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Objectives:To find the impact of outpatient security in health seeking behavior,health protection and medical ex-pense for chronic diseases.Methods:Based on the hypertension patients'all medical visits records of urban and rural residents who were insured under the basic medical insurance system in sample region of Nanjing from 2019 to 2021,the quantitative relationship between chronic disease outpatient treatment and patients'healthcare behaviors,health outputs,and healthcare costs was analyzed by an individual-time two-way fixed effect model and Utest test.Results:When the annual outpatient reimbursement ratio is in the range of(42.99%,64.11%),strengthening the security for outpatient service could make people seek medical advice reasonably and achieve a better health outcome,as well as controlling the medical expenses.Conclusion:Properly raising actual compensation for chronic outpatient care could lead to the rational health-seeking behaviors,safeguarding health for the insured,and on this basis,achieve control of medical costs and effective use of the basic medical insurance pool.
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Objective:By analyzing the cost change trend,internal structure change and main influencing factors of diabetes inpatients'hospitalization expenses,it provides empirical basis for promoting the reform of medical service prices,optimizing the internal structure of hospitalization expenses,effectively controlling hospitalization expenses,and reducing the economic burden of diabetes inpatients.Methods:Using the first page data of medical records of 13 426 diabetes inpatients in the target hospital from 2017 to 2021,it analyzes the structural change of diabetes inpatients'hospitalization expenses by using structural change degree and grey correlation degree methods,and analyzes the influencing factors of hospitalization expenses by using linear regression and BP neural network model.Results:Drug expenses and medical technology expenses are the top two in the proportion of total hospitalization expenses of discharged patients with diabetes,and they account for a large proportion in the total hospitalization expenses.The results of structural change and grey correlation show that drug expenses and medical technology expenses are these two factors that cause changes in the total hospitalization cost structure and have a high correlation with the total hospitalization cost,with a cumulative contribution rate of 90.50%.According to the results of linear regression and neural network model,the length of stay is the most important factor affecting the total cost of hospitalization of diabetes patients,followed by the number of operations/procedures and diagnoses.Conclusion:The internal composition of hospitalization expenses for diabetes patients is unreasonable.The proportion of drug expenses and medical technology expenses is too high.The proportion of medical and nursing expenses reflecting the technical labor value of medical personnel is relatively low.The structure of medical income needs to be further optimized.The length of stay is the most critical factor affecting the hospitalization expenses of diabetes patients.Reasonable control of the length of stay can effectively control the unreasonable growth of medical expenses and reduce the economic burden of diabetes patients.
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ObjectiveTo evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease(COPD) patients, and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease(COPD) patients. MethodsStudy subjects were recruited from chronic obstructive pulmonary patients aged ≥40 in Pudong New Area. Propensity score matching method was used to determine the intervention group and the control group. The control group received regular health education and follow-up management, and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat, mobile phone short message service(SMS)and telephone. Finally, a total of2 589 subjects were included in the analysis, including 1 300 in the intervention group and 1 289 in the control group. General demographic data, past medical history and family history of COPD, COPD related knowledge and practice survey, COPD related symptom assessment, acute onset, health service utilization and medical expenses before and after intervention were collected through questionnaire survey. The differences of acute attack, health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect. ResultsIn terms of acute attacks, after intervention, the incidence of acute attacks in the intervention group was lower than that before intervention(χ2=52.901, P<0.001), and the incidence of acute attacks in the groups with different intervention methods was lower than that before intervention (P<0.001). WeChat had the best effect, decreasing the incidence by 14.4%, followed by mobile phone SMS SMS decreasing by 12.3%. In terms of utilization of health services, the outpatient rate due to acute attack was lower in the intervention group after intervention than that before intervention (χ2=7.129, P=0.008), and the outpatient rate due to acute attack was lower in the subjects who received the forecast service through mobile phone SMS than that before intervention (χ2=4.675, P<0.001). In terms of medical expenses, there was no significant difference between control group and intervention group with different intervention methods before intervention (P>0.05). After intervention, the difference between the control group and the intervention group with different intervention methods was statistically significant (H=11.864, P<0.05). The results of multiple comparisons showed that compared with the control group, the average annual medical expenses of patients receiving mobile phone SMS and telephone forecasting services after intervention were lower than those of the control group, and the difference was statistically significant (P<0.05). ConclusionMeteorological risk forecasting service can reduce the acute onset of COPD, reduce the rate of consultation and medical expenses due to acute onset, and provide scientific basis for the basic COPD health management model.
