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Background: In China, the healthcare financing structure involves multiple parties, including the government, society and individuals. Medicare Fund is an important way for the Government and society to reduce the burden of individual medical costs. However, with the aging of the population, the demand of Medicare Fund is increasing. Therefore, it is necessary to explore the sustainability of the healthcare financing structure in the context of population ageing. Objective: The purpose of this paper is to organize the characteristics of population ageing as well as healthcare financing in China. On this basis, it analyzes the impact mechanism of population ageing on healthcare financing and the sustainability of existing healthcare financing. Methods: This paper mainly adopts the method of literature research and inductive summarization. Extracting data from Health Statistics Yearbook of China and Labor and Social Security Statistics Yearbook of China. Collected about 60 pieces of relevant literature at home and abroad. Results: China has already entered a deeply ageing society. Unlike developed countries in the world, China's population ageing has distinctive feature of ageing before being rich. A healthcare financing scheme established by China, composing of the government, society, and individuals, is reasonable. However, under the pressure of population ageing, China's current healthcare financing scheme will face enormous challenges. Scholars are generally pessimistic about the sustainability of China's healthcare financing scheme. Conclusions: Population ageing will increase the expenditure and reduce the income of the Medicare Fund. This will further affect the sustainability of the healthcare financing structure. As a consequence, the state should pay particular attention to this issue and take action to ensure that the Fund continues to operate steadily. [ABSTRACT FROM AUTHOR]

Objective: Unequal utilization of medical services will have a significant impact on the consumption of resources entitled through health insurance claims of patients. With the proposal of the goal of Healthy China, it is essential to achieve the equity of medical service utilization of patients with rare diseases to further promote social equity and justice. To analyze the consumption of medical resources of rare disease patients, so as to explore how different medical insurance types impact patients' medical resources consumption. This study pioneeringly used medical data from Peking Union Medical College Hospital. By analyzing the consumption data, this paper fills the research gap of existing studies on the analysis of medical service utilization inequality based on the perspective of insurance participation by examining the effects of different types of insurance coverage on medical resource consumption of hemophiliacs. At the same time, rare disease patients as a minority group have long been neglected in the analysis of medical resource consumption, and this paper fills the research gap of medical service utilization of this group to a certain extent by taking hemophiliacs as the object of analysis. Methods: Based on the medical data of hemophilia patients in Peking Union Medical College Hospital from 2010 to 2020, we analyze the consumption of medical resources of the patients, and use a multiple regression model to explore how different medical insurance types impact patients' medical resources consumption. Results: The study has three main findings. Firstly, the disparity in medical expenditure among different hemophilia patients is quite obvious, and the drug expense accounts for a large proportion of the total cost. Secondly, the ratio of reimbursement is generally low, and there is a wide difference in the amount of reimbursement for different types of medical insurance. Thirdly, the resource consumption of patients with different medical insurance types differs a lot. Conclusion: In order to improve the current medical insurance system and mechanism for providing orphan drugs, we put forward the following suggestions. First of all, the medical security system should expand its coverage to eliminate the medical expenditure gap between different hemophilia patients, therefore better promoting equity under the same insurance type. At the same time, the reimbursement level of medical expenses for patients with rare diseases should be appropriately improved, so as to reduce the financial burden of patients with rare diseases, and promote the realization of economic equity. In addition, society should pay special attention to the disadvantaged groups, reduce the differences between various medical insurance, and improve the level of health and equity of the whole society. [ABSTRACT FROM AUTHOR]

Background: Talent is a crucial resource for economic and social development, serving as the driving force behind urban progress. As China experiences rapid growth in digital city construction, the capability of e-services continues to improve incessantly. In China, the new-generation highly educated migrants (NGHEMs) account for ~ 20–30% of the total floating populations. This study aimed to explore the settlement intention of new-generation highly educated migrations in China from the new perspective of urban e-service capabilities. Furthermore, the mechanism of the urban e-services on the settlement intention on the NGHEMs will be proved. Methods: This paper employed data of China Migrants Dynamic Survey in 2017 and Evaluation Report of Government E-service Capability Index (2017). Descriptive analyses were conducted to investigate the factors influencing the settlement intention of NGHEMs in the destination city. Based on the principle of utility maximization, LASSO regression was employed to select individual and city characteristics that determined the settlement intention of NGHEMs. The impact of urban e-services on settlement intention was analyzed by using ordinal logit model. Additionally, robustness check, endogeneity analysis, and heterogeneity analysis were performed to validate the benchmark regression results. Finally, mediation model was employed to examine whether urban e-services enhance the settlement intention of NGHEMs by improving urban livability and urban innovation. Results: The results indicate that the urban e-services promote the NGHEMs' settlement intention in the destination cities. Moreover, the results are still robust through a series of robustness tests. Furthermore, from the perspective of individual and regional heterogeneity, urban e-services significantly enhances the settlement intention of NGHEMs with male and female, married and urban household registration, and urban e-services can promote the settlement intention of NGHEMs with over 3 million inhabitants and those in the eastern regions of China. Finally, the intermediary effect test shows that urban e-services promote the settlement intention of NGHEMs through urban livability and urban innovation. Conclusion: This study highlights the important impact of urban e-services on the settlement intention of new-generation highly educated migrants. The conclusions of this study provide suggestions for the government to use when designing policies to enhance the settlement intention of the NGHEMs and to improve the development of urban e-services. [ABSTRACT FROM AUTHOR]

