The Effect of Urban Basic Medical Insurance on Health Service Utilisation in Shaanxi Province,China: A Comparison of Two Schemes

Background

Urban population in China is mainly covered by two medical insurance schemes: the Urban Employee Basic Medical Insurance (UEBMI) for urban employees in formal sector and the Urban Resident Basic Medical Insurance (URBMI) for the left urban residents, mainly the unemployed, the elderly and children. This paper studies the effects of UEBMI and URBMI on health services utilisation in Shaanxi Province, Western China.

Methods

Cross-sectional data from the 4^th National Health Services Survey - Shaanxi Province was studied. The propensity score matching and the coarsened exact matching methods have been used to estimate the average medical insurance effect on the insured.

Results

Compared to the uninsured, robust results suggest that UEBMI had significantly increased the outpatient health services utilisation in the last two weeks (p<0.10), whilst the significant effect on hospitalisation was evident in the CEM method (p<0.10). The effect of URBMI was limited in that although being insured was associated with higher health services utilisation, compared with the uninsured, none of the improvement was statistically significant (p>0.10). It was also found that compared with the uninsured, basic medical insurance enrollees were more likely to purchase inpatient treatments in lower levels of hospitals, consistent with the incentive of the benefit package design.

Conclusion

Basic Medical insurance schemes have shown a positive but limited effect on increasing health services utilisation in Shaanxi Province. The benefit package design of higher reimbursement rates for lower level hospitals has induced the insured to use medical services in lower level hospitals for inpatient services.     

The idea of health: history,medical pluralism,and the management of the body in Emilia-Romagna,Italy

Basic beliefs about health in north central Italy derive from an approach to the personal management of the body that is not just reactive but also proactive. This article examines a complex field of health factors in relation to historical processes and a system of medical pluralism. Rapid demographic and social changes over the past century have brought an accommodation of ancient medical beliefs to more recent germ-oriented principles. An enduring belief in the permeability of the body leads to an emphasis on moderation in personal conduct to prevent debilitation, whether by atmospheric insults, microbial infection, or modern-day miasmas such as pollution or additives in food. The idea of health itself is analyzed to show how biomedicine varies across societies and how historical processes have shaped contemporary cultural patterns and led to generational continuities and differences in beliefs and behaviors. This information may also improve interactions between patients and health care providers.     

RobertP Vertes and RobertW Stackman Jr: Electrophysiological Recording Techniques Springer Protocols, Neuromethods Series Nr. 54

This article is a review of the book: 'Biomedical Image Processing', by Thomas M. Deserno, which is published by Springer-Verlag. Salient information that will be useful to decide whether the book is relevant to topics of interest to the reader, and whether it might be suitable as a course textbook, are presented in the review. This includes information about the book details, a summary, the suitability of the text in course and research work, the framework of the book, its specific content, and conclusions.     

医学图像融合技术的研究

利用图像融合技术,将不同模态的医学图像有机地结合在一起,可以充分利用各种医学图像的优点,为临床诊断和治疗提供帮助。本文主要介绍了医学图像融合技术的基本概念、发展情况、常用方法及面临的困难等,并对医学图像的研究前景作了预测。     

The European Federation of Organisations for Medical Physics Policy Statement No. 10.1: Recommended Guidelines on National Schemes for Continuing Professional Development of Medical Physicists

Continuing Professional Development (CPD) is vital to the medical physics profession if it is to embrace the pace of change occurring in medical practice. As CPD is the planned acquisition of knowledge, experience and skills required for professional practice throughout one's working life it promotes excellence and protects the profession and public against incompetence. Furthermore, CPD is a recommended prerequisite of registration schemes (Caruana et al. 2014 [1]; [2]) and is implied in the Council Directive 2013/59/EURATOM (EU BSS) [3] and the International Basic Safety Standards (BSS) [4]. It is to be noted that currently not all national registration schemes require CPD to maintain the registration status necessary to practise medical physics. Such schemes should consider adopting CPD as a prerequisite for renewing registration after a set period of time.This EFOMP Policy Statement, which is an amalgamation and an update of the EFOMP Policy Statements No. 8 and No. 10, presents guidelines for the establishment of national schemes for CPD and activities that should be considered for CPD.     

