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The impact of the new cooperative medical scheme on financial burden of tuberculosis patients: evidence from six counties in China

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Infectious Diseases of Poverty 2016年第1期5卷 63-74页

作者： Li Xiang Yao Pan Shuangyi Hou Hongwei Zhang Kaori DSato Qiang Li Jing Wang Shenglan Tang School of Medicine and Health Management Huazhong University of Science and TechnologyWuhanChina The Third Affiliated Hospital Sun Yat-sen UniversityGuangzhouChina Hubei Provincial Center for Disease Control and Prevention WuhanChina Shaanxi Provincial Institute for TB Control and Prevention Xi’anChina Duke Global Health Institute Duke UniversityDurhamNCUSA School of Public Health Xi’an Jiaotong UniversityXi’anChina Global Health Research Center Duke Kunshan UniversityKunshanChina

Background:Tuberculosis(TB)patients in China encounter heavy financial burdens throughout the course of their treatment and it is unclear how China’s health insurance systems affect the alleviation of this burden under the integrated approach.This study aimed to measure reimbursement for TB services under the New Cooperative Medical Scheme(NCMS)in rural China and to evaluate changes in catastrophic health expenditure(CHE)caused by the reimbursement policies.Methods:Reimbursement data were obtained from routine data systems for the NCMS in Yichang(YC)and Hanzhong(HZ).1884 TB inpatients reimbursed by NCMS from 2010 to 2012 were included.Household surveys were conducted.A total of 494 TB patients under the NCMS were selected in this paper.12 Focus Group Discussions(FGDs)were held.We measured the impact of the NCMS by counterfactual analysis,which analyzed the financial burden alleviation.Equity was assessed by Concentration Index(CI),and disaggregated by project sites.Results:TB inpatients were reimbursed with an effective reimbursement rate of 57.3%.Average out-of-pocket(OOP)payments for outpatient and inpatient services after diagnosis were 1413 yuan and 430 yuan,and 3572 yuan and 3013 yuan in YC and HZ,respectively.The reimbursement level for TB outpatient care after diagnosis was very low due to a limited outpatient quota.TB patients in HZ incurred higher effective reimbursement rates,but the incidence of CHE remained higher.The reduction of CHE incidence after the NCMS showed no difference statistically(P>0.05).The severity of CHE was alleviated slightly.CIs after reimbursement were all below zero and their absolute values were higher than those before reimbursement.Conclusions:Low reimbursement for TB patients could lead to heavy financial burden.Poor TB patients incurred high rates of CHE.The NCMS was found to be a protective factor for CHE,but the impact was modest and the equity of CHE did not improve.The NCMS reimbursement policies should be improved in the future to include a more comprehensive coverage o

关键词： NCMS Impact financial burden TB

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Non-medical financial burden in tuberculosis care: a cross-sectional survey in rural China

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Infectious Diseases of Poverty 2016年第1期5卷 37-43页

作者： Qiang Li Weixi Jiang Quanli Wang Yuan Shen Jingyuan Gao Kaori D.Sato Qian Long Henry Lucas Department of Biostatistics and Epidemiology School of Public HealthXi’an Jiaotong UniversityXi’anShaanxiChina Global Health Research Center Duke Kunshan UniversityKunshanJiangsuChina Duke Global Health Institute Duke UniversityDurhamNCUSA Institute of Development Studies at the University of Sussex BrightonUK

Background:Treatment of tuberculosis(TB)in China is partially covered by national programs and health insurance schemes,though TB patients often face considerable medical expenditures.For some,especially those from poorer households,non-medical costs,such as transport,accommodation,and nutritional supplementation may be a substantial additional burden.In this article we aim to evaluate these non-medical costs induced by seeking TB care using data from a large scale cross-sectional survey.Methods:A total of 797 TB cases from three cities were randomly selected using a stratified cluster sampling design.Inpatient medical costs,outpatient medical costs,and direct non-medical costs related to TB treatment were collected using in-person interviews by trained interviewers.Mean and median non-medical costs for different sub-groups were calculated and compared using Kruskal-Wallis and Mann–Whitney U tests.Regression analysis was conducted to assess the influence of different patient characteristics on total non-medical cost.Results:The median non-medical cost was RMB 1429,with interquartile range RMB 424–2793.The median non-medical costs relating to inpatient treatment,outpatient treatment,and additional nutrition supplementation were RMB 540,91,and 900,respectively.Of the 797 cases,20%reported catastrophic expenditure on non-medical costs.Statistically significant differences were detected between different cities,age groups,geographical locations,inpatient/outpatient care,education levels and family income groups.Conclusions:Non-medical costs relating to TB treatment are a serious financial burden for many TB patients.financial assistance that can limit this burden is urgently needed during the treatment period,especially for the poor.

