Additional file 1: of Effect of the new rural cooperative medical system on farmers’ medical service needs and utilization in Ningbo, China

Questionnaire of the Health Services Survey. (DOCX 19 kb

Cost-Effectiveness of Saxagliptin versus Acarbose as Second-Line Therapy in Type 2 Diabetes in China

<div><p>Objective</p><p>This study assessed the long-term cost-effectiveness of saxagliptin+metformin (SAXA+MET) versus acarbose+metformin (ACAR+MET) in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled on MET alone.</p><p>Methods</p><p>Systematic literature reviews were performed to identify studies directly comparing SAXA+MET versus ACAR+MET, and to obtain diabetes-related events costs which were modified by hospital surveys. A Cardiff Diabetes Model was used to estimate the long-term economic and health treatment consequences in patients with T2DM. Costs (2014 Chinese yuan) were calculated from the payer’s perspective and estimated over a patient’s lifetime.</p><p>Results</p><p>SAXA+MET predicted lower incidences of most cardiovascular events, hypoglycemia events and fatal events, and decreased total costs compared with ACAR+MET. For an individual patient, the quality-adjusted life-years (QALYs) gained with SAXA+MET was 0.48 more than ACAR+MET at a cost saving of ¥18,736, which resulted in a cost saving of ¥38,640 per QALY gained for SAXA+MET versus ACAR+MET. Results were robust across various univariate and probabilistic sensitivity analyses.</p><p>Conclusion</p><p>SAXA+MET is a cost-effective treatment alternative compared with ACAR+MET for patients with T2DM in China, with a little QALYs gain and lower costs. SAXA is an effective, well-tolerated drug with a low incidence of adverse events and ease of administration; it is anticipated to be an effective second-line therapy for T2DM treatment.</p></div

Table_1_The development and progress of health literacy in China.DOCX

Limited health literacy is a serious public health problem. It is strongly associated with increased hospital admissions and readmission, poorer self-management, and health outcomes. It can lead to poor management of chronic disease, lower health care quality, increased mortality, and higher healthcare expenditures. Understanding China's current situation and the progress of health literacy levels are critical to achieving practical solutions for improving population health. This paper intended to provide a concise overview of the key milestones and specific practices in health literacy in China. We summarized the characteristics and changing profile of health literacy from 2008 to 2020 in China. We developed an intervention framework based on social ecosystem theory for improving health literacy in China. Meanwhile, some multi-level actionable recommendations were proposed. The study revealed that China has made progress in improving health literacy in the last decades. Health literacy levels increased from 6.48% of the population in 2008 to 23.15% in 2020. Geographic disparities were substantial. The East performed better health literacy than the Central and West, and cities had higher adequate health literacy than rural areas. Social development index, age, and education level were highly associated with health literacy. A global joint effort to improve health literacy will be required. And we advocate a whole-of-society approach that involves the participation of the entire ecosystem around the targeted population.</p

Comparing Maternal Services Utilization and Expense Reimbursement before and after the Adjustment of the New Rural Cooperative Medical Scheme Policy in Rural China

