Out of Pocket Expenditure among Cancer Patients Availing Treatment at A Tertiary Care Centre in Hyderabad, India

Background: The expenses that the patient or the family pays directly to the health care provider, without a third-party (insurer or State) is known as 'Out of Pocket Expenditure' (OOPE). These expenses could be medi-cal and non-medical. About 150 million people face financial catastrophe every year due to health care pay-ments and cancer is one of the leading causes of high OOPE. Objectives: This study was conducted to estimate the OOPE among cancer patients and to determine the OOPE in relation to type of cancer and treatment modality.Methodology: A cross sectional study was conducted at a tertiary care centre in Hyderabad during August and September,2022 with a total study population of 400 cancer patients. After consenting the participants, data was collected via face-to-face interview using a semi structured questionnaire. Results: The mean OOPE per patient was found to be $1032.65 (₹84,643.20). This includes the medical and non-medical costs. Leukaemia was found to have the highest OOPE amongst all cancers followed by colon cancer. Similarly, radiotherapy + surgery was found to have the highest OOPE followed by chemotherapy + radiotherapy + surgery.Conclusion And Interpretation- This study is unique in its way that no other study has considered OOPE for different cancers in single research. We would like to highlight the quantification of OOPE among various types of cancers and its variation based on treatment modality used. It is necessary that future government in-itiatives consider the importance of mitigating the OOPE along with provision of cancer care.

Application value of ambulatory surgery mode for small and medium abdominal wall hernia repair / 中华消化外科杂志

Objective:To investigate the application value of ambulatory surgery mode for small and medium abdominal wall hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 33 patients with small and medium abdominal wall hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2019 to January 2021 were collected. There were 19 males and 14 females, aged 54(range, 26?85)years. Patients individually underwent Onlay repair, Sublay repair, intraperitoneal onlay mesh repair (IPOM)according to the diagnosis and treatment mode of ambulatory surgery. Observation indicators: catogaries of small and medium abdominal wall hernia, surgical methods, intraoperative measured diameter of hernia ring defect, operation time, volume of intraoperative blood loss, duration of hospital stay, delayed discharge of patients, hospitalization expenses, postoperative follow-up, complications, postoperative visual analogue scale of pain, chronic pain, postoperative satisfaction. Follow-up using telephone interview or outpatient examinations was conducted to detect hernia recurrence, surgical-related complications (wound infection, pain, hematoma or seroma, intestinal leakage, intestinal obstruction) and postoperative satisfaction at postoperative 3 days, 7 days, 1 month, 3 months, 6 months and 12 months. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and count data were represented as absolute numbers. Results:Of the 33 patients, 16 cases had umbilical hernia, 14 cases had incisional hernia, 3 cases had lumbar hernia. There were 7 patients treated with Onlay repair, 16 with Sublay repair, and 10 cases with IPOM. The intraoperative measured diameter of hernia ring defect, operation time and volume of intraoperative blood loss of 33 patients were 2.8(range, 1.0?6.0)cm, 51(range, 20?85)minutes, 4.3(range, 1.0?10.0)mL. The duration of hospital stay of 33 patients was 24?48 hours, including 25 cases with duration of hospital stay ≤24 hours, 8 cases with duration of hospital stay >24 hours and ≤48 hours. Of the 8 patients undergoing IPOM with delayed discharge, 5 cases had postoperative pain and 3 cases had dizziness, nausea and vomiting after general anesthesia. They were recovered and discharged from hospital after observation and symptomatic support until the next morning. The hospitalization expenses were 17 139(range, 6404?34 124)yuan. All the 33 patients were followed up regularly after operation. No hernia recur-rence, wound infection, hematoma and seroma, intestinal fistula or intestinal obstruction was observed during the follow-up period. From postoperative 3 days to 12 months, the visual analogue scale of pain was from 2.90±0.10 to 0 for patients with Onlay repair, from 3.10 ±0.10 to 0 for patients with Sublay repair, from 3.50 ±0.20 to 0 for patients with IPOM. No patient suffered from chronic pain after the operation and postoperative satisfaction of patients was 100%. Conclusion:The ambulatory surgery mode has safety and feasibility in small and medium abdominal wall hernia repair.

