Risk Management and Healthcare Policy最新文献

{"title":"Risk Governance of Payment Exceptions Under China's DRG/DIP Reform: A Structured Policy-Text Analysis of Special Case Negotiation Rules.","authors":"Kedi Sun","doi":"10.2147/RMHP.S635092","DOIUrl":"10.2147/RMHP.S635092","url":null,"abstract":"<p><strong>Purpose: </strong>Under China's diagnosis-related group/diagnosis-intervention packet (DRG/DIP) payment reform, special case negotiation addresses clinically atypical cases that do not fit standard case-based payment rules but may also create payment misfit, fund leakage, discretionary review, delay, and accountability risks. This study examined whether policies translate these risks into enforceable governance rules.</p><p><strong>Methods: </strong>A structured policy-text analysis examined 20 documents within one provincial policy chain: one national document, one provincial document, and 18 municipal documents covering all prefecture-level jurisdictions in the province. The municipal documents constituted a complete census within the selected province rather than a nationwide sample of Chinese provinces. A 30-node, five-domain framework used a 0-1-2 scale. Two coders worked independently, and final analyses used adjudicated scores.</p><p><strong>Results: </strong>Inter-coder agreement was 95.0% (Cohen's kappa, 0.899). Domain scores were highest for payment misfit risk control (0.797), discretion and capture risk control (0.786), and administrative burden and delay risk control (0.767), and lowest for accountability and equity risk control (0.512). Applicable scope, volume or proportion cap, and submission or review cycle were universally enforceable. The weakest or least consistently enforceable nodes concerned cross-area or fund responsibility, appeal or reconsideration, processing time limits, and special diseases, infectious diseases, or rare diseases. Vertical attenuation was highest for cross-area or fund responsibility (72.2%) and for processing time limits and special diseases, infectious diseases, or rare diseases (both 55.6%). Municipal documents formed balanced, boundary-heavy, procedure-heavy, and low-formalisation configurations.</p><p><strong>Conclusion: </strong>Special case negotiation requires a minimum risk-governance package-a minimum set of enforceable procedural safeguards-combining eligibility boundaries, traceable review, appeal routes, and clear accountability. The analysis evaluates formal policy design rather than implementation outcomes. Functionally, the framework may inform risk audits of outlier, high-cost, new-technology, and other payment-exception mechanisms in DRG or other case-based payment systems internationally.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"635092"},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicine Requirements and Budget Implication for Pediatric Acute Lymphoblastic Leukemia in Indonesia: A Morbidity-Based Approach.","authors":"Dita N S Argadiredja, Mohammed Alfaqeeh, Yasmin Fatinah, Vesara Ardhe Gatera, Lucia R Andalusia, Rano K Sinuraya, Dina Abushanab, Rizky Abdulah, Auliya A Suwantika","doi":"10.2147/RMHP.S621045","DOIUrl":"10.2147/RMHP.S621045","url":null,"abstract":"<p><strong>Background: </strong>Limited availability, high costs, and reliance on imported medicines challenge access to pediatric cancer treatment in Indonesia. For childhood acute lymphoblastic leukemia (ALL), the absence of reliable national quantification data complicates procurement, reimbursement, and budget planning. This study estimated hospital-level and national pharmaceutical requirements for pediatric ALL in Indonesia using a morbidity-based forecasting approach.</p><p><strong>Methods: </strong>A budget impact modeling approach using a morbidity-based pharmaceutical quantification framework was developed to estimate theoretical annual procurement requirements for pediatric ALL. Data were derived from three national cancer referral hospitals during the study reference period (January 2022-October 2023) and supplemented with registry data and national treatment guidelines. Drug quantities were calculated using standardized regimens for standard-risk and high-risk patients, assuming an average body weight of 24 kg and body surface area of 0.8 m². National estimates were extrapolated using disease incidence and risk-group distribution rather than comprehensive national medicine-utilization data. Drug prices were obtained from the national electronic procurement catalogue. The model assumed full completion of standardized treatment regimens without treatment interruptions or dose modifications.