ObjectiveTo investigate the factors that influence Chinese residents, self-rated health and the effects of the multilevel health insurance system and neighborhood social capital on self-rated health. MethodsBased on the 2018 China labor-force dynamics survey data, and Stata 15.0 software was used to conduct χ2 test, univariate analysis and multiple logistic regression model were used to analyze the influencing factors of self-rated health of Chinese residents. An interaction model was used to analyze the interactive effects of the multilevel health insurance system and the social capital of the neighborhood on self-rated health. ResultsA total of 10 201 people were investigated in this study, and 39.20% of them were self-rated unhealthy. After adjusting for confounders, the results of the multivariate logistic regression model showed that having social health insurance (OR=0.8, 95%CI 0.7 to 1.0) and having neighborhood social capital (OR=0.7, 95%CI 0.6 to 0.8) were more inclined to self-rated health. In addition, the results showed that being male, having a college degree or higher, having a job, and drinking alcohol increased the risk of self-rated unhealthy (P<0.05); whereas being 45-59 years of age, 60 years of age or older, in the central and western regions, exercising regularly, and having a disease or injury within two weeks decreased the risk of self-rated unhealthy (P<0.05). There was a positive multiplicative interaction effect between health insurance and neighborhood social capital on residents’ self-rated health (univariate: OR=1.5, 95%CI 1.1 to 3.7, P<0.05; multivariate: OR=1.7, 95%CI 1.2 to 2.4, P<0.05), and negative additive interactions (RERI=−0.8, 95%CI −1.4 to −0.1; AP=−0.3, 95%CI −0.6 to −0.1; SI=0.6, 95%CI 0.5 to 0.8). ConclusionAttention should be paid to the self-rated health status of key populations through means such as health promotion and education, and healthy behavior lifestyles should be promoted. The health insurance system should be further improved, and attention should be paid to the role of social capital in the neighborhood, encouraging residents to actively build a good social neighborhood, and realizing the coordinated development of the multilevel health insurance system and the social capital in the neighborhood.
ObjectiveThis study aims to investigate the variations in patient hospitalization expenses before the enforcement of the centralized procurement policy, after the implementation of the drug centralized procurement policy, and subsequent to the introduction of the consumables centralized procurement policy. The efficacy of the centralized procurement policy will also be examined. MethodsThis retrospective study utilizes data obtained from the medical records homepage of the Health Information Statistics Center under the Health Commission of Gansu Province. It included 32 938 inpatients who underwent PCI surgery for coronary heart disease in Gansu Province between January 1, 2018, and December 31, 2022. A double-breakpoint interrupted time series model was employed to analyze the fluctuation trends in hospitalization costs among patients across various stages of the centralized procurement policy's implementation. ResultsThroughout the three phases of implementing the centralized procurement policy, the average total hospitalization costs were RMB 46 149.49 yuan, RMB 46 629.12 yuan, and RMB 28 771.76 yuan, respectively. Upon initiating the centralized procurement policy with a focus on drug volume, there was an immediate reduction in average total hospitalization costs, drug costs, consumable costs, and medical service fees by 4.64%, 5.62%, 18.12%, and 8.85%, respectively. However, there was a subsequent increase of 25.28% in average medical service fees. Following this phase, average out-of-pocket costs, treatment costs, and other expenses exhibited a consistent upward trajectory, increasing by an average of 2.23%, 0.15%, and 1.21% per month. Upon the introduction of the centralized procurement policy for consumables, there was an immediate surge of 23.75% in average medical service fees, while average total hospitalization costs, out-of-pocket costs, consumable costs, treatment costs, and rehabilitation costs experienced a gradual decline. ConclusionThe enforcement of centralized procurement policies for drugs and consumables has effectively managed to reduce hospitalization costs for patients undergoing PCI surgery due to coronary heart disease, thereby easing the financial burden on patients. However, changes in consumable costs and average medical service fees were relatively modest. Going forward, it is essential to refine the centralized procurement policy concerning consumables, improve the compensation mechanism for medical service pricing, and enhance the overall value proposition of medical services.