Objectives: To evaluate the impact of external-care-seeking, explore the framework to regulate patients’ seeking doctor behavior and to promote better medical resources allocation. Methods: Obtaining data from regula...Objectives: To evaluate the impact of external-care-seeking, explore the framework to regulate patients’ seeking doctor behavior and to promote better medical resources allocation. Methods: Obtaining data from regular reports from public medical institutions in Shanghai, comparing patients who seek doctors from out-of-Shanghai residence and local patients with insurance in terms of the quantity of service, types of diseases, medical expenses, etc. Results: External-care-seeking has a large quantity, especially in hospitalization. In 2012, the number of discharged population from out-of-Shanghai accounted for 22.74% of the total discharged number, the proportion even higher than 30% in tertiary hospitals. Tertiary hospitals have a significant attraction effect, concentrating 59.42% of the outpatient and emergency visits and 71.82% of the amount of hospitalization, with corresponding cost of 75.86% and 82.56%. The top three divisions in tertiary hospitals for external-care-seeking were surgical, obstetrics and gynecology, internal medicine. Based on the interview, admitting out-of-shanghai patients is conducive to the improvement of the technical level of hospitals, and to the enhancement of the utilization efficiency of health resource. However, the local residents may have less accessibility of high quality of medical service. The average expense of external-care-seeking is higher than that of local patients happened in the same level of hospitals. Conclusions: External-care-seeking will have a more far-reaching impact on the health care system in Shanghai;some interventions might be necessary, such as rationally allocating medical resources based on the estimates of external-care-seeking and establishing a medical service supervision mechanism.展开更多
About 10 million people in China are infected with hepatitis C virus(HCV),with the seroprevalence of anti-HCV in the general population estimated at 0.6%.Delaying effective treatment of chronic hepatitis C(CHC)is asso...About 10 million people in China are infected with hepatitis C virus(HCV),with the seroprevalence of anti-HCV in the general population estimated at 0.6%.Delaying effective treatment of chronic hepatitis C(CHC)is associated with liver disease progression,cirrhosis,hepatocellular carcinoma,and liver-related mortality.The extrahepatic manifestations of CHC further add to the disease burden of patients.Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society.Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease.Traditionally,pegylatedinterferon plus ribavirin(PR)was the standard of care.However,a substantial number of patients are ineligible for PR treatment,and only 40%–75%achieved sustained virologic response.Furthermore,PR is associated with impairment of patient-reported outcomes(PROs),high rates of adverse events,and poor adherence.With the advent of direct acting antivirals(DAAs),the treatment of CHC patients has been revolutionized.DAAs have broader eligible patient populations,higher efficacy,better PRO profiles,fewer adverse events,and better adherence rates,thereby making it possible to cure a large proportion of all CHC patients.This article aims to provide a comprehensive evaluation on the value of effective,curative hepatitis C treatment from the clinical,economic,societal,and patient experience perspectives,with a focus on recent data from China,supplemented with other Asian and international experiences where China data are not available.展开更多
The relaxation of fertility policy in China makes it possible to observe and under-stand the patterns of childbearing behavior in low fertility settings.This paper takes Shanghai,a city with ultra-low fertility over t...The relaxation of fertility policy in China makes it possible to observe and under-stand the patterns of childbearing behavior in low fertility settings.This paper takes Shanghai,a city with ultra-low fertility over the long term,as an example to analyze families who have had a second child since the adjustment of China’s fertility policy.The paper reports the major results of a survey of couples with Shanghai house-hold registration(hukou)who have had a second child,and makes comparisons with other relevant survey.It seeks to answer the question"Who are the couples giving birth to second child?"The results show that most of the women who have had a second child after implementation of the Selective Two-child Policy in 2014 were born in the late 1970s and 1980s.Couples who had higher education levels and higher incomes,and in which the woman worked as a full-time housewife or worked in a less intense job with scheduling flexibility were more likely to have a second child.The ability of a couple to get help from their own parents for childcare,and the gender of the first child also affected the decision to have a second child.This study reveals that couples who have a second child tend to be those with better than average childcare resources.This suggests that formulating reasonable public poli-cies aimed at reducing the cost of childbearing and childrearing would be an effec-tive way to further release fertility potential.展开更多