</p><p><strong>Results: </strong>Pharmaceutical requirements and expenditure were highly concentrated in a limited number of medicines. The estimated annual national pharmaceutical expenditure was IDR 1.43 billion for standard-risk patients and IDR 4.48 billion for high-risk patients, with a combined budget of IDR 5.91 billion. L-asparaginase accounted for the largest share of expenditure, with annual national costs of IDR 993.3 million for standard-risk patients and IDR 2,885.2 million for high-risk patients. Vincristine and daunorubicin were additional major contributors. Across both risk groups, induction therapy represented the most resource-intensive treatment phase, and the ten highest-cost drug-risk group combinations accounted for approximately 97.8% of total pharmaceutical spending.</p><p><strong>Conclusion: </strong>This study provides the first national morbidity-based estimation of pediatric ALL pharmaceutical requirements and budget implications in Indonesia. The findings highlight key cost drivers and support regimen- and risk-specific forecasting for procurement planning and policy decision-making.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"621045"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Laboratory Data Integration into Outpatient Prescriptions on Community Pharmacist Feedback and Physician Responses: A Single-Center Retrospective Study.","authors":"Takahiro Motoki, Hiroaki Tanaka, Tatsuya Tai, Kazunori Yamaguchi, Shinji Kosaka, Yasuaki Mino","doi":"10.2147/RMHP.S623602","DOIUrl":"10.2147/RMHP.S623602","url":null,"abstract":"<p><strong>Purpose: </strong>Laboratory data with outpatient prescriptions have expanded, and their usefulness has been reported. However, the effect of a modification in laboratory data provision on the content of tracing reports (TRs) submitted by community pharmacists to provide clinical feedback to physicians and on physician responses remains unclear. This study aimed to evaluate the impact of a system-level modification in laboratory data provision on the inclusion of laboratory data-related descriptions in TRs and to assess the association between TR characteristics and physician responses.</p><p><strong>Patients and methods: </strong>We used TRs submitted by community pharmacies to a university hospital in Japan. An integrated prescription format (IPF), containing laboratory data automatically printed on prescriptions, was introduced in addition to the existing separate sheet format (SSF). Laboratory data-related descriptions in the TRs were compared pre- and post-implementation. Physician responses were evaluated, and associated factors were analyzed using logistic regression.</p><p><strong>Results: </strong>Laboratory data provision using SSF remained approximately 4% pre- and post-implementation, whereas IPF printed laboratory data fields on all prescriptions post-implementation. A total of 761 TRs were analyzed (pre-implementation, 389; post-implementation, 372). Laboratory data-related descriptions were identified in 16 TRs (2.1%), with a significant increase post-implementation (1.0% vs 3.2%; odds ratio [OR] 3.21, 95% confidence interval [CI] 1.03-10.04). Physician responses were recorded for 210 TRs (27.6%), with no significant difference pre- and post-implementation (27.8% vs 27.4%; OR 0.98, 95% CI 0.71-1.35). Multivariable analysis showed a strong association between pharmacists' proposals or concerns and physician responses (adjusted OR 10.39, 95% CI 5.39-20.03).</p><p><strong>Conclusion: </strong>The IPF-based laboratory data provision system increased inclusion of laboratory data-related descriptions in TRs but not physician responses. The findings suggest that providing information that includes clinically relevant proposals or concerns, rather than simply increasing the amount of information available, may be more important for promoting physician responses.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"623602"},"PeriodicalIF":2.