Background: Human communities suffered a vast socioeconomic burden in dealing with the pandemic of coronavirus disease 2019 (COVID-19) globally. Real-word data about these burdens can inform governments about evidence-based resource allocation and prioritization. The aim of this scoping review was to map the cost-of-illness (CoI) studies associated with COVID-19. Methods: This scoping review was conducted from January 2019 to December 2021. We searched cost-of-illness papers published in English within Web of Sciences, PubMed, Google Scholar, Scopus, Science Direct and ProQuest. For each eligible study, extracted data included country, publication year, study period, study design, epidemiological approach, costing method, cost type, cost identification, sensitivity analysis, estimated unit cost and national burden. All of the analyses were applied in Excel software. Results: 2352 records were found after the search strategy application, finally 28 articles met the inclusion criteria and were included in the review. Most of the studies were done in the United States, Turkey, and China. The prevalence-based approach was the most common in the studies, and most of studies also used Hospital Information System data (HIS). There were noticeable differences in the costing methods and the cost identification. The average cost of hospitalization per patient per day ranged from 101$ in Turkey to 2,364$ in the United States. Among the studies, 82.1% estimated particularly direct medical costs, 3.6% only indirect costs, and 14.3% both direct and indirect costs. Conclusion: The economic burden of COVID-19 varies from country to country. The majority of CoI studies estimated direct medical costs associated with COVID-19 and there is a paucity of evidence for direct non-medical, indirect, and intangible costs, which we recommend for future studies. To create homogeneity in CoI studies, we suggest researchers follow a conceptual framework and critical appraisal checklist of cost-of-illness (CoI) studies. [ABSTRACT FROM AUTHOR]

Background: According to the Chinese guidelines for lipid management (2023), evolocumab in combination with statins was recommended as secondary prevention of cardiovascular disease. However, because of the variation in the price of evolocumab and its different methods of confirming clinical efficacy, it was necessary to explore its economics and the impact of different methods of confirming efficacy on its economic studies. Objective: The purpose of this paper was to assess the cost-effectiveness of evolocumab with statins versus statins alone for patients with acute myocardial infarction(AMI) in China and to investigate the impact of different clinical effectiveness modeling approaches on economic outcomes. Methods: A Markov cohort state-transition model was used to estimate the incremental cost-effectiveness ratio (ICER) based on Chinese observational data on cardiovascular event rates, efficacy from the Asian subgroup of the FOURIER trial, cost and utility from the Chinese Yearbook of Health Statistics, health insurance data, and published studies conducted in China. This study conducted subgroup analyses for different populations and dosing regimens; sensitivity analyses for parameters such as cost, utility, and cardiovascular event rates; and scenario analyses on hospital hierarchy, time horizon, starting age, and price for statins. Results: ICERs ranged from 27423 to 214777 Chinese yuan(CNY) per QALY gained, all below the willingness-to-pay threshold of CNY 257094. Only when the time horizon became small, the ICERs were greater than the willingness-to-pay. The probabilities that adding evolocumab to statins was cost-effective ranged from 76 to 98%. When the time horizon became small, i.e. evolocumab was discontinued before the age of 75 (after conversion), the corresponding ICERs were almost always greater than the willingness-to-pay. ICERs for modelling approaches based on clinical endpoints were 1.34 to 1.95 times higher than ICERs for modelling approaches based on reduced LDL-C levels. Conclusions: From the Chinese healthcare and private payer perspectives, adding evolocumab to statin therapy in AMI patients is more likely to be a cost-effective treatment option at the current list price of CNY 283.8. However, evolocumab may not be cost-effective if used for shorter periods of time. The results based on different clinical effectiveness modeling approaches were significantly different. [ABSTRACT FROM AUTHOR]

Background: Medical insurance and social security cards are an important incentive for the floating population to live a stable life in their current residence, but there has been little studies on their effect on settlement intentions. Therefore, the purpose of this paper was to study the impact of basic medical insurance for urban employees and application for personal social security cards on the settlement intentions of the floating population. With the increase of the desire to settle, the health management and the development of public health will be improved. Methods: Based on the 2017 survey data from the dynamic monitoring of China's floating population, we explored the influence of basic medical insurance for urban employees and social security cards on the floating population's settlement intentions. Additionally, this study also examined the comprehensive causal relationship, with social integration as the mediator variable. We used SPSS 21.0 software. The input method was used to analyze the influence of the above variables by binary logistic regression. Then we used AMOS22.0 software to establish the structural equation model of the relationship between the above three independent variables. Finally, we used bootstrapping method to analyze the direct effect, indirect effect and total effect of independent variables on settlement intention. Results: The settlement intention of members of the floating population after participating in basic medical insurance for urban employees was 23.2% higher than that of those who did not participate. The decision as to whether to apply for a personal social security card is related to their settlement intention. The standardized regression coefficients among social insurance and security, social integration, and settlement intention were positive values, and the Z values of the overall effect, indirect effect, and direct effect were all greater than 1.96; the confidence interval of the indirect effect did not include 0. We found that this model is a partial intermediary model, with an intermediary ratio of 10.66%. Conclusions: This article highlights the important impact of basic medical insurance for urban employees and individual social security cards on the floating population. The conclusions of this study provide suggestions for the government to use when designing policies to enhance the settlement intentions of the floating population and to improve the development of public health undertakings. [ABSTRACT FROM AUTHOR]

