Medical Expenses Research Articles

Estimating the economic impact of complications after open tibial fracture: A secondary analysis of the pilot Gentamicin Open Tibia trial (pGO-Tibia).

To estimate the indirect economic impact of tibial fractures and their associated adverse events (AEs) in Tanzania. A secondary analysis of the pilot Gentamicin Open (pGO)-Tibia randomized control trial estimating the indirect economic impact of suffering an AE, defined as a fracture-related infection (FRI) and/or nonunion, after an open tibial fracture in Tanzania. The pGO-Tibia trial was conducted from November 2019 to August 2021 at the Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. One hundred adults with open tibial shaft fractures participated in this study. Work hours were compared between AE groups. Cost data were analyzed using a weighted-average hourly wage and converted into purchasing power parity-adjusted USD. Indirect economic impact was analyzed from the perspective of return to work (RTW), lost productivity, and other indirect economic and household costs. RTW was analyzed using a survival analysis. Half of patients returned to work at 1-year follow-up, with those experiencing an AE having a significantly lower rate of RTW. Lost productivity was nearly double for those experiencing an AE. There was a significant difference in the mean outside health care costs between groups. The total mean indirect cost was $2385 with an AE, representing 92% of mean annual income and an increase of $1195 compared with no AE. There were significantly more patients with an AE who endorsed difficulty affording household expenses postinjury and who borrowed money to pay for their medical expenses. This study identified serious economic burden after tibial fractures, with significant differences in total indirect cost between those with and without an AE. II.

Posttraumatic glaucoma in southern China: A ten-year retrospective study.

To analyze posttraumatic glaucoma regarding its demographics, presentations, different causes, surgical modalities, and hospitalization burden among patients in southern China. This retrospective study investigated all individuals with posttraumatic glaucoma admitted to the Zhongshan Ophthalmic Center of Sun Yat-Sen University from January 2012 through December 2021. Out of 2211 cases, 64.82% had closed globe injury (CGI), 28.22% had open globe injury (OGI), and 6.96% had chemical injury (CI). The mean age of all patients was 44.45 ± 19.45 years old. Males (83.36%), rural patients (56.17%), and farmers (27.14%) predominantly had posttraumatic glaucoma. The most common external injury mechanism was blunt objects (37.82%). Compared with the other two groups, the majority of surgical modalities were cataract extraction (27.12%) in the CGI group, combined anterior-posterior surgery (34.79%) in the OGI group, and cyclocryotherapy/cyclophotoagulation (49.1%) in the CI group. The CI group had higher times of hospitalization (3.542 ± 0.242) and hospitalization duration (8.373 ± 0.743 days), whereas the OGI group had more operation expense ($ 1476.729 ± 11.047) and medical consumables expense per head ($ 962.578 ± 25.801). Blunt injury, males, adults, farmers, and rural patients were high-risk factors for posttraumatic glaucoma. Chemical-induced glaucoma management requires a longer hospitalization period, while OGI requires more medical expenditure. This knowledge provides a new reference for clinicians to accurately diagnose and intervene in posttraumatic glaucoma. It also suggests that more education and long-term surveillance are needed regarding the presence of glaucoma after ocular trauma.

Pregnancy-related Factors Responsible for Delivering Low Birth Weight Babies: An Institutional-based Cross-sectional Study, Jamnagar, Gujarat.

The WHO defines LBW as "Birth weight less than 2500 grams" regardless of gestational age. Being born with a low birth weight also incurs enormous economic costs, including higher medical expenditures and social service expenses, and decreased productivity in adulthood. To study distribution of newborns' according to pregnancy related factors and its association with newborns' birth weight. An institutional based cross-sectional study. New-borns delivered at study institute were considered as study participants. Estimated final sample size was 500. Guardians (mothers) were face-to-face interviewed and also recorded data were collected from the case file and Mother and Child Protection Card. Prevalence of LBW newborns was higher in mothers with late ANC registration, <4 ANC visits, chronic medical conditions, infection during pregnancy, PIH, anemia, consuming tobacco, exposure to second hand smoke, LSCS/Assisted delivery, in female newborns', current pregnancy birth order number more than 2, in pre term newborns' and mothers with bad obstetric history. Create awareness and adoption of suitable family planning methods. Need to do early (within 12 weeks) ANC registration with minimum four ANC visits for better pregnancy outcome. Effective tracking and suitable intervention provided to improve current pregnancy outcome. Health care professional should pay special attention to high-risk pregnancy. Develop social culture in such a way that females are neither addicted nor exposed to any tobacco containing products in their life.

