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Background This study aimed to identify characteristics and trends in insurance-reimbursed inpatient care (NRIC) for gastric and oesophageal cancers and inform evaluation of medical systems reform. Methods The study extracted routinely collected records of claims for reimbursement from the New Rural Cooperative Medical System (NRCMS) in Anhui Province, China and performed descriptive and regression discontinuity analysis. Results From 2013 to 2017, NRIC in terms of person-time per million people (pmp) increased 5.60 and 20.62 times for gastric and oesophageal cancers, respectively. Total expense per episode for gastric and oesophageal cancers increased from 1130.25 and 22 697.99 yuan to 12 514.98 and 24 639.37 yuan, respectively. The ratio of out-of-pocket expenses per inpatient care episode to annual disposable income per capita was 0.43 for gastric cancer and 0.91 for oesophageal cancer and decreased by 0.17 and 0.47, respectively. Regression discontinuity modelling revealed that, when controlled for disposable income, illiteracy rate and months from start time, the treatment variable was significantly associated with person-times of NRIC pmp (β=0.613, p=0.000), length of stay per 105 people (β=−52.990, p=0.000) and total expenses per NRIC episode (β=2.431, p=0.000). Conclusions The study period witnessed substantial achievements in benefits to patients, inpatient care efficiency and equity. These achievements may be attributed mainly to the recent reforms launched in Anhui province, China. [ABSTRACT FROM AUTHOR]

Background: Early prevention and diagnosis are key to reducing the huge burden of gastric cancer (GC). Nearly half of the population worldwide are suffering from some form of digestive tract conditions (symptoms/diagnoses, DTCs) but their relations with GC are not well understood. We aim to explore the relationships (especially dose–effect relationships) between GC and DTCs. Methods: This study used data from a community-based case–control study in Anhui, China during 2016– 2019 and performed multivariate conditional logistic regression modeling of the associations between GC and DTCs. Results: A total of 2255 participants (451 cases and 1804 controls) completed the study. Statistically significant relations (P< 0.05) were found between GC and the presence of gastroesophageal reflux [odds ratio (OR)=1.41], odynophagia (OR=1.87), stomach discomfort (OR=1.86), poor appetite (OR=2.01) and Helicobacter pylori (H. pylori) infection (OR=4.39). When the DTCs were divided into duration grades, all these ORs presented an increasing trend (P< 0.05), being 1.89 to 2.45 for gastroesophageal reflux, 1.63 to 3.78 for stomach discomfort, 2.36 to 5.29 for poor appetite, and 3.95 to 10.03 for H. pylori infection. When the DTCs were divided into severity grades, the ORs also witnessed an increasing trend (P< 0.05), being 1.69 to 2.52 for gastroesophageal reflux, 2.44 to 3.56 for stomach discomfort, and 2.22 to 2.75 for poor appetite. When the DTCs were divided into duration-severity grades, the ORs displayed a much steeper increasing trend, being 0.49 to 4.96 for gastroesophageal reflux, 1.50 to 6.33 for odynophagia, 0.47 to 3.32 for stomach discomfort, and 0.40 to 10.47 for poor appetite. In contrast, the ORs for the lower DTCs were generally tested without statistical significance. Conclusion: The study revealed consistent dose–effect associations between GC and duration of gastroesophageal reflux, stomach discomfort, poor appetite, and H. pylori infection; severity of gastroesophageal reflux, stomach discomfort and poor appetite; and duration-severity of gastroesophageal reflux, odynophagia, stomach discomfort and poor appetite. These should inform future prevention, diagnosis and further research in patients with GC. [ABSTRACT FROM AUTHOR]

Children with upper respiratory tract infections (URTIs) are among the highest receivers of antibiotics. Using a retrospective cross-sectional study, we described clinical management in rural China of recent URTIs in children. We explored antibiotics using behaviors and associations of caregivers' variables and children's symptoms. Children with URTIs had a high consultation rate and a high prescription rate of antibiotics. For the children, some caregivers adopted, without rationale, 'self-medication' with antibiotics. Children with fever were more likely to be taken to a doctor; among those, children with particular symptoms were more likely to receive a prescription for antibiotics. Disseminating knowledge on antibiotics, and on interpretation and management of URTI symptoms will be important targets for caregiver and physician education and should become routine in training for physicians. Our findings also suggest the need to improve communication between doctors and caregivers, to strengthen regulation of drug sales, and to help caregivers learn when over-the-counter drug purchase without medical consultation is reasonable. These activities can help to improve health of a vast population of children in rural China. [ABSTRACT FROM AUTHOR]

