A Study of Patients' Willingness to Pay for a Basic Outpatient Copayment and Medical Service Quality in Taiwan.

Patients might be willing to pay more to obtain better quality medical services when they recognize that high-level hospitals have better quality. However, published papers have not found solid empirical evidence to support this possibility. Therefore, the purpose of this study is to empirically investigate patients' willingness to pay (WTP) for an outpatient copayment. The study aims to analyze the difference between the two WTP values: to implement a hierarchy of medical care and to improve the quality of medical services. This study administered a questionnaire using the contingent valuation method with a quasi-bidding game for patients' WTP and the SERVQUAL scale for medical service quality. The Wilcoxon signed-rank test was employed to test the difference between the two WTP values, notably to implement a hierarchy of medical care and to improve the quality of medical services. Both of the WTP values are higher than the academic medical centre's current copayment NT$420 (approximately US$14); the percentage of respondents willing to pay a higher copayment declined when the outpatient copayment was increased, and the patients' WTP to have better medical service quality was significantly higher than that to implement a hierarchy of medical care. Patients' desire to receive better medical services from higher-level hospitals might be stronger than their desire to implement hierarchical medical care. This study reported the relationship between the respondents' perceived medical service quality and WTP for having better service quality by using regression models. The respondents' perceptions of medical service quality, especially for "reliability" and "assurance," would positively affect their WTP. Policy makers should focus on improving the quality of medical services.

[Fibrous Meningioma with Ring Enhancement in Cerebellopontine Angle Region:Report of One Case].

Fibrous meningioma is a common subtype of meningioma. Contrast-enhanced scan typically shows evident homogeneous enhancement,while ring enhancement has not been described. In this article,we report a case of fibrous meningioma with ring enhancement in cerebellopontine angle region.

Functional changes of the lateral pterygoid muscle in patients with temporomandibular disorders: a pilot magnetic resonance images texture study.

BACKGROUND: Texture features were the intrinsic properties of the human tissues and could efficiently detect the subtle functional changes of involved tissue. The pathologic changes of the lateral pterygoid muscle (LPM) were significantly correlated with the temporomandibular disc displacement. However, the occult functional changes of LPM could not be detected by the naked eye on the medical images. The current study was aimed to evaluate the functional changes of the LPM in the patients with temporomandibular disorders (TMDs) using texture analysis. METHODS: Twenty-nine patients with TMD were performed with magnetic resonance (MR) imaging on a 3.0T MR scanner, who were consecutively recruited from the TMD clinic of Hainan Hospital of Chinese People's Liberation Army General Hospital from February 2019 to September 2019. The patients were classified into three groups according to the disc displacement: disc without displacement (DWoD), disc displacement with reduction (DDWR) and disc displacement without reduction (DDWoR). The gray-level co-occurrence matrix method was applied with the texture analysis of LPM on the axial T2-weighted imaging. The texture features included angular second moment, contrast, correlation, inverse different moment, and entropy. One-way analysis of variance was used for grouped comparisons and receiver operating characteristics (ROC) curve analysis was applied to evaluate the diagnostic efficacy of the texture parameters. RESULTS: Texture contrast of LPM presented significantly lower in DDWoR (46.30 [35.03, 94.48]) than that in DWoD (123.85 [105.06, 143.23]; test statistic = 23.05; P < 0.001). Texture entropy of LPM showed significant differences among DWoD (7.62 ±â€Š0.33), DDWR (6.76 ±â€Š0.35), and DDWoR (6.46 ±â€Š0.39) (PDWoD-DDWR < 0.001, PDWoD-DDWoR < 0.001, and PDDWR-DDWoR = 0.014). Area under the ROC curve (AUC) demonstrated that texture entropy had an excellent diagnostic accuracy for DWoD-DDWR (AUC = 0.96) and DWoD-DDWoR (AUC = 0.98). CONCLUSION: The texture contrast and entropy could identify the altered functional status of LPM in patients with TMD and could be considered as the effective imaging biomarker to evaluate the functional changes of LPM in TMD.

Value of Magnetic Resonance Imaging Texture Analysis in the Differential Diagnosis of Benign and Malignant Breast Tumors.

Objective To investigate the difference in texture features on diffusion weighted imaging (DWI) images between breast benign and malignant tumors.Methods Patients including 56 with mass-like breast cancer, 16 with breast fibroadenoma, and 4 with intraductal papilloma of breast treated in the Hainan Hospital of Chinese PLA General Hospital were retrospectively enrolled in this study, and allocated to the benign group (20 patients) and the malignant group (56 patients) according to the post-surgically pathological results. Texture analysis was performed on axial DWI images, and five characteristic parameters including Angular Second Moment (ASM), Contrast, Correlation, Inverse Difference Moment (IDM), and Entropy were calculated. Independent sample t-test and Mann-Whitney U test were performed for intergroup comparison. Regression model was established by using Binary Logistic regression analysis, and receiver operating characteristic curve (ROC) analysis was carried out to evaluate the diagnostic efficiency.Results The texture features ASM, Contrast, Correlation and Entropy showed significant differences between the benign and malignant breast tumor groups (PASM=0.014, Pcontrast=0.019, Pcorrelation=0.010, Pentropy=0.007). The area under the ROC curve was 0.685, 0.681, 0.754, and 0.683 respectively for the positive texture variables mentioned above, and that for the combined variables (ASM, Contrast, and Entropy) was 0.802 in the model of Logistic regression. Binary Logistic regression analysis demonstrated that ASM, Contrast and Entropy were considered as the specific imaging variables for the differential diagnosis of breast benign and malignant tumors.Conclusions The texture analysis of DWI may be a simple and effective tool in the differential diagnosis between breast benign and malignant tumors.

[Diagnostric Value of Contrast-enhanced T2 Fluid-attenuated Inversion Recovery Imaging for Splenic Hemangioma:A Case Report].

The diagnostic criteria of splenic hemangioma is the delayed filling enhancement pattern on the dynamic contrast CT imaging or magnetic resonance (MR) T1-weighted image,which requires long examination time and thus decreases the MR scanning efficiency. Contrast-enhanced T2 fluid-attenuated inversion recovery (FLAIR) imaging is a new MR imaging technique that can be used to evaluate the intrinsic characteristics of hemangioma. However,few literature has discribed its role in diagnosing splenic hemangioma. In this article we reported one case of splenic hemangioma diagnosed by contrast-enhanced T2 FLAIR imaging,which reduced the MR scanning time and provided valuable experience for the diagnosis of splenic hemangioma.

[Epidermoid Cyst in the Fourth Ventricle:Report of One Case].

We reported a case with epidermoid cyst (EC) in the fourth ventricle. The insinuation and scalloping growth pattern were the distinctive imaging characteristics of EC in the fourth ventricle on magnetic resonance imaging. The accurate identification of the punctate enhancement of vessels around the lesion may be helpful for its differential diagnosis from hemangioblastoma.