Impact of the COVID-19 pandemic on the demographic and disease burden of pediatric malignant solid tumors in China: a single-center, cross-sectional study.

With the development of the novel coronavirus disease 2019 (COVID-19), China implemented measures in an attempt to control the infection rate. We conducted a single-center, cross-sectional study to ascertain the impact of the COVID-19 pandemic on the equitable availability of medical resources for children diagnosed with malignant solid tumors in China. Data on the demographics, clinical characteristics, and medical expenses of 876 patients diagnosed with neuroblastoma, rhabdomyosarcoma (RMS), Wilms tumor, hepatoblastoma (HB), Ewing sarcoma (ES), and central nervous system (CNS) tumors from 2019 to 2021, during the COVID-19 pandemic, were retrospectively collected from the National Center for Children's Health. The Pearson χ2 test and Mann-Whitney test were performed to analyze the differences among variables. Except for the regional origin of children with tumors during the epidemic, no significant differences were found in the demographic or clinical characteristics of patients at initial diagnosis. The number of patients from northern China and northeastern China who attended Beijing Children's Hospital (BCH) increased after the outbreak of COVID-19 (P=0.001). There was no significant alteration observed in the frequency of hospitalizations per individual per annum (P=0.641) or the mean expense incurred per individual per hospitalization (P=0.361). In addition, the medical insurance coverage rate of real-time settlement increased year by year. After the COVID-19 outbreak, the origin of patients with solid tumor who visited BCH was concentrated in the northern region of China. COVID-19 had no impact on the other demographic factors, clinical characteristics, or economic burden of patients with pediatric malignant solid tumors.

Chemotherapy-related symptoms in children with leukemia: application of latent profile analysis and network analysis.

Children with leukemia may experience a range of chemotherapy-related symptoms. Identifying subgroups and their distinct characteristics of symptoms may improve symptom management. We aimed to identify subgroups and their distinct characteristics of chemotherapy-related symptoms in children with leukemia. A cross-sectional survey was conducted among 500 children with leukemia, who completed questionnaires that assessed their demographic and clinical characteristics, as well as the Memorial Symptom Assessment Scale. Latent profile analysis was conducted to identify subgroups of symptoms. Additionally, multiple regression analysis and network analysis were utilized to reveal the characteristics of each subgroup. Four subgroups were identified: "Profile 1: low symptom burden subgroup" (26.2%), "Profile 2: moderate symptom burden subgroup in transitional period" (14.8%), "Profile 3: moderate psychological symptom burden subgroup" (35.6%), and "Profile 4: high symptom burden subgroup" (23.4%). Multiple logistic regression analysis indicated that lower primary caregiver's education level, lower family monthly income, self-paid medical expenses, induction remission period, and consolidation enhancement period were associated with more severe symptoms of subgroups. Network analysis further revealed that nausea was the core symptom in Profiles 1 and 2, while the core symptom in Profile 3 was "I don't look like myself." Additionally, worrying was the core symptom in Profile 4. There exists heterogeneity in chemotherapy-related symptoms. Four subgroups and their corresponding characteristics of children with varying symptom severity were identified. Identifying these subgroups will facilitate personalized care, maximize intervention effectiveness, and alleviate symptom burden.

A Holistic Approach to Expressing the Burden of Caregivers for Stroke Survivors: A Systematic Review.

