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Due to the acceleration of population aging and the prevalence of unhealthy lifestyles, the huge population with cardiovascular disease (CVD) risk factors, the burden of CVD continues to increase in China. CVD is still the leading cause of death among urban and rural residents in China. In 2020, CVD accounted for 48.00% and 45.86% of the causes of death in rural and urban areas, respectively, and two out of every five deaths were due to CVD. It is estimated that the number of current CVD patients in China is 330 million, including 13 million cases of stroke, 11.39 million cases of coronary heart disease, 8.9 million cases of heart failure, 5 million cases of pulmonary heart disease, 4.87 million cases of atrial fibrillation, 2.5 million cases of rheumatic heart disease, 2 million cases of congenital heart disease, 45.3 million cases of peripheral artery disease, and 245 million cases of hypertension. The total hospitalization costs were 270.901 billion yuan for CVD in China in 2020. The prevention and treatment of CVD in China still has a long way to go. In general, we should not only do a good job in secondary prevention and treatment of CVD, but also further strengthen the upstream treatment of modifiable risk factors such as hypertension, hyperglycemia and hyperlipidemia starting with both preventive treatment and treatment diseases. In addition, attention should be paid to the allocation and prioritization of health care and public health resources, so as to reach the inflection point of CVD prevention and treatment as early as possible.

Background Since August 2022, Shengzhou City of Zhejiang Province has been carrying out the reform of outpatient payment mode in medical insurance, gradually carrying out the reform of capitation by implementing the total budget, updating the calculation standard of capitation fee, improving the incentive and constraint mechanism and other measures, so as to encourage primary health care institutions to provide appropriate basic medical services, reduce primary medical expenses, and promote the sustainable development of medical insurance fund. Objective To analyze the influence mechanism of capitation for outpatient services in basic medical insurance on medical expenses in Shengzhou City, Zhejiang Province, and to provide reference for improving the relevant payment system. Methods Using "capitation" and "medical costs" as both English and Chinese search terms, databases such as CNKI, Wanfang, PubMed and Web of Science were searched for relevant literature on capitation from 2000-01-01 to 2022-07-31, as well as the policy documents, government reports and news reports related to the implementation of capitation from April to July 2022. Personal interviews were conducted with representatives of capitation payment policy makers and implementers in Shengzhou City from September to December 2022 (n=13) . A qualitative analysis of capitation reform policy on medical expenses under the total outpatient budget in Shengzhou City, Zhejiang Province was performed by using system dynamics approach. Results The policies of the current round of medical insurance payment reform in Shengzhou were plotted as a cause graph with five feedback loops obtained, showing that the implementation of the total capitation budget policy can motivate primary health care institutions to provide standardized medical services for residents, promote an increase in the contracting rate in primary care, thus controling medical expenses; a scientific capitation fee standard can motivate primary health care institutions to autonomously control and reduce costs; increasing the reimbursement ratio of medical insurance can effectively reduce the medical burden of patients; improving the performance appraisal system is conducive to the continuous improvement of service capabilities of primary health care institutions; strengthening the construction of information sharing mechanisms can achieve data sharing and exchange, and comprehensively improve the health of residents. Conclusion The implementation of capitation reform in conjunction with multiple policy measures can improve the contracting and consultation rates in primary care institutions, broaden the sources of medical insurance fund, ensure the sustainability of medical insurance fund, improve the medical service and capabilities of primary care institutions, improve the health status of residents, and significantly improve the prevention and treatment effect of chronic diseases.