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Objective: The proportion of young patients in Japan in whom generic drugs are used is lower than that of other age groups. To promote the use of generic drugs in young patients, we need to change the parents’ attitude toward generic drugs. Therefore, we aimed to contribute to the maintenance and reform of the Japanese social security system by investigating the effects of parent’s sex, patient’s age, and use of the children’s medical expense subsidy system on the selection of generic drugs. Method: We surveyed parents of young patients (<20 years) whose prescriptions were filed at pharmacies from November 25 to December 1, 2019. Results: Of the 712 valid questionnaires retrieved, 74.3% of parents reported using generic drugs for young patients. Approximately 92.2% of the parents reported using the children’s medical expense subsidy system. The highest (51.4%) reason for switching to generics was “recommendation from a pharmacist, etc.” Cognitive methods using online content were higher among male parents than among female parents (28.0% vs. 11.5% ; P<0.001). Regarding catchphrases that make them want to hear, female parents were more likely to hear about generic drugs than male parents were if the catchphrases quality and safety were used (38.1% vs. 23.8% ; P=0.007). Compared to parents of 7-19-year old children (6.8%), parents of 0-6-year old children (13.1%) reportedly switched to generic drugs because they were easier to ingest (P=0.022). Conclusion: Recommendations from medical professionals such as pharmacists are effective in convincing parents of young patients to switch to generic drug use. To promote the use of generic drugs in young patients, in addition to explaining and publicizing its financial benefits, pharmacists need to explain the added value of generic drugs such as the ingenuity of its dosage form. In addition, it is essential to adopt a multifaceted approach that considers the parents’ background including (1) publicity using the internet for male parents, (2) reaching out to female parents with preschool children, (3) increasing publicity using tickets for children’s medical expenses subsidy system, and (4) drug education that matches the growth of children.
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RESUMEN No existe información sobre la estructura y costos anuales de una hospitalización por agudización de la EPOC en nuestro país actualmente Objetivos: Determinar la estructura de costos de los pacientes hospitalizados por EPOC reagudizada en un hospital público de la Ciudad Autónoma de Buenos Aires (CABA) en el año 2018. Materiales y métodos: Se evaluaron pacientes con EPOC reagudizada (GOLD), in ternados durante 2018 en nuestro hospital. Se determinaron costos directos (perspec tiva del financiador), según costos de medicamentos y la modulación de internación clínica y Unidad de Terapia Intensiva (UTI) del Gobierno de CABA a junio de 2021, valor dólar Banco Nación al 30 de Junio 2021 de $101,17. Resultados: Se internaron 26 pacientes, edad 64 ± 9,56 años, masculino 73%, 61% tabaquistas actuales y 39% extabaquistas (101,8 ± 47,1 paq.-año), seguro social 31%, FEV1% 31 mediana (23-42) y FEV1/FVC 0,46 ± 0,12. La duración de internación fue: guardia 1 d (1-1,75); piso, 9 d (4-12); y UTI, 13 d (11-29,5), con mortalidad 23% (n = 6). El costo final fue 1462,62 dólares/paciente, mediana (RIQ 25%-75%,763,85-2915,95), 162,44 dólares/d/paciente, y el costo total (n = 26) fue USD 117 480. El costo de UTI fue 9898,28 dólares/paciente, mediana (RIQ 25%-75%, 6700,94-35 780,25). El costo total (n = 3) fue USD 75 064,11. Conclusión: Los pacientes con EPOC reagudizada que se hospitalizan son en su mayoría hombres, más de 60 años, alta carga tabáquica y obstrucción grave. El costo directo desde la perspectiva del financiador fue de USD 1462 por paciente; el costo del paciente que se hospitaliza en UTI fue casi siete veces superior. Se deben instru mentar programas sistematizados de manejo de la EPOC para identificar pacientes con factores de riesgo, educar y permitir acceso a la medicación.