This systematic review explores the multifaceted challenges faced by caregivers of stroke survivors, addressing the global impact of strokes and the anticipated rise in survivors over the coming decades. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a thorough literature search identified 34 relevant studies published between 2018 and 2023. The review categorizes caregiver burden into four domains: physical health, social functioning, financial issues, and psychological health. Caregivers often experience a decline in physical health, marked by chronic fatigue, sleep disturbances, and pain. Emotional distress is prevalent, leading to anxiety and depression, especially in cases of high burden. Financial strains arise from medical expenses and employment changes, exacerbating the overall burden. Contextual factors, such as cultural norms and resource availability, influence the caregiver experience. The Newcastle-Ottawa scale assessed the methodological quality of studies. The conclusion emphasizes tailored interventions and support systems for caregivers, with practical recommendations for healthcare professionals, therapists, mental health professionals, financial counselors, and policymakers. This comprehensive review enhances the understanding of caregiver experiences and provides actionable insights to improve stroke care and rehabilitation The study's novelty lies in its holistic examination of caregiver burden in stroke care, its focus on the recent literature, and its emphasis on forecasting caregiver outcomes, contributing valuable insights for proactive intervention strategies.

RETRACTED: Ai et al. The Effects of Environmental Regulations on Medical Expenses: Evidence from China. Int. J. Environ. Res. Public Health2022, 19, 7567.

The authors and journal retract the following article: "The Effects of Environmental Regulations on Medical Expenses: Evidence from China" [...].

Drawing as a Way of Knowing: How a Mapping Model Assists Preoperative Evaluation of Patients with Thyroid Carcinoma.

Background: Effective pre-surgical planning is crucial for achieving successful outcomes in endocrine surgery: it is essential to provide patients with a personalized plan to minimize operative and postoperative risks. Methods: Preoperative lymph node (LN) mapping is a structured high-resolution ultrasonography examination performed in the presence of two endocrinologists and the operating surgeon before intervention to produce a reliable "anatomical guide". Our aim was to propose a preoperative complete model that is non-invasive, avoids overdiagnosis of thyroid microcarcinomas, and reduces medical expenses. Results: The use of 'preoperative echography mapping' has been shown to be successful, particularly in patients with suspected or confirmed neoplastic malignancy. Regarding prognosis, positive outcomes have been observed both post-surgery and in terms of recurrence rates. We collected data on parameters such as biological sex, age, BMI, and results from cytologic tests performed with needle aspiration, and examined whether these parameters predict tumor malignancy or aggressiveness, calculated using a multivariate analysis (MVA). Conclusions: A standard multidisciplinary approach for evaluating neck lymph nodes pre-operation has proven to be an improved diagnostic and preoperative tool.

New Directions, New Perspectives, and New Pathways in the Development of Subspecialties in General Medicine

Research Background: General medicine integrates content from clinical medicine, rehabilitation medicine, and social humanities. In the field of clinical medicine, its horizontal scope encompasses internal medicine, surgery, obstetrics and gynecology, pediatrics, emergency medicine, and other related disciplines. Research Objectives: The subspecialty development of general medicine aims to establish a specialized field with distinctive features based on the foundation of general medicine. It provides an explanation for the in-depth development and research in general medicine. This approach makes it easier to retain and attract outstanding talents, fully unleashing the interests of general practitioners. The development of subspecialties in general medicine aligns with the practical needs of China&amp;apos;s primary healthcare institutions. It seeks to break the deadlock of general medicine being broad but not precise, addressing issues such as reducing patient medical expenses, improving patient satisfaction, and truly solving difficulties in seeking medical care. This allows large specialized hospitals to focus on researching tumor diseases and various specialized surgical procedures, thereby enhancing the diagnosis and treatment rates of tumors and rare diseases. Research Results: With the progress and practical experiences in society, the development of subspecialties in general medicine is set to become a goal, a new direction, a new perspective, and a new pathway for the global development of primary healthcare institutions. Research Conclusions: Cultivating doctors with expertise in subspecialties of general medicine for grassroots healthcare is essential to address the spectrum of specialized diseases, truly embodying a patient-centric approach and ensuring tangible benefits for patients. Currently, the development of subspecialties in general medicine is still in the exploration stage.

