Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T15:26:50.091Z Has data issue: false hasContentIssue false

Patient Engagement at the Household Level: A Feasible Way to Improve the Chinese Healthcare Delivery System Toward People-Centred Integrated Care

Published online by Cambridge University Press:  30 May 2018

Abstract:

Influenced by the people-centered integrated care (PCIC) model, Healthy China 2030 was drafted recently with a special concern given to patient engagement. Although there are three levels of engagement (i.e., individual, household, community), patients are more likely to be empowered and activated through an individualistic approach. Thus, engaging patients at the household level appear to have been overlooked so far. Supported by ethical values and practical evidence, this article attempts to address the importance of engaging patients at the household level in shaping the Chinese healthcare system with the PCIC model orientation, and thus recommends four strategies for empowering and activating patients at the household level in the Chinese context.

Type
Special Section: Bioethics Beyond Borders
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. World Health Organization. 2018; available at http://www.who.int/servicedeliverysafety/areas/people-centred-care/strategies/en/ (last accessed 3 May 2017).

2. Barlow, J, Wright, C, Sheasby, J, Turner, A, Hainsworth, J. Self-management approaches for people with chronic conditions: a review. Patient Education Counseling 2002;48(2):177–87;CrossRefGoogle ScholarPubMed Forbat, L, Cayless, S, Knighting, K, Cornwell, J, Kearney, N. Engaging patients in health care: an empirical study of the role of engagement on attitudes and action. Patient Education Counseling 2009;74(1):8490;CrossRefGoogle ScholarPubMed McCarley, P. Patient empowerment and motivational interviewing: engaging patients to self-manage their own care. Nephrology Nursing Journal 2009;36(4):409–13;Google ScholarPubMed Gruman, J, Rovner, MH, French, ME, Jeffress, D, Spfaer, S, Shaller, D, et al. From patient education to patient engagement: implications for the field of patient education. Patient Education Counseling 2010;78(3):350–6;CrossRefGoogle ScholarPubMed Barello S, Graffigna G, Vegni E. Patient engagement as an emerging challenge for healthcare services: mapping the literature. Nursing Research and Practice 2012;2012:905934; Ishikawa H, Yano E. The relationship of patient participation and diabetes outcomes for patients with high vs. low health literacy. Patient Education Counseling 2011;84(3):393–7. Berkman, ND, Sheridan, SL, Donahue, KE, Halpern, DJ, Crotty, K. Low health literacy and health outcomes: an update systematic review. Annals of Internal Medicine 2011;155(2):97107;CrossRefGoogle ScholarPubMed Carman, KL, Dardess, P, Manurer, M, Sofaer, S, Adams, K, Bechtel, C, et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Affairs 2012;32(2):223–31;CrossRefGoogle Scholar Hibbard, JH, Greene, J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer date on costs. Health Affairs 2013;32(2):207–14;CrossRefGoogle ScholarPubMed World Health Organization. WHO Strategy on People-Centered and Integrated Health Services, at 22. 2015; available at http://apps.who.int/iris/bitstream/10665/155002/1/WHO_HIS_SDS_2015.6_eng.pdf (last accessed 3 May 2017); Castro EM, Regenmortel TV, Vanhaecht K, Sermeus W, Hecke AV. Patient empowerment, patient participation and patient-centeredness in hospital care: a concept analysis based on a literature review. Patient Education Counseling 2016;99(12):1923–39.

3. The World Bank Group, World Health Organization, China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security. Healthy China: deepening health reform in China, at 52. 2016; available at http://www.wpro.who.int/china/publications/2016-health-reform-in-china/en/ (last accessed 3 May 2017).

4. See note 3, The World Bank Group, World Health Organization, China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security 2016, at 51.

