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Zeng L, Zhong Y, Chen Y, Zhou M, Zhao S, Wu J, Dong B, Dou Q. Effect of long-term care insurance in a pilot city of China: Health benefits among 12,930 disabled older adults. Arch Gerontol Geriatr 2024; 121:105358. [PMID: 38341956 DOI: 10.1016/j.archger.2024.105358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The surge of disabled older people have brought enormous burdens to society. The aim of this study was to examine the impact of long-term care insurance (LTCI) implementation on mortality and changes in physical ability among disabled older adults. METHODS This was a prospective observational study based on data from the government-led LTCI program in a pilot city of China from 2017 to 2021. Administrative data included the application survey of activities of daily living (ADL), the baseline characteristics and all-cause mortality. Return visit surveys of ADL were conducted between August 2021 and December 2021. A regression discontinuity model was used to analyze the impact of LTCI on mortality. RESULTS A total of 12,930 individuals older than 65 years were included in this study, and 10,572 individuals were identified with severe disability and participated in the LTCI program. LTCI implementation significantly reduced mortality by 5.10 % (95 % CI, -9.30 % to -0.90 %) and extended the survival time by 33.74 days (95 % CI, 13.501 to 53.970). The ADL scores of the LTCI group dropped by 2.5 points on average, while the ADL scores of those did not participated in LTCI dropped by 25.0 points. The heterogeneity analysis revealed that the impact of LTCI on mortality reduction was more significant among females, individuals of lower age, those who were married, cared for by family members, and who lived in districts with rich care resources. CONCLUSIONS LTCI implementation had a favorable impact on the mortality and physical ability of participants.
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Affiliation(s)
- Lijun Zeng
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Zhong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxiao Chen
- School of Politics and Public Administration, Zhengzhou University, Zhengzhou, China
| | - Mei Zhou
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, China
| | - Jinhui Wu
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China
| | - Qingyu Dou
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China.
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Cho M, Kim W, Kim M, Ye R, Hwang Y, Lee DW, Shin J. The Effect of Telehealth on Patterns of Health Care Utilization and Medication Prescription in Patients with Diabetes or Hypertension During COVID-19: A Nationwide Study. Telemed J E Health 2024; 30:1297-1305. [PMID: 38206789 DOI: 10.1089/tmj.2023.0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Background: In response to the coronavirus disease-19 pandemic, audio-based telehealth services for consultation and medication prescription were temporarily introduced in Korea. This study investigated the impact of telehealth services on patterns of health care utilization and medication prescription in patients with hypertension or diabetes. Methods: The 2019 to 2021 Health Insurance Review and Assessment Service claims data were used. The difference-in-difference approach was used to investigate the effect of telehealth services between the case and control group before and after the intervention period. The pre-intervention period was from February 24, 2019, to February 23, 2020, and the post-intervention period from February 24, 2020, to February 23, 2021. The control group included individuals who used in-person outpatient services and the case group those who utilized both telehealth and in-person services. Results: A total of 250,640 patients with hypertension and 154,212 patients with diabetes were included. The use of telehealth services was associated with an increase in outpatient visits in those with hypertension (0.07, p = 0.0027) and diabetes (0.32, p < 0.0001). A decrease in hospitalizations (-0.2%, p = 0.0007) and emergency department visits (-0.11%, p = 0.0016) was found in individuals with hypertension. Policy implementation also resulted in an increase in medication possession ratio (MPR) and the proportion of appropriate prescription in patients with hypertension (MPR: 3.0%, p < 0.0001, prescription: 3.1%, p < 0.0001) and diabetes (MPR: 3.4%, p < 0.0001, prescription: 1.7%, p < 0.0001). Conclusions: The findings confirm a relationship between implementing telehealth services and improved patterns of health care utilization and medication prescription, suggesting the potential benefit of telehealth in managing chronic diseases.
