Does supplemental private health insurance impact health care utilization and seeking behavior of residents covered by social health insurance? Evidence from China National Health Services Survey.

BACKGROUND: Supplemental private health insurance (PHI) plays a crucial role in complementing China's social health insurance (SHI). However, the effectiveness of incorporating PHI as supplementary coverage lacks conclusive evidence regarding its impact on healthcare utilization and seeking behavior among SHI-covered individuals. Therefore, investigating the effects of supplementary PHI on health care utilization and seeking behavior of residents covered by social health insurance is essential to provide empirical evidence for informed decision-making within the Chinese healthcare system. METHODS: Data from the 2018 China National Health Services Survey were analyzed to compare outpatient and inpatient healthcare utilization and choices between PHI purchasers and non-purchasers across three SHI schemes: urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), and the new rural cooperative medical scheme (NRCMS). Using the Andersen Healthcare Services Utilization Behavior Model as the theoretical framework,binary logistic regression and multinomial logistic regression (MNL) models were employed to assess the impact of PHI on healthcare utilization and provider preferences. RESULTS: Among UEBMI, URBMI, and NRCMS participants with PHI, outpatient visit rates were 17.9, 19.8, and 21.7%, and inpatient admission rates were 12.4, 9.9, and 12.9%, respectively. Participants without PHI exhibited higher rates for outpatient visits (23.6, 24.3, and 25.6%) and inpatient admissions (15.2, 12.8, and 14.5%). Binomial logistic regression analyses revealed a higher probability of outpatient visits and inpatient admissions among UEBMI participants with PHI (p < 0.05). NRCMS participants with PHI showed a lower probability of outpatient visits but a higher probability of inpatient admissions (p < 0.05). Multinomial logistic regression indicated that NRCMS participants with PHI were more likely to choose higher-level hospitals, with a 17% increase for county hospitals and 27% for provincial or higher-level hospitals compared to primary care facilities. CONCLUSION: The findings indicate that the possession of PHI correlated with increased utilization of outpatient and inpatient healthcare services among participants covered by UEBMI. Moreover, for participants under the NRCMS, the presence of PHI is linked to a proclivity for seeking outpatient care at higher-level hospitals and heightened utilization of inpatient services. These results underscore the nuanced influence of supplementary PHI on healthcare-seeking behavior, emphasizing variations across individuals covered by distinct SHI schemes.

Case fatality rates of COVID-19 during epidemic periods of variants of concern: A meta-analysis by continents.

OBJECTIVES: To calculate the case fatality rates (CFR) of COVID-19 during epidemic periods of different variants of concern (VOC) by continents. METHODS: We systematically searched five authoritative databases (Web of Science, PubMed, Embase, Cochrane Library, and MedRxiv) for epidemiological studies on the CFR of COVID-19 published between January 1, 2020, and March 31, 2023. After identifying the epidemic trends of variants, we used a random-effects model to calculate the pooled CFRs during periods of different VOCs. This meta-analysis was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with PROSPERO (CRD42023431572). RESULTS: There were variations in the CFRs among different variants of COVID-19 (Alpha: 2.62%, Beta: 4.19%, Gamma: 3.60%, Delta: 2.01%, Omicron: 0.70%), and disparities in CFRs also existed among continents. On the whole, the CFRs of COVID-19 in Europe and Oceania were slightly lower than in other continents. There was a statistically significant association between the variant, HDI value, age distribution, coverage of full vaccination of cases, and the CFR. CONCLUSIONS: The CFRs of COVID-19 varied across the epidemic periods of different VOCs, and disparities existed among continents. The CFR value reflected combined effects of various factors within a certain context. Caution should be exercised when comparing CFRs due to disparities in testing capabilities and age distribution among countries, etc.

Improvement of Cancer Prevention and Control: Reflection on the Role of Emerging Information Technologies.

