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Purpose: The medical-pharmaceutical separation (MPS) reform is a healthcare reform that focuses on reducing the proportion of drug expenditure. This study aims to analyze the impact of the MPS reform on hospitalization expenditure and its structure in tertiary public hospitals. Methods: Using propensity score matching and multi-period difference-in-difference methods to analyze the impact of the MPS reform on hospitalization expenditure and its structure, a difference-in-difference-in-difference model was established to analyze the heterogeneity of whether the tertiary public hospital was a diagnosis-related-group (DRG) payment hospital. Of 22 municipal public hospitals offering tertiary care in Beijing, monthly panel data of 18 hospitals from July 2011 to March 2017, totaling 1242 items, were included in this study. Results: After the MPS reform, the average drug expenditure, average Western drug expenditure, and average Chinese drug expenditures per hospitalization decreased by 24.5%, 24.6%, and 24.1%, respectively (P < 0.001). The proportions of drug expenditure decreased by 4.5% (P < 0.001), and the proportion of medical consumables expenditure increased significantly by 2.7% (P < 0.001). Conclusion: The MPS reform may significantly optimize the hospitalization expenditure structure and control irrational increases in expenditure. DRG payment can control the tendency to increase the proportions of medical consumables expenditure after the reform and optimize the effect of the reform. There is a need to strengthen the management of medical consumables in the future, promote the MPS reform and DRG payment linkage, and improve supporting measures to ensure the long-term effect of the reform.

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This paper examined the effect of air pollution joint prevention and control on pollution emissions in China. Specifically, based on the panel data of 290 cities from 2007 to 2021, taking the implementation of the "Air Pollution Prevention and Control Action Plan" as a natural experiment, the difference-in-difference-in-difference (DDD) model was used to explore the effect of air pollution joint prevention and control on haze pollution. Results show that air pollution joint prevention has a significant impact on pollutant emissions either as a whole or as a single pollutant. In terms of individual urban agglomeration, whether the Yangtze River Delta or the Pearl River Delta urban agglomerations, the air pollution joint prevention and control policy has a significant impact not only on the overall reduction of pollutant emissions but also on the reduction of single PM2.5 or industrial sulfur dioxide emissions alone. Environmental regulations have also achieved the effect of haze control in general and have a significant impact on the reduction of PM2.5 or industrial sulfur dioxide emissions. Environmental regulations also significantly reduced PM2.5 emissions in these three urban agglomerations. These findings provide a scientific basis and essential reference for understanding the implementation effect of regional joint prevention and control policies comprehensively and objectively.

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BACKGROUND: Left without being seen (LWBS) rates have become a key metric of emergency department (ED) flow, and high rates have been associated with poor patient outcomes, especially at busy urban, academic hospitals. OBJECTIVE: To assess a triage intervention's impact on LWBS rates among Emergency Severity Index (ESI) level 2 patients especially at risk for adverse outcomes. METHODS: We conducted a retrospective review at an urban academic center of LWBS rates prior to and after a "direct bedding" intervention, which directed patients triaged to ESI level 2 to be immediately placed in any available ED area, including those typically reserved for lower-acuity complaints. Our primary analysis employs an adjusted difference-in-difference-in-difference (DDD) approach using controls from the previous year and a nearby affiliate community hospital that did not participate in the intervention. RESULTS: Mean daily patient volume increased from 275 to 298 arrivals after the intervention. In the primary DDD analysis, odds of LWBS were lower after the intervention (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.45-0.70, p < 0.001). LWBS was higher in the unadjusted analysis (unadjusted OR 1.39, 95% CI 1.31-1.49, p < 0.001), but still lower among ESI 1 or 2 patients targeted by the intervention (unadjusted OR 0.56, 95% CI 0.43-0.74, p < 0.001). CONCLUSIONS: "Direct bedding" of ESI 2 patients may expedite care for the sickest patients, reducing potential harm to patients who might otherwise LWBS, without compromising care for patients triaged to less acute ESI levels.

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We study the causal effect of maternal education on childhood immunization rates. We use the Compulsory Education Law of 1997, and the differentiation in its implementation across regions, as instruments for schooling of young mothers in Turkey. The Compulsory Education Law increased the compulsory years of schooling of those born after 1986 from 5 to 8 years. We find that education of mothers increases the probability of completing the full course of diphtheria, pertussis, and tetanus and Hepatitis B vaccinations for their children. The results are robust to variations in regression specification and including various individual and community variables.

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