Factors that associated with TB patient admission rate and TB inpatient service cost: a cross-sectional study in China

Background:China has recently adopted the“TB designated hospital model”to improve the quality of tuberculosis(TB)treatment and patient management.Considering that inpatient service often results in high patient financial burden,and therefore influences patient adherence to treatment,it is critical to better understand the TB patient admission rate and TB inpatient service cost,as well as their influential factors in this new model.Methods:Quantitative and qualitative studies were conducted in two cities,Hanzhong in Shaanxi Province and Zhenjiang in Jiangsu Province,in China.Quantitative data were obtained from a sample survey of 533 TB patients and TB inpatient records from 2010–2012 in six county designated hospitals.Qualitative information was obtained through interviews with key stakeholders(40 key informant interviews,14 focus group discussions)and reviews of health policy documents in study areas.Both univariate and multivariate statistical analyses were applied for the quantitative analysis,and the thematic framework approach was applied for the qualitative analysis.Results:The TB patient admission rates in Zhenjiang and Hanzhong were 54.8 and 55.9%,respectively.Qualitative analyses revealed that financial incentives,misunderstanding of infectious disease control and failure of health insurance regulations were the key factors associated with the admission rates and medical costs.Quantitative analyses found differences in hospitalization rate existed among patients with different health insurance and patients from different counties.Average medical costs for TB inpatients in Jurong and Zhenba were 7,215 CNY and 4,644 CNY,which was higher than the 5,500 CNY and 3,800 CNY limits set by the New Rural Cooperative Medical System.No differences in medical cost or length of stay were found between patients with and without comorbidities in county-level hospitals.Conclusions:TB patient admission rates and inpatient service costs were relatively high.Studies of related factors indicated that a package of interventions,including health education programs,reform of health insurance regulations and improvement of TB treatment guidelines,are urgently required to ensure that TB patients receive appropriate care.

Health care service usage and costs for high-needs elderly patients with heart failure

Heart failure(HF)has been defined as global disease of pandemic proportions,since it affects around 26 million people worldwide.[1]According to a recent study,age is the most important factor influencing the prevalence of HF,as it is for most other chronic conditions.[2]This means that,with the predicted aging of the population(the proportion of the world’s population aged 60 years and over will nearly double from 2015 to 2050),[3]there will be a growth in the total burden of HF,and a rise in the number of comorbidities in HF patients.According to a recent study,almost 86%of adults with HF have two or more comorbid conditions.[4]Comorbidity,defined as the co-existence of one or more additional conditions in individuals with a specified index medical condition,[5]adds to the complexity of treating elderly patients with HF.

The ecological cost of land reclamation and its enlightenment to coast sustainable development in the northwestern Bohai Bay,China

Land has been widely reclaimed in large area in coastal zones all over the world to relieve the pressure of land shortage,promoting social development and economic growth.Asia has become a focus of land reclamation with the rapid industrialization and urbanization.From the Binhai New Area of Tianjin to the Caofeidian New Area of Tangshan,the undergoing project of land reclamation on the northwest coast of Bohai Bay,China,is the largest in the world.To clarify the environmental issues and benefit sustainable development of the coastal zone,we conducted both retrospective and predictive assessments of the ecological cost caused by land reclamation on the northwest coast of Bohai Bay,China.We calculated the ecological costs of ten aspects of the four ecosystem services,i.e.,supply,regulation,support and culture,with the monetary estimate approach.The results indicate that the ecological cost of the new land reclamation is US$971.9 million from 2000 to 2010 and that the cost will be US$702.1 million from 2010 to 2020.The costs of gas regulation and marine food supply account for the greatest parts of the total value.Suggestions for land reclamation oriented to sustainable development in the study area are put forward,including a rational planning based on the comprehensive evaluation,reducing the amount of land reclamation area,optimizing the structure of the reclaimed land,reclaiming land with the concept of ＂low impact development＂ and implementing ecological compensation mechanisms,etc.

Can Low-Price Hospitals Ease The High Cost of Medical Services?

Going to a hospital is not an easy matter for most Chinese people, with overcrowding and soaring medical costs having become two focuses of public complaint. China's medical system has been on a marketization drive since the 1980s. A July 2005 report by the Development Research Center of the State Council, a think tank under China's cabinet, however, came to

Remote monitoring cost minimization for an unreliable sensor network with guaranteed network throughput

In this paper we consider a link-unreliable remote monitoring scenario where the monitoring center is geographically located far away from the region of the deployed sensor network,and sensing data by the sensors in the network will be transferred to the remote monitoring center through a third party telecommunication service.A cost associated with this service will be incurred,which will be determined by the number of gateways employed and the cumulative volume of data successfully received within a specified monitoring period.For this scenario,we first formulate a novel constrained optimization problem with an objective to minimize the service cost while a pre-defined network throughput is guaranteed.We refer to this problem as the throughput guaranteed service cost minimization problem and prove that it is NP-complete.We then propose a heuristic for it.The key ingredients of the heuristic include identifying gateways and finding an energy-efficient forest of routing trees rooted at the gateways.We also perform theoretical analysis on the solution obtained.Finally,we conduct experiments by simulations to evaluate the performance of the proposed algorithm.Experimental results demonstrate the proposed algorithm outperforms other algorithms in terms of both the service cost and the network lifetime.

Ecosystem service tradeoff between traditional and modern agriculture： a case study in Congjiang County, Guizhou Province, China

Besides crops, agriculture supplies all three major categories of ecosystem services （ES）. However, agriculture also supplies an array of ecosystem dis-services （EDS） that may harm other ecosystems. The flows of ES and EDS are directly dependent on the management of agricultural ecosystems. The traditional method of Chinese agriculture, which supports sustainable agriculture, has been proven to increase ES and reduce EDS. However, there is a lack of a detailed understanding of the ES and EDS associated with traditional agriculture, and also of differences between traditional and modem agriculture. In this study, an investigation was conducted on the ecosystem services （ES） and ecosystem dis-services （EDS） of traditional and modem agriculture in Congjiang County, Guizhou Province, China. Afterwards, the economic values of ES and EDS were quantified experimentally and calculated based on the market price. The results show that： the net economic value of traditional rice-fish agriculture was 3.31 x 104 CNY.haI （6.83 CNY = 1 USD as of July, 2009） and that of rice monoculture was 1.99 x 104 CNY.ha ~. Significant differences existed between traditional rice-fish and rice monoculture fields for their economic values of some ES or EDS. A benefit and cost analysis （BCA） model was used to adjust the conflict between the economic income and environmental loss from traditional and modem agricul- ture. The BCA model not only calculates the net income but also monetizes the EDS of the agricultural systems. The results showed that the net income of rice-fish agriculture was 1.94x 104CNY.ha-1 higher than that of rice monoculture. However, the benefit to cost ratio （BCR） of rice-fish agriculture was lower than that of rice monoculture, indicating that the traditional agricultural model was not the most optimized choice for farmers. The value of the rice-fish agriculture was much higher than that of the rice monoculture. Thus, when considering the benefits that rice-fish agriculture contributes to the large- scale society, these agricultural methods needs to be utilized. Furthermore, the labor opportunity costs were calculated and the comprehensive value of rice mono- culture was negative. Finally, the compensation standard was calculated based on the comprehensive benefit analysis. The lowest level was 1.09×103 CNY.ha-1, and the highest level was 1.21 × 104 CNY.ha-1.