Health Insurance Reimbursement Research Articles

Analysis of factors influencing the awareness of inpatients regarding hospital clinical pharmacy services and willingness to pay: a multicenter survey in Hebei Province, China.

Pharmacists are increasingly adopting patient-centered roles, improving healthcare outcomes by reducing medication errors and costs. In China, recent healthcare reforms recognize and compensate for pharmacy services. However, patient awareness of these services and their willingness to pay (WTP) remain underexplored. Therefore, this study aims to examine inpatient understanding of pharmacy services, their WTP in Hebei Province, and the factors affecting it. Between July and August 2024, a questionnaire was used to survey inpatients from 22 medical institutions across 11 prefecture-level cities in Hebei Province regarding their awareness of WTP for pharmacy services. Further investigation targeted inpatients unwilling to pay. The survey results were analyzed descriptively, with frequencies and percentages (%) used for categorical data and continuous data were presented as mean ± standard deviation (X ± SD). The chi-square test was used to determine statistically significant influences, and logistic regression analysis was performed to identify significant factors affecting inpatient WTP for pharmacy services. A column-line graph was validated using receiver operating characteristic curves and calibration graph analysis. In total, 464 questionnaires were distributed, with 432 valid responses, yielding a 93.10% effective response rate. Most inpatients (89.58%) viewed hospital pharmacists as primarily responsible for dispensing medication, while only 5.79% were aware of broader pharmacy services. Despite this, 72.69% of the inpatients were willing to receive pharmacy services, and 95.38% of those who had received such services found them beneficial. Half of the inpatients (216, or 50.00%) indicated WTP for pharmacy services. Among those initially unwilling to pay (216 inpatients), 102 indicated they would consider payment if a doctor recommended clinical pharmacist guidance. Of the 318 inpatients who were WTP, 315 (99.06%) chose health insurance reimbursement as a payment method. Key factors influencing inpatient WTP included literacy level, preferred source of medication counseling, prior pharmacy service experience, understanding of pharmacy service policies, and readiness to recommend these services (P < 0.05). Most inpatients lacked knowledge and trust in clinical pharmacists, with limited awareness of the value of pharmacy services. However, they demonstrated high acceptance and WTP for these services, with nearly all inpatients preferring health insurance reimbursement. Integrating pharmacy service fees into health insurance is crucial for promoting these services.

Direct medical cost of adjuvant systemic treatment for HER2-positive breast cancer in Vietnam

Context: HER2-positive breast cancer, one of the most aggressive subtypes of breast cancer, is associated with the high cost of HER2-targeted therapies. However, its financial burden in Vietnam has not been fully investigated. Aims: To determine the direct medical costs associated with HER2-positive breast cancer treatment in Vietnam from the perspective of healthcare payers, including social health insurance providers and patients. Methods: A multicenter study was conducted in two tertiary hospitals from January to December 2022. Retrospective patient-level data of 303 HER2-positive breast cancer patients who underwent adjuvant systemic treatment for initial treatment was analyzed. A micro-costing bottom-up approach was used to estimate the direct medical cost per inpatient admission in 2022. All cost calculations are presented as USD values using an exchange rate in 2022. Results: The average cost per inpatient admission was $680.0 ± $431.7. Of these, out-of-pocket costs accounted for approximately 42%. Drug costs were the main driver of total spending (92.9%), followed by hospital beds (2.2%), laboratory tests, and diagnostic imaging (2%). The cost of HER2-targeted therapy was responsible for 82.9% of the total direct medical cost. The average cost per inpatient admission of patients receiving chemotherapy with anti-HER2 agents was seven times higher than that of patients receiving chemotherapy alone ($864.0 vs. $120.6). Factors affecting the cost per inpatient admission were age, residence (urban or rural), occupation, and health insurance reimbursement rate. Conclusions: HER-positive breast cancer treatment imposes a significant financial burden in Vietnam, particularly with regimens containing HER2-targeted therapies. The findings of our study add to the increasing literature on the cost of breast cancer treatment and can contribute to the pharmacoeconomic analysis of HER2-positive breast cancer treatment in Vietnam.