Research on the Application and Effectiveness of the DRG Model on Perioperative Medical Management of Cholecystectomy

Objective: This study aimed to explore the application and effectiveness of the DRG model in the perioperative management of cholecystectomy. By comparing the DRG model with traditional management methods, this study focused on evaluating the potential impact of the DRG model in improving surgical efficiency and reducing complication rates and medical costs. Methods: The random envelope method was used to divide patients scheduled for cholecystectomy from January 2021 to October 2023 into two groups: one group underwent surgery under the DRG model (experimental group), and the other group underwent the traditional management model (control group). Data including basic information, surgery-related data, length of stay, complication records, and medical expenses were collected. Data analysis was carried out using a t-test and chi-square (χ2) test. Results: Results showed that the DRG model shortened the average length of stay, decreased the incidence of complications, reduced medical expenses, and increased patient satisfaction. These results demonstrate the effectiveness of the DRG model in the perioperative management of cholecystectomy, especially in improving surgical efficiency, reducing medical costs, and improving patient satisfaction. Conclusion: The DRG model in the perioperative management of cholecystectomy can significantly improve medical service quality and efficiency and enhance patient satisfaction as compared to traditional treatment methods.

The combination use of inclisiran and statins versus statins alone in the treatment of dyslipidemia in mainland China: a cost-effectiveness analysis.

Objective: Statin is well-established as a classical lipid-lowering drug, and its cost has reduced considerably in the past years. Inclisiran is a new and effective lipid-lowering drug given as a subcutaneous injection at 6-month intervals. This study aims to evaluate the cost-effectiveness of the combination use of inclisiran and statin versus statin alone for dyslipidemia in the mainland China population. Methods: The Markov decision-making model was used, and the clinical data and real-world data were collected at the University of Hong Kong-Shenzhen Hospital (HKU-SZH). Patients with cardiovascular disease (CVD) and blood lipid levels above the target on statin therapy were included as the target population and analyzed for cardiovascular events, future medical expenses, and the calculation made for the total life cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was conducted to evaluate the influence of parameter uncertainty on the base-case analysis results. Results: If inclisiran was priced at Chinese renminbi (RMB) 20,000.00 (USD 2,973.49) per injection, patients in the inclisiran and statin group would incur an incremental cost of RMB 449,233.56 (USD 66,789.60) compared with the statin group, and they would obtain 0.21 more QALYs in their life cycle. The subsequent ICER of RMB 2,127,756.78 (USD 316,343.32)/QALY was significantly higher than the willingness-to-pay (WTP) threshold of 3 times the per capita GDP of China, which was RMB 257,094.00 (USD 38,223.33)/QALY, suggesting that the combined use of inclisiran and statin was not cost-effective. If the price of inclisiran were reduced to RMB 2,500.00 (USD 371.69)/injection, the ICER of patients in the inclisiran and statin group would become RMB 257,790.63 (USD 38,326.91)/QALY, which is slightly lower than the WTP threshold of 3 times the per capita GDP of China, indicating that the combined use of inclisiran and statin would be cost-effective. Conclusion: If inclisiran is priced at RMB 20,000.00 (USD 2,973.49)/injection, then the combined use of inclisiran and statins is not cost-effective compared with statin alone. It will be economical only if the price of inclisiran is reduced by more than 88%.

