The security effect and operating mechanism of the "Zhanjiang model" of the serious illnesses medical insurance system

In China, the current critical illness insurance program varies significantly from region to region and is characterized by “fragmentation”. At present, the “Zhanjiang model” is one of the main representative models of critical illness insurance program. The “Zhanjiang model” is a reform and innovation made by the Zhanjiang Municipal Government in establishing a critical illness insurance program, in which commercial insurance has been introduced into the social security system for the first time in China. Through reinsurance, it has increased the reimbursement amount of insured patients with critical illnesses and improved the level of cooperation between the government and enterprises and the coverage scope of the insured persons. Still, there are problems that need to be further summarized and studied, including: how effective is the system in providing security for the insured people since its implementation? Can it effectively reduce the incidence of catastrophic medical expenditures for the insured families? Does the system fully demonstrate the characteristics of fairness and efficiency? And what are the major problems in the operating mechanism? Therefore, this research takes the “Zhanjiang model” as the case to study the role of critical illness insurance program in reducing both the incidence of catastrophic medical expenditures and the level of medical expenditures in the families in Zhanjiang, by applying the theories of health economics, welfare economics, public goods and social security and adopting the method of field research. At the same time, based on the principles of fairness and efficiency, this research adopts marginal utility and Gini coefficient to develop a model to describe the fairness and efficiency of the use of critical illness insurance funds. And by means of qualitative comparative research and literature induction research, this thesis studied and analyzed the operating mechanism of the “Zhanjiang model” from the aspect of the policy and proposed suggestions for optimization. The study found that: (1) After the implementation of the “Zhanjiang model”, according to data analysis in 2015, the incidence of catastrophic medical expenditures in Zhanjiang urban and rural households decreased from 5.34% to 3.14% under the 40% definition standard, and the proportion of per capita medical and health expenditures in Zhanjiang dropped from 37% to 11% during 2013-2018. However, critical illness medical insurance has exerted no obvious effect on reducing the incidence of family catastrophic medical expenditures, which should be further optimized. (2) Under the same budget constraints, the disease-free scheme of the critical illness insurance program could be more fair and effective. (3) The supporting policies for the “Zhanjiang model” of critical illness insurance program should be further improved; the level of coordination and fund utilization efficiency should be promoted; and a dynamic adjustment mechanism for diversified financing should be established. Each region should implement critical illness insurance policies according to its local conditions.Na China, os sistemas de seguros de saúde para cobrir custos provenientes de doenças graves, apresentam enormes diferenças de região para região, assumindo características fragmentadas. Atualmente, o modelo “Zhanjiang” constitui um dos principais modelos representativos deste tipo de seguros . O modelo “Zhanjiang” resulta de uma reforma inovadora destes sistemas, concebido pelas autoridades governamentais locais tendo sido o pioneiro em introduzir os seguros comerciais no sistema de seguro social da China. Através do resseguro proveniente desta cooperação entre o público e o privado, foi aumentado o reembolso das despesas dos segurados com doenças críticas e incrementado o nível de cooperação entre o governo e empresas, ampliando a cobertura dos segurados. Mesmo assim, existem problemas que merecem maior sistematização e pesquisa, incluindo: quão eficaz é o seguro após a implementação do sistema? Pode reduzir-se efetivamente a probabilidade de despesas médicas catastróficas das famílias seguradas? O sistema reflete totalmente justiça e eficiência? E quais são os principais problemas com os mecanismos de operacionalização? Assim, a presente tese toma o modelo do “Zhanjiang” como caso de estudo para investigar o papel do sistema de seguro de saúde na redução da probabilidade de despesas médicas catastróficas das famílias seguradas, assim como o nível de despesas médicas das famílias em Zhanjiang. Recorre-se às teorias da economia da saúde, economia do bem-estar, bens públicos e segurança social como suporte ao desenvolvimento da pesquisa de terreno. Em simultâneo, com base no princípio de justiça e eficiência, esta pesquisa adota a utilidade marginal e o coeficiente de Gini para estabelecer um modelo visando descrever a justiça e a eficiência no uso dos fundos do seguro de saúde para doenças graves. Através do estudo comparativo de natureza qualitativa, a presente tese analisa o mecanismo operacional do modelo de Zhanjiang, desde o nível da sua conceção enquanto política social, propondo sugestões de otimização. O estudo constatou que: (1) Após a implementação do modelo de Zhanjiang, de acordo com a análise de dados em 2015, a ocorrência de despesas médicas catastróficas de residentes urbanos e rurais em Zhanjiang caiu de 5,34% para 3,14%, abaixo do objetivo definido de 40%. De 2013 a 2018, a proporção de despesas médicas e de saúde per capita na cidade de Zhanjiang desceu de 37% para 11%. No entanto, ainda que estas reduções sejam importantes não debelaream ainda a ocorrência de despesas médicas catastróficas famíliares, o que deve ser no futuro otimizado. (2) Face às mesmas restrições orçamentais, o esquema do seguro de saúde sem restrição do tipo de doenças, deve ser mais justo e efetivo. (3) Devem ser melhoradas as políticas de apoio ao modelo Zhanjiang de seguros de saúde para doenças graves; o nível de coordenação e a eficiência de utilização dos fundos do seguro de saúde devem ser igualmente incrementados; o mecanismo de ajustamento dinâmico para o financiamento deve ser implementado. Cada região deve assim aplicar programas de seguros de saúde para doenças graves, de acordo com as condições locais