Effect of a Financial Incentive Scheme for Medication Review on Polypharmacy in Elderly Inpatients With Dementia: A Retrospective Before-and-After Study.

Polypharmacy is an important healthcare issue, especially in elderly patients with dementia. As an incentive to reduce polypharmacy, a health insurance reimbursement scheme was introduced in 2016 for medication review and the reduction of medications for inpatients in Japan. However, the effects of these incentive schemes were not evaluated. We identified 1,465,881 inpatients aged ≥65 years with dementia. An interrupted time-series analysis was conducted by fitting a Prais-Winsten linear regression model. The outcome measure was the number of classes of medications prescribed during discharge. No significant changes were observed in the average number of medication classes at discharge immediately after the introduction of the scheme (coefficient: -0.022, 95% confidence interval [CI]: -0.17 to 0.13). The slope change, representing the effect of the intervention over time, was also not significant (coefficient: -0.00053, 95% confidence interval: -0.0012 to 0.00018). The incentive scheme was not associated with a reduction in the number of medication classes at discharge among older inpatients with dementia.

Health Insurance Payment for Telehealth Services: Scoping Review and Narrative Synthesis.

As telehealth services have demonstrated significant advantages in providing qualified and accessible care, health insurance payments for telehealth services have been issued by various countries. However, the optimization of health insurance payments for telehealth services remains uncertain. We conducted a scoping review of the current situation regarding health insurance payments for telehealth services, with the aim of providing evidence to enhance policies related to health insurance payments for such services. This scoping review was conducted by comprehensively retrieving data from 6 electronic bibliographic databases from inception to October 2023. The databases included China National Knowledge Infrastructure, Wan Fang, Weipu, Web of Science, PubMed, and Embase, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Two authors independently assessed search results, extracted data, and evaluated the quality of the included studies using the Critical Appraisal Skills Programme checklist. After the initial screening of titles and abstracts, full texts were obtained and examined. The data regarding the first author, date of publication, country, type of telehealth services introduced in health insurance, health insurance reimbursement providers, reimbursement standards for telehealth (eg, the condition for the reimbursement and reimbursement rate), and key findings of studies were extracted and analyzed. Moreover, we also conducted a narrative synthesis to summarize and report the findings. A total of 7232 papers were retrieved. Following quality assessment, 23 papers were finally included, with the covered countries including China, the United States, Australia, France, Japan, the United Kingdom, and Germany. The forms of the services vary across different regions, mainly including consultation services, medical monitoring services, mental health services, health education services, and other services. Payment standards are generally categorized into fee-for-service and global budget payment, with clear health insurance payment quotas or proportions and certain restrictions (eg, specifying the location of medical visits and setting the limitation on distance from home to hospitals). The paying entities for health insurance payment include national health insurance and commercial health insurance. In addition, there are 2 kinds of reimbursement rates-a comparable rate for both telehealth and in-person health care services, and a lower rate for telehealth services compared to in-person health care services. To enhance the accessibility of telehealth services through health insurance payment, it is crucial to further refine the design of health insurance payment for telehealth and strengthen the supervision of services quality, bridging the gap between telehealth and in-person health care services. Additionally, this review did not include studies from all countries, and we recommend that future reviews should include a broader range of countries to provide a more comprehensive view of global telehealth insurance systems.

Factors Associated With Medical Expenses Among Long-Term Care Insurance Recipients Aged 65 Years or Older in Korea.

