ORCID Profile
0000-0001-9741-0986
Current Organisation
Nanjing Medical University
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Publisher: Springer Science and Business Media LLC
Date: 20-01-2016
Publisher: Springer Science and Business Media LLC
Date: 04-10-2021
DOI: 10.1007/S11657-021-01009-1
Abstract: This study reports hospitalization costs of fracture in Chinese patients aged over 45 years and evaluates their related factors in different fracture groups. To report hospitalization costs of treating fractures in Chinese patients aged over 45 years and to investigate the sociodemographic and health system factors related to variation in the costs. Study participants were selected from the 2016 Health Accounts Database in Jiangsu in which patients' hospitalization costs were kept at various levels in hospitals. A multi-stage stratified s ling method was used to select study participants. Electronic medical records of patients aged 45 years and over with fractures were included. The International Classification of Diseases, Tenth Revision (ICD-10) was used to identify patients who were hospitalized due to fractures. A generalized linear model was used to estimate the extent to which a range of health system and sociodemographic factors were associated with the variation on hospitalization costs. Costs data were presented and analyzed using 2016 U.S. dollars. A total of 39,300 patients were included in the study. Vertebra, tibia/fibula, and hip were the most frequent fracture sites. The mean (median) of hospitalization cost of included fractures ranged from USD 3142 (USD 2420) for hand and wrist fractures to USD 10,355 (USD 9673) for hip fractures. Longer length of hospital stay, higher hospital level, and being covered by a health insurance were associated with higher hospitalization costs for all fracture types. Our study reports hospital costs of the fracture using a large health accounts database in China and investigates the associated factors of hospital costs. Our results may inform cost-of-illness studies and economic evaluations of fracture preventions.
Publisher: Springer Science and Business Media LLC
Date: 10-01-2017
Publisher: Springer Science and Business Media LLC
Date: 02-02-2018
Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJOPEN-2018-025184
Abstract: ‘Horizontal inequity’ in healthcare finance occurs when people with equal income contribute unequally to healthcare payments. Prior research is lacking on horizontal inequity in China. Accordingly, this study set out to examine horizontal inequity in the Chinese healthcare financing system in 2002 and 2007 through two rounds of national household health surveys. Two rounds of cross-sectional study. Heilongjiang Province, China. Adopting a multistage stratified random s ling, 3841 households with 11 572 in iduals in 2003 and 5530 households with 15 817 in iduals in 2008 were selected. The decomposition method of Aronson et al was used in the present study to measure the redistributive effects and horizontal inequity in healthcare finance. Over the period 2002–2007, the absolute value of horizontal inequity in total healthcare payments decreased from 93.85 percentage points to 35.50 percentage points in urban areas, and from 113.19 percentage points to 37.12 percentage points in rural areas. For public health insurance, it increased from 17.84 percentage points to 28.02 percentage points in urban areas, and decreased from 127.93 percentage points to 0.36 percentage points in rural areas. Horizontal inequity in out-of-pocket payments decreased from 79.92 percentage points to 24.83 percentage points in urban areas, and from 127.71 percentage points to 53.10 percentage points in rural areas. Our results show that horizontal inequity in total healthcare financing decreased over the period 2002–2007 in China. In addition, out-of-pocket payments contributed most to the extent of horizontal inequity, which were reduced both in urban and rural areas over the period 2002–2007.
Publisher: Springer Science and Business Media LLC
Date: 07-06-2017
DOI: 10.1007/S11136-017-1614-5
Abstract: Despite a flurry of cost utility analyses conducted in the Chinese population in recent years, a standard set of health state utilities (HSUs) for the Chinese population is lacking. The aims of this study were to (1) determine benchmark age- and sex-specific HSUs for a Chinese population, and (2) assess key correlates of HSUs in this population. Quality-of-life was evaluated using the validated EQ-5D-3L questionnaire. HSUs were calculated using data collected from Gansu Province (n = 9833). Overall differences in HSUs were analysed using linear regression and a two-tailed p value <0.05 was determined to be statistically significant. The minimal difference in weighted index was set at 0.074. HSUs decreased with age in both males and females. Living in the non-capital areas, being separated/ orced/widowed or never married, being never educated, diagnosed with chronic disease, and no regular physical activity were associated with lower HSUs. HSUs for women were lower than for men in univariate regression analysis however, no differences were found after adjusting for other covariates. In addition, the difference in HSU reached the level of minimal difference in weighted index for participants with chronic disease. HSUs for those who were diagnosed with chronic disease were 0.098 (0.092-0.104) lower than those without chronic disease. This study reports HSUs for a Chinese population in Gansu and investigates the key correlates of HSUs in this population. In addition, the use of EQ-5D-3L in assessing population health is limited given the high ceiling effect and skewed HSUs.