The Medical Practitioner,Alcoholism and Motivation

Adverse influences on motivation for recovery from alcoholism must be searched for in three areas: society, the medical practitioner and the patient. Society is ambivalent because there is a vicarious release through identification with the cheerful “drunk” coupled with unconscious envy and resentment leading to punitive action.The current “alcohol culture” decrees that to drink is to be well, not to drink is to be ill.The medical profession attempts to suppress, deny, rationalize or reject the problem of alcoholism because it involves a change in attitude and recognition of limitations.The alcoholic patient has a notorious lack of motivation, but this must be recognized as a symptom of his disease, and with certain techniques this symptom is treatable. Furthermore, motivation fluctuates and many opportunities for treatment are available when the medical practitioner can detect that motivation is high. At times a coercive approach is required, at times a permissive one; and the optimal use of such approaches will increase the motivation to an effective level.     

九江市区域医疗联合体建设的实践与思考

介绍了九江市区域医疗联合体建设的基本情况、联合模式、主要做法以及主要成效,分析了医疗联合体运行过程中存在的一些共性问题。可借鉴国内医疗联合体建设的成功经验,进一步完善运作模式,推动医疗联合体健康发展。     

Functional Status Predicts Acute Care Readmissions from Inpatient Rehabilitation in the Stroke Population

Objective

Acute care readmission risk is an increasingly recognized problem that has garnered significant attention, yet the reasons for acute care readmission in the inpatient rehabilitation population are complex and likely multifactorial. Information on both medical comorbidities and functional status is routinely collected for stroke patients participating in inpatient rehabilitation. We sought to determine whether functional status is a more robust predictor of acute care readmissions in the inpatient rehabilitation stroke population compared with medical comorbidities using a large, administrative data set.

Methods

A retrospective analysis of data from the Uniform Data System for Medical Rehabilitation from the years 2002 to 2011 was performed examining stroke patients admitted to inpatient rehabilitation facilities. A Basic Model for predicting acute care readmission risk based on age and functional status was compared with models incorporating functional status and medical comorbidities (Basic-Plus) or models including age and medical comorbidities alone (Age-Comorbidity). C-statistics were compared to evaluate model performance.

Findings

There were a total of 803,124 patients: 88,187 (11%) patients were transferred back to an acute hospital: 22,247 (2.8%) within 3 days, 43,481 (5.4%) within 7 days, and 85,431 (10.6%) within 30 days. The C-statistics for the Basic Model were 0.701, 0.672, and 0.682 at days 3, 7, and 30 respectively. As compared to the Basic Model, the best-performing Basic-Plus model was the Basic+Elixhauser model with C-statistics differences of +0.011, +0.011, and + 0.012, and the best-performing Age-Comorbidity model was the Age+Elixhauser model with C-statistic differences of -0.124, -0.098, and -0.098 at days 3, 7, and 30 respectively.

Conclusions

Readmission models for the inpatient rehabilitation stroke population based on functional status and age showed better predictive ability than models based on medical comorbidities.     

医学生早期教育阶段综合能力培养之探索

现代医学模式要求医务工作者必须是高素质的人才。基础医学教育阶段是医学生培养过程中的基础环节和重要阶段,与临床教学阶段相比,基础教育阶段更有利于学生综合能力培养和开展素质教育。医学生综合能力的培养在医学教育中具有重要的地位,它的实现要靠教育者在教育教学的各个环节中主动施行,积极探讨医学生综合能力培养的有效实施途径和方法。我们课题组根据多年从事医学生人才培养的教育教学经验,针对医学生早期教育阶段的心理、生理、环境、知识结构特点,围绕综合能力培养这个核心课题,强化创新性人才培养,系统有序地按学生学习时间和课程进行各种能力的逐一培养,从学习能力,思维能力,观察能力,动手能力,合作能力,分析问题和解决问题能力,判断是非能力,语言表达能力,写作能力,创新开拓能力等,探索医学生早期教育阶段综合能力培养模式。     

Medical journals,impact and social media: an ecological study of the Twittersphere

Background:

Twitter is an increasingly popular means of research dissemination. I sought to examine the relation between scientific merit and mainstream popularity of general medical journals.