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Quantitative Analysis of Patients' Dignity and Privacy Needs in Anesthesia Nursing Services Based on the Kano and SERVQUAL Models.","authors":"Yan Cao, Huqing Liu, Xiaolan Feng","doi":"10.2147/RMHP.S622826","DOIUrl":"10.2147/RMHP.S622826","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing pulmonary anesthesia face dignity and privacy threats due to intraoperative positioning, unconsciousness, and postoperative discomfort. Existing studies focus mainly on technical safety, lacking systematic investigation from the patient's perspective. This neglect may lead to patient dissatisfaction and ethical concerns.</p><p><strong>Objective: </strong>To identify patients' dignity and privacy needs, evaluate service quality gaps, and prioritize improvement targets in pulmonary anesthesia nursing using an integrated Kano-SERVQUAL framework.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted between March and September 2025 among patients undergoing pulmonary resection under general anesthesia in five tertiary hospitals in China. A 25-item questionnaire based on the Kano and SERVQUAL models was developed to assess dignity- and privacy-related service needs. Kano attribute classification, Better-Worse coefficient analysis, SERVQUAL gap analysis, and integrated quadrant analysis were performed.</p><p><strong>Results: </strong>A total of 423 valid questionnaires were analyzed. Patients' dignity- and privacy-related needs showed a clear hierarchical structure, with informed consent, confidentiality protection, professional competence, and body privacy identified as fundamental requirements. Significant gaps were observed between patients' expectations and perceived service experiences, particularly in the domains of assurance and empathy. The integrated Kano-SERVQUAL analysis identified informed consent, privacy protection, responsiveness to patient concerns, professional competence, and respectful communication as the highest-priority areas for improvement.</p><p><strong>Conclusion: </strong>Patients undergoing pulmonary anesthesia place substantial importance on dignity and privacy protection, yet important service gaps remain. This study is among the first to integrate Kano-based need hierarchy analysis with SERVQUAL service quality assessment in pulmonary anesthesia nursing, enabling simultaneous evaluation of patient priorities and service deficiencies. The proposed framework offers a practical and evidence-based strategy for prioritizing patient-centered quality improvement and resource allocation in perioperative anesthesia care.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"622826"},"PeriodicalIF":2.6,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Application Effectiveness of Defect Management Improvement Models in the Cleaning, Disinfection, and Packaging Management of Surgical Instruments in Central Sterile Supply Departments: A Before-After Study.","authors":"Tingting Zheng, Aiying Zeng, Yingfeng Chen","doi":"10.2147/RMHP.S626310","DOIUrl":"10.2147/RMHP.S626310","url":null,"abstract":"<p><strong>Background: </strong>Central sterile supply departments (CSSDs) play a critical role in surgical patient safety by ensuring the effective cleaning and correct packaging of reusable surgical instruments. However, process defects may still occur and lead to rework, delays, or safety risks. This study evaluated the effectiveness of a closed-loop defect management improvement program for surgical instrument reprocessing in a CSSD.</p><p><strong>Methods: </strong>We conducted a retrospective quasi-experimental before-after study comparing pre-intervention (January-June 2025, conventional management) and post-intervention (July-December 2025, closed-loop defect management improvement model) periods at West China Hospital. Data were collected through routine operational audits performed by trained human observers, including visual inspection, ATP testing, and protein residue testing, according to departmental standards. The intervention included standardized defect recording, structured analysis, corrective actions, feedback, and targeted training. Outcomes included qualified rates of cleaning and packaging, along with assembly errors, label errors, packaging integrity violations, and instrument damage.</p><p><strong>Results: </strong>In 2025, 54,412 cleaned instruments and 6,488 packages were randomly inspected. Packaging tracking covered 215,927 packages (107,943 pre-intervention; 107,984 post-intervention). Compared with the pre-intervention period, the qualified rate of regular sampling tests increased from 97.99% to 99.76% (<i>P</i><0.05), and the packaging pass rate rose from 96.73% to 98.98% (<i>P</i><0.05). Assembly errors dropped from 43 to 15 cases, packaging damages from 57 to 6, and incorrect label information from 15 to 5 (all <i>P</i><0.05). Insufficient cleaning and instrument damage showed no significant difference.