Demand for social health insurance:Evidence from the Chinese New Rural Cooperative Medical Scheme

This paper assesses the determinants of enrolment in the New Rural Cooperative Medical Scheme (NRCMS), a heavily subsidized voluntary health insurance scheme in rural China. The analyses focus on the relationship between insurance purchase and health facility choice based on data drawn from the China Health and Nutrition Survey (CHNS). The results show that households from villages that reported use of village clinics are more likely to be insured compared with households from villages that reported use of county hospitals. The results indicate that the perception of quality of care is an important factor affecting people's enrolment decisions. The NRCMS is expected to help patients obtain better quality health services from higher-tier of the healthcare system that are unaffordable otherwise. However, given the prevailing fee-for-service payment mechanism for health care, the insurance may also drive up the healthcare cost and direct patients to use more expensive and unnecessary hospital care

The impact of public smoking bans on well-being externalities: evidence from a natural experiment

Recent studies on the effects of anti-smoking policies on subjective well-being present mixed results and focus mainly on smokers. We contribute to the literature by exploiting the policy experiment provided by the UK public smoking bans and evaluating the impact of smoking bans on the subjective well-being of smokers, non-smokers and couples of different types of smokers. We employ matching techniques combined with flexible difference-in-differences fixed effects panel data models on data from the British Household Panel Survey. We find that the UK public smoking bans appear to have a statistically significant short-term positive impact on the well-being of married individuals, especially among couples with dependent children. These effects appear to be substantial in size, robust to alternative specifications and may be driven by positive externalities due to parental altruism

Empirical essays on the evaluation of health care reforms in rural China

This thesis is comprised of three empirical studies on health care reforms in rural China. It specifically examines the determinant of enrolment in the social health insurance program, the effects of the insurance on health care utilization, and the extent of income-related inequity in the use of health care before and after the reforms. Chapter 2 analyses the determinant of enrolment in the New Rural Cooperative Medical Scheme (NRCMS) from 2004 to 2006. The results show that people who use low-level public health facilities (village clinics or town hospitals) are more likely to be insured while people who use high-level public health facilities (county or city hospitals) are less likely to be covered. The relationship remains strong and significant after controlling for various groups of independent variables, such as demographics, socio-economic characteristics and health variables. The results may be attributed to generous reimbursements for health services delivered by low-level health facilities, making insurance more attractive for people who use primary care. However, the fact that people who use high-level facilities are less likely to purchase the NRCMS may indicate problems related to weak health systems at the primary level and a breakdown in the referral system. Chapter 3 provides evidence on the effectiveness of the NRCMS on health care utilization to explore whether the insurance has helped patients to obtain more and better quality health services. As the program is a non-random policy initiative rolled out nationally, various matching methods with difference-in-difference (DID) models are employed based on data from the China Health and Nutrition Survey (CHNS). The results show that the introduction of the NRCMS was not clearly related to the overall use of medical care, but it may have directed patients from town hospitals towards village clinics and county hospitals. On the one hand, the NRCMS appears to partly rationalise the use of health services, with some increase in the use of primary care. On the other hand, the insurance may also alleviate financial barriers to accessing higher levels of medical facilities and help patients to obtain better quality health care. Chapter 4 examines how the income-related inequity of health care utilization in China develops from 2000 to 2009, the period before and after the health care reforms. The first part of the analysis uses Concentration Indices and Erreygers’ Indices of the need-standardized use of different types of health services and different levels of health facilities. Pro-rich inequity emerges with respect to the use of preventive care and county hospitals, and pro-poor inequity is found in the use of folk doctors and village clinics. The results indicate that the rich are more likely to obtain formal and better quality health services. The second part of the analysis assesses the contribution of various need and non-need factors to total inequity in health care use and shows that inequity is mainly driven by income. Therefore, policies that address the unequal distribution of income would help to reduce the degree of horizontal inequity in the use of health services

The impact of public smoking bans on well-being externalities : evidence from a policy experiment

