Evaluation of the effect of meteorological risk forecasting service intervention on acute onset and medical expenses of patients with COPD in Pudong New Area of Shanghai / 上海预防医学

ObjectiveTo evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease（COPD） patients， and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease（COPD） patients. MethodsStudy subjects were recruited from chronic obstructive pulmonary patients aged ≥40 in Pudong New Area. Propensity score matching method was used to determine the intervention group and the control group. The control group received regular health education and follow-up management， and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat， mobile phone short message service（SMS）and telephone. Finally， a total of2 589 subjects were included in the analysis， including 1 300 in the intervention group and 1 289 in the control group. General demographic data， past medical history and family history of COPD， COPD related knowledge and practice survey， COPD related symptom assessment， acute onset， health service utilization and medical expenses before and after intervention were collected through questionnaire survey. The differences of acute attack， health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect. ResultsIn terms of acute attacks， after intervention， the incidence of acute attacks in the intervention group was lower than that before intervention（χ2=52.901， P<0.001）， and the incidence of acute attacks in the groups with different intervention methods was lower than that before intervention （P<0.001）. WeChat had the best effect， decreasing the incidence by 14.4%， followed by mobile phone SMS SMS decreasing by 12.3%. In terms of utilization of health services， the outpatient rate due to acute attack was lower in the intervention group after intervention than that before intervention （χ2=7.129， P=0.008）， and the outpatient rate due to acute attack was lower in the subjects who received the forecast service through mobile phone SMS than that before intervention （χ2=4.675， P<0.001）. In terms of medical expenses， there was no significant difference between control group and intervention group with different intervention methods before intervention （P>0.05）. After intervention， the difference between the control group and the intervention group with different intervention methods was statistically significant （H=11.864， P<0.05）. The results of multiple comparisons showed that compared with the control group， the average annual medical expenses of patients receiving mobile phone SMS and telephone forecasting services after intervention were lower than those of the control group， and the difference was statistically significant （P<0.05）. ConclusionMeteorological risk forecasting service can reduce the acute onset of COPD， reduce the rate of consultation and medical expenses due to acute onset， and provide scientific basis for the basic COPD health management model.

An Analysis on the Role of Outpatient Security in Health Seeking Behavior,Health Protection and Medical Expenses for Chronic Diseases:Taking Hypertension Patients as an Example / 中国卫生经济

Objectives:To find the impact of outpatient security in health seeking behavior,health protection and medical ex-pense for chronic diseases.Methods:Based on the hypertension patients'all medical visits records of urban and rural residents who were insured under the basic medical insurance system in sample region of Nanjing from 2019 to 2021,the quantitative relationship between chronic disease outpatient treatment and patients'healthcare behaviors,health outputs,and healthcare costs was analyzed by an individual-time two-way fixed effect model and Utest test.Results:When the annual outpatient reimbursement ratio is in the range of(42.99％,64.11％),strengthening the security for outpatient service could make people seek medical advice reasonably and achieve a better health outcome,as well as controlling the medical expenses.Conclusion:Properly raising actual compensation for chronic outpatient care could lead to the rational health-seeking behaviors,safeguarding health for the insured,and on this basis,achieve control of medical costs and effective use of the basic medical insurance pool.

How heavy is the medical expense burden among the older adults and what are the contributing factors? A literature review and problem-based analysis.

In recent years, the aging population and increasing medical expenses among the older adults have emerged as significant public health concerns. National governments must conduct medical expense accounting and implement measures to reduce the burden of medical costs on the older population. However, limited studies have focused on total medical expenditure from a macro perspective, with many researches exploring individual medical expenses from different perspectives. This review introduces the trend of population aging and its impact on health cost change, reviews research on the medical expense burden of the older population and contributing factors, and points out underlying problems and limitations of current studies. Based on the present studies, the review emphasizes the necessity of medical expense accounting and analyzes the medical expense burden of the older population. Future studies should explore the impacts of medical insurance funds and health service system reforms on reducing medical expenses and developing a supporting medical insurance reform plan.

