Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

Effectiveness of Adherence to Standardized Hypertension Management by Primary Health Care Workers in China:a Cross-sectional Survey 3 Years after the Healthcare Reform

The standardized hypertension management provided by primary health care workers is an important part of China＇s recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.

The Current Status and Challenges Regarding Tuberculosis Infection Control in Health Care Facilities in China

Health care facilities are a high-risk environment for generating and spreading respiratory infectious diseases such as tuberculosis （TB）. The TB prevention and treatment staff in health care facilities are responsible for the identification, diagnosis, treatment, supervision, and management of TB patients .

mHealth as a health system strengthening tool in China

Over the past 70 years,there was a rapid epidemiological transition in disease burden in China,from infectious disease to non-communicable diseases(NCDs),which requires long-term prevention and management.Rapid growth in mobile phone use,internet connectivity and digital health technology,presents new opportunities for improvement in NCD healthcare delivery and population-based outcomes.Although there were a growing number of research to evaluate the feasibility and effectiveness of the mobile health(mHealth)interventions for NCD management,the extent to which mHealth contributes towards the health system strengthening in China remains unknown.In this paper,we provided a high-level overview of mHealth in China and its role for Chinese health system strengthening.We conclude with several recommendations for the future of mHealth research in China based on existing evidence identified.

Impact of the New Cooperative Medical Scheme on Health Care Service Utilization in Rural China

Using the 2000, 2004, and 2006 CHNS longitudinal survey data and econometric methods （random-effect probit regression model and DID methods）, this study conducted an empirical analysis to estimate the impact of NCMS. The major conclusions are as follows. First, predisposing factors, enabling factors, health care need factors, and lifestyle factors affect health care utilization. Second, results using DID methods indicate that NCMS did not affect health care service utilization （outpatient and inpatient） of individuals when ill, but it might increase the possibility of getting a health examination. Third, there is no difference in health care service utilization （both outpatient and inpatient） between the NCMS enrollment group and the non-enrollment group in both working age group （15-59） and the elderly group （60 and over）. Therefore, it can be said that NCMS did not affect the health care utilization in both the group. However, NCMS positively affects disease prevention behavior （visiting the hospital to receive a health examination） in the working age group, but the effect did not appear in the elderly group.

Spiritual care perceptions, spiritual health and their relationships with spiritual care competence among clinical nurses in China: A cross-sectional quantitative study

Objective:To investigate the status quo of spiritual care competence and assocaited influencing factors among clinical nurses in China,and examine the relationships among spiritual care perceptions,spiritual health and spiritual care competence,and the mediating role of spiritual health between spiritual care competence and spiritual care perceptions,in order to provide reference for the construction of spiritual care education intervention program to improve the spiritual care competence of clinical nurses in China.Methods:A total of 1454 clinical nurses from 17 hospitals in Tianjin were selected by convenience sampling method,and were investigated with sociodemographic characteristics questionnaire,the Chinese version of Spiritual Care Competence Scale(C-SCCS),the Chinese Version of the Spiritual Care-Giving Scale(C-SCGS)and the Spiritual Health Scale Short Form(SHS-SF).Results:The scores of spiritual care competence of nurses was(57.52±16.02).The results of multiple linear regression showed that nurses'spiritual care competence was influenced by 9 sociodemographic characteristics such as educational background and nursing age,as well as spiritual care perceptions and spiritual health factors,which accounted for 67.2%of the total variation.And spiritual care competence was positively correlated with spiritual care perceptions(r=0.639,P<0.01)and spiritual health(r=0.596,P<0.01).Besides,spiritual health played a mediating role between between other two variables,accounting for 27.5%of the indirect effect.Conclusions:The scores of spiritual care competence of clinical nurses was in the lower middle level,which needs to be further improved.It is recommended that nurse managers and educators should pay attention to the spiritual care education of nurses,and improve spiritual care perceptions and spiritual health level of nurses in multiple ways,at multiple levels,so as to improve their spiritual care competence and to maximize the satisfy spiritual care needs of patients.

