90 research outputs found
Réformes économiques et activités des hÎpitaux municipaux en zone rurale : une analyse dans la province de Shandong
Les vastes rĂ©formes entreprises en Chine dans le cadre de ce quâil est convenu dâappeler le Ă« socialisme de marchĂ© Ă» ont eu dâimportantes rĂ©percussions sur le fonctionnement du systĂšme de santĂ©. Cette communication se propose dâen analyser certains effets sur lâactivitĂ© et la performance dâun Ă©chantillon dâhĂŽpitaux municipaux situĂ©s dans une zone rurale de la province de Shandong. Les donnĂ©es de base ont Ă©tĂ© recueillies lors dâune enquĂÂȘte en 2002 et complĂ©tĂ©es par des informations Ă©manant des diffĂ©rents dĂ©partements de lâadministration concernĂ©s. Les dĂ©terminants de lâactivitĂ© des hĂŽpitaux ont Ă©tĂ© analysĂ©s Ă partir dâune analyse de panel sur la pĂ©riode 1986-2000. LâĂ©tude de leur performance a Ă©tĂ© faite en utilisant une analyse non paramĂ©trique (DEA et indice de Malmquist). Les rĂ©sultats obtenus suggĂšrent notamment que la contrainte de revenu de la population est un frein Ă lâaugmentation de la frĂ©quentation des hĂŽpitaux municipaux et que les mĂ©canismes dâassurance ne paraissent pas jouer en lâĂ©tat de rĂŽle significatif. LâactivitĂ© sâavĂšre influencĂ©e par des facteurs reprĂ©sentatifs de lâattractivitĂ© des hĂŽpitaux. Lâintroduction dâun systĂšme de Ă« gestion intĂ©grĂ©e Ă» a permis dâamĂ©liorer la qualitĂ© des soins des structures de santĂ© de village placĂ©s sous la tutelle des hĂŽpitaux municipaux tout en amĂ©liorant dans lâensemble la situation financiĂšre de ces derniers. Dans lâensemble, les hĂŽpitaux municipaux de notre Ă©chantillon ont amĂ©liorĂ© leur efficience durant la pĂ©riode dâĂ©tude sous lâinfluence de facteurs trĂšs variĂ©s selon les hĂŽpitaux. Mais il apparaĂźt que les hĂŽpitaux financiĂšrement contraints ont tendance Ă ĂÂȘtre comparativement plus efficients que les autres.activitĂ© et performance des hopitaux â efficience technique, RĂ©formes Ă©conomiques â dĂ©centralisation
Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data
In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.China, New Rural Cooperative Medical Scheme, Technical efficiency, data envelopment analysis, Township Hospitals.
The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China
Since 2003, the New Rural Cooperative Medical Scheme, a community-based health insurance, is gradually implemented in China, in order to increase the access of the poor to healthcare services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 randomly selected township hospitals of Weifang prefecture (Shandong province, China), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. Estimations highlight three main results. First, the New Rural Cooperative Medical Scheme has a positive impact on the utilization of township hospitals, mainly on inpatient services, but none effect on their financial structure. In addition, the positive impact on the volume of discharged patients is higher in poor areas rather than the non-poor, reflecting a decrease of the burden of hospitalization costs. Lastly, the marginal impact of the reform is decreasing over time.China, New Rural Cooperative Medical Scheme, Impact analysis, Township Hospitals.
Evolution de lâactivitĂ© et de la performance dâun Ă©chantillon d'hĂŽpitaux municipaux en Chine
La dĂ©centralisation en Chine a placĂ© les hĂŽpitaux municipaux (HM) au cĆur du systĂšme sanitaire en zone rurale. Nous avons utilisĂ© les informations collectĂ©es dans un Ă©chantillon de 21 HM de la province de Shandong et dans les administrations concernĂ©es pour analyser par des mĂ©thodes quantitatives les dĂ©terminants de leur activitĂ©, mesurer leur efficience et en rechercher les facteurs explicatifs pour la pĂ©riode 1986-2000. Nos rĂ©sultats suggĂšrent entre autres que le revenu per capita de la zone de desserte des HM ainsi que leur attractivitĂ© perçue ont un effet positif sur leur activitĂ©, que les tarifs pratiquĂ©s en sont un frein et que les dispositifs de couverture maladie nâont pas dâimpact significatif sur leur frĂ©quentation. LâintĂ©gration verticale partielle des HM avec les centres de santĂ© villageois a freinĂ© lâactivitĂ© de ces hĂŽpitaux. Leur efficience sâest globalement amĂ©liorĂ©e durant la pĂ©riode Ă©tudiĂ©e, mais selon une dynamique relativement hĂ©tĂ©rogĂšne,. Cette Ă©volution sâest faite en partie sous lâinfluence de facteurs institutionnels qui tiennent Ă des modalitĂ©s de rĂ©gulation sectorielle et Ă des questions de gouvernance liĂ©es aux relations entre les HM et la tutelle.
