Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospit...Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospitals through controlling unreasonable growth of medical expenses,so as to provide reference for controlling the rapid rise of medical cost in public hospitals and optimizing the cost structure.Methods Based on the changes of related indicators of medical expense control from 2012 to 2021,the overall characteristics,changes of cost structure and trends of medical expenses in general hospitals and TCM hospitals were investigated.Results and Conclusion From 2012 to 2021,the increase of medical expenses in general hospitals and traditional Chinese medicine hospitals had slowed down,the proportion of drug revenue to medical income began to decline,and the medical service income increased.However,the proportion of inspection,test and sanitary materials income has increased instead of decreasing,but the management cost has decreased.The two kinds of hospitals have achieved certain cost control results,the structure of medical cost has changed greatly,and the technical service and labor value of medical personnel have been reflected to a certain extent.However,it is still necessary to explore a more scientific and reasonable cost control mechanism to promote the further optimization of medical cost structure.展开更多
Information monopoly of bureaucrats helps them maximize discretionary budget. Public disclosure of budget can alleviate information asymmetry between government and the public and empower public supervision on governm...Information monopoly of bureaucrats helps them maximize discretionary budget. Public disclosure of budget can alleviate information asymmetry between government and the public and empower public supervision on government budget. With information intermediary function and reputational governance function, the media exert a budget intervention effect in the public disclosure of government budget, which further increases the effect of government budget disclosure. This paper investigates how media reports influence "three public expenses"(TPE) budget planning of central government departments by examining media reports on the disclosure of budget and final accounts and using TPE budget as a proxy variable for discretionary budget of bureaucrats. We have reached the following findings:(1) The higher the TPE budget implementation rate, the greater budget growth will be. But this correlation can be restrained by media attention;(2) Different stance of the media may exert different governance effects on TPE budget. Good news about TPE may motivate bureaucrats to restrain the positive impact of TPE budget implementation on budget growth. However, bad news about TPE will exert its budget intervention effect only when administrative governance mechanism intervenes. This study has broadened research on the media's governance effect from the perspective of government budget transparency and verified that under China's unique institutional background, the media may still play a positive role in public sector governance.展开更多
The reduction of health care expenses continues to be a major challenge for the economy and society of the United States and other nations. This study focused on a major source of health care expenses, inpatient hospi...The reduction of health care expenses continues to be a major challenge for the economy and society of the United States and other nations. This study focused on a major source of health care expenses, inpatient hospitals, at the community level. It was based on the assumption that fewer inpatient hospital admissions per population contribute to lower health care costs. The study demonstrated that the hospitals of Syracuse, New York have generated fewer inpatient admissions and discharges than those of other New York State metropolitan areas per population. It suggested that the application of utilization rates for inpatient hospitalization in Syracuse to some other New York State areas could result in substantial savings. Between 2016 and 2017, the hospital discharge rates in Syracuse were 1.6 - 3.1 percentage points lower than those of Albany, 2.2 - 5.0 percentage points lower than those of Rochester, 4.1 - 4.9 lower than those of New York City, 5.4 - 8.2 percentage points lower than those of Buffalo, and 17.2 - 18.3 percentage points lower than those of Utica. The study suggested that the conservative hospitalization rates in Syracuse were developed and sustained over long periods of time through the use of ambulatory surgery, reduction of admissions through hospital emergency departments, and limitation of the inpatient bed supply. This was a lengthy process that resulted in a conservative hospital admission pattern. The study demonstrated, more recently, that specific programs such as the reduction of inpatient hospital readmissions and hospital lengths of stay have supported additional reductions of hospital and related utilization in Syracuse.展开更多
The“Letagonins”:a concept socially constructed to designate the“beating”women of Ivorian society,evokes those who have as their leitmotif,a self-realization through work.The purpose lies in their ability to free t...The“Letagonins”:a concept socially constructed to designate the“beating”women of Ivorian society,evokes those who have as their leitmotif,a self-realization through work.The purpose lies in their ability to free themselves from male domination.This concept means in one of the local Ivorian languages,notably the Gouro1:female boy.These women of Gouro ethnicity show a deep passion for the marketing of food products in Abidjan.However,behind this passion for food is their commitment to funeral expenses;a cultural activity customary lying with agnatic parentage.The transgression of custom by the latter under the prism of their social repositioning is the symbolic manifestation of the destandardization of the traditional relationship between man and woman in the organization of funerals in Gouro country,in the central West Ivorian.Understanding this relational reconfiguration has fuelled our passion as a researcher.In fact,ethnography has been mobilized as a method of observing the funeral practices of these women.In this regard,the study traces the strategies for negotiating access to the land as well as those used to negotiate access to information.展开更多