This study examined the factors associated with medical expenses among LTCI (long-term care insurance) recipients in Korea. Secondary data analysis was performed using the 2019 Korea National Health Insurance (KNHI) reimbursement data of I metropolitan city. Data from 52 434 older adults who were LTCI recipients and living in I metropolitan city areas were included. Based on the Andersen healthcare utilization model, the variables included the predisposing (age, sex, and living alone), enabling (health insurance and place of residence), and need factors (disability, LTC grade, use of LTCI services, and participation in health screening). All the predisposing, enabling, and need factors were significant. Older age, higher LTC grade, use of visiting nursing service, admission to an aged care facility, and participation in health screenings were negatively associated with medical expenses. Females, those living alone, non-disabled individuals, medical aid beneficiaries, and rural residents were less likely to incur medical expenses. Appropriate use of LTCI services (e.g., visiting nursing) will help reduce unnecessary medical expenses. Nevertheless, access to health care services for older adults living alone in rural areas must be improved.

Tele-Assisted Home-Based Palliative Care Reduces Health Care Costs for Terminal Cancer Patients: Real-World Evidence From a Regional Hospital in Taiwan.

Background: Tele-assisted home-based palliative care (THPC) usually fulfills the desire of terminal patients to pass away at home. The overall costs of such a service deserve evaluation. Objectives: This study aims to determine health care utilization and costs for cancer patients at the end of life, stratified by THPC service. Design: Patients who received THPC were matched 1:1 based on age, gender, year of death, and propensity score with those who did not receive THPC. Setting/Subjects: A total of 773 cancer patients passed away in a regional hospital in Taiwan during the period of 2012-2020, of which 293 received THPC. Measurements: We measured the rates and costs of outpatient clinic visits, emergency department (ED) visits, hospitalizations, and intensive care unit (ICU) admissions during the last week, the last two weeks and the last month before death. In addition, we estimated the driving times and expenses required for transportation from each cancer patient's home to the hospital using Google Maps. National Health Insurance (NHI) reimbursements and out-of-pocket expenses were also calculated. Results: In comparison with patients without THPC, those who received THPC had a 50% lower likelihood of visiting the ED or being hospitalized, a more than 90% reduced chance of ICU admission, but were four times more likely to obtain their medicines from outpatient clinics. THPC patients had similar out-of-pocket expenditures, approximately half of the NHI costs, and lower rates and costs for ambulance transportation to the ED. Conclusions: THPC reduced health care costs for terminal cancer patients in the last week, the last two weeks, and the last month before death, while also increasing the likelihood of patients being able to rest and pass away at home.

Does outpatient mutual-aid reduce oncology patients' utilization of inpatient services?-An empirical study of outpatient mutual-aid policy in Wuhan, China.

The escalating costs of healthcare had prompted countries to undertake reforms, and in recent years China had focused on overhauling its outpatient healthcare system. China implemented the outpatient mutual-aid policy which had led to a change in the costs associated with outpatient treatment from being fully self-paid by the patient to being partially self-paid. This study aimed to assess the impact of the outpatient mutual-aid policy on inpatient services for oncology patients in Wuhan, China, exploring the impact that the cumbersome administration of health insurance would have on patient welfare. 24,260 oncology patients of the health insurance reimbursement database in Wuhan spanning from January 2022 to July 2023 were included. After data processing, 12,985 patients were included in the control group and 11,275 patients were included in the experimental group. The regression discontinuity design was employed to assess the impact of the policy. The findings was that the implementation of the outpatient mutual-aid would result in a reduction of 1.2days in the length of stay for oncology patients, a decrease in hospital costs by 5%, and a decline in expenditure of the health insurance reimbursement funds by 5 per cent. Incorporating outpatient costs into reimbursement supplanted the utilization of inpatient services, enhanced the allocation of healthcare resources, and alleviated the financial burden on oncology patients. Furthermore, it highlighted the detrimental impact of eligibility review to verify that a patient meets the reimbursement requirements of the health insurance policy on patient welfare.

