Universal Medical Insurance Research Articles

Practice Barriers for Nurse Practitioners in Rural Hospitals

Nurse practitioners (NPs) are regarded as part of the primary healthcare professional team in rural hospitals, which often faced difficulties in hiring doctors. Only a few studies have been conducted that assess the barriers to practice for NPs in rural hospitals in Taiwan. This study was designed to explore the barriers of practice for NPs working in rural hospitals. A qualitative research approach was used in this study, and participants were recruited using purposive sampling. Data on barriers to clinical practice were collected using face-to-face, in-depth interviews. A total of 10 NPs participated in this study. The three barriers identified were patient safety concerns, the impact of limited medical resources and the demands and heavy workload on NPs, and the difficulties of balancing the interests of profit-oriented hospitals and patients' personal medical insurance rights. To reduce barriers to practice, NPs require additional training from the government to strengthen their clinical knowledge and skills. In addition, when facing insufficient support from the Department of Health, these NPs may leverage online hospital marketing and crowdfunding platforms to obtain necessary software/hardware resources for their rural hospitals. If universal health insurance and personal medical insurance are misused within a hospital, NPs should have the moral courage to speak up and should be provided with adequate protection under rules and regulations that allow them to report cheating, illegal behaviors, and other activities that waste / misdirect healthcare resources.

Cost-effectiveness analysis of tislelizumab, nivolumab and docetaxel as second- and third-line for advanced or metastatic non-small cell lung cancer in China

Objective: Domestic PD-1inhibitor tislelizumab has emerged as a promising treatment for Chinese patients with driver-negative advanced or metastatic non-small cell lung cancer (NSCLC). The purpose of our study to evaluate whether tislelizumab is cost-effective as a second- or third-line treatment for this population compared with docetaxel (conventional chemotherapy) and nivolumab (imported PD-1inhibitor), from the perspective of the Chinese healthcare system. Material and Methods: A Markov model with a 3-week Markov cycle and a 30-year time horizon was built to compare the cost-effectiveness of second- or third-line tislelizumab versus docetaxel and nivolumab. Transition probabilities, including disease progression, survival, and adverse events (AEs)-related treatment discontinuation event, were estimated from the clinical trials. Costs and health utilities were collected from local hospitals, public database and published literature. Results: Compared with docetaxel, tislelizumab provided an additional 0.33 quality-adjusted life-years (QALYs) (1.37 vs. 1.04 QALYs) at an incremental cost of $9,286 ($23,646 vs. $14,360) for Chinese patients with driver-negative advanced or metastatic NSCLC, resulting in an incremental cost-effectiveness ratio (ICER) of $27,959/QALY under the WTP threshold of $35,663/QALY used in the model. Compared with nivolumab, tislelizumab was associated with a lower cost ($23,646 vs. $59,447) and higher QALYs (1.37 vs. 1.20 QALYs), resulting in its dominance of nivolumab. Conclusion: From the perspective of the Chinese healthcare system, domestic PD-1inhibitor tislelizumab immunotherapy represents a cost-effective treatment strategy compared with conventional docetaxel chemotherapy and imported PD-1inhibitor nivolumab immunotherapy in the treatment of driver-negative advanced or metastatic NSCLC beyond the first-line setting. In the era of “Universal Medical Insurance System”, the rational use of domestic anticancer drugs guided by cost-benefit evidence would be an effective means to balance the limited expenditure of medical insurance fund and the growing demand for cancer treatments.

An Introduction to The Impact of Universal Medicare on the Previously Insured Poor and Nonpoor, a Study on the Impact of Medicare in Nova Scotia by Murray G. Brown and Vernon A. Hicks

This research note directs the attention of policy scholars to a unique and important research study on Canadian Medicare that is not generally known. Conducted by Murray G. Brown and Vernon A. Hicks, the study examined the impact of Medicare on the demand for services in Nova Scotia before and after the introduction of universal medical care insurance. Titled The Impact of Universal Medicare on the Previously Insured Poor and Nonpoor, this research was written up into a report delivered to the US government but was, unfortunately, never disseminated—nor did it become known in Canada. By summarizing the history and context of the study, the approach and methods used by Brown and Hicks, and the study’s policy significance, this research note also acts as an introduction to the study.

Integration of military medical services and civilian health careas a key condition for the provision of medical care to military personneland the population in the event of a large-scale military conflict.