Are They Thinking Differently? The Perceptions and Differences in Medical Disputes between Veterinarians and Clients.

Medical disputes in veterinary practices are widespread; yet, a limited amount of research has been conducted to investigate the factors contributing to medical disputes. This study examined veterinarians' and clients' perceptions regarding risk factors and possible solutions to medical disputes. A total of 245 respondents from Taiwan, including 125 veterinarians and 120 clients, completed an electronic self-administered, semi-structured questionnaire in 2022. The questionnaire covered six dimensions: medical skills, complaint management, the attitudes of stakeholders during interactions, medical expenses, clients' perspectives, and communication modes. The results highlighted significant differences in the perceptions of risk factors for inducing medical disputes and possible solutions between clients and veterinarians in veterinary practice. First, young veterinarians and clients perceived medical skills as the highest risk factor for inducing medical disputes, while experienced veterinarians disagreed (p < 0.001). In addition, veterinarians with medical dispute experience identified stakeholders' attitudes during interactions as the top contributing factor. Second, regarding possible solutions, all veterinarians preferred offering clients cost estimates and cultivating empathy and compassion towards them. On the other hand, clients underscored the importance of obtaining informed consent for treatments and expenses and suggested that veterinarians should supply comprehensive written information to facilitate this process. This study underlies the importance of understanding stakeholders' perceptions to mitigate medical disputes and advocates for improved communication education and training for young veterinarians. These findings provide valuable insights for veterinarians and clients, contributing to preventing and managing medical disputes in veterinary practices.

Policy-Driven Post-Acute Care Program Lowers Mortality Rate and Medical Expenditures After Hospitalization for Acute Heart Failure: A Nationwide Propensity Score-Matched Study.

OBJECTIVE: The beneficial effects of multidisciplinary disease management programs have been demonstrated. The present study investigated the effects of a policy-driven, health insurance-reimbursed, heart failure (HF) post-acute care (PAC) program on mortality, health care service utilization, and readmission expenses for patients following hospitalization for HF. DESIGN: This was a retrospective propensity score-matched cohort study using the Taiwan National Health Insurance Research Database. SETTING AND PARTICIPANTS: In total, 4346 patients (2173 receiving HF-PAC and 2173 controls) with left ventricular ejection fraction of ≤40% who were discharged following hospitalization for HF were included for analysis. METHODS: All patients were followed up after discharge for all-cause mortality, emergency visits within 30 days, and length of stay and medical expenses for readmission within 180 days after discharge. RESULTS: After propensity score matching, baseline characteristics of the HF-PAC and control groups were similar. During a mean follow-up period of 1.59 ± 0.92 years, according to the Cox multivariable analysis, HF-PAC reduced mortality by 48% compared with the control group, independent of traditional risk factors (hazard ratio = 0.520, 95% CI = 0.452-0.597, P < .001). Kaplan-Meier curves revealed that HF-PAC was associated with a higher cumulative survival rate (log-rank = 96.43, P < .001). HF-PAC also decreased the frequency of emergency visits after discharge by 23% in the 30 days post discharge and decreased length of stay and medical expenses related to readmission by 61% and 63%, respectively, in the 180 days post discharge (all P < .001). CONCLUSIONS AND IMPLICATIONS: HF-PAC reduces short-term all-cause emergency visits, length of stay, and medical expenses for all-cause readmission and all-cause mortality in patients discharged following hospitalization for HF. Our findings suggest that PAC should include care continuity, optimal adaptation of transitional care components, and HF cardiologist engagement with multidisciplinary coordination.

Medical Opioid Disposal in Fukuoka and Kumamoto Cities.