Real-world experience with CDK4/6 inhibitors in hormone receptor-positive metastatic and recurrent breast cancer: findings from an Asian population

PurposeCyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy have demonstrated significant clinical benefits in progression-free and overall survival. This study investigates the outcomes associated with two kinds of CDK4/6i in patients with hormone receptor (HR)-positive metastatic and relapsed breast cancer to inform real-world evidence of treatment strategies.MethodsThis retrospective study included 340 Taiwanese patients with HR-positive advanced breast cancer from the Taipei Veterans General Hospital, between 2018 and 2023. We analyzed patient characteristics, treatment strategies and outcomes associated with two CDK4/6i. The efficacy of patients who experienced economic burden and interrupted CDK4/6i treatment after 2 years of National Health Insurance (NHI) reimbursement was also investigated.ResultsPatients receiving ribociclib and palbociclib showed no significant differences in age, histology, body mass index(BMI), or pathologic status. The distribution of disease status and endocrine therapy partners was comparable between the two groups. Dose reduction was similar, while patients with palbociclib tended to discontinue CDK4/6i usage, and those with ribociclib tended to switch to the other CDK4/6i or endocrine partners. There was no significant difference in progression-free survival (PFS) between the two CDK4/6i in the first-line setting. Adverse prognostic factors were increasing HER2 IHC score, higher Ki-67 levels, visceral and liver metastasis, prior chemotherapy, and endocrine therapy resistance, while higher BMI, bone-only metastasis, and letrozole treatment were associated with a lower risk of progression. The limited follow-up time in our study was insufficient to assess the outcomes of patients treated with interrupted CDK4/6i for up to two years under the NHI reimbursement policy.ConclusionTreatment outcomes between the two types of CDK4/6i did not differ significantly, indicating the safety and efficacy of CDK4/6i for the Asian population. Ribociclib and palbociclib showed similar efficacy in PFS in the real-world setting.

Impact of Continuous Positive Airway Pressure Termination on Permanent Work Disability in Obstructive Sleep Apnea: A French Nationwide ALASKA Database Analysis.

Rationale: Three-year continuous positive airway pressure (CPAP) therapy termination rates are up to 50%, and therapy termination is associated with higher all-cause mortality and incident cardiovascular event risk. Objectives: This study investigated the impact of CPAP therapy termination in the first year on long sick leave leading to permanent work disability in patients with obstructive sleep apnea based on data from the Nationwide Claims Data Lake for Sleep Apnoea (ALASKA). Methods: French national health insurance reimbursement system data were analyzed for all adults with OSA aged ≤62 years who started CPAP therapy in France in 2015 and 2016. CPAP therapy termination was defined as the cessation of CPAP reimbursements triggered by the respiratory physician or sleep specialist in charge of follow-up. Individuals who terminated therapy were compared with those who continued to use CPAP. The primary outcome was sick leave ultimately leading to permanent work disability. A multivariable Fine and Gray model, adjusted for age, sex, cardiovascular and metabolic comorbidities, depression, and CPAP prescriber clinical specialty was used to assess the risk of long-term sick leave leading to permanent work disability over 3 years' follow-up. Results: The analysis included 174,270 individuals (median age, 52.0 yr [interquartile range, 44.0-57.0 yr]; 67.5% male). The 1-year CPAP therapy termination rate was 22.3%. The proportion of individuals with long-term sick leave leading to permanent work disability was significantly higher in the CPAP termination versus continuation group (0.60% vs. 0.52%; P = 0.042). In an adjusted multivariable Cox model, CPAP termination was associated with an increased risk of permanent work disability (hazard ratio, 1.21; 95% confidence interval [CI], 1.04-1.41; P = 0.01), primarily in the subgroup aged >55 years (hazard ratio, 1.41; 95% CI, 1.06-1.87; P = 0.02). Conclusions: These real-world data from a comprehensive, unbiased database highlight the potential occupational impact of CPAP therapy termination.

307 Compatibility of Radiotherapy Product Cost with National Health Insurance Reimbursement in Indonesia

307 Compatibility of Radiotherapy Product Cost with National Health Insurance Reimbursement in Indonesia

TB notifications among citizens and non-citizens in Taiwan.