Analysis of the influence of age on average medical expenses under the diagnosis related group and prospective payment system model / 中华老年医学杂志

Objective:To study the influence of patients' ages on average medical expenses under the diagnosis related group and prospective payment system(DRG-PPS)model.Methods:Medical records of 52 987 selected patients at a third-tier general hospital in Beijing were collected from January 1 to December 31, 2019, and were then divided into three age groups based on age, the elderly group, the middle-aged group and the young group, and one-way ANOVA was used to determine differences in medical expenses between the same DRG group and different age groups.Related-sample nonparametric tests and linear regression were carried out for the three age groups to estimate the influence of the age factor on the medical expenses of different DRG groups.Results:First, the data of the three age groups in the same DRG group were analyzed by one-way ANOVA.The P values of the DRG groups were less than 0.05, except for the cb39 crystal surgery DRG group; Then, the data of the three age groups in different DRG groups were analyzed with the nonparametric test( P=0.021, less than 0.05); Finally, linear regression analysis was also used to analyze the case data of the three age groups.The p value was less than 0.05, and the standardized influence coefficient was 0.173, suggesting age was positively correlated with hospitalization expenses. Conclusions:Age affects average hospitalization expenses.After the implementation of the DRG-PPS model, the payment of DRG patients should be standardized with the inclusion of the age factor.

Estimating Economic Effects of Instituting a Refill Prescription System in Japan / 社会薬学

The refill-prescription system widely implemented overseas has been discussed toward its legislation for many years but has not been enforced yet in Japan. In considering introduction of such a refill-prescription system, numerical economic effects of its introduction can be expected in this paper. Based on the survey by Kurata at al. in 2016, the first and second groups were defined for patients with prescriptions of the same medicine more than twice for 14 days or more (20.2%) and for patients in the first group who were prescribed medication for more than 180 days and visited the pharmacy over 330 days (4.4%), respectively. The number of refill-prescriptions were estimated from the total number of the prescriptions put out in 2016. In the first group 166.7 million prescriptions were replaced by refill prescription, resulting in the reduction of medical and insurance expenses by 155.6 and 108.9 billion yens, respectively, while in the second group the reduction of 36.31 million prescriptions as well as 33.9 and 23.7 billion yens for those expenses, respectively, were expected. The monthly working time of overworking doctors with poor working environment was also calculated to be shortened by 6.1〜12.1 and 1.3〜2.6 hours for these two groups, respectively. Additionally, the introduction of the refill-prescription system was estimated to reduce the physical burden of one patient by 2.7〜5.3 hours per year for consultation and waiting hours in the medical institutions. Therefore, the refill-prescription system is thought to be useful for efficient allocation of medical resources to patients.

Pérdida de calidad de vida y carga económica causada por dengue desde la perspectiva de pacientes y sus familiares / Loss of quality of life and economic burden caused by dengue fever from the perspective of patients and their families

Introducción: En Cuba hay pocos datos disponibles sobre la pérdida de calidad de vida relacionada con la salud y la carga económica para los pacientes de dengue y sus familiares. Objetivo: Describir la pérdida de calidad de vida relacionada con la salud y la carga económica del dengue para los pacientes y sus familiares. Métodos: Se aplicó un cuestionario a 92 pacientes adultos confirmados de dengue y hospitalizados en el Hospital Clínico Quirúrgico Docente Ambrosio Grillo de Santiago de Cuba, entre enero y octubre 2015; también se les aplicó a sus familias. Se calculó la pérdida promedio de calidad de vida a través de una escala analógica (0-100) y de los costos no médicos directos (gastos de bolsillo) e indirectos por paciente. Resultados: la pérdida global de calidad de vida fue de 67,9 por ciento en el peor momento de la enfermedad. El promedio de días autopercibidos hasta la recuperación fue 13,1. El promedio de visitas por paciente a los servicios ambulatorios antes de la hospitalización fue 1,3, y el policlínico resultó el servicio más utilizado. La estadía hospitalaria promedio fue 3,96 noches. Ningún enfermo presentó dengue grave. Los costos no médicos directos para los pacientes y sus familiares, fueron 7,95 USD (CUC). El 44,7 por ciento fue utilizado en transporte y 32,0 por ciento en alimentación, financiados principalmente con los ahorros personales y donaciones de familiares y amigos. Los costos indirectos promedio fueron 4,10 USD (CUC). Conclusión: Hubo una sustancial pérdida de calidad de vida durante la enfermedad. Los costos no médicos directos y los indirectos para los pacientes y familiares fueron bajos. La carga económica asumida por el gobierno es 12 veces mayor que estos(AU)