Medical expenses are increasing year by year in Japan. However, the quantity of disposed medical opioids is not well known. In this study, we assessed disposed medical opioids in community pharmacies of Fukuoka city and in all of medical organizations of Kumamoto cities for 3 and 2 years, respectively. We collected official opioid disposal reports in Kumamoto city and Fukuoka City Pharmaceutical Association (FCPA) disposal information sheet in Fukuoka city. The total amount of disposed opioids was worth 7.1 million Yen from 2017 to 2019 in Fukuoka city, and 8.9 million Yen in for 2 years (2018 and 2019) in Kumamoto city. In Fukuoka city, the most disposed opioid was 20 mg Oxycontin®, worth approximately 940000 Yen. In Kumamoto city we assessed data in different organizations. The most disposed opioid was 5 mg Oxinorm® at a cost of 600000 Yen at the medical institutions over the 2-year study period. The most disposed opioid was 40 mg Oxycontin®, at a cost of 640000 Yen in community pharmacies. Two hundred micrograms E-fen® buccal tablet was the most disposed of opioid, was amounting to 960000 Yen in wholesalers. On the whole in Kumamoto city, non-dispensing was the most common reason of disposal. These results indicate that the amount of disposed opioids is huge. Small package simulation studies suggest that smaller package units of MS-Contin®, Anpec® suppository, and Abstral® sublingual tablet may be able to reduce the amount of disposed opioids.

The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China.

BACKGROUND: Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals. METHODS: A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively. RESULTS: The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions. CONCLUSION: The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals' performances among different ownership types under China's context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.

Influence of Parent’s Sex, Patient’s Age, and Use of Children’s Medical Expense Subsidy System on Young Patients Being Switched to Generic Drug Use / 社会薬学

Objective: The proportion of young patients in Japan in whom generic drugs are used is lower than that of other age groups. To promote the use of generic drugs in young patients, we need to change the parents’ attitude toward generic drugs. Therefore, we aimed to contribute to the maintenance and reform of the Japanese social security system by investigating the effects of parent’s sex, patient’s age, and use of the children’s medical expense subsidy system on the selection of generic drugs. Method: We surveyed parents of young patients (<20 years) whose prescriptions were filed at pharmacies from November 25 to December 1, 2019. Results: Of the 712 valid questionnaires retrieved, 74.3% of parents reported using generic drugs for young patients. Approximately 92.2% of the parents reported using the children’s medical expense subsidy system. The highest (51.4%) reason for switching to generics was “recommendation from a pharmacist, etc.” Cognitive methods using online content were higher among male parents than among female parents (28.0% vs. 11.5% ; P<0.001). Regarding catchphrases that make them want to hear, female parents were more likely to hear about generic drugs than male parents were if the catchphrases quality and safety were used (38.1% vs. 23.8% ; P＝0.007). Compared to parents of 7-19-year old children (6.8%), parents of 0-6-year old children (13.1%) reportedly switched to generic drugs because they were easier to ingest (P＝0.022). Conclusion: Recommendations from medical professionals such as pharmacists are effective in convincing parents of young patients to switch to generic drug use. To promote the use of generic drugs in young patients, in addition to explaining and publicizing its financial benefits, pharmacists need to explain the added value of generic drugs such as the ingenuity of its dosage form. In addition, it is essential to adopt a multifaceted approach that considers the parents’ background including (1) publicity using the internet for male parents, (2) reaching out to female parents with preschool children, (3) increasing publicity using tickets for children’s medical expenses subsidy system, and (4) drug education that matches the growth of children.

Impacts of the medical arms race on medical expenses: a public hospital-based study in Shenzhen, China, during 2009-2013.