Background: The shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, particularly for vulnerable populations, such as the elderly. When health systems face fiscal constraints, integrated care has been advanced as a potential solution by simultaneously improving health service effectiveness and efficiency. This paper addresses the latter. There are three study objectives: first, to compare efficiency differences between IC and non-IC hospitals in China; second, to examine variations in efficiency among different types of IC hospitals; and finally, to explore whether the implementation of IC impacts hospital efficiency. Methods: This study uses Data Envelopment Analysis (DEA) to calculate efficiency scores among a sample of 200 hospitals in H Province, China. Tobit regression analysis was performed to explore the influence of IC implementation on hospital efficiency scores after adjustment for potential confounding. Moreover, the association between various input and output variables and the implementation of IC was investigated using regression techniques. Results: The study has four principal findings: first, IC hospitals, on average, are shown to be more efficient than non-IC hospitals after adjustment for covariates. Holding output constant, IC hospitals are shown to reduce their current input mix by 12% and 4% to achieve optimal efficiency under constant and variable returns-to-scale, respectively, while non-IC hospitals have to reduce their input mix by 26 and 20% to achieve the same level of efficiency; second, with respect to the efficiency of each type of IC, we show that higher efficiency scores are achieved by administrative and virtual IC models over a contractual IC model; third, we demonstrate that IC influences hospitals efficiency by impacting various input and output variables, such as length of stay, inpatient admissions, and staffing; fourth, while bed density per nurse was positively associated with hospital efficiency, the opposite was shown for bed density per physician. Conclusions: IC has the potential to promote hospital efficiency by influencing an array of input and output variables. Policies designed to facilitate the implementation of IC in hospitals need to be cognizant of the complex way IC impacts hospital efficiency. [ABSTRACT FROM AUTHOR]

Background: The Chinese government has established a nationwide multiple-level medical insurance system. However, catastrophic health expenditure (CHE) causes great harm to the quality of life of households and pushes them into poverty. The objective of this paper is to assess the effect of medical insurance on CHE in China and compare the financial protection effects of different medical insurances. Methods: Panel data were obtained from China Family Panel Studies (CFPS) conducted in the years of 2012, 2014, and 2016. CHE incidence was measured by performing a headcount, and its intensity was estimated using overshoot and mean positive overshoot (MPO). In addition, concentration index (CI) was used to measure the degree of socioeconomic inequality of CHE occurrence. Furthermore, random effects panel Probit regression model was employed to assess the effect of medical insurance on CHE. Lastly, random effects panel Logit regression model was adopted to perform a robustness check. Results: From 2012 to 2016, the total CHE incidence jumped from 15.05% to 15.24%, and the CI in CHE changed from − 0.0076 to − 0.1512. Moreover, the total overshoot increased from 0.0333 to 0.0344, while the total MPO grew from 0.2213 to 0.2257. Furthermore, the global regression results show that residents covered by Supplementary Medical Insurance (SMI) were linked to a decreased probability of experiencing CHE. In addition, the regression results by gender indicate that SMI coverage for male residents had a significant effect on the prevention of CHE, while the effect was not significant for female residents. The regression results by health status show that SMI had a significant impact on reducing the likelihood of CHE occurrence for healthy residents, whilst the impact was not significant for unhealthy residents. Lastly, the robustness check results were consistent with those of previous findings. Conclusion: The results of this study suggest that CHE incidence and intensity became relatively higher among households. In addition, CHE occurrence was concentrated among the poorer households and the equality status worsened. Moreover, financial protection effects of the four medical insurance schemes against CHE varied significantly. Furthermore, the protection effect of SMI against CHE shows significant gender and health status disparities. [ABSTRACT FROM AUTHOR]

Background: Since December 2021, Wuxi, China has offered a two-dose human papillomavirus (HPV) vaccination to 14-year-old females for free. This study evaluated the costs and benefits of this vaccination scheduled in the Expanded Program on Immunization in Wuxi from the perspective of the cities' demographic characteristics, economic development, and policy support. Methods: The model-based economic evaluation used TreeAge Pro software to construct a decision tree-Markov model for the vaccination strategy in which 100,000 14-year-old females received two doses of bivalent HPV vaccine or no vaccination. Costs and effects of the strategy were assessed from a societal perspective through literature research and data obtained from the Wuxi Centre for Disease Control and Prevention. Univariate, multivariate, and probabilistic sensitivity analyses assessed the stability of the findings. Results: The cost of the bivalent HPV vaccine in Wuxi is 711.3 CNY. The two-dose of bivalent HPV vaccine for 100,000 14-year-old females would cost an additional 658,016 CNY compared to no vaccination, but would result in 1,960 Quality Adjustment Years of Life (QALYs). Using the per capita gross domestic product of 187,415 CNY in 2021 in Wuxi as the willingness-to-pay threshold, the vaccination strategy costs 3,357.37 CNY per QALY gained, which is much lower than the threshold, suggesting that it is a very cost-effective strategy. In addition, the vaccine strategy reduced the incidence of cervical cancer by 300 cases and cervical cancer deaths by 181 cases, representing a benefit-cost ratio of 2.86 (> 1) when health output outcomes were measured in monetary terms. These results suggested that the vaccination strategy was advantageous. Sensitivity analyses showed that changes in the parameters did not affect the conclusions and that the findings were robust. Conclusions: Compared to no vaccination, the delivery of two doses of bivalent HPV vaccine for 14-year-old females was a more highly cost-effective and optimal strategy. [ABSTRACT FROM AUTHOR]

Background: Based on CSS 2019 data, this article analyzes the impact of Basic Medical Insurance for Urban and Rural Residents (BMIUR) on perceived social equity of residents. Method: Using the CSS data of 2019, this article analyzes the influence of BMIUR on the perception of social equity of residents, on the basis of 2SLS model and mediating effect model. Results: We find that BMIUR has a significantly positive impact on the perception of social equity. That is to say, BMIUR can improve residents' evaluation of social equity and further promote the level of social equity, which makes residents more happiness. The conclusion remains valid after using robustness test and propensity score matching to conduct counterfactual reasoning. The discussion of mechanism indicates that the influence of BMIUR is mediated by enhancing social capital, improving satisfaction of income distribution and reducing self-paid medical expenses. This study also finds that the influence of BMIUR is more obvious in the low-income, low-skilled and mid-west groups. Conclusion: The reform of the medical security system should be regarded as a foothold for improving people's well-being and promoting social equity; Expanding people's social capital through multiple channels and improving income distribution mechanisms; Strengthen vocational skills training, especially to provide more public services and social security for low-income groups, low-skilled groups, and groups in the western region of China, in order to improve the welfare and policy effectiveness of China's social security reform. [ABSTRACT FROM AUTHOR]

