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Objective:To understand the present situation, operation mode, stakeholder's attitude, preliminary results and problems in Pharmacy Benefit Management (PBM) from pilot areas in China, and put forward corresponding suggestions. Methods :In this paper, we carried out an analysis of introduced PBM model after reviewing the existing literature, conducting interviews with key person in the pilot areas and process observation. Moreover, we combined all of the methods and techniques with quantitative analysis in order to find promising results. Results :We constructed a PBM model based on the information provided by the analysis mainly carried out in the piloting community health service centers. After launching the model, the number of drugs increased, the number of outpatients doubled, and the program was widely praised by the patients who joined it. To a certain extent, with the introduction of PBM model, patients with chronic diseases returned to the grassroots level and promoted the development of basic public health services. On the contrast, stakeholders showed different attitudes towards the program, and this inconsistency greatly affected its development through many factors. PBM promoted the management of chronic diseases and tiered care system in pilot areas, but some problems are still there. Conclusions :To a certain limit, PBM can improve the accessibility of drugs in primary health service centers and promote the management of chronic disease and separation of clinics from pharmacies. With the gradual elimination of drug-supporting medical system and the deepening of health insurance reform, PBM may play its positive role in improving service quality and controlling medical expenses. However, its long-term effect requires more follow-up studies,
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Objective:This study aimed to evaluate the impacts of the separation between revenue and expendi-ture on the outcome of the payment policy"fix out of pocket". Methods: Using descriptive analysis, difference in difference(DID) model based on data from Wanning county where the new policy has been carried out,Ledong coun-ty where has not,including claim data and hospital utilization data from Nov 2010 to Oct 2014. We also supplemen-ted and interpreted the results of quantitative analysis combined with qualitative data from the interview recording ma-terial;Results:As for the two most common hospitalized diseases(hypertension and pneumonia),the number of in-patient visits in primary medical institutions didn't change respectively. From DID model, the policy only increased out of pocket(OOP) in Wanning by 11% and 28% and decreased average medical expense in Qionghai by 66% and 67% respectively. Conclusion:The separation between revenue and expenditure make the"fix out of pocket"pay-ment policy have better performance on the control of medical expense.
ABSTRACT
<p><b>BACKGROUND</b>Root avulsion to all 5 roots of the brachial plexus is a common presentation and keeps a major reconstructive challenge. The contralateral C7 (CC7) nerve transfer has been used in treating brachial plexus avulsion injury (BPAI) since 1986. However, the effectiveness of the procedure remains a subject of controversy. The aim of this meta-analysis was to study surgical outcomes regarding motor and sensory recovery after CC7 nerve transfer.</p><p><b>METHODS</b>Chinese or English (i.e., "contralateral c-7", "contralateral c7", "c7 nerve root", and "seventh cervical nerve root") keywords were used for a literature search for articles related to CC7 nerve transfer in several databases (i.e., PubMed, Cochrane, Embase, CNKI, CQVIP, and Wanfang Data). Clinical research articles were screened, and animal studies as well as duplicate publications were excluded. Muscle strength and sensory recovery were considered to be effective only when the scores on the United Kingdom Medical Research Council scale were equal to or higher than M3 and S3, respectively.</p><p><b>RESULTS</b>The overall ipsilateral recipient nerve recovery rates were as follows: the efficiency rate for muscle strength recovery after CC7 nerve transfer was 0.57 (95% confidence interval [CI]: 0.48-0.66) and for sensory recovery was 0.52 (95% CI: 0.46-0.58). When the recipient nerve was the median nerve, the efficiency rate for muscle strength recovery was 0.50 (95% CI: 0.39-0.61) and for sensory was 0.56 (95% CI: 0.50-0.63). When the recipient nerve was the musculocutaneous nerve and the radial nerve, the efficiency rate for muscle strength recovery was 0.74 (95% CI: 0.65-0.82) and 0.50 (95% CI: 0.31-0.70), respectively.</p><p><b>CONCLUSIONS</b>Transfer of CC7 nerves to musculocutaneous nerves leads to the best results. CC7 is a reliable donor nerve, which can be safely used for upper limb function reconstruction, especially for entirely BPAI. When modifying procedures, musculocutaneous nerves and median nerve can be combined as recipient nerves.</p>