Effects of retirement on inpatient healthcare utilisation: an observational study in China.

OBJECTIVE: Previous studies have presented mixed evidence on retirement and inpatient healthcare utilisation. We aimed to examine the causal effect of retirement on inpatient healthcare utilisation in China and explore the heterogenous effects of sex, disease types and ways of hospital admission. DESIGN: This was a retrospective observational study from the electronic medical record at 376 tertiary hospitals in China between 2013 and 2018. SETTING: Nationwide data from China. PARTICIPANTS: We included the male sample aged between 50 and 70, and the female sample aged between 40 and 60 and with basic medical insurance system or public medical insurance. Observations with total expenditures per visit at the top or bottom 1% were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Inpatient expenditures per visit and inpatient days per visit. METHODOLOGY: We examined the effects by a non-parametric fuzzy regression discontinuity design, exploiting the mandatory retirement age as a source of exogenous variation in retirement status. RESULTS: Retirement reduced drug expenditures (ß=-467.46, p<0.05) and inpatient days per visit (ß=-0.99, p<0.05). The mitigation effect was concentrated on people admitted into hospital due to chronic diseases (ß=-551.28, p<0.05 for drug expenditures; ß=-1.08, p<0.05 for inpatient days per visit) and people admitted into hospital through outpatient services (ß=-353.75, p<0.001 for drug expenditures). For males, retirement significantly reduced diagnostic tests expenditures (ß=-302.38, p<0.05) and drug expenditures (ß=-728.31, p<0.05). Retirement significantly reduced inpatient days per visit (ß=-1.13, p<0.05) for females. CONCLUSION: The empirical findings suggested that retirement may lead to a reduction in inpatient healthcare utilisation, which underlined the importance for policy-makers to consider the externalities of retirement policies on inpatient healthcare utilisation.

Data envelopment analysis on the efficiency of vaccination services and its influencing factors in Beijing, China.

OBJECTIVES: Vaccination is an important part of public health services. We aim to assess the efficiency of vaccination services in Beijing, the capital of China, and to further study the influencing factors of efficiency. METHODS: Using the immunization service data of Beijing, China in 2020, we firstly developed a data envelopment analysis (DEA) model to calculate the score of vaccination efficiency. Secondly, we used DEA model scenario simulations with different combinations of input-output factors to derive the magnitude of the effect of each input factor on the efficiency. Finally, combined with the data from the Beijing Regional Statistical Yearbook 2021, we developed the Tobit model to examine the effect of external social environmental factors on efficiency. RESULTS: The average scores of efficiency of POVs (Point of Vaccination) in different areas of Beijing vary greatly. Different input factors had different degrees of positive effects on the efficiency score. In addition, the number of populations served by POV was positively associated with efficiency, the GDP and financial allocation of the POVs' district was also positively associated with efficiency score, while the total dependency ratio of the POVs' district was negatively associated with efficiency score. CONCLUSION: The efficiency of vaccination services varied considerably across POVs. Constrained by limited resources, efficiency scores can be increased by increasing input factors that have a larger impact on efficiency score and reducing those that have a smaller impact on efficiency. In addition, the social environment should be considered in allocating vaccination resources, and more resources should be invested in areas with low levels of economic development, low financial allocation, and high population.

Community-based rehabilitation interventions on quality of care for people with schizophrenia in China (CRISC): study protocol for a cluster-randomized controlled trial.

BACKGROUND: International consensus shows that community-based rehabilitation (CBR) service is an effective way to improve functioning and negative symptoms and address the treatment gap for schizophrenia. Rigorous trials are needed in China to demonstrate effective and scalable CBR interventions to significantly improve outcomes for people with schizophrenia and to provide evidence of the economic benefits. The objectives of this trial are to examine the effectiveness of CBR as an adjunct to test the usual facility-cased care (FBC) in comparison to FBC alone in improving a range of outcomes in people with schizophrenia and their caregivers. METHODS: This trial is a cluster randomized controlled trial design in China. The trial will be conducted at three districts of Weifang city, Shandong province. Eligible participants will be identified from the psychiatric management system where community-dwelling patients with schizophrenia have been registered. Participants will be recruited after providing informed consent. 18 sub-districts will be randomly allocated in a 1:1 ratio to facility-based care (FBC) plus CBR (intervention arm) or FBC alone (control arm). The structured CBR intervention will be delivered by trained psychiatric nurses or community health workers. We aim to recruit 264 participants. The primary outcomes include symptoms of schizophrenia, personal and social function, quality of life, family burden of caring, etc. The study will be conducted according to good ethical practice, data analysis and reporting guidelines. DISCUSSION: If the hypothesized clinical benefit and cost-effectiveness of CBR intervention are confirmed, this trial will provide significant implications for policy makers and practitioners to scale up rehabilitation services, as well as for people with schizophrenia and their family to promote recovery and social inclusion, and to alleviate the burden of care. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2200066945). Registered December 22, 2022.

