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.

Examining health anxiety among Lynch syndrome carriers

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.

Examining health anxiety among Lynch syndrome carriers

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.

Medical Service Utilization and Direct Medical Cost of Stroke in Urban China

Background: Understanding the treatment costs of stroke can guide health policies and interventions. However, few studies have analyzed the treatment costs of stroke in China. The aim of this study is to assess stroke-related medical service utilization, direct costs of stroke and associated stroke predictors, and, second, to understand the structure of medical resource use. Methods: This study used a 5% random sample of claim data from China’s Urban Basic Medical Insurance between January 2013 to December 2016. The sampling design assigned a sample weight to each beneficiary. Weighted descriptive analyses, Poisson regression and generalized linear model were used to analyze the medical service utilization, costs and their associations with patient characteristics. Results: In urban China, the annual prevalence of stroke was 730.43 (95% CI = 730.10-730.76) cases per 100 000 people, and nearly 2% of total health expenditures of urban residents was spent on stroke-related medical costs. Weighted average annual total medical cost of stroke was RMB10 637 [95% CI = 10 435-10 840] (US$1682, 95% CI = 1650-1714), with annual out-of-pocket (OOP) cost of RMB3093 [95% CI = 3026-3161] (US$489, 95% CI = 478-500). The average yearly number of stroke-related outpatient visit was 1.67 [SD = 3.39] and inpatient admission was 0.79 [SD = 0.83], with an average cost of RMB440 [SD = 739] (US$70, SD = 117) for outpatients and RMB12 702 [SD = 21 424] (US$2008, SD = 3387) for inpatients. Inpatient costs accounted for 94% (RMB10 034 or US$ 1586) of medical costs, and tertiary hospitals were the main provider of stroke care. Stroke-related medical care utilization and direct costs were associated with gender, age, pathological stroke types and insurance status. Medication costs contributed to 50.6% (RMB5382 or US$ 851) of the average stroke-related medical costs. Conclusion: China’s health system bares a large economic burden from stroke. Specific policies are needed to strengthen the capacity of secondary hospitals, alter the structure of medical resource allocation, and target specific sections of the stroke population.

Variations in Health Care Utilization Patterns Among Inflammatory Bowel Disease Patients at Risk for High Medical Service Utilization Enrolled in High Deductible Health Plans

Background High-deductible health plans (HDHPs) are increasing in prevalence as a cost control device for slowing health care cost growth by reducing nonessential medical service utilization. High cost-sharing associated with HDHPs can lead to significant financial distress and worse disease outcomes. We hypothesize that chronic disease patients are delaying or foregoing necessary medical care due to health care costs. Methods A retrospective cohort analysis of IBD patients at risk for high medical service utilization with continuous enrollment in either an HDHP or THP from 2009 to 2016 were identified using the MarketScan database. Health care costs were compared between insurance plan groups by Kruskal-Wallis test. Temporal trends in office visits, colonoscopies, emergency department (ED) visits, and hospitalizations were evaluated using additive decomposition time series analysis. Results Of 605,862 patients with a diagnosis of IBD, we identified 13,052 eligible patients. Annual out-of-pocket costs were higher in the HDHP group (n = 524) than the THP group (n = 12,458) ($2870 vs $1,864; P < 0.001) without any difference in total health care expenses ($23,029 vs $23,794; P = 0.583). Enrollment in an HDHP influenced colonoscopy, ED visit, and hospitalization utilization timing. Colonoscopies peaked in the fourth quarter, ED visits peaked in the first quarter, and hospitalizations peaked in the third and fourth quarter. Conclusions High-deductible health plan enrollment does not change the cost of care; however, it shifts health care costs onto patients and changes the timing of the care they receive. High-deductible health plans are incentivizing delays in obtaining health care with a potential to cause worse disease outcomes and financial distress. Further evaluation is warranted.