Methods:

I extracted impact factors and citations for 2014 for all general medical journals listed in the Thomson Reuters InCites Journal Citation Reports. I collected Twitter statistics (number of followers, number following, number of tweets) between July 25 and 27, 2015 from the Twitter profiles of journals that had Twitter accounts. I calculated the ratio of observed to expected Twitter followers according to citations via the Kardashian Index. I created the (Fifty Shades of) Grey Scale to calculate the analogous ratio according to impact factor.

Results:

Only 28% (43/153) of journals had Twitter profiles. The scientific and social media impact of journals were correlated: in adjusted models, Twitter followers increased by 0.78% (95% confidence interval [CI] 0.38%–1.18%) for every 1% increase in impact factor and by 0.62% (95% CI 0.34%–0.90%) for every 1% increase in citations. Kardashian Index scores above the 99% CI were obsverved in 16% (7/43) of journals, including 6 of the 7 highest ranked journals by impact factor, whereas 58% (25/43) had scores below this interval. For the Grey Scale, 12% (5/43) of journals had scores above and 35% (15/43) had scores below the 99% CI.

Interpretation:

The size of a general medical journal’s Twitter following is strongly linked to its impact factor and citations, suggesting that higher quality research received more mainstream attention. Many journals have not capitalized on this dissemination method, although others have used it to their advantage.Social media has reached near ubiquity; medical research, researchers and journals are no exception to its pervasiveness.^1–7 One of the most popular social media platforms is Twitter, with an estimated 302 million monthly active users sending 500 million tweets per day.⁸ Twitter differs from other social media platforms in that posts are limited to 140 or fewer characters. With an emphasis on brevity, Twitter provides a unique opportunity for medical knowledge to be disseminated to the general public.^9,10 However, people with questionable medical research pedigrees are the stars of Twitter.With more than 65 million followers, Canadian @justinbieber is one of the most popular Twitter celebrities, narrowly edging out the most popular physician (@bengoldacre) by a margin of 64.5 million followers. Despite widespread distaste among non-Beliebers, it can be argued that The Biebs does display a modicum of musical talent (assuming multiplatinum albums and chart-topping singles¹¹ are a proxy for talent). Conversely, the woefully popular @KimKardashian, who trumps top scientists by more than 33 million followers, falls into the “famous for being famous” trope, alongside fellow Glitterati Paris Hilton and Nicole Richie. The notion that people with dubious levels of talent and questionable means of attaining celebrity can become immensely popular is worrisome. This notion has sparked debate within the scientific community. Do these self-perpetuated self-promoters exist in academia? Are any scientists “renowned for being renowned”?¹²There has been increasing use of alternative means of quantifying journals’ impact, notably using the Altmetric statistic, which conglomerates an article’s social media presence through blogs, news outlets, Facebook and Twitter. In response to the meteoric unmeritocratic rise of social media celebrities via Twitter, @neilhall_uk developed the playfully dubbed Kardashian Index (K-index) to address these issues in an academic context.¹² The K-index quantifies the discrepancy between mainstream popularity and scientific merit by examining one’s social media profile in relation to one’s citations in peer reviewed works.Continuing in this vein, I propose the (Fifty Shades of) Grey Scale for use with medical journals (in reference to the book, which has sold more than 125 million copies to date, despite being critically lambasted).¹³ Using a similar equation to the K-index, the Grey Scale calculates the ratio of the number of actual to expected followers using journal impact factor (rather than citations, as in the K-index) as the predictor variable. Journal impact factor and total citations are closely related. Impact factor is the ratio of total citations to the number of articles published by the journal, which adjusts for journals that have many more, or fewer, citable publications (e.g., weekly or bimonthly journals).¹⁴Unpacking the mechanisms of Twitter celebrity is difficult. Personal Twitter profiles often include humour, wit and other attributes not normally attributed to the reporting of a new paper, as per general medical journal Tweets. By eliminating the individuality of the Tweet, looking only at medical journals’ Twitter profiles rather than individual researchers’, a more direct examination of the relation between Twitter celebrity and scientific merit is possible. Although Tweets linking to papers have been associated with greater citations than non-Tweeted papers,¹⁵ whether or not this translates into greater Twitter followings for the authors and the journal in which the paper was published has yet to explored. The relation between the number of Twitter followers and impact factor scores has recently been investigated in urology journals, where nonsignificant correlations between the number of Twitter followers and the impact factor of the journal were found.¹⁶The current study seeks to examine whether scientific merit (captured by journal impact factor and citations) translates into Twitter celebrity (i.e., number of followers) in general medical journals.     

