Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of...Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of drug pricing in China.Methods Through the literature analysis and policy review,the pricing subject,pricing basis and price control system in the pricing process of medical-accessed medicines were analyzed from the perspective of binary equilibrium and harmonious management.Results and Conclusion It is found that four balances in the drug pricing process,two balances in pricing basis and three balances in price control system need to be considered,respectively.Drug pricing is the key content of national medical insurance access,which is also the hotspot of the policy in the pharmaceutical fields in recent years.Drug pricing not only reflects the value of drugs,but also reflects a lot of top-level designs of binary equilibriums in medical insurance policy.While the rational design of drug pricing requires the joint efforts of the government,pharmaceutical companies and relevant experts to comprehensively consider many equilibriums,so as to improve the relevant systems.展开更多
Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for info...Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for information and related literature,and literature review was used.Results and Conclusion In foreign countries,the clinical value of innovative drugs and their impact on medical insurance funds were comprehensively evaluated based on factors such as quality-adjusted life years,clinical benefit,and improvement of clinical benefit.Then,the evaluation results were taken as an important basis for whether innovative drugs were admitted to the medical insurance catalog and establishing medical insurance payment standards.By using international experience for reference,innovative drug pricing methods and medical insurance payment standards for China’s national conditions can be improved by establishing a basic database of clinical value and drug economic evaluation of innovative drugs,as well as innovative drug payment models based on decision thresholds.展开更多
Objective To explore the impact of population aging on the expenditures of medical insurance funds against the background that great changes in population structure influences economic development.Methods Through anal...Objective To explore the impact of population aging on the expenditures of medical insurance funds against the background that great changes in population structure influences economic development.Methods Through analyzing the impact of the population aging,the income and accumulated balance of the medical insurance fund,and other related factors on the expenditure of the medical insurance fund,development status of the medical insurance fund for urban employees in China since 2003 was obtained.Stata 16.0 was used to perform multiple linear regression analysis on related factors to determine the correlation between population aging and the change in medical insurance expenditures.Results and Conclusion The factors that have a greater impact on the expenditure of the medical insurance fund are the amount of income from the medical insurance,followed by the number of people over the age of 65 in China and the urban retired employees participating in medical insurance.We should focus on the sustainable development of the urban employee medical insurance fund to deal with the threat of aging.展开更多
Objective To put forward some suggestions for the development of urban basic medical insurance of Liaoning by comparing the development situations in 14 cities of Liaoning Province.Methods Relevant data of urban basic...Objective To put forward some suggestions for the development of urban basic medical insurance of Liaoning by comparing the development situations in 14 cities of Liaoning Province.Methods Relevant data of urban basic medical insurance from 2008 to 2018 in 14 cities were collected to make a comparative analysis,and the 5 why analysis chart was drawn to investigate the development differences in 14 cities.Results and Conclusion The average growth rate of the number of urban residents covered by urban basic medical insurance varied greatly from 2014 to 2018.The range of average growth rate of urban residents’medical insurance is 19.1%,and the range of average growth rate of urban workers’medical insurance is 9.1%.Funding standards are basically the same.It is suggested each municipal government should attach importance to this issue.They can make full use of information technology to coordinate with various authorities and ensure the smooth development of medical insurance.Besides,they must actively adapt to their conditions to better develop the urban basic medical insurance of Liaoning.展开更多
Objective: An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China(mainland), in an attempt to offer a clue to further contro...Objective: An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China(mainland), in an attempt to offer a clue to further control the costs.Methods: The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page(IMRHP) dataset.The data were then processed with SAS(Version 9.3; SAS Institute, Cary, NC, USA). Indicators like means,increase(decrease) percentages were used to descriptively analyze the average hospitalization expense of each time(AHEET) and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results:In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance(URBMI)were the next,and those covered by New Rural Cooperative Medical System(NRCMS)had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions:The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.展开更多