Background: Medical insurance stands as a pivotal component within the overarching framework of public service systems. The intricate interplay between the extent of healthcare coverage and the overall well-being of the populace remains a pivotal research question within the academic sphere. Methods: Drawing from the comprehensive dataset of the Chinese Household Livelihood Survey, this article employs a rigorous data model to delve into the profound implications of medical coverage on population health. Results: The descriptive analysis revealed that areas with broader medical coverage tend to exhibit higher levels of overall population health. This initial observation provided a foundation for further quantitative exploration using multiple regression analysis. The regression analysis demonstrated a statistically significant positive relationship between medical coverage and population health. This finding is particularly noteworthy as it suggests that expanding access to healthcare services has tangible benefits for improving the overall health of a population. Conclusion: From the lens of familial sustenance, this article delves into the intricate health implications of medical coverage, thereby introducing a novel theoretical lens to the evolving discourse surrounding medical insurance healthcare systems and their impact on public health. This approach aims to enrich the current understanding of this complex relationship and contribute to the scholarly dialogue. [ABSTRACT FROM AUTHOR]

Chinese health system remains the crucial one for understanding the wider healthcare landscape across the Global South and in particular the leading Emerging Markets. Purpose of our observation was to understand the inner dynamics of mainland Chinese health reforms adopting a lengthy time horizon. We have analysed the public reports and seminal evidence on Chinese of multiple waves of national health reforms taking place since 1980s in terms of medical care and pharmaceuticals provision and financing. Chinese international trade with ASEAN nations and wider South-East Asia is accelerating its growth after the recovery of trade routes. In terms of health sector this means that global demand and supply of medical goods, services and pharmaceuticals remains largely driven by Chinese domestic developments. Furthermore, Chinese domestic manufacturing and sales of decent quality medical devices and services have grown exponentially. Some temporary pitfalls and increasing in rural–urban inequalities in equity of access and affordability of medical care and pharmaceuticals did take place. Despite these difficulties to generate a balanced development strategy for the largest global market, this is a clear path upwards. Further upcoming improvements expanding health insurance coverage are in strong demand for certain layers of the society. Domestic bottleneck weaknesses yet remain manufacturing, import and market penetration of cutting-edge pharmaceuticals such as monoclonal antibodies and targeted oncology agents. Yet some of these obstacles are likely to be overcome in foreseeable future with the adoption of responsible strategies by governmental agencies in health care arena. [ABSTRACT FROM AUTHOR]

Background: Based on CSS 2019 data, this article analyzes the impact of Basic Medical Insurance for Urban and Rural Residents (BMIUR) on perceived social equity of residents. Method: Using the CSS data of 2019, this article analyzes the influence of BMIUR on the perception of social equity of residents, on the basis of 2SLS model and mediating effect model. Results: We find that BMIUR has a significantly positive impact on the perception of social equity. That is to say, BMIUR can improve residents' evaluation of social equity and further promote the level of social equity, which makes residents more happiness. The conclusion remains valid after using robustness test and propensity score matching to conduct counterfactual reasoning. The discussion of mechanism indicates that the influence of BMIUR is mediated by enhancing social capital, improving satisfaction of income distribution and reducing self-paid medical expenses. This study also finds that the influence of BMIUR is more obvious in the low-income, low-skilled and mid-west groups. Conclusion: The reform of the medical security system should be regarded as a foothold for improving people's well-being and promoting social equity; Expanding people's social capital through multiple channels and improving income distribution mechanisms; Strengthen vocational skills training, especially to provide more public services and social security for low-income groups, low-skilled groups, and groups in the western region of China, in order to improve the welfare and policy effectiveness of China's social security reform. [ABSTRACT FROM AUTHOR]

The objective of this study was to estimate the willingness to pay (WTP) per quality-adjusted life year (QALY) among people with malignancies in China. The WTP for a QALY was estimated using a contingent valuation survey. Health utility was measured in EuroQol-5 dimensions (EQ-5D). The questionnaires were completed in face-to-face interviews. Respondents consisted of patients with malignant tumors and their family members and came from three tertiary hospitals in different cities with high, medium, and low gross domestic product (GDP) levels. In this study, we offered lump-sum payments and 10 year installment plans to respondents. Finally, we conducted sensitivity analysis and stepwise regression analyses to identify factors that affected the WTP/QALY ratios. A total of 1264 people participated in this survey, and 1013 people gave WTP responses for further analysis. The mean and median WTP/QALY values based on the lump-sum payments were 366,879 RMB (53,171USD, 5.1 times the GDP per capita) and 99,906 RMB (14,479USD, 1.39 times the GDP per capita) for the overall sample; 339,330 RMB (49,178USD, 4.71 times the GDP per capita) and 83,875 RMB (12,156USD, 1.16 times the GDP per capita) for the patient group; and 407,396 RMB (59,043USD, 5.66 times the GDP per capita) and 149,436 RMB (21,657USD, 2.08 times the GDP per capita) for the family group. Considering the skewedness of the data distribution, we suggest setting the cost-utility threshold with reference to the median. When the payment plan changed to 10-year installments, the median increased to 134,734RMB (19,527USD), 112,390 RMB (16,288USD) and 173,838 RMB (25,194USD) for the above groups, respectively. EQ-5D-5L health utility, annual household income per capita, patients with other chronic diseases, occupation, regular physical examinations (patients) and age (family members) were significantly related to WTP/QALY. This study provides empirical evidence of the monetary value of a QALY from a sample of the Chinese population with malignancies. In addition, the ratio of the WTP/QALY to GDP per capita was related to the disease and hypothetical scenario, and a higher ratio of GDP per capita for malignant tumor therapies should be considered. [ABSTRACT FROM AUTHOR]