</p><p><strong>Conclusion: </strong>In the CSSD, implementing the closed-loop defect management improvement model was associated with improved reprocessing quality and reduced packaging-related defects. Given that our pre-intervention quality rates already exceeded many published figures, we sought to determine whether implementing a closed-loop defect management improvement program could further reduce defect events and enhance reprocessing reliability, rather than merely meeting minimum standards.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"626310"},"PeriodicalIF":2.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Performance of Community Two Committees and Satisfaction with Urban Infectious Disease Governance: The Mediating Roles of Government Trust and Public Participation.","authors":"Weiqi Huang, Hongyu Li, Yiyang Sun, Yuan Zhang, Xiaoting Gao, Cheng Chen, Yanhua Hao, Qunhong Wu, Zhengwei Zhu, Huan Liu","doi":"10.2147/RMHP.S628130","DOIUrl":"10.2147/RMHP.S628130","url":null,"abstract":"<p><strong>Purpose: </strong>The community two committees play a pivotal role in urban grassroots public health emergency governance. Situated within China's distinctive grassroots governance context, this study examines the associations among the perceived performance of community two committees, government trust, public participation, and satisfaction with urban infectious disease governance.</p><p><strong>Patients and methods: </strong>Using 2023 China Social Governance Survey data, 3182 participants were selected for cross-sectional analysis. We estimated stepwise regression models and tested mediation using the weighted least squares mean and variance adjusted estimator and bootstrap procedures. We conducted robustness tests using alternative variable specifications and propensity score matching, and assessed potential endogeneity using the Oster test, Rosenbaum bounds, and the Lewbel approach.</p><p><strong>Results: </strong>Perceived performance of community two committees was positively associated with satisfaction with urban infectious disease governance (<i>β</i> = 0.158, 95% CI: 0.118-0.197). Government trust (<i>β</i> = 0.086, 95% CI: 0.068-0.104) and public participation (<i>β</i> = 0.031, 95% CI: 0.020-0.043) partially mediated this association, accounting for 29.20% and 10.40% of the total effect, respectively. In addition, a sequential indirect association through government trust and public participation was observed (<i>β</i> = 0.020, 95% CI: 0.013-0.027), accounting for 6.70% of the total effect. The robustness tests indicated that both the direct and indirect associations remained significant, while the sensitivity and supplementary endogeneity analyses suggested that the findings were not highly sensitive to omitted-variable bias or unobserved confounding.</p><p><strong>Conclusion: </strong>The study revealed that the perceived performance of community two committees was positively associated with satisfaction with urban infectious disease governance, with government trust and public participation sequentially mediating this association. Governments should strengthen the governance capacity of community two committees, improve transparency and responsiveness to foster public trust, and establish institutionalized channels for public participation in urban infectious disease governance.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"628130"},"PeriodicalIF":2.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of an Interpretable Machine Learning Model for Prediction of the Need for Surgical Evacuation in Patients with Incomplete Abortion.","authors":"Yusheng Li, Wenjun Chen, Mingxiao Wen, Chaying He, Yichao Zhang","doi":"10.2147/RMHP.S615337","DOIUrl":"10.2147/RMHP.S615337","url":null,"abstract":"<p><strong>Background: </strong>International guidelines lack standardized quantitative criteria for surgical evacuation in incomplete abortion, leading to heterogeneous clinical practice, which may result in unnecessary interventions and increased clinical and economic burdens on women and healthcare resources.