Mingshan Lu

University of Calgary · Department of Economics

Background and aims We report on a cost analysis study, using population level data to determine the emergency service costs avoided from emergency overdose management at supervised consumption services (SCS). Design We completed a cost analysis from a payer’s perspective. In this setting, there is a single-payer model of service delivery. Settin...

Background In cancer survival analyses using population-based data, researchers face the challenge of ascertaining the timing of recurrence. We previously developed algorithms to identify recurrence of breast cancer. This is a follow-up study to detect the timing of recurrence. Methods Health events that signified recurrence and timing were obtain...

Objective: The aim of the study was to compare the health outcomes and resource use of cancer patients who were new persistent opioid users with those who were not, after undergoing curative intent surgery for cancer. Background: Little is known about long-term health outcomes (overdose, mortality) and resource utilization of new persistent opio...

Background The Seattle Angina Questionnaire (SAQ) is a widely-used patient-reported outcomes measure in patients with heart disease. This study assesses the validity and reliability of the SAQ in a Canadian cohort of individuals with stable angina. Methods and results Data are from the Alberta Provincial Project for Outcome Assessment in Coronary...

Objective The objective of our study was to explore the perspectives of patients and general practitioners (GPs) regarding interventions to increase initiation of cholesterol lowering medication (or statins), including a proposed laboratory-based facilitated relay intervention. Design Qualitative descriptive study using interviews and focus groups...

Objective: Countries worldwide, including Canada, need tools for informed decision-making on the adoption of ICD-11. The purpose of the current study is to create a cost and outcome estimation framework for the transition from ICD-10-CA to ICD-11 in Canada and anticipate the benefits/outcomes and international considerations of ICD-11 adoption. Me...

Background: Impact of isolation precautions on psychological wellbeing of patients has yet to be fully quantified. Aim: To assess the impact of isolation precautions on patient's Health-related quality of life and depression or anxiety scales and estimate per day cost of anxiety and depression. Methods: Literature pertaining to impact of isola...

Background It is essential that clinical documentation and clinical coding be of high quality for the production of healthcare data. Objective This study assessed qualitatively the strengths and barriers regarding clinical coding quality from the perspective of health information managers. Method Ten health information managers and clinical codin...

Purpose Perceived social support is known to be an important predictor of health outcomes in patients with acute coronary syndrome (ACS). This study investigates patterns of longitudinal trajectories of patient-reported perceived social support in individuals with ACS. Methods Data are from 3013 patients from the Alberta Provincial Project for Out...

Objectives The shift to the patient-centred care (PCC) model as a healthcare delivery paradigm calls for systematic measurement and evaluation. In an attempt to develop patient-centred quality indicators (PC-QIs), this study aimed to identify quality indicators that can be used to measure PCC. Methods Design: scoping review. Data Sources: studies...

Reducing rural–urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-go...

Introduction Coded data serves a critical part in the process of identifying the resource allocation required for each department in a hospital and for research purposes. This paper attempts a cost-benefit analysis of the transition from ICD-9 health indicator coding system to ICD-10 coding system and quantify the economic impacts. Objectives and...

Introduction It is essential that clinical documentation and data coding be of high quality for the production of healthcare data for research or administrative purposes. However, there is a limited understanding of the facilitators and barriers of coded data quality and strategies to improve it. Objectives and Approach Our objective was to qualit...

Objectives The purpose of this study was to identify patient-centred quality indicators (PC-QI) and measures for measuring cultural competence in healthcare. Design Scoping review. Setting All care settings. Search strategy A search of CINAHL, EMBASE, MEDLINE, PsycINFO, Social Work Abstracts and SocINDEX, and the grey literature was conducted to...

[This corrects the article DOI: 10.1371/journal.pone.0187096.].

Background: Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation. Methods: Based on a narrative review of the PCC literature, a...

Background Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic...

Background Hospital length of stay (LOS) is a widely used measure for assessing cross-jurisdiction health system performance and informs resource allocation decisions. However, the accuracy of existing LOS risk adjustment models are limited, because they are mostly derived from administrative data, which mostly contain clinical/diagnostic informati...

Objective Risk adjustment methods are widely used to compare quality of care or predict health outcome, but the optimal approach is unclear for liver disease. This study is to compare the performance of common risk adjustment methods for predicting in-hospital mortality in patients with liver disease using Electronic Medical Record (EMR). ApproachT...

Objective With tremendous potential for research and policy use, the development of Electronic Medical Record (EMR) is unprecedentedly growing in China. The rich clinical and financial data in the Chinese EMR provides us a unique chance to examine the impacts of health insurance on health care utilization and outcomes, controlling for patient’s dis...