5. Wang, J. Family and autonomy: towards share medical decision-making in light of Confucianism. In: Fan, R, ed. Family-Oriented Informed Consent: East Asian & American Perspectives. Dordrecht: Springer; 2014:6384.Google Scholar

6. Denier, Y, Gastmans, C, Vandevelde, A. Justice, Luck & Responsibility in Health Care: Philosophical Background and Ethical Implications for End-of-Life Care. Dordrecht: Springer; 2013.CrossRefGoogle Scholar

7. See note 2, Word Health Organization 2015, at 22.

8. United States Census Bureau, Census 2000 Profiles of General Demographic Characteristics. May 2001; available at https://www.census.gov/prod/cen2000/doc/ProfilesTD.pdf (last accessed 3 May 2017).

9. Vincent, NA. What do you mean I should take responsibility for my own ill health? Journal of Applied Ethics and Philosophy 2009;1:3951.Google Scholar

10. There are diverse views of luck egalitarianism. They are different from one another primarily in their way of advocating equality. For example, Ronald Dworkin’s equality of resources, Richard Arneson’s equality of welfare, G. A. Cohen’s equality of access to advantages, Eric Rakowski’s equality of fortune, and John Roemer’s equality of opportunity.

11. Segall S. What’s so egalitarian about luck egalitarianism? Ratio 2015;28(3):349–68.

12. Huseby, R. Can luck egalitarianism justify the fact that some are worse off than others? Journal of Applied Philosophy 2016;33(3):259–69.CrossRefGoogle Scholar

13. According to Dworkin, “option luck is a matter of how deliberate and calculated gambles turn out…Brute luck is a matter of how risks turn out which are not in that sense deliberate gambles.” See: Dworkin, R. What is equality? Part 2: equality of resources. Philosophy & Public Affairs.1981;10(4):283345, at 293.Google Scholar

14. See note 13, Dworkin 1981, at 293. Dworkin, R. Sovereign Virtue: The Theory and Practice of Equality. Cambridge, MA: Harvard University Press; 2002, at 287;Google Scholar Brown, A. If we value individual responsibility, which policies should we favor? Journal of Applied Philosophy 2005;22(1):2344, at 25.CrossRefGoogle Scholar

15. Anderson, ES. What is the point of equality? Ethics 1999;109(2):287337.CrossRefGoogle Scholar

16. Barry, N. Defending luck egalitarianism. Journal of Applied Philosophy 2006;23(1):89107;CrossRefGoogle Scholar Segall, S. In solidarity with imprudent: a defense of luck egalitarianism. Social Theory and Practice 2007;33(2):177–98;CrossRefGoogle Scholar Dworkin R. Taking Rights Seriously. London and New York: Bloomsbury Academic; 2013, at 299.

17. Marriage Law of the People’s Republic of China (2001 Amendment): Article 21 (related by birth), Article 26 (related by adoption), and Articles 20 and 27 (related by marriage). (English translation). 2018; available at http://en.pkulaw.cn/display.aspx?id=1793&lib=law&SearchKeyword=&SearchCKeyword=%bb%e9%d2%f6 (last accessed 3 May 2017); Law of the People’s Republic of China on the Protection of the Rights and Interests of the Elderly (2015 Amendment): Article 15 (English translation). 2018; available at: http://en.pkulaw.cn/display.aspx?id=19790&lib=law&SearchKeyword=&SearchCKeyword=%c0%cf%c4%ea%c8%cb (last accessed 3 May 2017); Moskowitz S. Filial responsibility statutes: legal and policy considerations. Journal of Law & Policy 2001;9:709–36, at 711.

18. See note 15, Anderson 1999, at 296.

19. For the English translation of those basic virtues of Confucianism, see Runes DD. Dictionary of Philosophy. New York: Philosophical Library; 1983, at 338.

20. Chen, X, Fan, R. The family and harmonious medical decision making: cherishing an appropriate Confucian moral balance. Journal of Medicine and Philosophy 2010;35:573–86, at 577.CrossRefGoogle ScholarPubMed

21. Wong CK, Wang K, Kaun PY. Social citizenship rights and the welfare circle dilemma: attitudinal findings of two Chinese Societies. Asian Social Work and Policy Review 2009;3:51–62, at 53.

22. Fan R, Li R. Truth telling in medicine: the Confucian view. Journal of Medicine and Philosophy 2004;29:179–93. See note 20, Chen, Fan 2010, at 579.