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Affiliation(s)
- Minho Cho
- Health Insurance Review & Assessment Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Republic of Korea
| | - Woorim Kim
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
| | - Myunghwa Kim
- Health Insurance Review & Assessment Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Republic of Korea
| | - Ryemi Ye
- Health Insurance Review & Assessment Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Republic of Korea
| | - Yungi Hwang
- Health Insurance Review & Assessment Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Republic of Korea
| | - Dong Woo Lee
- Bureau of Healthcare Policy, Ministry of Health and Welfare, Sejong-si, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim W, Lee SC, Lee WR, Chun S. The effect of the introduction of the national lung cancer screening program on short-term mortality in Korea. Lung Cancer 2023; 186:107412. [PMID: 37856923 DOI: 10.1016/j.lungcan.2023.107412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND South Korea introduced the National Lung Cancer Screening Program (NLCSP) in 2019. This study investigated the effect of the NLCSP on one-year mortality in individuals with a history of lung cancer. METHODS This study used the 2018-2020 National Health Insurance Service claims data. The difference-in-differences approach was used to investigate the effect of participating in the NLCSP between the case and control groups before and after the intervention period. The case group included individuals aged between 54 and 74 years with a smoking history of ≥ 30 pack-years and the control group those aged between 54 and 74 years with a history of smoking of <30 pack-years and non-smokers. The pre-intervention period was from January 2018 to June 2019 and the post-intervention period from July 2019 to December 2020. RESULTS The introduction of the NLCSP was related to an overall decrease in one-year mortality (-3.21 % points, 95 % Confidence Interval (CI) -4.84 to -1.58). Specifically, this reduction was significant for lung cancer related mortality (lung cancer: -2.69 % points, 95 % CI -4.24 to -1.13). Furthermore, stronger associations were found in individuals of older age, residing in non-metropolitan areas, and who visited healthcare institutions in non-metropolitan areas. CONCLUSION The findings confirm a relationship between implementation of the NLCSP and one-year mortality in eligible individuals with a history of lung cancer, which is noteworthy considering that Korea is one of the first countries to include lung cancer into the national cancer screening program.
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Affiliation(s)
- Woorim Kim
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea; Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
| | - Sang Chul Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Woo-Ri Lee
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Sungyoun Chun
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea.
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4
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Effects of public long-term care insurance on the medical service use by older people in South Korea. HEALTH ECONOMICS, POLICY, AND LAW 2023; 18:154-171. [PMID: 36189771 DOI: 10.1017/s174413312200024x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Public long-term care insurance (LTCI), which provides home and institutional care benefits, was introduced in July 2008 in South Korea. This study aims to evaluate the effects of the introduction of LTCI on older people's medical service use, including outpatient visits, inpatient services and longer stays (181 days or longer) in hospitals by implementing a quasi-experiment design with a generalised difference-in-difference method. The results showed that the introduction of LTCI did not change the use of outpatient medical services, although the medical costs of older people who used medical services at least once decreased by 9.4%. For the inpatient services, hospitalisation rates declined by 2.7% as a result of the LTCI. Length of stay and inpatient expenses decreased by 15.6 and 9.5%, respectively. For older people of LTC grade 2, eligible for long-term care facilities (LTCF), prolonged hospitalisation rates decreased by 1.6% due to the LTCI. In conclusion, the introduction of LTCI in South Korea has contributed to decreasing the use of inpatient services and longer stays in hospitals, which suggests that the utilisation of LTCF has become a substitute for some social admissions in hospitals.
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Ma G, Xu K. Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:192. [PMID: 36612515 PMCID: PMC9819384 DOI: 10.3390/ijerph20010192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Long-term care insurance (LTCI) is a significant approach in the effort to actively manage aging and the currently unmet need for aged care in China. Based on data from the 2011, 2013, 2015, and 2018 phases of the China Health and Retirement Longitudinal Study, we used the propensity score matching-difference in difference (PSM-DID) approach to explore the impact of LTCI on out-of-pocket medical expenses and self-rated health. Results showed that LTCI can significantly reduce out-of-pocket medical expenses by 37.16% (p < 0.01) per year and improve self-rated health by 5.73% (p < 0.01), which conforms to the spirit of “value-based health care”. The results were found to be stable in the robustness tests conducted. Currently, China is at the intersection of “low-value-based health care” and “value-based health care”. Improving the health level of aged individuals while keeping medical costs under reasonable control is crucial for formulating and implementing a new round of healthcare reform in China.
