OBJECTIVETo understand the disease burden caused by cancers in Jinchang cohort, and develop effective strategies for cancer prevention and control in this population.

METHODSThe cancer mortality data from 2001 to 2013 and the medical records for cancer patients from 2001 to 2010 in Jinchang cohort were collected. The disease burden caused by cancer was analyzed by using mortality rate, potential years of life lost (PYLL), working PYLL (WPYLL), and direct economic burden.

RESULTSDuring 2001-2013, in Jinchang cohort, the five leading cancers ranked by mortality rate were lung cancer (78.06/100,000), gastric cancer (38.03/100,000), liver cancer (37.23/100,000), esophageal cancer (19.06/100,000), and colorectal cancer (9.53/100,000). The five leading cancers in terms of PYLL (person-years) and WPYLL (person-years) were lung cancer (3480.33, 1161.00), liver cancer (2809.03, 1475.00), gastric cancer (2120.54, 844.00), esophageal cancer (949.61, 315.00), and colorectal cancer (539.90, 246.00). From 2001 to 2010, the five leading cancers in term of average daily cost of hospitalization were gastric cancer (8,102.23 Yuan), esophageal cancer (7135.79 Yuan), colorectal cancer (7064.38 Yuan), breast cancer (6723.53 Yuan), and lung cancer (6309.39 Yuan).

CONCLUSIONSThe cancers common causing higher disease burden in Jinchang cohort were lung cancer, gastric cancer, liver cancer, esophageal cancer and colorectal cancer. The lung cancer disease burden was the highest.

Breast Neoplasms ; economics ; mortality ; China ; epidemiology ; Cohort Studies ; Colorectal Neoplasms ; economics ; mortality ; Cost of Illness ; Esophageal Neoplasms ; economics ; mortality ; Female ; Hospitalization ; economics ; Humans ; Liver Neoplasms ; economics ; mortality ; Lung Neoplasms ; economics ; mortality ; Male ; Neoplasms ; economics ; mortality ; Stomach Neoplasms ; economics ; mortality

BACKGROUNDThe new medical insurance policy (JRSYF(2010) No.255) was released by the Beijing Municipal Government and became effective on January 1, 2011. Medical expenses incurred during a stay in an emergency department (ED) observation unit can be reimbursed as a hospital admission. The aim of this study was to evaluate the impact of a new charging scheme during stays in ED observation unit under Beijing's Basic Medical Insurance.

METHODSData for those patients who had stayed in ED observation unit in 2010 (before the implementation of a new charging scheme) and 2012 (after the implementation of this policy) were retrospectively analyzed in terms of length of stay, patients who were observed (PO), and median medical costs.

RESULTSAfter the implementation of a new charging scheme, compared with the year of 2010, in year of 2012, there were statistically significant longer lengths of stay at the observation unit (6 (4-9) vs. 5 (4-7) days; P < 0.001), more PO (2 257 vs. 1 783; P < 0.001), and more median medical costs (RMB 6 026 vs. 3 650 Yuan; P < 0.01). The proportion of elderly patients (≥ 60 years of age) in 2012 was larger than that in 2010 (70.22% vs. 63.71%; P < 0.01). It was performed on those patients who were admitted after the implementation of a new charging scheme. Compared with patients who were not admitted had stayed in ED observation units, the patients who were admitted had stayed in ED observation units that had a higher proportion for >15 days (36.22% vs. 5.61%; P < 0.01); they had higher median medical costs RMB (9 186 vs. 5 668 Yuan; P < 0.001) and they were more elderly (≥ 60 years of age) (86.10% vs. 66.39%; P < 0.01).

CONCLUSIONSThe new charging scheme under Beijing's Basic Medical Insurance allows patients to get access to inpatient admission more easily. It lowers patients' financial burden in ED observation unit. Since more people stay at ED observation unit, it increases ED payments by the insurance system. However, it slows the turnover rate of ED observation unit and causes overcrowding in ED. Hence, the advantages and disadvantages of the new policy are obvious.