For more information,please click www.echinacities.com While it's at least very annoying,and at most woefully erroneous that many Chinese people judge all foreigners to be totally minted,it's not hard to see w...For more information,please click www.echinacities.com While it's at least very annoying,and at most woefully erroneous that many Chinese people judge all foreigners to be totally minted,it's not hard to see why,when many foreigners are here living decadent lifestyles,partying on weekends(and weekdays),travelling all over the country and mincing around town with Macbooks,iPods and Ray Bans.But then there are the secret 'squirrelers',who scrimp together just enough cash to展开更多
Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people＇s poverty caused by illness in China. This stu...Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people＇s poverty caused by illness in China. This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department （MID）, including 3229 people in Hubei province and 2628 people in Guangdong province. One-way ANOVA was used to compare the total medical expense, out-of-pocket （OOP） expense and hospital stay between variables. A multiple linear regression analysis was done to identify possible risk factors of total medical expense. The results showed that the average total medical expense per capita was 5709.89 yuan, and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province, respectively. The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuan in 2013. There were no significant differences in medical expenses between different genders of hypertensive patients （P〉0.05）. People of different ages, provinces, medical insurances and medical institution levels showed significant differences in medical expenses. The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region. Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances. And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.展开更多
IN the Shanghai Jewish Refugees Museum,a beautiful handbag is waiting for its owner in a display cabinet.The handbag belongs to a Jewish couple.When they sought refuge in Shanghai during World War II,they pawned the h...IN the Shanghai Jewish Refugees Museum,a beautiful handbag is waiting for its owner in a display cabinet.The handbag belongs to a Jewish couple.When they sought refuge in Shanghai during World War II,they pawned the handbag to Jin Wenzhen’s grandfather in exchange for their child’s medical expenses.He lent the couple the cash equivalent of one month’s revenue from his rice shop,but then never saw them again.展开更多
The super-deduction of research and development(R&D)expenses is at the core of the policy to stimulate enterprise innovation in China.This paper identifies whether firms are supported by the super-deduction polici...The super-deduction of research and development(R&D)expenses is at the core of the policy to stimulate enterprise innovation in China.This paper identifies whether firms are supported by the super-deduction policies for R&D expenses and uses the diferencein-diferences method to investigate the impact of the policies on R&D investment.The results show that changes in policy in 2013 significantly increased the R&D investment of firms engaging in key state-supported technologies.Policy changes in 2016 significantly increased the R&D investment of firms engaging in non-key-state-supported technologies.Enterprises not only invested all their tax incentives in R&D activities but also increased their investment in self-raised funds.The super-deduction policy had different impacts on different industries,firms with different boards,and firms with diferent ownership.The policy significantly affected the manufacturing and construction industries,the Small and Medium Enterprise Board,and non-state-owned enterprises.Through a mechanism analysis,we found that the policy significantly reduced the user cost of R&D and increased the net cash flow of enterprises,which could raise a firm's R&D investment.It is necessary to increase policy support,expand the scope of super-deductible expenses,and increase the super-deduction rate based on industry classification according to the sensitivity of different industries to the policy.展开更多
Background:The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014,designed specifically for patients diagnosed with Tuberculosis(TB).This study aimed to examine the...Background:The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014,designed specifically for patients diagnosed with Tuberculosis(TB).This study aimed to examine the changes in utilization and expenses of outpatient services before and after the reform implementation,among TB patients in the three counties in China.Methods:We collected quantitative data using surveys in 2013(baseline year)and 2015(final year).We used outpatient hospital records to measure service utilization and medical expenses of TB patients.We conducted qualitative interviews with local health authorities,officers of health insurance agencies,and hospital managers(n=18).We utilized three focus group discussions with hospital staff and TB doctors and