ABSTRACT There is not information about the annual and structure of costs of a hospitalization of COPD exacerbation in our country actually. Objective: To determine the structure of direct costs in hospitalized patients due to COPD exacerbations in a public hospital of Buenos Aires in 2018. Methods: Patients hospitalized of COPD exacerbation (GOLD) in 2018 were analyzed in our hospital. Direct costs were determined (financier perspective), due to modulation of the Health Ministry of Buenos Aires City Government, stratified by Intensive Care Unit hospitalization and in room at June 2021, in dollars (dol.), parity at June 30th 2021 was 1 dollar = 101,17$ (price Banco Nación). Results: 26 patients were hospitalized: age 64 ± 9.56 years, male gender 73%, 61% actual smokers and 39% ex-smokers (101.8 ± 47.1 pack-y, social health assurance 31% (n = 8); FEV1% 31 median (23-42) and FEV1/FVC 0,46 ± 0,12. Ward length of hospitalization (median) was 1 day (1-1,75), 9 days in room (4-12), 13 days in UCI (11- 29,5) with mortality rate 23% (n = 6). Final direct cost by patient was 1462,62 dol, median (IQR 25%-75%,763,85-2915,95),at 162,44 dol./day/patient. Total cost (n = 26) was 117 480 dol. UCI cost was median 9898,28 dol./patient (IQR 25%-75%, 6700,94-35 780,25). Final UCI total cost (n = 3) 75 942,3 dol. Conclusion: Patients with COPD exacerbation hospitalized were mainly males, sixty years old, heavy smokers and severe airway obstruction. With financier perspective, direct cost of hospitalization was 1462 dol./patient, almost seven times higher in UCI. Disease management program must be implemented to manage COPD, to identify patients at risk, to educate and to assure access to drugs.
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OBJECTIVE To learn from the self-medication tax system in Japan and improve over-the-counter drug cost sharing mechanism in China. METHODS By searching relevant policies and literature ,the evolution ,specific contents ,current situation and effects of Japanese self-medication tax system were summarized. Recommendations were put forward in the light of the actual situation of over-the-counter drug guarantee in China. RESULTS & CONCLUSIONS Japan has implemented the self-medication tax system since 2017. The Ministry of Health , Labour and Welfare has made clear provisions on the preconditions for applying for the tax system and the deduction standards of the tax system ,and established a list of drugs to be responsible for the regular inclusion and discharge of the drugs under the tax system. The self- medication tax system has a remarkable effect in promoting the self-health management ,disease prevention and reducing medical expenses of Japanese residents. Our country can learn from the self-medication tax system in Japan and the experience of implementing the special deduction system for major medical conditions in China. To promote rational self-medication ,it is advisable to add a special deduction system for over-the-counter drugs into deductions in personal income tax and formulate the criteria and scope of application ,and establish a special list of over-the-counter drugs,thereby reducing the heavy burden of medical expenses of residents ,and exploring a new way to share the costs of over-the-counter drugs which is applicable to our national conditions.
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Objective:To understand the medical cost ratio and its influencing factors of breast cancer chemotherapy and molecular targeted therapy in a hospital, for reference for reasonable control of medical cost.Methods:The first page data of all breast cancer chemotherapy and molecular targeted therapy cases in a tertiary hospital from January to June 2021 were selected to extract the data of age, hospitalization expenses, hospitalization time, complications or complications. The influence of each index on the distribution of medical expense ratio was analyzed by single factor analysis and chi-square test was used for comparison between groups.Results:A total of 3 109 cases of chemotherapy and molecular targeted therapy for breast malignant tumors were included, of which very low-rate, low-rate, high-rate and very high-rate accounted for 7.04%(219 cases), 58.32%(1 813 cases), 30.81%(958 cases) and 3.83%(119 cases) respectively. In addition to the way of admission, there were significant differences in the distribution of medical cost rates under different ages, time consumption index, complications or concomitants, admission departments, treatment methods and medical insurance types( P<0.01). Conclusions:There were many factors affecting the medical cost rate of breast malignant tumors. Relevant departments should expand the pilot scope of DRG payment, promote the multi-disciplinary diagnosis and treatment mode of tumors, refine the DRG grouping scheme, to provide standardized and homogeneous diagnosis and treatment services for tumor patients, and reasonably control the excessive growth of medical costs.