Introduction: Few data are available in Cuba about the loss of health-related quality of life and the economic burden caused by dengue fever to patients and their families. Objective: Describe the loss of health-related quality of life and the economic burden caused by dengue fever to patients and their families in Santiago de Cuba. Method: A questionnaire was applied to 92 adult patients with confirmed dengue fever admitted to Ambrosio Grillo Clinical Surgical University Hospital in Santiago de Cuba from January to October 2015. The questionnaire was also applied to their relatives. An analog scale (0-100) was used to estimate average loss of quality of life as well as indirect and direct non-medical costs expenses incurred by patients. Results: Global loss of quality of life was 67.9 percent at the worst stage of the condition. Average self-perceived days until recovery were 13.1. Average visits to outpatient services per patient before hospitalization were 1.3. The polyclinic was the most commonly used service. Average hospital stay was 3.96 nights. No patient had severe dengue fever. Direct non-medical expenses incurred by patients and their families were USD 7.95 (CUC), 44.7 percent of which were spent on transportation and 32.0 percent on food. These were mainly covered by personal savings and donations from relatives and friends. Average indirect expenses were USD 4.10 (CUC). Conclusion: There was considerable loss of quality of life during the disease. Patients and their families incurred low non-medical direct and indirect expenses. The economic burden undertaken by the government is 12 times as high(AU)

Research on the relationship between supply structure of health resources and growth of medical expenses in medical institutions from supply perspective: based on data from Fujian province / 中华医院管理杂志

Objective To compare such supply structure differences of health resources as number of beds and manpower at medical institutions of different types,and to analyze the extent and direction of the health resources supply in affecting the growth of medical expenses.Methods Clustering analysis was used to cluster health resources indicators in Fujian province.The hierarchical regression model was used to estimate the impact of such factors as population,social economy and health resource supply structure on medical cost growth.All the sample data were logarithmically processed to eliminate the influence of different index measurement units on the analysis results.Results The clustering indicators of health resources were classified into two categories:basic and quality health resources indicators.The per capita GDP had a positive impact on the per capita total hospital expenses (β =0.228,P ＜ 0.05),and the number of basic beds had a negative impact on the per capita total hospital expenses (β =-0.719,P ＜ 0.001).The increase in basic bed allocation had a significant effect on reducing the total cost of hospitalization per capita,but the regression results of quality health resources were generally not significant.Conclusions From the perspective of supply-side reform policy,the supply structure of health resources should be in line with the growth level of medical expenses,and the control of medical expenses should be strengthened.The government should strengthen the pertinence in the selection and target of health resource investment to ensure the sustainable and healthy development of health care.

Research on the relationship between supply structure of health resources and growth of medical expenses in medical institutions from supply perspective: based on data from Fujian province / 中华医院管理杂志

Objective@#To compare such supply structure differences of health resources as number of beds and manpower at medical institutions of different types, and to analyze the extent and direction of the health resources supply in affecting the growth of medical expenses.@*Methods@#Clustering analysis was used to cluster health resources indicators in Fujian province. The hierarchical regression model was used to estimate the impact of such factors as population, social economy and health resource supply structure on medical cost growth. All the sample data were logarithmically processed to eliminate the influence of different index measurement units on the analysis results.@*Results@#The clustering indicators of health resources were classified into two categories: basic and quality health resources indicators. The per capita GDP had a positive impact on the per capita total hospital expenses(β=0.228, P<0.05), and the number of basic beds had a negative impact on the per capita total hospital expenses(β=-0.719, P<0.001). The increase in basic bed allocation had a significant effect on reducing the total cost of hospitalization per capita, but the regression results of quality health resources were generally not significant.@*Conclusions@#From the perspective of supply-side reform policy, the supply structure of health resources should be in line with the growth level of medical expenses, and the control of medical expenses should be strengthened. The government should strengthen the pertinence in the selection and target of health resource investment to ensure the sustainable and healthy development of health care.

