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expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China:a hospital.based,multicenter,cross-sectional survey

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Chinese Journal of Cancer 2017年第8期36卷 352-366页

作者： Hui-Yao Huang Ju-Fang Shi Lan-Wei Guo Ya-Na Bai Xian-Zhen Liao Guo-iangLiu A-Yan Mao Jian-Song Ren Xiao-Jie Sun Xin-Yu Zhu Le Wang Bing-Bing Song Ling-Bin Du Lin Zhu Ji-Yong Gong Qi Zhou Yu-Qin Liu Rong Cao Ling Mai Li Lan Xiao-Hua Sun Ying Ren Jin-Yi Zhou Yuan-Zheng Wang Xiao Qi Pei-An Lou Dian Shi Ni Li Kai Zhang Jie He Min Dai Program Office for Cancer Screening in Urban China National Cancer Center/Cancer HospitalChinese Academy of Medical SciencesPeking Union Medical College17 South Panjiayuan LaneChaoyang DistrictBeijing 100021P.R.China Department of Cancer Epidemiology Henan Cancer HospitalAffiliated Cancer Hospital of Zhengzhou UniversityZhengzhouHenan 450008P.R.China Institute of Epidemiology and Health Statistics Lanzhou UniversityLanzhouGansu 730000P.R.China Hunan Office for Cancer Control and Research Hunan Provincial Cancer HospitalChangshaHunan 410006P.R.China Department of Health Economics School of Health ManagementHarbin Medical UniversityHarbinHeilongjiang 150081P.R.China Public Health Information Research Office Institute of Medical InformationChinese Academy of Medical SciencesBeijing 100020P.R.China Center for Health Management and Policy Key Lab of Health Economics and PolicyShandong UniversityJinanShandong 250012P.R.China Heilongjiang Office for Cancer Control and Research Affiliated Cancer Hospital of Harbin Medical UniversityHarbinHeilongjiang 150081P.R.China Zhejiang Office for Cancer Control and Research Zhejiang Cancer HospitalHangzhouZhejiang 310022P.R.China Teaching and Research Department Affiliated Cancer Hospital of Xinjiang Medical UniversityürümqiXinjiang 830011P.R.China Science and Education Department of Public Health Division Shandong Tumor HospitalJinanShandong 250117P.R.China Chongqing Office for Cancer Control and Research Chongqing Cancer HospitalChongqing 400030P.R.China Cancer Epidemiology Research Center Gansu Provincial Cancer HospitalLanzhouGansu 730050P.R.China Department of Health Policy and Economic Research Guangdong Provincial Institute of Public HealthGuangzhouGuangdong 511430P.R.China Department of Institute of Tumor Research Henan Cancer HospitalAffiliated Cancer Hospital of Zhengzhou UniversityZhengzhouHenan 450008P.R.China Institute of Chronic Disease Prevention and Control Harbin Center for Disease Control and PreventionHarbinHei

Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan(CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup(hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1 % of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3%of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups(P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,w

关键词： Colorectal neoplasms Direct expenditure Financial burden China

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expenditure of hospital care on cancer in China, from 2011 to 2015

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Chinese Journal of Cancer Research 2017年第3期29卷 253-262页

作者： Yue Cai Ming Xue Wanqing Chen Maogui Hu Zhiwen Miao Lan Lan Rongshou Zheng Qun Meng Center for Health Statistics and Information National Health and Family Planning Commission National Central Cancer Registry National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College State Key Laboratory of Resources and Environmental Information System Institute of Geographic Sciences and Natural Resources Research Chinese Academy of Sciences West China School of Public Health Sichuan University

Objective: A solid understanding of levels and trends of spending on cancer is important to evaluate whether our healthcare resources were wisely spent and to prioritize future resources for cancer treatment and prevention. However, studies on economic burden of cancers in China are scant and the results are inconsistent. Methods: The Chinese hospital information database and nearly 350 million inpatient medical record data were used. As the ratios of cancer inpatient payments to total inpatient payments were mainly influenced by the grades and sites of hospitals, the estimates of payments of cancer inpatients in this study were stratified by hospital grades and provinces. Only the payments of cancer inpatients happened in grade 2, grade 3 and specialized cancer hospitals were included in the analyses. The total medical payments of cancers in China were estimated based on the ratios of outpatient payments to inpatient payments in specialized cancer hospitals. Results: From 2011 to 2015, the payments of cancer inpatients in China have increased by 84.1% and the total inpatient payments reached 177.1 billion RMB in 2015, accounting for 4.3% of the total health expenditure in China. Based on the ratio of outpatient payments to inpatient payments, the total payments on cancer treatments in China were estimated to be 221.4 billion RMB in 2015. Among different cancer types, the highest payments were the treatment of trachea, bronchus and lung cancer. The major cancer inpatient payments (67.1% in 2015) spent in grade 3 general hospitals and this ratio increased continually from 2011 to 2015. The expenditure of cancer treatments also varies by region with the major expenditure in the eastern region of China. Conclusions: This study estimated the total payments of cancer treatments in China and analyzed how the money was spent on cancer treatments in the recent 5 years, which would provide information for decision makings on the allocation of resources to service provisioning, prevention strategies, research funding, and

