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Objective To analyze the composition and influencing factors of the hospitalization expenses of patients with cardiovascular and cerebrovascular diseases who has participated in basic medical insurance, and to provide evidence for controlling excessive increase in the hospitalization expenses and reducing the financial burden of patients. Methods The hospitalization information of 14,271 insured patients with cardiovascular and cerebrovascular diseases from January 1, 2019 to December 31, 2019 in Xianning City, Hubei Province was retrospectively collected. The basic information of the patients and the composition of their hospitalization expenses were descriptively analyzed, and the influencing factors of hospitalization expenses of the patients were analyzed by univariate analysis and logistic regression analysis. Results Among the patients included in the study, coronary heart disease, cerebral infarction, cerebral hemorrhage and essential hypertension were the four main types of cardiovascular and cerebrovascular diseases with the largest proportion of hospitalization expenses, accounting for 26.18%, 20.29%, 11.82% and 9.94%, respectively. The largest proportion of hospitalization expenses was treatment expenses and drug expenses, accounting for 44.09% and 32.52%, respectively. Logistic regression analysis showed that age, length of stay, type of insurance, type of cardiovascular and cerebrovascular diseases, whether there were other comorbidities or complications, and whether they visited tertiary medical institutions were the influencing factors of hospitalization expenses for patients with cardiovascular and cerebrovascular diseases. Conclusion It is necessary to strengthen the disease prevention and control for the elderly and patients with cardiovascular and cerebrovascular diseases such as coronary heart disease, cerebral infarction, cerebral hemorrhage and essential hypertension, accelerate the integration of the basic medical insurance system, scientifically and reasonably shorten the length of hospital stay, and strengthen the promotion of the hierarchical medical system.
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OBJECTIVE To investigate t he attitude of endocrinology physicians to clinical conversion and substitution of insulin drugs ，and to provide basis for improving the centralized procurement program of insulin. METHODS The proportion of convertible and substitutable insulin recognized by endocrinology physicians was investigated by questionnaire from 4 dimensions： intergenerational level ，bargaining group level ，common name level and brand/specification level. The subjects were endocrinology physicians in the third grade class A general hospitals in Nanchang. RESULTS A total of 89 questionnaires were successfully distributed，accounting for 80.2％ of the on-the-job endocrinology physicians （111 in total ）in the third grade class A general hospitals in Nanchang. Eighty-nine questionnaires were collected ，one of which was invalid ，and the effective rate was 98.9％. At the intergenerational level ，93.2％ of endocrinology physicians preferred insulin analogues. At the bargaining group level ，the weighted average of the convertible ratio between group 3 and group 4 approved by physicians was 63.9％. At the levels of common name and brand/specification ，the weighted averages of convertible proportion of each group were more than 70％. CONCLUSIONS The method of insulin grouping in Wuhan is reasonable which can complete clinical conversion and substitution of insulin in the group safely. It is suggested to cancel long-acting human insulin group. The weighted average of the proportion of convertible and substitutable drugs in the group is high. It is suggested to increase the agreed purchase volume of insulin and conduct“volume price linked ”negotiations. When the surveyed physicians choose the initial treatment scheme of insulin ，they pay more attention to the factors such as efficacy and safety ，so the replacement of insulin should be based on the clinical efficacy and drug safety.
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Objective To analyze the composition and influencing factors of hospitalization expenses for diabetic patients，and to provide reference for effective control of medical expenses. Methods The hospitalization cost data of diabetes patients in rural areas of Wugang from 2013 to 2017 were collected. Structural change analysis，non-parametric test and BP (Back Propagation)neural network model were used to analyze the hospitalization expenses and influencing factors. Results The top three components of hospitalization expenses were drug cost (50.02%), examination cost (15.35%) and laboratory cost (12.06%). The contribution rates of structural change of hospitalization expenses were the examination fee (41.00%), drug fee (34.92%) and treatment fee (13.41%), respectively. Factors affecting the total hospitalization cost of diabetic patients included length of stay, operation or not, hospital level, age, discharge year, complication or not and gender (P<0.05), among which length of stay had the greatest impact (sensitivity value was 0.669). Conclusion The hospitalization expenses of patients with diabetes is affected by a variety of factors. It is suggested to optimize the composition of hospitalization expenses by improving the price mechanism of medical services, and to control and reasonably reduce hospitalization expenses by implementing standardized management of clinical pathways, implementing two-way referral and strengthening tertiary prevention.