A multicenter survey on changes in nutritional risk and malnutrition incidence of elderly patients in Chinese large hospitals during hospitalization / 中华临床营养杂志

Objective To investigate the change of the nutritional status of elderly patients in Chinese major hospitals dynamically with nutritional risk screening 2002 (NRS 2002) and subjective global assessment (SGA) during hospitalization.Methods A prospective,multi-center survey was conducted on over 65 years old patients who were admitted in departments of gastroenterology,respiratory medicine,general surgery,geriatrics,thoracic surgery,neurology,orthopedics and medical oncology of 9 large hospitals in China for 7-30 days between June 2014 and September 2014.On admission and within 24 hours after discharge,the clinical data were recorded,physical indices were measured,and laboratory examination were conducted.NRS 2002 and SGA were used to make an evaluation.The nutritional supports and clinical outcomes were also recorded and then the correlation between nutritional status and clinical outcomes were analyzed.Results A total of 2558 patients above 65 years old were included into the study.Compared with their status on admission,their grip strength,upper arm circumference and crural circumference were reduced significantly at discharge (P＜0.05).The total protein,albumin and hemoglobin levels were significantly lower than those on admission (P＜0.05).The incidence of nutritional risk (NRS 2002 score ≥ 3) and malnutrition (SGA B + C) on admission were lower than those at discharge (51.1％ vs 53.0％,32.6％ vs 35.6％).The hospitalization time and medical expenses were higher in patients with malnutrition on admission than in those with normal nutrition intakes.The nutritional status at discharge was negatively correlated with hospitalization time and medical expenses.61.3％ patients having nutritional risk did not take nutritional support during the hospital stay,while utilization rate of parenteral nutrition was higher than that of enteral nutrition in patients receiving nutritional support (19.6％ vs 11.9％).Conclusion Elderly patients have higher possibilities of facing nutritional risk or malnutrition on admission,these are associated with poor clinical outcomes and their nutritional status will not improve significantly at discharge.Therefore,the screening and evaluation of nutritional status in elderly patients during hospitalization should be conducted and their nutritional intervention should be standardized so as to improve the clinical outcomes.

Direct medical expenses and its influencing factors of patients with pulmonary tuberculosis in Wuhan / 中华疾病控制杂志

Objective To analyze the direct medical expenses and its influencing factors of patients with pulmonary tuberculosis (TB) from 2011 to 2018 in Wuhan, so as to provide references for improving the TB derating policy. Methods A total of 1 258 953 medical records were studied, the direct medical expenses and its influencing factors were analyzed by rank sum test, multivariable linear regression and generalized estimated equation. Results The average direct medical expense of TB outpatients was 147.51 yuan each time, while that of TB inpatients was 8 849.57 yuan; and the average direct medical expenses of each year was 9 607.01 yuan per person. The average reimbursement ratio for TB outpatients was 6.36%, and 67.56% for inpatients. Analysis on the influencing factors showed that the direct medical expenses were related with patients’ age, sex, year, health care insurance, medical institution and whether they had surgery and Chinese traditional medicine or not (all P<0.01). Conclusions The current direct medical expenses of TB inpatients are relatively affordable, but low-income patients and patients still have heavy financial burden. TB treatment cycle is long and the outpatient medical service B also safficient. Improved derating policy is in need.

