The impact of technology on health care cost and policy development

The Impact of the Upgrading of the Industrial Structure on the Urban Employee Basic Medical Insurance Fund: An Empirical Study in China

BACKGROUND

During the transformation of economy to a high-quality level in China, industrial restructuring and upgrading have played an important role. The upgrading of the industrial structure has affected not only the development in society and economy but also other fields, thereby having great impact on social security. In recent years, with the aging of the population and economic development, the social medical insurance fund is undertaking more payment pressure. However, the existing research rarely focuses on the impact of industrial structure upgrading on medical insurance.

OBJECTIVE

The main aim of this study was to analyze the impact of the upgrading of industrial structure on the income and expenditure of the urban employee basic medical insurance fund.

METHODS

China's provincial panel data from 2007 to 2018, collected by the National Bureau of Statistics of China, were used to establish a panel regression model in order to investigate the impact of the upgrading of the industrial structure on the income and expenditure of the urban employee basic medical insurance fund.

RESULTS

The research showed that the upgrading of the industrial structure, in combination with the internal upgrading in the tertiary industry, had a positive impact on the income and expenditure of the urban employee basic medical insurance fund and that there were regional differences. The simple upgrading of the three major industries had no effect on the income or expenditure of the urban employee basic medical insurance fund. In addition to the upgrading of industrial structure, other factors such as the average salary of employed persons in urban units, the proportion of retirees among all insured persons in urban employee basic medical insurance and the expenditure of urban employee basic medical insurance were also found to have impact on the income of urban employee basic medical insurance. Moreover, the expenditure of urban employee basic medical insurance was associated with the proportion of retirees among all insured persons in urban employee basic medical insurance, GDP and an aging population.

CONCLUSION

In the context of the upgrading of the industrial structure, measures such as strengthening employment and income security, delaying retirement, adjusting birth policy, strengthening the scientific management of personal accounts and accurately positioning the regional industrial structure were suggested to be adopted in order to minimize the payment pressures on the urban employee basic medical insurance fund.

Promoting the Appropriate Use of Advanced Radiation Technologies in Oncology: Summary of a National Cancer Policy Forum Workshop

PURPOSE

Leaders in the oncology community are sounding a clarion call to promote "value" in cancer care decisions. Value in cancer care considers the clinical effectiveness, along with the costs, when selecting a treatment. To discuss possible solutions to the current obstacles to achieving value in the use of advanced technologies in oncology, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop, "Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology" in July 2015. The present report summarizes the discussions related to radiation oncology.

METHODS AND MATERIALS

The workshop convened stakeholders, including oncologists, researchers, payers, policymakers, and patients. Speakers presented on key themes, including the rationale for a value discussion on advanced technology use in radiation oncology, the generation of scientific evidence for value of advanced radiation technologies, the effect of both scientific evidence and "marketplace" (or economic) factors on the adoption of technologies, and newer approaches to improving value in the practice of radiation oncology. The presentations were followed by a panel discussion with dialogue among the stakeholders.

RESULTS

Challenges to generating evidence for the value of advanced technologies include obtaining contemporary, prospective, randomized, and representative comparative effectiveness data. Proposed solutions include the use of prospective registry data; integrating radiation oncology treatment, outcomes, and quality benchmark data; and encouraging insurance coverage with evidence development. Challenges to improving value in practice include the slow adoption of higher value and the de-adoption of lower value treatments. The proposed solutions focused on engaging stakeholders in iterative, collaborative, and evidence-based efforts to define value and promote change in radiation oncology practice. Recent examples of ongoing or successful responses to the discussed challenges were provided.

CONCLUSIONS

Discussions of "value" have increased as a priority in the radiation oncology community. Practitioners in the radiation oncology community can play a critical role in promoting a value-oriented framework to approach radiation oncology treatment.

What Was (Also) at Stake When a Robot Bathtub Was Implemented in a Danish Elder Center: A Constructivist Secondary Qualitative Analysis

Assistive technologies are often considered to be passive tools implemented in targeted processes. Our previous study of the implementation of the robot bathtub in a Danish elder center suggested that purposeful rationality was not the only issue at stake. To further explore this, we conducted a constructivist secondary qualitative analysis. Data included interviews, participant observations, working documents, and media coverage. The analysis was carried out in two phases and revealed that the bathing of the older people was constructed as a problem that could be offensive to the users' integrity, damaging to their well-being, and physically strenuous for the staff. The older users and the nursing staff were constructed as problem carriers. We conclude that technological solutions are not merely neutral and beneficial solutions to existing problems, but are rather part of strategic games contributing to the construction of the very problems they seek to solve.