Spiritual health, empathy ability and their relationships with spiritual care perceptions among nursing students in China: A cross-sectional correlational study

Objective:To investigate the status quo of spiritual care perceptions and associated factors among nursing students in China,and explore the relationships among spiritual care perceptions,spiritual health and empathy ability,in order to provide reference for the construction of spiritual care education intervention program to improve the spiritual care perceptions and competence of nursing students in China.Methods:A cross-sectional and correlational design was undertaken and a convenience sample of 3615 nursing students selected from 11 universities and colleges in Hebei Shijiazhuang and Tianjin,China from January to July 2021.Participants provided data on sociodemographic by completing the sociodemographic characteristics questionnaire,the Chinese Version of the Spiritual Care-Giving Scale(C-SCGS),Spiritual Health Scale Short Form(SHS-SF)and Jefferson Scale of Physician Empathy-Nursing Student(JSPE-NS).Results:The scores of spiritual care perceptions and spiritual health were 172.44±26.23 and 97.54±12.37,respectively,both in the middle level.The score of empathy ability was 102.92±19.65,lower than the average.Spiritual care perceptions of nursing students were positively correlated with spiritual health(r=0.635,P<0.01)and empathy ability(r=0.547,P<0.01).Conclusions:The level of spiritual care perceptions of nursing students in China needs to be improved.It is suggested that nurse managers and educators should pay attention to the spiritual care education of nursing students,by perfecting the spiritual care education system to improve their spiritual health level and empathy ability in multiple ways and levels,like clarifying and standardizing educational objectives,breaking through the traditional single evaluation system,and formulating scientific comprehensive evaluation standards and systems.,so as to improve their spiritual care perceptions and competence level.

Delivery of public health services by community health workers(CHWs)in primary health care settings in China:a systematic review(1996–2016)

Background:Community Health Workers(CHWs)have been widely used in response to the shortage of skilled health workers especially in resource limited areas.China has a long history of involving CHWs in public health intervention project.CHWs in China called village doctors who have both treatment and public health responsibilities.This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services.Methods:We searched studies published in Chinese or English,on Medline,PubMed,Cochrane,Google Scholar,and CNKI for public health services delivered by CHWs in China,during 1996-2016.The role of CHWs,training for CHWs,challenges,and facilitating factors were extracted from reviewed studies.Results:Guided by National Basic Public Health Service Standards,services provided by CHW covered five major areas of noncommunicable diseases(NCDs)including diabetes and/or hypertension,cancer,mental health,cardiovascular diseases,and common NCD risk factors,as well as general services including reproductive health,tuberculosis,child health,vaccination,and other services.Not many studies investigated the barriers and facilitating factors of their programs,and none reported cost-effectiveness of the intervention.Barriers challenging the sustainability of the CHWs led projects were transportation,nature of official support,quantity and quality of CHWs,training of CHWs,incentives for CHWs,and maintaining a good rapport between CHWs and target population.Facilitating factors included positive official support,integration with the existing health system,financial support,considering CHW’s perspectives,and technology support.Conclusion:CHWs appear to frequently engage in implementing diverse public health intervention programs in China.Facilitators and barriers identified are comparable to those identified in high income countries.Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.

Development of the Transitional Care Model for nursing care in China's Mainland:A literature review

Background:The Transitional Care Model(TCM)for nursing care has yet to be implemented in China despite its success in Western countries.However,rapid social changes have demanded an upgrade in the quality of nursing care;in 2010,the Chinese government has acknowledged the need to implement the TCM in China.Objective:This study has the following objectives:(1)perform a thorough review of the literature regarding the development and implementation of the TCM in China's Mainland within the past 5 years;(2)provide a comprehensive discussion of the current status,problems,and strategies related to the implementation of the TCM in China's Mainland;and(3)suggest strategies pertaining to the future of the TCM in China.Design:The current pertinent literature is systematically reviewed.Data sources:Systematic and manual searches in computerized databases for relevant studies regarding the TCM led to the inclusion of 26 papers in this review.Review methods:Abstracts that satisfied the inclusion criteria were reviewed independently by the two authors of this manuscript,and discrepancies were resolved through discussion.The same reviewers independently assessed the paper in its entirety for selected abstracts.Results:The present English literature reviewrevealed a paucity of updated information about the development and implementation of the TCM in China's Mainland.Nevertheless,the dramatic growth of the TCM in the past 5 years has had a vital impact within the society and in nursing development.This review also revealed numerous issues regarding the focus of the TCM.Overall implications for practiceandrecommendations for future researchare discussed.Conclusion:Despite the potential of this nursing model to have a successful and beneficial impact in China's Mainland,it remains an under-researched topic.Further research on education and training as well as premium policies for nurses under the TCM are needed.