The escalation of the military conflict in Ukraine threatens with a shortage of resources for the military medical service. The solution may be the integration of civil and military medicine - it is provided for by the military medical doctrine of NATO, but does not have a systematic implementation in the Russian Federation, which even in peacetime limits the availability of medical care to military personnel, and in the event of an escalation of the conflict in Ukraine threatens to overload the military medical service . Attempts to integrate civilian and military medical infrastructure were unsuccessful due to the lack of a systematic approach to their interaction and the inability of the departments concerned to reach an agreement on the mechanisms and sources of funding.The authors propose to return to the principles of organizational integration between military and civilian medicine, which were first proposed in the ХIX century by N.I. Pirogov, successfully used by the health care of the USSR during the civil and second world wars and forgotten after the collapse of the Soviet Union. For financial and economic integration, it is proposed to include military personnel in the CHI system for medical care that military medical institutions cannot provide due to their overload, remoteness or lack of necessary specialists.It is proposed to solve the problem of paying compulsory medical insurance contributions for military personnel by replacing the compulsory medical insurance contributions paid by employers (for employees) and the subjects of the Federation (for the non-working population) with a universal compulsory medical insurance contribution automatically withheld at the same rate for all legal entities and individuals from all non-cash transactions - thereby financing additional medical guarantees for military personnel, leveling the “free rider effect” in the CHI system.

Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance

BackgroundAfter achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI).MethodsWe employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity.ResultsFrom 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results.ConclusionsIn the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.

Health care reform and stroke prognosis in low-income Chinese populations from 1992 to 2018.

BackgroundTo assess the impact of the health care reform on stroke prognoses among low-income Chinese residents.MethodsStroke events and all-cause deaths were registered during 1992-2018 in Tianjin, China. Trends in stroke management and prognoses were compared during the study periods1992-2008 and 2009-2018.ResultsA total of 1462 patients were diagnosed with first-ever stroke during the study periods. For patients aged ≥45 years, the rates of neuroimaging-based diagnoses and hospitalization were greater in 2009-2018 than in 1992-2008, regardless of patient sex or stroke type. Overall, the one-year case fatality rate was significantly lower in 2009-2018 than in the earlier period; the case fatality rate for women aged ≥65 years decreased by 30.0%. Between both periods, the stroke recurrence rate increased 1.9-fold, including a 2.5-fold increase in men (all P < 0.05). During the 2009-2018 period, the one-year case fatality rate was higher among elderly male patients not using medical insurance than among those using it (32.8% vs 20.7%; P = 0.050). After 2009, a significant decline in the recurrence rate (P = 0.001) and a significant increase in the hospitalization rate (P = 0.004) were observed in the interrupted time-series analysis.ConclusionsThese findings suggest that the implementation of universal medical insurance for residents in urban and rural China played a major role in improving the prognoses of low-income, rural, first-ever stroke patients, especially for elderly (≥65 years old) residents. However, elderly male patients not using medical insurance benefits had a high case fatality rate. Thus, restructuring of the government medical insurance policy to facilitate its use by low-income, rural residents is crucial for reducing the stroke burden in China.

Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors.

This study aimed to investigate the patterns and predictive factors of healthcare-seeking behavior among older Chinese adults. A sample of 10,914 participants aged ≥60 years from the 2011, 2013 and 2015 China Health and Retirement Longitudinal Study (CHARLS) was included. The bivariate analyses and Heckman selection model was used to identify predictors of healthcare-seeking behavior. Results shows that the utilization rate of outpatient services increased from 21.61% in 2011 to 32.41% in 2015, and that of inpatient services increased from 12.44% to 17.68%. In 2015, 71.93% and 92.18% chose public medical institutions for outpatient and inpatient services, 57.63% and 17.00% chose primary medical institutions. The individuals who were female, were younger, lived in urban, central or western regions, had medical insurance, had poor self-rated health and exhibited activity of daily living (ADL) impairment were more inclined to outpatient and inpatient services. Transportation, medical expenses, the out-of-pocket ratio and the urgency of the disease were associated with provider selection. The universal medical insurance schemes improved health service utilization for the elderly population but had little impact on the choice of medical institutions. The older adults preferred public institutions to private institutions, preferred primary institutions for outpatient care, and higher-level hospitals for hospitalization.

Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis.