Background: Research on the relationships between economic development, energy consumption, environmental pollution, and human health has tended to focus on the relationships between economic growth and air pollution, energy and air pollution, or the impact of air pollution on human health. However, there has been little past research focused on all the above associations. Methods: The few studies that have examined the interconnections between the economy, energy consumption, environmental pollution and health have tended to employ regression analyses, DEA (Data Envelopment Analysis), or DEA efficiency analyses; however, as these are static analysis tools, the analyses did not fully reveal the sustainable economic, energy, environmental or health developments over time, did not consider the regional differences, and most often ignored community health factors. To go some way to filling this gap, this paper developed a modified two stage Undesirable Meta Dynamic Network model to jointly analyze energy consumption, economic growth, air pollution and health treatment data in 31 Chinese high-income and upper-middle income cities from 2013–2016, for which the overall efficiency, production efficiency, healthcare resource utilization efficiency and technology gap ratio (TGR) for all input and output variables were calculated. Results: It was found that: (1) the annual average overall efficiency in China's eastern region was the highest; (2) the production stage efficiencies were higher than the healthcare resource utilization stage efficiencies in most cities; (3) the high-income cities had lower TGRs than the upper–middle income cities; (4) the high-income cities had higher average energy consumption efficiencies than the upper-middle income cities; (5) the health expenditure efficiencies were the lowest of all inputs; (6) the high-income cities' respiratory disease and mortality rate efficiencies were higher than in the upper–middle income cities, which had improving mortality rate efficiencies; and (7) there were significant regional differences in the annual average input and output indicator efficiencies. Conclusions: First, the high-income cities had higher average efficiencies than the upper-middle income cities. Of the ten eastern region high-income cities, Guangzhou and Shanghai had average efficiencies of 1, with the least efficient being Shijiazhuang. In the other regions, the upper-middle income cities required greater technology and health treatment investments. Second, Guangzhou, Lhasa, Nanning, and Shanghai had production efficiencies of 1, and Guangzhou, Lhasa, Nanning, Shanghai and Fuzhou had healthcare resource utilization efficiencies of 1. As the average production stage efficiencies in most cities were higher than the healthcare resource utilization stage efficiencies, greater efforts are needed to improve the healthcare resource utilization. Third, the technology gap ratios (TGRs) in the high-income cities were slightly higher than in the upper-middle income cities. Therefore, the upper-middle income cities need to learn from the high-income cities to improve their general health treatment TGRs. Fourth, while the high-income cities had higher energy consumption efficiencies than the upper-middle income cities, these were decreasing in most cities. There were few respiratory disease efficiency differences between the high-income and upper-middle income cities, the high-income cities had falling mortality rate efficiencies, and the upper-middle income cities had increasing mortality rate efficiencies. Overall, therefore, most cities needed to strengthen their health governance to balance economic growth and urban expansion. Fifth, the average AQI efficiencies in both the high-income and upper-middle income cities were higher than the average CO2 efficiencies. However, the high-income cities had lower average CO2 emissions and AQI efficiencies than the upper-middle income cities, with the AQI efficiency differences between the two city groups expanding. As most cities were focusing more on air pollution controls than carbon dioxide emissions, greater efforts were needed in coordinating the air pollution and carbon dioxide emissions treatments. Therefore, the following suggestions are given. (1) The government should reform the hospital and medical systems. (2) Local governments need to strengthen their air pollution and disease education. (3) High-income cities need to improve their healthcare governance to reduce the incidence of respiratory diseases and the associated mortality. (4) Healthcare governance efficiency needs to be prioritized in 17 upper-middle income cities, such as Hangzhou, Changchun, Harbin, Chengdu, Guiyang, Kunming and Xi'an, by establishing sound medical management systems and emergency environmental pollution treatments, and by increasing capital asset medical investments. (5) Upper-middle income cities need to adapt their treatment controls to local conditions and design medium to long-term development strategies. (6) Upper-middle income cities need to actively learn from the technological and governance experiences in the more efficient higher-income cities. [ABSTRACT FROM AUTHOR]

This article aims to summarize the development and challenges of real-world data (RWD) and real-world evidence (RWE) in China and introduce a unique opportunity for medical devices to gain accelerated regulatory approval in China by utilizing RWE generated in a free trade pilot zone "Boao Lecheng" in Hainan Province. In 2020, the National Medical Products Administration (NMPA) issued a draft guideline on the "Use of real-world data to support clinical evaluation for medical devices", suggesting that RWE derived from RWD could support clinical evaluation throughout the life cycle of a medical device. Meanwhile, the Chinese government has allowed qualified RWD collected in Boao Lecheng to support registration application of innovative medical devices and drugs in China. These medical devices and drugs should have been approved abroad, but not in China yet, and met urgent and unmet medical needs in China. The article also presents the successful story of an innovative Glaucoma drainage tube as the first medical device approved in China using RWE generated in Boao Lecheng in 2020. Although we are witnessing an increased interest in RWE, a few challenges remain, e.g., limited data accessibility and data sharing, concerns on data quality, etc. Collaborations among relevant stakeholders in the RWE research are vital to address the challenges. [ABSTRACT FROM AUTHOR]