Adult ; Aged ; Emergency Service, Hospital ; economics ; Female ; Hospitalization ; economics ; Humans ; Insurance, Health ; economics ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo analyze the inpatient cost of AIDS related opportunistic infection in a high HIV epidemic area of China.

METHODSInformation was collected and analyzed from 158 inpatients with AIDS related opportunistic infection, including demographic characteristics of patients, types of opportunistic infection and treatment cost (median) from 2008 to 2010 in a high HIV epidemic area.

RESULTSThe inpatient cost per visit for AIDS related opportunistic infection was 2935.7 yuan. The fee per visit for examination, laboratory test, medicine, diagnosis and treatment, nursing, bed was 132.5, 269.0, 1485.5, 367.3, 302.5 and 264.0 yuan, respectively. The inpatient cost per visit for AIDS related opportunistic infection was 4383.1 yuan for male and 3418.6 yuan for female inpatient (U = -1.279, P = 0.201). The cost per visit for AIDS related opportunistic infection was 4703.1 yuan for Han nationality and 3475.9 yuan for minority patient (U = -1.025, P = 0.305). The inpatient cost per visit for AIDS related opportunistic infection was respectively 3429.3, 5022.2, 6705.5 and 2396.7 yuan for farmers, individual businessmen, employees of enterprise and public institution and jobless (H = 28.633, P = 0.000). The cost per visit was lowest for illiteracy patients (2590.2 yuan), 3626.5 yuan for primary school, 4214.3 yuan for junior high school and 6865.8 yuan for high school and higher education (H = 10.828, P = 0.013). The cost per visit for AIDS related opportunistic infection was respectively 2873.6, 4534.3, 3077.8 and 3208.1 yuan for under the age of 29, 30-39 years old, 40-49 years old and beyond the age of 50 (H = 1.515, P = 0.679). The AIDS related opportunistic infection cost per visit for inpatients infected through sex (4621.3 yuan) was higher than that of intravenous drug users (3208.6 yuan, U = -2.588, P = 0.010). Among various types of opportunistic infections, the cost was highest for neurological diseases (5819.7 yuan), 4300.8, 2806.8, and 2083.9 yuan for respiratory diseases, digestive system diseases and skin and mucous membrane diseases, respectively (H = 15.142, P = 0.004).

CONCLUSIONThe study shows difference of inpatient cost per visit between subgroups, the cost of public institution was higher than that of other professions, the cost of illiteracy patients was lower than other education level, the cost of inpatients infected through sex was higher than that of intravenous drug users, the cost of neurological diseases was higher than that of other types of opportunistic infections.

AIDS-Related Opportunistic Infections ; economics ; Acquired Immunodeficiency Syndrome ; economics ; Adult ; Female ; Health Care Costs ; Hospitalization ; economics ; Humans ; Male ; Middle Aged

PURPOSE: The aim of this study was to analyze economical efficiency of home care service by comparing a cost-utility ratio(CUR) between home care and hospitalization. METHOD: The analytic framework of this study was constructed in 5 stages: Identifying the analytic perspectives, measurement of costs, measurement of utility, analysis of CUR, and sensitivity test. Data was collected by reviewing medical records, home care service records, medical fee claims, and other related research. RESULT: The mean of the annual total cost was 23,317,636 Won in home care and 73,739,352 Won in hospital care. QALY was 0.389 in home care and 0.474 in hospital care, so CUR was 299,712,545 QALY in home care and 777,841,266 QALY in hospital care. CONCLUSION: The findings affirmed that home care had an economical efficiency in the aspect of utility compared to hospitalization. Therefore, the findings of this study can be used to develop a governmental health policy or to expand the home care system. In addition, the cost-utility analysis framework and process of this study will be an example model for cost-utility analysis in nursing research. Therefore, it will be used as a guideline for future research related to cost-utility analysis in nursing.
Costs and Cost Analysis ; Home Care Services/*economics ; Hospitalization/economics ; Humans ; Korea ; *Quality-Adjusted Life Years

