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Zhang X, Dai J, Li W, Chen Y, He Y, Yang Y, Yang L. Community medical service construction: identifying factors that influence medical choice for patients with non-communicable chronic diseases in the Southwest China. BMC Public Health 2024; 24:1353. [PMID: 38769495 PMCID: PMC11103853 DOI: 10.1186/s12889-024-18789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Community medical institutions play a vital role in China's healthcare system. While the number of these institutions has increased in recent years, their construction contents remain insufficient. The potential of community medical institutions in preventing, screening, diagnosing, and treating non-communicable chronic diseases (NCDs) has not been fully utilized. This study aims to assess the status of construction contents in community medical institutions in Southwest China and examine how these contents influence the medical choices of NCD patients. METHODS Descriptive statistics were used to evaluate the construction content of community medical institutions. Multiple-sets of multinomial logistic regression were employed to analyze the associations and marginal impacts between construction content and medical choices. Shapley value analysis was applied to determine the contribution and ranking of these impacts. RESULTS Descriptive statistics revealed satisfactory construction contents in community medical institutions. Notably, factors such as service attitude, nursing services, expert consultations, charging standards, medical equipment, medical examinations, privacy protection, and referrals significantly influenced medical choices. Among these, service attitude, charging standards, and privacy protection had the most significant marginal improvement effects on NCD patients' choices, with improvements of 12.7%, 10.2%, and 5.9%, respectively. The combined contribution of privacy protection, medical examinations, service attitude, charging standards, and nursing services to medical choices exceeded 80%. CONCLUSION Optimizing the service contents of community institutions can encourage NCD patients to seek medical care at grassroots hospitals. This study addresses crucial gaps in existing literature and offers practical insights for implementing new medical reform policies, particularly in underdeveloped regions of Southwest China focusing on hierarchical diagnosis and treatment.
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Affiliation(s)
- Xue Zhang
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, 650093, PR China
| | - Jing Dai
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, 650093, PR China.
- Sheng Ai Hospital of Traditional Chinese Medicine, Kunming, 650051, PR China.
| | - Wei Li
- Party Committee Office, Kunming Medical University, Kunming, 650051, PR China
| | - Yu Chen
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, 650093, PR China
| | - Yunyu He
- The First People's Hospital of Yunnan Province, Kunming, 650034, PR China
| | - Yunjuan Yang
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, 650022, PR China
| | - Liuyang Yang
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, 650093, PR China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, PR China
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Zhang T, Chen M. Inequality in benefit distribution of reducing the outpatient cost-sharing: evidence from the outpatient pooling scheme in China. Front Public Health 2024; 12:1357114. [PMID: 38500728 PMCID: PMC10945005 DOI: 10.3389/fpubh.2024.1357114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
Objective The implementation of the outpatient pooling scheme in China has substantially elevated the compensation levels for outpatient expenses. This study aims to assess whether socioeconomically disadvantaged enrollees benefit proportionally compared to their non-disadvantaged counterparts. Method A cohort comprising 14,581 Urban and Rural Resident Basic Medical Insurance (URRBMI) enrollees and 830 Urban Employee Basic Medical Insurance (UEBMI) enrollees was derived from the China Health and Retirement Longitudinal Study 2018. Outpatient pooling scheme benefits were evaluated based on two metrics: the probability of obtaining benefits and the magnitude of benefits (reimbursement amounts and ratios). Two-part models were employed to adjust outpatient benefits for healthcare needs. Inequality in benefit distribution was assessed using the concentration curve and concentration index (CI). Results Following adjustments for healthcare needs, the CI for the probability of receiving outpatient benefits for URRBMI and UEBMI enrollees were - 0.0760 and - 0.0514, respectively, indicating an evident pro-poor pattern under the outpatient pooling scheme. However, the CIs of reimbursement amounts (0.0708) and ratio (0.0761) for URRBMI recipients were positive, signifying a discernible pro-rich inequality in the degree of benefits. Conversely, socioeconomically disadvantaged UEBMI enrollees received higher reimbursement amounts and ratios. Conclusion Despite a higher likelihood of socioeconomically disadvantaged groups receiving outpatient benefits, a pro-rich inequality persists in the degree of benefits under the outpatient pooling scheme in China. Comprehensive strategies, including expanding outpatient financial benefits, adopting distinct reimbursement standards, and enhancing the accessibility of outpatient care, need to be implemented to achieve equity in benefits distribution.
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Affiliation(s)
- Tao Zhang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Zhejiang, China
| | - Minyan Chen
- Medical Insurance Department, Hangzhou Ninth People’s Hospital, Zhejiang, China
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Dong B. The impact of basic health insurance participation characteristics on the health of mobile populations: the mediating role of health service utilization behavior. Front Public Health 2024; 12:1243703. [PMID: 38362214 PMCID: PMC10867968 DOI: 10.3389/fpubh.2024.1243703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives It is a pivotal element of China's health system reform to improve the health security of health insurance for the mobile population. Achieving this objective is integral to the success of the reform. The aim of this study was to analyze the impact of different enrollment characteristics of basic health insurance on the health of the mobile population and to investigate the mediating role of health service utilization behavior. Methods This cross-sectional study included 135,372 migrants who participated in the 2018 China Migrants Dynamic Survey (CMDS). Two indicators were employed in this study to assess the characteristics of the mobile population's involvement in basic health insurance-namely, whether or not they participated in local health insurance and the type of health insurance in which they participated. The health status of the mobile population was measured using self-assessed health. Health service utilization behavior was divided into public health service utilization and medical service utilization. Multivariate ordered logistic regression was employed to examine the effect of health insurance on the health of the mobile population. Subsequently, the Bootstrap method was applied to analyze the mediating effect of health service utilization behavior in the relationship between health insurance and the health of the mobile population. Results Health insurance had a positive impact on health, public health services, and health service utilization among the mobile population. However, enrollment in local health insurance (OR = 1.088, 95% CI = 1.043-1.134) and enrollment in Basic Medical Insurance for Urban Employees (OR = 1.178, 95% CI = 1.090-1.273) were more likely to be associated with higher levels of health and a greater likelihood of receiving health service utilization. The results of the mediating mechanism analysis indicated that health education, health records, family doctor contracting, receiving inpatient services, and being hospitalized locally all played a partially mediating role in the impact of the place of enrollment on health. Regarding the effect of the type of enrollment on health, three types of services-namely, health education, health records, and contracting with a family doctor-played a partially mediating role, while receiving inpatient services and being hospitalized locally did not exhibit a mediating effect. The effect of the type of participation on health is partially mediated. Conclusion Based on the impact of the different enrolment characteristics of basic health insurance on the health of the mobile population and the mediating role of health service utilization in this impact, furthermore, improvement of health insurance coverage for the mobile population should focus on improving the accessibility of health services, increasing the level of health insurance coverage, mitigating differences in treatment between the different insurance systems, and simplifying the process of transferring the health insurance relationships.