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Affiliation(s)
| | - Kun Xu
- Correspondence: ; Tel.: +86-198-1075-0586
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Xia Q, Zhang X, Hu Y, Tian W, Miao W, Wu B, Lai Y, Meng J, Fan Z, Zhang C, Xin L, Miao J, Wu Q, Jiao M, Shan L, Wang N, Shi B, Li Y. The superposition effects of air pollution on government health expenditure in China- spatial evidence from GeoDetector. BMC Public Health 2022; 22:1411. [PMID: 35879697 PMCID: PMC9310420 DOI: 10.1186/s12889-022-13702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background As the fifth-largest global mortality risk factor, air pollution has caused nearly one-tenth of the world’s deaths, with a death toll of 5 million. 21% of China’s disease burden was related to environmental pollution, which is 8% higher than the US. Air pollution will increase the demand and utilisation of Chinese residents’ health services, thereby placing a greater economic burden on the government. This study reveals the spatial impact of socioeconomic, health, policy and population factors combined with environmental factors on government health expenditure. Methods Spearman’s correlation coefficient and GeoDetector were used to identify the determinants of government health expenditure. The GeoDetector consist of four detectors: factor detection, interaction detection, risk detection, and ecological detection. One hundred sixty-nine prefecture-level cities in China are studied. The data sources are the 2017 data from China’s Economic and Social Big Data Research Platform and WorldPOP gridded population datasets. Results It is found that industrial sulfur dioxide attributed to government health expenditure, whose q value (explanatory power of X to Y) is 0.5283. The interaction between air pollution factors and other factors will increase the impact on government health expenditure, the interaction value (explanatory power of × 1∩× 2 to Y) of GDP and industrial sulfur dioxide the largest, whose values is 0.9593. There are 96 simple high-risk areas in these 169 areas, but there are still high-risk areas affected by multiple factors. Conclusion First, multiple factors influence the spatial heterogeneity of government health expenditure. Second, health and socio-economic factors are still the dominant factors leading to increased government health expenditure. Third, air pollution does have an important impact on government health expenditure. As a catalytic factor, combining with other factors, it will strengthen their impact on government health expenditure. Finally, an integrated approach should be adopted to synergisticly governance the high-risk areas with multi-risk factors.
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Affiliation(s)
- Qi Xia
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Xiyu Zhang
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Yanmin Hu
- Heilongjiang Provincial Hospital, Harbin, 150086, Heilongjiang, China
| | - Wanxin Tian
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Wenqing Miao
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Bing Wu
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Yongqiang Lai
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Jia Meng
- The 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Zhixin Fan
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Chenxi Zhang
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Ling Xin
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Jingying Miao
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Qunhong Wu
- School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Mingli Jiao
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Linghan Shan
- School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Nianshi Wang
- The Department of Hospital Offices, the affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Liangxi District, Wuxi, 214002, Jiangsu, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, No.27 Zhongguancun South Avenue, Beijing, 100081, China.
| | - Ye Li
- Health Policy and Hospital Management Research Center, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China. .,School of Public Health, Harbin Medical University, Harbin, 150086, Heilongjiang, China.
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Costa-Font J, Jiménez-Martín S, Vilaplana-Prieto C. Do Public Caregiving Subsidies and Supports affect the Provision of Care and Transfers? JOURNAL OF HEALTH ECONOMICS 2022; 84:102639. [PMID: 35671607 DOI: 10.1016/j.jhealeco.2022.102639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
We study whether caregiving and intergenerational transfer decisions are sensitive to changes in economic incentives following the inception of a new unconditional and universal system of allowances and supports, after the introduction of the 2006 Promotion of Personal Autonomy and Care for Dependent Persons Act (SAAD in Spanish), and the ensuing effects of its austerity cuts after 2012. We find that whilst the introduction of a caregiving allowance (of a maximum value of €530 in 2011) increased the supply of informal caregiving by 20-22 percentual points (pp), the inception of a companion system of publicly subsidised homecare supports did not modify the supply of care. Consistent with an exchange motive for intergenerational transfers, we estimate an average 17 pp (8.2-8.7pp) increase (decrease) in downstream (upstream) transfers among those receiving caregiving allowances. Our estimates resulting from the reduction in the allowances and supports after the austerity cuts in 2012 are consistent with our main estimates, and suggest stronguer effects among lower-income families.
