Effects of a Diagnosis-Related Group Payment Reform on Length and Costs of Hospitalization in Sichuan, China: A Synthetic Control Study.

Background: Diagnosis-related group (DRG) payment policies are increasingly recognized as crucial instruments for addressing health care overprovision and escalating health care costs. The synthetic control method (SCM) has emerged as a robust tool for evaluating the efficacy of health policies worldwide. Methods: This study focused on Panzhihua city in Sichuan Province, a pilot city for DRG payment reform implementation, serving as the treatment group. In contrast, 20 nonpilot cities within the province were utilized as potential control units. A counterfactual control group was constructed to evaluate the changes in average inpatient stay duration and health care organization costs following the DRG payment reform initiated in 2018. Results: Focusing on Panzhihua, Sichuan Province, the analysis reveals that following the reform in March 2018, the average length of hospital stay in Panzhihua decreased by 1.35 days during 2019-2021. Additionally, the average cost per hospitalization dropped by 855.48 RMB, the average cost of medication per hospitalization decreased by 68.51 RMB, and the average cost of diagnostic and therapeutic procedures per hospitalization declined by 136.37 RMB. While global evidence backs DRGs for efficiency and cost reduction, challenges persist in addressing emerging issues like new conditions. Conclusion: Since its introduction in 2018, the DRG payment reform in Sichuan Province has effectively reduced both the duration of hospital stays and the operational costs of health care facilities. However, potential drawbacks include compromised service quality and an elevated risk of patient readmission, indicating a need for further refinement in the implementation of DRG payment reforms in China.

Health literacy and self-management among middle-aged and young hypertensive patients: a parallel mediation effect of illness perception and self-efficacy.

Background: Hypertension is increasingly prevalent among young and middle-aged populations in rural China, accompanied by suboptimal self-management. Given that this population forms the backbone of the labor force, enhancing their self-management capabilities is crucial for improving overall population health. Studies indicate that individuals with good health literacy are more likely to effectively manage their health. Methods: Grounded in the health literacy skills framework, a model was constructed in this study to examine the impact of health literacy on self-management among young and middle-aged hypertensive patients in rural China. Meanwhile, the mediating roles of illness perception and self-efficacy were also verified. Using a multi-stage stratified random sampling method, 338 patients were recruited to participate in the study. Structural equation modeling was utilized to establish the relationship model, and bootstrap tests were carried out to examine the mediating effects. Results: The average self-management score was 70.45 ± 11.36. Health literacy exhibited a positive correlation with self-management (standardized ß = 0.372, p < 0.001). The mediating effects through illness perception and self-efficacy were 0.040 and 0.236, constituting 6.68 and 39.31% of the total effect, respectively. Conclusion: Illness perception and self-efficacy serve as parallel mediators amid the association between health literacy and self-management. Implementing psychological counseling and health education is imperative for augmenting self-management competence and cultivating an adaptive coping mentality.

Performance of Spodoptera litura (Lepidoptera: Noctuidae) in responses to different amplitudes of alternating temperatures across permissive warm temperature regimes.

Climate change involves changes in the pattern of temperature fluctuations and the frequency and magnitude of thermal extremes. It is essential to investigate how insects respond to increased temperature variations, especially for species that usually experience diel temperature variations extending to thermal performance limits. To explicitly elucidate the effects of sizes of amplitudes of temperature variations, we used daily alternating temperatures with an equivalent mean of 28 °C to investigate the impact of different fluctuation amplitudes (±â€…0 °C,  ±â€…2 °C,  ±â€…4 °C, and  ±â€…6 °C) across permissive temperature regimes on the performance of Spodoptera lituraFabricius, a highly destructive polyphagous pest of crops and vegetables in tropical and temperate climates. Amplitudes of temperature fluctuations significantly affected developmental durations, adult life spans, pupal weights, fecundity, and fertility of S. litura. The survival rates from the egg stage to the adult eclosion did not differ significantly across different temperature treatments. The developmental durations of individual life cycles significantly increased with larger amplitudes in 3 fluctuating temperature treatments. The pupal weight was significantly lower and the adult life span was significantly shorter in the ±â€…6 °C treatment in all treatments. Fecundity and fertility were significantly reduced in the ±â€…6 °C treatment, making the continuation of generations nearly impossible. The results should provide critical information for understanding the ecology of this widespread pest under diel, seasonal, and global climate changes.