nurses.The x^2 tests and Mann-Whitney U tests were used to analyse quantitative data,and the thematic analysis using a framework approach was applied to analyse qualitative data.Results:Dantu and Yangzhong counties enacted TB-specific case-based payment method in 2014.Jurong County maintained global budget payment but raised the reimbursement rate for TB care.Compared to the baseline,the percentage of TB patients in Dantu and Yangzhong with eight or above outpatient visits increased from 7.5 to 55.1%and from 22.1 to 53.1%in the final survey,respectively.Jurong experienced the opposite trend,decreasing from 63.0 to 9.8%.In the final survey,the total outpatient expenses per patient during a full treatment course in Dantu(RMB 2939.7)and Yangzhong(RMB 2520.6)were significantly higher than those in the baseline(RMB 690.4 and RMB 1001.5,respectively),while the total outpatient expenses in Jurong decreased significantly(RMB 1976.0 in the baseline and RMB 660.8 in the final survey).Health insurance agencies in Dantu and Yangzhong did not approve the original design with outpatient and inpatient expenses packaged together,revealed by qualitative interviews.Furthermore,staff at designated hospitals misunderstood that health insurance agencies would only reimburse actual expenses.Many TB doctors complained about their reduced salary,which might be due to decreased hospital revenue generated from TB care after the payment method reform.Conclusions:The intended effect on cost containment of case-based payment was not evident in Dantu and Yangzhong.In Jurong,where the global budget payment system maintained with the reimbursement rate enhanced,we found an effect on cost containment but the quality of TB care might be compromised.The TBspecific case-based payment method could be redesigned to combine payment on outpatient and inpatient expenses and to set an appropriate payment standard for TB care during a full treatment course.Local health insurance agencies have to provide explicit explanations on the payment method.TB care providers should be provided with proper incentives.Monitoring and evluaiton on the quality of TB care should be undertaken at regular intervals.展开更多
Cardiovascular diseases(CVD)and their risk factors are exerting an increasingly significant impact on public health,and the incidence rate of CVD continues to rise.This article provides an interpretation of essentials...Cardiovascular diseases(CVD)and their risk factors are exerting an increasingly significant impact on public health,and the incidence rate of CVD continues to rise.This article provides an interpretation of essentials from the newly published Annual Report on Cardiovascular Health and Diseases in China(2024),aiming to offer scientific evidence for CVD prevention,treatment,and the formulation of relevant policies.展开更多
In recent years,surrogate models derived from genuine data samples have proven to be efficient in addressing optimization challenges that are costly or time⁃intensive.However,the individuals in the population become i...In recent years,surrogate models derived from genuine data samples have proven to be efficient in addressing optimization challenges that are costly or time⁃intensive.However,the individuals in the population become indistinguishable as the curse of dimensionality increases in the objective space and the accumulation of surrogate approximated errors.Therefore,in this paper,each objective function is modeled using a radial basis function approach,and the optimal solution set of the surrogate model is located by the multi⁃objective evolutionary algorithm of strengthened dominance relation.The original objective function values of the true evaluations are converted to two indicator values,and then the surrogate models are set up for the two performance indicators.Finally,an adaptive infill sampling strategy that relies on approximate performance indicators is proposed to assist in selecting individuals for real evaluations from the potential optimal solution set.The algorithm is contrasted against several advanced surrogate⁃assisted evolutionary algorithms on two suites of test cases,and the experimental findings prove that the approach is competitive in solving expensive many⁃objective optimization problems.展开更多
Osteoarthritis(OA)presents a growing health concern,with substantial societal and healthcare burdens.Current management focuses on symptom relief,lacking disease-modifying options.Emerging research suggests the sodium...Osteoarthritis(OA)presents a growing health concern,with substantial societal and healthcare burdens.Current management focuses on symptom relief,lacking disease-modifying options.Emerging research suggests the sodium channel Nav1.7 as a pivotal target in OA treatment.Preclinical studies demonstrate carbamazepine's efficacy in Nav1.7 blockade,offering significant joint protection in animal models.However,human trials are needed to validate these findings.Carbamazepine's repurposing holds promise for OA management,potentially revolutionizing treatment paradigms.Further research is essential to bridge the gap between preclinical evidence and clinical application,offering hope for improved OA management and enhanced patient quality of life.展开更多