Factors Affecting Dental Utilization and Dental Expenses in the Economically Active Population: Based on the 2010~2014 Korea Health Panel Data / 치위생과학회지

BACKGROUND: The health of the economically active population contributes to increased corporate productivity by reducing the productivity loss caused by disease and increasing job efficiency, which in turn is a national benefit. Since the economically active population is a concept encompassing workers and a source of economic development for a country, that population's health should be treated with importance not only from a personal standpoint but also at a national level. METHODS: In this study, data of 11,007 adults aged 20 years and older who participate in economic activities were analyzed in the five-year Korea Health Panel Study from 2010 to 2014 including the number of dental visits and dental medical expenses. RESULTS: Factors related to “gender,” “education level,” “age,” “duty category,” “income level,” “employment type,” “national health insurance,” and “chronic disease status” of the economically active population are affected in relation to the number of visits and dental medical expenses. The number of dental visits increased with higher education levels (p<0.001), and the number of visits to the dentist increased with older age (p <0.001). Dental medical expenses were 91,806 Korean won (KRW) more for “white-collar workers” than for “blue-collar workers” (p<0.03), and 127,674 KRW more for “regular workers” than for “atypical workers” (p<0.02). CONCLUSION: When it is necessary to improve policies to enhance the efficiency of the distribution of health and medical resources in the overall balance of the dental health sector, we should try to identify various factors of oral health disorder due to income inequality among the classes according to the country's employment type in order to find ways to reduce the health gap among the social classes.

Practices of a hospital to control of medical expenses / 中华医院管理杂志

Measures have been taken by the hospital to control drug expense proportion and consumables expense proportion, in addition to such actions as ceiling pricing for individual diseases, clinical pathways and better incentive mechanisms. All these measures help to curb unreasonable growth of medical expenses, and ease patients' burden. The study proves that the goal of expense control set in the healthcare reform can be achieved by setting multiple control indexes, strengthening pharmaceutical affairs management, normalizing procedure of consumables circulation, reforming the compensation incentive mechanism, giving the best play of cost control role of medical insurance, and introducing new technologies or programs.

Early Experiences with Ultra-Fast-Track Extubation after Surgery for Congenital Heart Disease at a Single Center

BACKGROUND: Early extubation after cardiovascular surgery has some clinical advantages, including reduced hospitalization costs. Herein, we review the results of ultra-fast-track (UFT) extubation, which refers to extubation performed on the operating table just after the operation, or within 1–2 hours after surgery, in patients with congenital cardiac disease. METHODS: We performed UFT extubation in patients (n=72) with a relatively simple congenital cardiac defect or who underwent a simple operation starting in September 2016. To evaluate the feasibility and effectiveness of our recently introduced UFT extubation strategy, we retrospectively reviewed 195 patients who underwent similar operations for similar diseases from September 2015 to September 2017, including the 1-year periods immediately before and after the introduction of the UFT extubation protocol. Propensity scores were used to assess the effects of UFT extubation on length of stay (LOS) in the intensive care unit (ICU), hospital LOS, and medical costs. RESULTS: After propensity-score matching using logistic regression analysis, 47 patients were matched in each group. The mean ICU LOS (16.3±28.6 [UFT] vs. 28.0±16.8 [non-UFT] hours, p=0.018) was significantly shorter in the UFT group. The total medical costs (182.6±3.5 [UFT] vs. 187.1±55.6 [non-UFT] ×100,000 Korean won [KRW], p=0.639) and hospital stay expenses (48.3±13.6 [UFT] vs. 54.8±29.0 [non-UFT] ×100,000 KRW, p=0.164) did not significantly differ between the groups. CONCLUSION: UFT extubation decreased the ICU LOS and mechanical ventilation time, but was not associated with postoperative hospital LOS or medical expenses in patients with simple congenital cardiac disease.