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Affiliation(s)
- Joan Costa-Font
- Department of Health Policy, London School of Economics and Political Sceince (LSE), AHIL, IZA and CESIfo.
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Chen H, Ning J. The Impacts of Long-Term Care Insurance on Health Care Utilization and Expenditure: Evidence From China. Health Policy Plan 2022; 37:717-727. [PMID: 35032390 DOI: 10.1093/heapol/czac003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/01/2021] [Accepted: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Long-term care insurance (LTCI) is one of the important institutional responses to the growing care needs of the ageing population. Although previous studies have evaluated the impacts of LTCI on health care utilization and expenditure in developed countries, whether such impacts exist in developing countries is unknown. The Chinese government has initiated policy experimentation on LTCI to cope with the growing and unmet need for aged care. Employing a quasi-experiment design, this study aims to examine the policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure in China. The Propensity Score Matching with Difference-in-difference approach was used to analyse the data obtained from four waves of China Health and Retirement Longitudinal Study (CHARLS). Our findings indicated that, in the aspect of health care utilization, the introduction of LTCI significantly reduced the number of outpatient visits by 0.322 times (p<0.05), the number of hospitalizations by 0.158 times (p<0.01), and the length of inpatient stay during last year by 1.441 days (p<0.01). In the aspect of out-of-pocket health expenditure, we found that LTCI significantly reduced the inpatient out-of-pocket health expenditure during last year by 533.47 yuan (p<0.01), but it did not exhibit an impact on the outpatient out-of-pocket health expenditure during last year. LTCI also had a significantly negative impact on the total out-of-pocket health expenditure by 512.56 yuan. These results are stable in the robustness tests. Considering the evident policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure, the expansion of LTCI could help reduce the needs for health care services and contain the increases in out-of-pocket health care expenditure in China.
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Affiliation(s)
- He Chen
- School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Road, Beijing, Haidian 100872, China
| | - Jing Ning
- School of Government, University of International Business and Economics, No. 10, Huixin Dongjie, Beijing, Chaoyang 100029, China
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9
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Lei X, Bai C, Hong J, Liu H. Long-term care insurance and the well-being of older adults and their families: Evidence from China. Soc Sci Med 2022; 296:114745. [DOI: 10.1016/j.socscimed.2022.114745] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/13/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
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Actual compliance rate of Enhanced Recovery After Surgery protocol in laparoscopic distal gastrectomy. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:184-190. [PMID: 35602855 PMCID: PMC8965987 DOI: 10.7602/jmis.2021.24.4.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022]
Abstract
Purpose The Enhanced Recovery After Surgery (ERAS) protocol enhances recovery rate after laparoscopic distal gastrectomy (LDG). An ERAS protocol has been applied to most patients who underwent LDG at our center. In this study, we determined the actual compliance rate of the ERAS protocol and analyzed the risk factors for noncompliance. Methods Medical records of 1,013 patients who underwent LDG from March 2016 to December 2017 were reviewed retrospectively. The compliance group (A) included 327 patients who were discharged within four days postoperatively. The noncompliance group (B) comprised 686 patients who were not discharged within four days postoperatively. Results The compliance rate of the ERAS protocol was 32.3%. Potential compliance rate was 53.2%. Most common reasons for noncompliance were fever (n = 115) and ileus (n = 111). The 30-day emergency room visit rate was significantly lower in group A than that in group B (p = 0.006). Median age, American Society of Anesthesiologists (ASA) physical status classification, operation time, and pathologic stage were significantly higher in group B than those in group A (p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively). Risk factors for noncompliance were ASA classification of ≥III (odds ratio [OR], 2.251; p = 0.007), age of ≥70 years (OR, 1.572; p = 0.004), operation time of ≥180 minutes (OR, 1.475; p = 0.003), and pathologic stage of ≥III (OR, 2.224; p < 0.001). Conclusion The current ERAS protocols should be applied to patients without risk factors.
