Longitudinal Association of Salaries for Medical Staff With Medical Service Utilization and Expenditure in China, 2007–2016

Objectives: To test the hypothesis that higher salary levels of the medical staff are associated with lower medical service utilization and expenditure.Methods: Using longitudinal data from 31 Chinese provinces for the period 2007-2016, we constructed fixed effects models to analyze the association between the salary of medical staff and medical service utilization, medical expenditure, medication expenditure, and medication proportion.Results: A 10,000 CNY increase in medical staff's salaries was associated with a 0.89% decrease in the average number of annual inpatient admissions per person; 1.88 and 1.59% decreases in average expenditures per outpatient visit and inpatient admission, respectively; 3.05 and 2.66% decreases in drug expenditures per outpatient visit and inpatient admission, respectively; 0.58 percent point and 0.39 percent point decreases in the share of drug expenditure in outpatient and inpatient, respectively. When medical staff's salaries increased by 450,000 CNY, the turning point was reached when the maximum medical expenditure savings offset the medical staff salary increases, yielding a 634 billion CNY surplus from medical expenditure.Conclusions: Our results supported the hypothesis that higher salary levels of the medical staff are associated with lower medical service utilization and expenditure. Further studies are requested to test whether higher medical staff's salaries will attenuate over-treatment and that savings from reduced prescriptions and service charges will offset the increased salaries of medical staff.

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The positive impacts and unintended consequences of the nationwide pricing reform for drugs and medical services in the urban public hospitals in China

10.21203/rs.3.rs-23258/v1 ◽

2020 ◽

Author(s):

Xiaoxi Zhang ◽

Hongyu Lai ◽

Lidan Zhang ◽

Jiangjiang He ◽

Bo Fu ◽

...

Keyword(s):

Drug Cost ◽

Outpatient Visit ◽

Financial Burden ◽

Drug Expenditure ◽

Unintended Consequences ◽

Public Hospitals ◽

Inpatient Admission ◽

Medical Expenditure ◽

Medical Services ◽

Positive Impacts

Abstract Since 2015, China has been rolling out the pricing reform for drugs and medical services (PRDMS) in the urban public hospitals in order to reduce the drug expenditure and to relieve the financial burden of patients. This study aims at evaluating the effectiveness of the reform implementation and investigating its positive impacts and unintended consequences to provide evidence base for further policy making. The Difference-in-difference (DID) approach was employed to analyze the reform impact on the 31 provincial administrative areas in China based on the data abstracted from China Statistics Yearbooks and China Health Statistics Yearbooks from 2012 to 2018. The reform resulted in the decrease of 7.59% in drug cost per outpatient visit, the decrease of 5.73% in drug cost per inpatient admission, the decrease of 3.63% in total cost per outpatient visit and an increase of 9.10% in the surgery cost per inpatient admission in the intervention group. However, no significant change in examination cost was found, and the reduction in the medical cost per inpatient admission was yet to be demonstrated, nor was the total outpatient/ inpatient expenses. The nationwide pricing reform for drugs and medical services in the urban public hospitals (PRDMS-U) in China is demonstrated to be effective in cutting down the drug expenditure. However, the revealed unintended consequences indicate that there are still significant challenges for the reform to encounter in the way ahead to reach the ultimate goal in curbing the medical expenditure. The underlying issue with the incentives of providers in service delivery remains to be unsolved and the pricing instrument alone should not be enough to change the behavior of providers. Our conclusion holds lessons for other low- and middle-income countries (LMICs) who are also conducting reforms to public hospitals.Authors Xiaoxi Zhang and Hongyu Lai contributed equally to this work.

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Examining health anxiety among Lynch syndrome carriers

10.32920/ryerson.14655069.v1 ◽

2021 ◽

Author(s):

Jenna J. Albiani

Keyword(s):

Lynch Syndrome ◽

Service Utilization ◽

Medical Service ◽

Qualitative Content Analysis ◽

Health Anxiety ◽

Physical Symptoms ◽

Genetic Mutation ◽

Self Report ◽

Psychological Consequences ◽

Medical Service Utilization

The current research was designed to examine health anxiety among individuals with Lynch syndrome; a genetic predisposition to adult onset cancers. This research had two aims: 1) To examine the severity of health anxiety in Lynch syndrome patients and identify predictors and consequences associated with health anxiety, and 2) To examine the additional impact health anxiety has on parents with Lynch syndrome. Two studies were conducted. In Study I, 209 individuals with Lynch syndrome, selected from a genetic cancer registry, completed self-report measures assessing health anxiety, medical and psychological variables, and medical service utilization. Results indicated that 30% of participants reported clinically significant levels of health anxiety. Regression analyses revealed that younger age, greater depression, anxiety, worry interference and emotional preoccupation coping were predictive of increased health anxiety. Increased health anxiety was associated with greater overall medical service utilization; specifically, visits to gastroenterologists and emergency departments. In Study II, purposive sampling was used to identify parents from Study I who reported the highest and lowest health anxiety. Twenty-one individuals completed semi-structured telephone interviews about their experience of being a parent with Lynch syndrome, their concerns of potentially passing down the genetic mutation to their children, and their perceptions of their children’s health. Qualitative content analysis using a template coding approach was used to examine the differences between parents with high and low health anxiety. Findings revealed that the most prevalent difference was in relation to parent’s perceptions of their personal health. Those with high health anxiety experienced worries that were more extreme, demonstrated a hypervigilance towards physical symptoms, discussed the emotional and psychological consequences of Lynch syndrome as more negative and severe, and had a tendency to engage in more dysfunctional coping strategies. Unexpectedly, with regards to their perceptions of their children, the parents in the high and low health anxiety groups exhibited similar worries. Taken together, the findings from Studies I and II suggest that health anxiety is of clinical significance for individuals with Lynch syndrome. Accurately identifying and treating health anxiety among this population may be one avenue to reduce the distress experienced by Lynch syndrome carriers.