Recent studies on the effects of anti-smoking policies on subjective well-being present mixed results and do not account for potential externalities, especially among couples. We contribute to the literature by evaluating the impact of smoking bans on well-being externalities among smokers and non-smokers as well as couples of different types of smokers. We exploit the policy experiment provided by the timing of the UK public smoking bans and measure well-being via the GHQ. We employ matching techniques combined with flexible difference-in-differences fixed effects panel data models on data from the British Household Panel Survey. The joint use of matching methods with fixed effects specifications allows building more comparable treatment and control groups, producing less model-dependent results and accounting for individual-level unobserved heterogeneity. We find that public smoking bans appear to have a statistically significant short-term positive impact on the well-being of married individuals, especially among women with dependent children. These effects appear to be robust to alternative specifications and placebo tests and are discussed in the light of the economic theory and recent evidence

Distribution and Determinants of Correlation between PM2.5 and O3 in China Mainland: Dynamitic simil-Hu Lines

In recent years, China has made great efforts to control air pollution. During the governance process, it is found that fine particulate matter (PM2.5) and ozone (O3) change in the same trend among some areas and the opposite in others, which brings some difficulties to take measures in a planned way. Therefore, this study adopted multi-year and large-scale air quality data to explore the distribution of correlation between PM2.5 and O3, and proposed a concept called dynamic similar hu lines to replace the single fixed division in the previous research. Furthermore, this study discussed the causes of distribution patterns quantitatively with geographical detector and random forest. The causes included natural factors and anthropogenic factors. And these factors could be divided into three parts according to the characteristics of spatial distribution: broadly changing with longitude, changing with latitude, and having local characteristics. Overall, regions with relatively more densely population, higher GDP, lower altitude, higher humidity, higher atmospheric pressure, higher surface temperature, less sunshine hours and more accumulated precipitation often corresponds to positive correlation coefficient between PM2.5 and O3, no matter in which season. The parts with opposite conditions that mentioned above are essentially negative correlation coefficient. And what's more, humidity, global surface temperature, air temperature and accumulated precipitation are four decisive factors to form the distribution of correlation between PM2.5 and O3. In general, collaborative governance of atmospheric pollutants should consider particular time and space background and also be based on the local actual socio-economic situations, geography and geomorphology, climate and meteorology and other comprehensive factors.Comment: Our research group have decided to withdraw this preprin

Systems Pharmacology Dissection of Multi-Scale Mechanisms of Action of Huo-Xiang-Zheng-Qi Formula for the Treatment of Gastrointestinal Diseases

Multi-components Traditional Chinese Medicine (TCM) treats various complex diseases (multi-etiologies and multi-symptoms) via herbs interactions to exert curative efficacy with less adverse effects. However, the ancient Chinese compatibility theory of herbs formula still remains ambiguous. Presently, this combination principle is dissected through a systems pharmacology study on the mechanism of action of a representative TCM formula, Huo-xiang-zheng-qi (HXZQ) prescription, on the treatment of functional dyspepsia (FD), a chronic or recurrent clinical disorder of digestive system, as typical gastrointestinal (GI) diseases which burden human physical and mental health heavily and widely. In approach, a systems pharmacology platform which incorporates the pharmacokinetic and pharmaco-dynamics evaluation, target fishing and network pharmacological analyses is employed. As a result, 132 chemicals and 48 proteins are identified as active compounds and FD-related targets, and the mechanism of HXZQ formula for the treatment of GI diseases is based on its three function modules of anti-inflammation, immune protection and gastrointestinal motility regulation mainly through four, i.e., PIK-AKT, JAK-STAT, Toll-like as well as Calcium signaling pathways. In addition, HXZQ formula conforms to the ancient compatibility rule of “Jun-Chen-Zuo-Shi” due to the different, while cooperative roles that herbs possess, specifically, the direct FD curative effects of GHX (serving as Jun drug), the anti-bacterial efficacy and major accompanying symptoms-reliving bioactivities of ZS and BZ (as Chen), the detoxication and ADME regulation capacities of GC (as Shi), as well as the minor symptoms-treating efficacy of the rest 7 herbs (as Zuo). This work not only provides an insight of the therapeutic mechanism of TCMs on treating GI diseases from a multi-scale perspective, but also may offer an efficient way for drug discovery and development from herbal medicine as complementary drugs

Impact of the Southwark and Lambeth Integrated Care Older People's Programme on hospital utilisation and costs: controlled time series and cost-consequence analysis.

