The coronavirus disease 2019(COVID-19)pandemic increased the burden on many healthcare systems and in the process,exposed the need for medical resources and physical space.While few studies discussed the efficient uti...The coronavirus disease 2019(COVID-19)pandemic increased the burden on many healthcare systems and in the process,exposed the need for medical resources and physical space.While few studies discussed the efficient utilization of medical resources and physical space so far.Therefore,this study aimed to summarize experiences related to facilities used for centralized isolation for medical observation and treatment during the COVID-19 pandemic in China and to provide suggestions to further improve the management of confirmed cases,suspected cases,and close contacts.In China,three types of facilities for centralized isolation(Fangcang shelter hospitals,refitted non-designated hospitals,and quarantine hotels)underwent retrofitting for the treatment and isolation of confirmed and suspected cases.These facilities mitigated the immediate high demand for space.Moreover,in order to minimize infection risks in these facilities,regulators and governmental agencies implemented new designs,management measures,and precautionary measures to minimize infection risk.Other countries and regions could refer to China’s experience in optimally allocating social resources in response to the COVID-19 pandemic.As a conclusion,government should allocate social resources and construct centralized isolation and quarantine facilities for an emergency response,health authorities should issue regulations for centralized isolation facilities and pay strict attention to the daily management of these facilities,a multidisciplinary administration team is required to support the daily operation of a centralized isolation facility,in-depth studies and international collaboration on the centralized isolation policy are encouraged.展开更多
Background:The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014,designed specifically for patients diagnosed with Tuberculosis(TB).This study aimed to examine the...Background:The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014,designed specifically for patients diagnosed with Tuberculosis(TB).This study aimed to examine the changes in utilization and expenses of outpatient services before and after the reform implementation,among TB patients in the three counties in China.Methods:We collected quantitative data using surveys in 2013(baseline year)and 2015(final year).We used outpatient hospital records to measure service utilization and medical expenses of TB patients.We conducted qualitative interviews with local health authorities,officers of health insurance agencies,and hospital managers(n=18).We utilized three focus group discussions with hospital staff and TB doctors and nurses.The x^2 tests and Mann-Whitney U tests were used to analyse quantitative data,and the thematic analysis using a framework approach was applied to analyse qualitative data.Results:Dantu and Yangzhong counties enacted TB-specific case-based payment method in 2014.Jurong County maintained global budget payment but raised the reimbursement rate for TB care.Compared to the baseline,the percentage of TB patients in Dantu and Yangzhong with eight or above outpatient visits increased from 7.5 to 55.1%and from 22.1 to 53.1%in the final survey,respectively.Jurong experienced the opposite trend,decreasing from 63.0 to 9.8%.In the final survey,the total outpatient expenses per patient during a full treatment course in Dantu(RMB 2939.7)and Yangzhong(RMB 2520.6)were significantly higher than those in the baseline(RMB 690.4 and RMB 1001.5,respectively),while the total outpatient expenses in Jurong decreased significantly(RMB 1976.0 in the baseline and RMB 660.8 in the final survey).Health insurance agencies in Dantu and Yangzhong did not approve the original design with outpatient and inpatient expenses packaged together,revealed by qualitative interviews.Furthermore,staff at designated hospitals misunderstood that health insurance agencies would only reimburse actual expenses.Many TB doctors complained about their reduced salary,which might be due to decreased hospital revenue generated from TB care after the payment method reform.Conclusions:The intended effect on cost containment of case-based payment was not evident in Dantu and Yangzhong.In Jurong,where the global budget payment system maintained with the reimbursement rate enhanced,we found an effect on cost containment but the quality of TB care might be compromised.The TBspecific case-based payment method could be redesigned to combine payment on outpatient and inpatient expenses and to set an appropriate payment standard for TB care during a full treatment course.Local health insurance agencies have to provide explicit explanations on the payment method.TB care providers should be provided with proper incentives.Monitoring and evluaiton on the quality of TB care should be undertaken at regular intervals.展开更多
Chronic obstructive pulmonary disease(COPD)is an epidemic in China.Ozone is a possible risk factor of COPD,with ozone concentrations increasing in China,despite air pollution mitigation measures that reduced particula...Chronic obstructive pulmonary disease(COPD)is an epidemic in China.Ozone is a possible risk factor of COPD,with ozone concentrations increasing in China,despite air pollution mitigation measures that reduced particulate matter.The WHO Air Quality Guidelines(AQG)recommendations in 2021 are a turning point that formally recognizes the crucial role of indoor air pollution.We aimed to investigate the premature COPD deaths attributable to ozone in 2019,taking the WHO AQG 2021 level into account to determine the gap to bridge ozone control in China.First,we assessed ozone exposures initiated from indoor and outdoor sources by gender and age groups in 344 cities under four scenarios:2019 as a baseline,and outdoor ozone at WHO AQG 2021 level in 2019,2030,and 2050,respectively.Subsequently,we estimated COPD deaths attributable to ozone.The results show that the COPD deaths attributable to ozone are 77,737 in 2019,and 527,872,1355 if the outdoor ozone concentration is reduced to the WHO AQG 2021 level in 2019(counterfactual scenario),2030,and 2050,respectively in urban China.The indoor ozone sources only contribute to less than 5%of COPD deaths.A gap of 68.5μg/m3 for the highest seasonal ozone concentration should be bridged to meet the WHO AQG 2021 and avoid over 76 thousand(98%)COPD deaths in 2019 in urban China.展开更多
文摘The coronavirus disease 2019(COVID-19)pandemic increased the burden on many healthcare systems and in the process,exposed the need for medical resources and physical space.While few studies discussed the efficient utilization of medical resources and physical space so far.Therefore,this study aimed to summarize experiences related to facilities used for centralized isolation for medical observation and treatment during the COVID-19 pandemic in China and to provide suggestions to further improve the management of confirmed cases,suspected cases,and close contacts.In China,three types of facilities for centralized isolation(Fangcang shelter hospitals,refitted non-designated hospitals,and quarantine hotels)underwent retrofitting for the treatment and isolation of confirmed and suspected cases.These facilities mitigated the immediate high demand for space.Moreover,in order to minimize infection risks in these facilities,regulators and governmental agencies implemented new designs,management measures,and precautionary measures to minimize infection risk.Other countries and regions could refer to China’s experience in optimally allocating social resources in response to the COVID-19 pandemic.As a conclusion,government should allocate social resources and construct centralized isolation and quarantine facilities for an emergency response,health authorities should issue regulations for centralized isolation facilities and pay strict attention to the daily management of these facilities,a multidisciplinary administration team is required to support the daily operation of a centralized isolation facility,in-depth studies and international collaboration on the centralized isolation policy are encouraged.
