Multiple sclerosis (MS) is a rare disease in China. Evidence on the extent and contributing factors of diagnostic delay in China remains limited. This study aimed to assess the proportion and duration of diagnostic delay in MS and to identify associated factors in the Chinese context. In July 2022, we conducted a nationwide cross-sectional survey in collaboration with a major Chinese MS patient network. A random sample of adults (≥ 18 years) with a clinically confirmed MS diagnosis was recruited through online patient support groups. Diagnostic delays were defined as the time between symptom onset and a confirmed MS diagnosis, with delays exceeding 3 months classified as “delayed”. Delay was further classified into pre-first-consultation and post-first-consultation intervals. Multivariable logistic regression and sensitivity analyses were used to assess associations between diagnostic delay and sociodemographic, clinical, and health system-related factors. Among the 722 participants (mean (SD) age 34.62 (9.86) years; 488 women (67.60

To measure and value the health-related quality of life (HRQOL) of Chinese Multiple sclerosis (MS) patients, and to explore the influencing factors. A national online survey amongst the patients was conducted in July 2022. Information on patient demographics, clinical characteristics (MS subtype and disability status), and the HRQOL measured by EQ-5D-5L were collected. Disability status was classified based on the self-reported Expanded Disability Status Scale (EDSS). Both the Tobit and logistic regression models were adopted to assess the impact of clinical characteristics on HRQOL with the adjustment of demographic characteristics. A total of 733 eligible patients (mean age 34.31 years; 67.7

Measuring healthcare access barriers is crucial for improving service equity. However, existing tools often lack a holistic, process-integrated approach. This study addresses this gap by developing and validating the Healthcare Access Barriers Scale (HABS), a new instrument that holistically assesses barriers before, during, and after medical visits. A cross-sectional survey was conducted among 2,009 Shanghai residents. HABS was developed based on Penchansky and Thomas’s Theory of Access and Saurman’s modification. Exploratory and confirmatory factor analyses (EFA, CFA) were used to assess its structure. Reliability and validity were tested using Cronbach’s alpha and model fit indices. EFA and CFA supported a six-factor structure of the HABS, corresponding to six key dimensions of access barriers: unawareness, unavailability, inaccessibility, inadaptability, unaffordability, and unacceptability. The HABS demonstrated strong reliability (Cronbach’s α = 0.974) and a good fit for the six-factor model (CFA: Comparative Fit Index [CFI] = 0.937, Tucker-Lewis Index [TLI] = 0.930, Root Mean Square Error of Approximation [RMSEA] = 0.069). The two most pronounced barriers were financial constraints (mean of unaffordability dimension = 3.26) and lack of awareness (unawareness = 3.19), highlighting cost burdens and health literacy gaps in this population. The HABS is a valid and reliable instrument for measuring perceived healthcare access barriers in urban populations, offering a more holistic, process-integrated assessment by capturing obstacles across the full continuum of care – before, during, and after healthcare visits. This unified scale can facilitate assessment of systematic barriers, comparisons across settings, and identification of target areas for intervention. Future use of the HABS may inform policies and programs aimed at improving access to health services and equity.