Background: Image-guided system (IGS) has been gradually applied in the field of rhinology, making functional endoscopic sinus surgery (FESS) a truly minimally invasive and precise surgery. This study was based on real-world data from China hospitals and aimed to evaluate the clinical and economic benefits of the IGS navigation system in FESS. Methods: This was a two-center retrospective chart review of patients with chronic rhinosinusitis who underwent FESS, including open frontal sinus between July 1, 2018 and December 31, 2019 in China. The intervention group consisted of 100 patients who underwent FESS with the IGS navigation system (IGS group), and the control group consisted of 100 patients who underwent conventional FESS (Non-IGS group). Data were collected from surgical notes and hospital medical records. The primary endpoints for clinical effectiveness and safety were avoid rehospitalization due to bleeding, avoid reoperation due to bleeding, and avoid reoperation due to recurrence. Results: There were no cases of rehospitalization due to bleeding, reoperation due to bleeding, and reoperation due to recurrence in the IGS group, with an avoidance rate of 100%. In the non-IGS group, there were four cases of rehospitalization and reoperation due to bleeding, with an avoidance rate 96.00% (P = 0.121). No cases of reoperation due to recurrence were in the non-IGS group. The total hospitalization cost was 17,391.51 CNY in the IGS group and 17,742.41 CNY in the non-IGS group per patient, with no statistical difference between the two groups (P = 0.715). Compared with the non-IGS group, the IGS group had an overall cost saving of 350.90 CNY per patient. Although the procedure-related medical costs of IGS group were increased by 1,286.12 CNY compared with the non-IGS group, this was more than offset by other costs. Conclusion: The results of the study indicated that the IGS may avoid occurrence of rehospitalization and reoperation due to postoperative bleeding. Although the use of navigation technology increased the cost of surgery, its clinical effectiveness brought other medical cost savings, resulting in no significant difference in the overall cost of navigation surgery compared to conventional surgery. The IGS should be considered cost-effectiveness in the treatment of FESS. [ABSTRACT FROM AUTHOR]

Objectives: Surgical lung resection involves a critical task of stapled ligation and transection of major vascular structures and tissue, which may lead to bleeding and complications. A newer powered stapling system with Gripping Surface Technology (GST) was introduced to account for tissue movements. This study aimed to examine the real-world effectiveness of GST system on intraoperative and postoperative outcomes of pulmonary resection. Methods: A retrospective analysis was conducted using the electronic medical records of Sichuan Provincial People's Hospital between July 2020 and March 2021 in China. Patients who underwent their first procedures of single-port lobectomy or multi-port segmentectomy by video-assisted thoracoscopic surgery were identified and grouped as GST group or manual stapler group (manual group) by the stapler types. The intraoperative outcomes such as bleeding rate, blood loss volume, and intervention rate at the staple line (including intraoperative pressure, suture, and electrocoagulation) were documented by trained nurses during the surgery. Propensity score matching was performed between the two groups, controlling forage, BMI, smoking history, history of surgery, complications, and level of complexity of pneumonectomy. Results: A total of 108 matched patients were included in the analysis (54 in the GST group and 54 in the manual group). GST group had lower risks for intraoperative bleeding (22.8% vs 51.9%; p = 0.003) and intraoperative interventions (31.5% vs 55.6%; p = 0.02), compared to the manual group. A decrease in the intraoperative blood loss was observed in the GST group, but not statistically significant (134.39 ± 52.82 ml vs 158.11 ± 73.14 ml, p = 0.102). The use of NEOVEIL (reinforcement material to prevent air leakage from the staple line) intraoperatively during surgery was significantly lower in the GST group (24.1%) than in the manual group (50%, p = 0.01). Conclusion: The GST system was associated with better intraoperative outcomes in clinical practice in China. [ABSTRACT FROM AUTHOR]

Background: Health equity remains a priority concerns by central government in China. This study aimed to explore ethnic gaps in access to health knowledge categories and sources based on the survey data from a publicly available dataset. Methods: Data were from 2015 China Migrants Dynamic Survey issued by The National Health Commission in China. Descriptive analyses were performed to reflect geodemographic differences in the floating population of ethnic minority (EMFP) and Han majority (HMFP) with Chi-square test. Ethnic gaps in access to health knowledge categories and sources were explored with Poisson regressions, logistic regressions, and bivariate ordered probit regressions. Results: In the sample, most of participants had inadequate health information literacy. There were significant differences regarding geodemographic factors between EMFP and HMFP. Illiterate EMFP had likelihood to obtain less health knowledge categories (IRR = 0.80, 95% CI 0.77–0.84) and sources (IRR = 0.83, 95% CI 0.80–0.86) as compared to illiterate HMFP. Most of correlations between health knowledge categories and sources were weak in the samples of EMFP and HMFP. Conclusion: Ethnic disparities in access to health knowledge categories and sources among the floating population in China were confirmed. Further effective efforts should be provided to reduce ethnic disparities in access to health knowledge under the ethnicity-orientated support of public health resource. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is the most prevalent cancer, and the leading cause of cancer-related deaths in China. The aim of this study was to estimate the direct medical expenditure incurred for lung cancer care and analyze the trend therein for the period 2002–2011 using nationally representative data in China Methods: This study was based on 10-year, multicenter retrospective expenditure data collected from hospital records, covering 15,437 lung cancer patients from 13 provinces diagnosed during the period 2002–2011. All expenditure data were adjusted to 2011 to eliminate the effects of inflation using China's annual consumer price index. Results: The direct medical expenditure for lung cancer care (in 2011) was 39,015 CNY (US$6,041) per case, with an annual growth rate of 7.55% from 2002 to 2011. Drug costs were the highest proportionally in the total medical expenditure (54.27%), followed by treatment expenditure (14.32%) and surgical expenditure (8.10%). Medical expenditures for the disease varied based on region, hospital level, type, and stage. Conclusion: The medical expenditure for lung cancer care is substantial in China. Drug costs and laboratory test are the main factors increasing medical costs. [ABSTRACT FROM AUTHOR]