Association of Urban-Rural Health Insurance Integration With Health Outcomes Among Middle-aged and Older Adults in Rural China.

This cohort study examines the association of urban-rural health insurance integration with health outcomes among middle-aged and older adults in rural China.

Impacts of the hearing aid intervention on healthcare utilization and costs among middle-aged and older adults: results from a randomized controlled trial in rural China.

Background: Hearing impairment has become a major global health issue. To reduce the burden of hearing impairment, we explored impacts of the hearing aid intervention on healthcare utilization and costs. Methods: In this randomized controlled trial, participants aged 45+ were allocated with a ratio of 1:1.5 (intervention: control). Neither the investigators nor the assessors were blinded to the allocation status. Those in the intervention group were fitted with hearing aids, and those in the control group received no care. We applied the difference-in-difference (DID) approach to examine the impacts on healthcare utilization and costs. Given that social network and age can be significant variables affecting effectiveness of the intervention, subgroup analyses by social network and age were used to explore the heterogeneity. Findings: 395 subjects were successfully recruited and randomized. 10 subjects did not meet the inclusion criteria and therefore, 385 eligible subjects (150 in the treatment group and 235 in the control group) were analyzed. The intervention significantly reduced their total healthcare costs (average treatment effect (ATE) = -1.26, 95% CI = -2.39, -0.14, p = 0.028) and total out-of-pocket (OOP) healthcare costs (ATE = -1.29, 95% CI = -2.37, -0.20, p = 0.021) in the 20-month follow-up. To be exact, it reduced self-medication costs (ATE = -0.82, 95% CI = -1.49, -0.15, p = 0.016) and OOP self-medication costs (ATE = -0.84, 95% CI = -1.46, -0.21, p = 0.009). Subgroup analysis showed that the impacts on self-medication costs and OOP self-medication costs varied by social network (ATE for self-medication costs = -0.26, 95% CI = -0.50, -0.01, p = 0.041; ATE for OOP self-medication costs = -0.27, 95% CI = -0.52, -0.01, p = 0.038). The impacts also varied by age groups (ATE for self-medication costs = -0.22, 95% CI = -0.40, -0.04, p = 0.019; ATE for OOP self-medication costs = -0.17, 95% CI = -0.29, -0.04, p = 0.010). There were no adverse events or side effects during the trial. Interpretation: Hearing aid use significantly lowered self-medication costs and total healthcare costs, but had no impacts on inpatient or outpatient services utilization or costs. The impacts were manifested among people with active social network or younger age. It can be speculated that the intervention may be adapted to other similar settings in developing countries to reduce healthcare costs. Funding: P.H. reports grants from National Natural Science Foundation of China (No. 71874005) and Major Project of the National Social Science Fund of China (No. 21&ZD187). Trial registration: Chinese Clinical Trial Registry: ChiCTR1900024739.

The dynamic relationship between subjective social status and health: Evidence from a Chinese cohort study.

PURPOSE: Using nationally representative longitudinal data from 2010 to 2018 in China, this study systematically investigates the relationship between Subjective Social Status (SSS) and health (physical health and mental health) in the Chinese adult population. METHODS: By applying between-within model, we disentangle the relationship between health outcomes and: (1) between-individual differences in SSS and (2) within-individual variations of SSS across time. In addition, to explore SSS mobility and trajectory, we further decomposed SSS into lagged SSS and the change between the current and lagged SSS (mobility). RESULTS: We find that there is significantly positive and unique relationship (independent of Objective Social Status (OSS)) between SSS and physical and mental health. However, for physical health, we observed an Inverse-U effect of average SSS, after some point (SSS = 3.93), higher average SSS is associated with a score decrease. Through heterogeneity analysis, we find that for physical health, within- and between-effects decreases with age and for mental health, the within effect is only significant among the urban population. Individuals with high expected mobility are also found to have significantly better health. CONCLUSIONS: These findings show that the personal relative deprivation has negative, particularly salient and unique effects on the health of the Chinese population, and it is important to consider the dynamic nature of SSS.