<sec><title>BACKGROUND</title>Substantial under-notification of TB among non-citizens has been noted previously. Foreign workers with TB who were deported previously could stay for anti-TB treatment since 2014. We assessed whether TB notification improved.</sec><sec><title>METHODS</title>We used the National Health Insurance (NHI) reimbursement database to identify potential TB cases that required notification. We matched potential TB cases with the national TB registry to determine whether they had been notified. Cases notified within 7 days of the initiation of anti-TB treatment were classified as having timely notification.</sec><sec><title>RESULTS</title>Of 53,208 potential TB cases identified in 2016-2020, 96.6% had been notified. The notification proportion increased from 95.5% in 2016 to 97.1% in 2020 among citizens and from 89.0% in 2016 to 96.9% in 2020 among non-citizens. Factors significantly associated with non-notification among non-citizens were previously notified TB (aOR 35.5, 95% CI 17.7-70.9), without health insurance (aOR 15.4, 95% CI 9.3-25.2) and having only one visit to health care facilities in 6 months (aOR 2.3, 95% CI 1.4-3.8). The proportion of TB cases notified within 7 days was 87% overall, 86.2% among citizens, and 96.5% among non-citizens.</sec><sec><title>CONCLUSION</title>TB notification has improved, especially among non-citizens, following a policy change that allows foreign workers to stay for anti-TB treatment.</sec>.

Survival outcomes of radium-223 therapy for metastatic castration-resistant prostate cancer following national health insurance reimbursement in Taiwan.

Radium-223 dichloride (Ra-223) prolongs overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) with symptomatic bone metastases. However, there is considerable variation in outcomes among individuals. We aimed to evaluate the prognostic determinants associated with patient survival following National Health Insurance (NHI) reimbursement for Ra-223 therapy in Taiwan. Patients with mCRPC who underwent Ra-223 treatment at Taipei Veterans General Hospital were retrospectively enrolled. Each intravenous Ra-223 dose was administered at 55 kBq/kg at 4-week intervals. Clinical outcomes were obtained from medical records; potential prognostic factors for survival were assessed. Kaplan-Meier analysis was used to generate cumulative survival curves; between-group differences were evaluated using the Chi-squared test. Statistical significance was set at p < 0.05. Seventy-six patients underwent Ra-223 therapy; 62 patients received NHI reimbursement and the remainder self-paid. Fifty patients (65.8%) completed six cycles of treatment; 26 (34.2%) received 1 to 5 cycles. Mortality occurred in 47 patients. Factors significantly associated with survival included ≤five bone metastases ( p = 0.0018), baseline prostate-specific antigen (PSA) ≤36 ng/mL ( p = 0.0004), baseline alkaline phosphate (ALP) <115 U/L ( p = 0.0007), and baseline hemoglobin (Hb) >12 g/dL ( p = 0.0029). Patients who completed six cycles of treatment achieved significantly higher OS compared to those who did not ( p < 0.0001). There has been a 4.4-fold increase in the number of patients since reimbursement began; there was no significant difference in OS between patients who received NHI reimbursement and those who self-paid. Administration of Ra-223 demonstrates considerable potential to extend the survival of patients with mCRPC. Survival outcomes may be influenced by various prognostic factors. However, no significant difference in OS was observed subsequent to reimbursement of Ra-223 therapy for mCRPC through the NHI system in Taiwan.