The Chinese government has made great progress in establishing the universal medical insurance system. This study aimed to analyze whether the universal medical insurance system protected middle-aged and elderly households from catastrophic health expenditure (CHE). The data were obtained from the China Health and Retirement Longitudinal Study. We used household as our unit of analysis and CHE was measured as out-of-pocket expenditures ≥ 40% of nonfood household expenditures. Univariate analysis was deployed to examine the impacts of different medical insurance schemes on CHE, and the factors associated with CHE were estimated using a random-effects logit regression model. We identified 10,005, 10,370, and 11,567 households in 2011, 2013, and 2015, respectively, and found 12.9% (2011), 26.6% (2013) and 27.9% (2015) of the households experienced CHE. When compared with no insurance, households enrolled in New Rural Cooperative Medical Insurance Scheme (P = 0.023) were associated with a lower incidence of CHE, but other insurance schemes were not significant. Households with members older than 65years (P < 0.001), members with chronic diseases (P < 0.001), members with poor self-reported health conditions (P < 0.001), and members receiving health care (P < 0.001) had a higher risk of CHE. Large household size (P < 0.001) and high household income per capita (P < 0.001) were major protective factors to CHE incidence. Despite China's great stride in the medical insurance coverage, it fell short to provide financial protection against medical expenditure burden. To reduce the risk of CHE, an integrated poverty and elderly-oriented medical insurance system could be put in place to address these problems.

Characteristics of Patients Sponsored by the Internet Platforms of Medical Mutual Aid

The morbidity and mortality of life-threatening diseases such as cancers are increasing year by year in China. Although the national medical insurance has been improved a lot, it still falls short of expecting “universal medical insurance”. To help the families of patients with cancer and other serious diseases to resolve the unaffordable medical cost, several internet platforms of “Peer to Peer Medical Mutual Aid” have gradually emerged recently. In the form of low threshold insurance combined with public support, these platforms provide subsidies to families of patients suffering from serious financial burden and then partly compensate them for the limit of national medical insurance. This article summarized the characteristics of declared patients sponsored by several medical mutual aid internet platforms. The results showed that the sponsored patients were mostly cancer patients (90.1%), aged 21 - 60 (88.4%), and the average amounts of financial support had a trend to decrease with the increase of age. In particular, the reported cases of thyroid cancer were increased dramatically recently, however, with a lowest average mutual aid fund. Given these data, it is urgent to list out a detailed rule for the use of national medical insurance on the treatment of cancer, to heighten the healthcare system for the occupational population, age from 21 to 60, and to establish the credit system for Medicare and Medicaid services.

The epidemiology of acute coronary syndromes in French Guiana

BackgroundFrench Guiana is an overseas territory of France with marked specificities in terms of populations, socioeconomic factors, risk factors, and an access to care. In this context, the objective of the present study was to describe the epidemiology of acute coronary syndromes in French Guiana and to make comparisons with mainland France and neighbouring country. MethodsThe data were obtained from a retrospective descriptive hospital-based cohort conceived to describe the incidence of acute coronary syndromes and their epidemiologic and clinical characteristics. It included patients aged 18 or more hospitalised for a first coronary syndrome in the reference centre for coronary syndromes in Cayenne French Guiana between Jan 1st 2012 and Dec 31st 2014. Overall, 266 patients were analysed. ResultsThe mean age was 64 years (SD=12.54). A majority of patients were men (sex ratio=1.83). The proportion of patients born in an overseas French territory (44.36%) was similar to that of those born in a foreign country (43.98%), and 11.65% were born in mainland France. Only 59% of patients had regular health insurance. Moreover, 33.21% had universal medical insurance (CMU for those below a minimal income), 4.91% had state insurance (for illegal foreign patients) and 2.64% had no insurance at all. The main risk factors were high blood pressure (73.68%), diabetes (39.85%), hypercholesterolemia (40.23%), and smoking (37.97%). Overall, 82/266 patients developed an ST elevation coronary syndrome (STEMI) and 184/266 had a non-ST elevation coronary syndrome NSTEMI or unstable angina pectoris. Thrombolysis was only performed in 20.73% of patients with STEMI. Mortality at 1 month was 8/82 (9.76%) for STEMI and 2/184 (1.09%) for NSTEMI. ConclusionsThe epidemiologic profile of acute coronary syndromes in French Guiana is different from that of mainland France and Europe to the neighbouring country Brazil. Mortality of STEMI also seems higher than in mainland France, but similar to Brazil. In a context of frequent health inequalities, interventions targeting the major risk factors, notably high blood pressure, obesity and diabetes, have the potential to significantly impact cardiovascular morbidity and mortality.