Cancer has become an important public health problem affecting the health of Chinese residents, as well as residents all over the world. With the improvement of cancer prevention and treatment, the growth of the mortality rate of cancers has slowed down gradually, but the incidence rate is still increasing rapidly, and cancers still impose heavy disease and economic burdens. Cancer screening and early cancer diagnosis and treatment are important ways to reduce the burden of cancer-related diseases. At present, various projects for early cancer diagnosis and treatment have been implemented in China. With the expansion of the coverage of these projects, the problems related to project implementation, operation, and management have emerged gradually. In recent years, emerging information technologies have been applied in the field of health and have facilitated health management and clinical decision-making. Meanwhile, China announced multiple policies to encourage and promote the application of information technologies in the field of health. Therefore, combined with the analysis of major problems in cancer prevention and control projects, this paper probes into how to apply information technologies such as biological information mining, artificial intelligence, and electronic information collection technology to various stages of cancer prevention and control. Information technologies realize the integrated management of prevention and control processes, for example, mobilization and preliminary identification, high-risk assessment, clinical screening, clinical diagnosis and treatment, tracking and follow-up, and biological sample management of high-risk groups, and promote the efficient implementation of cancer prevention and control projects in China.

Prevalence, awareness, treatment, and control of dyslipidemia in Chinese adults: a systematic review and meta-analysis.

Background: Researchers have conducted a considerable number of epidemiological studies on dyslipidemia in China over recent years. Nevertheless, a representative study to comprehensively appraise for the epidemiological status of dyslipidemia is still lacked. This meta-analysis is intended to explore the pooled prevalence, rates of awareness, treatment, and control of dyslipidemia among adults in Chinese Mainland. Materials and methods: A systematic review was performed on relevant cross-sectional studies published since January 2012 by searching six authoritative literature databases. Meta-analyses were conducted in included studies based on a random-effect model to summarize the epidemiological status of dyslipidemia in China. A potential source of heterogeneity was detected by subgroup analysis and meta-regression. Publication bias was assessed by Egger's test and funnel plots. A sensitivity analysis was conducted to examine the study quality's influence on the pooled estimate of prevalence and rates of awareness, treatment, and control. Results: Forty-one original researches with a total of 1,310,402 Chinese participants were finally included in the meta-analysis. The prevalence, rates of awareness, treatment, and control of dyslipidemia were 42.1%, 18.2%, 11.6%, and 5.4%, respectively. With a pooled prevalence estimate at 24.5%, low HDL-C was the most prevalent among various dyslipidemia types, followed by hypertriglyceridemia (TG) (15.4%), hypercholesterolemia (TC) (8.3%), and high LDL-C (7.1%). The pooled prevalence of elevated serum lipoprotein(a) [Lp(a)] was 19.4%. By gender, the prevalence of dyslipidemia was 47.3% in males and 38.8% in females. Subgroup analyses revealed that the prevalence in southern and urban areas were higher than their counterparts. Females and population in urban areas tended to possess higher rates of awareness, treatment, and control. Meta-regression analyses suggested that the year of screening influenced prevalence estimates for dyslipidemia. The impact of the study's quality on the pooled estimates is insignificant. Conclusion: Our study suggested a severe epidemic situation of dyslipidemia among adults in Chinese Mainland. More importantly, the awareness, treatment, and control rates were extremely low, revealing that dyslipidemia is a grave health issue. Consequently, we should attach more importance to the management of dyslipidemia, especially in economically underdeveloped areas. Systematic review registration: PROSPERO [CRD42022366456].

Comparative analysis of prevention and control measures toward COVID-19 epidemic between Shanghai and Beijing.

