Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic (original) (raw)
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Frontiers in Medicine, 2021
Background: The ongoing COVID-19 pandemic has brought significant challenges to health system and consumed a lot of health resources. However, evidence on the hospitalization costs and their associated factors in COVID-19 cases is scarce.Objectives: To describe the total and components of hospitalization costs of COVID-19 cases, and investigate the associated factors of costs.Methods: We included 876 confirmed COVID-19 cases admitted to 33 designated hospitals from January 15th to April 27th, 2020 in Guangdong, China, and collected their demographic and clinical information. A multiple linear regression model was performed to estimate the associations of hospitalization costs with potential associated factors.Results: The median of total hospitalization costs of COVID-19 cases was 2,869.4(IQR:2,869.4 (IQR: 2,869.4(IQR:3,916.8). We found higher total costs in male (% difference: 29.7, 95% CI: 15.5, 45.6) than in female cases, in older cases than in younger ones, in severe cases (% difference: 344.8, 95% C...
Journal of Clinical Medicine
The impact of the coronavirus disease 2019 (COVID-19) pandemic on health-care quality in the emergency department (ED) in countries with a low risk is unclear. This study aimed to explore the effects of the COVID-19 pandemic on ED loading, quality of care, and patient prognosis. Data were retrospectively collected from 1 January 2018 to 30 September 2020 at the ED of Tri-service general hospital. Analyses included day-based ED loading, quality of care, and patient prognosis. Data on triage assessment, physiological states, disease history, and results of laboratory tests were collected and analyzed. The number of daily visits significantly decreased after the pandemic, leading to a reduction in the time to examination. Admitted patients benefitted from the pandemic with a reduction of 0.80 h in the length of stay in the ED, faster discharge without death, and reduced re-admission. However, non-admitted visits with chest pain increased the risk of mortality after the pandemic. In con...
SSRN Electronic Journal, 2020
Objective: To clarify the clinical and medical expense characteristics of COVID-19. Methods: In this retrospective, single-center study, 55 cured cases with confirmed COVID-19 were analyzed for demographic, epidemiological, clinical, and radiological features and medical expense data. Results: The average age of the 54 successfully treated patients with COVID-19 was 53.2 years old (SD 19.0), including 27 men and 27 women. Off this, 31 (57.4%) patients had chronic diseases. Patients commonly had clinical manifestations of fever (45 [83.3%] patients), cough (29[54.7%] patients), expectoration (28 [51.9%] patients), fatigue (24[44.4%] patients) and diarrhea (8[14.8%] patients) on admission. There was a 10-day interval from the onset of signs and symptoms to hospital admission. About 80% of them got recovery after a two-week treatment. The mean interval from the onset of signs and symptoms to hospital discharge was 20.5 (IQR 16-29) days. The median total medical expense of the treated patient, in general, was 2579.6 (IQR 1366.1-4837.6) U.S. dollars. Still, the median medical expense was 8904.1 (IQR 6660.1-27143.8) U.S. dollars in patients with more than five comorbid illnesses during the treatment. Conclusion: There is a 3-week interval from the onset of signs and symptoms to cure, and most hospitalized patients get recovery within two weeks. The total medical expense of cases with more than five comorbid conditions during the treatment is higher. Quite a few COVID-19 cases with other serious diseases are likely to account for most of the total medical expenses. Research in context Evidence before this study We searched PubMed on May 13, 2020, for articles that describe the epidemiological, clinical, and health economic characteristics of COVID-19, using the search terms "COVID-19" or "2019 novel coronavirus (2019-nCoV)" with no language or time restrictions. Previously published research discussed the sources if SARS-CoV-2, epidemiological and clinical characteristics, mechanism, symptoms and diagnosis, prevention, and treatment strategies of COVID-19. The only report of the health care cost data of COVID-19 on China and the world was published on Apr 16, 2020, with analysis from the socioeconomic perspective. To the best of our knowledge, no study has examined the hospital cost data of COVID-19.
Decline in hospitalization for all medical conditions during the COVID-19 pandemic
Romanian Journal of Orthopaedic Surgery and Traumatology, 2020
Introduction: Hospital admissions fell dramatically in Romania during the COVID-19 pandemic partially due to urgent legislation for controlling the infection rates that influenced the selection criteria for hospitalization and also due to fear of infection with SARS-CoV-2 which resulted in avoiding medical services. Aim: This study aimed to assess the impact of COVID-19 pandemic on the population availability to access medical services by comparing the admission rates for all departments of the University Emergency Hospital, Bucharest, from March to August 2019 and March to August 2020. Methods: A cohort of 38.730 patients was analyzed according to hospitalization rate from March to August 2019 and March to August 2020. Results: From March to August 2020 patients were hospitalized as a result of a medical emergency rather than an appointment, as outpatient and hospitalization rates changed dramatically. Thus, 67.4% accessed hospitalization from March to August 2019 and 32.6% accesse...