Medical insurance and healthcare utilization among the middle-aged and elderly in China: evidence from the China health and retirement longitudinal study 2011, 2013 and 2015

BackgroundIn response to China’s rapidly aging population and increasing healthcare service demands, the Chinese government is developing a universal medical insurance system. This study aimed to assess healthcare utilization patterns and analyze the impacts of medical insurance schemes on healthcare utilization among the middle-aged and elderly in China.MethodsData was extracted from the China Health and Retirement Longitudinal Study in 2011, 2013 and 2015. Healthcare utilization was measured by outpatient and inpatient service utilization. Univariate analysis was deployed to examine the impacts of different medical insurance schemes on healthcare utilization. The factors associated with healthcare utilization were estimated using a random-effects logistic regression model.ResultsDuring the study period, the number of individuals involved was 17,250, 18,195 and 19,842, respectively. The proportion of individuals who received outpatient service was 18.6, 20.7 and 18.7% and those who used inpatient service was 9.6, 13.8 and 14.3%, respectively. We identified that medical insurance was a major protective factor for improving healthcare utilization but different medical insurance schemes exerted various impacts on the middle-aged and the elderly.ConclusionsDespite the growing population coverage, the Chinese government should make every effort to bridge the gap among people with different medical insurance schemes. Further evaluation is needed to assess whether the expanded medical insurance schemes could protect the middle-aged and elderly households from catastrophic health expenditure.

Impact of the 'Seguro Médico Siglo XXI' medical insurance programme on neonatal and infant mortality in Mexico, 2006-14: an ecological approach to estimation.

The 'Seguro Médico Siglo XXI' (SMSXXI), a universal coverage medical insurance programme for children under 5 years of age, started in 2006 to help avoid catastrophic health expenditures in poor families without social security in Mexico. The study used information from the National Health Information System for the 2006-14 period. An ecological approach was followed with a panel of the 2457 municipalities of Mexico as the units of analysis. The outcome variables were the municipality-level neonatal mortality and infant mortality rates in population without access to social security. The programme variable was the coverage of the SMSXXI programme at the municipality level, expressed as a proportion. Demographic and economic variables defined at the municipality level were included as covariates. Impact was estimated by fitting a fixed-effects negative binomial regression model. Results reveal that the SMSXXI significantly reduced both infant and neonatSal mortality in the target population, although in a non-linear fashion, with minimum mortality levels found around the 70% coverage range. The effect is mostly given by the transition from the first quintile to the fourth quintile of coverage (<13% vs 70.5-93.7% coverage), and it is attenuated significantly at coverage levels very close to or at 100%. The observed risk reduction amounted to an estimated total of 11 358 infant deaths being avoided due to the SMSXXI during the 2006-14 period, of which 48% were neonatal. In conclusion, we found a significant impact of the SMSXXI programme on both infant mortality and neonatal mortality. An attenuation of the effect of the insurance on mortality rates at levels close to 100% coverage may reflect the saturation of health units in detriment of the quality of care.

Ten-Year Assessment of China's Health Care Reform on Improving Stroke Prognoses Among Low-Income Populations: A Long-Term (1992-2018), Population-Based, Prospective Study