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Affiliation(s)
- Bo Dong
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
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Sumankuuro J, Griffiths F, Koon AD, Mapanga W, Maritim B, Mosam A, Goudge J. The Experiences of Strategic Purchasing of Healthcare in Nine Middle-Income Countries: A Systematic Qualitative Review. Int J Health Policy Manag 2023; 12:7352. [PMID: 38618795 PMCID: PMC10699827 DOI: 10.34172/ijhpm.2023.7352] [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: 04/26/2022] [Accepted: 10/18/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals. METHODS We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively. RESULTS Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members. CONCLUSION We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.
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Affiliation(s)
- Joshua Sumankuuro
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Policy and Management, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana
- School of Community Health, Charles Sturt University, Orange, NSW, Australia
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Adam D. Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Witness Mapanga
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Beryl Maritim
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Atiya Mosam
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Chen YT, Wu MR, Li ZX, Gu HQ, Zhou Q, Wang DD, Wang YJ, Xing-Quan Zhao. Assessment of rehabilitation following subarachnoid haemorrhage in China: findings from the Chinese Stroke Center Alliance. BMC Neurol 2023; 23:291. [PMID: 37542260 PMCID: PMC10403933 DOI: 10.1186/s12883-023-03349-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Rehabilitation improves functional recovery in subarachnoid hemorrhage (SAH) patients, and assessing patients for rehabilitation is the first step in this process. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation for patients with SAH. METHODS To identify patients hospitalized with SAH and to analyze rehabilitation assessment rates, we used data for 11,234 SAH patients admitted to 861 hospitals from the China Stroke Center Alliance from August 2015 to July 2019. We examined factors for rehabilitation assessment and analyzed the relationship between rehabilitation assessment and outcomes in these patients. RESULTS Among 11,234 patients with SAH, 6,513 (58.0%) were assessed for rehabilitation. Assessed patients had an increased length of stay (mean ± SD days: 17.3 ± 12.5 versus 11.6 ± 10.5, P = 49.4), a higher Glasgow Coma Scale (GCS) score on admission (mean ± SD GCS score: 12.3 ± 3.8 versus 11.8 ± 4.4, P = 12.2), and were more likely to be admitted to the stroke unit (19.6% versus 13.8%, P = 15.6). In multivariable analysis, factors associated with an increased likelihood of a rehabilitation assessment (p < 0.05) included a longer length of stay (odds ratio [OR], 1.04; 95% confidence interval (CI), 1.04 to 1.05) and care such as dysphagia screening (OR, 1.88; 95% CI, 1.73 to 2.04), DVT prophylaxis (OR, 1.56; 95% CI, 1.41 to 1.72) and vessel evaluation (OR, 1.80; 95% CI, 1.63 to 1.98). For the multivariate analysis of outcomes, patients undergoing rehabilitation assessment had a longer length of stay (OR, 1.96; 95% CI, 1.81 to 2.12), a higher modified Rankin Scale (mRS) score at discharge (OR, 1.49; 95% CI, 1.36 to 1.64), and higher rates of discharge to a rehabilitation center (OR, 3.23; 95% CI, 1.81-5.75). CONCLUSION More than two-fifths of SAH patients were not assessed for rehabilitation. Rates vary considerably among hospital grades, and there is a need to improve adherence to recommended care for SAH patients.
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Affiliation(s)
- Yi-Tong Chen
- Nursing Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mei-Ru Wu
- Nursing Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qi Zhou
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dan-Dan Wang
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xing-Quan Zhao
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Department of Neurology, Fengtai District, National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4Th Ring West Rd, Beijing, 100070, China.
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Chen L, Cheng M. Exploring Older Adults' Perceived Affordability and Accessibility of the Healthcare System: Empirical Evidence from the Chinese Social Survey 2021. Healthcare (Basel) 2023; 11:1818. [PMID: 37444653 DOI: 10.3390/healthcare11131818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The difficulties in accessibility and affordability of healthcare services have posed persistent challenges to the Chinese government ever since the 1990s. This research aimed to explore the perceived accessibility and affordability of the healthcare system, which is also referred to as the social problem of Kan Bing Nan, Kan Bing Gui among older Chinese adults. The research, based on 2169 sample data points from the Chinese Social Survey (CSS) 2021 database, explored the objective and subjective factors in constructing the public perceptions of accessibility and affordability of the healthcare system among both older adult users and older adult non-users of healthcare services, including healthcare expenditure variables, patient experience variables, financial protection variables, and social evaluation variables. The study utilized binary logistic regression analysis to investigate how four different sets of independent variables impact the perceived affordability and accessibility of the healthcare system by older adults. The research found that Kan Bing Nan, Kan Bing Gui was considered the most pressing issue among the older adults in China. Self-reported medical burdens, the cost of healthcare services, and the perceived fairness of public healthcare services were significantly associated with older adults' perceived affordability and accessibility of the healthcare system.
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Affiliation(s)
- Lu Chen
- School of Journalism and Communication, Guangzhou University, Guangzhou 510006, China
| | - Miaoting Cheng
- Department of Educational Technology, Faculty of Education, Shenzhen University, Shenzhen 518060, China
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Xie P, Li X, Guo F, Zhang D, Zhang H. Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City. Front Public Health 2023; 11:1146914. [PMID: 37228711 PMCID: PMC10203198 DOI: 10.3389/fpubh.2023.1146914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China. Methods Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses. Results The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001). Conclusions The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.