Study on the Occurrence of Accrued Receivables Related to Medical Expenses - Initial Analysis Using Accrued Receivable Data of Matsue Seikyo General Hospital - / 日本プライマリ・ケア連合学会誌

Objectives: The purpose of this study was to examine the occurrence of accrued receivables by types of medical insurance to clarify those responsible for the accrued receivables related to medical expenses.Methods: Using accrued receivable data for FY2016 (for practices from April 2016 to March 2017) obtained from Matsue Seikyo General Hospital, quantitative analysis was carried out for the occurrence of accrued receivables by hospital visiting patterns and insurance types.Results: The incidence rate of accrued receivables among all consultations at the hospital was 1.06%. The incidence rate was the lowest for patients with Union Health Insurance. On the other hand, the incidence rate of accrued receivables among patients with health insurance administered by the Japan Health Insurance Association, which is another employment-based health insurance, was three-times higher than that of those with Union Health Insurance, and higher than those with National Health Insurance or Advanced Elderly Medical Service. The incidence rate of public assistance was the highest at Seikyo General Hospital, including hospital admission; it was characterized by a high incidence of accrued receivables for expenses for diapers and hospital gowns during hospitalization.Conclusion: To mitigate this issue, cooperation of hospital staff was suggested to be important.

Key Issues on Long-Term Care Hospitals in Korea / 보건행정학회지

This study reviews the advent of long-term care (LTC) hospitals and its key issues in Korea. For analysis, enforcement ordinances and enforcement rules related to LTC hospitals were reviewed. Official statistic data were used for quantitative analysis and Organization for Economic Cooperation and Development data were utilized for comparative analysis. Various references and expert interviews were conducted for status analysis. As of 2016, the number of LTC hospitals was 1,386 and the number of beds were 246,373. It showed the trend of increasing medical care costs and the cost of care at LTC hospitals increasing from 998.8 billion Korean won in 2008 to 4,745.6 billion Korean won in 2016, accounting for 7.3% of the total National Health Insurance expenditure. From the societal perspective, several issues were pointed out within the current health care system related to LTC hospitals: establishment of roles, concerns about the increase in medical expenses, and the quality of medical personnel.

Economic burden among cardiovascular patients of middle-aged and elderly: An empirical analysis based on China Health and Retirement Longitudinal Survey data / 中国卫生政策研究

Objectives: China has observed an increasing prevalence of cardiovascular diseases among its population, which is putting heavy economic burden both on individuals and the whole society.Conducting a multi-angle study of cardiovascular patients with economic burden can help adjust the health care policy to reduce the economic burden of patients.Methods: Using the baseline data (2011) and follow-up data (2013) of the China Health and Retirement Longitudinal Survey, this study selected cardiovascular patients aged 45 and above to calculate their direct medical cost, direct non-medical cost as well as self-paid cost before and after reimbursement.The total cost and self-paid cost are both calculated, and gender difference and rural-urban difference are also analyzed.Results: The prevalence of cardiovascular disease among the population age 45 and above was 13.9% in 2013 and 12.1% in 2011, while the prevalence in women was higher than in men and urban areas higher than rural areas.The average annual total costs for individual patient before reimbursement in 2013 was lower than that in 2011, but contrary to the trend of self-pay costs.Urban patients had higher amount of direct medical cost, lower co-payment rate and lower non-medical cost such as transportation and accommodation than their rural counterpart.Both urban and rural patients self-paid more on outpatient services than inpatient services.Conclusion: Based on these analyses, this paper suggests that Chinese policy makers should look deeper into patient behaviors as well as their economic burden before revising the current health policy.More practices regarding to the unbalanced distribution of health resources between urban and rural areas are needed, in order to ensure patients living in remote areas could get access to appropriate treatment without paying heavy non-medical cost.

Rural chronic disease patient treatment flow and cost based on intervention study in Jiangsu Province / 中国卫生政策研究

