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Research on 2041 Cases of High Inpatient Expenditure and Influence Factors during 3 Years in a Single Center

Chinese medical Journal 2016年第19期129卷 2325-2330页

作者： Suo-Wei Wu Qi Pan Chao Li Qin Wang Jing-Chen Song Tong Chen Department of medical Administration Beijing Hospital Beijing 100730 China

Background：The study was to explore the causes of high inpatient expenditure through analyzing the distribution characteristics as well as the influence factors of high inpatient expenditure cases during 3 years within a Grade-A tertiary hospital through various aspects and multiple angles,thus identifying the major influence factors for high medical expenditure to develop further research.Methods：We retrospectively studied 204l inpatient cases which cost more than RMB 100,000 Yuan per case in a Grade-A tertiary hospital from 2013 to 2015.We analyzed the compositions of the medical cost to evaluate the major factors that cause the high inpatient expenditure.All the data and materials were collected from medical record system,and the statistical methods included t-test,variance of analysis,and multivariate linear regression.Results：The average cost of the 2,041 cases was RMB 152,173 Yuan for medicines and materials of medical costs,which respectively accounted for 33.03% and 32.32% of the total cost;and the average length of hospital stay was 28.39 days/person.Diseases of skeletal and muscular system,circulatory system,and tumor were the top three disease categories of high inpatient expenditure,which accounted for 39.00%,33.46%,and 18.03%,respectively.Complications,criticality of the disease,gender of the patients,the occurrence of death,and the excessive length of hospital stay all had great impacts on average medical expenditure,while age,hospital infection,and surgery showed no significant impact on average medical cost.Conclusions：The main factors for high inpatient expenditure included the inadequate use of high-value medicines and materials,lacking cost control measures within the hospital,the excessive length of hospital stay for inpatients,and the unnecessary treatment for the patients.

关键词： High Inpatient Expenditure Influence Factors medical cost

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Multi-source financing for tuberculosis treatment in China: key issues and challenges

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Infectious Diseases of Poverty 2021年第2期10卷 44-49页

作者： Qian Long Wei-Xi Jiang Hui Zhang Jun Cheng Sheng-LanTang Wei-Bing Wang Global Health Research Center Duke Kunshan UniversityJiangsuChina National Center for Tuberculosis Control and Prevention China CDCBeijingChina Duke Global Health Institute Duke UniversityDurhamNCUSA. Department of Epidemiology School of Public Health&Key Laboratory of Public Health Safety(Ministry of Education)Fudan University138 Vi Xue Yuan RoadShanghai 200032China.

Background:The End Tuberculosis(TB)Strategy of the World Health Organization highlights the need for patientcentered care and social protection measures that alleviate the financial hardships faced by many TB patients.In China,TB treatments are paid for by earmarked government funds,social health insurance,medical assistance for the poor,and out-of-pocket payments from patients.As part of Phase III of the China-Gates TB project,this paper introduces multi-source financing ofTB treatment in the three provinces of China and analyzes the challenges of moving towards universal coverage and its implications of multi-sectoral engagement for TB care.Main text:The new financing policies forTB treatment in the three provinces include increased reimbursement forTB outpatient care,linkage ofTB treatment with local poverty alleviation programs,and use of local government funds to cover some costs to reduce out-of-pocket expenses.However,there are several challenges in reducing the financial burdens faced byTB patients.First,medical costs must be contained by reducing the profit-maximizing behaviors of hospitals.Second,treatment forTB and multi-drug resistant TB(MDR-TB)is only available at county hospitals and city or provincial hospitals,respectively,and these hospitals have low reimbursement rates and high co-payments.Third,many patients with TB and MDR-TB are at the edge of poverty,and therefore ineligible for medical assistance,which targets extremely poor individuals.In addition,the local governments of less developed provinces often face fiscal difficulties,making it challenging to use of local government funds to provide financial support for TB patients.We suggest that stakeholders at multiple sectors should engage in transparent and responsive communications,coordinate policy developments,and integrate resources to improve the integration of social protection schemes.Conclusions:The Chinese government is examining the establishment of multi-source financing forTB treatment by mobilization of funds from the government

关键词： Tuberculosis medical cost Financial protection Universal health coverage Multi-sector engagement China

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Minimally invasive surgery alone compared with intensity-modulated radiotherapy for primary stage I nasopharyngeal carcinoma

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Cancer Communications 2019年第1期39卷 634-644页

作者： You-Ping Liu Xing Lv Xiong Zou Yi-Jun Hua Rui You Qi Yang Le Xia Shao-Yan Guo Wen Hu Meng-Xia Zhang Si-Yuan Chen Mei Lin Yu-Long Xie Li-Zhi Liu Rui Sun Pei-Yu Huang Wei Fan Xiang Guo Ming-Huang Hong Ming-Yuan Chen Department of Nasopharyngeal Carcinoma Sun Yat-sen University Cancer Center651 Dongfeng East RoadGuangzhou 510060GuangdongP.R.China State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapySun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of medical Imaging and Interventional Radiology Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Nuclear Medicine Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Clinical Trials Center Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China

