scholarly journals Impact of hierarchical hospital reform on patients with diabetes in China: a retrospective observational analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e041731
Author(s):  
Junfang Xu ◽  
Xin Wang ◽  
Hongying Hao ◽  
Jian Wang ◽  
Stephen Nicholas
Keyword(s):  
Hospital Costs ◽  
Binary Logistic Regression ◽  
Medical System ◽  
Hierarchical System ◽  
Reimbursement Rate ◽  
Average Hospital ◽  
Outpatient Visits ◽  
Patients With Diabetes ◽  
Tertiary Hospitals ◽  
Hierarchical Medical System

ObjectivesWe assess whether China’s diabetes pilot hierarchical diagnosis and treatment reforms shifted patient healthcare-seeking behaviour towards primary health institutions (PHIs) and away from secondary and tertiary hospitals. From the patients’ perspective, we evaluate whether the hierarchical system saw the decline of average hospital cost, out-of-pocket (OOP) expenses and the increase of reimbursement rate in PHIs. From the health system’s perspective, we also assessed whether the share of PHIs in total costs, total visits and reimbursement rate increased and the share of secondary and tertiary hospitals decreased.MethodsData were collected from the health insurance bureau of 11 cities in Shandong Province, China between 2015 and 2017, which included 9 118 518 outpatient visits and 622 739 inpatient visits. For both inpatients and outpatients and the health system, we analysed health services-seeking characteristics including hospital costs, hospital visits, OOP expense and reimbursements of hospital costs. Binary logistic regression was conducted to analyse the influencing factors of seeking PHI health services.ResultsPHIs remained the lowest hospital cost provider, but average hospital costs declined across all three healthcare levels of PHIs, secondary hospitals and tertiary hospitals from 2015 to 2017. The hierarchical system aimed to shift patients to PHIs, increasing PHIs’ share of total hospital costs. However, the PHI share of total outpatient costs declined 12.0%, while rising 15.0% in secondary hospitals, the opposite of the goal of the hierarchical medical system. Average outpatient visits rose roughly at the same rate in PHIs (5.1%) as secondary hospitals (6.8%), with no evidence of a shift in patient visits between hospital levels over 2015–2017. Average inpatient visits fell across all levels of hospitals, with no significant difference in the rate of decline between PHIs (9.4%) and secondary (7.5%) and tertiary (7.8%) hospitals. For outpatient and inpatient services, the binary logistic regression showed that over the 2015–2017 period patients with diabetes increasingly used higher level hospitals rather than PHIs (p<0.05). The only success of the hierarchical medical system was the relative fall of OOP outpatient expenses, which fell more rapidly in PHIs (13.7%) than secondary (5.0%) and tertiary (3.5%) hospitals. However, inpatient OOP expenses fell only 2.2% for PHIs, less than half that of secondary (5.5%) and tertiary (7.4%) hospitals, the opposite of the aim of the hierarchical system reform.ConclusionsThe implementation of the hierarchical medical system for patients with diabetes did not achieve its goal of increasing PHI utilisation and decreasing secondary and tertiary hospital utilisation. Enhancing the utilisation of PHIs for diabetes and other patients requires further health reform, including educating patients on PHI use, further reforming the health insurance schemes, improving PHI facilities and encouraging referrals to PHIs from higher level hospitals.

scholarly journals The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident’s Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits

2019 ◽  
Vol 16 (17) ◽  
pp. 3167 ◽  
Author(s):  
Yu-Hua Yan ◽  
Chih-Ming Kung ◽  
Horng-Ming Yeh
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Medical System ◽  
Medical Attention ◽  
Healthcare Seeking ◽  
Outpatient Visits ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior ◽  
Hierarchical Medical System