A pathway study of factors influencing quality of fertility life

BackgroudTo investigate the factors influencing fertility quality of life in infertile men, constructing a structural equation model of the factors influencing fertility quality of life in infertile men, and to provide suggested measures for improving fertility quality of life in infertile men.MethodsIt is a Observational study. Infertile men (n = 250) attending a fertility centre in a hospital in Xinjiang, matched 1:2 men with no obvious male factor in the control group (n = 500).The Quality of Fertility Life Scale, the Social Support Scale, the Fertility Stress Scale and the Positive Attention Awareness Scale were used to conduct the survey. The model was constructed by applying the maximum likelihood estimation method in Mplus 8.3 software, to explore the factors influencing the quality of reproductive life of infertile men through path analyses. Differences between the case and control groups were statistically significant (P < 0.05) in terms of total fertility quality of life scores, core entry dimensions, affective responses, physical and mental relationships, selective treatment dimensions, and treatment tolerance.ResultsPast medical history, history of exposure to hazardous environments, health insurance reimbursement, social support, fertility stress, and mindfulness are important factors affecting the quality of fertility life of infertile men.ConclusionThe quality of fertility life of infertile men is not optimistic. By improving the level of mindfulness, fertility stress, and social support, we propose appropriate measures to improve the quality of fertility life of infertile men. These measures can improve their confidence in clinical diagnosis and infertility treatment, enabling them to cope positively with these challenges.

Cardiothoracic surgery training in Africa: History and developments

ObjectiveCardiovascular disease is the leading cause of death globally, responsible for 17.5 million deaths each year, 80% of which occur in low- and middle-income countries, including countries in Africa. Cardiothoracic surgery, with its heavy financial outlay, is unavailable in many African countries. Many African healthcare givers are under the erroneous impression that the cardiovascular surgical landscape of Africa is blank. This review aims at describing the cardiothoracic surgery practice in Africa, the different training programs in the region, and its future prospects. MethodThrough a literature review, the authors elaborate on key points, such as healthcare and cardiothoracic surgery in Africa, African cardiothoracic practice and training, and the future of cardiothoracic surgery in Africa. ResultsAfrican countries with established cardiothoracic surgery capacity and training programs still face several challenges across multiple levels, including a persistent low enrollment rate in residency programs, insufficient local expertise, a lack of financial resources, an inadequate health infrastructure, and a skewed health insurance reimbursement system. Thus, there is still a growing burden of surgically correctable cardiovascular disease in these countries. ConclusionsCardiothoracic surgery in Africa has faced great challenges due to resource constraints, but it has demonstrated resilience and growth through diverse models and initiatives. The burden of cardiovascular diseases in Africa remains high, yet the capacity to provide cardiothoracic surgery is limited. With investment, support, and the implementation of comprehensive healthcare policies, cardiothoracic surgery practice can improve in this region and this can make a significant impact on the health and well-being of its population.

Setting a dutch integrative medicine research agenda: Results of a consensus-based strategy

IntroductionThe WHO Traditional Medicine Strategy 2014–2023 emphasises the significance of traditional medicine systems for preventing and treating diseases, worldwide. As a result, many countries have developed national research programmes and research institutes dealing with traditional, complementary and integrative medicine (TCIM) (WHO Global Report on Traditional and Complementary Medicine, Geneva, 2019) or integrative medicine (IM). Despite considerable public interest in IM in the Netherlands, no Dutch programme or research institute has been established, yet. In 2018, a consortium for integrative care and health was founded, and developed a national research agenda with research priorities for the Netherlands. MethodsThe consensus-based strategy for developing the research agenda involved: (1) conducting a literature review, (2) organising an online consensus meeting with a select group of integrative medicine (IM) experts, (3) conducting a survey among IM stakeholders, and (4) organising a second consensus meeting with the same group of IM experts to discuss the survey results and further refine the research agenda. Snowball sampling was used to recruit IM stakeholders, starting from a list of those interested in or connected to IM. ResultsNinety-two stakeholders completed the survey. The most promising research areas were oncology, pain management and palliative care. Respondents awarded the highest priority to research on the effectiveness, cost-effectiveness and safety of IM interventions. Directions for research included mind–body interventions, biological interventions and whole medical systems. Moreover, respondents strongly recommended developing reliable patient information tools. Facilitators for IM implementation were increasing attention on prevention, the rising incidence of chronic diseases and the shift from disease-focused to health-focused approaches. The identified barriers included a lack of knowledge about IM, the absence of health insurance reimbursement for complementary medicine, and governance structures of healthcare organisations. ConclusionsThe first Dutch IM research agenda was developed based on consensus among Dutch healthcare professionals, along with input from a smaller group of patients and researchers. This agenda provides clear research directions and distinguishes both positive developments and barriers for IM in the Netherlands.

