Purpose: To investigate the total current curative expenditure (CCE) of lung cancer in Hunan Province, China under the framework of the System of Health Accounts 2011 (SHA 2011) and explore the effect of insurance status, surgery and length of stay on the hospitalization expenses of patients with lung cancer. Methods: Through multistage stratified cluster random sampling, a total of 46,214 patients with lung cancer were enrolled from 1,072 medical institutions in Hunan Province in 2016. Under the SHA 2011 framework, the lung cancer CCE was analyzed. The relationships between hospitalization expenditure and the following factors (surgery, type of hospital, insurance status, length of stay, institution level, age and sex) were analyzed using Spearman's correlation analyses, and how these factors influenced hospital expenditure was explored through multiple stepwise regression analysis and structural equation modelling. Results: The CCE for lung cancer patients was 8063.75 million CNY. In total, 96.03% of the CCE for lung cancer occurred in hospitals and 58.88% of the expenditure flowed to general hospitals. The highest expenditures were incurred in the group aged 55-74 y, which accounted for 61.58% of the CCE. Drugs accounted for the greatest share expenditure to lung cancer patients at 34.31% of the CCE. Surgery, insurance status, institution level, sex and hospital type explained 57.5% of the variance in hospital expenses. The hospitalization expenses were related to surgery, insurance status, institution level and sex (rs = 0.033-0.688, p < 0.001). Surgery, insurance status and length of stay had direct effects on hospitalization expenses. Length of stay mediated the relationship between surgery and hospitalization expenses for lung cancer patients. Surgery mediated the relationship between insurance status and hospitalization expenses. All of these variables can explain 45% of the variance in hospitalization expenses. Conclusions: The CCE of lung cancer is extremely high. The problems related to treatment efficiency and equity are serious for lung cancer patients in China. It is essential to expand health insurance coverage and reduce the curative expenditure of lung cancer.
Background: The problem of AIDS response has not only involved public health, but also had a great impact on the family burden.The objective of this study was to estimate the preventive and curative care expenditure(PCE)for AIDS of Hunan Province in 2017 based on System of Health Accounts 2011(SHA2011)by quantity,financing scheme, health provider,health function,and to analyses the factors affecting patients' medical burden. Methods: Through stratified multi-stage sampling method, 1336 institutions were surveyed to obtain AIDS prevention and control data, and the official data collected from Health Statistical Yearbook, Health Financial Annual Reports and Government Input Monitoring System were used to estimate the AIDS PCE based on SHA2011. Univariate analyses and ordered logistic regression were used to evaluate the factors affecting the medical burden of AIDS patients. Results: The AIDS PCE of Hunan Province in 2017 was 266.67 million, mainly flowed to hospitals and disease prevention and control institutions. The proportions of curative care expenditure(CCE) and prevention expenditure were 51.39 and 48.61% respectively. Prevention expenditure were mainly used for traditional prevention methods. All prevention expenditure and 88.52% of CCE were borne by public financing scheme. Family health expenditure accounted for 11.12% of CCE, but there were still some people with heavy burden of treatment. Non insurance, coinfection and length of stay are risk factors to the total hospitalization expenses(Totalexp)and the out-of-pocket payments(OOPs)(all p < 0.05,OR > 1). Taking the age group under 30 as the reference, the partial regression coefficient of the age group over 60 was statistically significant (OR (Totalexp) = 1.809, OR (OOPs) = 0.30). Conclusion: The financing structure of the PCE for AIDS in Hunan Province was relatively stable and the flow of institutions was reasonable. The functional flow of expenditure embodied the principle of "prevention first". China should incorporate oral PrEP into the national guidelines as soon as possible to improve the allocation efficiency of AIDS prevention resources. Meantime, several measures should be taken to reduce the medical burden of AIDS patients, including expanding the scope of government assistance, adjusting insurance compensation measures, increasing the rate of patients participating in insurance,encouraging commercial insurance to join the AIDS insurance system,and controlling length of stay in hospital.