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Informa UK Limited
Date: 03-2016
DOI: 10.2147/PPA.S100175
Publisher: Wiley
Date: 21-05-2021
DOI: 10.1002/HEC.4281
Abstract: Health economics uses quality adjusted life years (QALYs) to help healthcare decision makers. However, unlike life expectancy for which age‐ and sex‐dependent national life tables are available, no general population norms exist to use as a benchmark against which to compare observed or modeled projections of QALYs in sub‐populations or patients. We developed a 2‐state Markov model to generate QALY population norms for the USA, UK, China and Australia. Annual age‐ and sex‐specific probabilities of all‐cause mortality were taken from life tables combined with general population country‐specific age‐ and sex‐specific health state utilities for the EQ‐5D‐3L (all countries) and SF‐6D (Australia) multi‐attribute utility instruments (MAUI). To validate our QALY benchmark model we found that the model closely predicted population life expectancies. Using EQ‐5D‐3L, undiscounted QALYs for males/females aged 18 years ranged 54.62/58.90 (USA), 55.55/60.21 (China), 57.11/60.16 (Australia), and 58.01/61.43 (UK) years. SF‐6D benchmark QALYs for Australia were consistently lower than those generated from the EQ‐5D‐3L. The gap in undiscounted QALYs between the UK (highest) and the USA (lowest) was 2.53 QALYs in women and 3.39 QALYs in men aged 18 years. Our model's QALY population norms can be used for internal validation of future health economic models for the country‐specific value sets for the instruments that we adopted, and when quantifying burden of disease in terms of QALYs lost due to illness compared to the general population. We have created a publicly available repository to continuously include QALY benchmarks that use country‐specific value sets for other MAUIs and life expectancies.
Publisher: Springer Science and Business Media LLC
Date: 10-02-2023
Publisher: Elsevier BV
Date: 04-2023
Publisher: Public Library of Science (PLoS)
Date: 17-03-2015
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJGH-2021-007714
Abstract: Multimorbidity is common among patients with diabetes and can lead to catastrophic health expenditure (CHE) for their families. This study aims to investigate the prevalence of multimorbidity and CHE among people with diabetes in China, and the association between multimorbidity and CHE and whether this is influenced by socioeconomic status and health insurance type. A national survey was conducted in China in 2013 that included 8471 people aged ≥18 years who were living with diabetes. The concentration curve and concentration index were used to measure socioeconomic-related inequalities. Factors influencing CHE and the impact of multimorbidity on CHE according to socioeconomic status and health insurance type were examined by logistic regression. There were 5524 (65.2%) diabetes patients with multimorbidity. The prevalence of CHE was 56.6%, with a concentration index of −0.030 (95% CI −0.035 to –0.026). For each additional chronic disease, the probability of CHE increased by 39% (OR=1.39, 95% CI 1.31 to 1.47). Factors that were positively associated (p .05) with CHE included older age male sex lower educational level being retired, unemployed or jobless being a non-smoker and non-drinker having had no physical examination lower socioeconomic status being in an impoverished family and residing in the central or western regions. Among participants with Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical Scheme, the probability of CHE increased by 32% (OR=1.32, 95% CI 1.23 to 1.43), 43% (OR=1.43, 95% CI 1.24 to 1.65) and 47% (OR=1.47, 95% CI 1.33 to 1.63), respectively, with each additional chronic disease. The association between multimorbidity and CHE was observed across all health insurance types irrespective of socioeconomic status. Multimorbidity affects about two-thirds of Chinese patients with diabetes. Current health insurance schemes offer limited protection against CHE to patients’ families.