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Health related behaviors are closely related to health outcomes. This paper reviews the studies on factors for health related behaviors worldwide published in recent 15 years, and systematically summarizes the current research status of the factors for health related behaviors. The factors influencing health related behaviors are individual social demographic factors, social cognitive factors of individuals, and social environmental factors. The individual social demographic factors mainly include gender, age, marital status, economic level and educational level. The social cognitive factors of individuals mainly include self-efficacy, health belief, social support and peer influence. The social environmental factors mainly include mass media, accessibility of facilities and level of urbanization, etc.
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OBJECTIVE:To analyze the current status and problems of medicine purchase and distribution of county,township public medical institutions in Hubei province,and to propose targeted policy recommendations. METHODS:By stratified typical sampling,medicine data of 3 county medical institutions and 40 township medical institutions in 3 counties of Hubei province were collected from medicine bidding and purchasing platform of county health and family planning bureau and hospital information system (HIS). Medicine purchase and distribution,distribution rate,purchase and distribution of essential medicine,Chinese patent medicine and injection,general information of top 10 medicines in the list of purchase amount were analyzed in different levels of medical institutions. RESULTS:The medicine purchase and distribution amount of the township medical institutions were lower than those of county medical institutions, but the total amount and distribution rate were higher than county medical institutions. The purchase amount of essential medicine accounted for nearly 3/4 of the total amount (90.6％ of the township medical institutions,and 48.4％ of the county medical institutions);the purchase amount of Chinese patent medicine accounted for about 1/4 of the total amount (35.4％ of the township medical institutions,15.4％ of the county medical institutions);purchase amount of injection accounted for nearly half (34.6％ of the township medical institutions,and 59.3％ of the county medical institutions). The distribution rates of essential medicine,Chinese patent medicine and injection were 93.0％,93.3％,and 93.2％in township medical institutions,and 81.8％,78.6％ and 79.6％ in county medical institutions,respectively. The rate of medicine distribution of township medical institutions was higher than that of the county medical institutions. The top 10 medicines in the list of purchase amount included 6 kinds of antibiotics,and the top 5 medicines included 2 kinds of injection. CONCLUSIONS:The policy of essential medicine purchase is well implemented in Hubei province,and purchase rate of essential medicine meet the policy requirements(40％-50％);but the proportion of injection purchase can partly reflect the high usage of injection,which may indicate the abuse of injection, and Chinese patent medicine has become an integral part of medicine purchase. Moreover, medicines still have the status of distribution untimely,and medicine distribution of the township medical institutions is better than that of county medical institutions.
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OBJECTIVE:To provide reference for promoting the rational use of essential drugs in primary medical institutions. METHODS:Twenty-three rural primary medical institutions(8 township health centers,15 village clinics)were randomly selected from 2 poverty-stricken counties in Chongzuo city of Guangxi Zhuang Autonomous Region. The utilization of essential drugs was investigated and analyzed statistically through exporting hospital information system data and on-site interviews. RESULTS:The utilization rate of essential drugs in sample township health centers was 72.4％,and the amount of essential drugs accounted for 78.3％. The utilization rate of variety from National List of Essential Drug was 36.9％,which in the Autonomous Regions Essential Drug List Supplement was 47.2％(utilization rate of chemical drugs was 53.9％,and that of Chinese patent drugs was 39.7％). The utilization rate of essential drugs in sample village clinics was 64.4％;utilization rate of variety from National List of Essential Drug was 18.3％, which in the Autonomous Regions Essential Drug List Supplement was 10.5％. The amount of 5 major categories accounted for 47.9％ of total amount of chemical agents,among which that of antimicrobial agents took up the highest proportion,being 35.9％. Among top 10 drugs in the list of amount,there were 8 national essential drugs and 4 antimicrobial agents. There were 2.90 kinds of drugs in each outpatient prescription averagely in sample township health centers;the average proportion of antibiotic prescription was 43.0％;the cost of each prescription was 33.12 yuan in average. CONCLUSIONS:The utilization rate of essential drugs in primary medical institutions is lower than the requirements of policy. There are great difference in utilization rate between chemical agents and Chinese patent drugs of township hospital in Autonomous Regions Essential Drug List Supplement. The cost proportion of antimicrobial agents is high. The rationality of prescription drug use still needs to be improved. It is suggested to guarantee essential drugs supply,adjust Autonomous Regions Essential Drug List Supplement in time,control the price of main categories and strengthen antimicrobial agent use monitoring so as to further promote rational drug use.