Background: In 2009, China launched a major health care reform aimed at providing all citizens with equal access to reasonable-quality, basic health care, with financial risk protection. However, the impact of the reform on improving stroke prognoses is unknown, especially among low-income residents. Thus, we aimed to assess the impact of the health care reform, 10 years after implementation, on improving stroke prognoses among low-income residents. Methods: Stroke events and all deaths were registered, annually, between 1992 and 2018 in a township in Tianjin, China. We analyzed changes in stroke management (rates of neuroimaging-based diagnoses and hospitalization) and prognoses (case fatality rates and recurrence) before (1992-2008) and after (2009-2018) implementation of the health care reform. Findings: In total, 1462 patients were diagnosed with first-ever stroke during the study period. For patients aged ≥45 years, the rates of neuroimaging-based diagnoses and hospitalization were greater in the 2009-2018 period than in the 1992-2008 period, regardless of patient sex or stroke type. Among all stroke patients, the one-year case fatality rate in the 2009-2018 period was significantly lower than that in the earlier period (P<0·05); the case fatality rate for women aged ≥65 years decreased by 30·0% (23·3% vs. 33·3%; P=0·043). Overall, between the two periods, the stroke recurrence rate increased 1·9-fold (P=0·001), including a 2·5-fold increase in men (P=0·010). During the 2009–2018 period, the one-year case fatality rate was higher among elderly male patients not using medical insurance than among those using it (32·8% vs. 20·7%; P=0·050). Interpretation: These findings suggest that the implementation of universal medical insurance for residents in urban and rural China played a major role in improving the prognoses of low-income, rural, first-ever stroke patients, especially for elderly (≥65 years old) residents. However, elderly male patients not using medical insurance benefits had a high case fatality rate. Thus, restructuring of the government medical insurance policy to facilitate its use by low-income, rural residents is crucial for reducing the stroke burden in China. Funding Statement: The authors stated: None. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This study was approved by the ethics committee of Tianjin Medical University General Hospital; written informed consent was obtained from each participant during recruitment.

Population aging in Japan: policy transformation, sustainable development goals, universal health coverage, and social determinates of health.

Japan is aging rapidly, and its society is changing. Population aging and social change are mutually linked and appear to form a vicious cycle. Post-war Japan started to invest intensively in infectious disease control by expanding health services and achieving universal medical insurance coverage in 1961. The high economic growth in the 1960s contributed to generate a thick middle class layer, but the lingering economic slump after the economic bubble crisis after 1991 and globalization weakened this segment of society. Health disparity has been acknowledged and social determinates of health have been focused. In this article, the author reviewed the response course to health challenges posed by population aging in Japan, and aims to offer lessons to learn for Asian nations that are also rapidly aging. The core viewpoints include: i) review health policy transformations until the super-aged society, ii) discuss how domestic issues in aging can be a global issue, iii) analyze its relationship with Japanese global health engagement, iv) debate the context of social determinates of health, and v) synthesize these issues and translate to future directions.

Healthcare Supply Chain Network Coordination Through Medical Insurance Strategies with Reference Price Effect.

China has established the universal medical insurance system and individual out of pocket costs have decreased, however, the average healthcare expenditure of the Chinese population and the expenses of the whole society have increased substantially. One major challenge which impedes the progress of attaining sustainable development of the social healthcare system in China is that the number of hospital admissions is disproportionate. Superior hospitals are overcrowded, whereas subordinate hospitals are experiencing low admissions. In this paper, we apply the game theory model to coordinate the healthcare supply chain network, which is composed of the government, medical insurance fund, superior hospitals, subordinate hospitals and patients. Especially by taking the reference price effect into account, this paper analyzes different medical insurance reimbursement strategies and their influence on patient choice and the healthcare supply chain network. The result shows that the reference price effect increases the leverage of medical insurance, guides patients’ choice, optimizes the allocation of medical resources and reduces the medical expends. In comparison to a decentralized decision- making strategy, a centralized decision- making strategy can stimulate both superior hospital and subordinate hospital’s cooperative intentions which benefits the social healthcare system.

Characteristics of dietary intake among adult patients in hospitals in a lower middle-income country in Southeast Asia.

Low-dietary intake is a common problem and cause of malnutrition during hospitalisation. This study aims to determine the current dietary intake and food sources of hospitalised adults in Ho Chi Minh City. Participants were adult patients from six general public hospitals in a multi-site survey undertaken in 2016. Dietary intakes for all foods consumed in the previous day were collected via interview using the 24 hours recall method. Nutritional status was assessed using Subjective Global Assessment or BMI. Data were collected from 887 participants. Most food consumed in hospital was from non-regulated foodservices. Food was self-provided and home-cooked (27.7%), bought from outside the hospital (13.6%), from the hospital canteen (16.8%) or a combination of these (39.4%). Only 1.3% of food was provided by the hospital. Energy intakes were very low with a median of 3550 kJ/day; and only 4.2% of participants met 100% of their energy requirements. Decreased appetite, fullness or restrictions due to medical indications were the most common reasons for low-dietary intake. Malnourished participants were 2.2 times more likely to have low-dietary intake compared to well-nourished participants. Non-regulated foodservices in hospital were not able to meet the dietary requirements of patients leading to hospital malnutrition. Standardisation of food from on-site canteens, covering meal costs from universal medical insurance, and developing guides for food provisioning for patients' families are potential solutions to improve patient nutritional status.