Medical therapy for benign prostatic hyperplasia: new terminology, new concepts, better choices

This article discusses 3 areas of medical therapy for benign prostatic hyperplasia (BPH) that are undergoing extensive research and evaluation: 1) the use of muscarinic receptor antagonists to treat lower urinary tract symptoms (LUTS) in men with BPH; 2) the definition of an "enlarged prostate"; and 3) sexual function and LUTS. Fears of worsening obstructive symptoms or causing acute urinary retention often keep practitioners from prescribing muscarinic receptor antagonists to men who might have concomitant bladder outlet obstruction; a multicenter, multinational, double-blind study showed that tolterodine is safe for men with low postvoid residual volumes. Most urologists accept that a prostate volume of more than 40 mL is consistent with an enlarged prostate; there is more debate regarding prostate volumes of 30 to 40 mL. Recently presented data suggest that combination medical therapy might be effective for men having prostates with volumes of more than 25 mL. The association between voiding and sexual function has been increasingly recognized and investigated, and there seem to be common pathophysiologic mechanisms governing both conditions. Targeted treatment algorithms addressing both conditions seem warranted.     

浅析新版《基本医疗保险药品目录》的制定

《基本医疗保险药品目录》是医保基金支付参保人员药品费用和强化医疗保险医疗服务管理的政策依据及标准。其根本目的是保证参保人员的合理用药需求,保障参保人员的合法权益,降低不合理用药支出。通过对新版《基本医疗保险药品目录》的新特点以及存在不足的分析,提出完善《基本医疗保险药品目录》制定的政策建议。     

The Ethics and Politics of Human Experimentation, by Paul M. McNeill

...McNeill's book raises some very important questions about the ways in which a society comes to terms with the fact that the practice of medicine is more closely linked with experimentation than ever before. That often puts the doctor-patient relation into a new setting. We have registered our objection to McNeill's tendency to see that relationship, where experimentation is involved, in an adversarial form: there are, we must repeat, more than two sides to this argument, and the medical scientist's commitment is not only to truth at any cost any more than the medical practitioner's is to treatment in all circumstances. Objections do not mean that we cannot learn from this book: on the contrary they may help us to sharpen our perceptions of what should happen. Fair-mindedness would suggest that failure to fulfill expectations is nothing like as widespread or for that matter incurable as McNeill's polemical tone might lead us to believe. When McNeill ceases to be the prosecuting counsel the true worth of his comments will become more apparent.     

Reefer Madness: Legal & Moral Issues Surrounding the Medical Prescription of Marijuana

California, Arizona, and several other states have recently legalized medical marijuana. My goal in this paper is to demonstrate that even if one grants the opponents of legalization many of their contentious assumptions, the federal government is still obligated to take several specific steps toward the legalization of medical marijuana. I defend this claim against a variety of objections, including the claims: that marijuana is unsafe, that marijuana cannot be adequately tested or produced as a drug, that the availability of synthetic THC makes marijuana superfluous, and especially that legalizing medical marijuana will increase recreational use by 'sending the wrong message '. I then go on to argue that given the intransigent position of the federal government on this issue, state governments are justified in unilaterally legalizing medical marijuana as an act of civil disobedience.
A large portion of this paper consists of an extensive response to the objection that legalizing medical marijuana will 'send the wrong message '– which I take to be the primary impediment to legalization. This objection basically claims that the consequences of withholding legalization (especially preventing increased recreational use) are superior to those of legalizing medical marijuana. I argue that legalization is justified even if one were to grant both that the harms of legalization outweighed its benefits and that utilitarianism is true. This requires a subtle and somewhat extended discussion of utilitarian moral and political theory.     