This paper describes how to use the Unified Modeling Language (UML) to modeling software processes in medical insurance MIS, and compares UML Modeling method with classic PO(Process Oriented) Modeling method. It indi...This paper describes how to use the Unified Modeling Language (UML) to modeling software processes in medical insurance MIS, and compares UML Modeling method with classic PO(Process Oriented) Modeling method. It indicates that the whole performance of application system model described by UML is much better than the one described by PO.展开更多
The paper reports three new ensembles of supervised learning predictors for managing medical insurance costs.The open dataset is used for data analysis methods development.The usage of artificial intelligence in the m...The paper reports three new ensembles of supervised learning predictors for managing medical insurance costs.The open dataset is used for data analysis methods development.The usage of artificial intelligence in the management of financial risks will facilitate economic wear time and money and protect patients’health.Machine learning is associated withmany expectations,but its quality is determined by choosing a good algorithm and the proper steps to plan,develop,and implement the model.The paper aims to develop three new ensembles for individual insurance costs prediction to provide high prediction accuracy.Pierson coefficient and Boruta algorithm are used for feature selection.The boosting,stacking,and bagging ensembles are built.A comparison with existing machine learning algorithms is given.Boosting modes based on regression tree and stochastic gradient descent is built.Bagged CART and Random Forest algorithms are proposed.The boosting and stacking ensembles shown better accuracy than bagging.The tuning parameters for boosting do not allow to decrease the RMSE too.So,bagging shows its weakness in generalizing the prediction.The stacking is developed using K Nearest Neighbors(KNN),Support Vector Machine(SVM),Regression Tree,Linear Regression,Stochastic Gradient Boosting.The random forest(RF)algorithm is used to combine the predictions.One hundred trees are built forRF.RootMean Square Error(RMSE)has lifted the to 3173.213 in comparison with other predictors.The quality of the developed ensemble for RootMean Squared Error metric is 1.47 better than for the best weak predictor(SVR).展开更多
Objective To study the use of real-world evidence by EU and its member states for establishing a strategy for rare diseases and provide references for the inclusion of orphan drugs in China’s medical insurance.Method...Objective To study the use of real-world evidence by EU and its member states for establishing a strategy for rare diseases and provide references for the inclusion of orphan drugs in China’s medical insurance.Methods A case analysis method was used to introduce the EU’s decision to include rare disease drugs in medical insurance by using real-world evidence because clinical data of rare diseases were difficult to obtain.Results and Conclusion China can use real-world evidence to make medical insurance decisions based on the experience of the EU and continue to invest more in rare diseases,which can solve the problem of few drugs for patients with rare disease.展开更多
Objective To discuss the methods of improving the social insurance of college students by taking the application of college students’social insurance in Shenyang as an example.Methods The investigation and literature...Objective To discuss the methods of improving the social insurance of college students by taking the application of college students’social insurance in Shenyang as an example.Methods The investigation and literature method were applied mainly.Results and Conclusion Through the questionnaire,the main problems for college students’medical insurance were analyzed in this paper,and proposals such as compulsory insurance,improving the level of medical services in colleges and hospitals,and strengthening commercial insurance and publicity were finally put forward.展开更多
At a seminar discussing ways to prevent chronic disease held in Shanghai on March 31, 2012, Chen Zhu, Minister of Health, revealed that the ministry was planning to include expenditures on counseling to stop smoking i...At a seminar discussing ways to prevent chronic disease held in Shanghai on March 31, 2012, Chen Zhu, Minister of Health, revealed that the ministry was planning to include expenditures on counseling to stop smoking into the basic medical insurance system provided by the govern- ment, and would pay for drugs that help reduce dependence on tobacco.展开更多
Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in China.Methods Literature research method was used to stud...Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in China.Methods Literature research method was used to study the policies related to the reimbursement management of innovative drugs in Germany,France and Japan,and their successful experience was summarized.Results and Conclusion China should establish an open and transparent value evaluation standard to improve the medical insurance reimbursement management of innovative drugs.Besides,the value of innovative drugs should be taken as an important basis for reimbursement decisions,and an independent third-party value evaluation agency must be established.展开更多
Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China. This stu...Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China. This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID), including 3229 people in Hubei province and 2628 people in Guangdong province. One-way ANOVA was used to compare the total medical expense, out-of-pocket (OOP) expense and hospital stay between variables. A multiple linear regression analysis was done to identify possible risk factors of total medical expense. The results showed that the average total medical expense per capita was 5709.89 yuan, and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province, respectively. The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuan in 2013. There were no significant differences in medical expenses between different genders of hypertensive patients (P〉0.05). People of different ages, provinces, medical insurances and medical institution levels showed significant differences in medical expenses. The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region. Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances. And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.展开更多