Purpose: By serving and providing a guide for other regional places, this study aims to advance and guide the epidemic prevention and control methods, and practices and strengthen people's ability to respond to COVID-19 and other future potential public health risks. Design/methodology/approach: A comparative analysis was conducted that the COVID-19 epidemic development trend and prevention and control effects both in Beijing and Shanghai. In fact, regarding the COVID-19 policy and strategic areas, the differences between governmental, social, and professional management were discussed and explored. To prevent and be ready for potential pandemics, experience and knowledge were used and summarized. Findings: The strong attack of the Omicron variant in early 2022 has posed challenges to epidemic prevention and control practices in many Chinese cities. Shanghai, which had achieved relatively good performance in the fight against the epidemic, has exposed limitations in its epidemic prevention and control system in the face of Omicron. In fact, the city of Beijing has undertaken prompt and severe lockdown measures and achieved rather good results in epidemic prevention and control because of learning from Shanghai's experience and lessons; adhering to the overall concept of "dynamic clearing," implementing precise prevention and monitoring, enhancing community control, and making emergency plans and preparations. All these actions and measures are still essential in the shift from pandemic response to pandemic control. Research limitations/implications: Different places have introduced different urgent policies to control the spread of the pandemic. Strategies to control COVID-19 have often been based on preliminary and limited data and have tended to be slow to evolve as new evidence emerges. Hence, the effects of these anti-epidemic policies need to be further tested.

Understanding the condition of disease prevention and control workforce by disciplines, duties, and work stress during the COVID-19 pandemic: A case from Beijing disease prevention and control system.

Objective: The duties, discipline cross-complementation, and work stress of professional staff during the COVID-19 pandemic are analyzed and summarized to provide a scientific basis for workforce allocation and reserve in respect of infectious disease prevention and control in the disease prevention and control (DPC) system. Method: The cross-sectional survey was made in April-May 2021 on professional staff in the Beijing DPC system by way of typical + cluster sampling. A total of 1,086 staff were surveyed via electronic questionnaire, which was independently designed by the Study Group and involves three dimensions, i.e., General Information, Working Intensity & Satisfaction, and Need for Key Capacity Building. This paper focuses on the former two dimensions: General Information, Working Intensity, and Satisfaction. The information collected is stored in a database built with Microsoft Excel 2010 and analyzed statistically with SPSS 22.0. The results are expressed in absolute quantities and proportions. Assuming that the overload of work stress is brought by incremental duties and cross-discipline tasks, a binary logistic regression model is constructed. Results: Among the 1086 staff surveyed, 1032 staff were engaged in COVID-19 prevention and control works, and they can be roughly divided into two groups by their disciplines: Public Health and Preventive Medicine (hereinafter referred to P, 637 staff, as 61.72%) and Non-Public Health and Preventive Medicine (hereinafter referred to N-P, 395 staff, as 38.28%). During the COVID-19 pandemic, the 1,032 staff assumed a total of 2239 duties, that is, 2.17 per person (PP), or 2.45 PP for the P group and 1.72 PP for the N-P group. As to four categories of duties, i.e., Spot Epidemiological Investigation and Sampling, Information Management and Analysis, On-site Disposal, Prevention, Control Guidance, and Publicity, the P group accounts for 76.14, 78.50, 74.74, and 57.66%, respectively, while the N-P group accounts for 23.86, 21.50, 25.26, and 42.34%, respectively. Obviously, the former proportions are higher than the latter proportions. The situation is the opposite of the Sample Detection and Other Works, where the P group accounts for 25.00 and 31.33%, respectively, while the N-P group accounts for 75.00 and 68.67%, respectively. The analysis of work stress reveals that the P group and N-P group have similar proportions in view of full load work stress, being 48.67 and 50.13%, respectively, and the P group shows a proportion of 34.38% in view of overload work stress, apparently higher than the N-P group (24.05%). Moreover, both groups indicate their work stresses are higher than the pre-COVID-19 period levels. According to the analysis of work stress factors, the duty quantity and cross-discipline tasks are statistically positively correlated with the probability of overload work stress. Conclusion: The front-line staff in the DPC system involved in the COVID-19 prevention and control primarily fall in the category of Public Health and Preventive Medicine discipline. The P group assumes the most duties, and the N-P group serves as an important cross-complement. The study results indicate that the prevention and control of same-scale epidemic require the duty post setting at least twice than usual. As to workforce recruitment, allocation, and reserve in respect of the DPC system, two solutions are optional: less addition of P staff, or more addition of N-P staff. A balance between P and N-P staff that enables the personnel composition to accommodate both routine DPC and unexpected epidemic needs to be further discussed.