文摘Objectives: To evaluate the impact of external-care-seeking, explore the framework to regulate patients’ seeking doctor behavior and to promote better medical resources allocation. Methods: Obtaining data from regular reports from public medical institutions in Shanghai, comparing patients who seek doctors from out-of-Shanghai residence and local patients with insurance in terms of the quantity of service, types of diseases, medical expenses, etc. Results: External-care-seeking has a large quantity, especially in hospitalization. In 2012, the number of discharged population from out-of-Shanghai accounted for 22.74% of the total discharged number, the proportion even higher than 30% in tertiary hospitals. Tertiary hospitals have a significant attraction effect, concentrating 59.42% of the outpatient and emergency visits and 71.82% of the amount of hospitalization, with corresponding cost of 75.86% and 82.56%. The top three divisions in tertiary hospitals for external-care-seeking were surgical, obstetrics and gynecology, internal medicine. Based on the interview, admitting out-of-shanghai patients is conducive to the improvement of the technical level of hospitals, and to the enhancement of the utilization efficiency of health resource. However, the local residents may have less accessibility of high quality of medical service. The average expense of external-care-seeking is higher than that of local patients happened in the same level of hospitals. Conclusions: External-care-seeking will have a more far-reaching impact on the health care system in Shanghai;some interventions might be necessary, such as rationally allocating medical resources based on the estimates of external-care-seeking and establishing a medical service supervision mechanism.
文摘About 10 million people in China are infected with hepatitis C virus(HCV),with the seroprevalence of anti-HCV in the general population estimated at 0.6%.Delaying effective treatment of chronic hepatitis C(CHC)is associated with liver disease progression,cirrhosis,hepatocellular carcinoma,and liver-related mortality.The extrahepatic manifestations of CHC further add to the disease burden of patients.Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society.Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease.Traditionally,pegylatedinterferon plus ribavirin(PR)was the standard of care.However,a substantial number of patients are ineligible for PR treatment,and only 40%–75%achieved sustained virologic response.Furthermore,PR is associated with impairment of patient-reported outcomes(PROs),high rates of adverse events,and poor adherence.With the advent of direct acting antivirals(DAAs),the treatment of CHC patients has been revolutionized.DAAs have broader eligible patient populations,higher efficacy,better PRO profiles,fewer adverse events,and better adherence rates,thereby making it possible to cure a large proportion of all CHC patients.This article aims to provide a comprehensive evaluation on the value of effective,curative hepatitis C treatment from the clinical,economic,societal,and patient experience perspectives,with a focus on recent data from China,supplemented with other Asian and international experiences where China data are not available.
基金supported by 2019 The National Social Sciences Fund of China(19CRK017):“Study on the new characteristics,causes,influences and trends of marriage behavior of residents in big cities of China”.
文摘The relaxation of fertility policy in China makes it possible to observe and under-stand the patterns of childbearing behavior in low fertility settings.This paper takes Shanghai,a city with ultra-low fertility over the long term,as an example to analyze families who have had a second child since the adjustment of China’s fertility policy.The paper reports the major results of a survey of couples with Shanghai house-hold registration(hukou)who have had a second child,and makes comparisons with other relevant survey.It seeks to answer the question"Who are the couples giving birth to second child?"The results show that most of the women who have had a second child after implementation of the Selective Two-child Policy in 2014 were born in the late 1970s and 1980s.Couples who had higher education levels and higher incomes,and in which the woman worked as a full-time housewife or worked in a less intense job with scheduling flexibility were more likely to have a second child.The ability of a couple to get help from their own parents for childcare,and the gender of the first child also affected the decision to have a second child.This study reveals that couples who have a second child tend to be those with better than average childcare resources.This suggests that formulating reasonable public poli-cies aimed at reducing the cost of childbearing and childrearing would be an effec-tive way to further release fertility potential.
