Analysis of influencing factors of medical cost ratio of breast cancer cases treated with chemotherapy and molecular targeted therapy / 中华医院管理杂志

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.

Evaluation of the impact of clinical pathway on medical efficiency and medical expenses of patients with two rheumatoid immune disease based on DRG data / 中国医师杂志

Objective:To evaluate the effect of clinical pathway implementation on medical efficiency and medical expenses of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" diseases by using diagnosis related group (DRG) related indicators.Methods:The data of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" included in the clinical pathway management from January 2017 to December 2019 in the Department of Rheumatology and Immunology of Jinhua Hospital, Zhejiang University School of Medicine were carried out. The impact of clinical pathway implementation on the average hospital stay, average cost and average drug cost of patients with the two diseases were analyzed and compared , so as to evaluate the effect of the implementation of the clinical pathway.Results:From the implementation of clinical pathway in 2017 to 2019, the number of patients admitted and total medical specialty services in the two groups of " rheumatoid arthritis" and " ankylosing spondylitis" increased year by year ( P<0.01). The average length of stay, average cost and average drug cost of patients in the " rheumatoid arthritis" disease group decreased year by year, with statistically significant differences between groups (all P<0.01). The average length of stay in the ankylosing spondylitis group was shortened year by year, and the difference was statistically significant ( P<0.01). Compared with 2017, the average cost in 2018 decreased significantly, and the difference was statistically significant ( P<0.01). There was no significant difference in average cost between 2018 and 2019 ( P>0.05). The average cost in 2018 was significantly higher than that in 2017 ( P<0.05). After analyzing the causes and optimizing the clinical pathway, the average cost in 2019 was significantly lower than that in 2018 ( P<0.01). Conclusions:Through the implementation of clinical pathways and continuous optimization of pathway connotation during use, the diagnosis and treatment efficiency of patients with " rheumatoid arthritis" and " ankylosing spondylitis" can be significantly improved, and medical costs can be reduced, which is in line with the current medical reform needs.

Public health emergencies in schools and economic loss in Luoyang from 2010 to 2019 / 中国学校卫生

Objective@#To analyze public health emergencies in schools and associated economic loss in Luoyang from 2010 to 2019, and to provide suggestions for developing evaluation mechanism for economic loss of public health emergencies in school settings.@*Methods@#Data of public health emergencies in schools during 2010-2019 in Luoyang was analyzed by descriptive epidemiological method; the integrity and logicality of the economic losses reports in emergencies were assessed; the overall economic losses of emergent events of public health in schools were evaluated.@*Results@#Among the 60 public health emergencies reported during 2010 to 2019 in Luoyang, 24 (40.00%) occurred in schools. Infectious diseases accounted for 91.67%(22). The peaks of public health emergencies were in May and December. Among the 24 public health emergencies, 50.00%(12) occurred in primary schools, with 386 (58.22%) cases. Nearly 75.00% (18/24) of public health emergencies in schools were reported, among them, reports with reasonable integrity accounted for 5.56% (1/18) and reports with logicality accounted for 38.89% (7/18). The highest integrity rate was found in disease prevention and control system (75.00%), while health supervision and law enforcement ranked the lowest (20.83%). According to the economic losses, the expense used for disease control and prevention was in front of the row(￥429 000), while the expense used for health supervision ranked at the bottom(￥20 800).@*Conclusion@#The reporting rate of economic losses of school public health emergencies in Luoyang is relatively high, but there is still a big gap in the integrality and logicality of the data. It is necessary to improve the standard of direct network reports of economic losses and to establish an effective evaluation mechanism for accurately responding to public health emergencies and evaluating economic losses.

