Expanding outpatient benefits package can reduce diabetes-related avoidable hospitalizations.

Objective: To evaluate the policy effect of replacing hospitalization service with outpatient service and reducing diabetes-related avoidable hospitalizations by improving outpatient benefits package. Methods: A database of hospital discharge from 2015 to 2017 in City Z was used. All diabetic inpatient cases enrolled in Urban Employee Basic Medical Insurance were selected as the intervention group, and diabetic inpatient cases enrolled in Urban and Rural Resident Basic Medical Insurance were selected as the control group. The Difference-in-Difference model was used to analyze the effect of improving outpatient benefits package level of diabetes from 1800 yuan (about $252.82) to 2400 yuan (about $337.09) per capita per year on avoidable hospitalization rate, average hospitalization cost and average length of stay. Results: The avoidable hospitalization rate of diabetes mellitus decreased by 0.21 percentage points (P < 0.01), the average total cost of hospitalization increased by 7.89% (P < 0.01), and the average length of stay per hospitalization increased by 5.63% (P < 0.01). Conclusions: Improving the outpatient benefits package of diabetes can play a role in replacing hospitalization service with outpatient service, reducing diabetes-related avoidable hospitalizations, and reducing the disease burden and financial burden.

The Association between Urbanization and Depression among the Middle-Aged and Elderly: A Longitudinal Study in China.

Urbanization has been and will continue to be the mainstream trend of global population movement, including China. Depression is the most common mental disorders and the leading factor of disabilities. However, the impacts of urbanization on the depression occurrence are still unclear. This paper analyzed the data from 3 waves of the China Health and Retirement Longitudinal Study (CHARLS) with sample size as 8510 adults representing the middle aged and elderly group in China. Depression was identified and measured by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Urbanization level was measured by population density, GDP per capita and secondary/tertiary industry as percentage to GDP in the China City Statistical Yearbook. The fixed effect regression model was used to explore the association between the changes of urbanization and depression. As result, depression is closely related to the urbanization, protective effects are found for 3 indicators above: The depression prevalence decreases while urbanization level increases (from lowest urbanization level to the highest: P < 0.01). Among the 10 depression symptoms, "Bothered", "Reduced energy leading to diminished activity" and "Hopelessness" are the most significantly improved with urbanization. The impact of urbanization on residents' mental health is a long-term, multi-factor interaction. Therefore we need to fully consider all possible influencing factors, and longer follow-up study to verify.

Comparative study of processed autogenous tooth bone and xenogeneic bovine bone in repairing an alveolar bone defect / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study was conducted to counter the osteogenesis effects of processed autogenous tooth bone and xenogeneic bovine bone following tooth extraction and to provide an experimental basis for clinical applications.</p><p><b>METHODS</b>Central incisors were extracted with general anesthesia on both sides of a maxillary arch in 12 rabbits, which were randomly divided into three groups, thereby containing four rabbits in each group. Three rabbits were assigned to the experimental groups and one was for the control group. In the experimental groups, the xenogeneic bovine bone was applied to the left incisor socket, whereas the processed autogenous tooth bone was applied to the right incisor socket. The blank control group only extracted the teeth and did not implant any bone powder. The three groups died after 4, 8, and 12 weeks, respectively. A mineralization degree of new bone tissues was observed by fluorescence staining and the formation of a new bone was observed by histology.</p><p><b>RESULTS</b>The sedimentary mineralization rate was greater in the processed autogenous tooth bone than in the xenogeneic bovine bone (P<0.05). The trabecular bone of the xenogeneic bovine bone was sparse and slender. The left sockets, which were filled with the xenogeneic bovine bone, had more woven and less lamellar bones than the right sockets, which were filled with the processed autogenous tooth bone.</p><p><b>CONCLUSIONS</b>The processed autogenous tooth bone offers more advantages as a bone-grafting material than the xenogeneic bovine bone in terms of bone increment.</p>

[An empirical analysis on the substitution effect of outpatient services on inpatient services].

OBJECTIVE: To study the substitution effect of outpatient services on inpatient services and provide suggestions on designing outpatient policies. METHODS: The data were from 13 districts/counties in one area of eastern China from 2007 to 2013 for the new cooperative medical scheme. This study employed a fixed effects model to analyze the impacts of outpatient visit times, expenditure amounts and reimbursements on inpatient services. RESULTS: One outpatient visit reduced the total amount of inpatient services by 20 Yuan. An increase of 10,000 Yuan outpatient reimbursements saved 9,700 Yuan inpatient expenses. An increase of 10,000 Yuan outpatient expenses led to a decrease of 3,000 Yuan inpatient reimbursements. The outpatient services did not increase the inpatient hospitalization times significantly. In particular, the effects of the outpatient services were mainly on the inpatient services at the district/county levels, and no significant impacts on the outpatient services at the city levels. CONCLUSION: There is a substitution effect of outpatient services on inpatient services. The health insurance departments should take this substitution effect into account and shift more funds on outpatient series, when they design outpatient and inpatient reimbursement policies.

