Enlightenment of the DRG payment reform in the United States on the reform of China′s medical insurance payment methods / 中华医院管理杂志

In order to curb the excessive growth of medical expenses, the United States has initiated payment reform of diagnosis-related groups (DRG) since 1983, and developed a series of complementary measures to address issues such as overcoding and declining healthcare service quality which were exposed during the reform. The authors discussed the implementation of DRG payment reform in the United States, namely the case-mix specialization of medical institutions and the reduction of costs, as well as the relationship between the two. On this basis, the authors suggested that when implementing reforms to the medical insurance payment system in China, it is imperative to avoid such loopholes as overcoding by medical institutions and excessive pursuit of efficiency at the expense of quality control, as well as the decline of comprehensive rescue capability and quality of care incurred by the exacerbated specialization.

Economic evaluation on strategy for preventing mother-to-child transmission of hepatitis B in Zhejiang Province / 中华预防医学杂志

Objective@#To evaluate the cost-benefit and cost-effectiveness of current strategy for preventing mother-to-child transmission (PMTCT) of hepatitis B virus.@*Methods@#A decision tree model with the Markov process was developed and simulated over the lifetime of a birth cohort in Zhejiang Province in 2016. The current PMTCT strategy was compared with universal vaccination and non-vaccination. Costs were assessed from social perspective. Benefits were the savings from reduced costs associated with disease and effectiveness were measured by quality-adjusted of life-years (QALY) gained. The net present value (NPV), cost-benefit ratio (BCR) and incremental cost-effectiveness ratio (ICER) were calculated. Univariate and Probabilistic Sensitivity Analyses (PSA) were performed to assess parameter uncertainties. The parameters of costs and utilities value of hepatitis B-related disease came from the results of the field survey, which were obtained by face-to-face questionnaire survey combined with inpatient medical records, including eight county and municipal hospitals in Jinhua, Jiaxing and Taizhou. A total of 626 outpatients and 523 inpatient patients were investigated. The annual total costs of infection was calculated by combining the costs of outpatient and inpatient.@*Results@#The PMTCT strategy showed a net-gain as 38 323.78 CNY per person, with BCR as 21.10, which was higher than 36 357.80 CNY per person and 13.58 respectively of universal vaccination. Compared with universal vaccination, the PMTCT strategy would save 2 787.07 CNY per additional QALY gained for every person, indicating that PMTCT would be cost-saving. The most important parameters that could affect BCR and ICER were the vaccine coverage rate and costs of hepatitis B related diseases respectively. The PSA showed the PMTCT strategy was preferable as it would gain more QALY and save costs.@*Conclusions@#The PMTCT strategy appeared as highly cost-beneficial and highly cost-effective. High vaccination rate was a key factor of high economic value.

Influencing factors for operative workload: analysis based on multivariate regression model / 中华医院管理杂志

Objective To establish a multi-regression workload model based on surgical related factors.Methods The routine surgery workload was measured by the RBRVS development process of Hsiao WC,and multiple regression models were established for the operative factors from the surgical project specifications,pricing regulations and the operative workload.Results Top workload factors of an operation were technical difficulty,surgical classification and time cost.Multiple regression equation R2=0.699.One degree increase of technical difficulty would push up workload by 0.034;one level of operation grade would raise workload by 0.793;and every one hour longer of the operation time would increase workload by 1.025. Conclusions Operations of higher level, technical difficulty and longer time cost should deserve more reimbursement in consideration of both pricing and income distribution.

The status quo of service quality evaluation of pension institutions in China and research progress / 中华流行病学杂志

With the accelerating process of population aging in China,social pension system has been rapidly developed,but its service quality remains poor.How to provide quality and efficient elderly care services has become a major livelihood issue of general public.The existing evaluation standards for service quality in the elderly care institutions vary greatly in terms of literature review and practice,and they have only single perspective and lack systematic review.Based on the three-dimensional theory of "structure-process-result" quality evaluation,this paper systematically compares and evaluates the evaluation index system and evaluation management mechanism of service quality of pension institutions in typical countries and regions,and provides an evidence-based basis for establishing an evaluation management system,which is in line with China's national conditions and covers evaluation principles,subject and object,regulation,rewards and punishments,and classifications.

Study on the status of frailty and related determinants among the elderly in China / 中华流行病学杂志

Objective To investigate the frailty status and related determinants among the elderly in China.Methods Frailty index (FI) was applied to evaluate the frailty status of the elderly.Data used in this study was from the China Health and Retirement Longitudinal Study (CHARLS) in 2011-2015.Binary logistic regression analysis was carried out to identify the determinants related to the status on frailty.Results The prevalence rates of frailty in the elderly were 18.7％,20.6％ and 28.4％ in 2011,2013 and 2015,respectively.Being female or elderly under advanced age,were both associated with the higher level of FI.Factors as hip fracture,falls,alcohol intake more than once a month,and less participation in social activities etc.,might serve as the risk factors for frailty.Conclusion Chinese elderly showed relatively high prevalence on frailty and with annual increasing trend.The status of frailty was related to factors as adverse events and unhealthy lifestyles.Comprehensive intervention strategies should be adopted in early life of the elderly to delay the development process of frailty.