A proactive financial navigation intervention in patients with newly diagnosed gastric and gastroesophageal junction adenocarcinoma

PurposeMany cancer patients and caregivers experience financial hardship, leading to poor outcomes. Gastric and gastroesophageal junction (GEJ) cancer patients are particularly at risk for financial hardship given the intensity of treatment. This pilot randomized study among gastric/GEJ cancer patients and caregivers tested a proactive financial navigation (FN) intervention to obtain a signal of efficacy to inform a larger, more rigorous randomized study.MethodsWe tested a 3-month proactive FN intervention among gastric/GEJ cancer patients and caregivers compared to usual care. Caregiver participation was optional. The primary endpoint was incidence of financial hardship, defined as follows: accrual of debt, income decline of ≥ 20%, or taking loans to pay for treatment. Data from participant surveys and documentation by partner organizations delivering the FN intervention was analyzed and outcomes were compared between study arms.ResultsNineteen patients and 12 caregivers consented. Primary FN resources provided included insurance navigation, budget planning, and help with out-of-pocket medical expenses. Usual care patients were more likely to experience financial hardship (50% vs 40%) and declines in quality of life (37.5% vs 0%) compared to intervention patients. Caregivers in both arms reported increased financial stress and poorer quality of life over the study period.ConclusionsProactive financial navigation has potentially positive impacts on financial hardship and quality of life for cancer patients and more large-scale randomized interventions should be conducted to rigorously explore the impact of similar interventions. Interventions that have the potential to lessen caregiver financial stress and burden need further exploration.Trial registrationTRN: NCT03986502, June 14, 2019.

ANALYSIS OF THE DEGREE OF STUDY AND GLOBAL EXPERIENCE IN OPTIMIZING URBAN NOISE POLLUTION

А collection and analysis of domestic and international publications on the impact of noise pollution on the physical and emotional well-being of mega-city residents were conducted. It was found that noise pollution directly affects the quality of life and the physical and mental health of people, leading to significant economic losses through medical expenses, deaths, and a decrease in the market value of real estate located near noise sources. Moreover, it was discovered that noise negatively influences not only the physical well-being of humans but also the behavior of urban animals and birds, compelling them to adapt their mating rituals and communication methods. While these behavioral changes help animals be more audible in noisy environments, they impact the reproductive success of certain species, potentially leading to their extinction and causing an ecological catastrophe. The study identified a global trend of lagging efforts to combat urban noise and solve problems only after their existence is acknowledged. The research explored the primary internationally recognized and widely used tools for reducing noise levels in urban environments, including methods within the field of landscape architecture: functional zoning of urban areas, construction of noise reduction screens (NRS), installation of noise-absorbing road surfaces, traffic restrictions, or speed limits, and the creation of green barriers, among others. Furthermore, the article outlined the main trends in the future development of improving sound comfort in cities, such as the establishment of "quiet zones" and the creation of unique soundscapes in contemporary mega-cities. Examples include the iconic sounds of Big Ben in London or the call to prayer from the Masjid al-Haram in Mecca, which provide emotionally rich experiences. In a broader sense, acoustic comfort should not be considered solely as the absence of noise but rather as a situation where acoustic environments offer significant opportunities for human development and careful consideration of their physical and mental well-being.

Comparison of transoral vestibular robotic thyroidectomy with traditional low-collar incision thyroidectomy.