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Objective To analyze the epidemic characteristics of road traffic injuries in Haishu District of Ningbo City and to provide evidence for effective prevention strategies. Methods Based on the "Ningbo Inpatient Injury Monitoring Report Card", we analyzed the epidemiological characteristics and the influencing factors of hospitalization expenses using the road traffic injuries cases collected from 2015-2019 of Haishu District were analyzed. Results The ratio of male to female was 1.46∶1 among the 8 543 cases. Most cases were between 25 to 64 years old. There were 83.09% cases had junior high school education or below. The top three occupations in the cases were preschoolers, transportation workers, and retired people. Road traffic injuries occurred more frequently in spring for preschoolers and in summer vacation for school-age children. Motor vehicle accidents caused more serious injuries than non-motor vehicle accidents (χ 2=59.069, P<0.001). The economic burden caused by the traffic injuries was heavy. The main influencing factors of hospitalization expenses for road traffic injuries were age, gender, severity of injury and the attribute of injury. The median hospitalization cost was 12 400 Yuan, and the interquartile distance was 23 400 Yuan. Conclusion Road traffic injury not only causes serious bodily injury, but also increases the economic burden of family and society directly or indirectly. Traffic safety education should be carried out for key groups to prevent the occurrence of road traffic injuries.
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Objective To analyze the hospitalization cost and its influencing factors of imported malaria patients in Guangxi Zhuang Autonomous Region and Yunnan Province, so as to provide insights into the evaluation of the economic burden due to imported malaria, and the guiding of malaria control and the rational allocation of medical resources. Methods The data pertaining to the hospitalization costs of imported malaria patients admitted to Shanglin County People’s Hospital in Guangxi Zhuang Autonomous Region during the period from January 1 through December 31, 2019, and Tengchong Municipal People’s Hospital in Yunnan Province from January 1, 2015 to December 31, 2019, were collected, and the epidemiological data of these imported malaria patients were extracted from the Information Management System for Parasitic Diseases Control and Prevention, China. The composition of the hospitalization expenses was analyzed using a descriptive method. In addition, the factors affecting the hospitalization expenses of imported malaria patients were identified using a univariate analysis and a recursive system model. Results A total of 206 imported malaria patients were included in this study, including 194 men (94.17%) and 12 women (5.83%). The mean length of hospital stay was 5.00 days per patient and the median hospitalization expenses were 2 813.07 Yuan per time, in which the expenses for laboratory examinations were the highest (45.31%, 1 274.62/2 813.07). Univariate analysis showed that hospital (z = 5.43, P < 0.01), type of malaria (χ2 = 34.86, P < 0.01) and type of payment (χ2 = 7.72, P < 0.05) were factors affecting the hospitalization expenses of imported malaria patients. Recursion system modeling revealed that the total effects on hospitalization expenses of imported malaria patients included length of hospital stay (0.78), selection of hospital (0.34), basic medical insurance for urban and rural residents (0.19), new rural cooperative medical care (0.17), Plasmodium falciparum malaria (0.15), gender (0.11) and P. vivax malaria (0.09). Conclusions The hospitalization expenses of imported malaria patients are affected by multiple factors in Guangxi Zhuang Autonomous Region and Yunnan Province, in which the length of hospital stay is the most predominant influencing factor. A reduction in the length of hospital stay is effective to decrease the hospitalization expenses of imported malaria patients.
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Objective:To explore the change trend of average hospitalization expense and cost structure of inpatients after the implementation of diagnosis-intervention packet (DIP) payment reform in Zhuhai.Methods:The data of hospitalization expense and the proportion of each classification cost (i.e. the value of a classification cost per thousand yuan of medical cost) in Zhuhai before and after the reform were analyzed by interrupted time series method, and the changes of per capita hospitalization cost and cost structure were studied.Results:The average hospitalization expense showed a linear change trend before and after the reform, and the immediate level and the slope of regression line did not change significantly after the reform, which was basically consistent with the trend before the reform. After the implementation of DIP, the proportion of various categories of expenses changed. Among them, the proportion of comprehensive medical services, treatment, traditional Chinese medicine, western medicine, blood and blood products, and other categories changed significantly, P values were less than 0.05. There was no obvious change in the proportion of expenses of diagnosis, rehabilitation and traditional Chinese medicine, but there was a change in the immediate level. The change in the level of diagnosis was -13.649 ( P< 0.001), the change in the level of rehabilitation was -1.053 ( P< 0.001), and the change in the level of traditional Chinese medicine was 2.781 ( P< 0.001). The immediate level and trend change of the proportion of consumables after the reform was not obvious. Conclusions:After the implementation of DIP payment in Zhuhai, the average expense of inpatients has not changed significantly, but the expense structure has changed significantly.