Aging in China: perspectives on public health

In line with the worldwide trend in population aging,China has stepped into an aging society since 2000.The outstanding features of aging,including a large proportion of the older population,rapid growth,dramatic expansion of the oldest-old,and uneven aging distribution,have put China in a unique position.Besides,older population is expanding in parallel with the escalating burden of disease,high prevalence of disability,and low social involvement.However,China is not prepared to solve these problems in terms of the economy,awareness,geriatric care system,geriatric team,social security,or age-friendly environment.From the perspective of public health,we summarized the major challenges and proposed the following policy recommendations:(1)strengthening the top-level design and building a"government-leading,multi-sectoral-cooperating,and society-participating"pattern;(2)enhancing health services by implementing the"comprehensive health"strategy;(3)developing home and community care,coordinately enhance institutional care,promote integration of medical and care systems,and establish a multidimensional tailored care system;(4)optimizing geriatric the supporting system,included the construction of geriatric team and the long-term care insurance system;and(5)establishing a physical and socially age-friendly environment.

Effect of Professional Designation on the Level of Task Performance by Community Health Workers in Enugu State

The study aimed at assessment of level of task performance of Primary Health Care Worker （PHCWs） according to their professional designations in selected Local Government Areas （LGA） in Enugu State. Descriptive survey research was used. 291 PHCWs were randomly selected from 9 LGA using a multistage method. Questionnaire was used to collect data and the instrument was validated using test-retest method with correlation coefficient of 0.79. The findings show that Community Health Extension Workers （CHEWs） performed higher than Environmental Health Officer （EVO） and Community Health Officers （CHOs） in the area of health education concerning prevailing health problems and method of control. They scored 66.09% as against 52.8% and 60.61% for EVO and CHEW respectively. The result showed that the professional designation has no significant effect （P 〈 0.05） on the level of task performed by PHCW and their levels of task performance were low. It was recommended that public Health physicians and Nurses should be involved in the PHC in Enugu State to provide the fight supervision to the PHCW.

China Elderly Care:A Confucian Legacy

This paper explores the Confucian roots of elderly care expectations and how these expectations may influence the current state of the elderly and elderly care in modem China.This paper posits that the outdated expectations combined with recent urbanization trends has put unrealistic pressures on society to adequately care for a rapidly aging population.Until expectations are adjusted to reflect modem day families and realities,the elderly will continue to struggle with a sense of inadequate care,which can lead to mental health issues and feelings of isolation.Once the shackles of Confucian expectations are removed,families,governments and private institutions will have the freedom to be more creative in the way they imagine solutions for elderly care.

High performing primary health care organizations from patient perspective:a qualitative study in China

Background There is a global call to build people-centred primary health care(PHC)systems.Previous evidence suggests that without organization-level reform efforts,the full potential of policy reforms may be limited.This study aimed to generate a profile of high performing PHC organizations from the perspective of patients.Methods We conducted semi-structured interviews with 58 PHC users from six provinces(Shandong,Zhejiang,Shaanxi,Henan,Shanxi,Heilongjiang)in China using purposive and snowball sampling techniques.Transcription was completed by trained research assistants through listening to the recordings of the interviews and summarizing them in English by 30-s segments to generate the narrative summary.Informed by the Classification System of PHC Organizational Attributes,thematic analysis aimed to identify domains and attributes of high performing PHC organizations.Results A profile of a high performing PHC organization with five domains and 14 attributes was generated.The five domains included:(1)organizational resources including medical equipment,human and information resource;(2)service provision and clinical practice including practice scope,internal integration and external integration;(3)general features including location,environment and ownership;(4)quality and cost;and(5)organizational structure including continuous learning mechanism,administrative structure and governance.Conclusions A five-domain profile of high performing PHC organizations from the perspective of Chinese PHC users was generated.Organizational resources,service delivery and clinical practices were most valued by the participants.Meanwhile,the participants also had strong expectation of geographical accessibility,high quality of care as well as efficient organizational structure.These organizational elements should be reflected in further reform efforts in order to build high performing PHC organizations.

