ABSTRACT
China’s chronic disease management suffers from problems such as unclear institutional function， insufficient information technology application， and weak regulation support. On the basis of current chronic disease management condition in China， this paper proposes to apply the concept of “people-centered” integrated health management to community chronic disease management and discusses the content and procedure of establishing an integrated community-based chronic disease management model driven by massive databases. The model innovatively combines technology integration， data integration and service integration， and can accurately and efficiently realize the "people-centered" full-course health management of various chronic diseases. Shanghai has provided integrated community-based chronic disease management service for 1.98 million citizens through applying this model. The model warrants further effectiveness and economic evaluation. This study provides precious experience for the development of chronic disease prevention and treatment in China.
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Medical insurance payment model is transforming from project-based purchases to service bundle-based strategic purchases. The new form of bundled purchases should found on a scientifically-led design process of such bundles. The core to bundled purchase would be the payment standard, and the key to its success would be process control. Establishment of such a foundation, a core, and a key, would promote the current price standards, and lead service providers to a standardized medical service standard, so as to ensure a precise rewarding system of payment and service. The big data diagnosis-intervention packet(DIP)is able to fulfill mentioned ambitions by integrating insurance payment and supervision into one management. DIP is a full-process payment mode that encompasses pre-service estimation, in-service process control, post-service grading, and resource allocation. It is an innovative practice in line with China′s national conditions for the modern governance of medical security and medical services.
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Objective To analyze the overall deployment of Class-A large medical equipments in China.Methods Data of Class A large medical equipments deployed from 2007 to 2015 were collected and classified regionally,for the purpose of measuring the overall deployment,growth level and plan performance.Results There were 403 large medical equipments in China,a rapid rise of deployment,yet still far below developed countries in terms of per capita deployment.Regional differences were significant.With PET-CT as an example,the plan performance in the east(92.19%)was much higher than the west of China(68.57%);plan performance of Class-A equipments was better,conducive to regulating the increase and distribution.Conclusions The deployment level of Class-A equipments in China is low in general,and calls for better regulation regardless of the planning and management progress.
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Achieving the millennium development goals and world peace and development are closely linked objectives, and WHO having been made great achievements and progress in the health sector through its related ob -jectives.All health-related millennium development goals such as maternal and child health , HIV/AIDS prevention and control , malaria and tuberculosis , safe drinking water and sanitation , and foreign medical assistance had been basically reached in China .This success was mainly due to the government attention and commitment , legal protec-tion, health information technology-informatization, effective projects and measures , but there are still differences in health status between regions and population groups , and increasing needs of health services quality improvement and chronic diseases control and prevention should be paid great attention in the future .
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The paper described the necessity of social capital utilization for public hospitals, and analyzed the model and characteristics of public hospital financing. It is pointed out that the key to the public-benefit nature in the financing calls for distinguishing responsibilities of the government and the market, defining the reasonable level and manner for investors' return, and building corresponding incentive mechanism and supervision mechanism.
