scholarly journals Suggestions on Linkage Mechanism between Medical Insurance and Hierarchical Medical System in a Southern City of Anhui Province in China: Analysis on Disease Structure of New Rural Cooperative Medical System (NCMS) Inpatients

2019 ◽  
Author(s):  
Luo Meng ◽  
Ru Zhi Tang ◽  
li Li Wang ◽  
hua Shao Li
Keyword(s):  
Respiratory System ◽  
Medical Insurance ◽  
Medical System ◽  
Malignant Neoplasms ◽  
Linkage Mechanism ◽  
Genitourinary System ◽  
Medical Institutions ◽  
Non Local ◽  
Southern City ◽  
Hierarchical Medical System

Abstract Objective: The chief aim of this paper is to explore the characteristics of medical treatment for NCMS inpatients in the central district of the southern city, and identify the main problems, so as to give some suggestions on the promotion of linkage mechanism between medical insurance and hierarchical medical system in the southern city. Methods: Hospitalization person-times and expenses were analyzed using the medical insurance inpatients who have settled in the NCMS information management system in the central district of the sourthen city from 2013 to 2015. Results: Among pieces of data, there were identical 5 system diseases hospitalized both in local and non-local medical institutions from 2013 to 2015: respiratory system diseases, malignant neoplasms, digestive system diseases, genitourinary system diseases, and circulatory system diseases, which also ranked top 5. In the hospitalization ratio of the top 5 systemic diseases in 2015, the respiratory system accounted for the largest proportion of 95.65%, and malignant neoplasms inpatients occupied the largest proportion who hospitalized in non-local medical institutions(36.27%). The proportion of inpatients with genitourinary system diseases hospitalized in non-local medical institutions was higher(10.32%), and the cost was lower(21.44%), compared with that of inpatients with digestive system diseases and circulatory system diseases. We chose the 3 repesentive system diseases to analyze diseases structure: there were 4 diseases of respiratory system diseases, 7 diseases of malignant neoplasms, 3 diseases of genitourinary system diseases both hospitalized in local and non-local medical institutions.Conclusions: All the preliminary results threw light on some defects in the process of medical treatment, which was rationality of choice and direction of diagnosis and treatment. The problem may be caused by included inpatients' incorrect medical concepts, unstandardized diagnosis and treatment behaviours, imperfect medical insurance reimbursement policy, and no adequate capacity to treat difficult and miscellaneous diseases. Under the background of deepening medical reform, the city municipal government needs to further increase the publicity of medical reform and make decisions to adapt to the changes in policy environment, for the medical insurance linkage mechanism with 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 Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors

2021 ◽  
Vol 18 (6) ◽  
pp. 2969
Author(s):  
Yanbing Zeng ◽  
Yuanyuan Wan ◽  
Zhipeng Yuan ◽  
Ya Fang
Keyword(s):  
Older Adults ◽  
Predictive Factors ◽  
Medical Insurance ◽  
Utilization Rate ◽  
Heckman Selection Model ◽  
Healthcare Seeking ◽  
Inpatient Services ◽  
Medical Institutions ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior

This study aimed to investigate the patterns and predictive factors of healthcare-seeking behavior among older Chinese adults. A sample of 10,914 participants aged ≥60 years from the 2011, 2013 and 2015 China Health and Retirement Longitudinal Study (CHARLS) was included. The bivariate analyses and Heckman selection model was used to identify predictors of healthcare-seeking behavior. Results shows that the utilization rate of outpatient services increased from 21.61% in 2011 to 32.41% in 2015, and that of inpatient services increased from 12.44% to 17.68%. In 2015, 71.93% and 92.18% chose public medical institutions for outpatient and inpatient services, 57.63% and 17.00% chose primary medical institutions. The individuals who were female, were younger, lived in urban, central or western regions, had medical insurance, had poor self-rated health and exhibited activity of daily living (ADL) impairment were more inclined to outpatient and inpatient services. Transportation, medical expenses, the out-of-pocket ratio and the urgency of the disease were associated with provider selection. The universal medical insurance schemes improved health service utilization for the elderly population but had little impact on the choice of medical institutions. The older adults preferred public institutions to private institutions, preferred primary institutions for outpatient care, and higher-level hospitals for hospitalization.