Selection of proxy indicators estimating the appropriateness of antibiotic prescriptions in general practice: a national consensus procedure in France.

GPs are responsible for more than 70% of outpatient antibiotic prescriptions in France. Metrics are important antibiotic stewardship tools that can be used to set targets for improvement and to give feedback to professionals and stakeholders. The primary objective of the present study was to select a set of proxy indicators (PIs) based on 10 previously developed PIs, to estimate the appropriateness of antibiotic prescriptions by GPs. The secondary objective was to evaluate the clinimetric properties of the selected PIs. A RAND-modified Delphi consensus procedure was conducted with a multidisciplinary panel of stakeholders. This procedure consisted of two successive online surveys with a consensus meeting in between. Clinimetric properties (measurability, applicability and potential room for improvement) were evaluated for the PIs selected through the consensus procedure, using 2022 Regional Health Insurance data. Seventeen experts participated in the first-round survey and 14 in the second-round. A final set of 12 PIs was selected. Among the 10 initial PIs, 3 were selected without modification and 7 were modified and selected. Moreover, two newly suggested PIs were selected. Ten of the 12 PIs presented good clinimetric properties. The 12 selected PIs cover the main situations responsible for inappropriate and unnecessary use of antibiotics in general practice. These PIs, easily calculable using routinely collected health insurance reimbursement data, might be used to give feedback to prescribers and stakeholders and help improve antibiotic prescriptions in primary care.

Analysis of Policy and Social Issues in China's Healthcare Sector

The significance of government policies on healthcare has been amplified due to the swift progress observed in China's healthcare industry. The primary objective of this study was to conduct an in-depth examination of the societal implications of China's healthcare policies, with particular emphasis on the social dimensions of the healthcare insurance system, the essential medications system, and the regulation of drug pricing. Through a comprehensive analysis of these challenges, the objective is to establish a foundational framework for future enhancements in policy. The focus of this study centres around the policies of China's pharmaceutical business. Various research methodologies are employed, such as literature review, policy analysis, example analysis, and quantitative data assessment. The examination of policies in a thorough manner indicates that the execution of the government's pharmaceutical policies, particularly in relation to the health insurance system, critical drug system, and drug price control, has the potential to give rise to a range of societal issues. The issues encompassed in this context comprise, though are not restricted to, the problematic aspects of health insurance reimbursement, shortages of pharmaceutical drugs, and the inequitable allocation of medical resources. In order to tackle these issues, policymakers have proposed a set of recommendations aimed at enhancing the efficiency of the health insurance system, bolstering the management of the drug supply chain, optimising the allocation of medical resources, fostering drug innovation and research and development, and reinforcing the governance and utilisation of health insurance funds.

Using a Systems Engineering Approach to Build a PCR Testing System at a Medical School During the COVID-19 Pandemic.