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Affiliation(s)
- Peixuan Xie
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xuezhu Li
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feifan Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Donglan Zhang
- Division of Health Services Research, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Hui Zhang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Zhang M, Bao Y, Yang Y, Kimber M, Levine M, Xie F. Identifying Attributes for a Value Assessment Framework in China: A Qualitative Study. PHARMACOECONOMICS 2023; 41:439-455. [PMID: 36729295 PMCID: PMC9893981 DOI: 10.1007/s40273-022-01235-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Value assessment frameworks (VAFs) are promising tools for measuring the value of health technologies and informing coverage policymaking; however, most published VAFs were developed for high-income countries. This study aimed to identify value attributes as part of the development of a VAF in China. METHODS We used the qualitative description approach. Specifically, we conducted open-ended semi-structured interviews with Chinese stakeholders, as well as a review and analysis of publicly available government documents related to health technology assessment (HTA) and coverage policies in China. Conventional content analysis and the constant comparison technique were used to generate value attributes. Multiple criteria were used to determine the inclusion of a value attribute, with response levels of included attributes finalized via consensus meetings among the research team. RESULTS Thirty-four stakeholders living or working in China completed the semi-structured interview. These stakeholders included policymakers (n = 4), healthcare providers (n = 8), HTA researchers (n = 6), patients and members of the general public (n = 9), and industry representatives (n = 7). In addition, 16 government documents were included for analysis. Twelve value attributes grouped in eight categories are included in the VAF: (1) severity of disease; (2) health benefit, including survival, clinical outcomes, and patient-reported outcomes; (3) safety; (4) economic impact, including budget impact to payer and patients, and cost effectiveness; (5) innovation; (6) organizational impact; (7) health equity; and (8) quality of evidence. CONCLUSION These 12 value attributes were identified for the development of a VAF to support health technologies' value assessment and coverage policymaking in China.
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Affiliation(s)
- Mengmeng Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Yun Bao
- Institute of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yi Yang
- Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Melissa Kimber
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, L8L 0A4, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Medicine,, McMaster University, Hamilton, ON, L8N 4A6, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, L8S 4K1, Canada.
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Liu HR, Chen SY, Zhang LY, Fu HQ, Jian WY. Expanding outpatient benefits package can reduce diabetes-related avoidable hospitalizations. Front Public Health 2023; 11:964789. [PMID: 36866089 PMCID: PMC9971935 DOI: 10.3389/fpubh.2023.964789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Objective To evaluate the policy effect of replacing hospitalization service with outpatient service and reducing diabetes-related avoidable hospitalizations by improving outpatient benefits package. Methods A database of hospital discharge from 2015 to 2017 in City Z was used. All diabetic inpatient cases enrolled in Urban Employee Basic Medical Insurance were selected as the intervention group, and diabetic inpatient cases enrolled in Urban and Rural Resident Basic Medical Insurance were selected as the control group. The Difference-in-Difference model was used to analyze the effect of improving outpatient benefits package level of diabetes from 1800 yuan (about $252.82) to 2400 yuan (about $337.09) per capita per year on avoidable hospitalization rate, average hospitalization cost and average length of stay. Results The avoidable hospitalization rate of diabetes mellitus decreased by 0.21 percentage points (P < 0.01), the average total cost of hospitalization increased by 7.89% (P < 0.01), and the average length of stay per hospitalization increased by 5.63% (P < 0.01). Conclusions Improving the outpatient benefits package of diabetes can play a role in replacing hospitalization service with outpatient service, reducing diabetes-related avoidable hospitalizations, and reducing the disease burden and financial burden.
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Affiliation(s)
- Hao-Ran Liu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Si-Yuan Chen
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Lan-Yue Zhang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
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Xi C, Shen JJ, Burston B, Upadhyay S, Zhou S. Epidemiological/Disease and Economic Burdens of Cervical Cancer in 2010-2014: Are Younger Women at Risk? Healthcare (Basel) 2023; 11:healthcare11010144. [PMID: 36611604 PMCID: PMC9818941 DOI: 10.3390/healthcare11010144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Cervical cancer is an important factor threatening women's health in China. This study examined the epidemiological and economic burden of cervical cancer among the medically insured population, which could provide data support for government departments to formulate policies. METHODS All new cases of cervical cancer under the Urban Employee Basic Medical Insurance (UEBMI) plan in a provincial capital city in eastern China from 2010 to 2014 were collected. The Cox proportional hazard model was used to analyze the factors affecting the survival rates for cervical cancer. Outpatient and hospitalization expenses were used to assess the direct economic burden, and the Potential Years of Life Loss (PYLL) and potential economic loss were calculated by the direct method to assess indirect burden. RESULTS During the observation period, there were 1115 new cases and 137 deaths. The incidence rate was 14.85/100,000 person years, the mortality was 1.82/100,000 person years, and the five-year survival rate was 75.3%. The age of onset was mainly concentrated in the 30-59 age group (82.9%) and the tendency was towards younger populations. The age of onset (HR = 1.037, 95% CI = 1.024-1.051), the frequency of hospitalization services (HR = 1.085, 95% CI = 1.061-1.109), and the average length of stay (ALOS) (HR = 1.020, 95% CI = 1.005-1.051) were the related factors affecting overall survival. Among the direct economic burden, the average outpatient cost was $4314, and the average hospitalization cost was $12,007. The average outpatient and hospitalization costs within 12 months after onset were $2871 and $8963, respectively. As for indirect burden, the average Potential Years of Life Loss (PYLL) was 27.95 years, and the average potential economic loss was $95,200. CONCLUSIONS The epidemiological and economic burden reported in the study was at a high level, and the onset age of cervical patients gradually became younger. The age of onset, the frequency of hospitalization services and the ALOS of cervical cancer patients should be given greater attention. Policymakers and researchers should focus on the trend of younger onset age of cervical cancer and the survival situation within 12 months after onset. Early intervention for cervical cancer patients, particularly younger women, may help reduce the burden of cervical cancer.
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Affiliation(s)
- Chuhao Xi
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Jay J. Shen
- Department of Healthcare Administration and Policy School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
| | - Betty Burston
- Department of Healthcare Administration and Policy School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
| | - Soumya Upadhyay
- Department of Healthcare Administration and Policy School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
| | - Shoujun Zhou
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
- School of Health Policy & Management, Nanjing Medical University, Nanjing 211100, China
- Correspondence:
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Chronic patients as retirement-aged workers: the impact of employment-based health insurance and chronic conditions on health-related working capacity and late-life career participation. Eur J Ageing 2022; 19:1351-1362. [PMID: 36692764 PMCID: PMC9729502 DOI: 10.1007/s10433-022-00721-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 01/26/2023] Open
Abstract
Retirement-aged workers with chronic conditions are increasingly engaged in late-life careers in the policy context of delayed retirement initiative. However, it remains uncertain as to how chronic conditions and employment-based social health insurance interact to affect health-related working capacity and late career participation in this group of people. Using data from the China Health and Retirement Longitudinal Study (CHARLS) and the discrete choice model, this study finds that chronic conditions are negatively associated with health-related working capacity (- 0.400, p < 0.01) and late-life career participation (- 0.170, p < 0.01). Employment-based health insurance is positively associated with health-related working capacity of retirement-aged workers (0.432, p < 0.01), but is negatively associated with their late-life career participation (- 1.027, p < 0.01). Moreover, employment-based health insurance could weaken the negative associations between chronic conditions and health-related working capacity (interaction = 0.285, p < 0.05) and late-life career participation (interaction = 0.251, p < 0.05). More fine-grained policies for delayed retirement are needed to focus on the long-neglected health of retirement-aged workers with chronic conditions.