Discussion of the Trust in Vaccination against COVID-19.

The COVID-19 pandemic has introduced serious challenges to global public health security, and the benefits of vaccination via public health interventions have been recognized as significant. Vaccination is an effective means of preventing and controlling the spread of COVID-19. However, trust is a major factor that influences vaccine hesitancy; thus, the distrust of vaccination has hindered the popularization of COVID-19 vaccines. This paper aims to discuss the main problems and the role of trust in the vaccination against COVID-19 to effectively promote and implement policy to promote the acceptance of COVID-19 vaccines.

The Running Track of Government Responsibility During the Pandemic, Characteristic Analysis of Policy Documents Relevant to the COVID-19 Pandemic Released by Beijing Municipal Government in 2020.

Objective: Provide a reference point for the division of labor during the collaboration of multiple departments and the planning for the prevention and control of the Covid-19 epidemic of departments of the Beijing Municipal Government, from the perspective of policy documents. Methods: Policy documents and daily updates on COVID-19 cases published in 2020 are taken from the official website of Beijing Municipal Government and Beijing Municipal Health Commission. The characteristics of the pandemic situation and the content of relevant documents issued by different departments are described in five stages. Results: There were 988 confirmed cases of COVID-19 in Beijing in 2020, and policy analysis covered 444 documents (257 policy documents and 187 explanations of policy). A total of 153 policy documents were directly issued by the Beijing Municipal Government and its 45 subordinate commissions and bureaus, while others were policy forwarding from the central government and its relevant departments, county-level governments of Beijing and other organizations. Most cases and documents emerged during the initial stage of the pandemic (Level-I of the Emergency Response, which is the most serious). It was found that as many as 109 documents published by Beijing Municipal Government during the Level I emergency response period were relevant to economic and social development, 83 documents were related to disease control and medical services, and the rest were in close relation to the production and daily life of the people. Overall, major policy measures taken were relevant to 7 fields: finance, transportation, economic activities, employment people's lives, epidemic prevention and control and medical insurance. Policy implementation objectives were centered on promoting epidemic prevention and control and maintaining the stability of social production and residents' life. However, there are different emphases in different stages of the epidemic. Conclusion: Beijing municipality realized an effective mode of collaboration among multiple departments and organizations in the prevention and control of the COVID-19 epidemic, which was an example of the practice of "Health in All Policies."

Medical expenditure for lung cancer in China: a multicenter, hospital-based retrospective survey.

BACKGROUND: Lung cancer is the most prevalent cancer, and the leading cause of cancer-related deaths in China. The aim of this study was to estimate the direct medical expenditure incurred for lung cancer care and analyze the trend therein for the period 2002-2011 using nationally representative data in China METHODS: This study was based on 10-year, multicenter retrospective expenditure data collected from hospital records, covering 15,437 lung cancer patients from 13 provinces diagnosed during the period 2002-2011. All expenditure data were adjusted to 2011 to eliminate the effects of inflation using China's annual consumer price index. RESULTS: The direct medical expenditure for lung cancer care (in 2011) was 39,015 CNY (US$6,041) per case, with an annual growth rate of 7.55% from 2002 to 2011. Drug costs were the highest proportionally in the total medical expenditure (54.27%), followed by treatment expenditure (14.32%) and surgical expenditure (8.10%). Medical expenditures for the disease varied based on region, hospital level, type, and stage. CONCLUSION: The medical expenditure for lung cancer care is substantial in China. Drug costs and laboratory test are the main factors increasing medical costs.