Research on economic burden and influencing factors of hand-foot-mouth disease in Xi’an, 2018 / 中国学校卫生

Objective@#To understand the economic burden caused by hand-foot-mouth disease (HFMD) in Xi’an, in order to provide scientific basis for government departments to allocate health resources rationally.@*Methods@#New cases of HFMD were selected randomly from designated hospitals in city and district level in Xi’an, 2018, Direct and indirect economic costs of patients caused by HFMD were collected using a questionnaire survey, hospital charging system inquiry as well as follow-up survey. Factors affecting the economic burden of HFMD were analyzed.@*Results@#A total of 438 mild as well as 60 severe cases were surveyed, with the overall medical insurance participation rate of 89.76%(447/498). The median of per capita direct economic burden of mild and severe cases were 635 and 7 972 yuan respectively, and the median of per capita indirect economic burden of mild and severe cases were 130 and 233 yuan respectively, in Xi’an. The overall economic burden attributable to HFMD was 23.1 million yuan in Xi’an 2018, in which the direct economic burden was 19.3 million yuan, indirect economic burden was 3.8 million yuan. Multiple Logistic regression analysis showed that the approach of diagnosis, type of cases, days of treatment and type of pathogen had significant influence on the economic burden of HFMD(P<0.05).@*Conclusion@#The economic burden of HFMD was heavy in Xi’an. Controling and reducing the incidence rate, as well as increasing the medical insurance coverage and reimbursement rate would lighten the economic burden caused by HFMD effectively.

Effect of partial rectal resection with transanal stapler in the treatment of rectum protrusion / 中国基层医药

Objective To investigate the clinical effect of transanal stapler partial rectal resection for rectocele.Methods From January 2012 to January 2018,90 patients with rectocele treated in Changzhi Traditional Chinese Medicine Hospital were divided into control group (45 cases) and observation group (45 cases) according to the operation method.The control group was treated with closed transrectal repair ,while the observation group was treated with partial rectal resection with anal stapler.The operative effect ,incidence of postoperative complications , recurrence rate,degree of pain after operation ,length of hospital stay and cost of treatment were compared between the two groups.Results The total effective rate of the two groups was 100.0%.The incidence of complications in the observation group was 2.2%(1／45),which was lower than that in the control group [17.8%(8／45)] (χ2 ＝4.444, P＝0.035).The recurrence rate in the observation group was 0(0／45),which was lower than that in the control group [13.3%(6／45)] (χ2 ＝4.464,P＝0.035).The hospitalization time in the observation group was shorter than that in the control group[(7.01 ±2.06)d vs.(11.31 ±2.42)d].Compared with the control group ,the treatment cost of the observation group was higher[(0.836 ±0.164)×104CNY vs.(0.605 ±0.136)×104CNY],and the post-operative pain score was lower [(4.24 ±1.33) vs.(6.45 ±1.17)] ( t＝9.076,7.273,8.369,all P＜0.001).Conclusion Transanal stapler partial rectal resection is effective in the treatment of rectocele , with less complications, lower recurrence rate and less pain after operation ,but the cost of treatment is higher.

Estimated economic burden of disease of Norovirus gastroenteritis of schools in the Pearl River Delta Region / 中国学校卫生

Objective@#This study aims to estimate the economic burden of disease of outbreak of norovirus gastroenteritis in the Pearl River Delta Region, and provide scientific evidence for the government’s decision-making and control measures.@*Methods@#Using a unified questionnaire, a survey was conducted to the schools and students’ families which had suffered an outbreak of norovirus gastroenteritis in the Pearl River Delta Region from October 2017 to April 2018.@*Results@#The survey found that the mean total economic burden of sick students was 720.41(95%UI=640.45-804.63)RMB. The mean economic burden of sick students who were inpatient, outpatient and self-treatment were 1 712.75(95%UI=328.50-34 00.00), 213.70(95%UI=191.83-236.33) and 58.97(95%UI=43.00-77.69)RMB, respectively. The mean economic burden of transport, extra tutoring and cost of lost labor were 53.63(95%UI=43.98-63.58), 558.49(95%UI=381.40-774.01) and 695.62(95UI=630.25-767.29)RMB. The mean total economic burden of health students was 382.62(95%UI=343.29-424.45)RMB. The mean total economic burden of school was 49 264.53(95%UI=22 363.38-79 976.25)RMB. The total economic burden of disease increases as the level of outbreak increases. The larger the epidemic level, the proportion of sick students’ financial burden gradually decreased, 56.58%,23.27% and 10.93%.@*Conclusion@#The high economic burden of disease of norovirus gastroenteritis in the Pearl River Delta Region, respectively, indicating that relevant departments should strengthen the prevention, control and education in order to mitigate the disease economic burden.

