Medicine, Dentistry & Health Sciences Collected Works - Research Publications
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ItemDevelopment of village doctors in China: financial compensation and health system support(BIOMED CENTRAL LTD, 2017-07-01)BACKGROUND: Since 1968, China has trained about 1.5 million barefoot doctors in a few years' time to provide basic health services to 0.8 billion rural population. China's Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China's rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China's experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. METHODS: This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China's experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968 -1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. RESULTS: The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot doctors. But After 1985, the formal health system played a more dominant role in the CHW system including both selection and training of village doctors. China applied various mechanisms to compensate village doctors in different stages. During 1960s and 1970s, the main income source of barefoot doctors was from their villages' collective economy. After 1985 when the rural collective economy collapsed and barefoot doctors were transformed to village doctors, they depended on user fees, especially from drug sale revenues. In the new century, especially after the new round of health system reform in 2009, government subsidy has become an increasing source of village doctors' income. CONCLUSION: The barefoot doctor policy has played a significant role in providing basic human resources for health and basic health services to rural populations when rural area had great shortages of health resources. The key experiences for this great achievement are the intersection between the community and the formal health system, and sustained and stable financial compensation to the community health workers.
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ItemFinancial protection of rural health insurance for patients with hypertension and diabetes: repeated cross-sectional surveys in rural China(BIOMED CENTRAL LTD, 2016-09-08)BACKGROUND: The New Cooperative Medical Scheme (NCMS) in rural China has been expanding in both population coverage and benefit package. China has also established an essential medicine policy in recent years to further reduce patients' medical expenditures and financial burden. This study aims to evaluate the impact of these policies on reducing medical expenditures and financial burden of patients diagnosed with hypertension and diabetes. METHODS: This study used repeated cross-sectional surveys in 2011 and 2012 in three counties of Shandong Province. Outpatient and inpatient service expenditures and catastrophic health expenditures (CHE) were measured and analyzed. RESULTS: Medical expenditures for outpatient services significantly increased for hypertensive and diabetic patients within a 1 year period, while inpatient service expenditures remained unchanged. Although NCMS increased its reimbursement rate, hypertensive and diabetic patients still heavily suffered CHE from both outpatient and inpatient services. Outpatient services were more important factors than inpatient services contributing to non-communicable chronic diseases (NCD) patients' financial burden. CONCLUSIONS: The effects of NCMS expansion have been offset by the rapid escalation of medical expenditures. More attention should be paid to the design of NCMS benefit package to cover NCD outpatient services. There is also an urgent need to reform the current Fee for Service to other provider payment methods in order to control the escalating NCD medical expenditures.
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ItemEpidemiological and Clinical Characteristics of COVID-19 Patients with Cancers: A Systematic Review and Meta-Analysis of Global Data(Cold Spring Harbor Laboratory, 2020)
Summary
Background:
Data on the prevalence of cancer in coronavirus disease 2019 (COVID-19)-infected patients and the severe illness incidence and mortality of COVID-19 patients with cancers remains unclear.Methods
We systematically searched PubMed, Embase, Cochrane Library, and Web of Science, from database inception to July 15, 2020, for studies of patients with COVID-19 infection that had available comorbidity information on cancer. The primary endpoint was the pooled prevalence of cancer in COVID-19 patients and the secondary endpoint was the outcomes of COVID-19-infected cancer patients with incidence of severe illness and death rate. We calculated the pooled prevalence and corresponding 95% confidence intervals (95% CIs) using a random-effects model, and performed meta-regression analyses to explore heterogeneity. Subgroup analyses were conducted based on continent, country, age, sample size and study design.Findings
A total of 107 eligible global studies were included in the systematic review. 90 studies with 94,845 COVID-19 patients in which 4,106 patients with cancer morbidity were included in the meta-analysis for prevalence of cancer morbidity among COVID-19 patients. 21 studies with 70,969 COVID-19 patients in which 3,351 patients with cancer morbidity who had severe illness or death during the studies. The overall prevalence of cancer among the COVID-19 patients was 0.07 (95% CI 0.05∽0.09). The cancer prevalence in COVID-19 patients of Europe (0.22, 95% CI 0.17∽0.28) was higher than that in Asia Pacific (0.04, 95% CI 0.03∽0.06) and North America (0.05, 95% CI 0.04∽0.06). The prevalence of COVID-19-infected cancer patients over 60 years old was 0.10 (95% CI 0.07∽0.14), higher than that of patients equal and less than 60 years old (0.05, 95% CI 0.03∽0.06). The pooled prevalence of severe illness among COVID-19 patients with cancers was 0.35 (95% CI 0.27∽0.43) and the pooled death rate of COVID-19 patients with cancers was 0.18 (95% CI 0.14∽0.18). The pooled incidence of severe illness of COVID-19 patients with cancers from Asia Pacific, Europe, and North America were 0.38(0.24, 0.52), 0.36(0.17, 0.55), and 0.26(0.20, 0.31), respectively; and the pooled death rate from Asia Pacific, Europe, and North America were 0.17(0.10, 0.24), 0.26(0.13, 0.39), and 0.19(0.13, 0.25), respectively.Interpretation