</p><p><strong>Methods: </strong>This retrospective study included clinical data from 411 patients with medical abortion at Hangzhou Women's Hospital (2023-2025). A stacking ensemble model with 5-fold cross-validation was constructed, and its performance was evaluated using AUC, with 95% CI, accuracy, sensitivity, and specificity, followed by internal hold-out validation. Feature importance was determined using a weighted average of Information Gain (IG) and SHapley Additive exPlanations (SHAP) values. SHAP analyses were further used to quantify the effects of key features on surgical intervention risk and identify critical risk thresholds.</p><p><strong>Results: </strong>The stacking model exhibited the optimal performance, with an internal validation AUC of 0.821 (95% CI: 0.795-0.846), accuracy 0.794, sensitivity 0.757 and specificity 0.806, and a hold‑out validation AUC of 0.801 (95% CI: 0.700-0.892), outperforming traditional and single ensemble models. Blood β-human chorionic gonadotropin (β-hCG), body mass index (BMI), uterine residual tissue blood flow resistance index (RI), and residual tissue size at first post-medical abortion review (RTS‑FPAR) were identified as core predictive factors. SHAP analysis confirmed that β-hCG ≥ 824.90 mIU/mL, BMI ≤ 18.91 or ≥ 23.42, RI ≤ 0.51, RTS‑FPAR ≥ 3.30 cm significantly elevated surgical intervention risk.</p><p><strong>Conclusion: </strong>The stacking model showed promising moderate performance in predicting the need for surgical evacuation in our study. Our findings suggest that existing criteria for surgical intervention may cover an overly broad range of cases, and more selective thresholds may support improved risk stratification to potentially reduce unnecessary interventions. These findings offer preliminary research insights for auxiliary risk assessment of incomplete abortion, and multi-centre external validation is required before clinical use.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"615337"},"PeriodicalIF":2.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Integrated FMEA-RCA Risk-Management Approach for Deep Vein Thrombosis Prevention in Patients Undergoing Total Knee Arthroplasty.","authors":"Tingting Li, Yupan Fan, Hua Zhang, Zhiyong Fan, Chenyang Zhang, Xiaoli Chen, Huijie Li, Na Li","doi":"10.2147/RMHP.S618180","DOIUrl":"10.2147/RMHP.S618180","url":null,"abstract":"<p><strong>Background: </strong>To explore the effectiveness of Failure Mode and Effects Analysis (FMEA) combined with Root Cause Analysis (RCA) in deep vein thrombosis (DVT) risk management for patients undergoing total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>In this prospective, non-randomized, quasi-experimental before-after design study, consecutive patients undergoing primary unilateral TKA were allocated according to admission period to receive either routine DVT risk management or an integrated FMEA-RCA program. Sample size calculation indicated that at least 64 patients per group were required, and 68 were enrolled in each group. Outcomes included RPN values, DVT incidence, length of stay, and HSS knee scores assessed preoperatively and at 6 weeks postoperatively.</p><p><strong>Results: </strong>The RPN values for all eight high-risk failure modes in the DVT prevention process were lower in the intervention group than in the control group (all Bonferroni-adjusted P values < 0.00625). The incidence of DVT was significantly lower in the intervention group than in the control group (5.88% vs 23.53%; χ² = 8.442, P = 0.004), and this association remained significant after adjustment for age, BMI, and baseline Caprini score (aOR = 0.24, 95% CI: 0.08-0.72; P = 0.011). The length of stay was shorter in the intervention group than in the control group (7.99 ± 2.06 vs 11.20 ± 4.21 days; mean difference = -3.21 days, 95% CI: -4.33 to -2.09; t = 5.647, P < 0.001). At 6 weeks postoperatively, HSS knee scores were higher in the intervention group than in the control group (82.30 ± 5.60 vs 76.80 ± 6.90; t = 4.327, P < 0.001).</p><p><strong>Conclusion: </strong>Combining FMEA with RCA could help identify key nursing control points in DVT prevention for patients undergoing TKA.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"618180"},"PeriodicalIF":2.