We have shown that cornerstone articles considering effects of corporate debt on the firm value and constituting the basis of the trade-off theory of capital structure are wrong.Their main mistake is in ignoring the b...We have shown that cornerstone articles considering effects of corporate debt on the firm value and constituting the basis of the trade-off theory of capital structure are wrong.Their main mistake is in ignoring the business securing expenses(BSEs).In the framework of the extended Merton model(EMM),we consider the cumulative effect of debt and corporate taxes on the firm value and its survival,in other words,we revisit Modigliani-Miller Proposition 3(MMP3).We show that(1)debt affects the firm value and its survival,(2)this effect is negative,diminishing the firm value and its chances to survive,(3)the pressure increases as the debt grows provoking the firm’s default,(4)the main factors depressing the levered firm are its debt payments added to the BSEs of the identical unlevered firm and the length of debt maturity,(5)corporate taxes cause development of positive skewness in the asset distribution,but do not affect the location of this distribution in the asset axis.The presented model helps estimate the consequences of choosing this or that level of debt in the presence of corporate taxes and can make a useful instrument for practicing financial managers.展开更多
Objective:To study the application effect of the Enhanced Recovery After Surgery(ERAS)model in patients undergoing spinal fracture surgery.Methods:A randomized controlled trial was designed,and 86 patients undergoing ...Objective:To study the application effect of the Enhanced Recovery After Surgery(ERAS)model in patients undergoing spinal fracture surgery.Methods:A randomized controlled trial was designed,and 86 patients undergoing spinal fracture surgery were randomly divided into the ERAS group and the conventional care group.Postoperative recovery outcomes of the two groups were compared.Results:The ERAS group showed better outcomes in terms of postoperative pain scores,activities of daily living,length of hospital stay,and adherence to rehabilitation training compared to the conventional care group,with shorter hospital stays and lower medical expenses(P<0.05).Conclusion:The ERAS model significantly improves the postoperative recovery quality of patients undergoing spinal fracture surgery,reduces hospital stay and medical costs,and increases patient satisfaction.展开更多
Objective:To investigate the economic burden of patients with acute kidney injury(AKI)by analyzing the distribution of hospitalization expenses and its influencing factors in the Affiliated Hospital of Hebei Universit...Objective:To investigate the economic burden of patients with acute kidney injury(AKI)by analyzing the distribution of hospitalization expenses and its influencing factors in the Affiliated Hospital of Hebei University.Methods:The hospitalization information of patients with AKI from January 2020 to January 2023 was collected and sorted through the hospital charging system and the factors affecting the total hospitalization cost were analyzed by multiple linear regression.Results:Univariate analysis showed that age,occupation,marriage,length of hospitalization,recovery of renal function,and stage of AKI had significant effects on hospitalization cost(P<0.05).The result of the multiple linear regression analysis model showed that age(t=4.11,P<0.0001),length of hospitalization(t=16.10,P<0.0001),recovery of renal function(t=3.26,P<0.0001),AKI stage(t=5.23,P=0.002)are factors affecting the economic burden of patients with AKI.Conclusion:AKI patients should be managed according to age stratification to effectively control the progression of the disease and improve the quality of the medical services provided.This will reduce the economic burden of patients.展开更多
Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put fo...Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.展开更多
Formal credit is critical in agricultural production,allowing more expenditure and productive input,thereby improving farmers'welfare.In pastoral China,formal financial institutions are gradually increasing.Howeve...Formal credit is critical in agricultural production,allowing more expenditure and productive input,thereby improving farmers'welfare.In pastoral China,formal financial institutions are gradually increasing.However,a limited understanding remains of how formal credit affects herders'household expenses.Based on a survey of 544 herders from the Qinghai-Xizang Plateau of China,this study adopted the propensity score matching approach to identify the effect of formal credit on herders'total household expenses,daily expenses,and productive expenses.The results found that average age,grassland mortgage,and other variables significantly affected herders'participation in formal credit.Formal credit could significantly improve household expenses,especially productive expenses.A heterogeneity analysis showed that formal credit had a greater impact on the household total expense for those at higher levels of wealth;however,it significantly affected the productive expense of herders at lower wealth levels.Moreover,the mediating effect indicated that formal credit could affect herders'household income,thus influencing their household expenses.Finally,this study suggests that policies should improve herders'accessibility to formal credit.展开更多
