Is There a Difference in the Utilisation of Inpatient Services Between Two Typical Payment Methods of Health Insurance? Evidence from the New Rural Cooperative Medical Scheme in China

Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China

Objective

This study aims to investigate the changes in admission appropriateness after patients were admitted and provide a reference for physicians to make admission decisions and for the supervision of medical service behavior by the medical insurance regulatory department.

Methods

Medical records of 4,343 inpatients were obtained based on the largest and most capable public comprehensive hospital in four counties in central and western China for this retrospective study. The binary logistic regression model was employed to examine the determinants of changes in admission appropriateness.

Results

Nearly two-in-thirds (65.39%) of the 3,401 inappropriate admissions changed to appropriate at discharge. Age, type of medical insurance, medical service type, severity of the patient upon admission, and disease category were found to be associated with the changes in the appropriateness of admission. Older patients (OR = 3.658, 95% CI [2.462-5.435]; P < 0.001) were more likely to go from "inappropriate" to "appropriate" than younger counterparts. Compared with circulatory diseases, the case evaluated as "appropriate" at discharge was more frequent in the urinary diseases (OR = 1.709, 95% CI [1.019-2.865]; P = 0.042) and genital diseases (OR = 2.998, 95% CI [1.737-5.174]; P < 0.001), whereas the opposite finding was observed for patients with respiratory diseases (OR = 0.347, 95% CI [0.268-0.451]; P < 0.001) and skeletal and muscular diseases (OR = 0.556, 95% CI [0.355-0.873]; P = 0.011).

Conclusions

Many disease characteristics gradually emerged after the patient was admitted, thus the appropriateness of admission changed. Physicians and regulators need to take a dynamic view of disease progression and inappropriate admission. Aside from referring to the appropriateness evaluation protocol (AEP), they both should pay attention to individual and disease characteristics to make a comprehensive judgment, and strict control and attention should be paid to the admission of respiratory, skeletal, and muscular diseases.

Trends in accessibility of negotiated targeted anti-cancer medicines in Nanjing, China: An interrupted time series analysis

Background

In order to establish a long-term strategy for bearing the costs of anti-cancer drugs, the state had organized five rounds of national-level pricing negotiations and introduced the National Health Insurance Coverage (NHIC) policy since 2016. In addition, the National Healthcare Security Administration (NHSA) introduced the volume-based purchasing (VBP) pilot program to Nanjing in September 2019. Taking non-small cell lung cancer as an example, the aim of the study was to verify whether national pricing negotiations, the NHIC policy and the VBP pilot program had a positive impact on the accessibility of three targeted anti-cancer drugs.

Methods

Based on the hospital procurement data, interrupted time series (ITS) design was used to analyze the effect of the health policy on the accessibility and affordability of gefitinib, bevacizumab and recombinant human endostatin from January 2013 to December 2020 in Nanjing, China.

Results

The DDDs of the three drugs increased significantly after the policy implementation (P < 0.001, P < 0.001, P = 0.008). The trend of DDDc showed a significant decrease (P < 0.001, P < 0.001, P < 0.001). The mean availability of these drugs before the national pricing negotiation was <30% in the surveyed hospitals, and increased significantly to 60.33% after 2020 (P < 0.001, P = 0.001, P < 0.001). The affordability of these drugs has also increased every year after the implementation of the insurance coverage policy. The financial burden is higher for the rural patients compared with the urban patients, although the gap is narrowing.

Conclusion

The accessibility of targeted anti-cancer drugs has increased significantly after the implementation of centralized prices, the NHIC policy and the VBP pilot program, and has shown sustained long-term growth. Multi-pronged supplementary measures and policy approaches by multiple stakeholders will facilitate equitable access to effective and affordable anti-cancer drugs.

Mechanism of Impact of Big Data Resources on Medical Collaborative Networks From the Perspective of Transaction Efficiency of Medical Services: Survey Study

Background

The application of big data resources and the development of medical collaborative networks (MCNs) boost each other. However, MCNs are often assumed to be exogenous. How big data resources affect the emergence, development, and evolution of endogenous MCNs has not been well explained.

