In the past few decades, Chinese government attempted to reduce the economic burden of chronic diseases and lower family financial risk of patients by establishing a nationwide coverage of Social Health Insurance syst...In the past few decades, Chinese government attempted to reduce the economic burden of chronic diseases and lower family financial risk of patients by establishing a nationwide coverage of Social Health Insurance system. However, the payment mode of Social Health Insurance varies across Chinese healthcare settings, and the effectiveness of each mode differs. This study aimed to evaluate the effects of integrated case payment on medical expenditure and readmission of inpatients with chronic obstructive pulmonary disease （COPD）, a complex, multicomponent, chronic condition. A nonrandomized, comparative method was used in this study. Inpatients with COPD before （n=1569） and after the integrated case payment reform （n=4764） were selected from the inpatient information database of the New Cooperative Medical Scheme Agency of Xi County. The integrated case payment comprises the case payment （including price-cap case payment and fixed-reimbursement case payment） and clinical pathway （including clinical pathway A, clinical pathway B and clinical pathway C）. Effects of integrated case payment were evaluated with indicators of per capita total medical expense and readmission within 30 days. A multivariate linear regression and a binary logistic regression were used to conduct statistical analysis. The results showed that case payment, comprising price-cap case payment （β=2382.988, P〈0.001） and fixed-reimbursement case payment β=2613.564, P〈0.001）, and clinical pathway C （β=1996.467, P〈0.001） were risk factors of per capita total medical expenses. Clinical pathway A （β=-1443.409, P〈0.001） and clinical pathway B （β=-1583.791, P〈0.001） were protective factors. The interactive effects of case payment with hospital level （β=0.710, P〈0.001） lowered the readmission rate within 30 days. Meanwhile, clinical pathways A （β=18.949, P〈0.001）, B （β=-19.752, P〈0.001） and C （β=-1.882, P〈0.1） were associated with the rate increase. The findings revealed that integrated case payment ensured the quality of care for inpatients with COPD to some extent. However, this payment mode increased the per capita total medical expense. Further, policy-makers should set reasonable reimbursement standards of case payment, unify the type of case payment, and strengthen the supervision of the reform to enhance its function on medical cost control.展开更多
With the artificial alder and cypress mixed forest being planted, there has been a marked land use change since 1970s' in Hilly Area of Central Sichuan Basin, China. Data from meteorological observations or posts ...With the artificial alder and cypress mixed forest being planted, there has been a marked land use change since 1970s' in Hilly Area of Central Sichuan Basin, China. Data from meteorological observations or posts operated over long time, measurement and calculation of NPP (net primary production) and biomass of biological community, and analysis of soil organic matter content show that the artificial alder and cypress mixed forest has outstanding eco-environmental effect: adjusting local climate, raising soil fertility, alleviating menace of drought, and raising NPP and biomass of biological community. It is very beneficial for improving ecological environment to afforest artificial alder and cypress mixed forest in populous Hilly Area of Central Sichuan Basin, China. Key Words: land use/land cover change (LUCC); eco-environmental effect; Hilly Area of Central Sichuan Basin; the artificial alder and cypress mixed forest展开更多
The paper describes the land use situation in the project area from two aspects. Firstly, natural situation (landscape, temperature, soil hydrology, natural disasters); secondly, land use situation (land use structure...The paper describes the land use situation in the project area from two aspects. Firstly, natural situation (landscape, temperature, soil hydrology, natural disasters); secondly, land use situation (land use structure, project construction scale, land area of different vegetation classes). Through the research on the land development and consolidation of Haiba Village of Fengjie County, the project is concluded and the implementation cases of the project are reduced from the following six aspects: land leveling project, water conservancy and irrigation, farmland road engineering, project management system, project funds management and completion and delivery of construction project. Besides, the social, ecological and economic interests obtained by the projects are analyzed, so as to provide reference for promoting land development and consolidation in the future.展开更多
基金This project was supported by grants from the National Natural Science Foundation of China （No.71373091, No. 71603132） and by the Humanities and Social Sciences Research Program of the Ministry of Education of China （No. 16YJA840013）.
文摘In the past few decades, Chinese government attempted to reduce the economic burden of chronic diseases and lower family financial risk of patients by establishing a nationwide coverage of Social Health Insurance system. However, the payment mode of Social Health Insurance varies across Chinese healthcare settings, and the effectiveness of each mode differs. This study aimed to evaluate the effects of integrated case payment on medical expenditure and readmission of inpatients with chronic obstructive pulmonary disease （COPD）, a complex, multicomponent, chronic condition. A nonrandomized, comparative method was used in this study. Inpatients with COPD before （n=1569） and after the integrated case payment reform （n=4764） were selected from the inpatient information database of the New Cooperative Medical Scheme Agency of Xi County. The integrated case payment comprises the case payment （including price-cap case payment and fixed-reimbursement case payment） and clinical pathway （including clinical pathway A, clinical pathway B and clinical pathway C）. Effects of integrated case payment were evaluated with indicators of per capita total medical expense and readmission within 30 days. A multivariate linear regression and a binary logistic regression were used to conduct statistical analysis. The results showed that case payment, comprising price-cap case payment （β=2382.988, P〈0.001） and fixed-reimbursement case payment β=2613.564, P〈0.001）, and clinical pathway C （β=1996.467, P〈0.001） were risk factors of per capita total medical expenses. Clinical pathway A （β=-1443.409, P〈0.001） and clinical pathway B （β=-1583.791, P〈0.001） were protective factors. The interactive effects of case payment with hospital level （β=0.710, P〈0.001） lowered the readmission rate within 30 days. Meanwhile, clinical pathways A （β=18.949, P〈0.001）, B （β=-19.752, P〈0.001） and C （β=-1.882, P〈0.1） were associated with the rate increase. The findings revealed that integrated case payment ensured the quality of care for inpatients with COPD to some extent. However, this payment mode increased the per capita total medical expense. Further, policy-makers should set reasonable reimbursement standards of case payment, unify the type of case payment, and strengthen the supervision of the reform to enhance its function on medical cost control.
基金Supported by the Knowledge Innovation Program of Chinese Academy of Sciences(KZCX1-SW-01-01B)Cultivatlon Foundation of Institute of Mountain Hazards and Environment,CAS
文摘With the artificial alder and cypress mixed forest being planted, there has been a marked land use change since 1970s' in Hilly Area of Central Sichuan Basin, China. Data from meteorological observations or posts operated over long time, measurement and calculation of NPP (net primary production) and biomass of biological community, and analysis of soil organic matter content show that the artificial alder and cypress mixed forest has outstanding eco-environmental effect: adjusting local climate, raising soil fertility, alleviating menace of drought, and raising NPP and biomass of biological community. It is very beneficial for improving ecological environment to afforest artificial alder and cypress mixed forest in populous Hilly Area of Central Sichuan Basin, China. Key Words: land use/land cover change (LUCC); eco-environmental effect; Hilly Area of Central Sichuan Basin; the artificial alder and cypress mixed forest
基金Supported by Chongqing Institute of Geology and Mineral Resources
文摘The paper describes the land use situation in the project area from two aspects. Firstly, natural situation (landscape, temperature, soil hydrology, natural disasters); secondly, land use situation (land use structure, project construction scale, land area of different vegetation classes). Through the research on the land development and consolidation of Haiba Village of Fengjie County, the project is concluded and the implementation cases of the project are reduced from the following six aspects: land leveling project, water conservancy and irrigation, farmland road engineering, project management system, project funds management and completion and delivery of construction project. Besides, the social, ecological and economic interests obtained by the projects are analyzed, so as to provide reference for promoting land development and consolidation in the future.