Background: Rapid economic growth in China has resulted in a commensurate increase in energy consumption, which in turn has seen an increase in environmental pollution problems. Past research has tended to focus on energy and environmental efficiency analyses and has rarely examined the media influence on environmental protection efforts. Further, most studies have used static models and ignored the dynamic changes over time. Methods: To go some way to filling this research gap, this study developed a modified undesirable Dynamic DEA model that included air quality index (AQI) and CO2 indicators to explore the relationships between energy, the environment, and media report efficiencies in 31 Chinese cities from 2013 to 2016. Results: It was found that: (1) Chongqing, Guangzhou, Nanjing and Shanghai had efficiencies of 1, but Lanzhou, Shijiazhuang, Taiyuan, Xining and Yinchuan needed significant improvements; (2) Chongqing, Guangzhou, Kunming, Nanning and Shanghai had relatively high media efficiencies, but the other cities had low efficiencies and required improvements; (3) the CO2 emissions efficiencies in most cities were better than the air quality index efficiencies; and 4. the media reports in most cities were found to have a more positive impact on the CO2 emissions efficiency than on the AQI efficiency. Conclusions: Environmental awareness enhances civilian health and promotes economic growth. Therefore, as the news media should be responsible for promoting environmental protection, they need to increase their environmental pollution coverage. It was found that the environmental pollution media report quality and especially air pollution reports needed improvements, and greater media coverage on environmental pollution and awareness was needed. [ABSTRACT FROM AUTHOR]

Objective: The changes of absolute value and relative value of clinical research coordinator service fee and its influence on the quality of drug clinical trial were analyzed. Methods: This study compared the amount and structural changes of drug clinical trial costs in before 3 years and after 3 years of self-examination and inspection initiated by the China Food and Drug Administration, identified the increase number and composition of each individual cost of a clinical trial research funds which including clinical research coordinator service fee, investigator labor fee, subjects examination fee, subjects traffic subsidy, documents management fee, drug management fee, etc. Result: The most significant appearance of increase in volume and proportion was the clinical research coordinator service fee. From the initial few to the global multicenter tumor drug clinical trials RMB31,624 or 34.92% of the proportion and domestic multicenter tumor drug clinical trials RMB16,500, accounted for 33.74%. Discussion: It has become common for more money to be spent on clinical trials to be accompanied by improved quality, but the occurrence and continuous increase of clinical research coordinator service fee were divided into two aspects, On the one hand, the quality of clinical trials was promoted by the large amount of low-skill trivial work undertaken by clinical research coordinator; on the other hand, the quality of clinical trials was undermined by the fact that clinical research coordinator did too much treatment evaluation work that should have been done by the investigator. Conclusion: The clinical research coordinators' access standards, pre-employment training and examination, job and performance evaluation, in addition to the SMO specification management and avoiding malicious competition between the industry, are important factors in the quality assurance of drug clinical trials. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer among women in China. Amplification of the Human epidermal growth factor receptor type 2 (HER2) gene is present and overexpressed in 18–20% of breast cancers and historically has been associated with inferior disease-related outcomes. There has been increasing interest in de-escalation of therapy for low-risk disease. This study analyzes the cost-effectiveness of Doxorubicin/ Cyclophosphamide/ Paclitaxel/ Trastuzumab (AC-TH) and Docetaxel/Carboplatin/Trastuzumab(TCH) from payer perspective over a 5 year time horizon. Methods: A half-cycle corrected Markov model was built to simulate the process of breast cancer events and death occurred in both AC-TH and TCH armed patients. Cost data came from studies based on a Chinese hospital. One-way sensitivity analyses as well as second-order Monte Carlo and probabilistic sensitivity analyses were performed.The transition probabilities and utilities were extracted from published literature, and deterministic sensitivity analyses were conducted. Results: We identified 41 breast cancer patients at Hangzhou First People's Hospital, among whom 15 (60%) had a partial response for AC-TH treatment and 13 (81.25%) had a partial response for TCH treatment.No cardiac toxicity was observed. Hematologic grade 3 or 4 toxicities were observed in 1 of 28 patients.Nonhematologic grade 3 or 4 toxicities with a reverse pattern were observed in 6 of 29 patients. The mean QALY gain per patient compared with TCH was 0.25 with AC-TH, while the incremental costs were $US13,142. The incremental cost-effectiveness ratio (ICER) of AC-TH versus TCH was $US 52,565 per QALY gained. Conclusions: This study concluded that TCH neoadjuvant chemotherapy was feasible and active in HER2-overexpressing breast cancer patients in terms of the pathological complete response, complete response, and partial response rates and manageable toxicities. [ABSTRACT FROM AUTHOR]

Background: To conduct an indirect treatment comparison of patients with high-volume mHSPC and a cost analysis between Abi-ADT and Doc-ADT therapies in China. Methods: The Bucher technique for indirect treatment comparison was used. A cost analysis was conducted from both healthcare and patient perspectives. Results: The indirect treatment comparison demonstrated no significant difference in PFS for Abi-ADT versus Doc-ADT (HR: 0.84, 95% CI 0.66–1.07). Doc-ADT therapy costs less than Abi-ADT, with potential savings of up to RMB 887,057 per patient from the healthcare perspective and RMB 226,210 per patient from the patient perspective. Conclusions: No significant differences in PFS between Doc-ADT and Abi-ADT therapy for patients with high-volume mHSPC. Doc-ADT therapy is a cost-saving alternative to Abi-ADT in China. [ABSTRACT FROM AUTHOR]

