Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expen...Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.展开更多
目的:了解中国卫生筹资转型的主要特征及历史沿革。方法:数据来源于全球卫生支出数据库(Global Health Expenditure Database,GHED)、《中国卫生健康统计年鉴》、《全国卫生健康财务年报》、《中国卫生总费用研究报告》等。采用描述性...目的:了解中国卫生筹资转型的主要特征及历史沿革。方法:数据来源于全球卫生支出数据库(Global Health Expenditure Database,GHED)、《中国卫生健康统计年鉴》、《全国卫生健康财务年报》、《中国卫生总费用研究报告》等。采用描述性统计和文献研究法进行分析。结果:21世纪以来,全球多数国家出现了卫生筹资转型现象,表现为卫生筹资规模扩大和公共筹资责任强化。中国的卫生筹资转型特征十分鲜明:一是卫生筹资规模扩大的速度更快,2000—2019年人均卫生总费用按可比价格水平增长了816.6%,明显快于全球其他国家的平均增长速度(102.1%);二是公共筹资责任强化的力度更大,2000—2019年个人现金卫生支出占卫生总费用的比例下降了30.6个百分点,降幅明显大于全球其他国家的平均水平(5.6个百分点);三是公共筹资中政府卫生支出的流向发生了重要转变,“补需方”占比逐渐提高,并于2011年超过“补供方”,同时,在“补供方”内部“补医院”占比持续增加,明显高于“补基层”和“补公卫”。据此可将中国卫生筹资转型扩展为规模维度、结构维度和流向维度三个维度。运用分析框架,将中国卫生筹资转型大致分为计划经济时期、经济转型时期、“后非典”时期和“新医改”以来4个阶段,并对每个阶段的主要特点和演变逻辑进行了分析。结论:应从系统结构功能层面提高卫生筹资体系的纵向“嵌入性”和横向“互补性”;更加突出卫生筹资转型对维护隐性价值和防范公共风险的作用,完善价值与风险的双向权衡机制;统筹兼顾卫生筹资转型所涉及的卫生健康伦理原则,优化政府实际治理模式下的预算决策机制;高度重视现代医学发展的全局性和深层次影响,探索中国卫生筹资转型的长期战略和路径选择。展开更多
基金co-supported by the National Natural Science Foundation of China (No. 81773521)CAMS Innovation Fund for Medical Sciences (No. 2017-I2M-1006, No. 2016-12M-2-004)+4 种基金the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (No. 2018RC330001)the National Key Projects of Research and Development of China (No. 2018 YFC1315000)China Scholarship Council (No. 201908110180)the Sanming Project of Medicine in Shenzhen (No. SZSM201911015)the Cancer Screening Program in Urban China funded by National Health Commission of People’s Republic of China
文摘Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.
文摘目的:了解中国卫生筹资转型的主要特征及历史沿革。方法:数据来源于全球卫生支出数据库(Global Health Expenditure Database,GHED)、《中国卫生健康统计年鉴》、《全国卫生健康财务年报》、《中国卫生总费用研究报告》等。采用描述性统计和文献研究法进行分析。结果:21世纪以来,全球多数国家出现了卫生筹资转型现象,表现为卫生筹资规模扩大和公共筹资责任强化。中国的卫生筹资转型特征十分鲜明:一是卫生筹资规模扩大的速度更快,2000—2019年人均卫生总费用按可比价格水平增长了816.6%,明显快于全球其他国家的平均增长速度(102.1%);二是公共筹资责任强化的力度更大,2000—2019年个人现金卫生支出占卫生总费用的比例下降了30.6个百分点,降幅明显大于全球其他国家的平均水平(5.6个百分点);三是公共筹资中政府卫生支出的流向发生了重要转变,“补需方”占比逐渐提高,并于2011年超过“补供方”,同时,在“补供方”内部“补医院”占比持续增加,明显高于“补基层”和“补公卫”。据此可将中国卫生筹资转型扩展为规模维度、结构维度和流向维度三个维度。运用分析框架,将中国卫生筹资转型大致分为计划经济时期、经济转型时期、“后非典”时期和“新医改”以来4个阶段,并对每个阶段的主要特点和演变逻辑进行了分析。结论:应从系统结构功能层面提高卫生筹资体系的纵向“嵌入性”和横向“互补性”;更加突出卫生筹资转型对维护隐性价值和防范公共风险的作用,完善价值与风险的双向权衡机制;统筹兼顾卫生筹资转型所涉及的卫生健康伦理原则,优化政府实际治理模式下的预算决策机制;高度重视现代医学发展的全局性和深层次影响,探索中国卫生筹资转型的长期战略和路径选择。