Provable learning of quantum states with graphical models

The complete learning of an $n$-qubit quantum state requires samples exponentially in $n$. Several works consider subclasses of quantum states that can be learned in polynomial sample complexity such as stabilizer states or high-temperature Gibbs states. Other works consider a weaker sense of learning, such as PAC learning and shadow tomography. In this work, we consider learning states that are close to neural network quantum states, which can efficiently be represented by a graphical model called restricted Boltzmann machines (RBMs). To this end, we exhibit robustness results for efficient provable two-hop neighborhood learning algorithms for ferromagnetic and locally consistent RBMs. We consider the $L_p$-norm as a measure of closeness, including both total variation distance and max-norm distance in the limit. Our results allow certain quantum states to be learned with a sample complexity \textit{exponentially} better than naive tomography. We hence provide new classes of efficiently learnable quantum states and apply new strategies to learn them

Research on torsional vibration reduction of crankshaft in off-road diesel engine by simulation and experiment

Formerly, torsional vibration of crankshaft in off-highway diesel engine (agricultural machinery) were given little attention at their developmental stages, however with increasing agricultural activities, numerous torsional vibration problems have been noted to occur in agricultural machinery, especially in their diesel engines. This results in engine vibration, crankshaft failure and undesirable engine noise. In this paper, a six-cylinder four-stroke inline diesel engine’s crankshaft model was developed using AVL Excite Designer. After experimentally validating the model, it was used to numerically determine the torsional vibrations of a crankshaft. For the reduction of torsional vibration, two methods of crankshaft improvements were proposed based on simulation results. The first method, is to decrease the inertia of the crank pulley while the second, involves the replacement of the crank pulley with a torsional vibration damper. To ensure minimal engine alterations and cost effectiveness, the second improvement method was adopted for improving torsional vibration. Afterwards, engine radiating noise and surface vibration measurements were conducted to ensure that the required limits were achieved by the improved engine. The simulation, experiment and the improvement process of the crankshaft torsional vibration are documented further in this research. These improvements have applicable values in the developmental or quality enhancement stage of diesel engines used in agricultural machinery

In vitro and in vivo antitumor effects of acetylshikonin isolated from Arnebia euchroma (Royle) Johnst (Ruanzicao) cell suspension cultures

<p>Abstract</p> <p>Background</p> <p>Shikonin derivatives have cytotoxic and antitumor effects. This study aims to investigate the antitumor effects of acetylshikonin isolated from a Chinese medicinal herb <it>Arnebia euchroma (Royle) Johnst</it>.</p> <p>Methods</p> <p>The 3-(4,5-dimethylthiazol- 2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to determine the <it>in vitro </it>antitumor effects of acetylshikonin on human lung adenocarcinoma cell line A549, human hepatocellular carcinoma cell line Bel-7402, human breast adenocarcinoma cell line MCF-7 and mouse Lewis lung carcinoma (LLC) cell line. C₅₇BL/6 mice with LLC model were used to study the <it>in vivo </it>antitumor effects of acetylshikonin. The expression of bax, bcl-2 and caspase-3 proteins in LLC tissue was determined with immunohistochemical staining.</p> <p>Results</p> <p>In A549, Bel-7402, MCF-7 and LLC cell lines, acetylshikonin inhibited cell growth in a dose-dependent manner. IC50 (means ± SD) were 5.6 ± 0.86 μg/ml, 6.82 ± 1.5 μg/ml, 3.04 ± 0.44 μg/ml and 2.72 ± 0.38 μg/ml respectively. Acetylshikonin suppressed tumor growth in C57BL/6 mice with LLC. The inhibition rate of acetylshikonin (2 mg/kg) was 42.85%. Immunohistochemical staining revealed that in the acetylshikonin groups the expression of bax and caspase-3 increased, whereas the expression of bcl-2 decreased, suggesting that acetylshikonin induced tumor cell apoptosis through activating the pro-apoptotic bcl-2 family and caspase-3.</p> <p>Conclusion</p> <p>Acetylshikonin isolated from <it>Arnebia euchroma (Royle) Johnst </it>cell suspension cultures exhibits specific <it>in vivo </it>and <it>in vitro </it>antitumor effects.</p

Modeling intraparticle transports during propylene polymerizations using supported metallocene and dual function metallocene as catalysts: Single particle model

Two improved multigrain models (MGMs) for preparing homopolypropylene and long chain branched polypropylene via propylene polymerization using silica-supported metallocene or dual function metallocene as catalysts are presented in this paper. The presented models are used to predict the intraparticle flow fields involved in the polymerizations. The simulation results show that the flow field distributions involve dare basically identical. The results also show that both the two polymerization processes have an initiation stage and the controlling step for them is reaction-diffusion-reaction with the polymerization proceeding. Furthermore, the simulation results show that the intra particle mass transfer resistance has significant effect on the polymerization but the heat transfer resistance can be ignored