Objective: To investigate the impact of New Rural Cooperative Medical System (NCMS)on rural resident’s medical burden. Methods: It investigates the survey data from the China Health and Nutrition Survey and employing difference-in-difference method based on the fixed effect model. Results: NCMS increases rural resident’s actual reimbursement rate, release the high health medical expenditure, but has limit impact on medical expenditure. The low-income group has greater risk on high medical expenditure. Conclusion: It is needed to improve the level of NCMS policy implementation; strengthen the supervision of designated medical institutions and increase policy support for low-income rural residents.

Objective To estimate the fatality rate of SARS so as to provide data for the evaluation of patient care. Methods Based on the clinical features of the death cases of SARS, the average period between the time of clinical diagnosis and the time of death was determined and a method of estimation, which was lagged in time, was thus developed. Differences in the fatality rates of SARS across the world as well as the patterns of the differences were discussed using Chi-square and trend Chi-square tests. Results The fatality rate of SARS in Beijing, which presented a progressively downward tendency, was 7.2% by June 5, 2003, ranking relatively high among the SARS-hit zones in China. Conclusion Certain achievements have been attained in the clinical treatment of SARS cases, and yet more efforts need to be exerted. It is estimated that the eventual fatality rate of SARS in Beijing will be around 8%.

Objective To analyze the optimal scales of secondary public hospitals so as to optimize the expansion of public hospitals.Methods Forty-six secondary public general hospitals in Beijing were selected as the sample,with input and output indicators pinpointed,for analysis of the status of economic return to scale of such hospitals from 1996 to 2012,and identification of inflexion points of the returns to scale.These efforts will help find an optimal scale of such hospitals.Resalts The period from 1996 to 2012 found the general effectiveness of such hospitals in a decline.In 2012,only 4 of the 46 hospitals were in DEA effectiveness status,and the other 42 hospitals were not; Forty-three inflexion points were identified.This study found that the strict control standards for secondary public general hospitals in Beijing were 298 beds and 585 staffs; the flexible control standards were 421 beds and 807 staffs.Conclclsion The optimal scales for secondary public hospitals were drown from the analysis,for references of other regions in China.The hospitals should prioritize resources efficiency instead of scale expansion.

Objective:To analyze the policy tools designed for function orientation and development of China′s infectious disease hospitals, in order to provide references for formulating and optimizing the functional implementation and sustainable development policies of these hospitals.Methods:Consulting the website of Peking University Law and official websites on health, and using such keywords as " medical institutions, infectious diseases, hospitals for infectious diseases, public health emergencies, specialized hospitals", and searching the national policy texts on the functions and development of infectious disease hospitals issued from December 1991 to January 2023. By means of Rothwell and Zegveld′s policy tool classification method, Nvivo 11 Pro software was used to analyze the text content from the dimensions of demand-type, supply-type, and environmental-type policy tools.Results:A total of 41 policy texts were included and 204 codes were obtained through text analysis. Of all the tools, environmental and supply-oriented policy tools were used the most, being 104 (50.99%) and 95 (46.56%) respectively, while demand-oriented policy tools were used the least, only 5 (2.45%). Of all the environmental-oriented policy tools, " goal planning" was the most used, being 34 (16.67%), while " publicity and guidance" was less used, only 4 (1.96%). Among the supply-oriented policy tools, " clarifying the reporting and handling service functions of public health emergencies" was the most widely used, being 34 (16.67%), while " Informationization" and " infrastructure construction" was less used, being 8 (3.92%) and 6 (2.94%) respectively. Few of the demand-oriented policy tools were in use, as " government purchase" and " medical insurance support" were both 2 (0.98% each), and " social medical care" was only 1 (0.49%).Conclusions:The distribution of three types of policy tools for function and development of infectious disease hospitals is unbalanced, the use of environmental and supply-oriented policy tools is excessive and internal structure is unbalanced. The proportion of environmental-oriented policy tools needs to be adjusted, and the frequency of use of supporting tools such as relevant standards, norms, incentives, supervision and publicity should be increased. Supply-oriented policies need to be further optimized, especially in terms of personnel training, funding, information technology and infrastructure construction. Demand-oriented policy tools are seriously underused and need to be further developed.

