Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China

Background:Health inequity is an important issue all around the world.The Chinese basic medical security system comprises three major insurance schemes,namely the Urban Employee Basic Medical Insurance(UEBMI),the Urban Resident Basic Medical Insurance(URBMI),and the New Cooperative Medical Scheme(NCMS).Little research has been conducted to look into the disparity in payments among the health insurance schemes in China.In this study,we aimed to evaluate the disparity in reimbursements for tuberculosis(TB)care among the abovementioned health insurance schemes.Methods:This study uses a World Health Organization(WHO)framework to analyze the disparities and equity relating to the three dimensions of health insurance:population coverage,the range of services covered,and the extent to which costs are covered.Each of the health insurance scheme’s policies were categorized and analyzed.An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city(YC),which included 1506 discharges,was conducted to identify the differences in reimbursement rates and out-of-pocket(OOP)expenses among the health insurance schemes.Results:Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by(TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI,who have less inpatient expenses than those covered by the UEBMI).We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups.In terms of financial inequity,TB patients who earned less paid more.The NCMS provides modest financial protection,based on income.Overall,TB patients from lower socioeconomic groups were the most vulnerable.Conclusion:There are large disparities in reimbursement for TB care among the three health insurance schemes and this,in turn,hampers TB control.Reducing the gap in health outcomes between the three health insurance schemes in China should be a focus of TB care and control.Achieving equity through integrated policies that avoid discrimination is likely to be effective.

Are free anti-tuberculosis drugs enough? An empirical study from three cities in China

Background:Tuberculosis(TB)patients in China still face a number of barriers in seeking diagnosis and treatment.There is evidence that the economic burden on TB patients and their households discourages treatment compliance.Methods:A cross-sectional study was conducted in three cities of China.Patients were selected using probability proportional to size(PPS)cluster sampling of rural townships or urban streets,followed by list sampling from a patient register.Data were collected using a questionnaire survey,key informant interviews and focus group discussions with TB patients to gain an understanding of the economic burden of TB and implications of this burden for treatment compliance.Results:A total of 797 TB patients were surveyed,of which 60 were interviewed in-depth following the survey.More than half had catastrophic health expenditure.TB patients with higher household incomes were less likely to report non-compliance(OR 0.355,95%CI 0.140–0.830)and patients who felt that the economic burden relating to TB treatment was high more likely to report non-compliance(OR 3.650,95%CI 1.278–12.346).Those who had high costs for transportation,lodging and food were also more likely to report non-compliance(OR 4.150,95%CI 1.804–21.999).The findings from the qualitative studies supported those from the survey.Conclusion:The economic burden associated with seeking diagnosis and treatment remains a barrier for TB patients in China.Reducing the cost of treatment and giving patients subsidies for transportation,lodging and food is likely to improve treatment compliance.Improving doctors’salary system to cut off the revenue-oriented incentive,and expanding current insurance’s coverage can be helpful to reduce patients’actual burden or anticipated burden.Future research on this issue is needed.

Modulation of the electronic states of perovskite SrCrO3 thin films through protonation via low-energy hydrogen plasma implantation approaches

Hydrogenation of transition metal oxides offers a powerful platform to tailor physical functionalities as well as for potential applications in modern electronic technologies.An ideal nondestructive and efficient hydrogen incorporation approach is important for the realistic technological applications.We demonstrate the proton injection on SrCro3 thin films via an efficient low-energy hydrogen plasma implantation experiments,without destroying the original lattice framework.Hydrogen ions accumu-late largely at the interfacial regions with amorphous character which extend about one-third of the total thickness.The Hx.SrCro3(HSCO)thin films appear like exfoliated layers which however retain the fully strained state with distorted perovskite structure.Proton doping induces the change of Cr oxidation state from Cr^4+to Cr^3+in HSCO thin films and a transition from metallic to insulat-ing phase.Our investigations suggest an attractive platform in manipulating the electronic phases in proton-based approaches and may offer a potential peeling off strategy for nanoscale devices through low-energy hydrogen plasma implantation approaches.

National Action Plan in Antimicrobial Resistance Using Framework Analysis for China

INTRODUCTION The emergence of multi-antibiotic-resistant bacteria has turned bacterial resistance into a pressing global issue.Antibiotics that once effectively treated various infectious diseases are now becoming less efficient against a new class of bacteria known as“Super Bacteria,”including methicillin-resistant Staphylococcus aureus(1).It is estimated that one person dies every minute due to drug-resistant strains of disease,and by 2050,drug-resistant bacterial infections could become the leading cause of death in humans(2).

Polypharmacy Among People Living with Dementia — Israel and 24 Countries in European Union, 2015–2019

What is already known about this topic?With a growing number of people living with dementia(PLWD),the practice of taking multiple medications to manage symptoms or comorbidities,i.e.,polypharmacy,among PLWD has become a global health challenge.What is added by this report?In 2015–2019,polypharmacy for PLWD varied substantially among 25 studied countries,with approximately 1 in 5 Estonian PLWD and 4 in 5 Cypriot PLWD having polypharmacy.In addition,Switzerland,Poland,Austria,and the Czech Republic have experienced a significantly increasing trend in polypharmacy for PLWD.What are the implications for public health practice?Countries should pay special attention to polypharmacy and make efforts to control polypharmacy among PLWD,especially in countries where the trend of polypharmacy among PLWD has been increasing.