Objective:To analyze the situation of seeking medical treatment and assess the impact of interven-tion on rural chronic disease patients.A comprehensive intervention strategy was developed and implemented in rural area of Jiangsu province.Methods:According to the implementation plan,a random sampling method was adopted in Gaochun,Jingjiang and Huaiyin districts of Jingsu province to select a total of 4 261 people to be surveyed on the baseline,with 2116 people were in the intervened group and 2 145 in the controlled group,which was conducted for one year.The changes of flow tendency,times and expenses of seeking medical treatment before and after the inter-vention were analyzed.Results:After intervention,patients with chronic disease choosing primary health institutions for medical treatment has obviously improved, which was observed to be significant when compared with the con-trolled group.The average times of seeking medical treatment in primary health institutions is exceeding 10 times and which is significantly higher than before the intervention and the controlled group.After the intervention, patients, medical expenses reduced,which is significantly lower than that of the controlled group.Conclusions: Through one year of intervention,more and more patients with chronic diseases were choosing primary health institutions for medi-cal treatment.But the medical expenses have not yet achieved good control.So the support of national policy to fur-ther standardize the patients,behavior of seeking medical treatment is still needed.

The Crowing-out Effect of Childcare Burden on Medical Expenses for the Elderly: Evidence from China Family Panel Studies(CFPS) / 中国卫生经济

Objective:To explore the impact of childcare burden on satisfaction level of the elderly medical demand in family,in order to provide the basis for policy making to realize healthy aging.Methods:Based on CFPS(China family panel studies) data,using OLS and quantile regression to conduct quantitatively study on the impact of children's dependency ratio on medical expenses for the elderly.Results:The estimates of children's dependency ratio's coefficients were significantly negative,while their absolute values presented a tendency of increasing with the increase of quantile.It showed that the crowding-out effect of childcare burden on medical expenses for the elderly was in existence.The higher medical expensed,the stronger the crowding-out effected.Conclusion:Childcare burden impacted the satisfaction level of the elderly medical demand,especially for the elderly often sick or suffering from a serious illness,whose medical demand would be even greater.

Analysis and corresponding strategy of emergency patients forgoing the invasive rescue therapy / 中华急诊医学杂志

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.

The investigation and analysis ondiarrhea incidence and treatment behavior in Tianjin community / 天津医药

Objective To investigate the symptoms of diarrhea and the behavior of medical treatment after diarrhea in 2013 in Tianjin City, and provid background information for the future population monitoring. Methods A stratified sam?pling method was used to investigate the symptoms, medical treatment and self medication behavior of 4028 residents in Tianjin. Results The number of people who had diarrhea in 2013 was 324, and the incidence rate of diarrhea was 8.04%. Diarrhea was mainly occurred in May-October (n=241, 74.38%). The incidence of diarrhea was the highest in 60-74 years old group, followed by 75-years old and 0-14 years old groups. The incidence of diarrhea was the lowest in 15-29 years old grouop. A total of 121 patients with diarrhea chose to go to hospital (47.08%), 78 patients chose to buy medicine for treat?ment (30.35%) and 58 patients did not do any disposal (22.57%). Among the patients with diarrhea, the highest proportion of patients chose to go to the first grade and the following medical institutions (68.59%, 83/121). There were 14.05%(17/121) and 17.36%(21/121) patients chose to go to the second and the third levels of medical institutions for the treatment. The av?erage cost for patients with diarrhea was 60 (20, 200) yuan. The purchasing expenditure median was 20 (11,50) yuan. The medical spending was more than the purchase of medicines (Z=2.412, P<0.05). The average cost of medical treatment was more higher in the second and the third levels of medical institutions than that of the first medical institution ( Z=50.709,P<0.05). The average cost of medical treatment was in turn increased for patients with diarrhea treated in Baodi county, Xiqing county, Hangu county and Heping county (Z=74.282,P<0.05). There was no statistical significance in medical expenses be?tween patients with different ages and patient with or without medical insurance. Conclusion There are high incidence of diarrhea in patients under 15 years old and patients over 60 years old. Residents suffering from diarrhea mainly choose their own medicine and the treatment in the first and following medical institutions.

A system dynamics model for study of military medical expenses in PLA hospitals / 军事医学

Objective To explore the application of a system dynamics(SD) model to military medical expenses in PLA hospitals.Methods According to relevant theories of SD, the study has selected some important variables and defined the primary function relations in order to establish a military medical expenses SD model.Results and Conclusion The SD model is suited to modeling the PLA medical expenses and can serve as a theoretical basis for the policy innovation of the PLA medical system.