BACKGROUND: Has the medical arms race (MAR) increased healthcare expenditures? Existing literature has yet to draw a consistent conclusion. Hence, this study aims to reexamine the relationship between the MAR and medical expenses by the data from public hospitals in Shenzhen, China, during the period of 2009 to 2013. METHODS: This study's data were collected through panel datasets spanning 2009 to 2013 from the Shenzhen Statistical Yearbook, Shenzhen Health Statistical Yearbook, and annual reports from the Shenzhen Municipal Health Commission. The Herfindahl-Hirschman index and hierarchical linear modeling were combined for empirical analysis. RESULTS: The MAR's impact on medical examination fees differed during the inpatient and outpatient stages. Further analysis verified that the MAR had the most significant impact on outpatient examination fees. Due to the characteristics of China's medical system, government regulations in the healthcare market may consequently accelerate the MAR among public hospitals. Strict government regulations on the medical system have also promoted increased medical examination costs to some extent. Once medical service prices are under strict administrative control, only drug and medical examination fees are the primary forms of extra income for hospitals. After the proportion of drug fees is further regulated, medical examinations will then become another staple method to generate extra revenue. These have distorted Chinese public hospitals' medical fees, which completely differ from those in other countries. CONCLUSION: The government should confirm that they have allocated sufficient financial investments for public hospitals; otherwise, the competition among hospitals will transfer the burden to patients, and especially to those who can afford to pay for care. A core task for public hospitals involves providing safer, less expensive, and more reliable medical services.

The Socio-Economic Cost of Diabetes Mellitus in Korea Using National Health Insurance Claim Data, 2017.

(1) Purpose: As the economy develops and lifestyles become more westernized, diabetes is on the rise in Korea. This study tried to measure the socio-economic cost of diabetes by estimating the direct medical expenses and indirect costs used in Korea during the year due to diabetes mellitus. (2) Methods: This study extracted the insurance claim records from the Korea National Health Insurance claim database to determine the healthcare services provided to patients with diabetes mellitus in 2017. The total diabetes mellitus-related cost was the sum of the direct medical care costs: the costs paid by insurers and patients, the non-covered care costs and the prescribed pharmaceuticals costs, and also the direct non-medical care costs: the transportation costs for visits in outpatients and inpatients and the guardian's cost for hospitalized patients, as well as the indirect cost: lost productivity. (3) Findings: The total socio-economic cost of diabetic patients in 2017 measured in this study was KRW 3.2 trillion, of which 48.3% was used for medical expenses, 10% was non-medical expenses, and 41.7% was estimated as indirect expenses. (4) Implications: Korea is considered to be aging significantly, and it is considered that more attention should be paid to reducing medical expenses through diabetes management.

Improved outcomes and reduced medical costs through multidisciplinary co-management protocol for geriatric proximal femur fractures: a one-year retrospective study.

BACKGROUND: To manage the rapidly growing incidence of, and related medical burden resulting from hip fractures in older adults in an aging society, studies involving orthogeriatric co-management treatment models have reported improved outcomes, including reduced medical costs. The treatment gap for osteoporosis was however seldom emphasized in the published treatment protocols. Aiming to improve the existing orthogeriatric protocol, we have established a patient-centered protocol for elderly patient hip fractures, which simultaneously focuses on fracture care and anti-osteoporosis agent prescription in regarding to healthcare quality and medical expense. METHODS: This was a retrospective study comparing patients who enrolled in the multidisciplinary co-managed protocol for geriatric hip fractures and those who did not. The inclusion criteria for this study were: (a) single-sided hip fractures treated from 1 to 2018 to 30 June 2020, (b) patients who were 60-years or older (c) trauma treated within 3 days from time of injury, and (d) minimal follow-up period of 12 months after surgery. RESULTS: From 1 to 2018 to 30 June 2020, 578 patients were included (267 patients in the protocol group vs. 331 patients in the conventional group). The protocol group was associated with significantly reduced lengths of hospital stay (p = 0.041), medical expenditures (p = 0.006), and mortality (p = 0.029) during their acute in-hospital admission period. Early osteoporosis diagnosis and anti-osteoporosis agent prescription were achieved in the protocol group, with a significantly wider coverage for BMD assessment (p < 0.001) and prescriptions for anti-osteoporosis medication (p < 0.001). Yet, there was no significant decline in the one-year refracture rate in the protocol group. CONCLUSIONS: The implementation of a multidisciplinary co-managed care protocol for geriatric proximal femur fractures successfully improved patient outcomes with significantly reduced lengths of stay, medical expenditures, and mortality during the acute in-hospital admission period. The high prescription rate of anti-osteoporosis medication after hip fractures in the protocol group was not associated with a significantly lower re-fracture rate in the 12-month follow-up. However, the association between early anti-osteoporosis agent prescription and reduced long-term medical expenses in this group of patients has provided a direction for future research.