Introduction Low adherence to colonoscopy has greatly reduced the efficiency and cost-effectiveness of colorectal cancer (CRC) screening in China. This study aims to examine the cost-effectiveness of five initial tests followed by several scenarios of colonoscopy adherence.Methods A microsimulation model was constructed to compare the parallel use of risk assessment and two-specimen faecal immunochemical test (FIT) (currently used method in Shanghai) and several assumed initial tests (one-specimen FIT, two-specimen FIT, and risk scoring systems (RSS) incorporating one-specimen or two-specimen FIT) under adherence of observed levels, 50%, 60%, 70%, 80% or 90% among 100 000 individuals aged 50–74 years. Incremental cost-effectiveness ratios (ICERs) were computed using the currently used or the next most effective method as the reference. One-way and probabilistic sensitivity analyses were performed to assess the robustness of the findings.Results The RSS incorporating two-specimen FIT was more effective in reducing CRC incidence and mortality at colonoscopy adherence levels below 80%, whereas the currently used method performed better at higher adherence levels. The currently used method was effective and cost-effective for CRC screening, with an ICER relative to the next most effective method ranging from 153.000 to 29 165.120 CNY per quality-adjusted life-year. Enhancing adherence to colonoscopy increased the detection of early-stage CRC and improved the cost-effectiveness ratio and ICER of the current method. The current method had a probability of 35.5%, 34.5%, 35.5%, 40.0%, 32.0% and 38.0% for being the optimal strategy at observed level, 50%, 60%, 70%, 80% and 90% adherence, respectively, all within a willingness-to-pay threshold of 1 to 3 times the gross domestic product per capita.Conclusions The parallel use of risk assessment and two-specimen FIT is a cost-effective method for CRC screening in Chinese populations. Enhancing colonoscopy adherence may further improve the effectiveness and cost-effectiveness of the screening programme.

Objective: We explored the differences in deep venous catheterization-associated complications between patients with hematological malignancies after peripherally inserted central catheter placement and such patients after implantable venous access port catheterization. Introduction: peripherally inserted central catheters and implantable venous access ports are the most popular devices used for chemotherapy. However, no study has revealed differences between peripherally inserted central catheters and implantable venous access ports in Chinese patients with hematological malignancies. Methods: The clinical data of 322 patients with hematological malignancies who were treated from January 1, 2020 to December 30, 2021 were included in a retrospective cohort study. Postoperative color Doppler ultrasonography and follow-up results were used to compare the incidence rates of deep venous catheterization -associated complications after peripherally inserted central catheters and implantable venous access ports catheterization. Results: The relative risk of catheter-related complications considering the type of device was 8.3 (95% CI = 3.0–22.8). In addition, chi-square segmentation analysis revealed a significant difference in the complication rate between the internal jugular vein and the basilic vein (χ 2 = 22.002, p < 0.0001) and between the subclavian vein and the basilic vein (χ 2 = 28.940, p < 0.0001). Conclusion: Implantable venous access ports are safer than peripherally inserted central catheters for Chinese patients with hematological malignancies. The implantation of implantable venous access ports could be firstly considered for systematic anti-cancer treatment.

We read the Long term health related quality of life after acute type B aortic dissection: a cross sectional survey study by Meccanici et al.1 with considerable interest and noted important questions arising from the publication.

Medical insurance fraud (MIF) poses a substantial global financial challenge, necessitating effective regulatory strategies, especially in China, where such measures are in a critical developmental phase. This study investigates the effectiveness of various regulatory components in deterring MIF among enrollees and explores preference heterogeneity among individuals with different characteristics, utilizing a discrete choice experiment survey. Grounded in deterrence theory, our conceptual framework incorporates five attributes: intensity of economic penalties, restrictions on medical insurance benefits, deterioration of social reputation, and certainty and celerity of penalties. Employing a D-efficiency design, 24 choice sets were generated and blocked into three versions. A multistage stratified sampling method was adopted to collect data from the basic medical insurance enrollees in Shanghai. The survey was conducted from September to October 2022. The sample representativeness was further improved via the entropy balancing approach. Data from the final sample of 1034 respondents were analyzed using mixed logit models (MIXLs), incorporating interactions with individual characteristics to assess preference heterogeneity. Results reveal that escalating economic penalties, suspending insurance benefits, listing individuals as unfaithful parties, ensuring penalty certainty, and expediting enforcement significantly enhance the deterrent effect. We observed preference heterogeneity across different demographics, including age, gender, education, health status, and employment status. The study underscores the pivotal role of economic penalties in deterring MIF, while also acknowledging the significance of non-economic measures such as enforcement efficiency and social sanctions. These findings offer valuable insights for policymakers to tailor and strengthen regulatory schemes against MIF, contributing to the advancement of more effective and precise healthcare policies.