Introduction to Cost Analysis in IR: Challenges and Opportunities

Demonstration of value has become increasingly important in the current health care system. This review summarizes four of the most commonly used cost analysis methods relevant to IR that could be adopted to demonstrate the value of IR interventions: the cost minimization study, cost-effectiveness assessment, cost-utility analysis, and cost-benefit analysis. In addition, the issues of true cost versus hospital charges, modeling in cost studies, and sensitivity analysis are discussed.

Preventable Complications Driving Rising Costs in Management of Patients with Critical Limb Ischemia

BACKGROUND

This study aimed to identify factors that drive increasing health-care costs associated with the management of critical limb ischemia in elective inpatients.

METHODS

Patients with a primary diagnosis code of critical limb ischemia (CLI) were identified from the 2001-2011 Nationwide Inpatient Sample. Demographics, CLI management, comorbidities, complications (bleeding, surgical site infection [SSI]), length of stay, and median in-hospital costs were reviewed. Statistical analysis was completed using Students' t-test and Mann-Kendall trend analysis. Costs are reported in 2011 US dollars corrected using the consumer price index.

RESULTS

From 2001 to 2011, there were a total of 451,823 patients who underwent open elective revascularization as inpatients for CLI. Costs to treat CLI increased by 63% ($12,560 in 2001 to $20,517 in 2011, P < 0.001 in trend analysis). Endovascular interventions were 20% more expensive compared with open surgery ($19,566 vs. $16,337, P < 0.001). Age, gender, and insurance status did not affect the cost of care. From 2001 to 2011, the number of patient comorbidities (7.56-12.40) and percentage of endovascular cases (13.4% to 27.4%) increased, accounting for a 6% annual increase in total cost despite decreased median length of stay (6 to 5 days). Patients who developed SSI had total costs 83% greater than patients without SSIs ($30,949 vs. $16,939; P < 0.001). Patients who developed bleeding complications had total costs 41% greater than nonbleeding patients ($23,779 vs. $16,821, P < 0.001). Overall, there was a 32% reduction in SSI rates but unchanged rates of bleeding complications during this period.

CONCLUSIONS

The cost of CLI treatment is increasing and driven by rising endovascular use, SSI, and bleeding in the in-patient population. Further efforts to reduce complications in this patient population may contribute to a reduction in health care-associated costs of treating CLI.

The adjunctive use of power Doppler imaging in the preoperative assessment of prostate cancer

OBJECTIVE

To determine if the adjunctive use of power Doppler imaging (PDI) could provide prognostic utility in the treatment of prostate cancer, as an accurate prediction of the clinical behaviour of prostate cancer is important to determine appropriate treatment.

PATIENTS AND METHODS

Most centres rely on a digital rectal examination or transrectal ultrasonography (TRUS) to assess the clinical stage of patients. In 2002, we began using a standardized form to evaluate TRUS findings and PDI findings. We compared preoperative clinical findings with those from pathological analysis of 620 radical prostatectomy specimens from 2002 to 2007.

RESULTS

The mean (sd) patient age was 58 (6.6) years with a mean prostate-specific antigen (PSA) level of 7.0 (4.5) ng/mL. Of the 620 specimens 157 (25.3%) had evidence of extracapsular extension on pathological evaluation; 443 (71.5%) men had a hypervascular lesion seen on TRUS, while 177 (28.5%) patients had none. There was no difference in preoperative PSA level, grade or stage of tumour. Furthermore, rates of biochemical recurrence or secondary treatment did not differ based on PDI findings. As a tool to help locate prostate tumours, PDI improved the specificity of TRUS but did not improve the overall accuracy or sensitivity.

CONCLUSION

PDI provides little prognostic utility to assess risk in prostate cancer. However, PDI might improve the specificity of TRUS in identifying prostate tumours and could have a role in image guidance for focal therapy of prostate cancer.