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OBJECTIVE:To provide reference for promoting the rational use of essential medicines in primary medical institutions.METHODS:Twenty six rural primary medical institutions (13 township health centers,13 village clinics) were randomly selected from 2 poverty-stricken county (city) in Huanggang city of Hubei province.The utilization of essential medicine was investigated and analyzed statistically through exporting hospital information system data and on-site interviews.RESULTS:The utilization rate of essential medicine in sample township health centers was 76.9％,and the amount of essential medicine accounted for 93.0％;the utilization rate of essential medicine in sample village clinics was 89.7％.The utilization rate of variety from essential medicine list was 53.6％ in sample township health centers and 25.0％ in sample village clinics;the utilization rate of variety from National Essential Medicine List was higher than that of Provincial Essential Medicine List Supplement.The amount of 5 major categories as antimicrobial agents,cardiovascular agent in sample primary medical institutions accounted for 64.7％ of chemical agents.The top ten medicines in the list of amount were all essential medicine,9 of which were national essential medicines.There were 2.8 kinds of medicines in each outpatient prescription averagely in sample township health centers.The proportion of antibiotic prescription was 44.2％.CONCLUSIONS:The utilization rate of essential medicines in township health centers of this area is lower than WHO recommended value,and the ratio of amount meets the policy requirements.The utilization rate of variety from Provincial Essential Medicine List Supplement is in low level in primary medical institutions;the amount of anti-microbial drugs is in high level;the rationality of medicine use in prescriptions needs to be improved.It is suggested to adjust the type of provincial supplement list dynamically according to actual situation and control the price and amount of main categories strictly,the rationality of prescription.
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The pharmaceutical circulation policy reform is the key link of the three medical linkage reform with a view of deepening medical reform.The policy formulation and implementation will inevitably lead to interest redistribution.Therefore, it is an effective means to comprehensively understand the unexpected results of the reform and the scientific decision-making of the policy direction, while ensuring the smooth progress of the reform.Based on the research literature presented on pharmaceutical circulation reform and policies since the new medical reform, this paper revealed the prevailing problems and limitations of the existing researches, demonstrated that policy evaluation based on the scientific theory framework is a powerful tool to judge whether the reform goals are achieved.With the introduction of the stakeholder theory and the game theory in pharmaceutical circulation policy evaluation, the complex influence factors can be quantified under scientific theoretical framework, so that the causal mechanism of the policy effect can be learnt, which can help to have a clearer interpretation of the pharmaceutical circulation reform policy, and to provide a scientific and reasonable reference for future policy direction.
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This paper summarizes the kinds of long term care facilities, service delivery organization, service model, service role and experience of long-term service system in the United States. It provides referral implications for China to explore and establish its own long-term care service system. . There is a variety of long-term care services such as short and long-term stay, adult day care, and home care services, with a gradual change from institutional services to home and community ones. Long-term care services are provided by paid both formal and mostly unpaid informal caregivers. Informal family caregivers are most frequently daughters (29. 3%), followed by spouses with (21. 2%). With the increased availability of the family and community-based services, the family caregivers are more likely to share long term care services with the paid formal ones. The United States has a well-structured long-term care service system whose access mechanism is rigorous and systematic, emphasizing the evaluation of service quality and effectiveness. Moreover, the U. S. long term care service system pays more attention on elders' wishes, respecting their preferences and rights of choice on the services. Based on the experience of the United States, China should primarily focuses on establishing a family and community-based long term care service system with a variety of service delivery facilities, give a full play to the community health facilities, social partners, and families. The Chi-nese government should not only give a focus to the service institutions and content diversification, but should as well establish a sound and detailed assessment and evaluation standard system to access the services and assure the effec-tiveness of service quality with a humanized concern.
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OBJECTIVE:To provide reference for introducing supply chain governance theory into essential medicine supply guarantee reform evaluation system in poverty and remote areas.METHODS:The literatures and reform policies in the field of essential medicine supply guarantee since the New Medical Reform were sorted out to analyze the problems and insufficiency of existing researches,and explore the feasibility of supply chain governance theory in the field of essential medicine supply guarantee.RESULTS:The research boundary of existing studies is not clear,and existing studies are lack of evaluation and analysis method,focus too much on using available data and the result of its quantitative,and lack of comprehensive analysis of combined quantitative and qualitative under theoretical framework.The introduction of supply chain governance theory reveal the mechanism of policy's effectiveness clearly,to provide the reference of policies' tendency.CONCLUSIONS:Through the establishment of theoretical framework based on supply chain governance theory,evaluation system will expand the study strategies and data collection technology in the field of drug circulation.Furthermore,supply chain governance theory and method can be generalized.It not only applies in poverty and remote areas and for the evaluation of essential medicine supply guarantee,but also can be used in the field of drug circulation reform.