Healthcare coverage and out-of-pocket medical expenses: evidence from the 2017 Tax Cuts and Jobs Act and the medical expense deduction.

OBJECTIVES: This study examines the link between health insurance and out-of-pocket medical expenses at the state level using data on the medical expense deduction obtained from the Internal Revenue Service. We exploit the fact that the Tax Cuts and Jobs Act lowered the threshold for the medical expense deduction in 2017 and examine whether health insurance coverage is related to the medical expense deduction based on the assumption that the lower threshold affected states with more people with large medical expenses. STUDY DESIGN: This was a state-level cross-sectional study. METHODS: Data on medical expense deductions are obtained from the Internal Revenue Service and combined with health insurance coverage data from the Small Area Health Insurance Estimates. The ordinary least squares are used to measure the relationship, and the best-fit lines are shown along with scatterplots to describe the finding. RESULTS: We find that the new law that allowed more taxpayers to take the benefit of medical expense deductions increased the share of tax returns with a medical expense deduction and the total medical expense deduction amounts in all states, but the increase was greater in states with larger uninsured populations. CONCLUSIONS: The finding highlights the role of employer-sponsored and private health insurance in reducing out-of-pocket medical expenses among the general population.

Does Use of Solid Cooking Fuels Increase Family Medical Expenses in China?

China has tried to replace solid fuels with cleaner energy in households. The benefits of fuel switching need to be identified. This article shows that households using solid cooking fuels suffer heavier medical expenses than those using non-solid cooking fuels. After accounting for family characteristics, using solid fuels is associated with 1.4-1.9% increases in medical care. Through the analysis of the impact mechanism, we found that solid cooking fuels harm the health conditions of family members and increase the probability of illness, thereby increasing medical expenses, while the ratio of fuel fees does not change significantly if switching cooking fuels. Furthermore, we explored heterogeneity to better understand the underlying relationship. For urban and higher-educated families with house ownership, the impact of solid fuels on medical expenses was weaker compared to rural and lower-educated households without owned houses. Therefore, considering the costs and benefits, we recommend continuing the conversion from solid fuels to non-solid fuels. In the fuel transition process, it is beneficial to raise residents' awareness and improve behavior to avoid indoor air pollution.

An integrated model for medical expense system optimization during diagnosis process based on artificial intelligence algorithm.

In the era of artificial intelligence, the healthcare industry is undergoing tremendous innovation and development based on sophisticated AI algorithms. Focusing on diagnosis process and target disease, this study theoretically proposed an integrated model to optimize traditional medical expense system, and ultimately helps medical staff and patients make more reliable decisions. From the new perspective of total expense estimation and detailed expense analysis, the proposed model innovatively consists of two intelligent modules, with theoretical contribution. The two modules are SVM-based module and SOM-based module. According to the rigorous comparative analysis with two classic AI techniques, back propagation neural networks and random forests, it is demonstrated that the SVM-based module achieved better capability of total expense estimation. Meanwhile, by designing a two-stage clustering process, SOM-based module effectively generated decision clusters and corresponding cluster centers were obtained, that clarified the complex relationship between detailed expense and patient information. To achieve practical contribution, the proposed model was applied to the diagnosis process of coronary heart disease. The real data from a hospital in Shanghai was collected, and the validity and accuracy of the proposed model were verified with rigorous experiments. The proposed model innovatively optimized traditional medical expense system, and intelligently generated reliable decision-making information for both total expense and detailed expense. The successful application on the target disease further indicates that this model is a user-friendly tool for medical expense control and therapeutic regimen strategy.