The morbidity and mortality of life-threatening diseases such as cancers are increasing year by year in China. Although the national medical insurance has been improved a lot, it still falls short of expecting “unive...The morbidity and mortality of life-threatening diseases such as cancers are increasing year by year in China. Although the national medical insurance has been improved a lot, it still falls short of expecting “universal medical insurance”. To help the families of patients with cancer and other serious diseases to resolve the unaffordable medical cost, several internet platforms of “Peer to Peer Medical Mutual Aid” have gradually emerged recently. In the form of low threshold insurance combined with public support, these platforms provide subsidies to families of patients suffering from serious financial burden and then partly compensate them for the limit of national medical insurance. This article summarized the characteristics of declared patients sponsored by several medical mutual aid internet platforms. The results showed that the sponsored patients were mostly cancer patients (90.1%), aged 21 - 60 (88.4%), and the average amounts of financial support had a trend to decrease with the increase of age. In particular, the reported cases of thyroid cancer were increased dramatically recently, however, with a lowest average mutual aid fund. Given these data, it is urgent to list out a detailed rule for the use of national medical insurance on the treatment of cancer, to heighten the healthcare system for the occupational population, age from 21 to 60, and to establish the credit system for Medicare and Medicaid services.展开更多
In 2020,the sudden new crown(COVID-19)virus swept the world.Countries have adopted different epidemic prevention measures.The COVID-19 has brought an extraordinary impact on the economic and social health of all count...In 2020,the sudden new crown(COVID-19)virus swept the world.Countries have adopted different epidemic prevention measures.The COVID-19 has brought an extraordinary impact on the economic and social health of all countries.Australia,located in the southern hemisphere,promptly adopted the closure and other epidemic prevention policies in late January.The whole people mobilized to actively fight against the epidemic.Compared with the passive immunization of developed countries such as the United Kingdom and the United States,it has experienced several twists and turns and achieved relatively successful results.However,the epidemic has profoundly affected public health and medical care.They are mainly manifested in mental and psychological,hand hygiene,respiratory diseases,surgical spectrum,cancer screening,and changes in national leadership’s response methods and medical insurance policies.Australia’s early physical distancing measures,relatively high per capita testing rates,political stability,national wealth and geographic isolation are among the explanatory factors.The country’s response to the COVID-19 pandemic has,thus far,been among the most successful in the world.展开更多
Objective:Adalimumab(ADA)is expensive and rarely used among patients.However,its cost for moderate to severe chronic plaque psoriasis can now be reimbursed since its addition to the National Reimbursement Drug List(NR...Objective:Adalimumab(ADA)is expensive and rarely used among patients.However,its cost for moderate to severe chronic plaque psoriasis can now be reimbursed since its addition to the National Reimbursement Drug List(NRDL)in January 2020.Therefore,we conducted this study to estimate the medical cost of ADA and its influencing factors in patients with psoriasis using ADA and thus gain a better understanding of the effect of the NRDL adjustment in China.Methods:This retrospective study evaluated the medical cost of ADA before and after the addition of ADA to the NRDL(2018—2022)among 320 patients in a large professional dermatology specialty hospital.Descriptive analysis,Welch’s analysis of variance,and multiple regression analysis were used to evaluate the medical cost and influencing factors.Results:Before ADA was added to the NRDL,patients’mean total cost and ADA cost were¥24,243.56±16,346.53 and¥20,391.11±14,440.69,respectively.After ADA became covered by the NRDL,the above 2 expenses decreased to¥10,461.19±7,554.66 and¥8,775.27±7,092.16,respectively.This significant decrease in the cost of ADA resulted in a significant 110.5-times increase in ADA use.Statistically significant differences were found in the total cost,patient type(outpatient/inpatient),insurance status(yes/no),reimbursement status(before/after),and age.Medical insurance reimbursement(P<0.001,β=-0.468,before reimbursement=1,after reimbursement=2)was the most significant influencing factor,followed by patient type(P=0.018,β=-0.215,outpatient=1,inpatient=2)and age(P=0.0046,β=-0.174).Conclusion:Medical insurance reimbursement is the most important factor affecting patients’total cost of ADA by reducing the economic burden,enhancing the availability of ADA,and stimulating the need for treatment.展开更多
