Objective:To examine the impact of outpatient service utilization on hospitalization rates in patients with heart failure,with a focus on identifying the threshold effect,and to provide evidence to support the design of outpatient medical insurance reimbursement policies for heart failure patients.Methods:Using a stratified random sampling method,individual reimbursement data of heart failure pa-tients covered by Urban Employee Basic Medical Insurance in Zhejiang Province from year 2013 to 2017 were extracted.A panel fixed-effects logit regression model and a threshold effect model were applied to analyze the impact of annual outpatient service utilization in the previous year on the hospitalization rate in the current year and to identify the threshold effect.The annual outpatient service utilization indicators included the annual outpatient visits,annual outpatient expenses,annual outpatient drug expenses,and annual outpatient self-expenses within the policy.Hospitalization rate indicators comprised the annual hospitalization rate,rehospitalization rate within 30 days,and rehospitalization rate within 90 days.Results:(1)The study found that an increase in prior-year annual outpatient service utilization led to a decrease in the current-year annual hospitalization rate.However,the effects on the rehospitalization rate within 30 days and rehospitalization rate within 90 days were not statistically significant;(2)The thre-shold effect of prior-year annual outpatient service utilization on the current-year annual hospitalization rate was also identified.When the prior-year annual outpatient visits were less than or equal to the threshold(12 visits),the current-year annual hospitalization rate decreased as the prior-year annual outpatient visits increased and statistically significant,and the regression coefficient was not significant when the prior-year annual outpatient visits were higher than the threshold(12 visits).Correspondingly,the thresholds for annual outpatient expenses and annual outpatient self-expenses within policy in the previous year were 3 342.8 yuan and 736.9 yuan,respectively.Conclusion:There is a threshold effect of prior-year annual outpatient service utilization on the current year's annual hospitalization rate in heart failure patients.These results have important implications for designing outpatient health insurance policies for heart failure patients to improve the patients' utilization of outpatient services and decrease the hospitali-zation rates.Specifically,policymakers should consider the identified thresholds when designing reim-bursement policies for heart failure patients,which may help to optimize the use of medical resources and reduce the burden of medical expenses.

Objective:To examine the impact of outpatient service utilization on hospitalization rates in patients with heart failure,with a focus on identifying the threshold effect,and to provide evidence to support the design of outpatient medical insurance reimbursement policies for heart failure patients.Methods:Using a stratified random sampling method,individual reimbursement data of heart failure pa-tients covered by Urban Employee Basic Medical Insurance in Zhejiang Province from year 2013 to 2017 were extracted.A panel fixed-effects logit regression model and a threshold effect model were applied to analyze the impact of annual outpatient service utilization in the previous year on the hospitalization rate in the current year and to identify the threshold effect.The annual outpatient service utilization indicators included the annual outpatient visits,annual outpatient expenses,annual outpatient drug expenses,and annual outpatient self-expenses within the policy.Hospitalization rate indicators comprised the annual hospitalization rate,rehospitalization rate within 30 days,and rehospitalization rate within 90 days.Results:(1)The study found that an increase in prior-year annual outpatient service utilization led to a decrease in the current-year annual hospitalization rate.However,the effects on the rehospitalization rate within 30 days and rehospitalization rate within 90 days were not statistically significant;(2)The thre-shold effect of prior-year annual outpatient service utilization on the current-year annual hospitalization rate was also identified.When the prior-year annual outpatient visits were less than or equal to the threshold(12 visits),the current-year annual hospitalization rate decreased as the prior-year annual outpatient visits increased and statistically significant,and the regression coefficient was not significant when the prior-year annual outpatient visits were higher than the threshold(12 visits).Correspondingly,the thresholds for annual outpatient expenses and annual outpatient self-expenses within policy in the previous year were 3 342.8 yuan and 736.9 yuan,respectively.Conclusion:There is a threshold effect of prior-year annual outpatient service utilization on the current year's annual hospitalization rate in heart failure patients.These results have important implications for designing outpatient health insurance policies for heart failure patients to improve the patients' utilization of outpatient services and decrease the hospitali-zation rates.Specifically,policymakers should consider the identified thresholds when designing reim-bursement policies for heart failure patients,which may help to optimize the use of medical resources and reduce the burden of medical expenses.

