OBJECTIVETo apply mixed logit model for analyzing the data of new rural cooperative medical with suitability and identify the factors affecting the residents choices of insurance mode.

METHODSHypothesis test of IIA was performed using the mogtest module of Stata10.0 to test the eligibility of the condition. The mixed logit model was established to allow the parameters to vary in the population using SAS9.1 MDC module.

RESULTSThe data in this study did not satisfy the IIA assumption (P<0.01), so that the multinomial logit model was not applicable. The adjusted Estrella of the mixed logit model was 0.6658.

CONCLUSIONThe mixed logit approach does not rely on the restrictive IIA assumption and allows for correlation patterns between choices and individual variation. This approach can help in the determination of the choices in new rural cooperative medical system.

Health Care Coalitions ; statistics & numerical data ; Insurance, Health ; Logistic Models ; Rural Health ; Rural Health Services ; statistics & numerical data

BACKGROUNDChina has achieved universal health insurance coverage. This study examined how patients and hospitals react to the different designs of the plans and to monitoring of patients by the local authority in the Chinese multiple health security schemes.

METHODSThe sample for analysis consisted of 1006 orthopedic inpatients who were admitted between January and December 2011 at a tertiary teaching hospital located in Beijing. We conducted general linear regression analyses to investigate whether medical expenditure and length of stay differed according to the different incentives.

RESULTSPatients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates. Under plans with an annual ceiling for insurance coverage, patients spent significantly more in the second half of the year than in the first half of the year. The length of stay was shorter among patients when there were government monitoring and a penalty to the hospital service provider.

CONCLUSIONSOur results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers. Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use.

China ; Female ; Health Personnel ; statistics & numerical data ; Humans ; Insurance, Health ; statistics & numerical data ; Male ; Motivation ; Patients ; statistics & numerical data

Health insurance big data not only provide real-world evidence of unmet needs in actual clinical practice but also of breakthroughs in the medical industry which will shape the future of health care. Big data are also expected to transform the existing medical paradigm and provide a truly personalized medical age. However, questions about research through the collection and utilization of various big data in various fields have also been raised because quality limitations cannot be overlooked. Therefore, many challenges remain to be overcome in the use of big data research as a basis for changing medical practice. Intervention and interpretation by clinical medical experts are required in judging the scientific trustworthiness of the big data analysis process and the validity of the results. Therefore, healthcare big data research cannot achieve its goal by the efforts of researchers alone. Teams of data analysis scientists, epidemiologists, statistics experts, and clinical researchers are required to collaborate closely with team members, from the design phase to expert consultation, through regular meetings. In addition, it is necessary, in the creation of a healthier community, to cooperate with government agencies that provide data based on the whole nation or the world's population, as well as interest groups representing the people, and policy-making organizations. In this paper, we describe the knowledge, practical clinical applications, and future research directions and prospects for the next phase of health care, from the design of clinical research using health insurance big data to report writing.
Delivery of Health Care ; Government Agencies ; Humans ; Insurance, Health ; Public Opinion ; Statistics as Topic ; Writing

BACKGROUNDAccording to the regulations of the Chinese and Shanghai governments, migrant workers employed in Shanghai should all be entitled to Shanghai Migrant Worker Hospitalization Insurance (SMWHI) without premium and the vast majority should also have the New Rural Cooperative Medical System (NRCMS). This study aimed to examine the status of the coverage and utilization of health insurance among migrant workers employed in Shanghai.

METHODSQuantitative and qualitative research methods were employed in the study. A survey of 1020 migrant workers employed in Shanghai was conducted in 2010 with a structured questionnaire. Focus group discussions were held with respondents who were unable to maintain health insurance coverage through NRCMS or SMWHI. In-depth interviews were held with village heads and employers of the migrant workers, migrant workers who were hospitalized within the last year, and various individuals employed by the insurance agencies.

RESULTSThe study found that 72.9% and 36.5% of migrant workers were covered by NRCMS or SMWHI, respectively, while 16.7% of them had no health insurance. The coverage by NRCMS among migrant workers correlated significantly with education level and workplace, while the coverage by SMWHI correlated significantly with the length of employment in Shanghai and workplace. The qualitative results confirmed that migrant workers were the main group who were not covered by NRCMS, and the coverage by SMWHI was completely dependent upon the employers of the migrant worker. The results also showed that health insurance utilization among migrant workers was strongly limited by hospital location.

