Dilemma of healthcare reform and invention of new discipline of health fiscalogy

Background:China's Reform and Open up Policy in 1980s has brought rapid economic development to Chinese society.With the deepening of economic reform,the withdrawal of the state in China has had visible and worrisome consequences for health and for the functioning of health services.The new round of healthcare reform after 2009 has made significant achievements on improving fundamental health and bringing back the nature of welfare of health.However,the financing mechanism of health system has not been established,and the underlying reason behind the healthcare reform dilemma and the theoretical solution need to be found.Methods:This study used the methods of literature review,theoretical research and comparative research to summarize and analyze the reasons and solutions of current dilemma in healthcare reform,and created the new discipline of health fiscalogy through theoretical analysis and vertical and horizontal comparison of healthcare system,especially health financing.Results:Dilemma in healthcare system emerged from the circumstances of rapid process of industrialization,urbanization and population aging,including the profit-driven phenomena,tendency of excessive marketization in public hospitals,strained doctor-patient relationship,high disease burden on individuals and families,and so on.It can be concluded that the theoretical basis of healthcare system and the nature of health resources are crucial in solving the dilemma of healthcare reform.The theoretical basis of healthcare reform should be health fiscalogy focusing on government as the main body of health care responsibility rather than health economics focusing on anti-monopoly.There are two key differences between health economics and health fiscalogy:responsible person/department of disease and health welfare,and nature of resource.The new discipline of health fiscalogy has universal and important implications on both China’s healthcare reform and the healthcare reform in the world.Conclusions:China’s healthcare reform should return from the paradigm of health economics and marketization financing model to the paradigm of health fiscalogy and government-led financing model,which is reflected in the main position of government and social welfare.

Effect of Chinese Traditional Healthcare Exercises on 136 Junior School Students

Objective： To observe the physiological and psychological effects of Chinese traditional healthcare exercises （CTHE） on the adolescents. Methods： A total of 136 healthy students of junior school were recruited and randomly divided into the test group （68 cases） and the control group （68 cases）. The subjects in the test group practiced CTHE, while those in the control group did ＂the 8th radio calisthenics＂, an official recommended calisthenics for promoting healthcare in China, 3 times a week, and 7 weeks practicing overall. The general body function examination and the meridian energy detection system were used to determine the effects of the two groups. Results： （1） After exercise, the chest circumference and heart rate were increased significantly （P〈0.01）, and both the systolic pressure （SP） and diastolic pressure （DP） were decreased significantly （P〈0.01）, while the weight had no significant change （P〉0.05） in the test group. In the control group, the chest circumference, the SP and DP had no significant improvement （P〉0.05）, while the heart rate was significantly increased and the weight was significantly decreased （P〈0.01）. （2） The test group achieved significant positive changes in the performance status, state of mind and fatigue index （P〈0.01 or P〈0.05）, while the control group only achieved a significant positive change in performance status （P〈0.01）, and a negative significant decrease in the autonomic nerve function （P〈0.05）. Conclusion： Junior school students would get physiological and psychological benefit from practicing CTHE, and which is suitable for them to practice.

Cost Effectiveness of Fluvoxamine versus Desvenlafaxine among the Patients with Major Depressive Disorder in China

Objectives: To estimate the cost effectiveness of fluvoxamine against desvenlafaxine in Chinese patients with major depressive disorder (MDD). Methods: A cost effectiveness of treating Chinese patients with MDD for 6 months maintenance period has been estimated by a decision tree model. The relative effectiveness on relapse rates came from a recent network meta analysis by Kishi et al. (2023) along with local drug cost data based on WHO defined daily dose (DDD) and relapse cost for the 6 months estimated from various sources were used in the model. Based on the Quality Adjusted Life Years (QALY) gain reported by Sobocki et al. (2007), QALY loss from a relapse was estimated. Univariate sensitivity analyses were presented by a Tornado diagram and extensive probabilistic sensitivity analysis based on 10,000 simulations was performed. The most recent cost effectiveness threshold of 1.5 times GDP suggested by Cai et al. (2022) was applied. Results: Fluvoxamine dominated desvenlafaxine (cost savings of 4003 CNY and 0.01 QALY higher in 6 months). The most sensitive parameters were relapse rates followed by desvenlafaxine cost and utility loss of relapse. However, the default result of fluvoxamine dominance was not changed for any univariate sensitivity analysis. The probabilistic sensitivity result showed the cost effectiveness acceptability at 1.5 times GDP as 99.93%. Conclusions: The cost effectiveness of fluvoxamine against desvenlafaxine among Chinese patients with MDD in a 6-month maintenance period was cost saving with better effectiveness (i.e., dominating) with low uncertainty.