Development trend of physical examination volume and revenue in health-checkup institutions in China from 2010 to 2019 / 中华健康管理学杂志

Objective:To investigate the development trend of physical examination volume and revenue in health-checkup institutions in China from 2010 to 2019.Methods:In this longitudinal study, the annual income, annual physical examination volume and other indicators reflecting institutional size were collected with questionnaire from 374 health-checkup institutions in the year of 2010, 2015 and 2019. The geometric mean method is used to calculate the compound annual growth rate (CAGR) of the annual physical examination volume, annual income, mean per capita cost from 2010 to 2015 and 2015 to 2019.Results:The annual physical examination volume of health-checkup institutions increased from 1.81 (1.00, 3.20) ×10 4 person times in 2010 to 5.08(3.50, 7.28)×10 4 person times in 2019; the CAGR of the physical examination volume from 2010 to 2015 was 14.04%(8.14%, 23.78%), and it was 9.49%(3.39%, 19.07%) from 2015 to 2019. The annual revenue increased from 768.73 (350.00, 1 623.75) ×10 4 yuan in 2010 to 3 500.00 (1 997.73, 6 818.54) ×10 4 yuan in 2019; the CAGR of annual revenue from 2010 to 2015 was 25.75% (15.17%, 35.09%), and it was 15.67% (8.78%, 26.11%) from 2015 to 2019. The mean per capita cost increased from 434.26 (278.82, 666.66) yuan in 2010 to 755.80 (506.90, 1 005.42) yuan in 2019; the CAGR of the mean per capita cost was 9.82% (1.71%, 17.10%) from 2010 to 2015, and it was 5.37% (0.95%, 10.46%) from 2015 to 2019. Conclusion:From 2010 to 2019, health-checkup institutions in China developed rapidly, and the CAGR of the annual physical examination volume, annual revenue, mean per capita cost are high.

New grey correlation and degree of structure variation analysis of hospitalization cost of childhood pneumonia / 上海交通大学学报（医学版）

Objective • To understand the structural changes and related reasons of the average cost of hospitalization of childhood pneumonia in Shanghai, and to propound related policy suggestion. Methods • New grey correlation and degree of structural variation analysis were used to research the average cost of hospitalization of 22 543 children with pneumonia from 2015 to 2018 in a children's specialized hospital in Shanghai. The average cost included 5 categories, i.e. medicine cost, material cost, examination and laboratory cost, labour cost and bed occupation cost. The relational degree and structural changes between each average cost and the average cost of hospitalization were discussed. Results • The new grey correlation analysis showed that the relational degree sort order of each average cost from the highest to the lowest were average examination and laboratory cost (γ3=1.000 0), average medicine cost (γ1=0.862 5), average bed occupation cost (γ5=0.845 1), average labour cost (γ4=0.796 8) and average material cost (γ2=0.786 3). The degree of structure variation analysis showed that the contribution rate of structure variation (CSV) sort order of each average cost in 2015-2018 from the highest to the lowest were average medicine cost (CSV1=36.22%), average bed occupation cost (CSV5=27.65%), average examination and laboratory cost (CSV3=13.91%), average material cost (CSV2=13.78%) and average labour cost (CSV4=8.44%). The average medicine cost and average material cost were negative variation. Conclusion • The average examination and laboratory cost and average medicine cost are the main factors that influenced the average cost of hospitalization of childhood pneumonia. The proportion of the average labour cost is relatively low. It is suggested that the cost structure like raising labour charges and optimizing diagnosis and treatment process should be further adjusted in order to control the growth of medical costs.

Management practice and thinking of different DRGs grouped patients in clinical pathway / 中华医院管理杂志

Objective To analysis the clinical pathway management efficiency under different DRG groups, for a basis for further optimizing clinical pathway management. Methods The retrospective analysis method was used to compare the average length of stay, sub-average costs, and drug proportions of patients with different DRGs in the same clinical pathway. Shapiro-Wilk was used to detect the normality of the samples, t test was used to analyze measurement data conformed to the normal distribution, non-parametric test was used to analyze the abnormal distribution data, and enumeration data was detected by using chi-square test. Results For patients with a clinical pathway of bronchial pneumonia, patients with severe complications and concomitant symptoms had no significant difference in mean hospitalization and sub-costs, regardless of whether they completed or entered the clinical pathway ( P >0.05). For the other two DRG patients, the difference between the average length of stay, sub-average costs, and the proportion of medications for patients who completed the clinical pathway and withdrew from or did not complete the clinical pathway was significant(P<0.05). In the severe surgical group, the length of stay and average cost for patients who completed the clinical pathway were lower than those who exited or did not enter the clinical pathway(P<0.05). Conclusions Patients with different severity of DRGs should be cautious when they are enrolled in the clinical pathway.