Objective China has collected high volume of electronic health record (EMR) data. The rich information in EMR data could be used for health services research. The first challenge is developing methods for extracting study variables. Our study aimed to develop and validate data extraction methods for defining clinical conditions. ApproachThe EMRs we...

Background Risk adjustment is essential for valid comparison of patients’ health outcomes or performances of health care providers. Several risk adjustment methods for liver diseases are commonly used but the optimal approach is unknown. This study aimed to compare the common risk adjustment methods for predicting in-hospital mortality in cirrhosis...

Introduction The concept of patient-centred care (PCC) is changing the way healthcare is understood, accepted and delivered. The Institute of Medicine has defined PCC as 1 of its 6 aims to improve healthcare quality. However, in Canada, there are currently no nationwide standards in place for measuring and evaluating healthcare from a patient-centr...

Background In 2003, the New Cooperative Medical Scheme (NCMS) was introduced in China to re-establish health insurance for the country’s vast rural population. In addition, the coverage of NCMS has been expanding after the new health care reform launched in 2009. This study aims to examine whether the NCMS and its recent expansion have reached the...

Background: Surveillance using coded administrative health data has shown that the prevalence of hypertension and diabetes in Canada increased substantially between 1998 to 2008. These findings require an assumption that the validity of hypertension and diabetes coding is stable over time. We tested this assumption by examining temporal trends in...

Background The adoption of the electronic medical record (EMR) is rapidly growing in China. Constantly evolving, Chinese EMRs contain vast amounts of clinical and financial data, providing tremendous potential for research and policy use; however, they are only partially standardized and contain free text or unstructured data. To utilize the inform...

Health decision-making requires evidence from high-quality data. As one example, the Discharge Abstract Database (DAD) compiles data from the majority of Canadian hospitals to form one of the most comprehensive and highly regarded administrative health databases available for health research, internationally. However, despite the success of this an...

Policy decisions in health care, such as hospital performance evaluation and performance-based budgeting, require an accurate prediction of hospital length of stay (LOS). This paper provides a systematic review of risk adjustment models for hospital LOS, and focuses primarily on studies that use administrative data. MEDLINE, EMBASE, Cochrane, PubMe...

Background: Mental health is increasingly becoming a huge public health issue in China. Yet for various cultural, healthcare system, and social economic reasons, people with mental health need have long been under-served in China. In order to inform the current on-going health care reform, empirical evidences on the economic burden of mental illne...

Currently, the most popular hospital payment method in China is fee-for-service (FFS) with a global budget cap. As of December 2009, a policy change means that heart stents are covered by public health insurance, whereas previously they were not. This policy change provides us an opportunity to study how a change in insurance benefit affected the q...

Background Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to inves...

Abstract Widespread integration of market-based incentives into healthcare systems calls for – and has elicited – increasing adoption of risk adjustment. By deterring selection, risk adjustment helps to assure fair and efficient payments among health insurers or capitated provider groups. However, since conventional risk adjustment allocates funds...

China's recent growth in income has been unequally distributed, resulting in an unusually rapid retreat from relative income equality, which has impacted negatively on health services access. There exists a significant gap between health care utilization in rural and urban areas and inequality in health care access due to differences in socioeconom...

Few population-based studies have examined the relationship between psychiatric and somatic or biomedical disorders. We examined the effect of the presence or absence of any psychiatric disorder on somatic or biomedical diagnosis disorder costs. Guided by the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experie...

Background The Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive...

Alberta Health Services maintains a database of children, adolescents and adults referred to the child and adolescent mental health and psychiatry intake service. In this study, we sought to systematically assess the impact, if any, of English language proficiency on enrolment of children for mental health services. Specifically, we assessed the ex...

To compare the health costs of groups with and without psychiatric diagnoses (PDs) using 9 years of physician billing data. A dataset containing registration data for all patients receiving public mental health service was constructed and subsequently matched, on age and sex, in a final patient to comparison patient ratio of 1:8, with health care u...

Improving patient compliance with physicians' treatment or prescription recommendations is an important goal in medical practice. We examine the relationship between treatment progress and patient compliance. We hypothesize that patients balance expected benefits and costs during a treatment episode when deciding on compliance; a patient is more li...

The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countrie...

Widespread integration of market-based incentives into healthcare systems calls for — and has elicited — increasing adoption of risk adjustment. By deterring selection, risk adjustment helps to assure fair and efficient payments among health insurers or capitated provider groups. However, since conventional risk adjustment allocates funds among reg...

Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital’s probability of receiving government financial support is inversely asso...

Under the current healthcare system in China, there is no government-sponsored health insurance program for children. Children from families who move from rural and interior regions to large urban centres without a valid residency permit might be at higher risk of being uninsured due to their low socioeconomic status. We conducted a survey in Shang...

No other country has undergone health care reforms as dramatic as China's. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper ad...