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Hospitalization Expenditures and Length of Stay for Patients Underwent Hysterectomy and Adnexectomy for Carcinoma in situ and Nonmalignant Lesions Diagnosis-Related Group: Impact of Beijing's Medicine-Consumables Linkage Reforms.","authors":"Juanjuan Liang, Yuanqing Cai, Rong Fan, Yuwei Zhang, Yangyi Hu, Wenjuan Wang","doi":"10.2147/RMHP.S620716","DOIUrl":"10.2147/RMHP.S620716","url":null,"abstract":"<p><strong>Purpose: </strong>Hysterectomy and adnexectomy for carcinoma in situ and nonmalignant lesions (HAC) is a subgroup of the diagnosis-related groups (DRG). A comprehensive set of reforms in Beijing, referred to as the medicine-consumables linkage (MCL) reforms, is intended to improve the quality of medical services. This study aims to analyze the impact of the MCL reforms on the changes in hospitalization expenditures, out-of-pocket (OOP) expenditures, and length of stay (LOS) for patients underwent HAC.</p><p><strong>Methods: </strong>We used an interrupted time series (ITS) model along with relevant data on HAC from January 2017 to December 2020 to analyze changes in hospitalization expenditures, OOP expenditures, and LOS for patients before and after the MCL reforms were implemented.</p><p><strong>Results: </strong>The results showed that after the reforms average surgical expenditures per hospitalization increased by 75.34%, whereas average examination and medical consumable expenditures per hospitalization decreased by 17.51% and 12.63%, respectively. The proportion of OOP expenditures decreased by 14.26%, and the average LOS per hospitalization decreased by 21.86%. The ITS analysis showed that the average total, laboratory test, drug, and OOP expenditures per hospitalization decreased monthly after the reforms. The impact of the reforms on the subgroup without comorbidity and complications was even more significant and reached the expected goals of the reforms.</p><p><strong>Conclusion: </strong>The hospitalization expenditure structure was optimized after the reforms, and the price of surgical services increased after the MCL reforms. The patients' cost burden was reduced, and the LOS for patients declined after the reforms. This study provides evidence and reference points for comparing hospitalization expenditures and the LOS for patients in optimizing DRG programs in China and other countries with similar hospitalization systems.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"620716"},"PeriodicalIF":2.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public Willingness to Pay for Alzheimer's Preventive Medication in Iran: A Contingent Valuation Study.","authors":"Moslem Soofi, Fatemeh Amiri, Satar Rezaei, Sina Ahmadi","doi":"10.2147/RMHP.S630737","DOIUrl":"10.2147/RMHP.S630737","url":null,"abstract":"<p><strong>Introduction: </strong>Alzheimer's disease is associated with substantial health and economic burdens worldwide. As the prevalence of the disease continues to increase, understanding public willingness to pay (WTP) for preventive interventions is important for healthcare planning and policy development. This study estimated WTP for a hypothetical Alzheimer's preventive drug and identified factors associated with WTP among adults in Iran.</p><p><strong>Methods: </strong>A descriptive-analytical cross-sectional study was conducted in 2025 among 495 adults aged 18-70 years (mean age: 36.05 ± 10.09 years) in Kermanshah, Iran, who were selected using multistage cluster sampling. WTP was assessed using the contingent valuation method (CVM) with a double-bounded dichotomous choice (DBDC) format. Responses were analyzed using a maximum-likelihood estimation model.</p><p><strong>Results: </strong>Seventy-two percent of participants expressed WTP for an Alzheimer's preventive drug. The estimated monthly mean WTP was 5,150,000 Iranian Rials (IRR) (approximately USD 5.1 at the time of the study). Higher WTP was significantly associated with gender, insurance coverage, preventive attitudes, perceived risk of Alzheimer's disease, and risk-taking behavior. Age, marital status, and educational attainment were not significantly associated with WTP.</p><p><strong>Conclusion: </strong>Participants placed considerable value on potential Alzheimer's disease prevention. The findings suggest that insurance coverage, public awareness initiatives, and consideration of individual risk perceptions may be important factors in the design and implementation of future Alzheimer's prevention programs. These findings should be interpreted in light of the cross-sectional design of the study.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"630737"},"PeriodicalIF":2.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}