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Inequity in the healthcare utilization among latent classes of elderly people with chronic diseases and decomposition analysis in China. BMC Geriatr 2022; 22:846. [PMID: 36357825 PMCID: PMC9650823 DOI: 10.1186/s12877-022-03538-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/18/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies have shown chronic disease-based healthcare utilization inequity is common. Hence, exploring this issue can help in establishing targeted measures and protecting the rights and interests of vulnerable groups. Against this background, the purpose of this study is to explore the latent classification of elderly patients with chronic disease and compare healthcare utilization inequity among latent classes. METHODS This study used the data of 7243 elderly patient with chronic diseases collected from the China Health and Retirement Longitudinal Study in 2018. Latent class analysis was used to classify the patients with chronic diseases, and analysis of variance and [Formula: see text] tests were utilized to test the differences in characteristics among latent classes. Healthcare utilization inequity was measured based on the concentration index (CI), and the CI was decomposed to compare the horizontal index of healthcare utilization among the latent classes. RESULTS The patients with chronic diseases were divided into five latent classes, namely, the musculoskeletal system, hypertension, respiratory system, digestive system and cardiovascular system groups. Statistically significant differences in social demographic characteristics were observed among the five latent classes (P < 0.05). A pro-rich healthcare utilization inequity for all respondents was observed (outpatient CI = 0.080, inpatient CI = 0.135), and a similar phenomenon in latent classes was found except for the musculoskeletal system group in outpatient visits (CI = -0.037). The digestive system group had the worst equity (outpatient CI = 0.197, inpatient CI = 0.157) and the respiratory system group had the best (outpatient CI = 0.001, inpatient CI = 0.086). After balancing the influence of health need factors, healthcare utilization inequity was almost alleviated. Furthermore, for all respondents, the contribution of health need factors (65.227% for outpatient and 81.593% for inpatient) was larger than that of socioeconomic factors (-21.774% for outpatient and 23.707 for inpatient), and self-rated health status was the greatest contributor (57.167% for outpatient and 79.399% for inpatient). The characteristics were shown in latent classes. CONCLUSIONS Healthcare utilization inequity still exists in elderly patients with chronic diseases, and the specific performances of inequity vary among latent classes. Moreover, self-rated health status plays an important role in healthcare utilization inequity. Providing financial support to low-income patients with certain chronic diseases, focusing on their physical and mental feelings and guiding them to evaluate their health status correctly could be essential for alleviating healthcare utilization inequity among elderly patients with chronic diseases.
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Xu D, Zhang H, Chen Y. Patients' views of shared decision making in inflammatory bowel disease: a survey in China. BMC Med Inform Decis Mak 2021; 21:340. [PMID: 34872536 PMCID: PMC8650369 DOI: 10.1186/s12911-021-01702-8] [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: 07/03/2021] [Accepted: 11/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background Recently, decision-making process has become increasingly complex. But there is limited information on Chinese patients’ views of shared decision making (SDM) in inflammatory bowel disease (IBD). This questionnaire investigation aimed to understand Chinese patients’ perspectives and expectations of SDM in IBD and analyze the possible factors that influence their views. Methods An online survey was conducted from July 19th to 24th, 2020. A total of 1118 patients completed the survey. Results One-third of patients were dissatisfied with the current decision-making model, and the satisfaction of inpatients was lower than that of outpatients. 84% of patients preferred to participate in SDM, who were young and had a high education level, high income, commercial insurance, strong learning ability and knowledge of SDM. Most of those who did not want to participate (72%) were worried about the cost. The kind of medicine (948, 84.8%), surgical indications (505, 45.2%) and operation methods (482, 43.1%) were the topics that patients thought most require SDM. Side effects of medicine (837, 74.9%), costs of therapy (675, 60.4%), and surgical risks (563, 50.4%) were considered to be the most influential factors for SDM. 52.7% of all patients hoped experts in different disciplines would participate in SDM. The most desirable amount of time for discussion was 30 to 60 min (562/1118, 50.3%), that were associated with the cost of SDM. Conclusion We can meet the needs of patients by reducing costs and strengthening online patient education and exploring a model suitable for Chinese IBD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01702-8.
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Affiliation(s)
- Dingting Xu
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou, Zhejiang, 310009, People's Republic of China
| | - Hanyun Zhang
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou, Zhejiang, 310009, People's Republic of China
| | - Yan Chen
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou, Zhejiang, 310009, People's Republic of China.
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Fu W, Shi J, Zhang X, Liu C, Sun C, Du Y, Wang H, Liu C, Lan L, Zhao M, Yang L, Bao B, Cao S, Zhang Y, Wang D, Li N, Chen W, Dai M, Liu G, He J. Effects of cancer treatment on household impoverishment: a multicentre cross-sectional study in China. BMJ Open 2021; 11:e044322. [PMID: 34193481 PMCID: PMC8246348 DOI: 10.1136/bmjopen-2020-044322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To determine the incidence and intensity of household impoverishment induced by cancer treatment in China. DESIGN Average income and daily consumption per capita of the households and out-of-pocket payments for cancer care were estimated. Household impoverishment was determined by comparing per capita daily consumption against the Chinese poverty line (CPL, US$1.2) and the World Bank poverty line (WBPL, US$1.9) for 2015. Both pre-treatment and post-treatment consumptions were calculated assuming that the households would divert daily consumption money to pay for cancer treatment. PARTICIPANTS Cancer patients diagnosed initially from 1 January 2015 to 31 December 2016 who had received cancer treatment subsequently. Those with multiple cancer diagnoses were excluded. DATA SOURCES A household questionnaire survey was conducted on 2534 cancer patients selected from nine hospitals in seven provinces through two-stage cluster/convenience sampling. FINDINGS 5.89% (CPL) to 12.94% (WBPL) households were impoverished after paying for cancer treatment. The adjusted OR (AOR) of post-treatment impoverishment was higher for older patients (AOR=2.666-4.187 for ≥50 years vs <50 years, p<0.001), those resided in central region (AOR=2.619 vs eastern, p<0.01) and those with lower income (AOR=0.024-0.187 in higher income households vs the lowest 20%, p<0.001). The patients without coverage from social health insurance had higher OR (AOR=1.880, p=0.040) of experiencing post-treatment household impoverishment than those enrolled with the insurance for urban employees. Cancer treatment is associated with an increase of 5.79% (CPL) and 12.45% (WBPL) in incidence of household impoverishment. The median annual consumption gap per capita underneath the poverty line accumulated by the impoverished households reached US$128 (CPL) or US$212 (WBPL). US$31 170 395 (CPL) or US$115 238 459 (WBPL) were needed to avoid household impoverishment induced by cancer treatment in China. CONCLUSIONS The financial burden of cancer treatment imposes a significant risk of household impoverishment despite wide coverage of social health insurance in China.