The status quo of service quality evaluation of pension institutions in China and research progress / 中华流行病学杂志

With the accelerating process of population aging in China,social pension system has been rapidly developed,but its service quality remains poor.How to provide quality and efficient elderly care services has become a major livelihood issue of general public.The existing evaluation standards for service quality in the elderly care institutions vary greatly in terms of literature review and practice,and they have only single perspective and lack systematic review.Based on the three-dimensional theory of "structure-process-result" quality evaluation,this paper systematically compares and evaluates the evaluation index system and evaluation management mechanism of service quality of pension institutions in typical countries and regions,and provides an evidence-based basis for establishing an evaluation management system,which is in line with China's national conditions and covers evaluation principles,subject and object,regulation,rewards and punishments,and classifications.

Study on the status of frailty and related determinants among the elderly in China / 中华流行病学杂志

Objective To investigate the frailty status and related determinants among the elderly in China.Methods Frailty index (FI) was applied to evaluate the frailty status of the elderly.Data used in this study was from the China Health and Retirement Longitudinal Study (CHARLS) in 2011-2015.Binary logistic regression analysis was carried out to identify the determinants related to the status on frailty.Results The prevalence rates of frailty in the elderly were 18.7％,20.6％ and 28.4％ in 2011,2013 and 2015,respectively.Being female or elderly under advanced age,were both associated with the higher level of FI.Factors as hip fracture,falls,alcohol intake more than once a month,and less participation in social activities etc.,might serve as the risk factors for frailty.Conclusion Chinese elderly showed relatively high prevalence on frailty and with annual increasing trend.The status of frailty was related to factors as adverse events and unhealthy lifestyles.Comprehensive intervention strategies should be adopted in early life of the elderly to delay the development process of frailty.

The Influencing Factors of Inpatient Care Utilization among the Elderly in China Based on SEM / 中国卫生统计

Objective To examine the utilization and cost of inpatient care and their influencing factors among the eld-erly in China from the view of social-ecology and to estimate the conditional and the unconditional cost,so as to provide refer-ence for allocating health resource efficiently among the elderly. Methods We build a social-ecological model( SEM) of the in-patient services utilization to estimate personal,familial and community circumstance factors of inpatient service utilizing a two-part model. Using joint modeling of likelihood and cost of inpatient care to estimate the parameter and predict the conditional and unconditional cost of inpatient. Data were extracted from Chinese longitudinal healthy longevity survey ( CLHLS) in 2011 on 8483 men more than 60 years old. Results The average cost of the elderly,24. 6% of whom actually utilize the services,is￥8082. 8. There are many reasons account for the utilization of inpatient care. In micro system,it was found that the elderly with chronic condition,having bad self-reported health and worse sleep quality have higher proportion of utilization and more cost of inpatient services. In mezzo system,the married men are more likely use inpatient services and spend more money curing disease than other groups. In macro system,the man who reside in the city or own more than one kind of social security have higher pro-portion and cost of inpatient care utilization. The predicted conditional and unconditional cost of inpatient service is ￥8397. 32,￥2478. 92,respectively. The male are higher than the female,theurban are higher than others. The elderly from 80 to 89 years old have the most expense in conditional predicted cost and 70~79 years old have most expense in unconditional predicted cost. Conclusion Social-ecological factors influence the behaviors of inpatient care utilization. Having chronic disease,self-reported health,sleep quality,marital status,residence and social security levels from different aspects are the primary factors which influ-ence proportion and expenditure of inpatient service utilization. The elderly with different characteristics have different conditional costs and unconditional costs,we should allocate health resources efficiently to promote the equity in health care utilization.

"Research on the KAP influencing factors for the ""Three-manager mode"" in hierarchical medical system for chronic diseases" / 中华医院管理杂志

