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.

The effect of work stress on turnover intention amongst family doctors: A conditional process analysis.

OBJECTIVE: To explore describe the mechanism between work stress, job satisfaction, perceived organizational support and turnover intention amongst family doctors in China, and to provide reference for improving the brain drain of family doctors. METHOD: Using convenience sampling, a questionnaire survey was conducted among 2358 family doctors in 13 provinces in eastern, central and western China. Pearson correlation analysis and hierarchical regression analysis were used to explore the effects of job stress, job satisfaction and perceived organizational support on family doctors' turnover intention. RESULTS: Family doctors' work stress was positively correlated with turnover intention (ß = 0.631, p＜0.001), job satisfaction played a partial mediating role in the influence path of work stress on turnover intention (ß = 0.9175, p＜0.001), perceived organizational support played a moderating role in the relationship between work stress, job satisfaction, and turnover intention (ß = 0.124, p＜0.05; ß = -0.022, p＜0.05). CONCLUSION: Hospital managers should take corresponding measures to reduce the work stress of family doctors, improve their job satisfaction, and provide more support and attention to family doctors to ensure the stable development of family doctors in China.

Will information interventions affect public preferences and willingness to pay for air quality improvement? An empirical study based on deliberative choice experiment.

Environmental information is a prerequisite for public participation in air quality improvement, and the choice of such participation behavior is influenced by the intervention of environmental information. Nonetheless, there has been insufficient analysis of how information interventions affect public preferences and willingness to pay for air quality improvement. The combination of deliberative and choice experiment is used to explore the importance of information interventions for public participation in air quality improvement, and the changes in public preferences and willingness to pay for air quality improvement before and after information interventions are compared to analyze the impact of information interventions on evaluation results of air quality value. The results suggest that information interventions do alter the preferences and willingness of the public to pay for air quality improvement, significantly increasing the choice certainty of respondents and decreasing the protest response. In addition, women and high-income groups showed a stronger willingness to improve air quality after the information interventions, with 35.15 CNY, 44.07 CNY and 46.75 CNY increases in willingness to pay for improved urban green coverage rate, fewer haze days and reduced morbidity. The combination of deliberative information interventions and choice experiment will help improve the effectiveness of air quality value evaluation, stimulate public environmental awareness and willingness to participate, and the results will aid government environmental management.