Strengthening the primary health care for non-communicable disease prevention and control in the post-pandemic period:a perspective from China

Non-communicable diseases(NCDs)have become the leading cause of deaths in China and many other countries worldwide.To call for actions in strengthening primary health care(PHC)and accelerate NCD prevention and control in the post-pandemic era in China,the 2023 Duke Kunshan Health Forum focused on innovative approaches and lessons learned during the pandemic that can be applied in addressing NCD challenges.In this article we summarize key points discussed by the participants in three areas:PHC as the foundation and ultimate solution for NCD prevention and control,post-pandemic opportunities to accelerate the NCD program with innovative approaches,and an action framework proposed by the Forum collaborators to address remaining challenges and achieve NCD control objectives in China.The core of the suggested action framework is to offer people-centered,lifetime,comprehensive,continued,and quality NCD prevention and control services,which rely on an integrated healthcare system connecting the primary,secondary,and tertiary levels of care.To achive this objective,six interconnected actions are recommended in the framework:prioritizing and integrating NCD in PHC and Universal Health Coverage(UHC)framework,engaging multiple stakeholders,directing resources to PHC for quality NCD services,leveraging advantages of new technology,encouraging the use of PHC and improving services,and strengthening best practice sharing.

Health reform in China:Developments and future prospects

In 2009,China initiated a new round of health reform to establish a wellfunctioning health system.The 2009 health reform did make some significant achievements in improving affordability and accessibility.In particular,social health insurance has been expanded significantly and various social health insurance plans have covered over 95%of total population in China by 2011.The Chinese government also has significantly increased fiscal input for health financing.However,affordability remains a serious concern as the social health insurers,as purchasers,were not very effective in containing the growth of health expenditure.Accessibility to primary care and public health is another concern.In this context,health governance reforms are necessary to address affordability and accessibility issues.Health governance set rules for key actors of the health system(including service providers,health insurers and government departments)by taking into account the strategies and incentives of these actors in their interactions.In recent years,a series of reforms in health governance have been initiated.Some progresses have been achieved.For the next stage of health reform,issues including how to further reform the governance structure of medical institutions and how to improve resource allocation in the health system are critical.

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.

Elderly healthcare service at the community health centers in the Pearl River Delta region,China

Objective:The recent population census showed China had officially become a graying society.In the meantime,China also faces a growing burden of non-communicable diseases.Since 2009,a series of policies have been implemented to enhance primary care at the community level.This study describes the elderly care services provided in the differently organized community health centers(CHCs).Methods:It covered 13 CHCs of six cities located within the Pearl River Delta(PRD)region.In-depth interviews were conducted with a total of 59 health administrators,CHC managers,and CHC doctors regarding elderly care.Results:The study found that accessibility of healthcare for elders has been improved due to the development of health insurance schemes as well as preferential policy to encourage the CHC utilization by the elderly.All the CHCs provide health examinations and chronic disease management to the permanent elderly within their catchment district.However,some preventative care such as fall prevention,immunization and mental health management are not provided.Conclusion:Key barriers include low capacity of health service providers in the CHCs,and a lack of government investment in CHCs.Our report provides an empirical evidence for the health care reform in China.

The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

Objective:This study focuses on Hangzhou,a Chinese city with a population of nine million urban and rural residents,to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then dis-seminate the findings through international third parties.Methods:Measures such as data analysis,study of documents and regulations,fieldwork,and expert discussions were used to systematically investigate primary health care in Hangzhou.The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs.Results:Community health services in Hangzhou are characterized as follows:They are gov-ernment led;they are guaranteed with enough financing,personnel,facilities,and regulation;sup-ported by the unified information platform;general practitioners have been assigned the key role of health‘gatekeepers’;they provide primary care combined with basic public health services;there are integrated urban and rural health services and insurance coverage;and there is health care-pen-sion-nursing integration and general practitioner-contracted‘smart’services.Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole,and some health indicators in Hangzhou are comparable to those in Western developed countries.Conclusion:It is reasonable to believe that the primary health care level in China,including Hangzhou,will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.