Objective

This study aimed to explore and understand the influence of the mechanism of a wide range of shared and private big data resources on the transaction efficiency of medical services to reveal the impact of big data resources on the emergence and development of endogenous MCNs.

Methods

This study was conducted by administering a survey questionnaire to information technology staff and medical staff from 132 medical institutions in China. Data from information technology staff and medical staff were integrated. Structural equation modeling was used to test the direct impact of big data resources on transaction efficiency of medical services. For those big data resources that had no direct impact, we analyzed their indirect impact.

Results

Sharing of diagnosis and treatment data (β=.222; P=.03) and sharing of medical research data (β=.289; P=.04) at the network level (as big data itself) positively directly affected the transaction efficiency of medical services. Network protection of the external link systems (β=.271; P=.008) at the level of medical institutions (as big data technology) positively directly affected the transaction efficiency of medical services. Encryption security of web-based data (as big data technology) at the level of medical institutions, medical service capacity available for external use, real-time data of diagnosis and treatment services (as big data itself) at the level of medical institutions, and policies and regulations at the network level indirectly affected the transaction efficiency through network protection of the external link systems at the level of medical institutions.

Conclusions

This study found that big data technology, big data itself, and policy at the network and organizational levels interact with, and influence, each other to form the transaction efficiency of medical services. On the basis of the theory of neoclassical economics, the study highlighted the implications of big data resources for the emergence and development of endogenous MCNs.

Subjective burdens among informal caregivers of critically ill patients: a cross-sectional study in rural Shandong, China

BACKGROUND

Informal caregivers are the main source of care for the critically ill, especially after discharge or during the terminal stages at home. However, the concern for informal caregivers is often overshadowed by critically ill patients. The purpose of this study is to determine the influencing factors of the subjective burden of informal caregivers and to seek solutions accordingly.

METHODS

Between July and August 2019, a cross-sectional study was conducted in Shandong, China, focusing on family caregivers and critically ill patients. Subjective caregiver burden was measured by the Chinese version of Zarit Burden Interview (ZBI). The stress process model was used to identify conditions relevant to the caregiving burden and to assess their impact on family caregivers.

RESULTS

554 samples were selected for analysis. The average scores of Zarit Caregiver Burden Interview (ZBI) scores in this study was 30.37±19.04 (n=554). ZBI scores of older, less educated, and spouse caregivers were significantly lower (4.12; 95%CI, 0.42 to 7.81; P =0.029). Objective and subjective burdens increased proportionally. Secondary role stress factors included the higher out-of-pocket (OOP) costs of critical diseases and lower household income, both of which increased caregivers' subjective burdens (1.28; 95%CI, -0.06 to 2.63; p=0.062). Formal medical aid systems played a positive role in reducing subjective caregiving burdens (-7.31; 95%CI, -13.23 to -1.40; p=0.016).

CONCLUSIONS

Health policies should address both the direct medical burdens and the intangible psychological burdens of critical diseases.

Does Health Insurance Lead to Improvement of Health Status Among Chinese Rural Adults? Evidence From the China Family Panel Studies

The purpose of this study is to examine the causal relationship between the New Rural Cooperative Medical Scheme (NRCMS) and health status among Chinese rural adults. The data were drawn from China Family Panel Studies performed in 2016, involving 2,093 rural adults. Furthermore, this study employed k-nearest neighbor matching out of propensity score matching (PSM) to investigate the impact of NRCMS on health status among rural adults. Moreover, radius matching, kernel matching, and nearest-neighbor matching within caliper out of PSM were adopted to conduct sensitivity analyses. This study demonstrates that NRCMS enrollment has had a significant and positive effect on the self-assessed and mental health of rural adults, and the health effect shows significant age and income disparities. Moreover, the positive health effect may result from 2 channels, including the increase of health services utilization and the fact that adults with NRCMS are more likely to seek health care in lower-level medical institutions.

Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China

The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.