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Affiliation(s)
- Wenqi Fu
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Jufang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Zhang
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Chengcheng Liu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chengyao Sun
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Yupeng Du
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Hong Wang
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Chaojie Liu
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Li Lan
- Department for Prevention and Control of Chronic Non-communicable Diseases, Harbin Center for Disease Control and Prevention, Harbin, China
| | - Min Zhao
- Department of Medical Administration, Yunnan Provincial Cancer Hospital, Kunming, China
| | - Li Yang
- Department of Preventive Medicine, School of Public Health, Guangxi Medical University, Nanning, China
| | - Burenbatu Bao
- Department of Hematology and Oncology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, China
| | - Sumei Cao
- Department of Cancer Prevention, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yongzhen Zhang
- Department of Epidemiology, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - DeBin Wang
- Health Management College, Anhui Medical University, Hefei, China
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Dai
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guoxiang Liu
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Jie He
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Zhu D, Ding R, Ma Y, Chen Z, Shi X, He P. Comorbidity in lung cancer patients and its association with hospital readmission and fatality in China. BMC Cancer 2021; 21:557. [PMID: 34001011 PMCID: PMC8130249 DOI: 10.1186/s12885-021-08272-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/29/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Comorbidity has been established as one of the important predictors of poor prognosis in lung cancer. In this study, we analyzed the prevalence of main comorbidities and its association with hospital readmission and fatality for lung cancer patients in China. METHODS The analyses are based on China Urban Employees' Basic Medical insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) claims database and Hospital Information System (HIS) Database in the Beijing University Cancer Hospital in 2013-2016. We use Elixhauser Comorbidity Index to identify main types of comorbidities. RESULTS Among 10,175 lung cancer patients, 32.2% had at least one comorbid condition, and the proportion of patients with one, two, and three or more comorbidities was 21.7, 8.3 and 2.2%, respectively. The most prevalent comorbidities identified were other malignancy (7.5%), hypertension (5.4%), pulmonary disease (3.7%), diabetes mellitus (2.5%), cardiovascular disease (2.4%) and liver disease (2.3%). The predicted probability of having comorbidity and the predicted number of comorbidities was higher for middle elderly age groups, and then decreased among patients older than 85 years. Comorbidity was positively associated with increased risk of 31-days readmission and in-hospital death. CONCLUSION Our study is the first to provide an overview of comorbidity among lung cancer patients in China, underlines the necessity of incorporating comorbidity in the design of screening, treatment and management of lung cancer patients in China.
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Affiliation(s)
- Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Yong Ma
- China Health Insurance Research Association, Beijing, 100013, China
| | - Zhishui Chen
- Department of Medical Insurance, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, 100191, China.
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Hou J, Chen W, Han Y, Wang L, Lee IH, Hsu LI, Xie D, Yin X, Hou F, Yang Y. Shifting demographics and comorbidity burden in adult Chinese urban patients with chronic hepatitis B, 2013 and 2016. J Comp Eff Res 2021; 10:647-657. [PMID: 33970683 DOI: 10.2217/cer-2020-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic hepatitis B demographics and comorbidity data are limited in China. Materials & methods: The China Health Insurance Association claims database from 2013 and 2016 was used to augment the existing data: the proportion of patients aged >45 years increased significantly from 40.3% in 2013 to 49% in 2016 (p < 0.001). Results: Significant increases in multiple comorbidities were observed, including hypertension (9.4-14.5%), hyperlipidemia (4.7-7.0%) and cardiovascular disease (5.7-10%; p < 0.001 for all comparisons). Increases were observed in renal impairment (8.8-10.0%; p < 0.001) and osteoporosis and/or pathologic nontraumatic bone fracture (3.8-7.3%; p < 0.001). Conclusion: Careful selection of treatment options and comorbidity monitoring should be considered when managing adult Chinese patients with chronic hepatitis B.
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Affiliation(s)
- Jinlin Hou
- Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wendong Chen
- Health Economics Outcomes Research, Normin Health Consulting Ltd, Mississauga, Ontario L5R 0E9, Canada
| | - Ying Han
- National Clinical Research Center for Digestive Diseases and XiJing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Lei Wang
- Department of Infectious Diseases, The Second Hospital of Shandong University, Jinan, China
| | - I-Heng Lee
- Health Economics Outcomes Research, Gilead Sciences Inc., Foster City, CA 94404, USA
| | - Ling-I Hsu
- Health Economics Outcomes Research, Gilead Sciences Inc., Foster City, CA 94404, USA
| | - Dongying Xie
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xueru Yin
- Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fengqin Hou
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Yida Yang
- Department of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
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Dai H, Xu S, Han J, Li Z, Cao J, Hu T, Li H, Wei J, Dou X, Zhou F, Zheng J. Prevalence and factors associated with anxiety and depressive symptoms among patients hospitalized with hematological malignancies after chimeric antigen receptor T-cell (CAR-T) therapy: A cross-sectional study. J Affect Disord 2021; 286:33-39. [PMID: 33676261 DOI: 10.1016/j.jad.2021.02.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND We conducted a survey to investigate the prevalence and factors associated with anxiety and depressive symptoms among patients hospitalized with hematological malignancies after chimeric antigen receptor T-cell (CAR-T) therapy. METHODS In total, 130 eligible patients completed the Self-Rating Anxiety Scale and Self-Rating Depression Scale at week 4 after CAR-T cell infusion. We collected sociodemographic information during the same period. We studied factors associated with anxiety and depressive symptoms using logistic regression analysis. RESULTS The prevalence of anxiety and depressive symptoms at week 4 after infusion were 13.8% and 40.0%, respectively. A cutoff value of 50 or above indicates significantly anxiety and depressive symptoms. Binary logistic regression analysis showed that high school education and above (OR = 0.22, 95% CI = 0.06-0.78) and middle age (OR = 0.16, 95% CI = 0.03-0.90) were associated with lower risk of anxiety symptoms, and increased odds of depressive symptoms was associated with old age (OR = 11.39, 95% CI = 2.50-51.88), non-manual occupations before illness (OR = 3.72, 95% CI = 1.20-11.58), and higher healthcare expenditure (OR = 3.93, 95% CI = 1.50-10.33), while lower risk of depressive symptoms was associated with rural household location (OR = 0.25, 95% CI = 0.08-0.76) and being cared for by spouse (OR = 0.12, 95% CI = 0.02-0.63). CONCLUSIONS Patients receiving CAR-T therapy with lower education background, old ages, urban household location, or who used to work as non-manual workers require more attention and psychological care. Support from a spouse and medical expense deductions from the government may help patients develop positive attitudes.