Discussing international issues of health care financing, this is the first volume in a completely new public health book series, edited by the Institute of Health Economics (IHE) in Edmonton, Canada. Starting with various funding methods, the reference also features sections on different health care payment and purchasing mechanisms, as well as eq...

With rapid economic growth and globalization, lifestyle in China has been changing dramatically. This study aimed to describe the male and female adult Chinese population health status. The Chinese Third National Health Services Survey was conducted in 2003 to collect information about health status and quality of life from randomly selected reside...

This paper investigates to what extent psychiatric disorders and mental distress affect labor market outcomes in two rapidly growing populations that have not been studied to date-ethnic minorities of Latino and Asian descent, most of whom are immigrants. Using data from the National Latino and Asian American Study (NLAAS), we examine the labor mar...

To describe patterns in physician and hospital utilization among rural and urban populations in China and to determine factors associated with any differences. In 2003, the Third National Health Services Survey in China was conducted to collect information about health services utilization from randomly selected residents. Of the 193,689 respondent...

In many developed countries, budgetary pressures have made government turn to private insurance as a means of reducing pressure on their public health system. Between 1997 and 2000 the Australian government implemented a series of financial incentives for supplementary private health insurance, intending to increase insurance enrollment and reduce...

This article reviews the basic theoretical model of risk adjustment (Glazer/McGuire 2000) with a special focus on a coherent presentation of the main results. With adverse selection a regulator pursuing efficiency and solidarity objectives will need a risk adjustment scheme acting on a signal to accomplish both aims. With an imperfect signal this r...

This study looks at the effect of performance-based contracting (PBC) on administrative information misreports in substance abuse treatment in Maine. For about 700 alcohol abuse treatment episodes in the period 1990-1995, we constructed clinician report gaming indicators from two data sets: the Maine Addiction Treatment System (MATS) and medical re...

We assessed the linkage and correct linkage rate using deterministic record linkage among three commonly used Canadian databases, namely, the population registry, hospital discharge data and Vital Statistics registry. Three combinations of four personal identifiers (surname, first name, sex and date of birth) were used to determine the optimal comb...

This study investigated the hypothesis that socioeconomic differences in health status change can largely be explained by the higher prevalence of individual health-risk behaviors among those of lower socioeconomic position. Data were from the Americans' Changing Lives study, a longitudinal survey of 3617 adults representative of the US non-institu...

This paper examines selection and matching incentives of performance-based contracting (PBC) in a model of patient heterogeneity, provider horizontal differentiation and asymmetric information. Treatment effectiveness is affected by the match between a patient's illness severity and a provider's treatment intensity. Before PBC, a provider's revenue...

In the health care market managed care has become the latest innovation for the delivery of services. For efficient implementation, the managed care organization relies on accurate information. So clinicians are often asked to report on patients before referrals are approved, treatments authorized, or insurance claims processed. What are clinicians...

This paper explores the relevance of the literature on for-profit versus not-for-profit hospital care to the Alberta government's Health Care Protection Act and to contracting-out of health services more generally. Thirty-four studies were identified and most found no difference between for-profit and not-for-profit full- service hospitals with res...

This paper studies the effectiveness of treatment for substance abuse with data on more than 10,000 treatment episodes from Maine. We measure effectiveness as the reduction in the rate of drug use between admission and discharge. In a nonexperimental setting we use instrumental variables to estimate the effect of treatment, measured as number of vi...

We survey the literature on physician compensation in Canada. After an overview of the institutions of physician payment, we examine the history of physician compensation and how we arrived at the predominant current form of payment, fee for service. Theoretical and empirical implications of fee for service payment mechanisms are explored. We close...

This paper examines the form of performance-based contract which is relatively new to healthcare systems. Economic theories on contracting are reviewed to provide theoretical support for potential impacts of performance-based contracting (PBC) on improving efficiency of the healthcare system. Implementation issues of PBC in healthcare practice are...

This paper studies the effect of incentive regulation on health care. In the context of incentive-based health contracts, which might also introduce an incentive for the providers simply to report better treatment outcomes, evaluation of treatment using the information supplied by the providers (reported output) could be problematic. The systematic...

Like many other medical technologies and treatments, there is a lack of reliable evidence on treatment effectiveness of mental health care. Increasingly, data from non-experimental settings are being used to study the effect of treatment. However, as in a number of studies using non-experimental data, a simple regression of outcome on treatment sho...

This paper constructs a model of saving for retired single people that includes heterogeneity in medical expenses and life expectancies, and bequest motives. We estimate the model using Assets and Health Dynamics of the Oldest Old data and the method of simulated moments. Out-of-pocket medical expenses rise quickly with age and permanent income. Th...

Thesis (Ph. D.)--Boston University, 1998. Vita. Includes bibliographical references (leaves 215-223).