ABSTRACT
Purpose: Cerebral infarction (CI) has been one of the leading causes of death in China since 2017, and controlling the medical expenses of this disease is an urgent issue for the Chinese government. This study aims to explore the important factors that affect the hospitalization expenses of CI patients and to provide a scientific basis for establishing a reasonable reimbursement mechanism and hospitalization expense standard for CI patients. Methods: Data from 109,314 inpatients from the Healthcare Security Administration of Chengdu in western China from January 2016 to December 2018 were utilized. Descriptive statistical analysis was used for variable characteristic analysis. The Mann-Whitney test and Kruskal-Wallis test were used for single-factor analysis, and multiple linear stepwise regression was used for single-factor analysis and multiple-factor analysis. Results: This study found that the average direct economic burden of CI in Chengdu was approximately 10,569 Chinese yuan (CNY), about 1450 US dollars, the average length of stay (LOS) was 14.47 days, the indirect economic burden was approximately 2817 CNY, and the total economic burden was 13,386 CNY for a CI inpatient. Gender, insurance type, grade of medical institution, the level of payment type, age, LOS, and complications and comorbidities (CCs) are the most important factors affecting CI medical costs. Conclusion: Citizens should improve their lifestyle habits to reduce disease risk to avoid the associated medical and economic burdens. Hospitals should improve their medical technology to decrease the LOS and reduce direct medical costs. The government should actively promote the hierarchical diagnosis and treatment policy to reduce the waste of medical resources caused by low-acuity patients going to high-level hospitals for treatment. The National Healthcare Security Administration should optimize the medical insurance payment method and establish a corresponding mechanism to reduce the occurrence of excessive medical treatments such as overuse.
ABSTRACT
The problem of delivering and fetching wagons at a railway station with mixed-shaped goods operation sites is considered, with a view to minimizing the running time between goods operation sites and waiting time of the locomotive in the planning period as the optimization objective. A general mathematical model for delivering and fetching wagons at a railway station with mixed-shaped goods operation sites has been formulated. The methods of judging and processing reverse of delivering and fetching wagons, dividing batches, and judging number of wagons for batch operation are provided to determine the feasibility of the solution, and an improved simulated annealing algorithm is introduced as our algorithm to the model. Finally, an experimental station is taken as an example to verify the model and algorithm. The results show that simulated annealing algorithm is relatively superior in computational efficiency and result compared with genetic algorithm and tabu search algorithm, the computing time of the algorithm provided can meet the requirements of planning shunting operations in railway station, and the model proposed is universal for other layout forms of GOSs and different operation forms.