Dual-source computed tomography(CT)has a series of functions such as rapid scanning,cardiac imaging,multi-site imaging and spectral imaging,and it has the advantages of high image quality and low radiation dose.The timely maintenance and repair can ensure the stable operation of equipment,and guarantee smooth progress of clinical examinations,and provide reliable basis for the diagnosis and treatment to patients.This paper sorted out and analyzed the mechanical structure about the SOMATOM Force CT equipment from three parts:operation and control,data acquisition,and processing and transmission.It also analyzed the correlation between the mechanical structure and functions around the key components such as X-ray tubes,detectors,collimators,slip rings and high-voltage generators,and clarified the role of each component in CT imaging.In general,this paper summarized the troubleshooting ideas and the key points of maintenance and repair for the mechanical faults of the SOMATOM Force CT scanning bed,cooling device and slip ring,which can accumulate the practical experience in improving the guarantee ability of engineers.

Dual-source computed tomography(CT)has a series of functions such as rapid scanning,cardiac imaging,multi-site imaging and spectral imaging,and it has the advantages of high image quality and low radiation dose.The timely maintenance and repair can ensure the stable operation of equipment,and guarantee smooth progress of clinical examinations,and provide reliable basis for the diagnosis and treatment to patients.This paper sorted out and analyzed the mechanical structure about the SOMATOM Force CT equipment from three parts:operation and control,data acquisition,and processing and transmission.It also analyzed the correlation between the mechanical structure and functions around the key components such as X-ray tubes,detectors,collimators,slip rings and high-voltage generators,and clarified the role of each component in CT imaging.In general,this paper summarized the troubleshooting ideas and the key points of maintenance and repair for the mechanical faults of the SOMATOM Force CT scanning bed,cooling device and slip ring,which can accumulate the practical experience in improving the guarantee ability of engineers.

Objective:To introduce several international long-term care insurance systems so as to provide references for building China's long-term care insurance system.Methods:Literature of International long-term care insurance system were reviewed to extract and summarize the content so as to provide suggestion and references for China's system construction.Results:It concluded 4 modes of systems for long-term care insurance including the private long-term care social insurance like Netherlands,the public long-term care social insurance like German and Japan,long-term care commercial insurance like America and national long-term care insurance like England.The advantages of different modes could be learned to form Chinese system.Conclusion:The long-term care insurance systems of Netherlands,German,Japan,American could be learned for our system construction,but they also had disadvantages.Therefore,on the basis of the foster strengths and circumvent weaknesses,the reasonable long-term care insurance system was formed.

Objective:To study direct medical cost of hypertensive patients without complicated disea-ses,to analyze substitution impacts of outpatient expenditure on inpatient expenditure,and then to make recommendations to health policy makers and hypertensive patients for managing hypertension.Methods:The claims data of hypertensive patients insured by the rural new cooperative medical scheme in a city in northern China from 2008 to 201 3 were analyzed,descriptive statistics employed to analyze direct medical cost of hypertensive patients and hypertensive patients without complicated diseases which was one of the three groups divided by medical treatment conditions (hypertension without complicated diseases,hyper-tension with complicated diseases,and other diseases),and the differences between groups compared by t test.The fixed effect two-part model was employed to analyze the substitution effect of outpatient services on inpatient services,and specific effects of outpatient times and reimbursement expenses on the inpatient expenditure were calculated by Logistic regression analysis.Results:For the hypertensive pa-tients,the average cost of outpatients was 283.49 Yuan in 2008 and rose to 370.93 Yuan in 201 3.After being divided into three groups,for hypertensive patients without complicated diseases,the average cost of outpatient was 449.79 Yuan in 2008 and rose to 582.53 Yuan in 201 3.In the total cost of the outpa-tient,45.73% was for the hypertensive patients without complicated diseases;in the total cost of the in-patient,only 9.29% was for the hypertensive patients without complicated diseases.By calculating the marginal effect of parameter estimation through the fixed effect two-part model,the inpatient cost could be significantly reduced by increasing the visit times of outpatient utilization or the cost of outpatient reim-bursement.For example,in 201 3,a 1 % rise of outpatient visit times increased outpatient expenditures by 6.48 million Yuan,which could reduce inpatient expenditures by 39.86 million Yuan.The substitu-ted ratio of outpatient cost on inpatient cost had been around 5 in 201 0 and later.Conclusion:The health policy-makers and hypertensive patients should pay more attentions to the substitution of outpatient cost for inpatient cost,especially for the hypertensive patients without complicated diseases whose direct medical cost was mainly due to outpatient rather than inpatient costs.