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Objective To examine the impact of loneliness on cognitive impairment among community-dwelling elderly people.Methods A cross-sectional survey was conducted between July and August 2015 with 895 community-dwelling elderly participants in four residential areas of Wuchang District,Wuhan.The Montreal Cognitive Assessment (MoCA) was used to measure cognitive function.Chi square test,t-test,and multivariate linear regression were used to analyze the data.Results Multivariate linear analysis showed that loneliness was independently and negatively associated with cognitive function among the participants (β=-1.2828,95％ CI:-2.27--0.30).Participants who felt loneliness recorded lower scores on visuospatial executive,attention,and language ability than those who did not (P＜0.05).Multivariate logistic analysis demonstrated that loneliness was also associated with cognitive function after adjustment for age and gender,with OR (95 ％CI) at 1.74(1.05 2.91) / 1.78 (1.07 2.94).Loneliness remained an independent risk factor for cognitive dysfunction after adjustment for age,gender,education level,monthly income,living arrangement,physical activity,mental activity,hypertension,diabetes,frequency of social interaction,and type of social interaction,with OR (95％CI) at 1.69(1.002.87) / 1.72(1.022.90).Conclusions Loneliness is a significant and independent impact factor for cognitive dysfunction among community dwelling elders.
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Objective To examine the impact of loneliness on cognitive impairment among community-dwelling elderly people.Methods A cross-sectional survey was conducted between July and August 2015 with 895 community-dwelling elderly participants in four residential areas of Wuchang District,Wuhan.The Montreal Cognitive Assessment (MoCA) was used to measure cognitive function.Chi square test,t-test,and multivariate linear regression were used to analyze the data.Results Multivariate linear analysis showed that loneliness was independently and negatively associated with cognitive function among the participants (β=-1.2828,95％ CI:-2.27--0.30).Participants who felt loneliness recorded lower scores on visuospatial executive,attention,and language ability than those who did not (P＜0.05).Multivariate logistic analysis demonstrated that loneliness was also associated with cognitive function after adjustment for age and gender,with OR (95 ％CI) at 1.74(1.05 2.91) / 1.78 (1.07 2.94).Loneliness remained an independent risk factor for cognitive dysfunction after adjustment for age,gender,education level,monthly income,living arrangement,physical activity,mental activity,hypertension,diabetes,frequency of social interaction,and type of social interaction,with OR (95％CI) at 1.69(1.002.87) / 1.72(1.022.90).Conclusions Loneliness is a significant and independent impact factor for cognitive dysfunction among community dwelling elders.
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Objective:The aim of the present study was to conduct an international comparison of the high-val-ue drugs payment systems of some selected countries, and introduce them to the Chinese context. Australia, America and Germany's high-value drugs payment systems were selected to serve as references for China. Methods: The main content and characteristics of three countries' payment systems were analyzed in four aspects:expenditure copayment mode, paid-scope selection, drug price negotiation, and drug rational use management which were then compared with the Chinese status. Results:Through the difference in healthcare system tradition, the above countries have vari-ous copayment mode, but they all select paid-drug by cost-effectiveness analysis with corresponding control measures. Conclusions:China should: establish a co-payment mode for the high-value drugs on the basis of a critical illness medical insurance found;build a national pharmaco-economic evaluation index system and improve the national nego-tiation superiority, while emphasizing on risk-sharing mechanism; and make series specifications to guarantee the drug to be rationally used.
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Objective To evaluate the medical efficiency of sample hospitals in Sanming city before and after Sanming health care reform.Methods One tertiary hospital,two general county hospitals and two TCM county hospitals in Sanming were sampled for the study.Two dimensions(the intensity index of medical work and work efficiency index)were selected.In addition,six indexes were identified,namely the number of discharged patients,number of outpatients and emergency diagnostics,doctor′s daily workload per capita for inpatients,bed turnover times,bed utilization rate and average days of stay.Descriptive trend analysis and comprehensive index method were applied in turn to evaluate the longitudinal changes in medical efficiency at the sample hospitals before and after the medical reform.Results The five sample hospitals in Sanming were found with less days of stay in average,and three were found with year-by-year rise of medical efficiency index,with one of them rising from 1.57 to 2.42.Conclusions Sanming′s health care reform has effectively improved internal operational efficiency at the sample hospitals,and has well addressed the relationship of medical service efficiency and scale expansion.On the other hand,the relationship between work intensity and medical efficiency needs to be further balanced,resource allocation to be further optimized,and more priority to be put in the development of TCM hospitals.