Abstract Background Nearly 30 years post legalisation and introduction, midwifery is still not optimally integrated within the health system of Canada’s largest province, Ontario. Funding models have been identified as one of the main barriers. Methods Using a constructivist perspective, we conducted a qualitative descriptive study to examine how antepartum, intrapartum, and postpartum funding arrangements in Ontario impact midwifery integration. We conceptualized optimal ‘integration’ as circumstances in which midwives’ knowledge, skills, and model of care are broadly respected and fully utilized, interprofessional collaboration and referral support the best possible care for patients, and midwives feel a sense of belonging within hospitals and the greater health system. We collected data through semi-structured telephone interviews with midwives, obstetricians, family physicians, and nurses. The data was examined using thematic analysis. Results We interviewed 20 participants, including 5 obstetricians, 5 family physicians, 5 midwives, 4 nurses, and 1 policy expert. We found that while course-of-care-based midwifery funding is perceived to support high levels of midwifery client satisfaction and excellent clinical outcomes, it lacks flexibility. This limits opportunities for interprofessional collaboration and for midwives to use their knowledge and skills to respond to health system gaps. The physician fee-for-service funding model creates competition for births, has unintended consequences that limit midwives’ scope and access to hospital privileges, and fails to appropriately compensate physician consultants, particularly as midwifery volumes grow. Siloing of midwifery funding from hospital funding further restricts innovative contributions from midwives to respond to community healthcare needs. Conclusions Significant policy changes, such as adequate remuneration for consultants, possibly including salary-based physician funding; flexibility to compensate midwives for care beyond the existing course of care model; and a clearly articulated health human resource plan for sexual and reproductive care are needed to improve midwifery integration.

Background: Nearly 30 years post legalisation and introduction, midwifery is still not optimally integrated within the health system of Canada's largest province, Ontario. Funding models have been identified as one of the main barriers. Methods: Using a constructivist perspective, we conducted a qualitative descriptive study to examine how antepartum, intrapartum, and postpartum funding arrangements in Ontario impact midwifery integration. We conceptualized optimal 'integration' as circumstances in which midwives' knowledge, skills, and model of care are broadly respected and fully utilized, interprofessional collaboration and referral support the best possible care for patients, and midwives feel a sense of belonging within hospitals and the greater health system. We collected data through semi-structured telephone interviews with midwives, obstetricians, family physicians, and nurses. The data was examined using thematic analysis. Results: We interviewed 20 participants, including 5 obstetricians, 5 family physicians, 5 midwives, 4 nurses, and 1 policy expert. We found that while course-of-care-based midwifery funding is perceived to support high levels of midwifery client satisfaction and excellent clinical outcomes, it lacks flexibility. This limits opportunities for interprofessional collaboration and for midwives to use their knowledge and skills to respond to health system gaps. The physician fee-for-service funding model creates competition for births, has unintended consequences that limit midwives' scope and access to hospital privileges, and fails to appropriately compensate physician consultants, particularly as midwifery volumes grow. Siloing of midwifery funding from hospital funding further restricts innovative contributions from midwives to respond to community healthcare needs. Conclusions: Significant policy changes, such as adequate remuneration for consultants, possibly including salary-based physician funding; flexibility to compensate midwives for care beyond the existing course of care model; and a clearly articulated health human resource plan for sexual and reproductive care are needed to improve midwifery integration. [ABSTRACT FROM AUTHOR]

Background: Bangladesh outperforms its Least Developed Country (LDC) status on a range of health measures including life expectancy. Its frontline medical practitioners, however, are not formally trained medical professionals, but instead lightly-trained 'village doctors' able to prescribe modern pharmaceuticals. This current study represents the most complete national survey of these practitioners and their informal 'clinics'. Methods: The study is based on a national Computer Assisted Telephone Interviewing (CATI) of 1,000 informal practitioners. Participants were sampled from all eight divisions and all 64 districts of Bangladesh, including 682 participants chosen from the purposively recruited Refresher Training program conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), supplemented with 318 additional participants recruited through snowball sampling. Primary and secondary outcome measures: In addition to demographics, village doctors were asked about the characteristics of their 'clinics' including their equipment, their training, income and referral practices. Results: Three quarters of the wholly male sample had not completed an undergraduate program, and none of the sample had received any bachelor-level university training in medicine. Medical training was confined to a range of short-course offerings. Village doctor 'clinics' are highly dependent on the sale of pharmaceuticals, with few charging a consultation fee. Income was not related to degree of short-course uptake but was related positively to degree of formal education. Finally, practitioners showed a strong tendency to refer patients to the professional medical care system. Conclusions: Bangladesh's village doctor sector provides an important pathway to professional, trained medical care, and provides some level of care to those who cannot afford or otherwise access the nation's established healthcare system. However, the degree to which relatively untrained paramedical practitioners are prescribing conventional medicines has concerning health implications. [ABSTRACT FROM AUTHOR]