Transoral vestibular robotic thyroidectomy can really make the patient's body surface free of scar. This study aimed to compare the surgical and patient-related outcomes between the transoral vestibular robotic thyroidectomy and traditional low-collar incision thyroidectomy. The clinical data of 120 patients underwent transoral vestibular robotic thyroidectomy (TOVRT) or traditional low-collar incision thyroidectomy (TLCIT) were collected from May 2020 to October 2021. Propensity score matching analysis was used to minimize selection bias. All these patients were diagnosed with papillary thyroid carcinoma (PTC) through ultrasound-guided fine-needle aspiration prior to surgical intervention and surgical plan was tailored for each patient. An intraoperative recurrent laryngeal nerve (RLN) detection system was used in all patients, whose RLNs were identified and protected. We performed transoral vestibular robotic thyroidectomy with three intraoral incisions. Additional right axillary fold incisions were adopted occasionally to enhance fine reverse traction of tissue for radical tumor dissection. Clinical data including gender, age, tumor size, BMI, operation time, postoperative drainage volume and time, pain score, postoperative length of stay (LOS),number of lymph nodes removed, complications, and medical expense were observed and analyzed. Propensity score matching was used for 1:1 matching between the TOVRT group and the TLCIT group. All these patients accepted total thyroidectomy(or lobectomy) plus central lymph node dissection and all suffered from PTC confirmed by postoperative pathology. No conversion to open surgery happened in TOVRT group. The operative time of TOVRT group was longer than that of TLCIT group (P < 0.05). The postoperative drainage volume of TOVRT group was more than that of TLCIT group (P < 0.05). The drainage tube placement time of TOVRT group were longer than that of TLCIT group (P < 0.05). Significant differences were also found in intraoperative bleeding volume, pain score and medical expense between the two groups (P < 0.05). The incidence of perioperative common complications such as hypoparathyroidism and vocal cord paralysis in the two groups was almost identical (P > 0.05). However, there were some specific complications such as surgical area infection (one case), skin burn (one case), oral tear (two cases), and paresthesia of the lower lip and the chin (two cases) were found in TOVRT group. Obviously, the postoperative cosmetic effect of the TOVRT group was better than TLCIT group (P < 0.05). TOVRT is safe and feasible for low to moderate-risk PTC patients and is a potential alternative for patients who require no scar on their neck. Patients accepted TOVRT can get more satisfaction and have less psychologic injury caused by surgery.

Collagen patch cover facilitates recovery of bowel function after laparoscopic colectomy

BackgroundNumerous factors can influence bowel movement recovery and anastomotic healing in colorectal surgery, and poor healing can lead to severe complications and increased medical expenses. Collagen patch cover (CPC) is a promising biomaterial that has been demonstrated to be safe in animal models and has been successfully applied in various surgical procedures in humans. This study.MethodsA retrospective review of medical records from July 2020 to June 2022 was conducted to identify consecutive patients who underwent laparoscopic colectomy. Patients who received CPC at the anastomotic site were assigned to the collagen group, whereas those who did not receive CPC were assigned to the control group.ResultsData from 241 patients (collagen group, 109; control group, 132) were analyzed. Relative to the control group, the collagen group exhibited a faster recovery of bowel function, including an earlier onset of first flatus (2.93 days vs. 3.43 days, p < 0.01), first defecation (3.73 days vs. 4.18 days, p = 0.01), and oral intake (4.30 days vs. 4.68 days, p = 0.04). CPC use was also associated with lower use of postoperative intravenous analgesics. The complication rates in the two groups did not differ significantly.ConclusionsCPCs can be safely and easily applied to the anastomotic site during laparoscopic colectomy, and can accelerate bowel movement recovery. Further studies on the effectiveness of CPCs in colorectal surgery involving larger sample sizes are required.Clinical trial registrationClinicalTrials.gov registration number: NCT05831956 (26/04/2023).

Comprehensive needs, social support, and disease perception in lung cancer patients treated with immune checkpoint inhibitors: a cross-sectional study.

The aim of this study was to investigate the comprehensive needs of lung cancer patients treated with immune checkpoint inhibitors and to explore the relationships between comprehensive needs and social support and disease perception, moreover, to analyse associated factors of comprehensive needs. The study was conducted in a teaching hospital in Jiaxing Province, China. A total of 141 patients with lung cancer completed a battery of self-report questionnaires, including the Comprehensive Needs Assessment Tool in Cancer for Patients (CNAT), Social Supportive Rating Scale (SSRS), Brief Illness Perception Questionnaire (BIPQ), and demographic and clinical characteristics questionnaire. The level of comprehensive needs was highest in the domain "medical demand" (42.17 ± 26.57), and the item with the highest level of comprehensive needs was "I need information about the financial support for my medical expenses" (2.00 ± 1.07). Statistically significant correlations were identified between the comprehensive needs score, social support, and disease perception. The multiple regression analysis showed that immunotherapy course, whether irAEs occur, social support, and disease perception were factors influencing patients' comprehensive needs. The most prevalent needs in lung cancer patients were found in the "medical needs" domain. Additionally, immunotherapy course, whether irAEs occur, disease perception, and social support were associated with comprehensive needs among lung cancer patients. It is essential to combine the associated factors to accurately evaluate patient needs. We should pay more attention to proposing the comprehensive measures for these patients and providing more individualized supportive care during the lengthy treatment period.