Background: The financial burden of cancers has profound effects and there is a clear need to explore the issue from different perspectives and for different population groups. This study aimed at investigating inpatient cancer care (ICC) burden in Anhui, a typical inland province of China.Methods: The study collected data through a household survey conducted during April to November, 2014 using cluster-randomized sampling and a structured questionnaire administered face-to-face by trained interviewers.Results: The survey covered 60,678 urban and rural residents and 318 person-times of ICC during the past year. Age-adjusted annual person-times and days of ICC per thousand population added up to 4.24 and 76.78 respectively and urban residents showed significantly greater admission rates and length of stay than that of rural ones. Total ICC expenditures accounted for 13.30 % of all that of inpatient care for the whole population. Per-case direct and indirect costs of all types of cancers were estimated as 10365.1 and 929.9 RMB. Per-case total cost on ICC at township hospitals was 2142.3 RMB and at province level hospitals, 17133.0 RMB. Significant variations in per-case ICC expenditures also existed between patients with different household income and type of medical insurance systems, but patients suffering from different types of cancers. Out-of-pocket payment due to ICC turned out to be catastrophic for 20.6 % of all cancer patients and 65.2 % for other medical insurance, 45.6 % for enrollees of urban and rural medical insurance, 43.2 % for the 65 to 74 years old. Multi regression revealed statistically significant association between ICC costs and education, reimbursement ratio, household income and level of hospital.Conclusions: Cancers characterize low incidence, moderate service use and high expenses. There exist substantial differences between subgroups and part of these variations cannot be explained by pathological factors. ICC expenses are catastrophic in nature to a large part of patients. There is a clear need for more effectively regulating cancer-related medical practices and service seeking behaviors. [ABSTRACT FROM AUTHOR]

China's Anhui Province has made great efforts reforming its health systems (eg, reimbursement for medical care for major diseases, clinical path management, and dual referrals), but little is known about the effect of these reforms. This study reveals important evidence in this regard using inpatient cancer care as an indicator of the effect of these reforms on health. The study used descriptive analysis of reimbursement records for inpatient cancer care in Anhui Province from 2013 to 2017, extracted from the New Rural Cooperative Medical System (NRCMS) database, a medical insurance scheme that covers more than 98% of rural residents. The study extracted 329 901 inpatient cancer care reimbursement records. From 2013 to 2017, overall coverage of NRCMS-reimbursed inpatient cancer care increased by 14·20 times; per 100 000 people, these increases were 2·22 to 78·42 for lung cancer, 9·09 to 55·74 for stomach cancer, 1·33 to 26·74 for oesophageal cancer, and 0·69 to 45·62 for colorectal cancer. The ratio of per case out-of-pocket expense to annual per capita dispensable income was reduced from 0·51 to 0·32 on average, and from 0·49 to 0·36 for lung cancer, 0·53 to 0·31 for stomach cancer, 0·52 to 0·32 for oesophageal cancer, and 1·02 to 0·55 for colorectal cancer. Both overall and cancer-specific inpatient cancer care expenditure increased at first, which was then followed by a decease. The proportion of cost on operation, nursing, and consultation increased from 1·61% to 10·74% in total expense for all inpatient cancer care and a similar trend was observable for all specific cancers. Overall length of stay decreased from 13·36 to 9·55 days. The Gini coefficient of expenses increased from 0·49 to 0·39 for all inpatient cancer care, and changed from 0·43 to 0·35 for lung cancer, 0·53 to 0·43 for stomach cancer, 0·47 to 0·38 for oesophageal cancer, and 0·51 to 0·41 for colorectal cancer. Health reformation in Anhui Province has resulted in a substantial improvement in coverage of NRCMS-reimbursed inpatient cancer care, economic burden due to inpatient cancer care, and service quality, efficiency, and equity. Natural Science Foundation of China. [ABSTRACT FROM AUTHOR]