Healthcare costs for patients with rare diseases: Evidence from China.

OBJECTIVE: Rare diseases cause a huge financial burden to countless patients and families. It is an important public health issue that requires widespread attention. This study analyzes medical expenses composition and the change in trends of out-of-pocket (OOP) expenses for patients with Amyotrophic lateral sclerosis (ALS) and explores the factors influencing these changes. METHODS: Data were obtained from the Chinese Medical Insurance Department database from 2018 to 2020, including 857 patients with ALS in 60 cities across 30 provinces. We used descriptive methods to analyse the baseline characteristics and medical expenses of outpatients and inpatients with ALS. And we used quantile regression to analyse the differences in patient OOP ratio and the factors influencing them. RESULTS: In China, 80.3% of ALS patients chose tertiary hospitals, with an annual direct medical cost of 11,339.7 RMB per patient and an OOP ratio of 41.6%. The annual medical cost for outpatients was 345.1 RMB per patient, with an OOP ratio of 36.7%. The annual medical cost for inpatients was 28,139.8 RMB per patient, with an OOP ratio of 41.7%. Compared to outpatients, inpatients had higher medical costs but lower actual reimbursement rates. The OOP ratio of ALS patients decreased, then increased over time. And the OOP ratio was influenced by medical institution, medical insurance, and age (p < 0.05). Patients who chose tertiary hospitals, those who were covered by the urban resident basic medical insurance and younger patients had relatively higher OOP ratio. CONCLUSION: In recent years, although China has begun to pay attention to the rights and interests of patients with rare diseases, the government has provided some healthcare security to patients with rare diseases. However, the level of medical insurance coverage was still low, the equity of protection was still insufficient and the financial burden on patients was high. Therefore, the government should further improve the healthcare system to provide full life-cycle and affordable healthcare services to patients with rare diseases.

Three-dimensional reduced graphene oxide decorated with cobalt metaphosphate as high cost-efficiency electrocatalysts for the hydrogen evolution reaction.

The development of cost-effective non-noble metal electrocatalysts is critical for the research of renewable energy. Transition metal cobalt metaphosphate-based materials have the potential to replace the noble metal Pt. Hence, in this work, we synthesize three-dimensional graphene-supported cobalt metaphosphate (Co(PO3)2-3D RGO) for the first time through the one-step hydrothermal synthesis method at low temperature with the aid of PH3 phosphating. In a 0.5 mol L-1 H2SO4 solution, the obtained electrocatalyst exhibits excellent electrochemical activity for the hydrogen evolution reaction (HER) with a small overpotential of 176 mV at a current density of 10 mA cm-2 and a Tafel slope of 63 mV dec-1. Additionally, in a 1 mol L-1 KOH solution, the electrocatalyst also shows outstanding HER activity with a small overpotential of 158 mV at a current density of 10 mA cm-2 and a Tafel slope of 88 mV dec-1. Co(PO3)2-3D RGO can maintain its catalytic activity for at least ten hours whether in acid or alkali. This work not only demonstrates an excellent electrocatalyst for the hydrogen evolution reaction, but also provides an extremely convenient preparation technology, which provides a new strategy for the development and utilization of high-performance electrocatalysts.