Objective To investigate the influencing factors for knowledge,attitude and practice(KAP)of the Three-manager mode about hierarchical medical system of Chronic diseases of the community residents in Xiamen,and provide references for the implementation of hierarchical medical system.Methods Multi-stage random sampling method was adopted,and 400 residents were randomly sampled from 5 communities of Xiamen for questionnaire survey.The survey features the dependent variable of the community residents′ knowing and joining-in the Three-manager mode,the internal factors(social demographic characteristics),and the external factors(medical expenditure and healthcare insurance).On such basis,four logistic regression models were built for analysis of such influencing factors.Results 41.10% of the surveyed were aware of the Three-manager mode,and 39.71% of the hypertension/diabetes patients among them joined in the hypertension network or diabetes network.Age,education,medical expenditure and referral experiences were significant influencing factors for KAP level of the Three-manager mode,while the residents of older age,higher education and referral experiences were high in their KAP;those of lower per capita monthly income,hypertension or diabetes,with coverage of medical insurance and satisfied with medical consultation in community were high in their awareness of Three-manager mode.Conclusions The KAP level of Three-manager mode of the community residents in Xiamen is acceptable,yet expected of further improvement.Room of further improvement includes enhancement of synergy of the Three-manager mode,enhanced motivation of government financial support and medical insurance,better service functions of community institutions,and especially the construction of hierarchical medical system.

Understanding of hierarchical medical mode in chronic diseases management among medical staff and residents in Xiamen / 中华全科医师杂志

Objective To estimate the status of understanding hierarchical medical mode in chronic disease management among medical staff and residents in Xiamen .Methods The multi-stage sampling was used in the study to select 49 physicians from the tertiary hospitals , 58 general practitioners ( GPs ) and health managers from 5 community health services centers , and 499 residents from 5 communities in Xiamen.We conducted a face-to-face survey to estimate their basic information , recognition for hierarchical medical mode , and patients'willingness for community first contact care .The data was described by mean value of frequency and constituent ratio , the chi-square test or Fisher's exact test was used for comparison among groups .Logistic regression was performed to analyze the factors influencing the residents 'preference for treatment in community medical institutions . Results The physicians from tertiary hospitals or community health service centers were almost all familiar with Xiamen mode (91/107, 85%), and more than half of them knew about the hierarchical medical system (67/107, 62.6%), 86.9% (93/107) of them knew about the guide of hierarchical medical system , 58.9%(63/107) of them received the relative training before .The physicians from community had higher knowledge , more frequency training , more referral experiences and more effective evaluation than the physicians from hospitals (all P<0.05).In our study, 86.2%(344/399) of residents were willing to see doctors in community health centers and 77.9%(311/399) of them were willing to return to community health service centers from tertiary hospitals for disease convalescence or chronic disease management;53.6% (214/399) of residents preferred to utilize community first contact care when they got chronic diseases , and they were more satisfied with the consultation and diagnosis process in community .The residents who knew about the hierarchical medical system were more likely to utilize community first contact care and return to community for medical care . However, the female or the higher-income residents were less likely to see doctors in community .Patients who had experienced transfer to community or had higher satisfaction to community care were more willing to return from hospitals to community for disease convalescence .The mode showed that the system was more effective in measuring and controlling blood pressure or blood glucose for patients who joined the patients 'network than for those did not join.(P<0.05).Conclusion Medical staff are familiar with hierarchical medical system , and the residents are likely to use community health service as their first contact care in Xiamen.The utilization of community first contact care is influenced by sex , family income, previous experience, knowledge of the system , and satisfaction to the system of patients .

The Influencing Factors of Inpatient Care Utilization among the Elderly in China Based on SEM / 中国卫生统计

Objective To examine the utilization and cost of inpatient care and their influencing factors among the eld-erly in China from the view of social-ecology and to estimate the conditional and the unconditional cost,so as to provide refer-ence for allocating health resource efficiently among the elderly. Methods We build a social-ecological model( SEM) of the in-patient services utilization to estimate personal,familial and community circumstance factors of inpatient service utilizing a two-part model. Using joint modeling of likelihood and cost of inpatient care to estimate the parameter and predict the conditional and unconditional cost of inpatient. Data were extracted from Chinese longitudinal healthy longevity survey ( CLHLS) in 2011 on 8483 men more than 60 years old. Results The average cost of the elderly,24. 6% of whom actually utilize the services,is￥8082. 8. There are many reasons account for the utilization of inpatient care. In micro system,it was found that the elderly with chronic condition,having bad self-reported health and worse sleep quality have higher proportion of utilization and more cost of inpatient services. In mezzo system,the married men are more likely use inpatient services and spend more money curing disease than other groups. In macro system,the man who reside in the city or own more than one kind of social security have higher pro-portion and cost of inpatient care utilization. The predicted conditional and unconditional cost of inpatient service is ￥8397. 32,￥2478. 92,respectively. The male are higher than the female,theurban are higher than others. The elderly from 80 to 89 years old have the most expense in conditional predicted cost and 70~79 years old have most expense in unconditional predicted cost. Conclusion Social-ecological factors influence the behaviors of inpatient care utilization. Having chronic disease,self-reported health,sleep quality,marital status,residence and social security levels from different aspects are the primary factors which influ-ence proportion and expenditure of inpatient service utilization. The elderly with different characteristics have different conditional costs and unconditional costs,we should allocate health resources efficiently to promote the equity in health care utilization.