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11
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Zhang L, Wu JY, Lam SK. Comparison of healthcare resource utilization in pediatric patients with refractory epilepsy: Vagus nerve stimulation and medical treatment cohorts. Epilepsy Behav 2021; 123:108281. [PMID: 34509035 DOI: 10.1016/j.yebeh.2021.108281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Refractory epilepsy imposes a substantial burden on affected patients, families, and healthcare system. In terms of treating seizures in children, vagus nerve stimulation (VNS) has been proved to be comparable to that of antiepileptic drugs (AEDs). This study compared healthcare resource utilization between pediatric patients treated with AEDs only and AEDs plus VNS. METHODS Pediatric patients diagnosed with refractory epilepsy between the 1st of January 2011 and the 31st of December 2016 were identified from the Pediatric Health Information System Database. Patients treated with AEDs only or AEDs plus VNS were included in the study and were followed up from one year before to two years after the date when defined criteria for refractory epilepsy were met. The difference-in-difference approach along with the hurdle model was used to compare the changes in healthcare resource utilization over time between patients treated with AEDs only and AEDs plus VNS. RESULTS The study included 1502 patients treated with AEDs plus VNS and 4541 patients treated with AEDs only. There was a difference in post-index all-cause and epilepsy-related inpatient visits compared to the pre-index period: inpatient hospitalizations were decreased in the AEDs plus VNS cohort, and increased in the AEDs only cohort. There was no significant difference in the pre-index to post-index change for all-cause and epilepsy-related emergency department visits between the two treatment cohorts. For outpatient encounters in the initial post-index period, patients treated with AEDs plus VNS had significantly higher increase in all-cause and epilepsy-related outpatient visits compared to the AEDs only cohort. CONCLUSIONS Compared to those treated with AEDs only, pediatric patients with refractory epilepsy treated with AEDs plus VNS have fewer inpatient visits and more outpatient visits within a 2-year follow-up. Given the lower acuity of care in outpatient versus inpatient settings, this study can inform treatment choices for children with refractory epilepsy.
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Affiliation(s)
- Lu Zhang
- Division of Pediatric Neurosurgery, Ann & Robert Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA
| | - Joyce Y Wu
- Division of Pediatric Neurology, Department of Pediatrics, Ann & Robert Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Ann & Robert Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL 60611, USA.
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Chen L, Zhang L, Xu X. Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge. BMC Health Serv Res 2020; 20:1057. [PMID: 33218328 PMCID: PMC7677443 DOI: 10.1186/s12913-020-05878-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
Background The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China’s public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China. Methods This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist. Results The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. Conclusion Some policy implications on the future development of China’s LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.
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Affiliation(s)
- Linhong Chen
- School of Mathematics and Statistics, Chongqing Technology and Business University, Chongqing, 400067, China.,School of Public Administration, Sichuan University, Chengdu, 610065, China
| | - Lu Zhang
- Research Center for Economy of Upper Reaches of the Yangtse River, Chongqing Technology and Business University, Chongqing, 400067, China
| | - Xiaocang Xu
- School of Economics, Chongqing Technology and Business University, Chongqing, 400067, China. .,Department of Actuarial Studies & Business Analytics, Macquarie University, Sydney, 2109, Australia.