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Affiliation(s)
- Hongyuan Dai
- School of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Shuya Xu
- School of Nursing, Xuzhou Medical University, Jiangsu, China; Intensive care unit, the Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Jing Han
- School of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Zhenyu Li
- Department of hematology, the Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Jiang Cao
- Department of hematology, the Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Tingyu Hu
- Department of hematology, the Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Hongxia Li
- Department of hematology, the Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Jing Wei
- Department of hematology, the Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Xue Dou
- School of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Fang Zhou
- School of Nursing, Xuzhou Medical University, Jiangsu, China.
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Li X, Chattopadhyay K, Xu S, Chen Y, Xu M, Li L, Li J. Prevalence of comorbidities and their associated factors in patients with type 2 diabetes at a tertiary care department in Ningbo, China: a cross-sectional study. BMJ Open 2021; 11:e040532. [PMID: 33414143 PMCID: PMC7797259 DOI: 10.1136/bmjopen-2020-040532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To determine the prevalence of comorbidities in patients with type 2 diabetes mellitus (T2DM) and identify the factors independently associated with comorbidities in a tertiary care department in Ningbo, China. DESIGN A computerised medical records database was used to conduct a cross-sectional study. SETTING The study was conducted in a tertiary care department in Ningbo, China. PARTICIPANTS The study was conducted on adult patients with T2DM, and it included 8 years of data, from 1 January 2012 to 31 December 2019. THE PRIMARY OUTCOME MEASURE Comorbidity was defined as the coexistence of at least one other chronic condition, that is, either a physical non-communicable disease (duration ≥3 months), a mental health condition (duration ≥3 months) or an infectious disease (duration ≥3 months). RESULTS In total, 4777 patients with T2DM satisfied the eligibility criteria. Over 8 years, the prevalence of comorbidities was 93.7%. The odds of comorbidities increased with the age of patients (18 to 39 years: 1; 40 to 59 years: OR 2.80, 95% CI 1.98 to 3.96; 60 to 69 years: OR 4.43, 95% CI 3.04 to 6.44; and ≥70 years: OR 10.97, 95% CI 7.17 to 16.77). The odds were lower in female patients (OR 0.66, 95% CI 0.51 to 0.84), patients residing in rural areas (OR 0.75, 95% CI 0.59 to 0.95) and patients without health insurance (OR 0.62, 95% CI 0.46 to 0.83). The odds were higher in single/divorced/widowed patients compared with those in married patients (OR 1.95, 95% CI 1.21 to 3.12). CONCLUSIONS A large percentage of patients with T2DM in the tertiary care department in Ningbo, China, had comorbidities, and the factors associated with comorbidities were identified. The findings could be used in developing, evaluating and implementing interventions aimed at improving outcomes in patients with T2DM with comorbidities.
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Affiliation(s)
- Xueyu Li
- School of Medicine, Ningbo University, Ningbo, China
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shengnan Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Yanshu Chen
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Miao Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
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Ding R, Zhu D, Ma Y, Shi X, He P. Comparison of health service use and costs in stroke with and without comorbidities: a cross-sectional analysis using China urban medical claims data. BMJ Open 2020; 10:e037032. [PMID: 33303430 PMCID: PMC7733184 DOI: 10.1136/bmjopen-2020-037032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Stroke is the leading cause of death and disability in China, but there is scare of evidence on whether and to what extent comorbidity affects the stroke-related costs in health system. We examined the association between comorbidity and stroke-related health service utilisation and costs in urban China. SETTINGS The data used in this study were extracted by a 5% random sampling from claims data of China Urban Employees' Basic Medical Insurance and Urban Residents' Basic Medical Insurance from 2013 to 2016, which covered more than 93% of residents in urban China. The data included 89 cities and contained beneficiaries' demographic information, medical diagnoses and expenditures of outpatient and inpatients services. PARTICIPANTS 382 906 patients with stroke were identified as the study population in this study. PRIMARY AND SECONDARY OUTCOME MEASURES The information on health service utilisation and cost was extracted based on the condition that stroke was claimed as the index disease. RESULTS Among 382 906 patients with stroke, 41.0% had a comorbidity. The estimated number of annual outpatient visits among patients with 0, 1, 2 and 3 or more comorbidities were 1.97, 2.30, 2.34 and 2.37, respectively. The annual outpatient expenditure increased from 762.4 (95% CI 746.9 to 777.8) RMB among patients without any comorbidities to 1156.4 (1132.7 to 1180.2) RMB among patients with three or more comorbidities. The increased utilisation and costs among patients with comorbidity were also observed for inpatient services. Stroke-related services utilisation and costs were significantly increased among patients who comorbid conditions like hypertension or chronic pulmonary diseases. CONCLUSION Comorbidity among patients with stroke was associated with increased healthcare utilisation and cost. It poses an extra substantial healthcare burden in China. Our study provides information for both clinical management and health service planning and financing for patients with stroke.