23. See note 22, Fan, Li 2004, at 179.

24. Fan R. Reconsidering surrogate decision making: Aristotelianism and Confucianism on ideal human relations. Philosophy East and West 2002;52(3):346–72.

25. See note 5, Wang 2014, at 63–80. Lee SC. Family consent in medical decision-making in Taiwan: the implication of the new revisions of the Hospice Palliative Care Act. In: Fan 2014, at 125–36.

26. Yung L. The east Asian family-oriented principle and the concept of autonomy. In: Fan 2014, at 109–24.

27. Choi K. The ideal of autonomy and its misuse. In: Fan 2014, at 86.

28. Ell K, Social networks, social support and coping with serious illness: the family connection. Social Science & Medicine 1996;42(2):173–83.

29. Qiu S. Equality and the right to health: a preliminary assessment of China. In: Toebes B, ed. The Right to Health. Dordrecht: Springer; 2014:97–120, at 113.

30. See note 29, Qiu 2014, at 113.

31. State Council, Guiding Opinion of State Council on Deepening the Reform of the Household Registration System, at para 9 [in Chinese]. 2014; available at http://www.gov.cn/zhengce/content/2014-07/30/content_8944.htm (last accessed 3 May 2017).

32. Wang H, Liu Z, Zhang Y, Luo Z. Integration of current identity-based district-varied health insurance schemes in China: implications and challenges. Frontiers of Medicine 2012;6(1):79–84, at 80.

33. In 2012, Guangzhou province initiated the experiment of family-based “sharing insurance.” Thereafter, Chengdu and Shenzhen became the pilot areas of family-based “sharing insurance” in 2015. In 2017, the local government of Zhejiang province issued a series of supportive policies to encourage the development of family-based “sharing insurance.”

34. Zhou S. The condition, problems and recommendations on realizing the equalization of essential healthcare services [in Chinese]. Chinese Journal of Health Policy 2010;3(7):52–56; Xia Q, Yin A. Analysis on the universal coverage medical insurance system with urban-rural integration in China [in Chinese]. Chinese Journal of Health Policy 2010;3(1):49–53; Zheng X. Review on integration of urban-rural basic medical insurance research [in Chinese]. Chinese Journal of Health Policy 2012;5(9):58–61; Yuan B, Xu J, Meng Q. Analysis on integrating medical insurance schemes in China: lessons from international experiences. Health Development Outlook, at 23. 2015; available at file://campus.eur.nl/users/home/56835zli/Desktop/Health+Development+Outlook-23.pdf (last accessed 3 May 2017).

35. For the English version of those legislations, see pkulaw database. January 11, 2018; available at http://en.pkulaw.cn/ (last accessed 3 May 2017).

36. For the English version of this Article, see Law of the People’s Republic of China on the Protection of the Rights and Interests of the Elderly (2015Amendment). 2018; available at http://en.pkulaw.cn/display.aspx?id=19790&lib=law&SearchKeyword=&SearchCKeyword=%c0%cf%c4%ea%c8%cb (last accessed 3 May 2017).

37. Moskowitz S. Filial responsibility statutes: legal and policy considerations. Journal of Law & Policy 2001;9:709–36, at 709; Edelstone SF. Filial responsibility: can the legal duty to support our parents be effectively enforced? Family Law Quarterly 2002;36(3):501–14. Ting GHY, Woo J. Elder care: is legislation of family responsibility the solution? Asian Journal of Gerontology & Geriatrics 2008;4:72–5.

38. For the English translation of this Article, see Law on Practicing Doctors of the People’s Republic of China (2009 Amendment). 2018; available at http://en.pkulaw.cn/display.aspx?id=22771&lib=law&SearchKeyword=&SearchCKeyword=%D6%B4%D2%B5%D2%BD%CA%A6 (last accessed 3 May 2017).

39. See note 3, The World Bank Group, World Health Organization, China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security 2016, at 52–64.

40. See note 3, The World Bank Group, World Health Organization, China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security 2016, at 52.