Background: Different classification of hospitals (COH) have an important impact on medical expenditures in China. The objective of this study is to examine the impact of COH on medical expenditures with the hope of providing insights into appropriate care and resource allocation. Methods: From the perspective of COH framework, using the Urban Employee Basic Medical Insurance (UEBMI) data of Chengdu City from 2011 to 2015, with sample size of 488,623 hospitalized patients, our study empirically analyzed the effect of COH on medical expenditure by multivariate regression modeling. Results: The average medical expenditure was 5468.86 Yuan (CNY), the average expenditure of drug, diagnostic testing, medical consumables, nursing care, bed, surgery and blood expenditures were 1980.06 Yuan (CNY), 1536.27 Yuan (CNY), 500.01 Yuan (CNY), 166.23 Yuan (CNY), 221.98 Yuan (CNY), 983.18 Yuan (CNY) and 1733.21 Yuan (CNY) respectively. Patients included in the analysis were mainly elderly, with an average age of 86.65 years old. Female and male gender were split evenly. The influence of COH on total medical expenditures was significantly negative (p < 0.001). The reimbursement ratio of UEBMI had a significantly positive (p < 0.001) effect on various types of medical expenditures, indicating that the higher the reimbursement ratio was, the higher the medical expenditures would be. Conclusions: COH influenced medical expenditures significantly. In consideration of reducing medical expenditures, the government should not only start from the supply side of healthcare services, but also focus on addressing the demand side. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the cost-effectiveness of one-time standard endoscopic screening with Lugol's iodine staining for esophageal cancer (EC) in China. Methods: A Markov decision analysis model with eleven states was built. Individuals aged 40 to 69 years were classified into six age groups in five-year intervals. Three different strategies were adopted for each cohort: (1) no screening; (2) one-time endoscopic screening with Lugol's iodine staining with an annual follow-up for low-grade intraepithelial neoplasia (LGIN); and (3) one-time endoscopic screening with Lugol's iodine staining without follow-up. Quality-adjusted life-years (QALYs) indicated the effectiveness of the model. The incremental cost-effectiveness ratio (ICER) was used as the evaluation indicator. Sensitivity analysis was performed to assess the robustness of the model. Results: One-time screening with follow-up was the undominated strategy for individuals aged 40–44 and 45–49 years, which saved USD 10,942.57 and USD 6611.73 per QALY gained compared to nonscreening strategy. For those aged 50–69 years, the nonscreening scenarios were undominated. One-time screening without follow-up was the extended dominated strategy. Compared to screening strategies without follow-up, all the screening strategies with follow-up were more cost-effective, with the ICER increasing from 299.57 USD/QALY for individuals aged 40–44 years to 1617.72 USD/QALY for individuals aged 65–69 years. Probabilistic sensitivity analysis (PSA) supported the results of the base case analysis. Conclusions: One-time EC screening with follow-up targeting individuals aged 40–49 years was the most cost-effective strategy. [ABSTRACT FROM AUTHOR]

Background: Inappropriate admissions cause excessive utilization of health services compared with outpatient services. However, it is still unclear whether inappropriate admissions cause excessive use of health services compared with appropriate admissions. This study aims to clarify the differences in the hospitalization performances between appropriately admitted inpatients and inappropriately admitted inpatients. Methods: A total of 2575 medical records were obtained after cluster sampling in three counties. Admission appropriateness was assessed by appropriateness evaluation protocol (AEP). The propensity score matching (PSM) was computed to match patients in treatment and control group with similar characteristics, and to examine the differences in the utilization of hospitalization services between the two groups. The samples were matched in two major steps in this study. In the first step, total samples were matched to examine the differences in the utilization of hospital services between the two groups using 15 individual covariates. In the second step, PSM was computed to analyze the differences between the two groups in different disease systems using 14 individual covariates. Results: For the whole sample, the inappropriate group has lower expenditure of hospitalization (EOH) (difference = − 0.12, p = 0.003) and shorter length of stay (LOS) (difference = − 0.73, p = 0.016) than the appropriate group. For number of clinical inspection (NCI), it has no statistically significant difference (difference = − 0.39, p = 0.082) between the two groups. Among different disease systems, no significant differences were observed between the two groups among EOH, LOS and NCI, except that the EOH was lower in the inappropriate group than that in the appropriate group for surgical disease (difference = − 0.169, p = 0.043). Conclusion: Inappropriate admissions have generated excessive health service utilization compared with appropriate admissions, especially for internal diseases. The departments in charge of medical services and hospital managers should pay high attention to the health service utilization of the inappropriately admitted inpatients. Relevant medical policies should be designed or optimized to increase the appropriateness in health care service delivery and precision in clinical pathway management. [ABSTRACT FROM AUTHOR]

Objectives: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally. In China, sorafenib and oxaliplatin plus infusional-fluorouracil/leucovorin (FOLFOX4) are approved for the systemic treatment of advanced HCC. This study compared the cost-effectiveness of these therapies from a healthcare system perspective and a patient perspectives. Methods: A Markov model was constructed using overall and progression-free survival rates and adverse event (AE) rate from two randomized controlled studies of advanced HCC patients from Asia: EACH for FOLFOX4 and ORIENTAL for sorafenib. The patients in the Markov model were followed until death, the length of each Markov cycle was 1 month, and the survival was adjusted for quality-adjusted life years (QALYs). Direct medical costs included costs of therapies, AE treatment, general ward and tests. Costs were derived from published sources, interviews with oncologists and hospital data from China. One-way and probabilistic sensitivity analyses (PSA) were performed to test the robustness of the results. Results: From the healthcare system perspective, FOLFOX4 dominated sorafenib with lower therapy costs (FOLFOX4: US$ 6972; sorafenib: US$ 12,289), lower direct medical costs (FOLFOX4: US$ 8428; sorafenib: US$ 12,798), and higher QALYs (FOLFOX4: 0.42; sorafenib: 0.38) per patient. This result was robust according to comprehensive one-way sensitivity analyses. According to the PSA, at the cost-effectiveness threshold for China (3 × GDP, US$ 22,073), FOLFOX4 should be chosen in 63.9% of simulations. From the patient perspective, FOLFOX4 also dominated sorafenib. Conclusions: The study results indicate that FOLFOX4 dominates sorafenib because it appears to provide higher effectiveness with significantly lower costs in treating Chinese advanced HCC patients. [ABSTRACT FROM AUTHOR]