Cost analysis of the colorectal neoplasm screen program in Beijing / 中华预防医学杂志

<p><b>OBJECTIVE</b>To conduct with a cost analysis of the colorectal neoplasm screening program in Beijing, and provide data evidence for decision making.</p><p><b>METHODS</b>Based on stratified cluster sampling method, we carried out a 2-stage colorectal neoplasm screening program within 6 districts, Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan, of Beijing city between October, 2012 to May. 2013. The first stage of the program was to conducting a cancer risk level evaluation for community residents who were forty years older and the second stage's task was to providing clinical exam for those high risk people who were selected from the first stage. There were about 12 953 residents were involved in this program. We calculated the main cost of the colorectal neoplasm screen program in Beijing. Then estimate the cost of detecting one Colorectal Neoplasm patient of this program and compare it with the total treatment cost for a patient.</p><p><b>RESULT</b>2 487 high risk residents were selected by the first stage and 1 055 of them made appointment for the colonoscopy exam but only 375 accepted the exam, participate rate was 35.5%. 9 neoplasm cancer patients and 71 pre-cancer patient were found at the second stage, the detection rate were 69.2/100 000 and 546/100 000, respectively. The direct input for this neoplasm screening program was 227 100 CNY and the transport expense was 4 200 CNY in the calculations. The cost for detecting one cancer patient was about 19 900 CNY. Comparing with the total medical care cost of a cancer patient (1 282 800 CNY), especially for those have been diagnosed as middle to end stage cancer, the screening program (cost 842 800 CNY) might help to reduce the total health expenditure about 128 700 CNY, based on 12 953 local residents age above 40 years old.</p><p><b>CONCLUSION</b>An colonoscopy based colorectal neoplasm screening program showed its function on medical expenditure saving and might have advantage on health social labor creating.</p>

The current situation and problems of primary health care personnel since the new round of China's health care reform / 中国卫生政策研究

Objective: To analyze the current situation and problems of primary health care personnel since the new round of China's health care reform, and to provide a reference for stabilizing the primary health care personnel. Methods: This paper uses descriptive statistical analysis to calculate Gini coefficient and Theil index in order to ana-lyze the equity in headcount, structure and distribution of primary health care personnel among all health care institu-tions nationwide. Results: Between 2008 and 2013, the number of primary health care personnel significantly in-creased and their quality was improved. Moreover, although the Gini coefficient and Theil index of primary health care personnel continuously decreased in China's eastern, central and western provinces the difference inside the east-ern China is the main factor affecting the overall difference. Conclusions:Not only the problems of insufficient num-ber and loss of personnel still coexist in the primary health care personnel in China, but also there are other issues such as the structural imbalance of professional titles is especially prominent, the urban-rural and regional gaps are still large, etc. The main reasons for these issues are related to the irrational incentive mechanism, the inefficiency of the synergistic effects of administrative staffing policy and some reform measures, etc. This paper suggests further re-forming the income distribution system and improving primary governance capability in order to strengthen the policies to synergically attract and stabilize primary healthcare personnel.

Analysis on the Impact of New Rural Cooperative Medical System on Medical Burden of Rural Residents / 中国卫生经济

Objective: To investigate the impact of New Rural Cooperative Medical System (NCMS)on rural resident’s medical burden. Methods: It investigates the survey data from the China Health and Nutrition Survey and employing difference-in-difference method based on the fixed effect model. Results: NCMS increases rural resident’s actual reimbursement rate, release the high health medical expenditure, but has limit impact on medical expenditure. The low-income group has greater risk on high medical expenditure. Conclusion: It is needed to improve the level of NCMS policy implementation; strengthen the supervision of designated medical institutions and increase policy support for low-income rural residents.