Clinical characteristics, medical service utilization, and expenditure for colorectal cancer in China, 2005 to 2014: Overall design and results from a multicenter retrospective epidemiologic survey.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited. METHODS: Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records. RESULTS: In the full cohort of 8465 patients, the mean ± SD age at diagnosis was 59.3 ± 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan. CONCLUSIONS: The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China.

Collaboration and Cooperation of Public Health Service Management in China.

OBJECTIVES: Collaboration and cooperation are critical for public health management. Nevertheless, collaboration and cooperation between government departments, as well as other entities, are still in a weak condition in China. This article analyzes the status of collaboration and cooperation in the management of public health services in China and explores the problems and gives strategic suggestions for strengthening collaboration and cooperation in the development of public health service systems in China, in order to provide a reference for improvement of public health management in the future. METHODS: This study uses a qualitative case study approach, including documents review, in-depth interview, and focus group. RESULTS: The main problems of collaboration and cooperation in public health service management in China include problems of effective collaboration and cooperation between institutions and relevant departments, public information platform, and implementation of public health and health promotion. On this basis, several relevant policy recommendations are put forward. CONCLUSIONS: Collaboration and cooperation are critical for the overall coordination and sustainable development of public health in China, and there is still work to be done in order to achieve appropriate cooperation and collaboration between different entities in the provision of public health services.

Health-related quality of life of patients with colorectal neoplasms in China: A multicenter cross-sectional survey.

BACKGROUND AND AIM: This study aimed to clarify health-related quality of life (HRQoL) of patients with colorectal precancer and colorectal cancer (CRC) in China and to better understand related utility scores. METHODS: A hospital-based cross-sectional survey was conducted in precancer and CRC patients from 2012 to 2014, covering 12 provinces in China. HRQoL was assessed with EuroQol 5-Dimensions 3-Levels. Utility scores were derived using Chinese value set. A multivariate regression model was established to explore potential predictors of utility scores. RESULTS: A total of 376 precancer (mean age 58.7 years, 61.2% men) and 2470 CRC patients (mean age 58.6 years, 57.6% men) were included. In five dimensions, there was a certain percentage of problem reported among precancer (range: 12.0% to 36.7%) and CRC (range: 32.4% to 50.3%) patients, with pain/discomfort being the most serious dimension. Utility scores of precancer and CRC patients were 0.870 (95% confidence interval [CI], 0.855-0.886) and 0.751 (95% CI, 0.742-0.759), both of which were lower than those of general Chinese population (0.960 [95% CI, 0.960-0.960]). Utilities for patients at stage I to stage IV were 0.742 (95% CI, 0.715-0.769), 0.722 (95% CI, 0.705-0.740), 0.756 (95% CI, 0.741-0.772), and 0.745 (95% CI, 0.742-0.767), respectively. Multivariate analysis showed that therapeutic regimen, time point of the interview, education, occupation, annual household income, and geographic region were associated with utilities of CRC patients. CONCLUSION: Health-related quality of life of both precancer and CRC patients in China declined considerably. Utility scores differed by sociodemographic and clinical characteristics, and findings of these utilities may facilitate implementation of further cost-utility evaluations.

Using a Chinese time trade-off approach to explore the health utility level and quality of life of cancer patients in urban China: a multicentre cross-sectional study.