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Objective To understand the situation of undergraduates' quality of life and analyze the influence factors in order to offer basis for improving personnel training mode of public health department in Wuhan University. Methods Questionnaire survey has been conducted among all undergraduates of public health department in Wuhan University. The questionnaire includes the level of internationalization, compound and practice innovation activities. At the same time, students' quality of life has been investigated using the WHOQOL-BREF. SPSS13.0 has been used to make statistical analysis. Scores between groups has been compared utilizing t test, analysis of variance has been made and influence factors has been ana-lyzed utilizing multiple linear regression. Results The average of the undergraduate graduates' quality of life total score is(3.54±0.77),with a scoring rate of 70.9%. The dimension with the highest scoring rate is social relations, and its scoring rate is 75.1%. The dimension with the lowest scoring rate is environment, with scoring rate 65.9%. Compared with the norm, the scores of the overall quality of life, physical health, social relations and environment are all above the norm(P<0.05). The result of multiple linear regression indicates that female(t=-2.338, P=0.020), students from high income family(t=3.512, P=0.001) and students with a high degree of practice innovation activity participation(t=3.515, P=0.001) have a high quality of life. Conclusion The students' quality of life from school of public health, Wuhan University is slightly higher than the general population. The quality of life is influenced significantly by part of cultivating ways. There is a need which personnel training mode is innovated in order to improve the quality of cultivation.
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Under the background of globalization, public health issues are becoming more and more complicated. In the international arena, global health has gradually replaced international health and "global public health" as one of the dominant terms in the field of public health. However, until now, there is no unified understanding and definition for the concept of global health domestically and internationally. In this article, various foreign experts 'views and domestic experts' opinions about the concept of global health are collected and solicited, in order to generalize appropriate Chinese definition of global health of China.
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Humans , China , Global Health , Public Health , VocabularyABSTRACT
In this paper, a systematical and retrospective review was made on how the drug purchasing system of Chinese healthcare institutions has evolved from decentralized purchasing to centralized purchasing based on four stages as budding stage, initial stage, adjustment stage and deepening stage. In each stage, the working characteris-tics, achievements and problems have been analyzed. Targeting at the problems and challenges confronted with cur-rent drug purchasing, recommendations was made to reform and improve public hospitals’ centralized purchasing sys-tem, such as persisting centralized purchasing online at provincial level, sticking to “four favorable” principles, breaking through the mechanism of compensating medical cost with drug-selling profits, promoting coordinated inter-action reforms in healthcare insurances, distribution and pricing, strengthening comprehensive services and supervi-sion, etc.
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With the rapid development and increased integration of Chinese economy with global economy, China assumes more responsibilities and obligations for global health, resulting in great poten-tial needs for professionals in global health. From the angle of global health talent need , this article deeply illuminated that the global health talent training was helpful to take advantage of international resources to solve the problem of health, serve China's peaceful development strategy, comply with development trend of public health, and remedy limitations of traditional medicine undergraduate. Training undergraduates in global health who are China-specific and global competent is the only way to meet the talent demand of China's future. Multi-level global health education will become an important part of medical education in future in China.
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Objective:To study the quality of life of elders enjoying five guarantees in rural welfare institute.Methods:By a multi-stage cluster sampling stratification method,549 rural elders enjoying five guarantees(A group)and 131 rural common elders(B group),aged 60 years and older,were randomly selected from 6 counties and cities in Hubei province.The Short-Form 36 Health Survey Scale(SF-36)was employed in the investigation by face-to-face interviews.Results:Group A had higher score than Group B in terms of role limitations due to physical health(RP),general health perceptions(GH),vitality(VT),role limitations due to emotional problems(RE),and mental health(MH )[e.g.,GH:(55.7±23.8)vs.(52.3±24.4),P<0.05].People in mountain areas had lower score than those in both plain and hill areas in terms of all factors of SF-36 scale[e.g.,PF(77.7±22.0),(72.4±25.5)vs.(65.5±26.7),P<0.05].Conclusion:The elders in rural welfare institute have a good quality of life,which is influenced by different geographical situation significantly.
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0.05) among wu-bao elders in each factor of SCL-90 on sex, marriage and education. 3. The score of SCL-90 of those wu-bao lived in mountain area and small hill area were higher than that lived in plain (143.8?44.5 and 144.5?48.3 vs. 128.6?32.6). 4. There were three important risk factors which led to the mind abnormal of rural wu-bao elders including the body health status, whether labor sometimes or not, and the satisfaction degree about service. Conclusions:1.The mental health status of rural wu-bao elders was the same as that of common elders.2. The mental health status of wu-bao elders in plain area was better than that of ones in hills area and in mountains area.3.There were three major factors which effected the mental health of wu-bao elders including the body health status、whether labor sometimes or not, and the satisfaction degree about service .