[Influence of contractual medical association on inpatient service performance].

OBJECTIVE: To study the influence of contractual medical association on inpatient service performance. METHODS: The data came from "Database of Inpatient Record" administered by Department of Medical Insurance. Using diagnosis related groups (DRG) as the tool of risk-adjustment, the third-tier general hospitals and second-tier general hospitals in medical alliance as the intervention group, and the average level of the same grade local hospitals as the control group, the influence of medical alliance on inpatient service performance was evaluated. The difference in difference (DID) method was used for the data analysis. The assessing indicators included the number of DRG group, case mix index (CMI), the total weight, cost efficiency index and time efficiency index. RESULTS: After the establishment of medical association, compared with the average level of the same grade local hospitals, in the third-tier general hospitals of medical alliance, the growth rate of the total weight had declined, and cost efficiency index had increased, while in the second-tier general hospitals of medical alliance, the CMI value had declined, and the cost efficiency index had increased. CONCLUSION: Contractual medical association played a role of triage patients, and improved the service levels and management efficiency of the second-tier general hospitals.

[Impact of primary care oriented outpatient benefit package design in new rural cooperative medical system on hypertension outpatient services utilization].

OBJECTIVE: To study the impact of primary care oriented outpatient benefits package design of outpatient services coverage and ladder reimbursement of county, town and village levels in the new rural cooperative medical system (NRCMs) on hypertension outpatient services utilization. METHODS: The panel data of treatment and control groups in 2009 and 2011 before and after the policy reform were drawn from the household survey data of the innovative payment system project. The difference in difference (DID) method was used for data analysis. The outcome indicators included the utilization of outpatient services of patients with self-reported hypertension and their main treatment locations. RESULTS: The primary care oriented outpatient benefit package design in the NRCMs reduced the probability of no treatment in the latest three months of hypertension by 10.2 percent points. Meanwhile, it increased the probability of choosing village clinic as the preferred location by 15.7 percent points. CONCLUSION: Primary care oriented outpatient benefits package design lead patients with hypertension to use the nearest outpatient services at low risk of disease.

Oral zinc supplementation for the treatment of acute diarrhea in children: a systematic review and meta-analysis.

Evidence supporting the impact of therapeutic zinc supplementation on the duration and severity of diarrhea among children under five is largely derived from studies conducted in South Asia. China experiences a substantial portion of the global burden of diarrhea, but the impact of zinc treatment among children under five has not been well documented by previously published systematic reviews on the topic. We therefore conducted a systematic literature review, which included an exhaustive search of the Chinese literature, in an effort to update previously published estimates of the effect of therapeutic zinc. We conducted systematic literature searches in various databases, including the China National Knowledge Infrastructure (CNKI), and abstracted relevant data from studies meeting our inclusion and exclusion criteria. We used STATA 12.0 to pool select outcomes and to generate estimates of percentage difference and relative risk comparing outcomes between zinc and control groups. We identified 89 Chinese and 15 non-Chinese studies for the review, including studies in 10 countries from all WHO geographic regions, and analyzed a total of 18,822 diarrhea cases (9469 zinc and 9353 control). None of the included Chinese studies had previously been included in published pooled effect estimates. Chinese and non-Chinese studies reported the effect of therapeutic zinc supplementation on decreased episode duration, stool output, stool frequency, hospitalization duration and proportion of episodes lasting beyond three and seven days. Pooling Chinese and non-Chinese studies yielded an overall 26% (95% CI: 20%-32%) reduction in the estimated relative risk of diarrhea lasting beyond three days among zinc-treated children. Studies conducted in and outside China report reductions in morbidity as a result of oral therapeutic zinc supplementation for acute diarrhea among children under five years of age. The WHO recommendation for zinc treatment of diarrhea episodes should be supported in all low- and middle-income countries.

[Social determinants of chronic disease in a working population in China].