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OBJECTIVE: To analyze the utilization of hospital service and its related influencing factors among patients with occupational pneumoconiosis. METHODS: A total of 178 patients with occupational pneumoconiosis were selected as the study subjects using the convenience sampling method. The utilization of hospital service and health-related quality of life of patients with pneumoconiosis and its complications were investigated using the Questionnaire on Pneumoconiosis Patients′ Medical Consultation Behavior and its Influencing Factors and the European Quality of Life Inventory.RESULTS: The one-year hospitalization rate of patients with pneumoconiosis was 57.3%(102/178), and 88.2% of the patients were hospitalized once a year. The median number of hospitalization time in a year was 20.0 days. Visual health scale(VAS) score was(58±15) points. The multiple logistic regression analysis results showed that the utilization of hospital service among patients with employment injury insurance and fund reimbursement provided by the local governmentwere higher than those without employment injury insurancea nd without fund reimbursement provided by the local government(all P<0.05). The utilization of hospital service of patients with problems in usual activities and those unable to perform usual activities were higher than those without any problems(P<0.05). The utilization hospital service of patients with VAS scores <60 was higher than those with VAS scores of 60-<75(P<0.05). CONCLUSION: The patients with pneumoconiosis have a relatively overall high level of utilization of hospital service. The employment injury insurance, fund reimbursement provided by the local government, VAS score, and status of physical health are important influencing factors of utilization of hospital service.
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【Objective】 To discuss the influence of direct reimbursement of blood expenses in hospitals on the recruitment of blood donors in Xianyang City. 【Methods】 Blood donors or reimbursers, who reimbursed blood expenses either at hospitals or at our blood center were investigated, and these two kinds of blood expense reimbursements were compared in terms of convenience, the impact on the enthusiasm of blood donation, as well as the impact of the awareness of hospital reimbursement on the recruitment of blood donors. 【Results】 The direct reimbursement of blood expenses at hospitals took 22 minutes per person, without any round trips nor transportation costs. The rate of satisfaction, long-term intention to blood donation, and voluntary mobilization of others were 98.11%, 91.89%, and 82.56%, respectively, higher than those in the reimbursers at blood station(P<0.01). 35.16%, 38.90%, 98.56%, 94.24% and 93.37% of the blood donors, who were aware of benefits of hospital reimbursement, had donated for 2~3 times, donated more than 3 times, satisfied with the way of reimbursement, intended to redonate and mobilize others, which were higher than those who were unaware of the the hospital reimbursement(P<0.05). 【Conclusion】 Direct reimbursement of blood expenses at hospitals not only improved the convenience, but also increased the enthusiasm of blood donors by improving their satisfaction, which was conductive to blood donation recruitment.
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Objective To understand the status of economic burden of maternal health care of pregnant women in China, and to discuss the equity and accessibility of maternal health care during pregnancy among different regions and populations. Methods A total of 9 193 women during early pregnancy were recruited from the Chinese Pregnant Women Cohort Study between July 25, 2017 and November 26, 2018. Information on general condition and economic burden of maternal health care was surveyed. SPSS 25.0 software was used for statistical analysis. Results The median direct medical cost of maternity check-ups for pregnant women was 400 CNY per visit, and the median cost of lost work was 360 CNY per visit. The analysis of the results showed that the median medical expense was highest in pre-pregnant women with BMI 2 (P=0.008). The median medical expense was higher in urban residents than rural residents (Ptrend=0.003). The higher the socioeconomic status was, the higher the direct medical expense was (Ptrend=0.003). The cost of lost work was lower in pregnant women with higher socioeconomic status (P=0.025, Ptrend=0.017). In addition, the medical expense was highest in women living in the eastern part of China (P<0.001). The direct medical expenses (P=0.002) and lost-time expenses of pregnant women in the North were higher than those in the South (P=0.013). Conclusion The problem of equity and accessibility of maternal health care still existed. It is recommended that relevant departments further improve maternal health care services and build a diversified healthcare service system to ensure maternal and child health and promote eugenics.
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Objective:To analyze internal composition of hospitalization expense for patients with cerebral infarction. Methods:Data of hospitalization expenses from patients with cerebral infarction discharged from 2014 to 2018 were collected, and analyzed with grey correlation and degree of structural variation. Results:The costs for rehabilitation treatment, medicines and consumables mainly contributed to structural variation, accumulated to 74.63%. The costs for rehabilitation treatment (0.982), medicine (0.979), imaging (0.978) and laboratory tests (0.972) were the most relative to the average expense of hospitalization. Conclusion:It is preliminarily successful for cost control, and needs further impove to respond the contribution of professionals.