Objective: This study investigated the impacts of the hierarchical medical system under the national health insurance program on residents’ healthcare-seeking behavior in Taiwan. Background: Healthcare authorities in Taiwan initiated an allowance reduction for outpatient visits at regional hospitals and higher hierarchical hospitals in 2018. The ultimate goal is to implement a hierarchical medical system to provide residents accessible as well as consistent medical services. Methods: This research was conducted through a questionnaire survey, and data were collected between August and December 2018 from the records of subjects who had recently sought medical attention. A total of 1340 valid questionnaires were returned. Results: A principal finding was that there were significant differences in the knowledge of new policies by age, marital status, annual income, education level, and occupation (p < 0.001). Regarding the effects on healthcare-seeking behavior, there were significant differences from persons aged 40–49 years (p < 0.1), in junior high school (p < 0.05), not aware of the policy (p < 0.001), and awareness of both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals (p < 0.001). Conclusion: The health administration authorities should devote more effort into promoting knowledge of the policy in order to better inform the public about the hierarchical medical system.

scholarly journals Factors affecting health care users’ first contact with primary health care facilities in north eastern China, 2008–2018

2021 ◽  
Vol 6 (2) ◽  
pp. e003907
Author(s):  
Ran Liao ◽  
Yaqian Liu ◽  
Shunzhuang Peng ◽  
Xing Lin Feng
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Eastern China ◽  
Medical System ◽  
Health Care Facilities ◽  
Factors Affecting ◽  
Primary Health ◽  
North Eastern ◽  
First Contact ◽  
Hierarchical Medical System

BackgroundChina set out the vision to establishing a hierarchical medical system, with primary health care (PHC) facilities serving health care users’ first contact. Common ailments were listed, supported by a series of auxiliary policy measures. We aim to assess whether these policies were effective to prompt users’ preference to PHCs within these contexts.MethodsUsing data from three waves of National Health Service Survey, we examined trends in care users’ first contact with PHC facilities in Jilin, a north eastern province, during 2008–2018. We analysed trends and factors affecting care users’ choices, stratified by type of diseases and urban–rural settings.ResultsFrom 38 823 respondents, the survey identified 3302 health care users who sought outpatient care. 54.92% and 82.49% with diseases recommended to PHC, in urban and rural Jilin, respectively, contacted PHC facilities first. While 33.51% and 61.19% with diseases not recommended to PHC did so. Care users’ first contact with PHC facilities followed an inverse U shape during 2008–2018. Such trends were more profound among care users with hypertension and/or diabetes. Neither social health insurance coverage nor contracting with family doctors was associated with care users’ first contacts. Only 1.25% care users had referral experiences. Low perceived quality was the main barrier to choose PHC facilities.ConclusionHealth care users sought PHC in a chaotic manner in Jilin. None of the recent efforts seemed effective in prompting their preference to PHC facilities. Without levering quality of PHC, an effective hierarchical medical system could be hardly forged in China.

scholarly journals Mycosis fungoides and Sézary syndrome: a population-wide study on prevalence and health care use in Finland in 1998–2016

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaana Keto ◽  
Sonja Hahtola ◽  
Miika Linna ◽  
Liisa Väkevä
Keyword(s):  
Health Care ◽  
Mycosis Fungoides ◽  
Hospital Costs ◽  
Fold Increase ◽  
Medical Specialty ◽  
Health Care Use ◽  
Sézary Syndrome ◽  
Sezary Syndrome ◽  
Outpatient Visits