OBJECTIVE: To identify the social determinants of chronic disease in China. METHODS: Cross sectional data of working population aged from 18 to 60 years were drawn from the database of Chinese Family Panel Studies (CFPS) 2010. Logistic regression model was used for analyzing the difference of chronic conditions prevalence among the self-evaluated social status, income, education, working organizations and properties and management positions, respectively. RESULTS: The highest and higher groups of subjective social status, the least and higher groups of education, low-income group had a higher probability of suffering from chronic diseases. In terms of the nature of jobs, the farmers and the self-employed had a higher risk of suffering from chronic diseases than those employed by other formal sectors. The people engaged in the management were also with a higher risk. CONCLUSION: Income, education, nature and content of jobs are the social determinants of chronic diseases in China. All these determinants need to be considered during the policy-making aimed to improve health equity.

[Empirical analysis of relationship between scales and outputs of inpatient services of public comprehensive hospitals in Beijing area].

OBJECTIVE: To analyze the relationship between scale and outputs of inpatient services of public general hospitals. METHODS: Data on hospital scales and outputs were drawn from Beijing Health Statistics Annuals and the Database of Inpatient Record administered by Beijing Health Bureau. The outputs of inpatient services were measured, risk-adjusted by Beijing Diagnosis Related Groups (BJ-DRGs). Based on the Cobb-Douglas production function, regression analysis was used to evaluate the contribution of manpower and material resources to the changes in outputs of hospitals on different scales, respectively. RESULTS: Public general hospitals with 200-800 beds were at the stage of economical scale. In the 200-500-bed hospitals, investment of both human and material resources contributed to output changes. In the 501-800-bed hospitals, output changes were positively correlated with manpower input, but not with material resources. CONCLUSION: In the specific environment in Beijing, medium-sized hospitals are appropriate when the government plan to build hospitals mainly focused on inpatient services. The larger the scale of hospitals is, the more important is the manpower imput. The personnel system reform for public hospitals is urgent.

[An international comparison of physician control systems].

This study compares physicians' regulations set by the United Kingdom, the United States, Canada and Germany which have typical healthcare systems. Physicians' regulations are defined in this study as four aspects: physicians' training and qualifications, career pathways, payment methods and behavior regulations. Strict access rules, practicing with freedom, different training models between general and special practitioners, health services priced by negotiations and regulations by professional organizations are the common features of physicians' regulations in these four western countries. Three aspects--introducing contract mechanism, enhancing the roles of professional organizations and extending physicians' practice space should be taken into account in China's future reform of physicians' regulations.

Evaluating performance of local case-mix system by international comparison: a case study in Beijing, China.

BACKGROUND: Case-mix is an important tool for health planning and management in many countries. As a major developing country, China is considering the introduction of the case-mix system in the health reform. Beijing, the capital of China, developed a local case-mix version whose performance needs to be evaluated before utilization. OBJECTIVE: The objective of this study was to evaluate the performance of the case-mix system developed in Beijing by comparing it with those used in Australia and the U.S.A. METHOD: A total of 1.3 million inpatient records from 154 hospitals in Beijing in 2008 were grouped respectively using three case-mix systems: (i) Beijing Diagnosis Related Groups (BJ-DRGs); (ii) US-based All Patient DRGs; and (iii) Australian Refined DRGs. Coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of DRGs system. RESULTS: The BJ-DRGs produced the best CV and RIV results for expenditure. However, at the level of Major Diagnostic Category (MDC), three MDCs of BJ-DRGs gave the poorest RIVs for both expenditure and length of stay. CONCLUSIONS: Although the performance of BJ-DRGs was acceptable, further revision and improvement is needed. Comparisons with other mature DRGs versions can assist in identifying the improvement priorities of the local version.

[Using diagnosis relative groups mortality risk classification to assess medical quality].

OBJECTIVE: To introduce diagnosis related groups to assess the medical quality and try to establish an effective quality evaluation approach. METHODS: Using Australia-Refined Diagnosis Related Groups, version 5.0 (AR-DRGs v5.0) to classify the 160 000 discharged cases from 7 large hospitals in Beijing in 2005. Based on this, mortality risk classification was established to adjust the whole-hospital risks. And then hospital mortality of all the risk groups from each hospital was calculated respectively, which was used as the basic quality assessment criterion. The differences between the assessment results from using the raw hospital mortality and from using Diagnosis Relative Groups Mortality Risk Classification (DRGs-MRC) were compared. RESULTS: (1) The risk types were different among the discharged cases in different hospitals; (2) The assessment results from these two approaches about No.6 hospital were similar in that No.6 hospital had a good quality performance; (3) The raw hospital mortality was the lowest in No.2 hospital (0.98%), but the mortality of low risk group in this hospital was higher than the average level of the same risk group among these 7 hospitals; the status of No.5 hospital was much the same. CONCLUSION: Compared with raw hospital mortality, DRGs-MRC improved the comparability of cases and the reliability of the assessment result.