Regions with higher concentrations of residents with post-secondary education receive more PHC resources, while regions with higher concentrations of high-income households show poorer accessibility and poorer availability to PHC. CONCLUSION: The good accessibility and availability of primary health care reflects that the network layout of existing PHC systems in Hong Kong is reasonable and can meet the needs of most residents. No serious gap between social groups further shows equality in resource allocation of PHC in Hong Kong. However, affordability of PHC is not ideal. Indeed, narrowing the gap between availability and affordability is key to fully utilizing the capacity of the PHC system in Hong Kong. The private sector plays an important role in this, but the low coverage of medical insurance in outpatient services exacerbates the crowding of public PHC and underutilization of private PHC. We suggest diverting patients from public to private institutions through medical insurance, medical vouchers, or other ways, to relieve the pressure on the public health system and make full use of existing primary health care in Hong Kong.

Asunto(s)

COVID-19 , Atención Primaria de Salud , Determinantes Sociales de la Salud , Humanos , Costos y Análisis de Costo , COVID-19/epidemiología , Hong Kong/epidemiología , Análisis Espacial , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud

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The aim of this study is to examine the evolution of inequality by focusing on the impacts of the economic structure. The technique of decomposition by income sources is employed to evaluate the contribution of the three major sectors, namely the agricultural, industrial, and service sectors to overall inequality. The data cover almost all the countries in the world from 2001 to 2017 for a total of 18 years. There are four stages of analysis in this study. The first stage of study is to provide an overall view of the evolutionary trend of global inequality, the second stage focuses on the North-South divide, the third stage determines the impacts of income groups, and the fourth stage investigates the impacts for each region. There are several salient findings: First, global inequality had declined in the study period. Second, the service sector is identified as the largest contributor to global inequality, followed by the industrial sector, while the contribution of the agricultural sector is negligible. For the North-South divide, disparity in the service sector was more marked in the North than in the South. The industrial sector played a major role in the South and contributed more than 40% to overall inequality. For the comparison amongst the income groups, our findings show that the higher the income, the higher the percentage contribution of the service sector (except for the low-income group). Finally, for the comparison across regions, although the contribution of the agricultural sector in most regions are below 1.5%; however, the contribution of the agricultural sector in both Sub-Saharan Africa and South Asia is more than 8%. It implies that a lot of people in these regions still rely on the agricultural sector for a living, and the development in the industrial and service sectors in these two regions lagged behind those of the other regions. Our analysis show that the evolution pattern is very different for each region, therefore, it is necessary to take the effects of income and geographical location into consideration in formulating development policies.