From preparedness to recovery: Learning lessons of COVID-19 outbreak from China
East African Health Research Journal
At the end of December 2019, the Chinese public health authorities reported several cases of acute respiratory syndrome in Wuhan City, Hubei province, China. Chinese scientists soon identified a novel coronavirus as the main causative agent. The disease is now referred to as coronavirus disease 2019 (COVID-19), and the causative virus is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 outbreak was declared a pandemic by the World Health Organization on March 12th, 2020. COVID-19 propagates quickly and threatens the population at large; around 20% of affected populations have presented severe forms of the diseases. In China approximately ~5% cases became critical patients in need of admission to intensive-care units. The need for intensive care has led to unprecedented overcrowding in hospitals, with catastrophic situations witnessed in Italy and other countries. The highest mortality rates have been witnessed amongst the elderly with several comorbidities. In this viewpoint we draw lessons from the implementation of population containment measures, vulnerable people protection and relevant public health pillars in China. We then discuss how these lessons can or cannot be applied to other settings.
PLOS ONE
Background The COVID-19 pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has substantially impacted healthcare utilization worldwide. The objective of this retrospective analysis of a large hospital discharge database was to compare all-cause and cause-specific hospitalizations during the first six months of the pandemic in the United States with the same months in the previous four years. Methods Data were collected from all hospitals in the Premier Healthcare Database (PHD) and PHD Special Release reporting hospitalizations from January through July for each year from 2016 through 2020. Hospitalization trends were analyzed stratified by age group, major diagnostic categories (MDCs), and geographic region. Results The analysis included 286 hospitals from all 9 US Census divisions. The number of all-cause hospitalizations per month was relatively stable from 2016 through 2019 and then fell by 21% (57,281 fewer hospitalizations) between Marc...
The COVID-19 Run on Medical Resources in Wuhan China: Causes, Consequences and Lessons
Healthcare
The COVID-19 run on medical resources crashed Wuhan’s medical care system, a medical disaster duplicated in many countries facing the COVID-19 pandemic. In a novel approach to understanding the run on Wuhan’s medical resources, we draw from bank run theory to analyze the causes and consequences of the COVID-19 run on Wuhan’s medical resources and recommend policy changes and government actions to attenuate runs on medical resources in the future. Like bank runs, the cause of the COVID-19 medical resource run was rooted in China’s local medical resource context and a sudden realignment of expectations, reflecting shortages and misallocations of hospital resources (inadequate liquidity and portfolio composition); high level hospitals siphoning-off patients from lower level health providers (bank moral hazard and adverse selection problem); patients selecting high-level hospitals over lower-level health care (depositor moral hazard problem); inadequate government oversight and uncontro...
European Journal of Public Health, 2021
At the onset of the COVID-19 pandemic, health care providers had to abruptly change their way of providing care in order to simultaneously plan for and manage a rise of COVID-19 cases while maintaining essential health services. Even the most well-resourced health systems faced pressures from new challenges brought on by COVID-19, and every country had to make difficult choices about how to maintain access to essential care while treating a novel communicable disease. Using the information available on the HSRM platform from the early phases of the pandemic, we analyze how countries planned services for potential surge capacity, designed patient flows ensuring separation between COVID-19 and non-COVID-19 patients, and maintained routine services in both hospital and outpatient settings. Many country responses displayed striking similarities despite very real differences in the organization of health and care services. These include transitioning the management of COVID-19 mild cases...
Difference in impact on emergency department visits following four major peaks of COVID-19 cases
Journal of Hospital Administration
Objective: Several variants of SARS-CoV-2 have emerged since its first appearance in 2019, greatly impacting healthcare systems across the globe. Previous literature indicated a substantial decline in emergency department (ED) visits in hospitals since the start of the COVID-19 pandemic. However, little research has been done to compare different variants’ (Ancestral, Alpha, Delta, Omicron, etc.) impact on patients presenting to the ED. Thus, the purpose of this retrospective observational study is to compare the changes in total ED volume following four major peaks of SARS-CoV-2 infection within a multi-hospital health system.Methods: Utilizing electronic healthcare record (EHR) data, total ED visits (484,268) and COVID-19 case counts (24,358) were collected and analyzed to compare ED census and COVID-19 trends across four years and four variant peak periods, from January 2019 to June 2022.Results: Results showed that ED visits declined after the first two major peaks (Ancestral an...