The prevalence and incidence of cardiovascular diseases (CVD) are increasing in Chinese residents due to ever-deepening influence of associated risks caused by socioeconomic factors (such as the acceleration of population aging and urbanization) and lifestyle changes (such as recently emerged unhealthy lifestyle factors) . In 2019, CVD-related death accounted for 46.74% and 44.26% of all deaths occurring in China's rural and urban areas, respectively. Two out of every five deaths were due to CVD. It is estimated that about 330 million individuals suffer from CVD in China, among whom the number of those suffering from stroke, coronary heart disease, heart failure, pulmonary heart disease, atrial fibrillation, rheumatic heart disease, congenital heart disease, lower extremity artery disease and hypertension is 13 million, 11.39 million, 8.9 million, 5 million, 4.87 million, 2.5 million, 2 million, 45.3 million and 245 million, respectively. In 2019, the total hospitalization costs were 313.366 billion yuan for cardiovascular and cerebrovascular diseases. The burden of CVD is continually increasing, especially in rural areas. The mortality of coronary heart disease and cerebrovascular disease consistently exceeded the urban level in recent years due to unequal allocation of healthcare resources, low awareness of such diseases and poor compliance to the treatment. In the meantime, great progresses have been made in CVD prevention and control, such as decreased smoking prevalence, improved hypertension control rate, significantly improved clinical diagnosis, treatment and basic research, and enhanced community-based containment of CVD. Moreover, relevant rehabilitation has been increasingly valued, and the research and development of medical devices are in a rapid stage of progress.

Background The high prevalence of multimorbidity among middle-aged and older adults has become a serious issue needing to be addressed by China's healthcare system. The number of chronic diseases is related to health service utilization and medical costs, but there is still a lack of relevant national surveys in China. Objective To understand the prevalence and features of multimorbidity and to examine its associations with health service utilization and medical costs among middle-aged and older Chinese adults. Methods Data were collected from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS) during April to October 2021, involving 16 674 Chinese adults (≥45 years old) . Multimorbidity was defined as the coexistence of two or more of the self-reported 14 chronic conditions. Health service utilization was measured using inpatient service utilization in the past year and outpatient service utilization in the past month. Medical costs were measured using total inpatient cost and out-of-pocket (OOP) cost for inpatient care in the past one year, total outpatient costs and OOP cost for outpatient care in the past one month. Logistic regression was used to estimate the association between the number of chronic diseases and health service utilization. Quantile regression was adopted to estimate the association between the number of chronic diseases and medical costs. Results Of all participants, 9 561 (57.34%) had multimorbidity. 2 624 (15.74%) had utilized inpatient services in the past year, and 2 588 (15.52%) used outpatient services in the past one month. Inpatient service utilization, outpatient service utilization, total inpatient cost, OOP cost for inpatient care, total outpatient cost, and OOP cost for outpatient care varied significantly by the number of chronic diseases (P

This study explores the variation in specialist physician fees and examines whether the variation can be attributed to patient risk factors, variation between physicians, medical specialties, or other factors. We use health insurance claims data from a large private health insurer in Australia. Although Australia has a publicly funded health system that provides universal health coverage, about 44 % of the population holds private health insurance. Specialist physician fees in the private sector are unregulated; physicians can charge any price they want, subject to market forces. We examine the variation in fees using two price measures: total fees charged and out-of- pocket payments. We follow a two-stage method of removing the influence of patient risk factors by computing risk-adjusted prices at patient-level, and aggregating the adjusted prices over all claims made by each physician to arrive at physician-level average prices. In the second stage, we use variance-component models to analyse the variation in the physician-level average prices. We find that patient risk factors account for a small portion of the variance in fees and out-of-pocket payments. Physician-specific variation accounts for the bulk of the vari- ance. The results underscore the importance of understanding physician characteristics in formulating policy efforts to reduce fee variation., Competing Interests: Declaration of competing interest All authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

In cases on compensation for personal injury, the issue of medical expense compensation involves the vital interests of the compensation obligor, the injured party and the medical institution. The rationality of medical expenses is likely to be controversial, however, there is no unified standard and stipulation for the medical expense rationality identification in forensic clinical identification at present, therefore, in the practice of judicial expertise, expert opinions easily become confused, and the legitimate rights of the parties could be infringed, which affects the impartiality and authority of judicial expertise. This article starts with the concept of medical expense and the rationality of medical expense and the reasons for disputes over the rationality of medical expense, to put forward the basic principles that should be followed in the identification of rationality of medical expenses, for peer reference.