<div><p>Background</p><p>The New Rural Cooperative Medical Scheme (NCMS) includes a maternal care benefits package that is associated with increasing maternal health services. The local compensation policies have been frequently adjusted in recent years. This study examined the association between the NCMS maternal-services policy adjustment and expense reimbursement in Yuyao, China.</p><p>Methods</p><p>Two household surveys were conducted in Yuyao in 2008 and 2011 (before and after the NCMS policy adjustment, respectively). Local women (N = 154) who had delivery history in the past three years were recruited. A questionnaire was used to collect information about delivery history, maternal health services utilization (prenatal care, postnatal care, and the grade of delivery institutions), NCMS participation, and reimbursement status. Logistic regression analyses were used to predict the association between policy adjustment and maternal health utilization and the association between policy adjustment and out-of-pocket proportion. Next, t-tests and covariance analyses adjusting for household income were used to compare the out-of-pocket proportion between 2008 and 2011.</p><p>Results</p><p>Results revealed that compensation policy adjustment was associated with an increase in postnatal visits (adjusted OR = 3.32, <i>p</i> = 0.009) and the use of second level or above institutions for delivery (adjusted OR = 2.32, <i>p</i> = 0.03) among participants. In 2008, only 9.1% of pregnant women received reimbursement from the NCMS; however, this rate increased to 36.8% in 2011. After policy adjustment, there were no significant changes in the proportion of out-of-pocket expenses shared in delivery fee (<i>F</i> = 0.24, <i>p</i> = 0.63) and in household income (<i>F</i> = 0.46, <i>p</i> = 0.50).</p><p>Conclusions</p><p>Financial compensation increase improved maternal health services utilization; however, this effect was limited. Although the reimbursement rate was raised, the out-of-pocket proportion was not significant changed; therefore, the compensation design scheme must be adjusted in practice.</p></div

Demand curve of services in inpatient care, pre/post-reform.

<p>Note: P1 and P2 represent the service prices pre- and post-reform; U1 represents service demand pre-reform, U2 represents theoretical service demand post-reform, and U2' represents actual service demand post-reform.</p

Differences in OOP proportion between 2008 and 2011 by covariance analyses.

<p>Differences in OOP proportion between 2008 and 2011 by covariance analyses.</p

Effect of multiple drug resistance on total medical costs among patients with intra-abdominal infections in China

<div><p>Background</p><p>Multiple drug resistant (MDR) intra-abdominal infections (IAIs) are associated with notable direct and societal costs. As previous studies have not considered the impact of MDR on the total medical costs (TMCs) of IAIs, the present one examines this, as well as further estimates the additional costs at a national level.</p><p>Methods</p><p>This is a retrospective study. Firstly, we randomly selected a sample of 40% of all inpatients discharged between 2014 and 2015 from a teaching hospital, due to limits in budget and the large number of patients. Then, we manually selected 254 patients with IAIs according to the International Classification of Disease, 10^th revision, using electronic medical records. Eventually, 101 patients with IAIs (64 MDR patients and 37 non-MDR patients) were included after excluding cases without laboratory test results, any pathogens detected, or antimicrobial resistant pathogens. Univariate analysis and a generalized linear model were applied to assess the parameters associated with TMCs.</p><p>Results</p><p>Compared to non-MDR patients, those with MDR pathogens were significantly associated with higher TMCs, higher antimicrobial costs, higher antimicrobial usage, larger number of pathogens, and longer length of stay and were more likely to have insurance and combination antimicrobial therapy. In addition, the average TMC among patients with MDR pathogens was ¥ 131801, which is ¥ 90201 higher than those without MDR pathogens. If our results are applied to the whole country, the sum of all attributable TMCs was ¥ 37 billion. The societal costs, furthermore, were ¥111 billion in 2015.</p><p>Conclusion</p><p>Our results provide information that should lead to increased efforts to reduce inappropriate antimicrobial therapy, in order to decrease the emergence of MDR pathogens and to reduce their economic burden.</p></div

Base Case Results for Saxagliptin plus Metformin Compared with Acarbose plus Metformin (2014 Chinese yuan).

<p>Base Case Results for Saxagliptin plus Metformin Compared with Acarbose plus Metformin (2014 Chinese yuan).</p

Demand curve of drugs in outpatient care, pre/post-reform.

<p>Note: P1 and P2 represent drug prices pre- and post-reform; U1 represents drug demand pre-reform, U2 represents theoretical drug demand post-reform, and U2' represents actual drug demand post-reform.</p

Annual Direct Medical Costs for Diabetes-Related Complications (2014 Chinese Yuan).

<p>Annual Direct Medical Costs for Diabetes-Related Complications (2014 Chinese Yuan).</p