Objective To provide reference for China’s medical insurance reimbursement plan of multi-indication drugs.Methods By referring to relevant foreign literature,the implementation process and conditions of different rei...Objective To provide reference for China’s medical insurance reimbursement plan of multi-indication drugs.Methods By referring to relevant foreign literature,the implementation process and conditions of different reimbursement management modes of multi-indication drugs were analyzed to provide suggestions for reimbursement of multi-indication drugs in China.Results and Conclusion It is suggested to further explore the suitable conditions and select the corresponding mode in China.Payment standards should be set according to value pricing and budget impact analysis.Besides,data collection and analysis mechanism must be improved.Lastly,reward and punishment mechanism can be adopted to improve management efficiency.展开更多
文摘Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of drug pricing in China.Methods Through the literature analysis and policy review,the pricing subject,pricing basis and price control system in the pricing process of medical-accessed medicines were analyzed from the perspective of binary equilibrium and harmonious management.Results and Conclusion It is found that four balances in the drug pricing process,two balances in pricing basis and three balances in price control system need to be considered,respectively.Drug pricing is the key content of national medical insurance access,which is also the hotspot of the policy in the pharmaceutical fields in recent years.Drug pricing not only reflects the value of drugs,but also reflects a lot of top-level designs of binary equilibriums in medical insurance policy.While the rational design of drug pricing requires the joint efforts of the government,pharmaceutical companies and relevant experts to comprehensively consider many equilibriums,so as to improve the relevant systems.
文摘Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for information and related literature,and literature review was used.Results and Conclusion In foreign countries,the clinical value of innovative drugs and their impact on medical insurance funds were comprehensively evaluated based on factors such as quality-adjusted life years,clinical benefit,and improvement of clinical benefit.Then,the evaluation results were taken as an important basis for whether innovative drugs were admitted to the medical insurance catalog and establishing medical insurance payment standards.By using international experience for reference,innovative drug pricing methods and medical insurance payment standards for China’s national conditions can be improved by establishing a basic database of clinical value and drug economic evaluation of innovative drugs,as well as innovative drug payment models based on decision thresholds.
文摘Objective To explore the impact of population aging on the expenditures of medical insurance funds against the background that great changes in population structure influences economic development.Methods Through analyzing the impact of the population aging,the income and accumulated balance of the medical insurance fund,and other related factors on the expenditure of the medical insurance fund,development status of the medical insurance fund for urban employees in China since 2003 was obtained.Stata 16.0 was used to perform multiple linear regression analysis on related factors to determine the correlation between population aging and the change in medical insurance expenditures.Results and Conclusion The factors that have a greater impact on the expenditure of the medical insurance fund are the amount of income from the medical insurance,followed by the number of people over the age of 65 in China and the urban retired employees participating in medical insurance.We should focus on the sustainable development of the urban employee medical insurance fund to deal with the threat of aging.
文摘Objective To put forward some suggestions for the development of urban basic medical insurance of Liaoning by comparing the development situations in 14 cities of Liaoning Province.Methods Relevant data of urban basic medical insurance from 2008 to 2018 in 14 cities were collected to make a comparative analysis,and the 5 why analysis chart was drawn to investigate the development differences in 14 cities.Results and Conclusion The average growth rate of the number of urban residents covered by urban basic medical insurance varied greatly from 2014 to 2018.The range of average growth rate of urban residents’medical insurance is 19.1%,and the range of average growth rate of urban workers’medical insurance is 9.1%.Funding standards are basically the same.It is suggested each municipal government should attach importance to this issue.They can make full use of information technology to coordinate with various authorities and ensure the smooth development of medical insurance.Besides,they must actively adapt to their conditions to better develop the urban basic medical insurance of Liaoning.
基金supported by National Natural Science Foundation of China (No. 71403189)
文摘Objective: An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China(mainland), in an attempt to offer a clue to further control the costs.Methods: The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page(IMRHP) dataset.The data were then processed with SAS(Version 9.3; SAS Institute, Cary, NC, USA). Indicators like means,increase(decrease) percentages were used to descriptively analyze the average hospitalization expense of each time(AHEET) and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results:In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance(URBMI)were the next,and those covered by New Rural Cooperative Medical System(NRCMS)had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions:The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.