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The Selection of the Medical Institutions by Motivation of Medical Service Utilization

Journal of Digital Convergence ◽

10.14400/jdc.2015.13.11.217 ◽

2015 ◽

Vol 13 (11) ◽

pp. 217-230 ◽

Cited By ~ 2

Author(s):

Jeong-Yeon Kim

Keyword(s):

Service Utilization ◽

Medical Service ◽

Medical Service Utilization ◽

Medical Institutions ◽

Selection Of

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Reducing medical service utilization by encouraging vaccinesRandomized controlled trial

American Journal of Preventive Medicine ◽

10.1016/s0749-3797(04)00177-1 ◽

2004 ◽

Vol 27 (4) ◽

pp. 284-288 ◽

Cited By ~ 1

Author(s):

G BERG ◽

E THOMAS ◽

S SILVERSTEIN ◽

C NEEL ◽

M MIRELES

Keyword(s):

Service Utilization ◽

Medical Service ◽

Controlled Trial ◽

Medical Service Utilization

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Psychopathology as a Predictor of Medical Service Utilization for Youth in Residential Treatment

The Journal of Behavioral Health Services & Research ◽

10.1007/s11414-012-9301-3 ◽

2012 ◽

Vol 40 (1) ◽

pp. 36-45 ◽

Cited By ~ 10

Author(s):

Timothy D. Nelson ◽

Tori R. Smith ◽

Robert Pick ◽

Michael H. Epstein ◽

Ronald W. Thompson ◽

...

Keyword(s):

Residential Treatment ◽

Service Utilization ◽

Medical Service ◽

Medical Service Utilization

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Emergency Medical Service Utilization and Response Following COVID-19 Emergency and Stay-at-Home Policies: An Interrupted Time-Series Analysis

Cureus ◽

10.7759/cureus.19794 ◽

2021 ◽

Author(s):

Allyson W O'Connor ◽

Haylea A Hannah ◽

Elisabeth A Burnor ◽

Kai G Fukutaki ◽

Troy Peterson ◽

...

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Emergency Medical Service ◽

Service Utilization ◽

Medical Service ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Medical Service Utilization ◽

Series Analysis ◽

Emergency Medical

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Impact of China’s healthcare price reforms on traditional Chinese medicine public hospitals in Beijing: an interrupted time-series study

BMJ Open ◽

10.1136/bmjopen-2019-029646 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029646 ◽

Cited By ~ 4

Author(s):

Dawei Zhu ◽

Xuefeng Shi ◽

Stephen Nicholas ◽

Qian Bai ◽

Ping He

Keyword(s):

Time Series ◽

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Medical Service ◽

Outpatient Visit ◽

Herbal Medicines ◽

Interrupted Time Series ◽

Inpatient Admission ◽

Outpatient Visits ◽

Drug Expenditures

ObjectiveTo evaluate the 2017 implementation of China’s 2009 healthcare price reforms on Beijing’s secondary and tertiary traditional Chinese medicine (TCM) hospitals.DesignWe employed a panel-interrupted time-series model with hospital fixed effects to estimate the impact of the price reforms.SettingBeijing, April 2014 to April 2018.ParticipantsAll TCM hospitals in Beijing.Outcome measuresOur dependent variables comprised the monthly outpatient and inpatient revenues, the number of monthly outpatient visits and inpatient admissions, the average total expenditures per outpatient visit and per inpatient admission, the average drug expenditures (except herbal medicines) per outpatient visit and per inpatient admission and the average medical service expenditures per outpatient visit and per inpatient admission.ResultsIn tertiary hospitals, the price reforms led to significant reductions in the number of outpatient visits (23.1%), inpatients admission (4.6%) and drug expenditures (except herbal medicines) per inpatient admission (14.0%), and an instant raise in average total expenditure per outpatient (22.0%), medical service expenditures per outpatient visit (58.2%) and inpatient admission (19.0%). There was no significant association between the price reforms and the monthly outpatient and inpatient revenues. After the price reforms, the previous upward trend in medical service expenditures per outpatient visit rose more sharply (from 0.5% to 1.6%). In secondary hospitals, the price reforms decreased the level of drug expenditures (except herbal medicines) per outpatient visit (13.0%) and per inpatient admission (20.8%), but increased medical service expenditures per inpatient admission by 19.0%.ConclusionThe Beijing price reforms adjusted the cost structures in secondary and tertiary TCM hospitals without negatively impacting the operation of the hospitals, and through the increased hierarchical medical service fee, shifted patient choices away from tertiary to other health facilities, especially for patients with minor illnesses.

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