This systematic review aims to summarize the progress made in the study of the cost-effectiveness of robot-assisted radical prostatectomy (RARP) worldwide and to analyze the economic factors influencing this, in an attempt to provide methodological guidance for conducting economic evaluation studies in a domestic context, and to put forward suggestions for improving the cost-effectiveness of RARP in emerging markets. We conducted a systematic literature review and analysis of studies published worldwide from January 2000 to July 2024 concerning the economic evaluation of RARP compared with laparoscopic radical prostatectomy (LRP) or open radical prostatectomy (ORP). A total of 16 papers were included. The literature was generally of good quality. Methodological approaches. varied among studies, leading to inconsistent economic findings. The choice of research settings, including the perspective of the study and time horizon, as well as differences in parameters such as surgical volumes and cost of equipment purchases, were the main factors that affected the cost-effectiveness of RARP. Based on the methodology used in the included studies, we suggest that short-term, localized economic evaluations should be carried out first, based on follow-up studies in emerging markets, whereas long-term economic evaluations can be performed when sufficient data are available. Referring to the analysis of the economic factors influencing cost-effectiveness in the included studies, we suggest that different research settings should be chosen according to the purpose for which policymakers allocate public funds, and that the cost-effectiveness of RARP can be enhanced through technical improvements and resource optimization.

Multiple sclerosis (MS) is uncommon in China and the standard of care is underdeveloped, with limited utilization of disease-modifying treatment (DMT). An understanding of real-world disease burden (including direct medical, non-medical, and indirect costs, such as loss of productivity), is currently lacking in this population. To investigate the overall burden of managing patients with MS in China, a cross-sectional survey of physicians and their consulting patients with MS was conducted in 2021. Physicians provided information on healthcare resource utilization (HCRU; consultations, hospitalizations, tests, medication) and associated costs. Patients provided data on changes in their life, productivity, and impairment of daily activities due to MS. Results were stratified by disease severity using generalized linear models, with a p value < 0.05 considered statistically significant. Patients with more severe disease had greater HCRU, including hospitalizations, consultations and tests/scans, and incurred higher direct and indirect costs and productivity loss, compared with those with milder disease. However, the use of DMT was higher in patients with mild disease severity. With the low uptake and limited efficacy of non-DMT drugs, Chinese patients with MS experience a high disease burden and significant unmet needs. Therapeutic interventions could help save downstream costs and lessen societal burden.

Background: To effectively improve the regulatory systems of medical insurance, a deep dive into their impact on enrollees is essential. The challenge lies in comprehensively and quantitatively assessing these effects, amidst a noticeable research gap in evaluating regulatory impacts within the medical insurance domain. This study aimed to develop a conceptual framework based on deterrence theory to assess the effects of medical insurance regulations on deterring medical insurance fraud and abuse (MIFA) among enrollees, focusing on Shanghai as a case study. Methods: This study integrated data for analysis from three distinct sources and used mixed methods. The Database of Medical Insurance Supervision on Enrollees (DMISE), spanning 2017 to 2021, provided a foundational analysis of the system's implementation. We utilized a multistage stratified sampling method to conduct a questionnaire survey to gauge enrollees' perceptions of deterrence, employing the Enrollees' Perceived Deterrence Scale (EPDS), developed for this study. Semi-structured interviews with key informants offered deeper insights into the regulatory systems. Our evaluation was guided by a conceptual framework that identified three key dimensions of deterrence: severity, certainty, and celerity. Results: Our study analyzed 12,898 historical fraud and abuse cases, involving 10,723 enrollees, alongside 965 valid questionnaires. It revealed that the medical insurance regulatory system in Shanghai exerted a high level of deterrence. Enrollees rated the perceived severity of the regulatory system as the highest. Although administrative sanctions were the primary measures, and were effective, there is a need for greater intensity and precision in their application. The certainty of detection was high, at approximately 80–90%. Whilst some covert activities remained difficult to detect, the certainty of enforcement was approximately 99%. Celerity received the lowest scores, indicating delays in both detection and penalty imposition within the regulatory response. Conclusion: The study developed a theoretical analytical framework to assess the effectiveness of deterrence within medical insurance regulatory systems. It identified both the strengths and weaknesses of severity, certainty, and celerity in the current regulatory system, providing valuable insights for enhancing deterrence. These findings offer important guidance for policymakers to strengthen regulatory schemes against MIFA, contributing to the advancement of more effective healthcare policies.

