The primary objective of this paper is to evaluate the impact of Taiwan's National Health Insurance program (NHI), established in 1995, on improving elderly access to care and health status. Further, we estimate the extent to which NHI reduces gaps in access and health across income groups. Using data from a longitudinal survey, we adopt a difference-in-difference methodology to estimate the causal effect of Taiwan's NHI. Our results show that Taiwan's NHI has significantly increased utilization of both outpatient and inpatient care among the elderly, and such effects were more salient for people in the low- or middle-income groups. Our findings also reveal that although Taiwan's NHI greatly increased the utilization of both outpatient and inpatient services, this increased utilization of health services did not reduce mortality or lead to better self-perceived general health status for Taiwanese elderly. Measures more sensitive than mortality and self-perceived general health may be necessary for discerning the health effects of NHI. Alternatively, the lack of NHI effects on health may reflect other quality and efficiency problems inherent in the system not yet addressed by NHI.

BackgroundRecently Echinoderm microtubule-associated protein-like 4- anaplastic lymphoma kinase (EML4-ALK) fusion gene has become an important biomarker for ALK tyrosine kinase inhibitor (crizotinib) treatment in NSCLC. However, the best detection method and the significance of EML4-ALK variant types remain uncertain.MethodsReverse transcriptase-polymerase chain reaction (RT-PCR), fluorescence in Situ hybridization (FISH) and Immunohistochemical (IHC) stain were performed on tumor tissues of 312 NSCLC patients for detection of ALK rearrangements. Mutation analyses for EGFR and KRAS genes were also performed.ResultsThirteen of the 312 patients (4.17%) had ALK rearrangements detected by RT-PCR. If RT-PCR data was used as the gold standard, FISH tests had a low sensitivity (58.33%), but very good specificity (99.32%). IHC stain had better sensitivity (91.67%) than FISH, but lower specificity (79.52%), when the cut off was IHC2+. All of the 8 patients with high abundance of EML4-ALK positive cells in tumor tissues (assessed by the signal intensities of the RT-PCR product), were also have high expression of ALK protein (IHC3+), and positive for FISH, except one failed in FISH. Variants 3a+3b (4/5, 80%) of EML4-ALK fusion gene were more common to have high abundance of EML4-ALK positive cells in tumor tissues than variant 1 (1/3, 33.3%). Meta-analysis of the published data of 2273 NSCLC patients revealed that variant 3 (23/44, 52.3%) was the most common type in Chinese population, while variant 1 (28/37, 75.7%) was most common in Caucasian.ConclusionsAmong the three detection methods, RT-PCR could detect not only the presence of EML4-ALK fusion gene and their variant types, but also the abundance of EML4-ALK positive cells in NSCLC tumor tissues. The latter two factors might affect the treatment response to anti-ALK inhibitor. Including RT-PCR as a diagnostic test for ALK inhibitor treatment in the prospective clinical trials is recommended.

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BackgroundThe online health care community is not just a place for the public to share physician reviews or medical knowledge, but also a physician-patient communication platform. The medical resources of developing countries are relatively inadequate, and the online health care community is a potential solution to alleviate the phenomenon of long hospital queues and the lack of medical resources in rural areas. However, the success of the online health care community depends on online contributions by physicians.ObjectiveThe aim of this study is to examine the effect of incentive mechanisms on physician’s online contribution behavior in the online health community. We addressed the following questions: (1) from which specialty area are physicians more likely to participate in online health care community activities, (2) what are the factors affecting physician online contributions, and (3) do incentive mechanisms, including psychological and material rewards, result in differences of physician online contributions?MethodsWe designed a longitudinal study involving a data sample in three waves. All data were collected from the Good Doctor website, which is the largest online health care community in China. We first used descriptive statistics to investigate the physician online contribution behavior in its entirety. Then multiple linear and quadratic regression models were applied to verify the causal relationship between rewards and physician online contribution.ResultsOur sample included 40,300 physicians from 3607 different hospitals, 10 different major specialty areas, and 31 different provinces or municipalities. Based on the multiple quadratic regression model, we found that the coefficients of the control variables, past physician online contributions, doctor review rating, clinic title, hospital level, and city level, were .415, .189, –.099, –.106, and –.143, respectively. For the psychological (or material) rewards, the standardized coefficient of the main effect was 0.261 (or 0.688) and the standardized coefficient of the quadratic effect was –0.015 (or –0.049). All estimates were statistically significant (P<.001).ConclusionsPhysicians with more past physician online contribution, with higher review ratings, coming from lower level clinics, not coming from tertiary hospitals, and not coming from big cities were more willing to participate in online health care community activities. To promote physician online contribution, it is necessary to establish an appropriate incentive mechanism including psychological and material rewards. Finally, our findings suggest two guidelines for designing a useful incentive mechanism to facilitate physician online contribution. First, material reward is more useful than psychological reward. Second, as indicated by the concave-down-increasing causal relationship between rewards and physician online contribution, although an appropriate reward is effective in encouraging willingness on the part of physicians to contribute to the online health care community, the effect o...

Purpose Electronic word-of-mouth (eWOM) is very important for consumer decision making; previous international product diffusion studies have investigated eWOM and cultural factors that influence consumers’ acceptance of new products, but they have not adequately compared the differences in these factors between the USA and China. Therefore, the purpose of this paper is to compare the impact of eWOM on consumer choices in China and the USA. The authors addressed the following questions: What are the cross-cultural differences in consumers’ eWOM behavior between the USA and China: Which genres of Hollywood movies have better cross-culture predictability in terms of box office performance; and What factors affect the success of Hollywood movies in entering the Chinese market? Design/methodology/approach Real eWOM data were collected from two online movie review websites, IMDb.com (the USA) and Douban.com (China), from January 2010 to December 2015. In addition, box office revenue information was collected from BoxOfficeMojo.com. The authors used an independent sample t-test to check whether the differences in consumers’ eWOM behavior between China and the USA and different types of movie lead to cultural discount differences. Furthermore, a log-linear regression model is used to examine which factors influence the commercial success of new movies. Findings There are specific similarities and differences between the American and Chinese movie markets. First, the results show that American consumers are more engaged in online review systems and tend to submit extreme reviews, but Chinese consumers tend to submit moderate reviews on movies, and the eWOM variance there is smaller than in the USA. Second, genres are useful variables as indicators of movie content; the genres of comedy and drama are not popular in the Chinese market. Finally, eWOM variance has a positive impact on box office in China, but eWOM variance has no impact on the US box office. In addition, the interactive effect of the average rating and eWOM variance on sales is positively significant in China. Importantly, the one-star reviews have a negative impact on the Chinese box office, but it has no impact on US box office. Practical implications Understanding how cultural factors influence consumer eWOM communication will help managers to better apply this new marketing communication tool to create more aggressive and targeted promotional plans. Marketers may use eWOM behavior to better respond to and target consumers to overcome barriers to the selection of their products by consumers. Therefore, more effective management of eWOM can improve the acceptance of and preference for products in different cultural consumer groups. Originality/value This study expands the existing body of knowledge on eWOM and international marketing literature. Clearly, culture is an important determinant of eWOM’s impact on sales. In addition, it provides strategic direction and practical implications for eWOM communication management in cross-cultural settings.