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Affiliation(s)
- Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yong Ma
- China Health Insurance Research Association, Beijing, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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Behzadifar M, Saran M, Behzadifar M, Martini M, Bragazzi NL. The 'Health Transformation Plan' in Iran: A policy to achieve universal health coverage in slums and informal settlement areas. Int J Health Plann Manage 2020; 36:267-272. [PMID: 32996231 DOI: 10.1002/hpm.3082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 01/23/2023] Open
Abstract
Universal health coverage (UHC) is one of the strategies that health decision- and policy-makers worldwide are implementing to guarantee a good health status to everyone. Living in slums is characterized by several issues, including homelessness and malnutrition, environmental challenges, lack of sanitation and access to safe, healthy drinking water, waste disposal problems, widespread social disruptions, job insecurity, feelings of dissatisfaction and inadequacy. In Iran, the 'Health Transformation Plan' (HTP), despite its weaknesses, has had good effects on the health level of people living in slums, ensuring insurance coverage and reducing many economic, social and cultural problems, with a dramatic decline in out-of-pocket expenditures. Good governmental financial support and an adequate revision of the initial packages of health services and provisions have resulted in a higher access rate to healthcare. The HTP has been, indeed, a major step towards reaching UHC in Iran. If policy- and decision-makers can further improve the present situation and provide more and better-quality services to these people, it can be expected that health indicators in suburbs will be significantly improved. Researchers should monitor the impact of HTP and examine its effects on health indicators, specifically among particularly vulnerable groups such as children, women and the elderly.
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Affiliation(s)
- Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Saran
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mariano Martini
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
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Geng J, Chen X, Bao H, Qian D, Shao Y, Yu H. Patients' preferences for health insurance coverage of new technologies for treating chronic diseases in China: a discrete choice experiment. BMJ Open 2020; 10:e038051. [PMID: 32967882 PMCID: PMC7513632 DOI: 10.1136/bmjopen-2020-038051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Our study aimed to inform insurance decision-making in China by investigating patients' preferences for insurance coverage of new technologies for treating chronic diseases. DESIGN We identified six attributes of new medical technologies for treating chronic diseases and used Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). After conducting the DCE, we analysed the data by mixed logit regression to examine patient-reported preferences for each attribute. SETTING The DCE was conducted with patients in six tertiary hospitals from four cities in Jiangsu province. PARTICIPANTS Patients aged 18 years or older with a history of diabetes or hypertension and taking medications regularly for more than 1 year were recruited (n=408). RESULTS The technology attributes regarding expected gains in health outcomes from the treatment, high likelihood of effective treatment and low incidence of serious adverse events were significant, positive predictors of choice by the study patients (p<0.01). The out-of-pocket cost was a significant, negative attribute for the entire study sample (β = -0.258, p<0.01) and for the patients with Urban-Rural Residents Basic Medical Insurance (URRBMI) (β = -0.511, p<0.01), but not for all the patients with Urban Employees Basic Medical Insurance (UEBMI) (β = -0.071, p>0.05). The severity of target disease was valued by patients with lower EQ-5D-5L index value as well as URRBMI enrollees. CONCLUSIONS Patients highly valued the health benefits and risks of new technologies, which were closely linked to their feelings of disease and perceptions of health-related quality of life. However, there existed heterogeneity in preferences between URRBMI and UEBMI patients. Further efforts should be made to reduce the gap between insurance schemes and make safe and cost-effective new technologies as a priority for health insurance reimbursement.
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Affiliation(s)
- Jinsong Geng
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Xiaowei Chen
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
- Library and Reference Department, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Haini Bao
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Danmin Qian
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Yuting Shao
- Department of Ophthalmology, Tongji University School of Medicine, Shanghai, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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22
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Ma C, Zhang Y, Li Y, Wang Y, Jiang Y, Wang X, Ma S. Healthcare, Insurance, and Medical Expenditure of the Floating Population in Beijing, China. Front Public Health 2020; 8:375. [PMID: 32850597 PMCID: PMC7423999 DOI: 10.3389/fpubh.2020.00375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background: China has a large floating population created by the fast urbanization and unique hukou system. With low socioeconomic status, labor-intensive jobs, and the lack of portability of health insurance, the floating population are often disadvantageous in healthcare. However, there is often insufficient attention to healthcare of the floating population. Method: To provide an informative description of certain aspects of the floating population under healthcare, particularly including demographic characteristics, illness conditions, insurance utilization, and medical expenditure, a survey study was conducted in Beijing, China, collecting data on 437 subjects. Characteristics of the floating population and treatments of their illness conditions are examined using univariate and multivariate regression analysis. Results: Personal characteristics and healthcare of the floating population are examined in detail. It is found that the floating population has low insurance coverage and utilization rates. Multiple personal characteristics are identified as significantly associated with insurance utilization and medical expenditure. Conclusions: This study suggests the necessity of further improving healthcare and health insurance protection for the floating population. The identified significant characteristics may assist healthcare providers and other stakeholders identifying the less advantaged.
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Affiliation(s)
- Chenjin Ma
- School of Statistics, Renmin University of China, Beijing, China
| | - Yuming Zhang
- School of Statistics, Renmin University of China, Beijing, China
| | - Yang Li
- School of Statistics, Renmin University of China, Beijing, China.,Center for Applied Statistics, Renmin University of China, Beijing, China.,Statistical Consulting Center, Renmin University of China, Beijing, China
| | - Yu Wang
- School of Statistics, Renmin University of China, Beijing, China
| | - Yan Jiang
- School of Statistics, Renmin University of China, Beijing, China
| | - Xiaojun Wang
- School of Statistics, Renmin University of China, Beijing, China
| | - Shuangge Ma
- School of Statistics, Renmin University of China, Beijing, China.,School of Public Health, Yale University, New Haven, CT, United States
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23
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Chen S, Chen Y, Feng Z, Chen X, Wang Z, Zhu J, Jin J, Yao Q, Xiang L, Yao L, Sun J, Zhao L, Fung H, Wong ELY, Dong D. Barriers of effective health insurance coverage for rural-to-urban migrant workers in China: a systematic review and policy gap analysis. BMC Public Health 2020; 20:408. [PMID: 32228665 PMCID: PMC7106835 DOI: 10.1186/s12889-020-8448-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND More than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China's total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China. METHODS A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed. RESULTS (1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers. CONCLUSION It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW's characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW's job stability.