Background Financial protection, as a key dimension of Universal Health Coverage (UHC), has been under increasing attention in recent years. A series of studies have examined the nationwide extent of catastrophic health expenditure (CHE) and medical impoverishment (MI) in China. However, disparities in financial protection at the province level have rarely been studied. The aim of this study was to investigate provincial variations in financial protection as well as its inequality across provinces.Methods Using data from the 2017 China Household Finance Survey (CHFS), this study estimated the incidence and intensity of CHE and MI for 28 Chinese provinces. Ordinary least square (OLS) estimation, using robust standard errors, was used to explore the factors associated with financial protection at the province level. Moreover, this study examined the urban-rural differences in financial protection within each province, and calculated the concentration index of CHE and MI indicators for each province using household income per capita.Findings The study revealed large provincial variations in financial protection within the nation. The nationwide CHE incidence was 11.0% (95% CI: 10.7%, 11.3%), ranging from 6.3% (95% CI: 5.0%, 7.6%) in Beijing to 16.0% (95% CI: 14.0%, 18.0%) in Heilongjiang; the national MI incidence was 2.0% (95% CI: 1.8%, 2.1%), ranging from 0.03% (95% CI: 0.00%, 0.06%) in Shanghai to 4.6% (95% CI: 3.3%, 5.9%) in Anhui province. We also found similar patterns for provincial variations in intensity of CHE and MI. Moreover, substantial provincial variations in income-related inequality and urban-rural gap existed across provinces. Eastern developed provinces in general had much lower inequality within them, compared with central and western provinces.Interpretation Despite the great advances towards UHC in China, substantial provincial variations exist in financial protection across provinces. Policymakers should pay special attention to low-income households in central and western provinces. Provision of better financial protection for these vulnerable groups will be key to achieving UHC in China.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background Rising costs of medical service and the need to better utilize limited resources makes the pursuit of hospital efficiency a key objective for healthcare systems. There is inconsistent evidence regarding the comparison of hospital efficiency. In China, limited research has been conducted in comparing the efficiency of Chinese public and private hospitals at the county-level, especially in western China where national GDP falls in the lowest quartile. Method We selected county-level hospitals from one western province by convenience sampling and conducted questionnaire survey in 2018. We first measured efficiency for the hospitals by bootstrap data envelopment analysis (DEA) with the following input variables: hospital bed, expensive equipment, medical staff and operating expenditure, and output variables revenue from outpatient and inpatient services; the efficiency scores were compared statistically between public and private hospitals by normality and non-parametric tests. Then we conducted bootstrap truncated regression on the estimated efficiency scores against environmental and institutional factors. Results Sixty-four county hospitals from 30 counties across the province were included in the study: 52 public hospitals, and 12 private hospitals. Relative efficiency was estimated to be 0.83 for public hospitals, and 0.96 for private hospitals, with statistically significant difference (p=0.001). Approximately 25.0% and 83.3% of public and private hospitals, respectively, were efficient. The truncated regression showed that being a private hospital (p<0.001), higher physician-nurse ratio (p=0.007), and higher revenue from outpatient services (p=0.041) were able to increase the efficiency by 0.158 (0.116, 0.199), 0.305 (0.190, 0.420), and 0.253 (0.129, 0.378), respectively. Conclusion The overall efficiency of the county level hospitals in a western province of China in 2018 was low. Private county hospitals were significantly more efficient than their public counterparts. Outpatient service revenue and physician nurse ratio were determinants of county hospital efficiency and may serve as future policy intervention targets.