OBJECTIVES: To estimate the impact on hospital utilisation and costs of a multi-faceted primary care intervention for older people identified as being at risk of avoidable hospitalisation. DESIGN: Observational study: controlled time series analysis and estimation of costs and cost consequences of the Programme. General practitioner (GP)'s practice level data were analysed from 2009 to 2016 (intervention operated from 2012 to 2016). Mixed-effect Poisson regression models of hospital utilisation included comparisons with control practices and background trends in addition to within-practice comparisons. Cost estimation used standard tariff values. SETTING: 94 practices in Southwark and Lambeth and 263 control practices from other parts of England. MAIN OUTCOME MEASURES: Hospital utilisation: emergency department attendance, emergency admissions, emergency admissions for ambulatory sensitive conditions, outpatient attendance, elective admission and length of stay. RESULTS: By the fourth year of the Programme, there were reductions in accident and emergency (A&E) attendance (rate ratio 0.944, 95% CI 0.913 to 0.976), outpatient attendances (rate ratio 0.938, 95% CI 0.902 to 0.975) and elective admissions (rate ratio 0.921, 95% CI 0.908 to 0.935) but there was no evidence of reduced emergency admissions. The costs of the Programme were £149 per resident aged 65 and above but savings in hospital costs were only £86 per resident aged 65 and above, equivalent to a net increase in health service expenditure of £64 per resident though the Programme was nearly cost neutral if set-up costs were excluded. Holistic assessments carried out by GPs and consequent Integrated Care Management (ICM) plans were associated with increases in elective activity and costs; £126 increase in outpatient attendance and £936 in elective admission costs per holistic assessment carried out, and £576 increase in outpatient and £5858 in elective admission costs per patient receiving ICM. CONCLUSIONS: The Older People's Programme was not cost saving. Some aspects of the Programme were associated with increased costs of elective care, possibly through the identification of unmet need

Identification of efferocytosis-related subtypes in gliomas and elucidating their characteristics and clinical significance

Introduction: Gliomas, the most prevalent tumors of the central nervous system, are known for their aggressive nature and poor prognosis. The heterogeneity among gliomas leads to varying responses to the same treatments, even among similar glioma types. In our study, we efferocytosis-related subtypes and explored their characteristics in terms of immune landscape, intercellular communication, and metabolic processes, ultimately elucidating their potential clinical implications.Methods and Results: We first identified efferocytosis-related subtypes in Bulk RNA-seq using the NMF algorithm. We then preliminarily demonstrated the correlation of these subtypes with efferocytosis by examining enrichment scores of cell death pathways, macrophage infiltration, and the expression of immune ligands. Our analysis of single-cell RNA-seq data further supported the association of these subtypes with efferocytosis. Through enrichment analysis, we found that efferocytosis-related subtypes differ from other types of gliomas in terms of immune landscape, intercellular communication, and substance metabolism. Moreover, we found that the efferocytosis-related classification is a prognostic factor with robust predictive performance by calculating the AUC values. We also found that efferocytosis-related subtypes, when compared with other gliomas in drug sensitivity, survival, and TIDE scores, show a clear link to the effectiveness of chemotherapy, radiotherapy, and immunotherapy in glioma patients.Discussion: We identified efferocytosis-related subtypes in gliomas by analyzing the expression of 137 efferocytosis-associated genes, exploring their characteristics in immune landscape, intercellular communication, metabolic processes, and genomic variations. Moreover, we discovered that the classification of efferocytosis-related subtypes has a strong prognostic predictive power and holds potential significance in guiding clinical treatment

Neonatal health care costs of very preterm babies in England: a retrospective analysis of a national birth cohort