计算机仿真技术在优化就医序列中的应用研究

积极推进预约诊疗服务、方便群众看病就医、缩短病人无效等候之间,是公立医院改革的重要课题,优化就医序列是解决上述课题的有效方法。通过计算机仿真技术充分挖掘现有医疗资源,可以优化调度资源,提高医院服务能力和质量。在分析了国内外计算机仿真技术在医院管理优化就医序列中的应用,初步研究了存在问题,并提出了相应的发展对策。     

Arational Behavior and Medical Care, Report of Bureau of Research and Planning

Testing the hypothesis that arationality on the part of a patient in the treatment of an illness is in direct relation to perceived chance or danger inherent in that illness and is in inverse relation to medical knowledge about that illness, the authors of an unpublished doctoral dissertation conclude that "those who are scientifically more knowledgeable" in the area of medical practice are "also more rational." Arational behavior is categorized as 1) the type that involves the use of, or belief in the efficacy of accepted religious practices for the treatment of illness, 2) the use of some religious charms and trinkets, and 3) the use of ineffective or harmful health foods, herbs, and various compounds. The authors conclude that an increase in technological discoveries will result in a trend toward greater rationality and more rational behavior in seeking treatment for illness.     

大型医疗设备成本绩效考核数学模型的建立

目的探讨医疗设备绩效管理的新模式,提高医疗设备的经济效益。方法研制医疗器械成本效益分析评价模型,对医疗设备使用中影响成本的元素进行分析,并提出合理的改善方法。结果通过开展医疗设备使用效益分析,为决策提供可靠的数字依据,对医疗设备的投资及使用进行监督核算。     

Access and Use of Medical Care among Obese Persons

The prevalence of obesity and severe obesity is growing rapidly, along with obesity‐related comorbidities and mortality. Given the increased health risks associated with obesity, it is vital that obese persons have adequate access to, and make consistent use of, medical care services. Assuming obese persons have access to medical care that is comparable to non‐obese persons, one would expect to observe greater use of medical services among obese persons. In this article we briefly review empirical evidence of the access to and use of medical care among obese persons. Although certain subgroups that tend to have disproportionately high prevalences of obesity (i.e., low socioeconomic status, minority groups) have reduced access to care, no studies have specifically examined whether or not obese persons have the same access to health care as do their lean counterparts. With respect to use of health care services, however, obesity has been consistently linked with greater rates of utilization and increased health care expenditures. Both the increased use and cost appear to be largely a function of treating obesity‐associated comorbidities such as diabetes and hypertension. We conclude that, although it is clear that obesity is associated with both greater use and cost of medical care, the relationship between obesity and access to medical care has not been determined.     

Medical Need,Equality, and Uncertainty

Many hold that distributing healthcare according to medical need is a requirement of equality. Most egalitarians believe, however, that people ought to be equal on the whole, by some overall measure of well‐being or life‐prospects; it would be a massive coincidence if distributing healthcare according to medical need turned out to be an effective way of promoting equality overall. I argue that distributing healthcare according to medical need is important for reducing individuals' uncertainty surrounding their future medical needs. In other words, distributing healthcare according to medical need is a natural feature of healthcare insurance; it is about indemnity, not equality.     

An Ecological Perspective on Medical Care: Environmental, Occupational, and Public Health Impacts of Medical Supply and Pharmaceutical Chains

Healthcare organizations are increasingly examining the impacts of their facilities and operations on the natural environment, their workers, and the broader community, but the ecological impacts of specific healthcare services provided within these institutions have not been assessed. This paper provides a qualitative assessment of healthcare practices that takes into account the life-cycle impacts of a variety of materials used in typical medical care. We conducted an ethnographic study of three medical inpatient units: a conventional cancer ward, palliative care unit, and a hospice center. Participant observations (73 participants) of healthcare and support staff including physicians, nurses, housekeepers, and administrators were made to inventory materials and document practices used in patient care. Semi-structured interviews provided insight into common practices. We identified three major domains that highlight the cumulative environmental, occupational health, and public health impacts of medical supplies and pharmaceuticals used at our research sites: (1) medical supply procurement; (2) generation, handling, and disposal of medical waste; and (3) pharmaceutical handling and disposal. Impacts discovered through ethnographic inquiry included occupational exposures to chemotherapy and infectious waste, and public health exposures to pharmaceutical waste. This study provides new insight into the environmental, occupational, and public health impacts resulting from medical practices. In many cases, the lack of clear guidance and regulations regarding environmental impacts contributed to elevated harms to the natural environment, workers, and the broader community.