Discussion on Forensic Identification of the Rationality of Medical Expense / 法医学杂志

In cases on compensation for personal injury, the issue of medical expense compensation involves the vital interests of the compensation obligor, the injured party and the medical institution. The rationality of medical expenses is likely to be controversial, however, there is no unified standard and stipulation for the medical expense rationality identification in forensic clinical identification at present, therefore, in the practice of judicial expertise, expert opinions easily become confused, and the legitimate rights of the parties could be infringed, which affects the impartiality and authority of judicial expertise. This article starts with the concept of medical expense and the rationality of medical expense and the reasons for disputes over the rationality of medical expense, to put forward the basic principles that should be followed in the identification of rationality of medical expenses, for peer reference.

Effect of partial rectal resection with transanal stapler in the treatment of rectum protrusion / 中国基层医药

Objective@#To investigate the clinical effect of transanal stapler partial rectal resection for rectocele.@*Methods@#From January 2012 to January 2018, 90 patients with rectocele treated in Changzhi Traditional Chinese Medicine Hospital were divided into control group (45 cases) and observation group (45 cases) according to the operation method.The control group was treated with closed transrectal repair, while the observation group was treated with partial rectal resection with anal stapler.The operative effect, incidence of postoperative complications, recurrence rate, degree of pain after operation, length of hospital stay and cost of treatment were compared between the two groups.@*Results@#The total effective rate of the two groups was 100.0%.The incidence of complications in the observation group was 2.2%(1/45), which was lower than that in the control group [17.8%(8/45)] (χ2=4.444, P=0.035). The recurrence rate in the observation group was 0(0/45), which was lower than that in the control group [13.3%(6/45)] (χ2=4.464, P=0.035). The hospitalization time in the observation group was shorter than that in the control group[(7.01±2.06)d vs.(11.31±2.42)d]. Compared with the control group, the treatment cost of the observation group was higher[(0.836±0.164)×104CNY vs.(0.605±0.136)×104CNY], and the post-operative pain score was lower[(4.24±1.33) vs.(6.45±1.17)](t=9.076, 7.273, 8.369, all P<0.001).@*Conclusion@#Transanal stapler partial rectal resection is effective in the treatment of rectocele, with less complications, lower recurrence rate and less pain after operation, but the cost of treatment is higher.

A systematic review of the economic burden of influenza in China / 中华预防医学杂志

Objectives@#To understand the status of studies about influenza economic burden in mainland China and summarize their major results.@*Methods@#The words of influenza, flu, cost, economic, burden, effectiveness, benefit, utility, China, and Chinese, were used as search keywords. Journal papers published during 2000-2018 were searched from Chinese electronic databases (CNKI and Wanfang) and English electronic databases (PubMed, Web of science, EconLit and Cochrane Library). The language of literature was restricted to Chinese and English. A total of 23 effective documents were included, and the descriptive characteristics, research indexes and methods included in the literature were analyzed. The monetary unit used in this review is Chinese Yuan (CNY).@*Results@#The 23 study sites were mainly in the relatively developed and populous regions. The total cost per capita of laboratory-confirmed influenza,of all age-group was reported in 6 literatures, and only 4 literatures reported it in out-patients (range: 768.0-999.9 CNY), Only one study reported this indicator in inpatients (9 832.0 CNY). One literature reported the total cost per capita of influenza-like illness,, which was 205.1 CNY. And one literature reported that the direct medical cost of inpatients per capita in children under 5 years of age was 6 072.0 CNY while two literature reported this index for the elderly over 60 years of age, ranging from 14 250.0 to 19 349.1 CNY. Four articles reported the economic burden of influenza in urban and rural areas, one of which showed that the related expenses of urban influenza inpatients accounted for 31% of the average annual income, while which for the rural flow was 113%.@*Conclusion@#The average economic burden of lab-confirmed influenza case is higher than that of influenza-like illness, and there are differences in outpatient indirect expenses and inpatients direct medical expenses. The direct medical burden for the hospitalized 60-years-and-beyond influenza case group is heavier thar other age group. By region, the influenza associated individual economic burden in rural area is higher than that of urban area..