Abstract Background Information about health care use and costs of cutaneous T-cell lymphoma (CTCL) patients is limited, particularly in a European setting. Methods In this population-wide study we set out to investigate prevalence, and trends in health care use in two CTCL subtypes, mycosis fungoides (MF) and Sézary syndrome (SS) over a time period of 19 years in 1998–2016 by using a nation-wide patient register containing data on all diagnosed MF and SS cases in Finland. Results The prevalence of diagnosed MF and SS rose from 2.04 to 5.38/100000, and from 0.16 to 0.36/100000 for MF and SS respectively during 1998–2016. We found a substantial decrease in inpatient treatment of MF/SS in the past two decades with a mean of 2 inpatient days/patient/year due to MF/SS in 2016, while the mean numbers of MF/SS related outpatient visits remained stable at 8 visits/year/patient. Most MF/SS-related outpatient visits occurred in the medical specialty of dermatology. In a ten-year follow-up after MF/SS diagnosis, the main causes for outpatient visits and inpatient stays were MF/SS itself, other cancers, and other skin conditions. Also cardiovascular disease and infections contributed to the number of inpatient days. Mean total hospital costs decreased from 11,600 eur/patient/year to 3600 eur/patient/year by year 4 of the follow-up, and remained at that level for the remainder of the 10-year follow-up. MF/SS accounted for approximately half of the hospital costs of these patients throughout the follow-up. Conclusions The nearly 3-fold increase in prevalence of diagnosed MF/SS during 1998–2016 puts pressure on the health care system, as this is a high-cost patient group with a heavy burden of comorbidities. The challenge can be in part answered by shifting the treatment of MF/SS to a more outpatient-based practice, and by adapting new pharmacotherapy, as has been done in Finland.

Hypoglycaemia requiring medical assistance in patients with diabetes: A prospective multicentre survey in tertiary hospitals

2015 ◽  
Vol 41 (2) ◽  
pp. 126-131 ◽  
Author(s):  
S. Liatis ◽  
M. Mylona ◽  
S. Kalopita ◽  
A. Papazafiropoulou ◽  
S. Karamagkiolis ◽  
...  
Keyword(s):  
Medical Assistance ◽  
Patients With Diabetes ◽  
Tertiary Hospitals

scholarly journals A Study on the Public Awareness of Hierarchical Medical System in Taiwan

Health ◽  
2019 ◽  
Vol 11 (04) ◽  
pp. 361-370 ◽  
Author(s):  
Yu-Hua Yan ◽  
Chih-Ming Kung ◽  
Chen-Luan Lu
Keyword(s):  
Public Awareness ◽  
Medical System ◽  
The Public ◽  
Hierarchical Medical System

REDUCING THE LITERAL AND HUMAN COST OF CHILD ABUSE: IMPACT OF A NEW HOSPITAL MANAGEMENT SYSTEM

PEDIATRICS ◽  
1973 ◽  
Vol 51 (5) ◽  
pp. 840-848
Author(s):  
Eli H. Newberger ◽  
John J. Hagenbuch ◽  
Nancy B. Ebeling ◽  
Elizabeth Pivchik Colligan ◽  
Jane S. Sheehan ◽  
...  
Keyword(s):  
Child Abuse ◽  
Hospital Stay ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Average Hospital Stay ◽  
Total Hospital ◽  
Average Hospital ◽  
Consultation Group ◽  
Human Cost ◽  
Hospital Management System

Social service personnel from one public and two voluntary agencies were integrated into a consultation group in an academic pediatric hospital, leading to a reduction in the actual cost of medical services and the risk of reinjury subsequent to the diagnosis of child abuse. In the 1969-1970 hospital year, 62 cases of child abuse were seen, of which 39 were hospitalized. The average hospital stay was 29 days; the average hospital cost $3,000. Total hospital costs for the 39 cases were $123,000, of which bed costs made up $95,000. There were at least three subsequent incidents of child abuse in these 39 cases, and there was one subsequent death; the reinjury rate was 10% for hospitalized cases. In September 1970 the Trauma X Group, an interdisciplinary, interagency consultation unit based in the hospital, was formed. With formal consultation and continued surveillance after discharge by the Trauma X Group, the following data were obtained from the 1970-1971 hospital year. Of 86 cases, 60 were hospitalized. The average hospital stay was 17 days; the average hospital cost $2,500. Total hospital costs for the 60 cases was $150,000, of which bed costs made up $101,000. There was one incident of reinjury and no deaths subsequent to diagnosis in these 60 cases; the reinjury rate was 1.7%. The risk of reinjury calculated from a modified life table was reduced from 8% in the year previous to the formation of the group to 7% and 2%, respectively, in the subsequent year and six-month periods, supporting the dollar-cost impression of effectiveness. Foster placement, furthermore, was infrequent and does not explain the differential impact of the Trauma X Group in the intervals under study.