关键词： Non-medical cost financial burden Tuberculosis China

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Impacts of a comprehensive tuberculosis control model on the quality of clinical services and the financial burden of treatment for patients with drug-resistant tuberculosis in China:a mixed-methods evaluation

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Infectious Diseases of Poverty 2021年第2期10卷 92-93页

作者： Wei-Xi Jiang Zhi-Peng Li Qi Zhao Meng-Qiu Gao Qian Long Wei-Bing Wang Fei Huang Ni Wang Sheng-Lan Tang 不详 National Center for Tuberculosis Control and Prevention China CDCNo.27 Nanwei RoadXicheng DistrictBeijing 100050China Duke Global Health Institute Duke University310Trent DriveDurhamNC 27710USA

Background:The China National Health Commission-GatesTB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB(DRTB).This study aims to evaluate the quality of DRTB clinical services and assess the financial burden of DRTB patients during the intervention period.

关键词： Drug-resistant tuberculosis Quality of health services financial burden

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Robotics in total knee replacement:Current use and future implications

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World Journal of Orthopedics 2024年第6期15卷 489-494页

作者： Majd M Alrayes Mohamed Sukeik Department of Trauma and Orthopedics Orthopedic Surgery DepartmentKing Faisal Specialist Hospital and Research CenterRiyadh 11564Saudi Arabia Department of Trauma and Orthopaedics Dr.Sulaiman Al-Habib HospitalKhobar 34423Saudi Arabia

Robotic total knee replacement(TKR)surgery has evolved over the years with the aim of improving the overall 80% satisfaction rate associated with TKR surgery.Proponents claim higher precision in executing the pre-operative plan which results in improved alignment and possibly better clinical outcomes.Opponents suggest longer operative times with potentially higher complications and no superiority in clinical outcomes alongside increased costs.This editorial will summarize where we currently stand and the future implications of using robotics in knee replacement surgery.

关键词： Total knee replacement Robotic Conventional Radiological assessment financial burden Clinical outcomes

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The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients

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Infectious Diseases of Poverty 2019年第4期8卷 101-101页

作者： Yan-Jiao Xin Li Xiang Jun-Nan Jiang Henry Lucas Sheng-Lan Tang Fei Huang 不详 National Center for Tuberculosis Control and Prevention China CDCBeijingChina

Background:Tuberculosis(TB)is still a major public health problem in China.To scale up TB control,an innovative programme entitled the'China-Gates Foundation Collaboration on TB Control in China was initiated in 2009.During the second phase of the project,a policy of increased reimbursement rates under the New Cooperative Medical Scheme(NCMS)was implemented.In this paper,we aim to explore how this reform affects the financial burden on TB patients through comparison with baseline data.Methods:In two cross-sectional surveys,quantitative data were collected before(January 2010 to December 2012)and after(April 2014 to June 2015)the intervention in the existing NCMS routine data system.Information on all 313 TB inpatients,among which 117 inpatients in the project was collected.Qualitative data collection included 11 focus group discussions.Three main indicators,non-reimbursable expenses rate(NER),effective reimbursement rate(ERR),and out-of-pocket payment(OOP)as a percentage of per capita household income,were used to measure the impact of intervention by comprising post-intervention data with baseline data.The quantitative data were analysed by descriptive analysis and non-parametric tests(Mann-Whitney U test)using SPSS 22.0,and qualitative data were subjected to thematic framework analysis using NvivolO.Results:The nominal reimbursement rates for inpatient care were no less than 80%for services within the package.Total inpatient expenses greatly increased,with an average growth rate of 11.3%.For all TB inpatients,the ERR for inpatient care increased from 52 to 66%.Compared with inpatients outside the project,for inpatients covered by the new policy,the ERR was higher(78%),and OOP showed a sharper decline.In addition,their financial burden decreased significantly.Conclusions:Although the nominal reimbursement rates for inpatient care of TB patients greatly increased under the new reimbursement policy,inpatient OOP expenditure was still a major financial problem for patients.Limited diagnosis and treatment options in