The comparison of difference and analysis of hospitalization expenses between patients with different ages with cerebral infarction / 中华老年医学杂志

Objective To compare the average hospitalization costs in cerebral infarction patients at different ages and analyze the causes.Methods Data of hospitalization expenses in cerebral infarction patients at different ages at our hospital from June 2013 to May 2018 were collected and analyzed by using SPSS18.0 software.The lengths of hospital stay and hospitalization costs were compared among patients at different ages.Results The average lengths of hospital stay were (11.5 ±6.2) d,(11.6±6.5) d and (12.5±9.4) d in the middle-aged,older age and advanced-age groups respectively(F=23.61,P =0.00).The hospitalization expenses were (11971.50± 12610.40) yuan,(12510.22±14075.46) yuan and (14765.59±19907.66) yuan and the medicine costs were (5401.66 ±5688.98) yuan,(5595.21±6152.13) yuan and (7184.69±9696.47) yuan in the middle-aged,older age and advanced-age groups respectively (F =34.12 and 73.52,P =0.00).The average drug proportion was 45.12％,44.73 ％ and 48.65 ％ in the middle-aged,older age and advanced-age groups respectively(x2 =19.03,P =-0.00).Hospitalization costs,drug costs and length of hospital stay were increased with aging.Conclusions Age significantly affects the total hospitalization costs and drug costs in hospitalized patients with cerebral infarction.Hospitalization expenses and drug charges are increased along with aging in cerebral infarction patients aged 45 years and older.

Medical charges and the cold reality of surgeons of Korea

Surgery is a very hands-on area of medical care, in that surgeons identify problems in patients' bodies and directly change them through operations. Therefore, it is not only necessary for surgeons to have a high level of expertise, but also to take considerable responsibility for the outcomes of each operation. However, surgery, which was once an object of envy, has long been a process to avoid, due to various circumstances, such as abnormal medical expenses in the medical field and social phenomena that avoids difficult work. It is unfortunate that medical professionals do not receive sympathy from others within the same medical field because of the general difficulties of the profession. The fundamental problem in this situation is the abnormal profit structure of the Korean medical system. Efforts by various related organizations will be needed to objectively evaluate the problems of the current medical insurance system and to make reasonable adjustments considering the difficulty, frequency, and resource-intensiveness of medical care.

Analysis of hospitalization costs among CHD patients undergoing PCI in a hospital of Anhui province during 2012-2016 / 心血管康复医学杂志

Objective:To analyze hospitalization cost of patients with coronary heart disease (CHD) undergoing per-cutaneous coronary intervention (PCI) in recent years and its influencing factors.Methods:Hospitalization cost data of CHD patients undergoing PCI in a hospital of Anhui province from 2012 to 2016 were collected.Changes of hos-pitalization costs and its influencing factors were statistically analyzed.Results:Number of hospitalized CHD pa-tients undergoing PCI gradually rose year by year.From 2012 to 2016,there was significant rise in mean examina-tion fee per time (except 2012 vs.2013),significant reductions in mean medicine fee per time,mean bed fee and other fees (except 2013 vs.2014 ) and mean hospitalization duration per time (except 2012 vs.2013,2014 vs.2015),P＜0.05 or ＜ 0.01.Patients with full public insurance possessed the highest mean hospitalization fee per time.Mean medicine fee per time of male group was significantly higher than that of female group [5368.66 (3831.01,7974.22) RMB vs.5045.16 (3721.97,7308.26) RMB],P＝0.019.Mean treatment fee per time of 50～70 years group was significantly higher than that of ≤50 years group [ (36351.63 (27925.86,47714.41) RMB vs.34622.20 (27296.66,46504.87) RMB],P＝0.024;compared with ≤50 years group and 50～70 years group,there were significant rise in all fees in ＞70 years group,P＜0.05 or ＜0.01.Compared with hospitalization ≤7d group,there were significant rise in all fees in 7～14d group and ＞14d group,and those of ＞14d group were signif-icantly higher than those of 7～14d group,P＝0.001 all.Multifactor linear regression analysis indicated that hospi-talization duration was independent risk factor for hospitalization fee of CHD patients undergoing PCI (β＝0.461,P＝0.001),while insurance way was its independent protective factor (β＝ -0.078,P＝0.001).Conclusion:Eco- nomic burden of CHD inpatients undergoing PCI is still heavy,we must improve theraputic effect,reduce hospital stays,in order to reduce patients′economic burden.

