Background China proposed the Zero Markup Drug Policy (ZMDP), which popularized in tertiary hospitals across the country in 2017, to control drug expenditures’ rapid growth further and reduce the public’s medical burden. This study aims to evaluate the impact of ZMDP on the drug cost of chronic disease outpatients in the tertiary hospital in Chongqing. Methods We collected and described the drug-cost data for outpatients with chronic diseases in a Chongqing’s tertiary hospital from 2015 to 2019. The instantaneous and long-term changes of the outpatient volume and average drug cost after the ZMDP were evaluated using interrupted time series (ITS). We also analyzed the policy’s impact under the stratification of gender, age, and basic medical insurance types. Results A total of 350,848 outpatients were collected from January 2015 to February 2019. After the ZMDP, the outpatient volume for diabetes, hypertension, and coronary heart disease (CHD) all showed a downward trend, with a decrease of 53.04 (P = 0.012), 142.19 (P < 0.01) and 12.16 (P < 0.001) per month. Simultaneously, the average drug cost decreased by 4.44 yuan (P = 0.029), 5.87 yuan (P < 0.001) and 10.23 yuan (P = 0.036) per month, respectively. By gender, the average drug cost of diabetes in males had the most considerable instantaneous change, reducing by 51.21 yuan (P = 0.017); the decline of CHD in women is the most obvious, with an average monthly decrease of 12.51 yuan (P < 0.001). By age, the instantaneous change of CHD was the greatest for those older than 65 years old, with a decrease of 102.61 yuan (P = 0.030). CHD in 46–65 years old showed the most significant reduction, with an average monthly decline of 11.70 yuan (P < 0.01). BMIUE’s hypertension had the most considerable instantaneous change, which decreased 59.63 yuan (P = 0.010). BMIUE’s CHD showed the most apparent downward trend, with an average monthly decrease of 10.02 yuan (P = 0.010). Conclusion The ITS analysis is an effective method of health policy evaluation. The implementation of the ZMDP can reduce the drug cost for chronic disease outpatients in the tertiary hospital and their economic burden. Follow-up policies still require targeted price adjustments in the health service system to adjust the drug cost-effectively.
China is a multicultural country that has arisen from its 56 ethnicities, with a diverse population of over 1.3 billion people and an imbalanced economic development. The health care system in China is tending to be overall funded through urban and rural health insurance plans. Although China has invested in the basic research of genome science, public health genomics-related programs and services in China started late. Prenatal screening is offered as part of routine clinical prenatal services and is free of charge in some economically advanced cities. Newborn screening programs are mandated throughout the country but vary between provinces and territories in terms of organization and diseases screened for; most screening tests are paid by out-of-pocket expenses. Genetic tests are encouraged while there are only one accredited state laboratory and few territorial laboratories in China. Further national genomics policies are needed in China in a range of genetic issues and infrastructure of public health genomics. Careful measurement is essential to understanding the nature and scale of the task ahead.
Objective: To analyse the epidemiological characteristics of leprosy in Chongqing from 1949 to 2018 and evaluate the prevention and treatment effects over time to provide a basis for improving leprosy prevention and treatment strategies in Chongqing.Methods: Epidemiological indicators such as the incidence rate, prevalence rate, and annual estimated percentage change (EAPC) were used to evaluate the prevalence of leprosy. The prevention and treatment of leprosy patients were evaluated by indexes representing delay in diagnosis, the cure rate and the course of the disease. The statistical software used mainly include SPSS20.0, GraphPad Prism 8, ArcGIS 10.7.Results: From 1949 to 2018, a total of 3698 cases of leprosy were reported in Chongqing, with a sex ratio (male:female) of 3.814:1. The incidence of leprosy in the city peaked at 0.848/105 people in 1960 and remained below 0.100/105 people after 2004, achieving the World Health Organization (WHO) standard for the elimination of leprosy. The mortality rate remained at or below 0.100 per 100,000 people. The median time between disease onset and diagnosis in the whole population was 3.576(1.435, 7.621) years.The early detection rate was 31.314%, and the rate of patients with grade 2 disability was 31.989%, which decreased significantly over time (χ2=5.063, P=0.024). Compared with dapsone(DDS), multidrug therapy (MDT) was associated with a higher cure rate and a shorter disease course (χ2=608.346, P=0.000).Conclusions: Currently, leprosy in Chongqing remains in a low epidemic state. However, to maintain the status of meeting the WHO standards for the elimination of leprosy, there are some challenges that should not be overlooked by leprosy prevention workers. For example, the early detection of leprosy and the prevention and treatment of related disability still need to be strengthened.
Background: Tracheobronchomalacia (TBM) is often manifested as wheezing. Reassessing the role of TBM in persistent wheezing in children is essential. Methods:We selected children who were diagnosed with TBM by bronchoscopy and who underwent bronchoscopic reexamination for persistent wheezing or chronic cough between January 2009 and July 2019. The clinical and bronchoscopy data were collected and retrospectively reviewed. For statistical analysis, we used the Kaplan-Meier method, Kruskal-Wallis test, and Fisher exact test.Results: A total of 79 patients (57 males and 22 females) were included. The median age of the first TBM diagnosis was 7 (interquartile [IQR] 4-11) months. The median age of the first wheezing episode was 4 (IQR 3-7) months. During the time interval between the two bronchoscopies, malacia lesions resolved in 50 patients (63.3%), improvement was seen in 14 patients (17.7%), no change was observed in 11 patients (13.9%), and the condition was aggravated in 4 patients (5.1%). The malacia lesions in 37 patients resolved before 2 years of age. Among the 50 resolved patients, 22 patients (44.0%) reported wheezing three times or more between bronchoscopy evaluations, and 13 of these 22 patients (59.1%) with atopy or family history of allergic diseases were ultimately diagnosed with bronchial asthma. Conclusions:In children with persistent wheezing, the role of TBM should be reassessed, especially in those with atopy or family history of allergic diseases, and bronchial asthma should be considered early.
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