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ANTECEDENTES Y OBJETIVOS El sobrepeso comprende un problema de salud a nivel global. Al mirar las tendencias en la población infantil, el último reporte de salud pública de la Organización para la Cooperación y el Desarrollo Económicos sobre el país, estima que casi un 45% de los niños y niñas chilenos tienen obesidad o sobrepeso, lo que supera al 25% promedio que presentan los países miembros. El presente informe tiene como objetivo evaluar los cupones o vouchers para la compra de frutas y verduras en función de reducir la obesidad, y de esta manera informar a las autoridades sobre las distintas estrategias efectivas que abordan la obesidad infantil. METODOLOGÍA Se buscaron revisiones sistemáticas en las bases de datos Medline y Embase, utilizando Ovid, en marzo de 2019. Además, se construyó una matriz de evidencia en Epistemonikos con el objetivo de encontrar literatura adicional. Se utiliza la metodología de certeza de la evidencia GRADE. Se incluyen evaluaciones de cupones, vouchers, tarjetas de descuento para la compra de F&V, estudios que evalúan el efecto en cualquier tipo de población y contexto. Se excluyen artículos que utilizaran un diseño observacional, intervenciones que contemplaran reembolsos, transferencias o entregas directas de dinero a los usuarios, reducciones de precios al oferente o proveedor y la entrega gratuita de alimentos RESULTADOS -Se recuperaron 9 revisiones sistemáticas, de las cuales se obtienen los siguientes resultados -Es incierto si la entrega de vouchers aumentaría el consumo diario de frutas. La certeza en la evidencia es muy baja. -La entrega de vouchers podría aumentar el porcentaje de personas que compran frutas y verduras en el mercado. La certeza en la evidencia es baja.
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Vegetables/supply & distribution , Food Assistance , Diet, Healthy , Fruit/supply & distribution , Access to Healthy Foods , Chile , Financing, GovernmentABSTRACT
OBJECTIVE: To study direct medical expense and its influential factors, and to provide empirical reference for medical expenses control of pulmonary embolism and the adjustment of anticoagulant drug reimbursement strategy. METHODS: Based on the national urban basic medical insurance data in 2014, the data of patients with pulmonary embolism were extracted by equidistant sampling method to form a sample database. According to related therapy information and expense information of pulmonary embolism patients in sample database, descriptive analysis was performed for demographic characteristics of patients (including gender, age, type of medical insurance, region, type of medical institution, etc.), direct medical expenses and direct medical expenses of patients with different anticoagulants, etc. Multiple linear regression analysis was used to analyze potential influential factors for the medical expenses of patients. RESULTS: A total of 475 pulmonary embolism patients were included, a total of 1 090 visits were recorded, and the average length of stay was 12.37 days. The annual medical expense per capita of patients was 10 847.42 yuan (median was 4 113.00 yuan), hospitalization expense per capita was 19 056.30 yuan (median was 13 042.86 yuan), and outpatient expense per capita was 1 049.61 yuan (median was 418.70 yuan). Results of subgroup analysis showed that annual medical expense in eastern, central and western cities were 9 203.54, 16 931.99 and 15 891.21 yuan. Per capita annual medical expenses of patients in tertiary hospitals were the highest (11 733.40 yuan), followed by secondary hospitals, and the lowest was other medical related institutions. Among different anticoagulants treatment groups, the annual medical expense per capita (24 553.80 yuan) and annual drug expense per capita (12 088.96 yuan) were the highest in anticoagulant regimen of combined use of LMWH and UFH, while patients treated with warfarin alone had the lowest annual medical expense per capia (2 350.24 yuan) and annual drug expense per capita (1 163.67 yuan). The multiple linear regression showed that the factors affecting medical expense per visit were type of patient (inpatient or outpatient),type of medical institution and type of complications. CONCLUSIONS: Direct medical expense per capita of patients with pulmonary embolism is still high, and the economic burden of disease is still heavy. Patients with pulmonary embolism treated with combination of LMWH and UFH had the highest medical expense per capita. The types of visit, types of medical institutions and complications can influence medical expense of patients significantly.