Factors influencing the incidence and treatment of intracranial aneurysm and subarachnoid hemorrhage: time trends and socioeconomic disparities under an universal healthcare system

BackgroundDespite increasing usage of endovascular treatments for intracranial aneurysms, few research studies have been conducted on the incidence of unruptured aneurysm (UA) and subarachnoid hemorrhage (SAH), and could not show...

Impact of universal medical insurance system on the accessibility of medical service supply and affordability of patients in China.

BackgroundChina’s universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China.MethodsSegmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic payments and seeking-care choices for UMIS beneficiaries were selected to measure the affordability and medical service flow of patients after the implementation of UMIS.ResultsChina’s UMIS was established in 2008. After that, the trending increase of the expenditure of the UMIS was higher than that of increase in revenue compared to previous years. Up to 2014, the UMIS had covered 97.5% of the entire population in China. After introduction of the UMIS, there were significant increases in licensed physicians, nurses, and hospital beds per 1000 individuals. In addition, hospital outpatient visits and inpatient visits per year increased compared to the pre-UMIS period. The average fatality rate of inpatients in the overall hospital and general hospital and the average fatality rate due to acute myocardial infarction (AMI) in general hospitals was significantly decreased. In contrast, no significant and prospective changes were observed in rural physicians per 1000 individuals, inpatient visits and inpatient fatality rate in the community centers and township hospitals compared to the pre-UMIS period. After 2008, the rates of catastrophic payments for UMIS inpatients at different income levels were declining at three levels of hospitals. Whichever income level, the rate of catastrophic payments for inpatients of Urban Employee’s Basic Medical Insurance was the lowest. For the low-income patients, a single hospitalization at a tertiary hospital can lead to catastrophic payments. It is needless to say what the economic burden could be if patients required multiple hospitalizations within a year. UMIS beneficiaries showed the intention of growth to seek hospitalization services in tertiary hospitals.ConclusionsIntroduction of the UMIS contributed to an increase in available medical services and the use thereof, and a decrease in fatality rate. The affordability of UMIS beneficiaries for medical expenses was successfully ameliorated. The differences in patients’ affordability are mainly manifested in different medical insurance schemes and different seeking-care choices. The ability of the poor patients covered by UMIS to resist catastrophic medical payments is still relatively weak. Therefore, the current UMIS should reform the insurance payment model to promote the integration of medical services and the formation of a tiered treatment system. UMIS also should establish supplementary medical insurance packages for the poor.

Function of the national big data platform for medical and healthcare management in medical and healthcare system reform

The reform of medical and healthcare system is the inevitable process for the medical and healthcare developing in China. The main contents of the reform include establishing a scientific and reasonable system of medical treatment and classification, a scientific and effective modern hospital management system, a universal medical insurance system with efficient operation, a standardized and orderly drugs and medical equipment supply, and a strict and standardized comprehensive supervision system. The national big data platform for medical and healthcare management can play an important role in the reform of medical and healthcare system in China. First, it can help to improve the treatment effect of the disease, improve the prognosis, reduce the morbidity and mortality rate, and improve the health level. Second, it can effectively control the risk of medical insurance funds, and reduce the fund operational risk. Third, it can improve the efficiency of healthcare services and medical service resource utilization, so as to reduce medical costs. Fourth, it can help to build the link between residents and family doctors and hospitals, and to promote the medical consortium and hierarchical medical system through electronic signatures, online booking, telemedicine, real-time health monitoring, and two-way referral. Fifth, it can help to establish a medicine and medical equipment circulation system with the characteristics of source-traceable, full controllable, risk-preventable, responsibility-assessable, performance-assessable, and open-and-transparent. Finally, it can effectively improve the quality evaluation and regulatory level of the medical system in China. The existing problems in medical reform in China were introduced, and the relationship and the significance of the national big data platform for medical and healthcare management to medical and healthcare system reform were analyzed. Key words: Healthcare big data; Medical and healthcare system reform; Hierarchical medical system; Medical insurance supervision; Medical institution evaluation; Medicine and medical equipment supervision

China's Health Reform Update.

China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners' and patients' interests can be better aligned is essential for reforms to succeed.