A cost-effective analysis of various disease modifying anti-rheumatic drugs for patients with Rheumatoid Arthritis

Background: Rheumatoid Arthritis (RA) is a chronic disabling disorder that lowers quality of life in the affected patients. Early treatment with disease-modifying anti-rheumatic drugs (DMARDs, provides better control of disease and minimize joint destruction. Long term therapy imparts considerable economic burden to the patients. Cost effective analysis was performed among the patients treated with methotrexate (MTX) alone, hydroxychloroquine (HCQ) alone, and both (MTX+HCQ).Methods: A prospective, observational study for six months to analyze the cost-effectiveness in RA patients with DMARDs-MTX, HCQ and MTX+HCQ. A total of 91 patients were included for analysis; 43 patients in MTX and HCQ group; 37 patients in MTX group and 11 patients in HCQ group. To assess the functional disability,” Stanford Health Assessment Questionnaire - Disability Index” (HAQ-DI) was administered. The patients were followed up for four months. The HAQ-DI at the baseline was compared with that of final follow up. The change in HAQ-DI and the total costs were used to find out the average cost- effective ratio (ACER).Results: The least ACER was obtained for Hydroxychloroquine and highest was for Methotrexate. But there was no statistically significant difference in ACER between various treatment groups. There was no significant difference in the disease activity improvement between the three groups.Conclusions: MTX, HCQ and MTX+HCQ showed improvement in disease activity without any significant difference. MTX is superior considering direct cost but there is no difference in the total cost between three groups.

Cost-effectiveness of the Use of Statins in the Korean Population

OBJECTIVE: Statins reduce risk of cardiovascular disease through lowering of LDL-C (Low Density Lipoprotein cholesterol). We analyzed cost-effectiveness of statins in the reduction of serum LDL-C level among Korean population at high cardiovascular risk. METHODS: Rosuvastatin (5, 10, and 20 mg), atorvastatin (10, 20, 40, and 80 mg) and simvastatin (20, 40, and 80 mg) were included for the analysis, because those statins and doses were mostly prescribed in Korea. We determined effectiveness as % reduction of LDL cholesterol (LDL-C) levels per mg dose and % population reached to the ideal LDL-C level (<100 mg/dL), which is the target goal of LDL-C level for the high cardiovascular risk group as recommended by NCEP-ATP III guideline. The annual cost, which included overall cost for the drug price and management during follow up, was calculated. Average cost-effectiveness ratio (ACER) was calculated and used as the parameter representing cost-effectiveness of each statins. RESULTS: The lowest dose of each statins showed that achieving LDL-C target level was not high even in subjects showing relatively low basal LDL-C levels (<160 mg/dL). Also in case basal LDL-C level was over 160 mg/dL, the majority of statins were not sufficient to control LDL-C levels except atorvastatin 80 mg. In case of basal LDL-C level was lower than 160 mg/dl, atorvastatin 20 mg was the most cost-effective statin for LDL-C reduction regardless of considering basal LDL-C level. Simvastatin 40 mg was also cost-effective if basal LDL-C levels were between 100-129 mg/dL. CONCLUSIONS: For the reduction of LDL-C level in high risk subjects showing moderately elevated basal LDL-C level, atorvastatin 20 mg is the most cost-effective statin treatment strategy and then simvastatin 40 mg or rosuvastatin 10 mg was the second best option.

Estudio de Costos Promedios de Servicios en el Hospital Nacional. Años 2.009/10 / Average Cost Study Services in the National Hospital. 2009/10 Year

RESUMEN Objetivo:El presente trabajo busca definir los costos promedios de los servicios brindados por el Hospital Nacional y proveer de información económica puntual a los Departamentos Médicos y Administrativos. Material y Métodos:Es un estudio descriptivo, que utilizando los archivos del Hospital Nacional, define servicios brindados y asigna costos promedios luego de agrupar los gastos correspondientes a cada área, siendo el costo promedio de cada servicio el cociente entre los gastos y el total de servicios brindados por esa área en un año. Resultados:Los resultados son los costos promedios de 28 servicios que brinda el Hospital Nacional. Conclusión:El método utilizado permite obtener datos precisos y útiles para la planificación.

ABSTRACT Objetive:This paper seeks to define the average costs of services provided by the National Hospital and provide accurate financial information to the Medical and Administrative Departments. Material and Methods:It is a descriptive study using the National Hospital files, define services provided and costs allocated to group averages after expenses for each area, with the average cost of each service by dividing the total costs and services provided by that area in a year. Results:The results are the average costs of 28 services provided by the National Hospital. Conclusion: The method allows for accurate and useful data for planning.