PURPOSE: A quality of life assessment is useful in identifying a specific health impact on patients who are suffering from various medical conditions. This study estimated the quality of life among patients with cancers of the lungs, breast, colorectum, oesophagus, liver, and stomach in urban China and evaluates the associated factors. METHODS: This study employed a random cluster sampling strategy to recruit patients with lung, breast, colorectal, oesophageal, liver, or stomach cancer from eleven third-grade class-A (the highest level) hospitals in Beijing between October 2013 and May 2014. We performed a quality of life survey that included solicitation of sociodemographic and clinical information and the use of a EuroQoL five-dimension three-level questionnaire. We applied the Chinese time trade-off method to calculate the health utility values, which were transformed into binary variables (using the median as the cut-off). In addition, multivariable logistic regression analysis was used to examine the factors associated with the quality of life. RESULTS: A total of 637 patients (91 with lung cancer, 152 with breast cancer, 60 with colorectal cancer, 108 with oesophageal cancer, 154 with liver cancer, and 72 with stomach cancer) were included in this study; the medians of the health utility values were 0.780, 0.800, 0.800, 0.860, 0.800, and 0.870, respectively. The most common concerns for patients of all six cancer types were pain/discomfort and anxiety/depression. The reported health status of patients was associated with various demographic and clinical variables. CONCLUSION: This study highlighted that pain relief and psychological support are important aspects of patient management for those with these types of cancer. Individuals with factors associated with a poorer quality of life should be targets for additional support.

Outcome Assessment for a Telemedicine-Based Second Opinion Program for Midwest China.

Through an examination of the records of a telemedicine-based second opinion program in county-level hospitals in central and western China, the impact of this service on the diagnosis and treatment of cancer-related diseases was analyzed and evaluated. In this study, all 135 cancer-related cases were included in the analysis. The basic characteristics of the patients were described, the opinions of the original and second diagnosis and treatment were compared, the rate of consistency between them was calculated, the therapeutic regimens were analyzed and the differences between groups were tested. In 94.07% of the cases, the reason for the doctor's request for second opinion service was to assist in the formulation of therapeutic regimen. 64.44% of cases were confirmed with the diagnosis and 17.78% therapeutic regimen by the second opinion service. 126 cases obtained improved therapeutic regimens, and there were statistically significant differences in treatment methods in the diagnosis changed group. Comparing with other international SO studies, the diagnostic consistency rate obtained in this study was lower but not the lowest. The therapeutic consistency rate was quite low, due to the high proportion of original therapeutic regimens missing. This telemedicine-based second opinion program has brought beneficial improvements to the diagnosis and treatment of cancer-related diseases in county-level hospitals in central and western China.

Health-related quality of life in patients with esophageal cancer or precancerous lesions assessed by EQ-5D: A multicenter cross-sectional study.

BACKGROUND: We aimed to obtain a set of health state utility scores of patients with esophageal cancer (EC) and precancerous lesions in China, and to explore the influencing factors of health-related quality of life (HRQoL). METHODS: A hospital-based multicenter cross-sectional study was conducted. From 2013 to 2014, patients with EC or precancerous lesions were enrolled. HRQoL was assessed using a European quality of life-5 dimension (EQ-5D-3L) instrument. Multivariable linear regression analysis was performed to explore the influencing factors of the EQ-5D utility scores. RESULTS: A total of 2090 EC patients and 156 precancer patients were included in the study. The dimension of pain/discomfort had the highest rate of self-reported problems, 60.5% in EC and 51.3% in precancer patients. The mean visual analog scale (VAS) score for EC and precancer patients were 68.4 ± 0.7 and 64.5 ± 3.1, respectively. The EQ-5D utility scores for EC and precancer patients were estimated as 0.748 ± 0.009 and 0.852 ± 0.022, and the scores of EC at stage I, stage II, stage III, and stage IV were 0.693 ± 0.031, 0.747 ± 0.014, 0.762 ± 0.015, and 0.750 ± 0.023, respectively. According to the multivariable analyses, the factors of region, occupation, household income in 2012, health care insurance type, pathological type, type of therapy, and time points of the survey were statistically associated with the EQ-5D utility scores of EC patients. CONCLUSIONS: There were remarkable decrements of utility scores among esophageal cancer patients, compared with precancer patients. The specific utility scores of EC would support further cost-utility analysis in populations in China.

Medical expenditures for colorectal cancer diagnosis and treatment: A 10-year high-level-hospital-based multicenter retrospective survey in China, 2002-2011.