The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China
Since 2003, the New Rural Cooperative Medical Scheme is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.China;New Rural Cooperative Medical Scheme;Impact analysis;Township Hospitals.
Curative Activities of Township Hospitals in Weifang Prefecture, China: An Analysis of Environmental and Supply-Side Determinants
Township hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized.Health insurance, China, Healthcare services, Hausman-Taylor, Fixed-effects vector decomposition
The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China
Since 2003, the New Rural Cooperative Medical Scheme is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.China;New Rural Cooperative Medical Scheme;Impact analysis;Township Hospitals.
Curative Activities of Township Hospitals in Weifang Prefecture, China: An Analysis of Environmental and Supply-Side Determinants
International audienceTownship hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized.Les hĂŽpitaux municipaux, qui sont un maillon essentiel du systĂšme de santĂ© rural Chinois, ont Ă©tĂ© affectĂ©s par les rĂ©formes Ă©conomiques successives depuis les annĂ©es 1980 et ont ainsi vu leur frĂ©quentation sâaffaiblir. Ă partir dâobservations longitudinales sur neuf annĂ©es (2000-2008) et 24 hĂŽpitaux municipaux sĂ©lectionnĂ©s de façon alĂ©atoire dans la prĂ©fecture de Weifang (Province du Shandong, Chine), cet article analyse les facteurs dâenvironnement et dâoffre qui influencent le volume des activitĂ©s curatives des hĂŽpitaux municipaux, mesurĂ©par le volume de consultations externes et dâhospitalisations. Afin dâestimer lâeffet de variables invariantes dans le temps, deux estimateurs sont utilisĂ©s : Hausman-Taylor et Fixed-Effect Vector Decomposition. Les rĂ©sultats des estimations des deux estimateurs sont similaires. Ils montrent que le systĂšme dâassurance mutualiste graduellement introduit Ă partir de 2003 influence positivement lâactivitĂ© des hĂŽpitaux municipaux, mĂȘme sâil subsiste des barriĂšres financiĂšres Ă lâaccĂšs aux soins de santĂ© coĂ»teux. Lâanalyse souligne aussi queles liens de rĂ©fĂ©rencement entre les diffĂ©rents niveaux de structures de santĂ© devraient ĂȘtre renforcĂ©s et que la taille des hĂŽpitaux municipaux, qui semble surestimĂ©e, doit ĂȘtre adaptĂ©e en fonction des facteurs environnementaux
Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data
In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.China;New Rural Cooperative Medical Scheme;Technical efficiency;data envelopment analysis;Township Hospitals.
Effect of low-dose rituximab treatment on autoimmune nodopathy with anti-contactin 1 antibody
BackgroundAutoimmune nodopathy with anti-contactin-1 (CNTN1) responds well to rituximab instead of traditional therapies. Although a low-dose rituximab regimen was administered to patients with other autoimmune diseases, such as myasthenia gravis and neuromyelitis optica spectrum disorders, and satisfactory outcomes were obtained, this low-dose rituximab regimen has not been trialed in anti-CNTN1-positive patients.MethodsAntiâCNTN1 nodopathy patients were enrolled in this prospective, open-label, self-controlled pilot study. A cell-based assay was used to detect anti-CNTN1 antibodies and their subclasses in both serum and cerebrospinal fluid. Clinical features were evaluated at baseline, 2 days, 14 days, and 6 months after single low-dose rituximab treatment (600 mg). The titers of the subclasses of anti-CNTN1 antibody and peripheral B cells were also evaluated at baseline, 2 days, and 6 months after the rituximab regimen.ResultsTwo patients with antiâCNTN1 antibodies were enrolled. Both patients had neurological symptoms including muscle weakness, tremor, sensory ataxia, numbness and mild nephrotic symptoms. In the field of neurological symptoms, sensory ataxia markedly improved, and the titer of anti-CNTN1 antibody as well as CD19+ B cells decreased only two days following low-dose rituximab treatment. Other neurological symptoms improved within two weeks of rituximab treatment. At the 6-month follow-up, all neurological symptoms steadily improved with steroid reduction, and both the anti-CNTN1 antibody titer and CD19+ B cells steadily decreased. No adverse events were observed after this single low-dose rituximab treatment.ConclusionsWe confirmed the clinical efficacy of low-dose rituximab by B cell depletion in autoimmune nodopathy with anti-CNTN1 antibody. This rapid and long-lasting response suggests that low-dose rituximab is a promising option for anti-CNTN1 nodopathy
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