Evolution of Japanese self-medication tax system and its enlightenment to China / 中国药房

OBJECTIVE To learn from the self-medication tax system in Japan and improve over-the-counter drug cost sharing mechanism in China. METHODS By searching relevant policies and literature ，the evolution ，specific contents ，current situation and effects of Japanese self-medication tax system were summarized. Recommendations were put forward in the light of the actual situation of over-the-counter drug guarantee in China. RESULTS & CONCLUSIONS Japan has implemented the self-medication tax system since 2017. The Ministry of Health ， Labour and Welfare has made clear provisions on the preconditions for applying for the tax system and the deduction standards of the tax system ，and established a list of drugs to be responsible for the regular inclusion and discharge of the drugs under the tax system. The self- medication tax system has a remarkable effect in promoting the self-health management ，disease prevention and reducing medical expenses of Japanese residents. Our country can learn from the self-medication tax system in Japan and the experience of implementing the special deduction system for major medical conditions in China. To promote rational self-medication ，it is advisable to add a special deduction system for over-the-counter drugs into deductions in personal income tax and formulate the criteria and scope of application ，and establish a special list of over-the-counter drugs，thereby reducing the heavy burden of medical expenses of residents ，and exploring a new way to share the costs of over-the-counter drugs which is applicable to our national conditions.

Analysis of influencing factors of medical cost ratio of breast cancer cases treated with chemotherapy and molecular targeted therapy / 中华医院管理杂志

Objective:To understand the medical cost ratio and its influencing factors of breast cancer chemotherapy and molecular targeted therapy in a hospital, for reference for reasonable control of medical cost.Methods:The first page data of all breast cancer chemotherapy and molecular targeted therapy cases in a tertiary hospital from January to June 2021 were selected to extract the data of age, hospitalization expenses, hospitalization time, complications or complications. The influence of each index on the distribution of medical expense ratio was analyzed by single factor analysis and chi-square test was used for comparison between groups.Results:A total of 3 109 cases of chemotherapy and molecular targeted therapy for breast malignant tumors were included, of which very low-rate, low-rate, high-rate and very high-rate accounted for 7.04%(219 cases), 58.32%(1 813 cases), 30.81%(958 cases) and 3.83%(119 cases) respectively. In addition to the way of admission, there were significant differences in the distribution of medical cost rates under different ages, time consumption index, complications or concomitants, admission departments, treatment methods and medical insurance types( P<0.01). Conclusions:There were many factors affecting the medical cost rate of breast malignant tumors. Relevant departments should expand the pilot scope of DRG payment, promote the multi-disciplinary diagnosis and treatment mode of tumors, refine the DRG grouping scheme, to provide standardized and homogeneous diagnosis and treatment services for tumor patients, and reasonably control the excessive growth of medical costs.

Long-Term Survival and Medical Costs of Patients with Prolonged Mechanical Ventilation and Tracheostomy: A Nationwide Cohort Study.

Few large-scale studies have focused on tracheostomy in patients with prolonged mechanical ventilation. This retrospective population-based study extracted data from the longitudinal National Health Insurance Research Database in Taiwan to compare long-term mortality between patients on prolonged mechanical ventilation with and without tracheostomy and their related medical expenditures. Data on newly developed respiratory failure in patients on ventilator support were extracted from 1 January 2002 to 31 December 2008. Of 10,705 patients included, 1372 underwent tracheostomy (n = 563) or translaryngeal intubation (n = 779). Overall survival of the patients with tracheostomy was followed for 5 years. Average survival was 4.98 years for the patients with tracheostomy and 5.48 years for the patients with translaryngeal intubation (not significant). Sex, age, premium-based monthly salary difference, occupation, urbanization level, chronic obstructive pulmonary disease, chronic heart failure, chronic renal disease, and cerebrovascular diseases were significantly associated with mortality for endotracheal intubation. Male sex, chronic heart failure, chronic renal disease, age ≥45 years, and low income were associated with significantly higher mortality. Although total medical expenditures were higher for the patients with tracheostomy, annual medical expenditures were not significantly different. There were no differences in long-term mortality between the two groups.