Background The problem of AIDS response has not only involved public health, but also had a great impact on the family burden.The objective of this study was to estimate Hunan Province preventive and curative care expenditure(PCE) of AIDS in 2017 based on System of Health Accounts 2011 by quantity,financing scheme,health provider,health function,and to analyse the factors affecting patients' medical burden.Methods Through stratified multi-stage sampling method, 1336 institutions were surveyed to obtain AIDS prevention and control data, and combined with official data of Hunan Health Statistical Yearbook, Health Financial Yearbook and Government Input Monitoring System to estimate the AIDS PCE under the framework of SHA2011.Univariate analysis and ordered logistic regression were used to evaluate the factors affecting the medical burden of AIDS patients.Results The AIDS PCE of Hunan in 2017 was 266.67 million, mainly flowed to hospitals and disease prevention and control institutions. The proportions of curative care expenditure(CCE) and prevention expenditure were 51.39%, 48.61% respectively. From the point of view of the allocation of prevention expenditure, AIDS prevention methods were relatively traditional, and oral PrEP was not included in the national plan. All prevention expenditure and 88.52% of CCE were borne by public financing scheme.Family health expenditure accounted for 11.21% of CCE. None insurance, co-infection and length of stay are risk factors to the total expenditure of hospitalization and out-of-pocket health expenditure(all p <0.05,OR>1).Taking the age group under 30 as the reference, the partial regression coefficient of the age group over 60 was statistically significant ( OR (Totalexp) =1.809, OR (OOP) =0.30).Conclusions The financing structure of the Hunan Province PCE of AIDS was relatively stable and the flow of institutions was reasonable. The functional flow of expenditure embodied the principle of "prevention first". China should incorporate oral PrEP into the national guidelines as soon as possible to improve the allocation efficiency of AIDS prevention resources. Meantime, several measures should be taken to reduce the hospitalization expenses and medical burden of AIDS patients, including adjusting insurance compensation measures, increasing the rate of patients participating in insurance,encouraging commercial insurance to join the AIDS insurance system,and controlling length of stay in hospital.
KAT6A syndrome is an autosomal dominant genetic disorder associated with intellectual disability due to mutations in the lysine acetyltransferase 6A ( KAT6A) gene. There are some differences in phenotype between KAT6A gene variants. This current case report describes a 1-month-old male infant that had a nonsense mutation in the KAT6A gene. Neither of his parents had the mutation. The proband had feeding difficulties and a physical examination revealed the following: moderate dysphagia, hypoplastic laryngeal cartilage, poor audio-visual response, poor head-up ability, no active grasping awareness, microcephaly, high arched palate and he was significantly behind other children of the same age. Echocardiography showed that the foramen ovale was not closed. He was diagnosed with atrial septal defect (ASD) when 2 years old. The patient received ASD repair at 32 months of age. Head colour Doppler ultrasonography and brain magnetic resonance imaging showed cysts in the right ventricle and choroid plexus, which returned to normal at 2 years of age. This current case demonstrates that immediate surgery should be considered in newborns with KAT6A syndrome presenting with a heart malformation. A new KAT6A syndrome phenotype is described in this current case report, which requires early diagnosis and treatment.
Background: Respiratory disease is now the leading cause of morbidity and mortality worldwide. They simultaneously impact public health at the population level and also cause great financial distress for families . Understanding the distribution of diseases and the Current Curative Expenditure (CCE) can provide a basis for policy decisions and interventions. This study analyzed the status of respiratory diseases spending using data from “System of Health Accounts 2011” (SHA 2011) to provide health policy advice to Hunan Province, China, and insights for other more developed areas in China. Methods: Data were collected by multi-stage stratified random sampling approach and the medical expenses of patients with respiratory diseases were calculated based on the SHA 2011, including the dimensions of institutional resource flow and service function. Regression analyses were conducted to identify influencing factors of hospitalization expenses. All analyses were conducted using software SPSS 25.0. Results: The CCE for Respiratory diseases in 2017 was 215.42 billion Chinese yuan (CNY), accounting for 15.94% of total expenditure on health in Hunan Province, China. Children aged 0-4 and elderly aged 60-69 spent the most on the treatment for such diseases. Length of stay, age, and institution level were the three most important factors affecting hospitalization expenses. Conclusions: The CCE of respiratory diseases is extremely high, with problems related to treatment efficiency and equity. It is essential to expand health insurance coverage, establish hierarchical medical system, and reduce curative expenditure.
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