Health and health system effects on poverty: A narrative review of global evidence

Ill-health causes poverty. The effect runs through multiple mechanisms that span lifetimes and cross generations. Health systems can reduce poverty by improving health and weakening links from ill-health to poverty. This paper maps routes through which ill-health can cause poverty and identifies those that are potentially amenable to health policy. The review confirms that ill-health is an important contributor to poverty and it finds that the effect through health-related loss of earnings is often larger than that through medical expenses. Both effects are smaller in countries that are closer to universal health coverage and have higher social safety nets. The paper also reviews evidence from low- and middle-income countries (LMICs) and the United States (US) on the poverty-reduction effectiveness of public health insurance (PubHI) for low-income households. This reveals that PubHI does not always deliver financial protection to its targeted population in LMICs. Countries that have succeeded in achieving this goal often combine extension of coverage with supply-side interventions to build capacity and avoid perverse provider incentives in response to insurance. In the US, PubHI is effective in reducing poverty by shielding low-income households with children from healthcare costs and, consequently, generating long-run improvements in health that increase lifetime earnings. Poverty reduction is a potentially important co-benefit of health systems.

The impact of long-term care insurance pilot on the mental health of older adults: Quasi-experimental evidence from China

The Chinese government launched pilot programs for a long-term care insurance system in response to the ongoing increase in the aging population. This study uses the difference-in-differences (DID) model to analyze the impact of long-term care insurance on older adults' mental health based on China Health and Retirement Longitudinal Study (CHARLS) four-period panel data from 2011 to 2018. This study found that long-term care insurance reduced Center for Epidemiological Studies Depression Scale (CES-D) scores among older adults by 1.059 points. Moreover, there was an improvement of 0.181 and 0.870 points in mental status and scenario memory scores, respectively. The impact of the long-term care insurance pilot program on improving the mental health of older adults was more pronounced, especially for those with chronic diseases or disabilities as well as those living in rural and western regions. This study also revealed that long-term care insurance enhances mental health by reducing medical expenses and increasing daily companionship and social interaction. Therefore, a pilot study of long-term care insurance showed a significant improvement in the mental health of older adults. To provide a comprehensive care service system for older adults, the government should expand the scope of the pilot program and increase the accessibility of mental health services for older adults.

Impact of National Public-Private Mix and Medical Expense Support Program to Control Tuberculosis in South Korea: An Interrupted Time Series Analysis.

Tuberculosis (TB) remains a major threat to global public health. Various measures at the national level have been implemented to control TB, and no evidence with long-term effectiveness has yet been evaluated on TB control programs. We confirmed the long-term effectiveness of the TB control programs in reducing overall burden in South Korea using interrupted time series analysis. Our finding suggests that, along with the public-private mix, relieving the economic burden of people with TB may complement achieving the End TB Strategy. For countries currently developing strategies for TB control, results may provide important insights in effective TB control.

The clan and informal financing in China: An analysis of the trickle-down effect

This study investigates the impact of clans on a household's informal financing. Using data from the China Family Panel Studies (CFPS), we find that clans significantly promote informal financing; a series of robustness checks verify this result. We further demonstrate that clans motivate affluent households with a collectivist ethos to lend, thus aiding households facing liquidity constraints in entrepreneurship, mortgage repayments, and medical expenses. However, our findings indicate that poor households do not benefit from clans, reflecting the proverb “help the starving but not the poor.” We confirm the indispensable role of clans in informal financing through analyzing the development of formal finance and population outflows. Our results clarify the relationship between clan culture and informal financing in contemporary China.