Assessment of medical malpractice cost at a Japanese national university hospital.

Medical safety management has an economic dimension that has received little attention. Medical expenses associated with medical malpractice in Japan should be investigated in relation to patient safety measures and their consequences. We analyzed medical accidents that occurred within the past seven years at a university hospital. We determined that 197 accidents involved negligence by the hospital in the years from 2011 to 2017, for which the institution bore the costs of the resulting treatment; those expenses totaled JPY 30.547 million. Most incidents occurred in the hospital ward (82, 41.6%); those in the operating room were the most expensive (JPY 19.493 million, 63.8%). The greatest number of cases involved drug administration (63, 32.0%). Materials inadvertently left in surgical sites ("remnants") cost the hospital the most per incident (JPY 9.767 million, 32.0%). Of these, medical treatment costs for remnants associated with vascular invasion were the highest. Although the total number of malpractice incidents increased over time, the annual cost to the hospital decreased, especially in cases in which costs exceeded JPY 100,000, and those associated with the operating room. Our results suggested that adverse events must be addressed to foster patient safety, decrease medical expenses, and improve hospital administrative capacity.

The Path Analysis of Family Doctor's Gatekeeper Role in Shanghai, China: A Structural Equation Modeling (SEM) Approach.

Studies globally have provided substantial evidence that PHC could conduct doctor-visiting behaviors, control medical expense, and improve population health. This study aimed to map how family doctor (FD) in Shanghai achieved gate-keeper goals including health management, medical expense control, and conducting ordered doctor-visiting behavior. A total of 2754 and 1995 valid questionnaires were collected in 2013 and 2016 respectively in Shanghai. The data were analyzed using structural equation modeling (SEM). Invariance analysis was also performed for 2 waves of data. We found that the coefficient of cognition on health management (ß5 = 0.26, P < .05) was larger than that of signing with FD (ß4 = 0.06, P < .05). SEM model also showed that first-contact at community health service center (CHSC) had a positive effect on health management (ß6 = 0.30, P < .05), and the latter also affected health management results positively (ß8 = 0.39, P < .05), suggesting that the path for FD was through first-contact and health management. Besides, the gate-keeper role of medical expense control was significant through the first-contact (ß10 = -0.12, P < .05) mediation rather than health management (ß9 = 0.03, P > .05). The model fit was acceptable (RMSEA = 0.033). A "cognition-behavior-outcomes (health and medical expense)" path of FD's gate-keeper role was found. It is necessary to consolidate FD contracted services rather than reimbursement discount the latter of which is proved to be unsustainable.

Convalescent Hospital Use among Young and Older Female Cancer Survivors.

This study analyzed national health data to assess convalescent hospital use among female cancer survivors according to age group. This retrospective study collected data from women recovering from breast, colon, and stomach cancer, based on health insurance claim data over 5 years (2013-2017), from the Korea Health Insurance Review and Assessment Service (KHIRA). Interestingly, the number of young and older women who were treated in convalescent hospitals increased every year. In addition, total medical expenses increased in both groups. The annual rate of convalescent hospitalization was higher in older women (8.29~16.39%) than in younger women (4.01~7.46%). The total yearly medical expenses of cancer survivors in convalescent hospitals increased in both age groups and all cancer types, and the range of increase rate was from 7.7% in young breast cancer survivors to 32.2% in young colon cancer survivors. Visit days and days of medication increased noticeably in young colon cancer survivors. Taken together, these data have confirmed the importance of developing standard guidelines for inpatient management in convalescent hospitals and the health management of women cancer survivors by cancer type. This includes establishing a health management system and medical policies.