Objective: To investigate the implementation of disease prevention and control services at tertiary public general hospitals in Beijing for providing evidences to explore and build a scientific evaluation model of disease control service in medical institutions. Methods: June to September 2018, through a questionnaire survey of 50 tertiary public general hospitals in Beijing, a descriptive analysis was made on the department setting, personnel allocation and service provision status of disease prevention and control at tertiary public general hospitals in Beijing. Results: Among the 44 investigated public tertiary general hospitals, 26(59.1%) medical institutions have set up departments of disease prevention and control. The average staffing of 44 hospitals was 5.8 persons for the department. Professional composition of the staff was mostly nursing and clinical disciplines, and the academic and professional titles were mostly undergraduate and intermediate degrees respectively. Overall performance of disease prevention and control services in public tertiary general hospitals was satisfactory. The work was well carried out in communicable disease control and death-surveillance management, namely in immunoprophylaxis, chronic noncommunicable diseases and injury monitoring, which varies widely in mental health services, occupational health management, environmental and health monitoring and other functions. Conclusions Professional ability and management level of personnel still need to be improved. We should further clarify the joint prevention and control mechanism of the " Three-in-one" nature of disease control institutions, medical institutions and communities, promote the combination of medical treatment and prevention, and explore the classification and grading evaluation of disease control work based on the types and quantity requirements of disease prevention and control services undertaken by hospitals, so as to effectively improve the level of disease control services in hospitals.

Objective: To explore the establishment of an evaluation indicator system for disease prevention and control workload at public hospitals, based on the current situation of disease prevention and control work undertaken by public hospitals of and above secondary level in Beijing, and to provide evaluation assistance for them to do better in this regard. Methods: This research was based on our pervious study of the current situation description of disease prevention and control work undertaken by public hospitals in Beijing, by which the contents of routine disease prevention and control work at hospitals have been initially established. The unit strength of each work was consulted, and the disease prevention and control work was classified according to the results. Meanwhile the consistency test of the work intensity within the category was carried out. After integration, the classification and evaluation indicator of disease prevention and control work in public hospitals of and above secondary level in Beijing was finally established. Results: The workload evaluation indicator system was divided into eight parts: report work, report quality control work, monitoring work, training work, work of public health related clinical diagnosis and treatment, work of clinical examination and vaccination, work of sampling and testing and public health related consultation work. The work intensity of each category ranged from 4.78 to 7.34. Conclusions The evaluation indicator system of workload is suitable for the evaluation of basic works. The unified transformation of workload by using the value of work intensity is conducive to management evaluation, but the limitation of the indicators exists in time and region, making it necessary to adjust by the local specific situation at the promotion and application level.

Objective:To analyze the current allocation situation and equity of Class B large medical equipment in China,and provide references for reasonably optimizing the allocation of medical equipment.Methods:Based on the allocation data of Class B large medical equipment in China at the end of the 13th Five Year Plan period,the agglomeration degree method was used to evaluate the equity of equipment allocation in various regions from the dimensions of geography,population,and economic development.Results:The current allocation of Class B large medical equipment per million population was 3.19,and the eastern region(3.64)was higher than the central region(3.42),the central region(2.24)was higher than the western region.The agglomeration degree of medical equipment based on geographical area showed that most of the equipment in the eastern region was in a rich state,and the allocation equity was relatively good in the central region,but generally poor in the western region.The agglomeration degree of medical equipment based on population distribution was higher in the eastern region than in the central region and even higher in the western region.The equipment in the eastern region could basically meet the demand of the local population,while the allocation in the central and western regions was slightly insufficient.The distribution of medical equipment agglomeration degree based on economic development varied significantly among different regions,and the allocation equity of central region was generally better than that of eastern and western regions.Conclusion:The total allocation of Class B large medical equipment in China is not high,and the government needs to continue planning and improving it.The distribution of medical equipment allocation based on geography,population and economic development is unbalanced among the eastern,central and western regions.Improving the equity of medical equipment allocation also needs to consider regional differences and characteristics according to local conditions.

OBJECTIVETo conduct with a cost analysis of the colorectal neoplasm screening program in Beijing, and provide data evidence for decision making.

METHODSBased on stratified cluster sampling method, we carried out a 2-stage colorectal neoplasm screening program within 6 districts, Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan, of Beijing city between October, 2012 to May. 2013. The first stage of the program was to conducting a cancer risk level evaluation for community residents who were forty years older and the second stage's task was to providing clinical exam for those high risk people who were selected from the first stage. There were about 12 953 residents were involved in this program. We calculated the main cost of the colorectal neoplasm screen program in Beijing. Then estimate the cost of detecting one Colorectal Neoplasm patient of this program and compare it with the total treatment cost for a patient.