Medical service utilisation and direct medical cost of depression: a cross-sectional analysis of urban medical claims data from China.

OBJECTIVES: Depression is becoming a growing cause of disability, suicides and disease burden. It incurred substantial costs to societies all over the world. Estimating the medical costs of depression will provide implications for related policies and interventions. However, there is scarce of evidence on the economic costs of depression in China. The aim of this study is to assess depression-related medical service utilisation, the direct medical costs of depression and potential associated factors. SETTINGS: This study used data that comprised 5% random sample of claims data from China's Urban Basic Medical Insurance between January 2013 and December 2016. Beneficiaries' demographic information, diagnoses and cost of outpatient and inpatient services were recorded in the data set. PARTICIPANTS: 26 123 patients with depression were identified as the study population in this study. PRIMARY AND SECONDARY OUTCOME MEASURES: The information on health service utilisation and cost was extracted based on the condition that depression was claimed as the index disease. RESULTS: From 2013 to 2016, weighted average annual total medical cost of depression in urban China was RMB2706.92, and the annual out-of-pocket cost was RMB786.4. The annual total medical cost of depression among urban residents in China was estimated to be 4.4 billion RMB (95% CI 4.15 to 4.67) (US$ 0.70, 95% CI 0.66 to 0.74). Nearly 65% of medical costs (RMB 1795.7 or US$ 285.0) were accounted by inpatient expenditure, and tertiary hospitals were the main provider of depression treatment. Depression-related medical care utilisation and direct costs were associated with gender, age, insurance status, severity of depression and diagnosis. Medication costs and medical service contributed to 41.7% and 56.6% of the average depression-related medical costs. CONCLUSION: Depression poses a considerable burden on both the health system and the individual in urban China. Specific policies to strengthen the mental health resources in primary and secondary hospitals are in urgent need, and effective treatment strategies are important to prevent a progression and recurrence of depression, as well as an increase in medical cost.

Antidepressant use and expenditure in the treatment of patients with depression: Evidence from China urban medical claims data.

OBJECTIVES: Few studies have analyzed the use of antidepressants among population suffering from depression in China. This study aimed to describe the prevalence and the cost of commonly prescribed antidepressants among patients with depression. METHODS: This study used data that comprised 5% random sample of claims data from China's Urban Basic Medical Insurance between 2013 and 2016. We estimated the prevalence, calculated the proportions of those on antidepressant treatment as well as those on specific drugs. RESULTS: Among 26 826 patients with depression, 62.31% were prescribed with antidepressants in urban China, and the estimated average annual total cost of antidepressants per patient was RMB887.7(USD140.9). The prevalence of antidepressant prescription was higher among patients aged 15-24 years, having URBMI insurance, with recurrent depression and having severe or moderate depression. Approximately 9.3% of patients used more than one type of antidepressants and 19% of patients have only one prescription of antidepressant in a year. CONCLUSION: Our analyses showed that antidepressant prescribing was prevalent among patients with depression, particularly in adolescents and youth groups, and are subject to variation with clinical features and different insurance scheme. Further investigation of antidepressant use patterns, such as duration, combination and switching, as well as treatment trajectories will facilitate our understanding of the pharmacotherapy practices of depressive disorders.

Does self-perceived income priority matter? The association between income inequality and allostatic load in China.

There is a scarcity of evidence about the association between income inequality and allostatic load (AL) across diverse population, which is critical to identify the downstream biological pathway of the inequality-health linkage. This study aimed to determine the association of income inequality with AL, and assess whether there are differences in such association between people with different perception of income priority. We utilized data from the 2006 and 2009 wave of China Health and Nutrition Survey (CHNS). Multilevel linear regression analyses were conducted to examine the association between AL score and community Gini coefficient. Additionally, to investigate whether the association of income inequality and AL score would vary among individuals with different perception of income priority, a cross-level interaction term for Gini coefficient and self-perceived income priority was applied. Both the cross-sectional analysis in 2009 (coefficient = 0.081, p = .016) and the time-lagged analysis (0.106, 0.008) suggested that community-level Gini coefficient was positively associated with AL. Similar result was only found among individuals from low median income communities in subsample analysis. Additionally, the cross-level interaction between Gini coefficient and self-perceived income priority was significantly associated with AL among respondents from low-median income communities. There is a positive association between income inequality and AL among Chinese adults, with individual who perceived income as a higher priority in their life suffering more from income inequality. This study contributes to the increasing efforts and new perspective to understand the inner mechanism of both the detrimental effect of income inequality and the accumulation of AL.