文摘Background:The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014,designed specifically for patients diagnosed with Tuberculosis(TB).This study aimed to examine the changes in utilization and expenses of outpatient services before and after the reform implementation,among TB patients in the three counties in China.Methods:We collected quantitative data using surveys in 2013(baseline year)and 2015(final year).We used outpatient hospital records to measure service utilization and medical expenses of TB patients.We conducted qualitative interviews with local health authorities,officers of health insurance agencies,and hospital managers(n=18).We utilized three focus group discussions with hospital staff and TB doctors and nurses.The x^2 tests and Mann-Whitney U tests were used to analyse quantitative data,and the thematic analysis using a framework approach was applied to analyse qualitative data.Results:Dantu and Yangzhong counties enacted TB-specific case-based payment method in 2014.Jurong County maintained global budget payment but raised the reimbursement rate for TB care.Compared to the baseline,the percentage of TB patients in Dantu and Yangzhong with eight or above outpatient visits increased from 7.5 to 55.1%and from 22.1 to 53.1%in the final survey,respectively.Jurong experienced the opposite trend,decreasing from 63.0 to 9.8%.In the final survey,the total outpatient expenses per patient during a full treatment course in Dantu(RMB 2939.7)and Yangzhong(RMB 2520.6)were significantly higher than those in the baseline(RMB 690.4 and RMB 1001.5,respectively),while the total outpatient expenses in Jurong decreased significantly(RMB 1976.0 in the baseline and RMB 660.8 in the final survey).Health insurance agencies in Dantu and Yangzhong did not approve the original design with outpatient and inpatient expenses packaged together,revealed by qualitative interviews.Furthermore,staff at designated hospitals misunderstood that health insurance agencies would only reimburse actual expenses.Many TB doctors complained about their reduced salary,which might be due to decreased hospital revenue generated from TB care after the payment method reform.Conclusions:The intended effect on cost containment of case-based payment was not evident in Dantu and Yangzhong.In Jurong,where the global budget payment system maintained with the reimbursement rate enhanced,we found an effect on cost containment but the quality of TB care might be compromised.The TBspecific case-based payment method could be redesigned to combine payment on outpatient and inpatient expenses and to set an appropriate payment standard for TB care during a full treatment course.Local health insurance agencies have to provide explicit explanations on the payment method.TB care providers should be provided with proper incentives.Monitoring and evluaiton on the quality of TB care should be undertaken at regular intervals.
基金supported by the National Natural Science Foundation of China(No.51978366)and Research Fund(No.2021JC005),Vanke School of Public Health,Tsinghua University.MY acknowledges financial support from the Shuimu Tsinghua Scholar Program(No.2021SM002).
文摘Chronic obstructive pulmonary disease(COPD)is an epidemic in China.Ozone is a possible risk factor of COPD,with ozone concentrations increasing in China,despite air pollution mitigation measures that reduced particulate matter.The WHO Air Quality Guidelines(AQG)recommendations in 2021 are a turning point that formally recognizes the crucial role of indoor air pollution.We aimed to investigate the premature COPD deaths attributable to ozone in 2019,taking the WHO AQG 2021 level into account to determine the gap to bridge ozone control in China.First,we assessed ozone exposures initiated from indoor and outdoor sources by gender and age groups in 344 cities under four scenarios:2019 as a baseline,and outdoor ozone at WHO AQG 2021 level in 2019,2030,and 2050,respectively.Subsequently,we estimated COPD deaths attributable to ozone.The results show that the COPD deaths attributable to ozone are 77,737 in 2019,and 527,872,1355 if the outdoor ozone concentration is reduced to the WHO AQG 2021 level in 2019(counterfactual scenario),2030,and 2050,respectively in urban China.The indoor ozone sources only contribute to less than 5%of COPD deaths.A gap of 68.5μg/m3 for the highest seasonal ozone concentration should be bridged to meet the WHO AQG 2021 and avoid over 76 thousand(98%)COPD deaths in 2019 in urban China.