RESULT2 487 high risk residents were selected by the first stage and 1 055 of them made appointment for the colonoscopy exam but only 375 accepted the exam, participate rate was 35.5%. 9 neoplasm cancer patients and 71 pre-cancer patient were found at the second stage, the detection rate were 69.2/100 000 and 546/100 000, respectively. The direct input for this neoplasm screening program was 227 100 CNY and the transport expense was 4 200 CNY in the calculations. The cost for detecting one cancer patient was about 19 900 CNY. Comparing with the total medical care cost of a cancer patient (1 282 800 CNY), especially for those have been diagnosed as middle to end stage cancer, the screening program (cost 842 800 CNY) might help to reduce the total health expenditure about 128 700 CNY, based on 12 953 local residents age above 40 years old.

CONCLUSIONAn colonoscopy based colorectal neoplasm screening program showed its function on medical expenditure saving and might have advantage on health social labor creating.

Adult ; Aged ; China ; Colonoscopy ; Colorectal Neoplasms ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Early Detection of Cancer ; Health Care Costs ; Humans ; Mass Screening ; Middle Aged ; Risk Assessment

OBJECTIVETo survey the acceptance and willingness-to-pay for colorectal cancer colonoscopy screening among high risk populations in urban China.

METHODSFrom 2012 to 2013, a Cancer Screening Program in Urban China (CanSPUC) was initiated in 9 provinces, the current survey was conducted among those participants who were evaluated as "high risk for colorectal cancer" by a risk-factor-evaluation-model (community-based) and then went through a colonoscopy screening procedure (hospital-based). All the data were obtained through a questionnaire-based interview (face-to-face or self-completed), mainly focusing on the acceptance and willingness-to-pay of the participants for colorectal colonoscopy screening.

RESULTSThe current analysis included a total of 1 624 participants, with an median age of 55.0 years (P25 = 49.0, P75 = 61.0 years) and an annual income per capita of 17 thousand (range: 10-25 thousand) Chinese Yuan (CNY), 42.8% (695/1 624) of whom were males. Of all the participants, 87.0% (1 414/1 624) could totally or substantially accept the colonoscopy screening, particularly in those at higher education level (junior high school: OR = 0.34, 95% CI: 0.22-0.52; high school OR = 0.41, 95% CI: 0.26-0.66; college or over OR = 0.35, 95% CI: 0.20-0.59). Of all the participants, 13.0% (210/1 624) could not or hardly accept it, particularly in those with older age (60-69 years) (OR = 1.48, 95% CI: 1.06-2.07), not in marriage (OR = 2.15, 95% CI: 1.25-3.70) or with family member(s) to raise (OR = 1.60, 95% CI: 1.17-2.20). 1 388 (85.5%) of all the participants had willingness-to-pay for a long-term colonoscopy screening service, particularly in those working in public (OR = 0.61, 95% CI: 0.44-0.84) or enterprise sectors (OR = 0.60, 95% CI: 0.38-0.94), but 82.3% (1 141/1 386) of whom would only pay less than 100 CNY; 14.5% (236/1 624) of total had no willingness-to-pay, particularly in those living in areas with moderate (OR = 4.08, 95% CI: 2.75-6.33) or high GDP per capita (OR = 3.26, 95% CI: 2.11-4.92), or with an absence of willingness-to-pay for colonoscopy screening (OR = 3.98, 95% CI: 2.81-5.65).

CONCLUSIONSAlthough a larger community-based colorectal cancer screening program was warranted to examine the extrapolation of these findings, it suggested that the acceptance for colorectal cancer colonoscopy screening among the selected high-risk populations was considerable. The willing-to-pay was relatively high but the amount of payment was limited, the indicated subgroups with potentially less acceptance or willingness need to be more focused in the future to reach a higher participation rate. The data will also be informative in integrating the screening service into the local health insurance system.

China ; Colonoscopy ; Colorectal Neoplasms ; Data Collection ; Demography ; Early Detection of Cancer ; Family ; Fees and Charges ; Female ; Humans ; Income ; Insurance, Health ; Male ; Mass Screening ; Middle Aged ; Patient Acceptance of Health Care ; Risk Factors ; Surveys and Questionnaires ; Urban Population