基金Supported by the National Natureal Science Foundation of China (6 98730 36 )
文摘This paper describes how to use the Unified Modeling Language (UML) to modeling software processes in medical insurance MIS, and compares UML Modeling method with classic PO(Process Oriented) Modeling method. It indicates that the whole performance of application system model described by UML is much better than the one described by PO.
文摘The paper reports three new ensembles of supervised learning predictors for managing medical insurance costs.The open dataset is used for data analysis methods development.The usage of artificial intelligence in the management of financial risks will facilitate economic wear time and money and protect patients’health.Machine learning is associated withmany expectations,but its quality is determined by choosing a good algorithm and the proper steps to plan,develop,and implement the model.The paper aims to develop three new ensembles for individual insurance costs prediction to provide high prediction accuracy.Pierson coefficient and Boruta algorithm are used for feature selection.The boosting,stacking,and bagging ensembles are built.A comparison with existing machine learning algorithms is given.Boosting modes based on regression tree and stochastic gradient descent is built.Bagged CART and Random Forest algorithms are proposed.The boosting and stacking ensembles shown better accuracy than bagging.The tuning parameters for boosting do not allow to decrease the RMSE too.So,bagging shows its weakness in generalizing the prediction.The stacking is developed using K Nearest Neighbors(KNN),Support Vector Machine(SVM),Regression Tree,Linear Regression,Stochastic Gradient Boosting.The random forest(RF)algorithm is used to combine the predictions.One hundred trees are built forRF.RootMean Square Error(RMSE)has lifted the to 3173.213 in comparison with other predictors.The quality of the developed ensemble for RootMean Squared Error metric is 1.47 better than for the best weak predictor(SVR).
文摘Objective To study the use of real-world evidence by EU and its member states for establishing a strategy for rare diseases and provide references for the inclusion of orphan drugs in China’s medical insurance.Methods A case analysis method was used to introduce the EU’s decision to include rare disease drugs in medical insurance by using real-world evidence because clinical data of rare diseases were difficult to obtain.Results and Conclusion China can use real-world evidence to make medical insurance decisions based on the experience of the EU and continue to invest more in rare diseases,which can solve the problem of few drugs for patients with rare disease.
文摘Objective To discuss the methods of improving the social insurance of college students by taking the application of college students’social insurance in Shenyang as an example.Methods The investigation and literature method were applied mainly.Results and Conclusion Through the questionnaire,the main problems for college students’medical insurance were analyzed in this paper,and proposals such as compulsory insurance,improving the level of medical services in colleges and hospitals,and strengthening commercial insurance and publicity were finally put forward.
文摘At a seminar discussing ways to prevent chronic disease held in Shanghai on March 31, 2012, Chen Zhu, Minister of Health, revealed that the ministry was planning to include expenditures on counseling to stop smoking into the basic medical insurance system provided by the govern- ment, and would pay for drugs that help reduce dependence on tobacco.
文摘Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in China.Methods Literature research method was used to study the policies related to the reimbursement management of innovative drugs in Germany,France and Japan,and their successful experience was summarized.Results and Conclusion China should establish an open and transparent value evaluation standard to improve the medical insurance reimbursement management of innovative drugs.Besides,the value of innovative drugs should be taken as an important basis for reimbursement decisions,and an independent third-party value evaluation agency must be established.
基金This project was supported by Key projects of National Natural Science Foundation of China (No.71333005).
文摘Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China. This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID), including 3229 people in Hubei province and 2628 people in Guangdong province. One-way ANOVA was used to compare the total medical expense, out-of-pocket (OOP) expense and hospital stay between variables. A multiple linear regression analysis was done to identify possible risk factors of total medical expense. The results showed that the average total medical expense per capita was 5709.89 yuan, and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province, respectively. The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuan in 2013. There were no significant differences in medical expenses between different genders of hypertensive patients (P〉0.05). People of different ages, provinces, medical insurances and medical institution levels showed significant differences in medical expenses. The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region. Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances. And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.