OBJECTIVE: Colorectal cancer (CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China. METHODS: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan (CNY) using 2011 values. RESULTS: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stage-I cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval (95% CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011 (P for trend <0.001), with a cumulative increase of 2.4 times (from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages I, II, III and IV were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively (P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion (52.6%). CONCLUSIONS: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.

Short-term impact of breast cancer screening intervention on health-related quality of life in China: A multicentre cross-sectional survey.

OBJECTIVE: The impact of participating in breast cancer screening programmes on health-related quality of life (HRQoL)is poorly understood. METHODS: Based on a national breast cancer screening programme in China, a multicentre cross-sectional survey was conducted covering 12 provinces from September 2013 to December 2014. HRQoL of participants in the screening population and general population was evaluated by the three-levelEuroQol-five-Dimensions (EQ-5D-3L) instrument, and utility scores were generated through the Chinese value set. Univariate and multivariate regression analyses were performed to explore determinants of utility scores and anxiety/depression problems. RESULTS: For screening group and general population (n = 4756, mean age = 51.6 year old), the corresponding utility scores were 0.937 (95% CI, 0.933-0.941) and 0.953 (0.949-0.957) (P < .001). Pain/discomfort and anxiety/depression were the most common reported in both groups (51.4% and 34.3%, P < .001). Utility scores at prescreening, in-screening, and postscreening interview timings were 0.928 (0.921-0.935), 0.958 (0.948-0.969), and 0.938 (0.933-0.943), respectively (P < .001); the corresponding proportions of anxiety/depression reporting were 25.9%, 16.3%, and 21.1%, respectively (P = .004). Interview timing, geographical region, and insurance status were associated with HRQoL and anxiety/depression in women at high-risk of breast cancer. CONCLUSIONS: Utility scores of screening participants were significantly lower than that of general population in China, but the difference may be clinically insignificant. Further cohort studies using HRQoL measurements are needed.

Cost-utility analysis of screening for colorectal precancerous lesions and cancer in Beijing: A case-control study.

OBJECTIVE: To provide an objective cost-utility evaluation of a colorectal cancer screening program in a hypothetical general population. MATERIALS AND METHODS: A cost-utility analysis was conducted comparing screened individuals with the general population. Patients were evaluated as part of the screening program which conducted colorectal cancer risk assessments and performed colonoscopies from October 2012 to May 2013. Data were compared to a hypothetical group of the same size, consisting of the general population in which no cancer screening had been conducted. The cost and utility data have been published previously. RESULTS: The average cost per quality-adjusted life year (QALY) of colorectal cancer screening population was 84,092 CNY, while the average cost per QALY of the general population was 122,530 CNY. The colorectal cancer screening program saved 43,530 CNY per additional QALY. CONCLUSION: The colorectal cancer screening program could improve health-related quality of life and reduce medical expenditure.

Studying Communication Problems for Emergency Management of SARS and H7N9 in China.

BACKGROUND: Severe Acute Respiratory Syndrome (SARS) and Influenza A virus Subtype H7N9 (H7N9) have both had a great impact on China in the 21st century, causing significant negative impacts on health, the economy, and even global security. The control efforts for SARS were heavily criticized, the H7N9 response, 10 years later was acknowledged to be much better. AIMS: This article explores communication for emergency management of SARS in 2003 and H7N9 in 2013 in China, to provide useful evidence for government and practitioner on management improvement for infectious disease outbreaks response in China and international community in the future. METHODS: This study uses a qualitative case study approach, including in-depth interviews, literature review, and document, to analysis the emergency management of SARS in 2003 and H7N9 in 2013 in China, identified the problems of communication with the emergency management process for SARS and H7N9. RESULTS: The control efforts for SARS were slow to be mobilized and were heavily criticized and generally considered to be suboptimal, as the poor handling of SARS exposed serious communication problems in the then emergency management system processes. The H7N9 response, 10 years later, was acknowledged to be much better. CONCLUSION: Communication is very important in the prevention and control of infectious diseases. From SARS to H7N9, the progress had been made in information disclosure.