CONCLUSIONSWe observed that the status of health insurance among migrant workers was not accordant with theory, and that Chinese health insurance policy should be further reformed in order to realize full coverage and equal utilization of health insurance among migrant workers in China.

Adolescent ; Adult ; China ; Female ; Humans ; Insurance Coverage ; statistics & numerical data ; Insurance, Health ; statistics & numerical data ; utilization ; Male ; Transients and Migrants ; statistics & numerical data ; Young Adult

BACKGROUNDChina has not established social security system for rare diseases. Rare diseases could easily impoverish patients and their families. Little research has studied the equity and accessibility of health services for patients with rare diseases in China. This study aimed to explore the factors that influence health expenditure of rare diseases and evaluate its equity.

METHODSQuestionnaire survey about living conditions and cost burden of patients with rare diseases was conducted. Individual and family information, health expenditure and reimbursement in 2014 of 982 patients were collected. The impact of medical insurance, individual sociodemographic characteristics, family characteristics, and healthcare need on total and out-of-pocket (OOP) health expenditures was analyzed through the generalized linear model. Equity of health expenditure was evaluated by both concentration index and Lorenz curve.

RESULTSOf all the surveyed patients, 11.41% had no medical insurance and 92.10% spent money to seek medical treatment in 2014. It was suggested female (P = 0.048), over 50 years of age (P = 0.062), high-income group (P = 0.021), hospitalization (P = 0.000), and reimbursement ratio (RR) (P = 0.000) were positively correlated with total health expenditure. Diseases not needing long-term treatment (P = 0.000) was negatively correlated with total health expenditure. Over 50 years of age (P = 0.065), high-income group (P = 0.018), hospitalization (P = 0.000) and having Urban Employee Basic Medical Insurance (UEBMI) (P = 0.022) were positively correlated with OOP health expenditure. Patient or the head of the household having received higher education (P = 0.044 and P = 0.081) and reimbursement ratio (P = 0.078) were negatively correlated with OOP health expenditure. The equity evaluation found concentration indexes of health expenditure before and after reimbursement were 0.0550 and 0.0539, respectively.

CONCLUSIONSOOP health expenditure of patients with UEBMI was significantly more than that of patients without medical insurance. However, for any other medical insurance, there was no difference between OOP health expenditure of the insured patients and patients without insurance. The current reimbursement policies have increased the equity of health expenditure, but are biased toward high-income people.

China ; Female ; Health Expenditures ; statistics & numerical data ; Humans ; Insurance, Health ; economics ; statistics & numerical data ; Male ; Rare Diseases ; economics ; Surveys and Questionnaires

OBJECTIVES: The symptoms of fungal infections vary from minor to severe. According to recent reports, fungal infection prevalence is increasing due to increases in the aging population and in patients with compromised immune systems. However, the total prevalence of fungal infections in South Korea is unknown. We investigated the recent 5-year prevalence of each type of fungal infection in South Korea across age, sex, and regional groups. METHODS: Nationwide data from the National Health Insurance of South Korea were used. The target population included patients who had received treatment for a fungal infection that was listed as the main disease. For each patient, multiple treatments were counted as one case per year in the data analysis. RESULTS: The annual prevalence of all-type mycoses increased from 6.9% in 2009 to 7.4% in 2013. Among the specific groups, the prevalence of dermatophytosis was highest (5.2%), followed by that of opportunistic mycoses (1.7%) and superficial mycoses (0.2%). The prevalence of subcutaneous mycoses and generalized mycoses was very low (8 cases per 100,000 persons and 3 cases per 1 million persons, respectively). CONCLUSIONS: Every year, approximately 7.1% of the Korean population receives treatment for fungal diseases. Cases of opportunistic mycoses are assumed to increase each year. Therefore, further research is needed to understand and monitor the prevalence of mycoses to establish management policies to reduce the burden of fungal diseases.
Aging ; Health Services Needs and Demand ; Humans ; Immune System ; Insurance, Health ; Korea ; Mycoses ; National Health Programs* ; Prevalence* ; Statistics as Topic ; Tinea

BACKGROUNDThe New Rural Cooperative Medical Scheme (NCMS) has been further adjusted and optimized to reduce the financial burden of rural residents and to achieve universal coverage for them. In this study, we aimed to explore the impact of NCMS on medical service utilization and medical expense of inpatients in recent years.