To address the challenges of high-dimensional constrained optimization problems with expensive simulation models,a Surrogate-Assisted Differential Evolution using Manifold Learning-based Sampling(SADE-MLS)is proposed....To address the challenges of high-dimensional constrained optimization problems with expensive simulation models,a Surrogate-Assisted Differential Evolution using Manifold Learning-based Sampling(SADE-MLS)is proposed.In SADE-MLS,differential evolution operators are executed to generate numerous high-dimensional candidate points.To alleviate the curse of dimensionality,a Manifold Learning-based Sampling(MLS)mechanism is developed to explore the high-dimensional design space effectively.In MLS,the intrinsic dimensionality of the candidate points is determined by a maximum likelihood estimator.Then,the candidate points are mapped into a low-dimensional space using the dimensionality reduction technique,which can avoid significant information loss during dimensionality reduction.Thus,Kriging surrogates are constructed in the low-dimensional space to predict the responses of the mapped candidate points.The candidate points with high constrained expected improvement values are selected for global exploration.Moreover,the local search process assisted by radial basis function and differential evolution is performed to exploit the design space efficiently.Several numerical benchmarks are tested to compare SADE-MLS with other algorithms.Finally,SADE-MLS is successfully applied to a solid rocket motor multidisciplinary optimization problem and a re-entry vehicle aerodynamic optimization problem,with the total impulse and lift to drag ratio being increased by 32.7%and 35.5%,respec-tively.The optimization results demonstrate the practicality and effectiveness of the proposed method in real engineering practices.展开更多
文摘Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospitals through controlling unreasonable growth of medical expenses,so as to provide reference for controlling the rapid rise of medical cost in public hospitals and optimizing the cost structure.Methods Based on the changes of related indicators of medical expense control from 2012 to 2021,the overall characteristics,changes of cost structure and trends of medical expenses in general hospitals and TCM hospitals were investigated.Results and Conclusion From 2012 to 2021,the increase of medical expenses in general hospitals and traditional Chinese medicine hospitals had slowed down,the proportion of drug revenue to medical income began to decline,and the medical service income increased.However,the proportion of inspection,test and sanitary materials income has increased instead of decreasing,but the management cost has decreased.The two kinds of hospitals have achieved certain cost control results,the structure of medical cost has changed greatly,and the technical service and labor value of medical personnel have been reflected to a certain extent.However,it is still necessary to explore a more scientific and reasonable cost control mechanism to promote the further optimization of medical cost structure.
基金sponsored by National Natural Sciences Foundation Programs (Grant No.71172222) and (Grant No.71572194)the Overseas and Hong Kong and Macao Scholars Collaborative Research Program (Grant No.71428008) of the National Natural Sciences Foundation
文摘Information monopoly of bureaucrats helps them maximize discretionary budget. Public disclosure of budget can alleviate information asymmetry between government and the public and empower public supervision on government budget. With information intermediary function and reputational governance function, the media exert a budget intervention effect in the public disclosure of government budget, which further increases the effect of government budget disclosure. This paper investigates how media reports influence "three public expenses"(TPE) budget planning of central government departments by examining media reports on the disclosure of budget and final accounts and using TPE budget as a proxy variable for discretionary budget of bureaucrats. We have reached the following findings:(1) The higher the TPE budget implementation rate, the greater budget growth will be. But this correlation can be restrained by media attention;(2) Different stance of the media may exert different governance effects on TPE budget. Good news about TPE may motivate bureaucrats to restrain the positive impact of TPE budget implementation on budget growth. However, bad news about TPE will exert its budget intervention effect only when administrative governance mechanism intervenes. This study has broadened research on the media's governance effect from the perspective of government budget transparency and verified that under China's unique institutional background, the media may still play a positive role in public sector governance.
文摘The reduction of health care expenses continues to be a major challenge for the economy and society of the United States and other nations. This study focused on a major source of health care expenses, inpatient hospitals, at the community level. It was based on the assumption that fewer inpatient hospital admissions per population contribute to lower health care costs. The study demonstrated that the hospitals of Syracuse, New York have generated fewer inpatient admissions and discharges than those of other New York State metropolitan areas per population. It suggested that the application of utilization rates for inpatient hospitalization in Syracuse to some other New York State areas could result in substantial savings. Between 2016 and 2017, the hospital discharge rates in Syracuse were 1.6 - 3.1 percentage points lower than those of Albany, 2.2 - 5.0 percentage points lower than those of Rochester, 4.1 - 4.9 lower than those of New York City, 5.4 - 8.2 percentage points lower than those of Buffalo, and 17.2 - 18.3 percentage points lower than those of Utica. The study suggested that the conservative hospitalization rates in Syracuse were developed and sustained over long periods of time through the use of ambulatory surgery, reduction of admissions through hospital emergency departments, and limitation of the inpatient bed supply. This was a lengthy process that resulted in a conservative hospital admission pattern. The study demonstrated, more recently, that specific programs such as the reduction of inpatient hospital readmissions and hospital lengths of stay have supported additional reductions of hospital and related utilization in Syracuse.
