Effect of health insurance on direct hospitalisation costs for in-patients with ischaemic stroke in China.

Objectives The aim of the present study was to determine the direct medical costs of hospitalisations for ischaemic stroke (IS) in-patients with different types of health insurance in China and to analyse the demographic characteristics of hospitalised patients, based on data supplied by the China Health Insurance Research Association (CHIRA). Methods A nationwide and cross-sectional sample of IS in-patients with International Classifications of Diseases 10th Revision (ICD-10) Code I63 who were ensured under either the Basic Medical Insurance Scheme for Employees (BMISE) or the Basic Medical Insurance Scheme for Urban Residents (BMISUR) was extracted from the CHIRA claims database. A retrospective analysis was used with regard to patient demographics, total hospital charges and costs. Results Of the 49588 hospitalised patients who had been diagnosed with IS in the CHIRA claims database, 28850 (58.2%) were men (mean age 67.34 years) and 20738 (41.8%) were women (mean age 69.75 years). Of all patients, 40347 (81.4%) were insured by the BMISE, whereas 8724 (17.6%) were insured by the BMISUR; the mean age of these groups was 68.55 and 67.62 years respectively. For BMISE-insured in-patients, the cost per hospitalisation was RMB10131 (95% confidence interval (CI) 10014-10258), the cost per hospital day was RMB787 (95% CI 766-808), the out-of-pocket costs per patient were RMB2346 (95% CI 2303-2388) and the reimbursement rate was 74.61% (95% CI 74.48-74.73%). For BMISUR-insured in-patients the cost per hospitalisation was RMB7662 (95% CI 7473-7852), the cost per hospital day was RMB744 (95% CI 706-781), the out-of-pocket costs per patient were RMB3356 (95% CI 3258-3454) and the reimbursement rate was 56.46% (95% CI 56.08-56.84%). Conclusions Costs per hospitalisation, costs per hospital day and the reimbursement rate were higher for BMISE- than BMISUR-insured in-patients, but BMISE-insured patients had lower out-of-pocket costs. The financial burden was higher for BMISUR- than BMISE-insured in-patients. For BMISUR-insured in-patients, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursements to meet the health needs of in-patients with different income levels. What is known about the topic? Cardiovascular and cerebrovascular diseases are major non-communicable diseases affecting the health of the Chinese population. The China Health Statistics Yearbook (2013) reported that across all in-patients, 195million (5.82%) had been discharged with a diagnosis of cerebrovascular disease. Of these, 118million had IS, accounting for 60.51% of all in-patients with cerebrovascular disease and 54.97% of hospitalisation costs for all cerebrovascular disease in-patients. After the two basic insurance systems, namely the BMISE and BMISUR, had been established, the out-of-pocket expenses for patients were reduced. However, to date there have been no studies investigating how the different types of health insurance (i.e. the BMISE and the BMISUR) affected the costs of treatment of IS in-patients in China. What does this paper add? This paper reports the direct costs for patients diagnosed with IS based on data supplied by the CHIRA. Direct hospitalisation costs depending on the type of insurance cover, age and gender were also evaluated. What are the implications for practitioners? The present study found that the personal financial burden of disease treatment was higher for in-patients insured under the BMISUR than BMISE. For in-patients insured under the BMISUR, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursement rates to meet the health needs of patients with different incomes.

European Reference Networks and its inspiration for China′s healthcare alliances / 中华医院管理杂志

Introduced in the paper is the profile of the European Reference Networks(ERNs) which were established to cope with rare diseases, complicated diseases, low incidence diseases and those of high costs. ERNs are valuable for the healthcare alliances to be built in China, in terms of objectives, tasks and mechanisms. It also presents policy references for improvement of the health service system, rational allocation of medical resources and better medical competence in China.

Application of TOPSIS Method in the Assessment of TCM Appropriate Technology ;Packages / 中国中医药信息杂志

Objective To evaluate the promotional effectiveness of different TCM appropriate technology packages; To provide a scientific basis for improving the technology package. Methods 8 assessment indexes, including input costs, the number of experts, the number of people with senior professional post, the number of grassroots people under the guidance of experts, the number of training hours, the number of people receiving training, evaluating rate and the number of users were selected. TOPSIS method was used to evaluate the promotional effectiveness of five kinds of TCM packages in grassroots. Results The Ci values for appropriate technology packages were 0.76 for pains in neck, shoulder, waist and lower extremities, 0.49 for gynecological diseases, 0.44 for infantile diarrhea, 0.66 for chronic gastropathy, and 0.00 for tumors. Conclusion The effectiveness of promotion of TCM appropriate technology packages from high to low is pains in neck, shoulder, waist and lower extremities package, chronic gastropathy package, gynecological diseases package, infantile diarrhea package, tumors package.