METHODSThe research data of Hainan Province were extracted from the Chinese NCMS platform from 2012 to 2014. Detailed information included total expenditure, average inpatients costs, average out-of-pocket payments, actual reimbursement rate, and average annual growth rate of the above indicators. Descriptive analysis was used to gauge the effects of NCMS.

RESULTSIn the utilization of medical services, NCMS inpatients in tertiary hospital decreased from 25.49% in 2012 to 20.39% in 2014, inpatients in county hospitals increased from 39.49% to 55.92%, simultaneously. The total expenditure in county hospitals rose steadily from 28.46% to 46.66%, meanwhile, the total expenditure in tertiary hospitals fell from 60.44% to 44.51%.The average out-of-pocket costs of rural inpatients remained stable over the years. Furthermore, the compensation fund of NCMS inpatients grew significantly. The actual inpatient reimbursement rate at township health centers increased from 76.93% to 84.04%. Meanwhile, the rate at county hospitals and tertiary hospitals increased slightly from 59.37% and 46.10% to 61.25% and 47.71%, respectively.

CONCLUSIONSWith the improvement of the reimbursement ability, especially after the new health care reform in 2009, the NCMS have been playing a prominent role in alleviating the economic burden of farmers' medical treatment. Meanwhile, more patients go to primary hospitals than tertiary hospitals, and the capability of primary hospitals has been greatly improved.

China ; Female ; Health Expenditures ; statistics & numerical data ; Hospitalization ; statistics & numerical data ; Humans ; Inpatients ; statistics & numerical data ; Insurance, Health ; economics ; Male ; Rural Population

PURPOSE: The objective of this study was to analyze the effects of medical staffing level as bed-to-medical staff ratio on patient outcomes as length of stay (LOS) among hospitals in Korea. METHODS: Two hundred and fifty one hospitals participated in the study between January and March 2008. Data for the study was requested by an electronic data interchange from the Health Insurance Review Agency in 2008. In data analysis, SPSS WIN 15.0 program was utilized for descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and multiple regression. RESULTS: The mean score for length of stay was 13.6 days. The mean of operating bed-to-nurse ratio was 7.93:1. The predicting factors for LOS were bed-to-nurse's aide ratio, bed-to doctor's ratio, severely ill patient rate, and hospital type. These factors explained 28.9% of the variance in patient outcomes. CONCLUSION: This study results indicate that the relationship between medical staffing level and patient outcomes is important in the improvement of the quality of patient care. Thus, improvements in the quality of the nurse practice environment could improve patient outcomes for hospitalized patients.
Electronics ; Electrons ; Humans ; Insurance, Health ; Length of Stay ; Patient Care ; Statistics as Topic

PURPOSE: This study was conducted to analyze the health concerns, health behavior, and related factors for elders taking part in activities at senior centers. METHOD: A total of 811 elders were selected through conveniently sampling. Data were collected from November 21, 2006 to December 20, 2006. Data analysis included frequency, t-test, ANOVA, Duncan test, and Stepwise Multiple Regression using SPSS Win 15.0. RESULTS: For health concerns statistically significant differences were found for gender, age, family, pockety money, sleeping time, regular health check-ups, and exercise. For health behavior statistically significant differences were found for gender, age, family, pocket money, religion, medical insurance, perceived health status, sleeping time, regular health check-ups, chronic illness, regular breakfast, exercise, and drinking. Perceived health status was identified as a variable influencing the health behavior. CONCLUSION: The results suggest that perceived health status can be considered as factor for significant nursing interventions to help single elders and older elders in senior centers.
Breakfast ; Chronic Disease ; Drinking ; Health Behavior* ; Humans ; Insurance ; Nursing ; Senior Centers* ; Statistics as Topic

China ; Family Characteristics ; Financing, Government ; organization & administration ; Health Care Coalitions ; economics ; statistics & numerical data ; trends ; Humans ; Insurance, Health, Reimbursement ; statistics & numerical data ; trends ; Monte Carlo Method ; Rural Health