OBJECTIVE: To analyze the new rural cooperative medical system in Hunan from 2003 to 2009 and to provide reference for scientific decision making. METHODS: We dynamically analyzed the participation rate, fund raising and fund operation efficiency of the new rural cooperative medical system in the past 7 years. RESULTS: From 2003 to 2009, the participation rate increased from 60.7% to 91.22%, funding increased from 30 to 100 yuan/person, degree of hospitalization income from 26.75% to 41.63%, hospitalization rate from 4.57% to 8.26%, and cost of hospitalization times from 2389.46 to 2518.00 yuan. CONCLUSION Implementation of the new rural cooperative medical system is indeed a boon to farmers, and the enthusiasm of farmers' participation is significantly improved. We must strengthen the supervision of the designated medical institutions, to effectively reduce health care cost and the burden of medical expense of farmers.
China ; Cooperative Behavior ; Delivery of Health Care ; trends ; Hospitalization ; economics ; Humans ; Rural Health Services ; economics ; organization & administration

OBJECTIVE: To explore the level and influential factors for out-of-pocket (OOP) expenditure regarding Hunan Provincial Urban Employee Basic Medical Insurance (UEBMI) and to provide evidence for improvement of medical insurance payment system.
 METHODS: Stratified random sampling method was used to obtain 10 527 records of cancer inpatients from January 2011 to December 2014. Social demographic and expenditure information were collected from UEBMI information system. The proportion of OOP expenditure for inpatient and each part of the cost was described. Multiple linear regression was used to analyze main related factors of OOP expenditure.
 RESULTS: The median proportion of OOP for inpatients costs was 20.11%, and remained stable from 2011 to 2014. The main related factors for OOP expenditure were age, civil servant, retirment status, hospital level, cost of hospitalization, hospitalization duration, medicine cost, proportion of general medical service charges, treatment cost, expenses of examination and laboratory test, and cancer type.
 CONCLUSION OOP expenditure among UEBMI cancer inpatients was under control and stable. The level can well reflect the policy preferences. It could be further improved through the control of related factors, particularly the hospital level.
Health Care Costs ; Health Expenditures ; Hospitalization ; economics ; Humans ; Inpatients ; Neoplasms ; economics

This study was conducted to estimate the socioeconomic costs of overweight and obesity in a sample of Korean adults aged 20 yr and older in 2005. The socioeconomic costs of overweight and obesity include direct costs (inpatient care, outpatient care and medication) and indirect costs (loss of productivity due to premature deaths and inpatient care, time costs, traffic costs and nursing fees). Hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, stroke, colon cancer and osteoarthritis were selected as obesity-related diseases. The population attributable fraction (PAF) of obesity was calculated from national representative data of Korea such as the National Health Insurance Corporation (NHIC) cohort data and the 2005 Korea National Health and Nutrition Examination Survey (KNHANES) data. Direct costs of overweight and obesity were estimated at approximately U$1,081 million equivalent (men: U$497 million, women: U$584 million) and indirect costs were estimated at approximately U$706 million (men: U$527 million, women: U$178 million). The estimated total socioeconomic costs of overweight and obesity were approximately U$1,787 million (men: U$1,081 million, women: U$706 million). These total costs represented about 0.22% of the gross domestic product (GDP) and 3.7% of the national health care expenditures in 2005. We found the socioeconomic costs of overweight and obesity in Korean adults aged 20 yr and older are substantial. In order to control the socioeconomic burden attributable to overweight and obesity, effective national strategies for prevention and management of obesity should be established and implemented.
Adult ; Aged ; Arthritis/economics ; Cardiovascular Diseases/economics ; *Cost of Illness ; Diabetes Mellitus/economics ; Dyslipidemias/economics ; Female ; Health Care Costs/statistics & numerical data ; Health Expenditures ; Hospitalization/economics ; Humans ; Male ; Middle Aged ; Neoplasms/economics ; Nutrition Surveys ; Obesity/*economics/*psychology ; Republic of Korea ; Socioeconomic Factors