Abstract W P289: Cost Burden of Stroke Mimics and Transient Ischemic Attacks Following Intravenous Tissue Plasminogen Activator Treatment

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Nitin Goyal ◽  
Shailesh Male ◽  
Sushma Bellamkonda ◽  
Ramin Zand
Keyword(s):  
Cost Analysis ◽  
Direct Cost ◽  
Hospital Costs ◽  
Final Diagnosis ◽  
The United States ◽  
Personnel Cost ◽  
Excess Cost ◽  
Average Hospital ◽  
Intravenous Tissue Plasminogen Activator ◽  
Iv Tpa

Objective: The decision to treat a patient with acute stroke symptoms is based on pertinent history, brief neurological examination, urgent labs, and head CT. In this setting, patients with stroke mimic (SM) may mistakenly receive IV-tPA. The main goal of this study was to investigate the excess direct and indirect hospital costs among patients who received IV-tPA when the final diagnosis was not ischemic stroke. Method: We reviewed the records of 538 IV-tPA treated patients who presented to our primary stroke centers. The excess cost analysis compared the actual direct and indirect hospital costs of an individual patient to what their direct and indirect hospital costs would have been had they primarily been diagnosed with SM or TIA. We obtained the actual and itemized direct and indirect hospital costs of each patient who had a diagnosis of SM or TIA. We determined the ‘calculated cost’ for each patient based on the projected direct and indirect hospital costs associated with each patient’s actual diagnosis, symptoms, severity of disease, other active clinical problems, and hospital course. Results: Seventy-four of 538 post IV-tPA patients had final diagnosis of SM and 21 had TIA. The excess direct and indirect hospital costs for SM was $257,975 and $152,813, respectively. The median excess cost was $5,401 per admission. The excess total cost for TIA was $85,026 with a median of $3,407 per admission. Considering the 2013 Wage Index report for Memphis, TN (WI: ∿ 0.93), and a 42% rate of direct personnel cost in our direct cost analysis, we can estimate that, in the United States, the excess direct hospital cost associated with administration of IV-tPA to patients with SM is approximately 15 million dollars per year with an average hospital direct cost of $3600 per admission. Conclusion: Our study reveals that administration of IV-tPA to patients with SM is associated with significant excess cost; mainly from the cost of unnecessary hospital admission, IV-tPA, and higher level of care.

DYSLIPIDEMIA – TYPE2 DIABETES AND NON DIABETES POPULATION IN AND AROUND ERODE DISTRICT, TAMILNADU

2021 ◽  
pp. 8-9
Author(s):  
Murugesan Thinakaran ◽  
Thangadurai Chitra
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Lipid Status ◽  
Type2 Diabetes ◽  
Patients With Diabetes ◽  
Tertiary Hospitals ◽  
Low Hdl

Background and objects: Patients with diabetes mellitus are at high risk of cardiovascular events because of abnormal lipid status. Dyslipidemia is common in diabetes mellitus and is associated with cardiovascular complications. Early diagnosis and treatment is the main cornerstone in the prevention of its multiple complications. The aim of the study was to determine the prevalence of abnormal lipid prole levels. Materials and Method: The study population was made up of Eighty-ve (85) already diagnosed type 2 diabetic patients and Ninety-two (92) with an age range of 28 to 70 years, who come from routine health, follow up at various tertiary hospitals in Erode. The samples were analyzed using the chemical analyzer COBAS INTEGRA 400. Results and Conclusion: Dyslipidemia was found in 63.52% in type2 diabetes patients and 43.47% in non-diabetic patients. High TG, high LDL-C, high TC and low HDL-C exhibited an increasing trend in the proportion of patients with dyslipidemia. The following risk factors namely female sex, age above 50- years, BMI (overweight and obese), poor glycemic control, central obesity and physical inactivity were associated with diabetic dyslipidemia. This study presents some interesting and novel ndings which may be very important in the care and management of patients with type-2 diabetes.

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