Objective: To evaluate in-hospital fees and surgical outcomes of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) using a Japanese nationwide database., Methods: All data were obtained from the Diagnosis Procedure Combination database between April 2020 and March 2022. Basic characteristics and perioperative indicators, including in-hospital fees, were compared among the RARC, LRC and ORC groups. Propensity score-matched comparisons were performed to assess the differences between RARC and ORC., Results: During the study period, 2931, 1311 and 2435 cases of RARC, LRC and ORC were identified, respectively. The RARC group had the lowest in-hospital fee (median: 2.38 million yen), the shortest hospital stay (26 days) and the lowest blood transfusion rate (29.5%), as well as the lowest complication rate (20.9%), despite having the longest anesthesia time (569 min) among the three groups (all P < 0.01). The outcomes of LRC were comparable with those of RARC, and the differences in these indicators between the RARC and ORC groups were greater than those between the RARC and LRC groups. In propensity score-matched comparisons between the RARC and ORC groups, the differences in the indicators remained significant (all P < 0.01), with an ~50 000 yen difference in in-hospital fees., Conclusions: RARC and LRC were considered to be more cost-effective surgeries than ORC due to their superior surgical outcomes and comparable surgical fees in Japan. The widespread adoption of RARC and LRC is expected to bring economic benefits to Japanese society., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

This study examines the impact of social insurance benefit restrictions on physician behaviour, using ophthalmologists as a case study. We examine whether ophthalmologists use their market power to alter their fees and rebates across services to compensate for potential policy-induced income losses. The results show that ophthalmologists substantially reduced their fees and rebates for services directly targeted by the benefit restriction compared to other medical specialists' fees and rebates. There is also some evidence that they increased their fees for services that were not targeted. High-fee charging ophthalmologists exhibited larger fee and rebate responses while the low-fee charging group raise their rebates to match the reference price provided by the policy environment., (© 2024 The Authors. Health Economics published by John Wiley & Sons Ltd.)

Background: Abroad medical electives are recognized as high-impact practice and considered a necessity to provide global health training. As of recently, the COVID-19 pandemic and its related travel restrictions prohibited most international elective activities. Another important barrier to abroad electives that received comparably little attention is elective and application fees, which - combined - may be as high as $5000 per month, and may prevent students with limited financial resources from applying for an international elective. Elective fees have never been systematically analyzed and trends in teaching and application fees have rarely been subject to dedicated scientific investigations., Methods: Using data from two large elective reports databases, the authors addressed this gap in the literature. The authors analyzed trends in abroad elective fees within the last 15 years in some of the most popular Anglo-American elective destinations among students from Germany, including the United States of America, Australia, New Zealand, the Republic of South Africa, Ireland and the United Kingdom., Results: The authors identified n = 726 overseas elective reports that were uploaded between 2006 and 2020, of which n = 438 testimonies met the inclusion criteria. The United Kingdom and Australia were the most popular elective destinations (n = 123 and n = 113, respectively), followed by the Republic of South Africa (n = 104) and the United States of America (n = 44). Elective fees differed substantially-depending on the elective destinations and time point. Median elective fees were highest in the United States of America (€ 1875 for a 4-week elective between 2018-2020), followed by the Republic of South Africa (€ 400) and Australia (€ 378). The data also suggests an increasing trend for elective fees, particularly in the United States., Conclusions: Rising fees warrant consideration and a discussion about the feasibility of reciprocity and the bidirectional flow of students in bidirectional exchange programs., (© 2024. The Author(s).)