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Objective: To investigate and analyze the performance of informed consent of self-expense medical expenses by medical staff. Methods: By using stratified random method, a sample of 480 medical records of medical insurance patients was selected from 40 wards of a third class A hospital in Zhejiang province in 2016. Combined with semi-open questionnaire, the performance of medical staff was investigated to do informed consent of self-expense medical expenses. Results: In general, the rate of informed consent was low, and only the rate of informing bed fee was over 70%. Medical staff thought that the effective performance of informed consent was affected by many factors, such as subjective and objective factors. Conclusion: There are still some problems in the performance of informed consent of self-expense medical expenses. It is necessary to take multi-party linkage and multi-measures interventions to improve the rate of informed consent.
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Objective To explore the utilization of the basic medical insurance and the influence of age factors on the medical expenses of the retirees. Methods Descriptive statistics and variance analysis were used to analysis the 265 426 medical service use records of the retirees in Y city in 2016. Results Increase of age pushes up the utilization rate of retirees for hospitalization services and reduces the service utilization of chronic disease outpatient clinics. In total, the medical expenses are concentrated in the age of 60-70, and the total medical cost of the population decreases with age. The per-capita medical expenses of different age groups were different, the greater the age the higher the average.Conclusions The change of the disease spectrum such as higher incidence of chronic diseases poses a new challenge to the medical service system. Aging will continue to pressurize the medical security system. It is urgent to establish a healthcare system centering on the elderly and a sound medical insurance system.
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OBJECTIVE: The aims of this study were to develop a mobile app-based clinical decision support system (CDSS) for implementation of Korean clinical imaging guidelines (K-CIGs) and to assess future developments therein. MATERIALS AND METHODS: K-CIGs were implemented in the form of a web-based application (http://cdss.or.kr/). The app containing K-CIGs consists of 53 information databases, including 10 medical subspecialties and 119 guidelines, developed by the Korean Society of Radiology (KSR) between 2015 and 2017. An email survey consisting of 18 questions on the implementation of K-CIGs and the mobile app-based CDSS was distributed to 43 members of the guideline working group (expert members of the KSR and Korean Academy of Oral and Maxillofacial Radiology) and 23 members of the consultant group (clinical experts belonging to related medical societies) to gauge opinion on the future developmental direction of K-CIGs. RESULTS: The web-based mobile app can be downloaded from the Google Play Store. Detailed information on the grade of recommendation, evidence level, and radiation dose for each imaging modality in the K-CIGs can be accessed via the home page and side menus. In total, 32 of the 66 experts contacted completed the survey (response rate, 45%). Twenty-four of the 32 respondents were from the working group and eight were from the consulting group. Most (93.8%) of the respondents agreed on the need for ongoing development and implementation of K-CIGs. CONCLUSION: This study describes the mobile app-based CDSS designed for implementation of K-CIGs in Korea. The results will allow physicians to have easy access to the K-CIGs and encourage appropriate use of imaging modalities.
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Humans , Consultants , Decision Support Systems, Clinical , Electronic Mail , Korea , Mobile Applications , Surveys and QuestionnairesABSTRACT
Objective To analyze the demographic information and related costs of inpatients with chronic kidney disease (CKD) in a tertiary referral hospital in Shanghai from 2011 to 2016, so as to provide reference for further understanding and improving the current situation of medical treatment of patients with CKD in Shanghai. Methods We retrospectively reviewed the clinical data (age, gender, hospital stay, disease diagnosis, hospitalization expenses and so on) of inpatients with CKD in a tertiary referral hospital in Shanghai from 2011 to 2016. The general characteristics and disease diagnosis of the inpatients with CKD were statistically analyzed by calculating the proportion of each index using a simple statistical description method. The treatment, hospitalization expenses of the inpatients with CKD were compared between different groups by variance analysis and non-parametric test. Results The percent of inpatients from Jiangsu, Zhejiang, Anhui and Jiangxi provinces around Shanghai was 49.97% (10 033/20 079), surpassing that of inpatients from Shanghai (38.78%, 7 787/20 079). The proportion of inpatients with chronic renal failure was the highest (51.98%, 10 438/20 079), and more young people tended to suffer from the disease. The per capita hospitalization expense was increased annually, and the median hospitalization expense was 8 252.51 yuan in 2016. There were significant differences in per capita hospitalization expenses between the different year groups (P0.001). Conclusion Active and effective measures should be taken to deal with the problem of large numbers of nonlocal patients seeking medical services in Shanghai. It is necessary to popularize the knowledge about CKD in young people, and reduce the social and personal losses due to the illness. The economic burden caused by CKD needs to be further studied.