关键词： Cancer payments expenditure economic burden

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Contemporary trends on expenditure of hospital care on total cancer and its subtypes in China during 2008-2017

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Chinese Journal of Cancer Research 2021年第5期33卷 627-636页

作者： Yue Cai Wanqing Chen Xiaoxu Wang Xue Xia Xiang Cui Shiyong Wu Jinghua Li School of Public Health Jilin UniversityChangchun 130021China Center for Health Statistics and Information National Health CommissionBeijing 100044China Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Epidemiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

Objective:To describe the contemporary trends in total,inpatient,and outpatient expenditure on major subtypes of cancer in different classifications of hospitals in China's Mainland.Methods:Home page of Inpatient Medical Records(HIMRs)and Hospital Annual Reports(HARs)were used to estimate hospital care expenditure on cancer.Inpatient payments and their share of cancer were calculated with the top-down method.Kriging spatial interpolation methods were used at the county level and summed at the province level.Outpatient expenditure was estimated with inpatient expenditure and the ratios of outpatient to inpatient payments in specialized cancer hospitals,stratified by province.Total expenditure on cancer was the sum of both payments.Log-linear regression was applied to estimate annual percentage change(APC)of expenditure.Results:Total expenses for cancer of Chinese residents reached up to 304.84 billion Chinese Yuan(CNY)in2017,accounting for 5.8%of the total health expenses(THE).After adjusting for consumer price index(CPI),medical expenses for cancer have increased from 63.30 billion CNY in 2008 to 249.56 billion CNY in 2017[APC:15.2%,95%confidence interval(95%CI):13.4%-17.0%].The APC was slightly higher than THE around 2013,while was lower after 2013.During 2008-2017,the ratio of inpatient to outpatient costs for cancer decreased from4.3:1 to 3.8:1.The inpatient payments for cancer mainly happened in grade 3 general hospitals,East China,and among lung,colorectal,and stomach cancer;while the fastest increase was found in West China,and among thyroid,prostate,and colorectal cancer.Conclusions:During 2008-2017,the rapid growth trend of medical expenses for cancer has been effectively controlled with the continuous deepening of medical reform and improvements of residents’health care.More attention should be paid to potential increases of medical costs caused by technological progress and demand release.Socialized and multi-channel insurance financing modes should be explored in the future.

关键词： Cancer payments expenditure economic burden

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Medical expenditure for esophageal cancer in China:a 10-year multicenter retrospective survey(2002-2011)

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Chinese Journal of Cancer 2017年第11期36卷 548-559页

作者： Lan-Wei Guo Hui-Yao Huang Ju-Fang Shi Li-Hong Lv Ya-Na Bai A-Yan Mao Xian-Zhen Liao Guo-Xiang Liu Jian-Song Ren Xiao-Jie Sun Xin-Yu Zhu Jin-Yi Zhou Ji-Yong Gong Qi Zhou Lin Zhu Yu-Qin Liu Bing-Bing Song Ling-Bin Du Xiao-Jing Xing Pei-An Lou Xiao-Hua Sun Xiao Qi Shou-Ling Wu Rong Cao Li Lan Ying Ren Kai Zhang Jie He Jian.Gong Zhang Min Dai Department of Cancer Epidemiology Henan Office for Cancer Control and Research The Affiliated Cancer Hospital of Zhengzhou University Henan Cancer Hospital No. 127 Dongming Road Zhengzhou 450008 Henan P. R China Program Office for Cancer Screening in Urban China Cancer Hospital Chinese Academy of Medical Sciences (CAMS) Peking Union Medical College National Cancer Center of China No. 17 Panjiayuannanli Chaoyang District Beijing 100021 P. R. China Department of Human Resources The Affiliated Cancer Hospital of Zhengzhou University Henan Cancer Hospital Zhengzhou 450008 Henan P. R. China Institute of Epidemiology and Health Statistics Lanzhou University Lanzhou 730000 Gansu P. R. China Public Health Information Research Office Institute of Medical Information Chinese Academy of Medical Sciences (CAMS) Beijing 100020 P. R. China Hunan Office for Cancer Control and Research Hunan Provincial Cancer Hospital Changsha 410006 Hunan P. R. China Department of Health Economics School of Health Management Harbin Medical University Harbin 150081 Heilongjiang P. R. China Center for Health Management and Policy Key Lab of Health Economics and Policy Shandong University Jinan 250012 Shandong P. R. China Institute of Chronic Non.Communicable Diseases Prevention and Control Jiangsu Provincial Center for Disease Control and Prevention Nanjing 210009 Jiangsu P. R. China Science and Education Department Public Health Division Shandong Tumor Hospital Jinan 250117 Shandong P. R. China Chongqing Office for Cancer Control and Research Chongqing Cancer Hospital Chongqing 400030 P. R. China Teaching and Research Department Affiliated Cancer Hospital of Xinjiang Medical University ürümqi 830011 Xinjiang P. R. China Cancer Epidemiology Research Center Gansu Provincial Cancer Hospital Lanzhou 730050 Gansu P. R. China Heilongjiang Office for Cancer Control and Research Affiliated Cancer Hospital of Harbin Medical University Harbin 150081 Heilongjiang P R. China Zhejiang Office for Cancer

Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan(CNY; 1 CNY = 0.155 USD) based on the2011 value and inflated using the year-specific health care consumer price index for China.Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27% was observed from 2002(25,111 CNY) to 2011(46,124 CNY). The average expenditures were 34,460 CNY for stage Ⅰ,39,302 CNY for stage Ⅱ,40,353 CNY for stage Ⅲ, and 37,432 CNY for stage IV diseases(P expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy(P expenditure.Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.

关键词： Esophageal neoplasms Medical expenditure Diagnosis and treatment China

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The Research of Change Trend of Our Government's Public expenditure Scale

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陕西师范大学学报（哲学社会科学版） 2004年第S2期33卷 441-443页

作者：孔祥利西北工业大学经济研究中心陕西西安710072

It is obvious that the change trend of our government expenditure scale declined constantly .The expenditure proportion of science, education, culture and hygiene increased fast, reflected the situation that the finance of our country was transformed into “public finance” from “building type finance” gradually.The expenditure proportion of the local is higher than central authorities. This is disadvantageous for our country’s economy development and society stability.

关键词： Public expenditure Scale Chinese Economy Finance

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The "Three Party" Predicament and Strategy Research of Enterprises' R&D expenditure Tax Motivation Policy Implementation

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财会月刊（中） 2015年第9期 3-8页

作者： Youtang Zhang Liu Yang School of management Wuhan University of Technology

In the age of information economy, the deduction policy of enterprises' R&D expenditure plays an important role in encouraging technology company to innovate and promoting the technology. However, with the deepening of policy implementation, the main subjects, science and technology department, tax department, and technology company, are having some problems, which has a negative impact on the implementation of the deduction policy.This paper reorganizes the main policy of enterprises' R&D expenditure deduction and analyses the reality that "three party" are facing, then gives some advice to the regulation of R&D expenditure deduction policy.

关键词： R&D expenditure deduction tax motivation policy i

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Healthcare for Patients with Hepatitis B Virus:Analysis of 367381 Inpatient Cases in China

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Current Medical Science 2022年第3期42卷 658-665页

作者： Da ZHOU Shi-ran SUN Yang SUN Rui MIN Center for Health Information and Statistics of Hubei Wuhan 430079China Department of Hepatobiliary Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China School of Politics and Management Wuhan UniversityWuhan 430072China School of Public Health Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Objective Hepatitis B virus(HBV)infection,which has been recognized as an international public health challenge,has caused significant morbidity for the entire world.This research focused on patients with HBV in China to examine health utilization and expenses.Methods Patients hospitalized with HBV from 2017 to 2019 in tertiary hospitals in Hubei,a province located in central China,were selected as the study population.Healthcare information was collected from the provincial inpatient electronic system database.Univariate and regression analyses were performed to describe the basic situation of healthcare services and determine the influencing indicators of inpatient service expenditure.Results A total of 367381 cases of HBV infection were identified in the study area.Most of these cases were patients who were married(90.2%)and males(63%).With the great efforts by the universal coverage of the basic medical insurance(BMI)in China,the increasing rate of inpatient hospitalization for HBV was 3.5 times higher than that of the total inpatient health service cases in the study area.The average age of this group was 52.84±14.10 years and 11.1%of patients paid for their own medical expenditures without insurance.The average length of stay(LOS)was 11.10 days,and the average cost per patient was 15712.05 RMB.Both values were higher than the average level in study area.Gender,marital status,career,payment type,and kind of hospitals significantly influenced healthcare utilization.Males and the elderly might incur higher healthcare costs than their counterparts.Conclusion The BMI operated by government has played a role in the utilization release of health services for HBV carriers.However,researchers must pay more attention to the continuing increase in the medical expenses of this group.