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJGH-2020-003570
Abstract: This study aims to systematically evaluate vertical and horizontal equity in the Chinese healthcare financing system over the period 2008–2018 during the progress towards Universal Health Coverage (UHC), and to examine how both types of equity have changed during this period. Household information on healthcare payments was collected from 2398 households involving 7021 in iduals in 2008, 3600 households involving 10 466 in iduals in 2013 and 3660 households involving 11 550 in iduals in 2018. Redistributive effects of healthcare financing system were decomposed into progressivity, pure horizontal inequity and reranking. Progressivity analysis and the Aronson-Johnson-Lambert decomposition method were adopted to measure the vertical equity and horizontal equity of healthcare financing. Over the period 2008–2018, healthcare financing through indirect taxes showed a slightly prorich structure and healthcare financing through direct taxes showed a propoor structure in both urban and rural areas. Urban Employee Basic Medical Insurance experienced redistribution from the poor to the rich during the period 2008–2013, but then experienced redistribution from the rich to the poor during the period 2013–2018. Urban Resident Basic Medical Insurance (URBMI), New Rural Cooperative Medical Scheme (NRCMS), Urban and Rural Resident Basic Medical Insurance (URRBMI) and out-of-pocket payments experienced redistribution from the poor to the rich over the entire period. China’s healthcare financing has experienced redistribution from the poor to the rich during 10 years of progress toward the UHC. UHC improved access to and utilisation of healthcare in urban areas. The flat rate contribution mechanism should be renovated for URBMI, NRCMS and URRBMI.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2015
DOI: 10.1007/S00198-015-3093-2
Abstract: A state-transition microsimulation model was used to project the substantial economic burden to the Chinese healthcare system of osteoporosis-related fractures. Annual number and costs of osteoporosis-related fractures were estimated to double by 2035 and will increase to 5.99 (95 % CI 5.44, 6.55) million fractures costing $25.43 (95 % CI 23.92, 26.95) billion by 2050. Consequently, cost-effective intervention policies must urgently be identified in an attempt to minimize the impact of fractures. The aim of the study was to project the osteoporosis-related fractures and costs for the Chinese population aged ≥50 years from 2010 to 2050. A state-transition microsimulation model was used to simulate the annual incident fractures and costs. The simulation was performed with a 1-year cycle length and from the Chinese healthcare system perspective. Incident fractures and annual costs were estimated from 100 unique patient populations for year 2010, by multiplying the age- and sex-specific annual fracture risks and costs of fracture by the corresponding population totals in each of the 100 categories. Projections for 2011-2050 were performed by multiplying the 2010 risks and costs of fracture by the respective annual population estimates. Costs were presented in 2013 US dollars. Approximately 2.33 (95 % CI 2.08, 2.58) million osteoporotic fractures were estimated to occur in 2010, costing $9.45 (95 % CI 8.78, 10.11) billion. Females sustained approximately three times more fractures than males, accounting for 76 % of the total costs from 1.85 (95 % CI 1.68, 2.01) million fractures. The annual number and costs of osteoporosis-related fractures were estimated to double by 2035 and will increase to 5.99 (95 % CI 5.44, 6.55) million fractures costing $25.43 (95 % CI 23.92, 26.95) billion by 2050. Our study demonstrated that osteoporosis-related fractures cause a substantial economic burden which will markedly increase over the coming decades. Consequently, healthcare resource planning must consider these increasing costs, and cost-effective screening and intervention policies must urgently be identified in an attempt to minimize the impact of fractures on the health of the burgeoning population as well as the healthcare budget.
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-019564
Abstract: Government healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China’s rural ethnic minority areas. Inner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province. Two rounds of cross-sectional study. One thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed. Benefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified s les were conducted. The overall CI for outpatient care was –0.0146 (P .05) in 2010 and –0.0992 (P .01) in 2013. In 2010, the CI was –0.0537 (P .01), –0.0085 (P .05) and −0.0034 (P .05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was –0.1353 (P .05), –0.0695 (P .05) and –0.1633 (P .01) at the levels of VCs, THCs and CHs, respectively. Implementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients’ care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution.
Publisher: Public Library of Science (PLoS)
Date: 10-2014
No related grants have been discovered for Mingsheng Chen.