关键词： Tuberculosis New cooperative medical scheme financial burden China

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Is the Problem of Population Aging Real?An Answer Obtained from the Labor Force Participation of the G7 Countries

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China Population and Development Studies 2017年第2期1卷 1-15页

作者： Nan LI United Nations Population Division

Old-age dependency ratio(OADR)is commonly used to indicate the financial burden of population aging;increases in OADR have caused widespread concerns.To better measure the financial burden,this paper proposes a dependency ratio of non-labor-force population to labor-force population(NLDR).This ratio includes OADR as a special case.This paper finds that,when measured by NLDR,financial burden actually declined in five of the G7 countries during the years 2000-2014.To project future trends,labor force participation rates by age f(x)can be forecasted using the coherent LeeCarter method.This paper combines the forecasted f(x)and the population projections of the United Nations,to forecast increases of NLDR for the G7 countries between 2014 and 2050.These increases are on average less than onefifth of the increases projected for OADR.Because OADR ignores the increase of labor force participation,its description of the problem of population aging for the G7 countries in the past is unrealistic and inaccurate,and forecasts of the future based on OADR are likely to be just as unrealistic.Understanding the conditions and reasons for increases in labor force participation can provide valuable insights into the issues of population aging in China,where the remarkable increase of OADR may result in real financial burdens.One condition for labor force participation to increase could be that people remain in good health,which makes continuing to work more feasible.Other reasons for labor force participation to increase are likely to be found in government policies that encourage people to continue working longer.For China,collecting reliable data on labor force participation is also crucial.Without these data,the effects of the policies that encourage people to continue working longer cannot be detected;and therefore the policies cannot be properly developed.

关键词： Population ageing financial burden Labor force participation Coherent Lee-Carter method

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中国长期护理保险制度的可持续评价与趋势分析

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社会保障制度 2020年第8期

作者：张盈华

长期护理保险制度是我国正在探索建立的新的社会保险项目。从2012年青岛基本医疗护理保险试点开始，2017年底15个试点城市相继出台政策方案。在对试点城市持续跟踪和深入调研后发现我国长期护理保险制度试点中普遍存在受益面过窄的问题... 详细信息

长期护理保险制度是我国正在探索建立的新的社会保险项目。从2012年青岛基本医疗护理保险试点开始，2017年底15个试点城市相继出台政策方案。在对试点城市持续跟踪和深入调研后发现我国长期护理保险制度试点中普遍存在受益面过窄的问题，暴露出地方政府对这项制度财务可持续性的担忧。研究表明长期护理保险的基金支出对待遇水平的敏感度显著高于受益面，缴费率对缴费年龄的敏感度高于待遇水平和受益面。在宽、中、窄受益面下，不同待遇水平的基金支出规模差异大，2015年最小和最大支出规模分别为GDP的0.08％和1.90％，随着老龄化和高龄化推高失能发生率，到2055年这一比例将分别升至0.28％和5.90％；相应地，维持基金收支平衡的缴费率最低由0.13％升至0.55％，最高由0.74％升至3.32％。借鉴国外同类制度的运行规律和国内已有社会保险项目的经验，应以制度的财务可持续为目标控制基金支出规模，据此设立受益资格和待遇门槛。研究显示制度的最优选择应是宽受益面和低待遇率的组合，在此基础上尽可能实现全员参保缴费。

关键词：长期护理保险基金支出缴费率可持续趋势分析 long-term care insurance fund expenditure contribution rate financial burden trend analysis

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