During the COVID-19 pandemic, there was an increasing need to expand diagnostic testing in hospitals. At Keio University Hospital (KUH), clinical staff were concerned that the demand for PCR testing might exceed the capacity of the Clinical Laboratory. In response, basic researchers at Keio University School of Medicine (KUSM) set out to build a new, collaborative, PCR testing system. To be authorized to perform such diagnostic PCR testing, KUSM registered its core laboratory as an external clinical laboratory (ECL). In the pandemic, there was a pressure to build the PCR system quickly. Speed required discussions that developed a shared understanding of the unprecedented, new KUH/KUSM PCR system. To design, construct, and archive the new PCR testing system, we used a systems engineering (SE) approach. This included diagram visualization of functional flows and application of the Unified Architecture Framework (UAF), both of which are often used in system building. We considered daily demand for PCR testing at KUH and KUSM, and daily COVID-19 infections in Japan. We operated the collaborative PCR testing system from August 2020 to June 2022. Given public health insurance reimbursement policies, KUH focused on individuals with suspicious symptoms, while the ECL at KUSM screened samples from asymptomatic individuals. KUSM performed about half as many tests as KUH. Interviewing KUH staff revealed that diagrams helped promote a better understanding of the KUH/KUSM PCR testing system. When designing temporary systems that may be repurposed in the future, we suggest using an SE approach with diagrams and UAF perspectives. This approach will enable stakeholders to understand what is being proposed to be built, and facilitate achieving an informed consensus on the proposed system. We suggest that SE approaches should be widely used in projects that involve building and operating complex, collaborative systems, and documenting the process.

Late delivery of antibiotics: a new proxy for antimicrobial stewardship?

ObjectivesTo analyse the time elapsed between the prescription of antibiotics and their pick-up at the pharmacy and identify their determinants. MethodsWe used the National Health Insurance reimbursement databases on antibiotics delivery in 2021 in La Manche, Western France. Delayed delivery was defined as the time between prescription and antibiotic pick-up of >24 hours. ResultsWe enrolled 207 250 prescriptions, of whom 18 728 (9.0%) collected their antibiotics at the community pharmacy >24 hours after prescription. Independent factors associated with delayed delivery were age >15 years (15-64 years: OR, 2.08 [1.98–2.19]; p < 0.001 and >65 years OR, 3.27 [3.09–3.46]; p < 0.001), male sex (OR, 00.77 [0.75–0.80]; p < 0.001), low income (OR, 1.08 [1.02–1.15]; p = 0.013), chronic diseases (OR, 1.29 [1.25–1.34]; p < 0.001), prescription during the weekend (OR, 1.49 [1.43–1.56]; p < 0.001), summer season (OR, 1.11 [1.07–1.16]; p < 0.001), lock-down period (OR, 4.15 [3.80–4.53]; p < 0.001), and distance from the patient home to his general practitioner office and the pharmacy >10 km (OR, 1.17 [1.13–1.21]; p < 0.001). DiscussionThe delayed delivery of antibiotics after prescription is not uncommon, especially in elderly patients, those with low income or chronic diseases, in case of weekend prescriptions, summer season and when the pharmacy is > 10 km away from the patient's home and his general practitioner office. If confirmed, this potential indicator of unnecessary prescriptions, readily available in some databases, may be used to target antimicrobial stewardship programmes and monitor the effect of interventions.

Health insurance's contribution to reducing the financial burden of tuberculosis in Guizhou Province, China.

Despite global efforts to end tuberculosis (TB), the goal of preventing catastrophic health expenditure (CHE) due to TB remains unmet. This cross-sectional study was conducted in Guizhou Province, Southwest China. Data were collected from the Hospital Information System and a survey of TB patients who had completed standardized antituberculosis treatment between January and March 2021. Among the 2283 participants, the average total expenditure and out-of-pocket expenditure were $1506.6 (median=$760.5) and $683.6 (median=$437.8), respectively. Health insurance reimbursement reduced CHE by 16.8%, with a contribution rate of 24.9%, and the concentration index changed from -0.070 prereimbursement to -0.099 postreimbursement. However, the contribution of health insurance varied significantly across different economic strata, with contribution rates of 6.4% for the lowest economic group and 53.1% for the highest group. For patients from lower socioeconomic strata, health insurance contributed 10.7% to CHE in the prediagnostic phase and 23.5% during treatment. While social health insurance alleviated the financial burden for TB patients, it did not provide sufficient protection for those in lower economic strata or during the prediagnostic stage. This study underscores the need for more effective and equitable subsidy policies for TB patients .