关键词： healthcare utilization expenditure hepatitis B virus infection inpatients hospitalization

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Hypertension and medical expenditure in the Japanese population:Review of prospective studies

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World Journal of Cardiology 2014年第7期6卷 531-538页

作者： Koshi Nakamura Tomonori Okamura Katsuyuki Miura Akira Okayama Department of Epidemiology and Public Health Kanazawa Medical University Department of Preventive Medicine and Public Health School of MedicineKeio University Department of Public Health and Center for Epidemiologic Research in AsiaShiga University of Medical Science Research Institute of Strategy for Prevention

Hypertension is a major determinant of health and is likely to have an effect on medical economics.The economic burden due to hypertension may be attributable not only to antihypertensive medication but also to the very expensive procedures required for cases of cardiovascular disease that occur more frequently in hypertensive compared with normotensive individuals.The objective of this article was to review articles published on prospective cohort studies that measured medical expenditure attributable to hypertension in community-dwelling populations in Japan.Many medical services in these populations are provided under the medical insurance system that requires the enrolment of all Japanese residents.Personal medical expenditure attributable to hypertension increases with worsening severity of the condition.Medical expenditure was increased further in cases of hypertensive patients who have another concomitant cardiovascular risk factor.In particular,hypertension,especially moderate-to-severe untreated hypertension,increases the risk of long-term hospitalization resulting in considerably higher medical expenditure,compared with non-hospitalized cases.Therefore,assuming that the use of antihypertensive medication is essential for hypertensive patients to prevent serious vascular diseases,a cost-effective highrisk strategy needs to be considered to reduce both ill-health and the economic burden due to hypertension.However,from a population perspective,medical expenditure attributable to hypertension comes mainly from pre-to-mild hypertension.Therefore,there is also a need to consider a population strategy that aims to shift the entire population to lower levels of blood pressure.

关键词： Hypertension Medical expenditure Japan Cohort study

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Association between resting energy expenditure, psychopathology and HPA-axis in eating disorders

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World Journal of Clinical Cases 2014年第7期2卷 257-264页

作者： Giovanni Castellini Walter Castellani Lorenzo Lelli Carolina Lo Sauro Carla Dini Lisa Lazzeretti Lorenza Bencini Edoardo Mannucci Valdo Ricca Department of Neuroscience PsychologyDrug Research and Child HealthUniversity of Florence50134 FirenzeItaly Department of Respiratory Physiopathology Palagi Hospital50134 FirenzeItaly Department of Health Science University of Florence50134 FirenzeItaly Nutrition Service University of Florence50134 FirenzeItaly Non Invasive Cardiology Department of Heart and VesselsUniversity of Florence50134 FirenzeItaly

AIM: To investigate the complex relationships between resting energy expenditure(REE), eating psychopathology, and Hypothalamus Pituitary Adrenal axis functioning in patients with eating disorders. METHODS: The study was designed as a crosssectional survey, and it was planned by the Clinic for Eating Disorders of the University of Florence(Italy). The protocol was approved by the Ethics Committee of the Institution. Twenty two anorexia nervosa and twenty one Bulimia Nervosa patients were assessed by means of a clinical interview and the structured clini-cal interview for diagnostic and statistical manual of mental disorders, fourth edition. Eating attitudes and behaviour were specifically investigated by means of the eating disorder examination questionnaire(EDE-Q). Patients were also evaluated by means of the symptom checklist(SCL 90-R), REE was measured by means of indirect calorimetry, and blood cortisol morning levels were evaluated. RESULTS: Both anorexia nervosa and bulimia nervosa patients showed a reduced REE as compared with predicted REE. Body mass index(BMI) was positively associated with resting energy expenditure in Bulimics, whereas a strong, negative association between BMI and REE was observed in Anorectics. The pattern of associations between variables supported a mediation model, where shape concern accounted for variations in REE and cortisol levels(mediator), and variations in the mediator significantly accounted for variations in REE. When these associations where taken into account together, the relationship between shape concern and REE was no longer significant, whereas the association between cortisol levels and REE retained its significance, showing strong evidence for a single, dominant mediator. Anorectics and Bulimics showed an opposite pattern of association between BMI and REE. In Anorectics only, a higher REE was associated with a more severe eating disorder specific psychopathology, and cortisol levels represent a possible mediating factor for this relationship. CONCLUSION: The da

关键词： Anorexia nervosa Bulimia nervosa Cortisol Psychopathology Resting energy expenditure

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An Assessment Of The Assignment Of expenditure Responsibilities In China

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公共经济与政策研究 2009年第1期 74-95页

作者： Jorge Martinez-Vazquez Baoyun Qiao Professor of Economics and Director of International Studies Andrew Young School of Policy StudiesGeorgia State University Professor of Economics School of Public Finance and PolicyCentral University of Finance and Economics

I.INTRODUCTION China has been carrying out significant fiscal decentralization policy for over three decades.However,these reforms have largely concentrated on the revenue side of the budgets,and generally they have n... 详细信息

关键词： Assessment The Assignment expenditure Responsibilities

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