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Objective To compare the efficacy and cost of surgical clipping and endovascular embolization in the treatment of anterior and posterior communicating artery aneurysm and to conduct cost-effectiveness analysis. Methods The data of treatment outcomes and costs in patients with anterior or posterior communicating artery aneurysms admitted to Huashan hospital from 2002 to 2006 were analyzed using a retrospective cohort study. Results A total of 302 patients were included in the study. They were divided into surgical clipping group (n = 150; 65 males, age [48. 11 ±9. 94] years), interventional treatment group (n = 152;75 males, age [52. 56 ± 11. 09] year). The age of the former was lower than that of the latter (t = -3. 670, P =0. 000). There was no significant difference in preoperative clinical conditions (such as location of aneurysms and Hunt-Hess grade) between the two groups. The good outcome rate in the interventional treatment group was significantly higher than that in the surgical clipping group (84. 87% vs. 74. 67%, χ2 = 4. 875, P = 0. 027). There was no significant difference in hospital mortality (5. 33% vs. 3. 94%,χ2 =0. 328, P =0. 567) and complication rate (26.67% vs. 19. 74% , χ2 =2.036, P =0.154) between the surgical clipping group and the interventional treatment group, but the intraoperative aneurysm rupture (10. 67% vs. 3. 95%, χ2 =5.047, P =0.028) and the incidence of postoperative intracranial infection (6/144 vs. 0/152, χ2 = 6.203, P =0.014) in the surgical clipping group were higher than those in the interventional treatment group. The length of hospital stay in the interventional treatment group was significantly shorter than that in the surgical clipping group ([10. 0 ± 7. 0] dvs. [23.0 ± 11. 0] d, Z = -10. 35, P ＜0.001). The median cost of treatment was 95 327.63 %,yuan in the interventional treatment group, and the interquartile range (IQR) was 26 312. 98 yuan; it was significantly higher than the surgical clipping group (median 30 072. 01 yuan, IQR 11 178. 54 yuan) (Z = -14.449, P＜0.001). Compared with the surgical clipping group, while the mRS score improved in the interventional treatment group 0. 10, the cost was about 66 438 yuan, so that the surgical clipping was more cost-effective. Conclusions The efficacy of the intervention treatment of anterior and posterior communicating artery aneurysms is better than that of the surgical clipping The mortality and total complication rate are almost the same with the surgical clipping Thehospital stay is shorter, but the cost of treatment is higher. From an economic point of view, the surgical clipping is more cost-effective.
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Objective To estimate fairness in the financial contributions of suburban households of Shanghai to the health system and the situation throughout the country. Methods A household survey was conducted to obtain data on health expenditure and government health input, which was then analyzed by means of the index for and methodology of fairness in the financial contributions of households in the performance assessment of the health system as introduced by the WHO. Results The coefficient of fairness in the financial contributions of households to the health system was estimated to be 0.735 and the rate of cooperative medical care coverage was positively related to the fairness. Conclusion The fairness level of the financial contributions of suburban households of Shanghai to the health system tallies with the level estimated by the WHO for China while the national level is lower. The calculations of government subsidy for household health, as recommended by the WHO in estimating fairness in the financial contributions to the health system, do not conform to the actual situation in China.
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PurposeTo study the effect of gasoline on the extracellular matrix of dermis in rat. Methods45 male Wistar rats were divided into control group, 3 different exposure level groups, which were exposed to gasoline on 2 cm× 3 cm skin area with the dose of 250 mg/cm2 for 1 (group A) ,4(group B)and 8 days (group C) respectively,and an intervention group exposed to 250 mg/cm2 × 8 days gasoline after the application of protective agent on skin. After the treatment, collagen, elastin and glycosaminoglycan (GAG) were assayed in skin departed from intoxicated area.ResultsCompared with control group, collagen was decreased in group C(P<0.05); elastin was decreased in group B and C (P<0.05); glycosaminoglycan was decreased in all exposure groups and intervention group ( P < 0.05 or P < 0.01 )。 Collagen, elastin and glycosaminoglycan(GAG) were significantly lower in group C than in intervention group ( P < 0.05 ). ConclusionsThe extracellular matrix of dermis,including collagen,elastin and GAG were decreased in rat dermal exposed to gasoline.
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Objective To explore appropriate organization and financing models of urban employees supplementary medical insurance under the conditions of the market economy. Methods Employee surveys on willingness to participate in, willingness to pay for, and actual enrolment in supplementary medical insurance were conducted in Shanghai, Wenzhou and Chengdu and nationally different operational models were compared so as to analyze prospectively coverage and operational models of feasible supplementary medical insurance options. Results Characteristics of the employees needs for various supplementary medical insurance options were garnered and appropriate coverage and operational models were put forward. Conclusion It is suggested that the role of the government in the development of supplementary medical insurance be clearly defined, the development of supplementary medical insurance be promoted through policy support and guidance, and the supervision of supplementary medical insurance be strengthened.