文摘The“Letagonins”:a concept socially constructed to designate the“beating”women of Ivorian society,evokes those who have as their leitmotif,a self-realization through work.The purpose lies in their ability to free themselves from male domination.This concept means in one of the local Ivorian languages,notably the Gouro1:female boy.These women of Gouro ethnicity show a deep passion for the marketing of food products in Abidjan.However,behind this passion for food is their commitment to funeral expenses;a cultural activity customary lying with agnatic parentage.The transgression of custom by the latter under the prism of their social repositioning is the symbolic manifestation of the destandardization of the traditional relationship between man and woman in the organization of funerals in Gouro country,in the central West Ivorian.Understanding this relational reconfiguration has fuelled our passion as a researcher.In fact,ethnography has been mobilized as a method of observing the funeral practices of these women.In this regard,the study traces the strategies for negotiating access to the land as well as those used to negotiate access to information.
文摘For more information,please click www.echinacities.com While it's at least very annoying,and at most woefully erroneous that many Chinese people judge all foreigners to be totally minted,it's not hard to see why,when many foreigners are here living decadent lifestyles,partying on weekends(and weekdays),travelling all over the country and mincing around town with Macbooks,iPods and Ray Bans.But then there are the secret 'squirrelers',who scrimp together just enough cash to
基金This project was supported by Key projects of National Natural Science Foundation of China （No.71333005）.
文摘Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people＇s poverty caused by illness in China. This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department （MID）, including 3229 people in Hubei province and 2628 people in Guangdong province. One-way ANOVA was used to compare the total medical expense, out-of-pocket （OOP） expense and hospital stay between variables. A multiple linear regression analysis was done to identify possible risk factors of total medical expense. The results showed that the average total medical expense per capita was 5709.89 yuan, and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province, respectively. The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuan in 2013. There were no significant differences in medical expenses between different genders of hypertensive patients （P〉0.05）. People of different ages, provinces, medical insurances and medical institution levels showed significant differences in medical expenses. The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region. Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances. And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.
文摘IN the Shanghai Jewish Refugees Museum,a beautiful handbag is waiting for its owner in a display cabinet.The handbag belongs to a Jewish couple.When they sought refuge in Shanghai during World War II,they pawned the handbag to Jin Wenzhen’s grandfather in exchange for their child’s medical expenses.He lent the couple the cash equivalent of one month’s revenue from his rice shop,but then never saw them again.
文摘The super-deduction of research and development(R&D)expenses is at the core of the policy to stimulate enterprise innovation in China.This paper identifies whether firms are supported by the super-deduction policies for R&D expenses and uses the diferencein-diferences method to investigate the impact of the policies on R&D investment.The results show that changes in policy in 2013 significantly increased the R&D investment of firms engaging in key state-supported technologies.Policy changes in 2016 significantly increased the R&D investment of firms engaging in non-key-state-supported technologies.Enterprises not only invested all their tax incentives in R&D activities but also increased their investment in self-raised funds.The super-deduction policy had different impacts on different industries,firms with different boards,and firms with diferent ownership.The policy significantly affected the manufacturing and construction industries,the Small and Medium Enterprise Board,and non-state-owned enterprises.Through a mechanism analysis,we found that the policy significantly reduced the user cost of R&D and increased the net cash flow of enterprises,which could raise a firm's R&D investment.It is necessary to increase policy support,expand the scope of super-deductible expenses,and increase the super-deduction rate based on industry classification according to the sensitivity of different industries to the policy.
文摘Background:The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014,designed specifically for patients diagnosed with Tuberculosis(TB).This study aimed to examine the changes in utilization and expenses of outpatient services before and after the reform implementation,among TB patients in the three counties in China.Methods:We collected quantitative data using surveys in 2013(baseline year)and 2015(final year).We used outpatient hospital records to measure service utilization and medical expenses of TB patients.We conducted qualitative interviews with local health authorities,officers of health insurance agencies,and hospital managers(n=18).We utilized three focus group discussions with hospital staff and TB doctors and nurses.The x^2 tests and Mann-Whitney U tests were used to analyse quantitative data,and the thematic analysis using a framework approach was applied to analyse qualitative data.Results:Dantu and Yangzhong counties enacted TB-specific case-based payment method in 2014.Jurong County maintained global budget payment but raised the reimbursement rate for TB care.Compared to the baseline,the percentage of TB patients in Dantu and Yangzhong with eight or above outpatient visits increased from 7.5 to 55.1%and from 22.1 to 53.1%in the final survey,respectively.Jurong experienced the opposite trend,decreasing from 63.0 to 9.8%.In the final survey,the total outpatient expenses per patient during a full treatment course in Dantu(RMB 2939.7)and Yangzhong(RMB 2520.6)were significantly higher than those in the baseline(RMB 690.4 and RMB 1001.5,respectively),while the total outpatient expenses in Jurong decreased significantly(RMB 1976.0 in the baseline and RMB 660.8 in the final survey).Health insurance agencies in Dantu and Yangzhong did not approve the original design with outpatient and inpatient expenses packaged together,revealed by qualitative interviews.Furthermore,staff at designated hospitals misunderstood that health insurance agencies would only reimburse actual expenses.Many TB doctors complained about their reduced salary,which might be due to decreased hospital revenue generated from TB care after the payment method reform.Conclusions:The intended effect on cost containment of case-based payment was not evident in Dantu and Yangzhong.In Jurong,where the global budget payment system maintained with the reimbursement rate enhanced,we found an effect on cost containment but the quality of TB care might be compromised.The TBspecific case-based payment method could be redesigned to combine payment on outpatient and inpatient expenses and to set an appropriate payment standard for TB care during a full treatment course.Local health insurance agencies have to provide explicit explanations on the payment method.TB care providers should be provided with proper incentives.Monitoring and evluaiton on the quality of TB care should be undertaken at regular intervals.