To our knowledge, this study is the most comprehensive and up-to-date metaanalysis assessing the prevalence of cancer among COVID-19 patients, severe illness incidence and mortality rate. The prevalence of cancer varied significantly in geographical continents and age. The COVID-19 patients with cancer were at-risk for severe illness and a high death rate. The European COVID-19 patients had the highest cancer prevalence among the three continents examined and were also the most likely to progress to severe illness and death. Although the Asia Pacific COVID-19 patients had the lowest cancer prevalence, their severe illness rate was similar to that of European’s.Research in context
Evidence before this study
Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a newly discovered coronavirus, which leads to respiratory illness and can be transmitted from person to person. As the infection has become widespread, concern for the influence of COVID-19 on patients with cancer has grown. Previous studies suggest that patients with a history of active malignancy might be at increased risk for COVID-19, developing COVID-19-related complications and having a poorer prognosis. Until now, however, few studies explored the following two questions: 1) what is the estimated prevalence of cancer patients with COVID-19 infection; and 2) do COVID-19-infected cancer-patients have distinct clinical courses and worse outcomes compared with COVID-19-infected patients without cancers. The latter is based on the former to further explore the characteristics of clinical outcomes of such patients. The clarification of these two questions will greatly help to understand the relationship between COVID-19 and cancer in terms of clinical epidemiology, and thus facilitate the formulation of targeted and relevant public health policies.Added value of this study
To our knowledge, this systematic review and meta-analysis of 107 studies is the most comprehensive and up-to-date assessing the prevalence of cancer among COVID-19 patients, the incidence of severe illness and mortality rate of COVID-19 patients with cancers. We provided a relatively accurate overall cancer prevalence among the all COVID-19 patients (7%), stratified by geographical continent, country, age, study sample size, and study design type. We also presented the pooled severe illness and mortality rates stratified by continent. European COVID-19-infected cancer patients seemed the most likely to both develop cancer and progress to severe illness and death.Implications of all the available evidence
Our findings have reinforced important considerations of clinical care and emphasized the urgent unmet needs for COVID-19 patients with cancers using the pooled prevalence, incidence of severe illness, and death rates as evidence. Also, after comparing the cancer prevalence, incidence of severe illness, and death rate of COVID-19 patients from different continents, European population may require stronger control measures than the Asia Pacific and North American populations. In the future, as more data will be available, it will be interesting to further investigate the differences of sociodemographic and climcopathological features between COVID-19-infected patients with cancer and without cancer. -
ItemRisk assessment and prediction of severe or critical illness of COVID-19 in the elderly(Cold Spring Harbor Laboratory, 2020)
Background:
This study aims to investigate the clinical characteristics and risk prediction of severe or critical events of COVID-19 in the elderly patients in China.Methods:
The clinical data of COVID-19 in the elderly patients admitted to the Shanghai Public Health Clinical Center during the period of January 20, 2020 to March 16, 2020 were collected. A retrospective cohort study design was conducted to screen out independent factors through Cox univariable regression analysis and multivariable regression analysis, and the efficacy of risk prediction of severe or critical illness was examined through the receiver operating characteristic (ROC) curve.Results:
A total of 110 elderly patients with COVID-19 were enrolled. 52 (47.3%) were males and 21 (19.1%) had severe or critical illness. Multivariable regression analysis showed that CD4 cells and D-dimer were independent risk factors. D-dimer, CD4 cells, and D-dimer/CD cells ratios with cut off values of 0.65 (mg/L), 268 (cell/ul) and 431 were in the prediction of severe or critical illness of the elderly COVID-19. The AUC value of D-dimer, CD4 cells, CD4 cells/D-dimer ratio, the tandem group and the parallel group were 0.703, 0.804, 0.794, 0.812 and 0.694, respectively.Conclusions:
D-dimer, CD4 cells and their combination have risk assessment value in predicting severe or critical illness of COVID-19 in the elderly. -
ItemSocioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis(MDPI, 2020-02)BACKGROUND: This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE. METHODS: We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE. RESULTS: The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas. CONCLUSION: Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.