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Feng J, Wang Z, Yu Y. Does long-term care insurance reduce hospital utilization and medical expenditures? Evidence from China. Soc Sci Med 2020; 258:113081. [PMID: 32540515 DOI: 10.1016/j.socscimed.2020.113081] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/10/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
This study examines the effect of long-term care insurance (LTCI) on hospital utilization and expenditures among the elderly in China. We exploit the introduction of public LTCI in Shanghai, China, and implement a difference-in-difference technique to disentangle the effects of LTCI. We find that the introduction of LTCI significantly reduces the length of stay, inpatient expenditures, and health insurance expenditures in tertiary hospitals by 41.0%, 17.7%, and 11.4%, respectively. We find a greater effect on people over 80 years old. Outpatient visits in tertiary hospitals decrease by 8.1% per month after LTCI. The possible mechanisms are the substitution of long term care for hospitalization and health improvement. Our cost-effectiveness analysis indicates that every extra 1 yuan spent in LTCI will generate a decrease of 8.6 yuan in health insurance expenditures.
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Affiliation(s)
- Jin Feng
- School of Economics, Fudan University, Room 415, 600 Guoquan Road, Yangpu District, Shanghai, 200433, China.
| | - Zhen Wang
- School of Economics, Fudan University, Room 213, 600 Guoquan Road, Yangpu District, Shanghai, 200433, China.
| | - Yangyang Yu
- School of Public Economics & Administration, Shanghai University of Finance & Economics, Room 210, Fenghuang Buidling, 111 Wuchuan Road, Yangpu District, Shanghai, 200433, China.
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14
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Kim JH, Lee Y. Implementation of long-term care and hospital utilization: Results of segmented regression analysis of interrupted time series study. Arch Gerontol Geriatr 2018; 78:221-226. [PMID: 30015058 DOI: 10.1016/j.archger.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 07/08/2018] [Accepted: 07/08/2018] [Indexed: 11/19/2022]
Abstract
This population-based time series study aimed to examine the effects of the long-term care insurance (LTCI) program on hospital utilization in Korea. Health insurance claim data and LTCI data were combined into a database of 92,596 individuals who were enrolled in Health Insurance at baseline. They were made of people who applied to LTCI program at least once since July 2008, and their hospital utilization records since 2002 were observed. Estimates of length of hospital stay (LOS) after the introduction of LTCI program were calculated using a segmented regression analysis. Although average LOS in hospitals implementation was lower pre-implementation period than post-implementation (16.865 days, SD: 4.864; 26.078 days, SD: 2.215, respectively, p < .0001), a decreasing trend was observed along the post-implementation period. The estimate for baseline trend, which reflect a trend in LOS before LTCI implementation, was 0.219 days (p < .0001). The estimate for Level change after intervention which is only indicated as the change of LOS was 2.821 days at the time of LTCI implementation, and was statistically significant (p < .0001). The estimate for Trend change after intervention, reflecting the trend in LOS after LTCI implementation, was -0.313, indicating a decreasing trend in LOS of -0.094 days (p = 0.0055), compared with the baseline trend. LTCI program was significantly associated with a decreasing trend in LOS. The results suggest that the introduction of LTCI program may have played a role in reducing LOS in older adults.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Health Administration, Dankook University College of Health Science, Cheonan, Republic of Korea; Institute of Health Promotion and Policy, Danook University, Cheonan, Republic of Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea.
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15
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Jeon B, Kwon S. Health and Long-Term Care Systems for Older People in the Republic of Korea: Policy Challenges and Lessons. Health Syst Reform 2017; 3:214-223. [PMID: 31514668 DOI: 10.1080/23288604.2017.1345052] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The Republic of Korea is experiencing a rapidly aging population with increased life expectancy and lowered fertility. National health insurance has provided universal access to health care for all since 1989, and mandatory long-term care insurance (LTCI) was introduced in 2008, in which everybody who contributes to health insurance simultaneously contributes to LTCI. Although health services and long-term care are universally accessible, health differentials remain across socioeconomic groups. LTCI covers about 7% of older people through eligibility assessment and provides benefits for institutional and home-based care and cash benefits in exceptional cases. Long-term care (LTC) benefit eligibility has been criticized for being excessively reliant on physical functionality, and recently eligibility has been extended to people with dementia. Despite the oversupply of LTC providers, quality of care has been a concern and calls for more investment in the quality evaluation system and training of care workers. There continues to be overreliance on inpatient care and unmet health care needs among LTC users as a result of weak gatekeeping by primary care and a lack of effective coordination between health care and LTC.