© 2023 The Authors. Due to be published by BMJ. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://bmjpaedsopen.bmj.com/content/7/1/e001818Objectives: Babies born between 27+0 and 31+6 weeks of gestation represent the largest group of very preterm babies requiring NHS care, however up-to-date cost figures for the UK are not currently available. This study estimates neonatal costs to hospital discharge for this group of very preterm babies in England. Design: Retrospective analysis of resource use data recorded within the National Neonatal Research Database (NNRD). Setting: Neonatal units in England. Patients: Babies born between 27+0 and 31+6 weeks of gestation in England and discharged from a neonatal unit between 2014 and 2018. Main outcome measures: Days receiving different levels of neonatal care were costed, along with other specialised clinical activities. Mean resource use and costs per baby are presented by gestational age at birth, along with total costs for the cohort. Results: Based upon data for 28,154 very preterm babies, the annual total costs of neonatal care were estimated to be £262 million, with 95% of costs attributable to routine daily care provided by units. The mean (SD) total cost per baby of this routine care varied by gestational age at birth; £75,594 (£34,874) at 27 weeks as compared with £27,401 (£14,947) at 31 weeks. Conclusions: Neonatal healthcare costs for very preterm babies vary substantially by gestational age at birth. The findings presented here are a useful resource to stakeholders including NHS managers, clinicians, researchers, and policy makers.This work is supported by the National Institute for Health Research, Health Services and Delivery Research Stream, project number 15/70/104 CRN accrual was approved by the NIHR for the period (1 August 2017 to 31 August 2018)

A ‘telephone first’ approach to demand management in English general practice: a multimethod evaluation

Background: The increasing difficulty experienced by general practices in meeting patient demand is leading to new approaches being tried, including greater use of telephone consulting. Objectives: To evaluate a ‘telephone first’ approach, in which all patients requesting a general practitioner (GP) appointment are asked to speak to a GP on the telephone first. Methods: The study used a controlled before-and-after (time-series) approach using national reference data sets; it also incorporated economic and qualitative elements. There was a comparison between 146 practices using the ‘telephone first’ approach and control practices in England with regard to GP Patient Survey scores and secondary care utilisation (Hospital Episode Statistics). A practice manager survey was used in the ‘telephone first’ practices. There was an analysis of practice data and the patient surveys conducted in 20 practices using the ‘telephone first’ approach. Interviews were conducted with 43 patients and 49 primary care staff. The study also included an analysis of costs. Results: Following the introduction of the ‘telephone first’ approach, the average number of face-to-face consultations in practices decreased by 38% [95% confidence interval (CI) 29% to 45%; p < 0.0001], whereas there was a 12-fold increase in telephone consultations (95% CI 6.3-fold to 22.9-fold; p < 0.0001). The average durations of consultations decreased, which, when combined with the increased number of consultations, we estimate led to an overall increase of 8% in the mean time spent consulting by GPs, although there was a large amount of uncertainty (95% CI –1% to 17%; p = 0.0883). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload. Comparing ‘telephone first’ practices with control practices in England in terms of scores in the national GP Patient Survey, there was an improvement of 20 percentage points in responses to the survey question on length of time to get to see or speak to a doctor or nurse. Other responses were slightly negative. The introduction of the ‘telephone first’ approach was followed by a small (2%) increase in hospital admissions; there was no initial change in accident and emergency (A&E) department attendance, but there was a subsequent small (2%) decrease in the rate of increase in A&E attendances. We found no evidence that the ‘telephone first’ approach would produce net reductions in secondary care costs. Patients and staff expressed a wide range of both positive and negative views in interviews. Conclusions: The ‘telephone first’ approach shows that many problems in general practice can be dealt with on the telephone. However, the approach does not suit all patients and is not a panacea for meeting demand for care, and it is unlikely to reduce secondary care costs. Future research could include identifying how telephone consulting best meets the needs of different patient groups and practices in varying circumstances and how resources can be tailored to predictable patterns of demand.The National Institute for Health Research Health Services and Delivery Research programme