Background: We explored the impact of medical service fee adjustments on the choice of medical treatment for hypertensive patients in Beijing. We hope to provide decision-making reference to promote the realization of hierarchical diagnosis and treatment in Beijing., Methods: According to the framework of modeling simulation research and based on the data of residents and medical institutions in Beijing, we designed three models of residents model, disease model and hospital model respectively. We then constructed a state map of patients' selection of medical treatment and adjusted the medical service fee to observe outpatient selection behaviors of hypertensive patients at different levels of hospitals and to find the optimal decision-making plan., Results: The simulation results show that the adjustment of medical service fees can affect the proportion of patients seeking medical treatment in primary and tertiary hospitals to a certain extent, but has little effect on the proportion of patients receiving medical treatment in secondary hospitals., Conclusions: Beijing can make adjustments of the current medical service fees by reducing fees in primary hospitals and slightly increasing fees in tertiary hospitals, and in this way could increase the number of patients with hypertension in the primary hospitals., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: This study aimed to evaluate the effects of medical fee revisions aimed to reduce psychotropic polypharmacy in Japan on the proportion of psychotropic polypharmacy in discharge prescriptions for patients with major depressive disorder (MDD) or bipolar disorder (BD) using a nationwide inpatient database., Methods: In this retrospective cohort study, we used the Diagnosis Procedure Combination database to identify patients with MDD or BD discharged between April 2012 and March 2021. We targeted medical fee revisions in October 2014, April 2016, and April 2018. The major outcome was the monthly proportion of psychotropic polypharmacy in prescription at discharge using the criteria following the April 2018 revision (antidepressants ≥3, antipsychotics ≥3, anxiolytics ≥3, hypnotics ≥3, or sum of anxiolytics and hypnotics ≥4). We performed interrupted time series analyses to evaluate the changes in level and trend between pre- and post-revisions., Results: We identified 63,289 and 33,780 patients with MDD and BD respectively in the entire study period. In both the patient groups, there were significant decreases in the proportion of psychotropic polypharmacy at revision in October 2014, and no significant trend and level change at revision were observed in April 2016 and April 2018, with a few exceptions., Conclusions: The medical fee revisions aimed to reduce psychotropic polypharmacy in Japan might have had a limited impact on discharge prescriptions for patients with MDD and BD., Competing Interests: Declaration of Competing Interest Shinsuke Kito reports grants and personal fees from Inter Reha CO., Ltd., Kyowa Pharmaceutical Industry CO., Ltd., Lundbeck Japan K.K., Sumitomo Pharma CO., Ltd., Otsuka Pharmaceutical CO., Ltd., Takeda Pharmaceutical CO., Ltd., Teijin Pharma Ltd., and Viatris Inc., outside the submitted work; the other authors have no competing interests to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

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Objective To investigate the symptoms of diarrhea and the behavior of medical treatment after diarrhea in 2013 in Tianjin City, and provid background information for the future population monitoring. Methods A stratified sampling method was used to investigate the symptoms, medical treatment and self medication behavior of 4028 residents in Tianjin. Results The number of people who had diarrhea in 2013 was 324, and the incidence rate of diarrhea was 8.04%. Diarrhea was mainly occurred in May-October (n=241, 74.38%). The incidence of diarrhea was the highest in 60-74 years old group, followed by 75- years old and 0-14 years old groups. The incidence of diarrhea was the lowest in 15-29 years old grouop. A total of 121 patients with diarrhea chose to go to hospital (47.08%), 78 patients chose to buy medicine for treatment (30.35%) and 58 patients did not do any disposal (22.57%). Among the patients with diarrhea, the highest proportion of patients chose to go to the first grade and the following medical institutions (68.59%, 83/121). There were 14.05% (17/121) and 17.36% (21/121) patients chose to go to the second and the third levels of medical institutions for the treatment. The average cost for patients with diarrhea was 60 (20, 200) yuan. The purchasing expenditure median was 20 (11,50) yuan. The medical spending was more than the purchase of medicines (Z=2.412, P < 0.05). The average cost of medical treatment was more higher in the second and the third levels of medical institutions than that of the first medical institution (Z=50.709，P＜ 0.05). The average cost of medical treatment was in turn increased for patients with diarrhea treated in Baodi county, Xiqing county, Hangu county and Heping county (Z=74.282，P＜0.05). There was no statistical significance in medical expenses between patients with different ages and patient with or without medical insurance. Conclusion There are high incidence of diarrhea in patients under 15 years old and patients over 60 years old. Residents suffering from diarrhea mainly choose their own medicine and the treatment in the first and following medical institutions. [ABSTRACT FROM AUTHOR]