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Affiliation(s)
- Shanquan Chen
- The School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Zheng Wang
- Research Center for Healthcare Management, School of Economic and Management, Tsinghua University, Beijing, China.,Guizhou Provincial Institute of Health Development, Guizhou Medical University, Guiyang, Guizhou, China
| | - Jianfeng Zhu
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Jun Jin
- Department of Sociology, Tsinghua University, Beijing, China
| | - Qiang Yao
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China
| | - Li Xiang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Yao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Health Bureau, Macao SAR, China
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China
| | - Lu Zhao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hong Fung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eliza Lai-Yi Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Dong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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24
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Liang C, Mei J, Liang Y, Hu R, Li L, Kuang L. The effects of gatekeeping on the quality of primary care in Guangdong Province, China: a cross-sectional study using primary care assessment tool-adult edition. BMC FAMILY PRACTICE 2019; 20:93. [PMID: 31272392 PMCID: PMC6610915 DOI: 10.1186/s12875-019-0982-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/18/2019] [Indexed: 11/10/2022]
Abstract
Background Developed countries have widely implemented a gatekeeping system as a core policy of primary care, also known as the system of first visit in the community. As gatekeepers, general practitioners are responsible for the diagnosis and treatment of residents in the community health centres, and referring patients to specialists as appropriate. After several years of healthcare reform, gatekeeping policy has achieved remarkable success in China. Shenzhen and Dongguan were the first batch of pilot cities that implemented the policy of gatekeeping. This study aims to examine the effects of gatekeeping on the quality of primary care between the gatekeeping and non-gatekeeping groups in these two pilot cities. Methods A cross-sectional survey was conducted in five community health centres in Shenzhen and Dongguan cities, both located within Guangdong Province, China, using a validated Chinese version of the Primary Care Assessment Tool-Adult Edition (PCAT-AE) and carrying out face-to-face interviews with patients 18 years and older. Analyses were grouped according to whether or not patients had gatekeepers. Propensity Score Matching was used to control for confounding factors. A chi-square test was used to compare the factors mentioned above and an independent t-test was performed to compare the eight domains of the core functions of primary care between the two groups of patients. Results In total, 765 valid questionnaires were collected for analysis, after matching the sample size were 238 pairs. All the confounding factors observed between the gatekeeping and non-gatekeeping groups were balanced. The PCAT-AE scores for first-contact utilisation (3.29 > 2.66, p < 0.001) and coordination (2.06 > 1.95, p < 0.05) were higher in the gatekeeping group after matching, but the domains of accessibility (1.59 < 1.67, p < 0.05) and continuity (2.26 < 2.40, p < 0.05) were lower. The PCAT-AE mean score was slightly higher in gatekeeping group (1.98 > 1.93, p > 0.05) but without statistical significance. Conclusion This study demonstrated that gatekeeping has helped to improve first-contact utilisation and coordination of primary care, but that other goals such as continuity and comprehensiveness have been harmed. To establish a sustainable gatekeeping system and to strengthen the core functions of the community comprehensively, the current gatekeeping system needs refinement.
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Affiliation(s)
- Cuiying Liang
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jie Mei
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yuan Liang
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ruwei Hu
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Li Li
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio, 44106, USA.,Department of Family Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Li Kuang
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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25
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Wang H, Jin C, Bai F, Lin X, Fang L, Sun H, Cheng W, Song P. Driving factors and mode transformation regarding health technology assessment (HTA) in China: Problems and recommendations. Biosci Trends 2019; 13:110-116. [PMID: 31006715 DOI: 10.5582/bst.2019.01100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As the reform of Chinese medical and health undertakings has advanced (since 2015), the admission, pricing and payment policies regarding the new health technologies of China have undergone significant changes, and health technology assessment (HTA) has gradually become one of the current reform and research hotspots in China. Based on the perspective of HTA driving factors and the development mode, this paper proposes a two-stage mode of HTA development in China, namely, the mode driven by the management of new heath technology admission and another one driven by new health technology pricing and medical insurance payment. In addition, the paper also proposes the challenges that HTA faces in China under the current mode, including the development system, process standard, data mechanism, and policy application. Besides, recommendations are provided for the further development of HTA construction in China, including strengthening the development system of regional HTA centers, formulating HTA process guidance, building a database, improving evaluation quality and intensifying policy integration.
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Affiliation(s)
- Haiyin Wang
- Shanghai Health Development Research Center (Shanghai Medical Information Center)
| | - Chunlin Jin
- Shanghai Health Development Research Center (Shanghai Medical Information Center)
| | - Fei Bai
- Medical Administration Center of National Health Commission
| | - Xia Lin
- Medical Administration Center of National Health Commission
| | - Liang Fang
- Shanghai Health Development Research Center (Shanghai Medical Information Center)
| | - Hui Sun
- Shanghai Health Development Research Center (Shanghai Medical Information Center)
| | - Wendi Cheng
- Shanghai Health Development Research Center (Shanghai Medical Information Center)
| | - Peipei Song
- Shanghai Health Development Research Center (Shanghai Medical Information Center).,National Center for Global Health and Medicine
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26
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Fan H, Zhao Y, Chen GD, Sun M, Zhu JH. Health insurance status and risk factors of mortality in patients with septic acute kidney injury in Ningbo, China. J Int Med Res 2018; 47:370-376. [PMID: 30328368 PMCID: PMC6384465 DOI: 10.1177/0300060518802526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To investigate the relationship between health insurance status and outcomes of septic acute kidney injury (AKI) related hospitalizations in an intensive care unit (ICU) in Ningbo, China. METHODS For this retrospective study, information was extracted from patients notes and billing records for patients >18 years of age with a diagnosis of AKI admitted to the ICU department, Ningbo First Hospital from April 2013 to March 2018. RESULTS Of the 368 patients with sepsis admitted to ICU, 167 (45%) developed AKI; 95 patients were insured and 72 were uninsured. Compared with insured patients, uninsured patients were younger, had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, but had less catheter interventions and received less renal replacement therapy (RRT). Results from a multivariate analysis showed that independent predictors of ICU mortality were age, APACHE II scores, MODS scores, use of RRT and lack of insurance. CONCLUSIONS Uninsured patients with septic AKI were younger, stayed a shorter time in ICU, had higher illness severity scores and a higher ICU mortality than insured patients. Importantly a major risk factor for ICU mortality in this group was lack of insurance.
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Affiliation(s)
- Heng Fan
- 1 Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
| | - Yu Zhao
- 2 Department of Nephrology, Ningbo Urology and Nephrology Hospital, Ningbo, China
| | - Guo-Dong Chen
- 1 Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
| | - Min Sun
- 1 Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
| | - Jian-Hua Zhu
- 1 Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
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