Background:The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy(IMRT)as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma(NPC),but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients.Endoscopic nasopharyngectomy(ENPG)was successfully applied in recurrent NPC with radiation free and relatively low medical costs.In this study,we examined whether ENPG could be an effective treatment for localized stage I NPC.Methods:Ten newly diagnosed localized stage I NPC patients voluntarily received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center.Simultaneously,the data of 329 stage I NPC patients treated with IMRT were collected and used as a reference cohort.The survival outcomes,quality of life(QOL),and medical costs between two groups were compared.Results:After a median follow-up of 59.0 months(95%CI 53.4-64.6),no death,locoregional recurrence,or distant metastasis was observed in the 10 patients treated with ENPG.The 5-year overall survival,local relapse-free survival,regional relapse-free survival,and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients(100%vs.99.1%,100%vs.97.7%,100%vs.99.0%,100%vs.97.4%,respectively,P>0.05).In addition,compared with IMRT,ENPG was associated with decreased total medical costs($4090.42±1502.65 vs.$12620.88±4242.65,Pmedical costs,and satisfactory QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refused radiotherapy.However,the application of ENPG should be prudent,and prospective clinical tri-als were needed to further verify the results.

关键词： Nasopharyngeal carcinoma Localized Early stage Endoscopic nasopharyngectomy Intensity-modulated radiotherapy Survival medical cost Quality of life

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medical Resource Utilizations and Economic Burden in Chinese Cancer Patients with Chemotherapy-induced Anemia:A Populational Database Study

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Chinese Journal of Cancer Research 2008年第4期20卷 307-315页

作者：刘介宇刘沧梧刘季鑫萧金福陈立宗 Department of Nursing Taipei College of Nursing Division of Biostatistics and Bioinformatics Taiwan Health Research Institutes Institute of Cancer Research Taiwan Health Research Institutes

Objective： Most of published studies emphasized the medical cost of treating chemotherapy-induced anemia （CIA） by using specific agents, for example, epoetin α, epoetin β, darbepoetin α or combined with red blood cell transfusions, however, the investigation of the overall medical resources utilizations and economic burden of CIA is still limited. Besides, such studies which emphasized Chinese population still lack. The aim of this study is to investigate the medical resource utilization and the economic burden of Chinese cancer patients with CIA by using a populational representative claim database. Methods： The data for this study are from the 2000-2003 Population Health Insurance Research Database （PHIRD） in Taiwan. On the basis of issuing catastrophic illness cards in the enrollment data files, a total of 26,053 beneficiaries were identified from the PHIRD, who were newly diagnosed with these four cancers in 2001 and 2002 （2001： n=12,954; 2002： n=13099）. A generalized linear model （GLM） was employed for analyzing the differences of medical resource utilization and economic burden between the anemic and non-anemic groups. Results： Analyses showed that the anemic patients were significantly more likely to have longer length of hospital stay than non-anemic patients （P〈0.05） across all these four cancers and in two study periods （except women breast cancer in 2002/03）. As regards the health care expenditures, the average one-year total medical cost was USD$8,982 （2001/02） and USD$8,990 （2002/03） for anemic patients among these four cancers, and USD$7,769 （2001/02） and USD$7713 （2002/03） for non-anemic patients （P〈0.0001）. As for ambulatory costs, anemic patients＇ was significantly higher than non-anemic patients＇ for lung cancer （in 2001/02）, women breast cancer （in 2001/02 and 2002103） and the summarized data （in 2001/02）. As for inpatient costs, anemic patients＇ was significantly higher than non-anemic patients＇ for gastric cancer （in 2002/03）, colon and rectal cancer （in 2001/02 and 2002/03）, lung cancer （in

关键词： Economic burden medical cost Cancer Chemotherapy Anemia

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城乡失能老人照料成本研究

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社会保障制度 2018年第1期

作者：沙莎周蕾

基于多状态生命表方式，使用中国老年健康长寿2008-2012年纵向调查数据，将我国失能老人照料成本分为直接成本、机会成本和医疗成本，重点关注机会成本，设计出高、中、低三种机会成本方案，对我国城乡失能老人余生照料成本做出估算。... 详细信息

基于多状态生命表方式，使用中国老年健康长寿2008-2012年纵向调查数据，将我国失能老人照料成本分为直接成本、机会成本和医疗成本，重点关注机会成本，设计出高、中、低三种机会成本方案，对我国城乡失能老人余生照料成本做出估算。根据城乡失能老人照料成本特征与规律，建立和完善老年长期护理保险制度、开展针对老年照料提供者的帮助计划是解决城乡失能老人照料的根本路径。

关键词：失能老人直接成本机会成本医疗成本　　disabled elderly direct cost opportunity cost medical cost

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