文摘The morbidity and mortality of life-threatening diseases such as cancers are increasing year by year in China. Although the national medical insurance has been improved a lot, it still falls short of expecting “universal medical insurance”. To help the families of patients with cancer and other serious diseases to resolve the unaffordable medical cost, several internet platforms of “Peer to Peer Medical Mutual Aid” have gradually emerged recently. In the form of low threshold insurance combined with public support, these platforms provide subsidies to families of patients suffering from serious financial burden and then partly compensate them for the limit of national medical insurance. This article summarized the characteristics of declared patients sponsored by several medical mutual aid internet platforms. The results showed that the sponsored patients were mostly cancer patients (90.1%), aged 21 - 60 (88.4%), and the average amounts of financial support had a trend to decrease with the increase of age. In particular, the reported cases of thyroid cancer were increased dramatically recently, however, with a lowest average mutual aid fund. Given these data, it is urgent to list out a detailed rule for the use of national medical insurance on the treatment of cancer, to heighten the healthcare system for the occupational population, age from 21 to 60, and to establish the credit system for Medicare and Medicaid services.
文摘In 2020,the sudden new crown(COVID-19)virus swept the world.Countries have adopted different epidemic prevention measures.The COVID-19 has brought an extraordinary impact on the economic and social health of all countries.Australia,located in the southern hemisphere,promptly adopted the closure and other epidemic prevention policies in late January.The whole people mobilized to actively fight against the epidemic.Compared with the passive immunization of developed countries such as the United Kingdom and the United States,it has experienced several twists and turns and achieved relatively successful results.However,the epidemic has profoundly affected public health and medical care.They are mainly manifested in mental and psychological,hand hygiene,respiratory diseases,surgical spectrum,cancer screening,and changes in national leadership’s response methods and medical insurance policies.Australia’s early physical distancing measures,relatively high per capita testing rates,political stability,national wealth and geographic isolation are among the explanatory factors.The country’s response to the COVID-19 pandemic has,thus far,been among the most successful in the world.
基金supported by the Chinese Academy of Medical Sciences Medicine and Health Technology Innovation Project(No.2017-I2M-1-017)
文摘Objective:Adalimumab(ADA)is expensive and rarely used among patients.However,its cost for moderate to severe chronic plaque psoriasis can now be reimbursed since its addition to the National Reimbursement Drug List(NRDL)in January 2020.Therefore,we conducted this study to estimate the medical cost of ADA and its influencing factors in patients with psoriasis using ADA and thus gain a better understanding of the effect of the NRDL adjustment in China.Methods:This retrospective study evaluated the medical cost of ADA before and after the addition of ADA to the NRDL(2018—2022)among 320 patients in a large professional dermatology specialty hospital.Descriptive analysis,Welch’s analysis of variance,and multiple regression analysis were used to evaluate the medical cost and influencing factors.Results:Before ADA was added to the NRDL,patients’mean total cost and ADA cost were¥24,243.56±16,346.53 and¥20,391.11±14,440.69,respectively.After ADA became covered by the NRDL,the above 2 expenses decreased to¥10,461.19±7,554.66 and¥8,775.27±7,092.16,respectively.This significant decrease in the cost of ADA resulted in a significant 110.5-times increase in ADA use.Statistically significant differences were found in the total cost,patient type(outpatient/inpatient),insurance status(yes/no),reimbursement status(before/after),and age.Medical insurance reimbursement(P<0.001,β=-0.468,before reimbursement=1,after reimbursement=2)was the most significant influencing factor,followed by patient type(P=0.018,β=-0.215,outpatient=1,inpatient=2)and age(P=0.0046,β=-0.174).Conclusion:Medical insurance reimbursement is the most important factor affecting patients’total cost of ADA by reducing the economic burden,enhancing the availability of ADA,and stimulating the need for treatment.
文摘Objective To provide reference for China’s medical insurance reimbursement plan of multi-indication drugs.Methods By referring to relevant foreign literature,the implementation process and conditions of different reimbursement management modes of multi-indication drugs were analyzed to provide suggestions for reimbursement of multi-indication drugs in China.Results and Conclusion It is suggested to further explore the suitable conditions and select the corresponding mode in China.Payment standards should be set according to value pricing and budget impact analysis.Besides,data collection and analysis mechanism must be improved.Lastly,reward and punishment mechanism can be adopted to improve management efficiency.