Comparison of the influence of putting T tube drainage or not on surgery effect of laparoscopic choledocho－lithotomy / 中国基层医药

Objective To compare the influence of putting T tube drainage or not on surgery effect of laparo －scopic choledocholithotomy .Methods From January 2014 to December 2017,76 patients with laparoscopic choledo－cholithiasis in the People's Hospital of Houma were selected in the research .All patients underwent laparoscopic choledocholithotomy.According to the random number table method,the patients were randomly divided into observation group(without T tube drainage ) and control group(with T tube drainage),with 38 cases in each group.The operation time,postoperative hospital stay ,anal exhaust time,hospitalization expenses ,bile leakage and postoperative satisfaction between the two groups were compared .Results There was no statistically significant difference in the operation time between the two groups(t＝0.39,P＞0.05).The hospitalization days,hospitalization expense and anus exhaust time in the observation group were significantly lower than those in the control group ( t＝12.54,5.05,11.32,all P＜0.01).The incidence rate of bile leakage of the observation group was 2.63%,which was significantly lower than 28.95%of the control group (χ2＝8.02,P ＝0.01).The postoperative satisfaction of the observation group was 97.37%,which was significantly higher than 63.16%of the control group(χ2＝11.96,P＜0.01).Conclusion The non－T tube drainage in laparoscopic choledochotomy can reduce the hospitalization time , hospitalization cost, incidence rate of postoperative bile leakage and improve the patients 'satisfaction.Therefore,it has good safety and feasibility,which is worthy of clinical application and promotion .

Duration of and fee for comprehensive assessment and care planning for patients with hypertension and/or diabetes in primary care

The enhanced primary care demonstration (EPD) was launched in November 2014 to provide high-quality care for people with chronic illnesses. In the EPD, comprehensive assessment and care planning (CAP) is a critical component, along with behavior modification and case management services. In this study, we measured CAP duration and calculated the fee for CAP sessions performed with patients with hypertension and/or diabetes mellitus. In 5 primary care clinics participating in the EPD, the duration of CAP sessions and usual consultations was measured. The duration of CAP sessions was measured on 2 separate occasions because CAP involves 2 separate consultations, including an initial consultation for comprehensive patient assessment and laboratory testing and a follow-up consultation for creating a care plan based on the assessment and test results. The CAP fee was calculated as the ratio of CAP time to the usual consultation time. The median (interquartile range) and the mean ± standard deviation of CAP duration were 15.4 (7.1) minutes and 15.6 ± 4.2 minutes, respectively. The first and second CAP sessions lasted for 5.3 and 4.6 times longer than usual consultations, respectively. The calculated CAP fees were 76,299 won (median) and 65,766 won (mean). The length of CAP sessions for patients with hypertension and/or diabetes mellitus was approximately 5 times longer than that of usual consultations. If consultation lengths were measured in a representative patient sample, it would be possible to improve the external validity of the measurements.

Duration of and fee for comprehensive assessment and care planning for patients with hypertension and/or diabetes in primary care

The enhanced primary care demonstration (EPD) was launched in November 2014 to provide high-quality care for people with chronic illnesses. In the EPD, comprehensive assessment and care planning (CAP) is a critical component, along with behavior modification and case management services. In this study, we measured CAP duration and calculated the fee for CAP sessions performed with patients with hypertension and/or diabetes mellitus. In 5 primary care clinics participating in the EPD, the duration of CAP sessions and usual consultations was measured. The duration of CAP sessions was measured on 2 separate occasions because CAP involves 2 separate consultations, including an initial consultation for comprehensive patient assessment and laboratory testing and a follow-up consultation for creating a care plan based on the assessment and test results. The CAP fee was calculated as the ratio of CAP time to the usual consultation time. The median (interquartile range) and the mean ± standard deviation of CAP duration were 15.4 (7.1) minutes and 15.6 ± 4.2 minutes, respectively. The first and second CAP sessions lasted for 5.3 and 4.6 times longer than usual consultations, respectively. The calculated CAP fees were 76,299 won (median) and 65,766 won (mean). The length of CAP sessions for patients with hypertension and/or diabetes mellitus was approximately 5 times longer than that of usual consultations. If consultation lengths were measured in a representative patient sample, it would be possible to improve the external validity of the measurements.