Effect of intermittent hypoxia on neuronal apoptosis and inducible nitric oxide synthase expression in rat hippocampus / 中华老年医学杂志

Objective To investigate the effect of intermittent hypoxia on neuronal apoptosis and inducible nitric oxide synthase (iNOS) expression in rat hippocampus,in order to explore the potential mechanism of hippocampal neuronal apoptosis induced by intermittent hypoxia.Methods Twenty-four Wistar male rats (280-350 g) were randomly divided into three groups:the normal control,intermittent normoxia and intermittent hypoxia group (n=8 each).The animal model of intermittent hypoxia was established by an automated nitrogen/oxygen profile system.The three groups were respectively exposed to continuous normoxia (21 ％O2),cyclical normoxia (21 ％O2),and cyclical hypoxia [alternating between normoxia (21 ％ O2) and hypoxia (5 ％ O2),every 120 seconds] throughout the eight hours of light time(8:00-16:00).The rats were dissected and the hippocampus was removed at the end of the designated duration of exposures for six weeks.TdT-mediated dUTP nick end labeling (TUNEL) was used to detect the apoptotic rate of the hippocampus region in each group.Reverse transcription-PCR,immunohistochemistry (IHC) and Western blotting were used to examine mRNA and protein expressions of iNOS in the hippocampus tissue.Results The apoptotic rate of hippocampal neurons was higher in intermittent hypoxia group than in intermittent normoxia group [(28.236±0.081) ％ vs.(9.341±0.026)％,P＜0.05].The mRNA and protein expressions of iNOS were higher in intermittent hypoxia group than in intermittent normoxia group (3.394± 1.344 vs.0.125±0.040,7.793±0.052 vs.1.356±0.039,both P＜0.05].Conclusions Intermittent hypoxia can induce hippocampal neuronal apoptosis in rats,accompanied by the upregulation of iNOS gene transcription and protein expression,which indicates that iNOS may involve in the process of hippocampal neuronal apoptosis induced by intermittent hypoxia.

Study of national natural science foundation investment of traditional Chinese medicine R & D in common illnesses / 国际中医中药杂志

Objective Study the National Natural Science Foundation investment of traditional Chinese Medicine R&D investment in common illnesses to understand the total investment as well as researching areas, agency and disease. Methods Filtered research data of common illnesses from National Natural Science Foundation website database with keywords. Quantitative analysis was made with the obtained data. Results National Natural Science Foundation of China invested a total of more than 50 million RMB in common illness R&D, of which nearly 400 million RMB was invested to traditional Chinese medicine. Cancer R&D investment was the highest, bone diseases R&D investment was less than 0.1% of the total investment. Conclusion Total investment in common illness increased year by year, but the investment in traditional Chinese medicine ratio was still low.

Cost of chronic hepatitis B infection in China.

GOALS: The objective of this study was to estimate the direct medical costs associated with the treatment of chronic hepatitis B (CHB) infection and its complications in China. BACKGROUND: CHB infection is a major health problem in China, with an estimated 112 million chronic carriers. However, the economic burden associated with CHB and its complications has not been well characterized. STUDY: A retrospective analysis of the medical records of a sample of patients with CHB from Beijing, China was conducted. The utilization and costs were estimated for four illness stages associated with CHB (CHB infection, compensated cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma). Annual utilization and costs were estimated for inpatient, outpatient, and medications for each illness stage and valued in year 2002 U.S. dollars (currency conversion was based on a 2002 exchange rate of 8.271 Chinese Yuan Renminbi = U.S. 1 dollar). RESULTS: A total of 837 patients were identified for inclusion in the study. The average annual treatment costs per person were as follows: CHB, US 142 dollars; compensated cirrhosis, US 185 dollars; decompensated cirrhosis, US 1702 dollars; and hepatocellular carcinoma, US 4741 dollars. CONCLUSIONS: The results from this analysis provide estimates of the costs associated with CHB and its complications in China and show that progression of the disease is associated with increasing healthcare costs. These estimates can be used to evaluate the cost-effectiveness of intervention.