BACKGROUND/AIMS: Gastrointestinal (GI) diseases impose a heavy economic burden. We aimed to provide the first report on the health care utilization and costs of GI diseases in Korea. METHODS: We collected the data from all insurance claims database of National Health Insurance Corporation in Korea and the cause of death database in 2007 of Korea National Statistical Office. We compiled information about all digestive disease as a primary diagnosis on clinic visits, hospitalization, and cause of death from these databases. RESULTS: Seventeen million people (35.6%) had a diagnosis of GI diseases during the year 2007. Among them, the proportion of patients with upper GI diseases was prevalent in 54.9% (9.5 million patients/year). The 1/4 patients in out-patients clinic had any one of gastroesophageal reflux disease, irritable bowel syndrome and constipation. Thirteen percent of the total direct cost in 2007 was attributed to all GI diseases, which was 3,649 billion won (0.4% of GDP). The patients with hospitalization occupied by 5% of all patients with GI diseases, however, attributed to 58.9% of GI-related direct costs. GI malignancy was the major cause of medical expenses in hospitalization. Stomach cancer continues to be the leading cause of GI-related death in Korea. CONCLUSIONS: GI diseases causes a heavy socioeconomic burden with high morbidity of functional GI disorders in outpatients care and high mortality of GI malignancy in inpatient care. This report highlights the healthcare utilization burden of GI diseases for researchers and public health policy maker to create new directions of integrated researches and health care plan.
Databases, Factual ; Gastrointestinal Diseases/*economics ; Gastrointestinal Neoplasms/economics/mortality ; *Health Care Costs ; Hospitalization/economics ; Humans ; National Health Programs/economics ; Republic of Korea ; Survival Analysis

OBJECTIVETo evaluate the economic loss of nosocomial infections (NI) in patients with cerebral hemorrhage or cerebral infarction.

METHODSWe used case-control method to compare the medical expenses between 46 pairs of cerebral hemorrhage or cerebral infarction patients with or without NI.

RESULTSThe median hospital stay, total treatment expense, medications expense, examination expense, and treatment expense of NI were significantly higher in the NI group than in non-NI group (all P < 0.01 ).

CONCLUSIONSNI can prolong hospital stay and increase medical expenses of patients with cerebral hemorrhage or cerebral infarction. Effective measures should be taken to control NI.

Aged ; Aged, 80 and over ; Case-Control Studies ; Cerebral Hemorrhage ; economics ; Cerebral Infarction ; economics ; Cost of Illness ; Cross Infection ; economics ; Female ; Hospitalization ; economics ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the economic burden of patients with acute and chronic hepatitis B, cirrhosis and liver cancer caused by hepatitis B virus (HBV).

METHODSCluster sampling was used on cases consecutively collected during the study period. Questionnaire survey was conducted and information on the expenses during hospitalization was collected from the hospital records and through interviewing those patients.

RESULTSYearly costs related to patients with acute hepatitis B, severe hepatitis B, chronic hepatitis B, cirrhosis, hepatocellular carcinoma were 66.7, 138.1, 127.4, 151.7 and 377.2 thousand Yuan, respectively.

RESULTSfrom multiple linear regression model showed that the type of medical insurance scheme, annual days of hospitalization, classifications of HBV-related diseases and personal income were major influencing factors on the cost.

CONCLUSIONHBV infection caused considerable burden to families and the society, indicating that HBV infection control programs would bring huge potential benefits. The reform of insurance scheme should be administrated to promote social fairness.

Adult ; Carcinoma, Hepatocellular ; economics ; China ; Cost of Illness ; Female ; Health Care Costs ; statistics & numerical data ; Hepatitis B ; economics ; Hepatitis B virus ; Hepatitis B, Chronic ; economics ; Hospitalization ; economics ; Humans ; Liver Cirrhosis ; economics ; Liver Neoplasms ; economics ; Male ; Middle Aged ; Surveys and Questionnaires ; Young Adult