Cost-effectiveness analysis of selective intraoperative laparoscopic cholangiography in county level hospitals / 中华全科医师杂志

Objective To analyze the cost-effectiveness of selective intraoperative laparoscopic cholangiography (LIOC) in the county level hospitals.Methods The medical costs and cost-effectiveness of 60 patients undergoing LIOC (group A) during laparoscopic cholecystectomy (LC) in 2014 and 52 patients undergoing LC (group B) only in 2013 at 3 county level hospitals were analyzed.Results The direct medical care costs of group A were less than that of group B significantly [(9 072 ± 1 282) Yuan vs.(10 941 ± 4 064) Yuan,t =-3.38,P =0.001],there were no significant different in indirect medical care costs between group A and group B[(2 039 ± 1 020) vs.(2 100 ± 1 172) Yuan,t =0.24,P =0.810].The cure rate was 100％ in two groups;however,the cost per patient in group A was less than that in group B [(11 111 ± 2 348)vs.(13 041 ± 5 118)Yuan].The direct medical care cost of the patients who needed additional treatment in group A was significantly less than that in group B [(10 828 ± 1 101)vs.(16 533 ±1 733)Yuan,t =-11.45,P =0.000].There were no significant different in direct operational costs between group A (LIOC + LC) groups and group B (LC) [(8 378 ± 326) vs.(8 225-± 363) Yuan,t =1.96,P =0.054].Conclusions Selective LIOC is a cost-effective procedure and should be recommended in county level hospitals in which magnetic resonance cholangiopancreatography is not available.

Direct medical costs and influencing factors in severe hand, foot and mouth disease in children aged between six months and five years old / 中华预防医学杂志

Objective@#To estimate the direct medical cost of severe hand, foot and mouth disease (HFMD) in patients aged less than five years.@*Methods@#A stratified sampling method was used to collect data on severe HFMD cases reported in the National HFMD surveillance database between Jan 1, 2012, and Dec 31, 2013. The sampling was referenced with the national aetiologic distribution of Enterovirus A71 (EV-A71), Coxsackievirus A16 (CV-A16) and other Enteroviruses (OEV) for severe HFMD cases and the included cases were distributed among seven geographic regions (Northeast, North China, Northwest, Central China, Southwest, East China and South China). A nationwide telephone interview using a structured questionnaire was conducted to obtain the direct medical cost and any complications that occurred in patients during the outbreak of laboratory-confirmed HFMD. After excluding the cases who could not recall their medical expenses or complications, a total of 685 cases were included in the analysis. Kruskal-Wallis H test was used to analyze the differences among patients who reported different complications. Multiple linear regression with bootstrap analysis of 500 replicates was used to explore the factors that influenced the direct medical costs.@*Results@#Of 685 patients analyzed, 456 (66.6%) were male and 229 (33.4%) were female. The direct medical costs P50 (P25, P75) were 14 250 (10 301, 20 600) Yuan. In total, 127 (18.5%) patients were diagnosed with severe HFMD patients with respiratory disease, 38 (5.5%) patients were diagnosed with aseptic meningitis, and 378 (55.2%) with encephalitis/brainstem encephalitis/acute flaccid paralysis. Furthermore, 53 (18.5%) patients were diagnosed with myocarditis, 39 (5.7%) with pulmonary hemorrhage/pulmonary edema and 50 (7.3%) with cardiopulmonary failure. The median (interquartile range) direct medical costs were 12 360 (7 313, 16 480) Yuan for severe HFMD patients with respiratory disease, 13 803 (9 064, 19 930) Yuan for aseptic meningitis, 14 438 (11 000, 20 015) Yuan for encephalitis/brainstem encephalitis/acute flaccid paralysis, 14 800 (8 500, 21 218) Yuan for myocarditis, 20 600 (12 500, 31 130) Yuan for pulmonary hemorrhage/pulmonary edema, and 20 043 (12 772, 28 840) Yuan for cardiopulmonary failure (H=17.70, P<0.001). The results of multiple linear regression with bootstrap analysis revealed that the direct medical cost for severe HFMD patients from Central China was 7 881 (95% CI: 3 814-11 949) Yuan higher than that of North China; severe HFMD patients diagnosed with OEV had direct medical costs of 1 987 (95%CI: 206-3 769) Yuan less those associated with EV-A71; severe HFMD patients whose duration of illness was ≥21 d had 20 480 (95% CI: 10 985- 29 974) Yuan higher direct medical costs those whose illness lasted ≤5 d; the direct medical costs for severe HFMD patients with pulmonary hemorrhage/pulmonary edema and cardiopulmonary failure were 7 874 (95%CI: 3 723-12 026) and 9 855 (95% CI: 328- 19 382) Yuan higher, respectively, than that associated with respiratory disease.@*Conclusion@#The direct medical costs associated with severe HFMD were found to be substantial. The total cost was affected by the duration of the illness and the severity of any complications.