文摘Cardiovascular diseases(CVD)and their risk factors are exerting an increasingly significant impact on public health,and the incidence rate of CVD continues to rise.This article provides an interpretation of essentials from the newly published Annual Report on Cardiovascular Health and Diseases in China(2024),aiming to offer scientific evidence for CVD prevention,treatment,and the formulation of relevant policies.
基金Sponsored by Scientific and Technological Innovation Programs of Higher Education Institutions in Shanxi(Grant No.2022L294)Taiyuan University of Science and Technology Scientific Research Initial Funding(Grant Nos.W2022018,W20242012)Foundamental Research Program of Shanxi Province(Grant No.202403021212170).
文摘In recent years,surrogate models derived from genuine data samples have proven to be efficient in addressing optimization challenges that are costly or time⁃intensive.However,the individuals in the population become indistinguishable as the curse of dimensionality increases in the objective space and the accumulation of surrogate approximated errors.Therefore,in this paper,each objective function is modeled using a radial basis function approach,and the optimal solution set of the surrogate model is located by the multi⁃objective evolutionary algorithm of strengthened dominance relation.The original objective function values of the true evaluations are converted to two indicator values,and then the surrogate models are set up for the two performance indicators.Finally,an adaptive infill sampling strategy that relies on approximate performance indicators is proposed to assist in selecting individuals for real evaluations from the potential optimal solution set.The algorithm is contrasted against several advanced surrogate⁃assisted evolutionary algorithms on two suites of test cases,and the experimental findings prove that the approach is competitive in solving expensive many⁃objective optimization problems.
文摘Osteoarthritis(OA)presents a growing health concern,with substantial societal and healthcare burdens.Current management focuses on symptom relief,lacking disease-modifying options.Emerging research suggests the sodium channel Nav1.7 as a pivotal target in OA treatment.Preclinical studies demonstrate carbamazepine's efficacy in Nav1.7 blockade,offering significant joint protection in animal models.However,human trials are needed to validate these findings.Carbamazepine's repurposing holds promise for OA management,potentially revolutionizing treatment paradigms.Further research is essential to bridge the gap between preclinical evidence and clinical application,offering hope for improved OA management and enhanced patient quality of life.
文摘We have shown that cornerstone articles considering effects of corporate debt on the firm value and constituting the basis of the trade-off theory of capital structure are wrong.Their main mistake is in ignoring the business securing expenses(BSEs).In the framework of the extended Merton model(EMM),we consider the cumulative effect of debt and corporate taxes on the firm value and its survival,in other words,we revisit Modigliani-Miller Proposition 3(MMP3).We show that(1)debt affects the firm value and its survival,(2)this effect is negative,diminishing the firm value and its chances to survive,(3)the pressure increases as the debt grows provoking the firm’s default,(4)the main factors depressing the levered firm are its debt payments added to the BSEs of the identical unlevered firm and the length of debt maturity,(5)corporate taxes cause development of positive skewness in the asset distribution,but do not affect the location of this distribution in the asset axis.The presented model helps estimate the consequences of choosing this or that level of debt in the presence of corporate taxes and can make a useful instrument for practicing financial managers.