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Affiliation(s)
- Boyoung Jeon
- Department of Health Services Research , Faculty of Medicine, University of Tsukuba , Tsukuba, Ibaraki , Japan
| | - Soonman Kwon
- Graduate School of Public Health , Seoul National University , Seoul , Korea
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16
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Hyun KR, Kang S, Lee S. Population Aging and Healthcare Expenditure in Korea. HEALTH ECONOMICS 2016; 25:1239-1251. [PMID: 26085120 DOI: 10.1002/hec.3209] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/16/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
Korea's rapid population aging has been considered as a major factor in increase of healthcare expenditure (HCE). However, there were no clear empirical evidences in Korea that show if population aging has a significant impact on HCE. To examine the 'red herring' argument, this study used Heckman, two-part, and augmented model with Korean National Health Insurance claim data for the deceased and survivors of aged 20 years and over verified by Korean National Health Insurance Service between January 1 and December 31, 2010. Our results suggest that when time to death is controlled for as explanatory variable, HCE decreases as a function of age, and HCE during the terminal year increases as a function of time to death, and HCE in the last quarter of life decreases with age. Therefore, this study affirms that there is no age effect in Korea experiencing the most rapid population aging among Asian countries. An increase in the number of elderly, due to the aging of baby boomers, may not increase a share of HCE out of gross domestic product (GDP) in Korea. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kyung-Rae Hyun
- Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, South Korea
| | - Sungwook Kang
- School of Public Health, Daegu Haany University, Daegu, South Korea
| | - Sunmi Lee
- Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, South Korea
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Arefnezhad M, Yazdi Feyzabadi V, Homaie Rad E, Sepehri Z, Pourmand S, Rava M. Does Using Complementary Health Insurance Affect Hospital Length of Stay? Evidence from Acute Coronary Syndrome Patients. Hosp Pract (1995) 2016; 44:28-32. [PMID: 26782008 DOI: 10.1080/21548331.2016.1143781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Length of stay (LOS) is used as an indicator to show the efficacy of hospitals. An increase in hospitalized days is not cost effective and decreases the efficacy of hospitals. Using insurance has some side effects. One of these side effects is increasing the LOS. In this study we attempt to discover the effects of complementary health insurance (CHI) on LOS in patients with acute coronary syndrome (ACS). METHODS In this cross-sectional study, 260 patients were surveyed. By using Poisson regression, the effects of using complementary health insurance on LOS were examined. The effects of confounders were also controlled in the model. RESULTS The results of this study demonstrated that the relationship between use of CHI and LOS is direct. In addition, an increase in age and income also increases the LOS. The average LOS was 4.13 days, while it was 5.31 for CHI users, and 3.81 for CHI nonusers. CONCLUSION Government budget is restricted and ACS treatments are costly. Decreasing LOS in ACS patients can help to spend the budget more effectively.
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Affiliation(s)
- Masoud Arefnezhad
- a School of Public Health , Zabol University of Medical Sciences , Zabol , Iran
| | - Vahid Yazdi Feyzabadi
- b Department of Health Management and Economics, School of Public Health , Tehran University of Medical Sciences , Tehran , Iran
- c Health Services Management Research Center, Institute for Futures Studies in Health , Kerman University of Medical Sciences , Kerman , Iran
| | - Enayatollah Homaie Rad
- b Department of Health Management and Economics, School of Public Health , Tehran University of Medical Sciences , Tehran , Iran
| | - Zahra Sepehri
- a School of Public Health , Zabol University of Medical Sciences , Zabol , Iran
| | - Saeideh Pourmand
- a School of Public Health , Zabol University of Medical Sciences , Zabol , Iran
| | - Mohadeseh Rava
- a School of Public Health , Zabol University of Medical Sciences , Zabol , Iran
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