A trend analysis on disease spectrum and cost constitution in inpatients aged over 65-year-old in Sichuan Provincial People's Hospital from 2010 to 2014 / 中华老年医学杂志

Objective To retrospectively investigate the disease spectrum of inpatients aged over 65 year and cost constitution in Sichuan Provincial People's Hospital from 2010 to 2014,so as to provide baseline data for further study.Methods The inpatients'disease spectrum and costs were collected from hospital information system.The diseases were classified according to the International Classification of Diseases(ICD-10).The data were analyzed using SPSS 18.0 software.Results The total number of old inpatients was 111,935,and male (55.2 ％) was more than female (44.8 ％).The average age was (74.5 ±6.8)years.The top four systematic diseases of primary diagnosis were circulatory system disease (21.0 ％),respiratory system disease (13.7 ％),digestive system disease (12.7％)and neoplasms (12.1％).The total number of male inpatients was more than the female inpatients.The average cost per capita was increased from (￥)18,778.1 yuan to (￥)23,391.9 yuan since 2010.The proportion of all costs accounted for by drugs in elderly inpatients was decreased from 45.5％ to 38.9％ since 2010.Nosocomial infection was decreased from 3.19％ to 0.16％ since 2010.Conclusions The number of elderly inpatients are more in male than in female in Sichuan Provincial People's Hospital from 2010 to 2014.The most common systematic disease is circulatory system diseases,and followed by respiratory system diseases,digestive system diseases and neoplasms.The proportion of all expenditures accounted for by drugs was declined in five years,while the average cost per capita is increased.

Analysis of substitutional effect of outpatient expenditure on inpatient expenditure in hypertensive patients with rural new cooperative medical scheme / 北京大学学报(医学版)

Objective:To study direct medical cost of hypertensive patients without complicated disea-ses,to analyze substitution impacts of outpatient expenditure on inpatient expenditure,and then to make recommendations to health policy makers and hypertensive patients for managing hypertension.Methods:The claims data of hypertensive patients insured by the rural new cooperative medical scheme in a city in northern China from 2008 to 201 3 were analyzed,descriptive statistics employed to analyze direct medical cost of hypertensive patients and hypertensive patients without complicated diseases which was one of the three groups divided by medical treatment conditions (hypertension without complicated diseases,hyper-tension with complicated diseases,and other diseases),and the differences between groups compared by t test.The fixed effect two-part model was employed to analyze the substitution effect of outpatient services on inpatient services,and specific effects of outpatient times and reimbursement expenses on the inpatient expenditure were calculated by Logistic regression analysis.Results:For the hypertensive pa-tients,the average cost of outpatients was 283.49 Yuan in 2008 and rose to 370.93 Yuan in 201 3.After being divided into three groups,for hypertensive patients without complicated diseases,the average cost of outpatient was 449.79 Yuan in 2008 and rose to 582.53 Yuan in 201 3.In the total cost of the outpa-tient,45.73% was for the hypertensive patients without complicated diseases;in the total cost of the in-patient,only 9.29% was for the hypertensive patients without complicated diseases.By calculating the marginal effect of parameter estimation through the fixed effect two-part model,the inpatient cost could be significantly reduced by increasing the visit times of outpatient utilization or the cost of outpatient reim-bursement.For example,in 201 3,a 1 % rise of outpatient visit times increased outpatient expenditures by 6.48 million Yuan,which could reduce inpatient expenditures by 39.86 million Yuan.The substitu-ted ratio of outpatient cost on inpatient cost had been around 5 in 201 0 and later.Conclusion:The health policy-makers and hypertensive patients should pay more attentions to the substitution of outpatient cost for inpatient cost,especially for the hypertensive patients without complicated diseases whose direct medical cost was mainly due to outpatient rather than inpatient costs.

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.