41. Nutbaum D. The evolving concept of health literacy. Social Science & Medicine 2008;67(12):2072–8.

42. Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ 2007;335:24.

43. Trost SG, Sallis JF, Pate RR, Freedson PS, Taylor WC, Dowda M. Evaluating a model of parental influence on youth physical activity. American Journal of Preventive Medicine 2003;25(4):277–82.

44. See note 3, The World Bank Group, World Health Organization, China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security 2016, at 52.

45. Greca A, Auslander W, Greco P, Spetter D, Fisher E Jr., Santiago J. I get by with a little help from my family and friends: adolescents’ support for diabetes care. Journal of Pediatric Psychology 1995;20(4):449–76; Toljamo M, Hentinen M. Adherence to self-care and social support. Journal of Clinical Nursing 2001;10(5):618–27.

46. See note 3, The World Bank Group, World Health Organization, China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security 2016, at 52.

47. Van Uden-Kraan CF, Drossaert CH, Taal E, Seydel E, Laar MA. Participation in online patient support groups endorses patients’ empowerment. Patient Education and Counseling 2009;74(1):61–9; Van Uden-Kraan CF, Drossaert CH, Taal E, Smit WM, Bernelot Moens HJ, Van de Laar MA. Determinants of engagement in face-to-face and online patient support groups. Journal of Medical Internet Research 2011;13(4):e106; McGowan PT. Self-management education and support in chronic disease management. Primary Care: Clinics in Office Practice 2012;39(2):307–25; Chan J, Sui Y, Oldenburg B, Zhang Y, Chung HH, Goggins W, et al. Effects of telephone-based peer support in patients with type 2 diabetes mellitus receiving integrated care: a randomized clinical trial. JAMA Internal Medicine 2014;174(6):972–81; Markowitz FE. Involvement in mental health self-help groups and recovery. Health Sociology Review 2015;24(2):199–212. Zhong X, Wang Z, Fisher EB, Tanasugarn C. Peer support for diabetes management in primary care and community settings in Anhui province, China. Annual Family Medicine 2015;13:S50–8.

48. Carter-Edwards L, Skelly Ah, Cagle CS, Appel SJ. They care but don’t understand: family support of African American women with type 2 diabetes. The Diabetes Educator 2004;30(3):493–501; Miller TA, Dimatteo MR. Importance of family/social support and impact on adherence to diabetic therapy. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2013;6:421–6. See note 27, Choi 2014, at 86.

49. See note 3, The World Bank Group, World Health Organization, China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security 2016, at 58.

50. Dutch Civil Code, Article 7: 449.

51. Dutch Civil Code, Article 7: 448, para. 3.

52. Li X, Xing Y, Lin Q, Wei L, Dong M, Ma X, et al. Female cancer patients’ awareness and role in family-based medical decision making mode in Confucian area. Journal of Clinical Oncology. 2016;34(26):237.

53. See note 3, The World Bank Group, World Health Organization, China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security 2016, at 59–60.

54. “Nudges” is a new concept developed by Richard Thaler and Cass Sustein. It refers to an organized context (“choice architects”) in which people are able to make better choices. An example given is that physicians have to provide alternative treatments for their patients. The activity of providing alternative treatments is what is meant by making a “choice architect.” For detailed analysis, see Thaler R, Sustein C. Nudge: Improving Decisions about Health, Wealth, and Happiness. New Haven and London: Yale University Press; 2008; Thaler R, Sustein C. Libertarian paternalism. The American Economic Review 2003;93(2):175–9; Sustein C, Thaler R. Libertarian paternalism is not an Oxymoron. The University of Chicago Law Review 2003;70(4):1159–202.

55. See note 3, The World Bank Group, World Health Organization, China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security 2016, at 62.

56. National Health and Family Planning Commission of the P. R. China. 2016: Guiding opinions on advancing the contracts with general practitioners. June 6, 2016; available at http://www.nhfpc.gov.cn/tigs/s3577/201606/e3e7d2670a8b4163b1fe8e409c7887af.shtml (last accessed 3 May 2017).