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

scholarly journals Observation of Synchronous Primary Multiple Carcinoid of the Trachea and Main Bronchus

2021 ◽  
Vol 4 (1) ◽  
pp. 94-100
Author(s):  
V. D. Chkhikvadze ◽  
N. V. Nudnov ◽  
N. V. Chernichenko ◽  
Y. Yu. Murzin ◽  
D. S. Kontorovich ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Respiratory System ◽  
Main Bronchus ◽  
Left Main Bronchus ◽  
Malignant Neoplasms ◽  
Left Main ◽  
Timely Manner ◽  
Low Degree ◽  
Cervical Trachea ◽  
Trachea And Bronchi

Carcinoid tumors are rare malignant neoplasms of the respiratory system. They belong to neuroendocrine tumors with a low degree of (G1, G2) malignancy. Even less common is the primary multiplicity of these tumors in the trachea and bronchi, which can complicate the only radical, surgical treatment. We present an observation of a 75-year-old patient who was able to diagnose a carcinoid of the cervical trachea and left main bronchus in a timely manner, determine the exact localization and prevalence of the tumor, and successfully conduct surgical treatment in 2 stages. 

Reforming Payment Methods for Basic Medical Insurance to Accommodate Traditional Chinese Medicine (TCM) in China : A Case Study of Shaanxi Province

2020 ◽  
Author(s):  
FANG ZHOU ◽  
XIAOHAO ZHANG ◽  
ZHIGUO MA
Keyword(s):  
Medical Insurance ◽  
Diagnosis And Treatment ◽  
Shaanxi Province ◽  
Insurance Fund ◽  
Payment Methods ◽  
Treatment Services ◽  
Basic Medical Insurance ◽  
Medical Institutions ◽  
Insurance Funds ◽  
Basic Medical

Abstract Background: Traditional Chinese medicine (TCM) attaches importance to the philosophy of holism and disease prevention. Meanwhile, costs arising from TCM diagnosis and treatment services are relatively low. Such features cater to the needs of less developed countries and regions to increase the equity and accessibility of medical services and to save basic medical insurance funds. However, China’s current payment system for basic medical insurance fails to fully regard these features, thus unable to incent the demand for and supply of TCM services. Methods: Based on the analysis of the features or rather the advantages of TCM, the article, taking Shaanxi Province located in central China as an example, studies the status quo of economic development, coverage of TCM diagnosis and treatment services by basic medical insurance, implementation of payment methods for basic medical insurance in TCM medical institutions, and aims to explore the reformation of payment methods for basic medical insurance. Results: Statistics have shown that the economic power of Shaanxi Province is below average in China, as a result of which, Shaanxi Province is confronted with a general lack of basic medical insurance fund. On the other hand, the present payment methods for basic medical insurance fail to accommodate the features of TCM. Besides, only a very limited number of TCM medical institutions, service items and medicines are covered by basic medical insurance. Consequently, the advantages of TCM are not exploited to the full in a country that has always treasured TCM. Therefore, reformation in payment methods is pressing. Conclusion: In view of the economic and social development of Shaanxi Province, this article proposes to reform the payment methods for basic medical insurance by introducing a new medicinal-effect-based payment method to accommodate TCM. This payment method has the following four features. Firstly, it advocates strengthening process supervision of diagnosis and treatment activities in medical institutions, establishing a rating system for therapeutic or prophylactic effects, and implementing a reward and punishment mechanism accordingly. Secondly, special audit standards for TCM services shall be determined by the health care department of the people’s government together with the relevant TCM administrative department, more TCM institutions, service items and medicines shall be covered by basic medical insurance, and the negotiation mechanism with medical insurance institutions shall be adjusted. Thirdly, in pricing the fees and standards for TCM services, the price control administrations of the people’s government shall consult TCM experts, and dynamic price adjustments based on costs and professional technical values shall be made. Last but not least, outpatient diagnosis and treatment services shall be covered by basic medical insurance fund, a practice which will not only give full play to the advantages TCM services, but also help reduce the financial burden on patients and save medical insurance funds.

History and examination

2017 ◽  
pp. 24-91
Author(s):  
Ian B. Wilkinson ◽  
Tim Raine ◽  
Kate Wiles ◽  
Anna Goodhart ◽  
Catriona Hall ◽  
...  
Keyword(s):  
Physical Examination ◽  
Respiratory System ◽  
Vascular System ◽  
Venous Pressure ◽  
Cranial Nerves ◽  
Heart Sounds ◽  
Mental Function ◽  
Genitourinary System ◽  
Musculoskeletal Examination ◽  
Neurological System

This chapter discusses taking a history and examination of a patient. It includes symptoms, systemic enquiry, physical examination, signs, cardiovascular system, pulses, jugular venous pressure, heart sounds, cardiac murmurs, respiratory system, gastrointestinal system, abdomen, neurological system, cranial nerves, musculoskeletal examination, peripheral vascular system, genitourinary system, breast, thyroid, speech and higher mental function, movement disorders, psychiatric assessment, and method and order for a routine examination.

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