文摘Objective:To study the application effect of the Enhanced Recovery After Surgery(ERAS)model in patients undergoing spinal fracture surgery.Methods:A randomized controlled trial was designed,and 86 patients undergoing spinal fracture surgery were randomly divided into the ERAS group and the conventional care group.Postoperative recovery outcomes of the two groups were compared.Results:The ERAS group showed better outcomes in terms of postoperative pain scores,activities of daily living,length of hospital stay,and adherence to rehabilitation training compared to the conventional care group,with shorter hospital stays and lower medical expenses(P<0.05).Conclusion:The ERAS model significantly improves the postoperative recovery quality of patients undergoing spinal fracture surgery,reduces hospital stay and medical costs,and increases patient satisfaction.
文摘Objective:To investigate the economic burden of patients with acute kidney injury(AKI)by analyzing the distribution of hospitalization expenses and its influencing factors in the Affiliated Hospital of Hebei University.Methods:The hospitalization information of patients with AKI from January 2020 to January 2023 was collected and sorted through the hospital charging system and the factors affecting the total hospitalization cost were analyzed by multiple linear regression.Results:Univariate analysis showed that age,occupation,marriage,length of hospitalization,recovery of renal function,and stage of AKI had significant effects on hospitalization cost(P<0.05).The result of the multiple linear regression analysis model showed that age(t=4.11,P<0.0001),length of hospitalization(t=16.10,P<0.0001),recovery of renal function(t=3.26,P<0.0001),AKI stage(t=5.23,P=0.002)are factors affecting the economic burden of patients with AKI.Conclusion:AKI patients should be managed according to age stratification to effectively control the progression of the disease and improve the quality of the medical services provided.This will reduce the economic burden of patients.
文摘Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.
基金funding from the National Natural Science Foundation of China (72303086)the Leading Scientist Project of Qinghai Province, China (2023-NK-147)+1 种基金the Consulting Project of Chinese Academy of Engineering (2023-XY-28,2022-XY-139)the Fundamental Research Funds for the Central Universities, China (lzujbky-2022-sp13)
文摘Formal credit is critical in agricultural production,allowing more expenditure and productive input,thereby improving farmers'welfare.In pastoral China,formal financial institutions are gradually increasing.However,a limited understanding remains of how formal credit affects herders'household expenses.Based on a survey of 544 herders from the Qinghai-Xizang Plateau of China,this study adopted the propensity score matching approach to identify the effect of formal credit on herders'total household expenses,daily expenses,and productive expenses.The results found that average age,grassland mortgage,and other variables significantly affected herders'participation in formal credit.Formal credit could significantly improve household expenses,especially productive expenses.A heterogeneity analysis showed that formal credit had a greater impact on the household total expense for those at higher levels of wealth;however,it significantly affected the productive expense of herders at lower wealth levels.Moreover,the mediating effect indicated that formal credit could affect herders'household income,thus influencing their household expenses.Finally,this study suggests that policies should improve herders'accessibility to formal credit.
基金co-supported by the National Natural Science Foundation of China(Nos.52272360,52232014,52005288,52201327)Beijing Natural Science Foundation,China(No.3222019)+1 种基金Beijing Institute of Technology Research Fund Program for Young Scholars,China(No.XSQD-202101006)BIT Research and Innovation Promoting Project(No.2022YCXZ017).
文摘To address the challenges of high-dimensional constrained optimization problems with expensive simulation models,a Surrogate-Assisted Differential Evolution using Manifold Learning-based Sampling(SADE-MLS)is proposed.In SADE-MLS,differential evolution operators are executed to generate numerous high-dimensional candidate points.To alleviate the curse of dimensionality,a Manifold Learning-based Sampling(MLS)mechanism is developed to explore the high-dimensional design space effectively.In MLS,the intrinsic dimensionality of the candidate points is determined by a maximum likelihood estimator.Then,the candidate points are mapped into a low-dimensional space using the dimensionality reduction technique,which can avoid significant information loss during dimensionality reduction.Thus,Kriging surrogates are constructed in the low-dimensional space to predict the responses of the mapped candidate points.The candidate points with high constrained expected improvement values are selected for global exploration.Moreover,the local search process assisted by radial basis function and differential evolution is performed to exploit the design space efficiently.Several numerical benchmarks are tested to compare SADE-MLS with other algorithms.Finally,SADE-MLS is successfully applied to a solid rocket motor multidisciplinary optimization problem and a re-entry vehicle aerodynamic optimization problem,with the total impulse and lift to drag ratio being increased by 32.7%and 35.5%,respec-tively.The optimization results demonstrate the practicality and effectiveness of the proposed method in real engineering practices.
