2006年乌兰察布市布鲁菌病防治项目情况分析

为有效控制布病疫情的蔓延，保护人民健康，根据《2006年中央补助地方传染病专项资金内蒙古自治区布鲁氏菌病防治项目实施方案》的要求和《乌兰察布市布病防治项目实施方案》的具体安排，察右后旗、商都县、化德县、四子王旗疾病预防控制中心积极开展了2006年度乌兰察布市布病防治项目工作。旨在通过对不同地区的流行病学调查分析，[第一段]     

人才测评与医院竞聘

人才竞聘实施方案的设计是否科学合理，关系到整个竞聘工作是否顺利及能否实现预期的招聘目的。许多关键问题、原则问题、细节问题应尽量体现在实施方案中，使之成为整个竞聘工作的操作指导性文件。     

X线影像数字化装置市场分析

本文对X线影像数字化装置的国内市场进行了分析，论及实施方案和市场风险。     

湖北省新型农村合作医疗试点工作方案(摘录)

编者按：作为国务院确定的新型农村合作医疗的试点省，湖北、云南、浙江、吉林四省已从2003年起陆续启动试点工作，并根据各地实际出台了具体的实施方案。本刊“政策之窗”栏目从本期起将连续刊登4个试点省的实施方案，希望对各地在实施并推广新型农村合作医疗制度时有所借鉴和帮助。     

山东省加强艾滋病感染者和病人管理

山东省日前出台《艾滋病病毒感染者和艾滋病病人随访工作实施方案》，确定了对艾滋病病毒感染者和病人治疗随访的工作目标。     

医保病人费用结算的实践与思考

天津市按照《国务院关于建立城镇职工基本医疗保险制度的决定》精神，结合实际情况，制订了“天津市城镇职工基本医疗保险实施方案（以下简称“医保实施方案”)，并制订了相关配套办法，于2001年11月1日在全市全面实施了医疗保险。     

甘肃省汉族学生2000年视力状况分析

为了解甘肃省学生视力状况，分析其原因并提出相应的干预措施，2000年按全国学生体质调研实施方案，对甘肃省大中小学生视力状况进行了调查，现分析如下。     

医院安防体系建设重在安全计划制定及审计

当前，安全防范管理与安全防范体系建设，已成为构建设平安社会、促进社会发展的重要工作内容和研究课题。所谓安全防范管理体系，就是通过对目标主体的安全调研与风险分析．提出基于组织结构、安保策略、运行计划、运行演练及包括应急预案等在内的安全管理计划与实施方案。该管理体系既包括了安全计划，又包括了实施方案。其目的是为合理调用各方资源来应对危机，提高抗风险的能力，达到确保防范主体的安全目标。     

找寻新医改的驱动力

《关于深化医药卫生体制改革的意见》可称为是新医改的一份规划愿景图，而《医药卫生体制改革近期重点实施方案（2009—2011年）》（下称“实施方案”）则是一份落实行动的路线图。对于愿景来说，观点杂陈，见仁见智；而对于路线图来说，则更重可实施性。从当前的现实来看，能否让“五项改革”落地，则取决于对既有和潜在资源的挖掘和使用力度。这是决定新医改驱动力的关键。     

常熟市城区入托入学儿童预防接种证查验情况分析

为了解常熟市城区入托入学新生预防接种情况，并对漏种疫苗儿童及时补种，按照江苏省预防接种证查验及疫苗补种工作实施方案，我中心对城区幼儿园及小学凭证入托入学情况开展调查，现分析如下。     

Development in harmonisation of proficiency testing (for vapours, gasses, and dusts) in the European Union.

A network has been established of the 11 major proficiency schemes in the European Union concerned with the occupational hygiene and environmental analyses of chemicals and dusts in the air. A comparison of all the schemes was carried out and a compendium is being produced. This will allow users of the schemes such as testing laboratories, customers, and regulatory bodies to choose the scheme that is most suited to their purpose. All schemes have been compared with the revised ISO Guide 43, published in 1997. The performance statistics in most schemes conform to the criteria in European Standard EN 482 that define the acceptability limits for overall uncertainty in measurement. However, the performance statistics and assessment strategies of the different schemes vary. While many of the schemes supply similar sample material such as lead on filters and benzene on charcoal, there are a number of sample types that many schemes would like to introduce. However, it would be uneconomic to do this on a national basis and the network is developing procedures to introduce them throughout the member countries. Additionally, there are countries that have no schemes at present and may wish to introduce them. The network will provide a framework to help set up schemes in these areas.     

The value of early discharge: dispelling some myths

Our objective in this paper is to assess the value of early discharge schemes following the economic evaluation of three such schemes in New South Wales, Australia. An early discharge programme for obstetric patients, a fractured hip management programme and a continuing community cancer care programme were evaluated. The results of the economic evaluation of these schemes are discussed in the light of four commonly held beliefs about the value of early discharge: that early discharge schemes succeed in reducing length of stay, that early discharge schemes save money, that the welfare of patients is not reduced by early discharge and that early discharge schemes are cost-effective. The caution expressed by previous authors about the perceived advantages of early discharge schemes is still warranted.     

The role of community-based health insurance within the health care financing system: a framework for analysis

There is increasing advocacy for community-based health insurance (CBHI) schemes as part of a broader solution to health care financing problems in low-income countries, but to date there is very limited understanding of how CBHI schemes interact with other elements of a health care financing system. This paper aims to set out a preliminary conceptual framework for understanding such interactions, and highlights the kind of research questions raised by such a framework. A basic conceptual map of a CBHI scheme is developed, and extensions added to this map that incorporate (1). effects upon non-members of schemes, (2). government subsidies to providers, (3). government subsidies to schemes, and (4). issues raised by the existence of multiple risk-pooling schemes in a particular context. The utility of a broader approach to analyzing/assessing CBHI schemes is illustrated through examination of two policy issues, namely (1). coordination of CBHI risk pools and government risk pools, and (2). equity implications of CBHI schemes and the role of government subsidies in such schemes. It is concluded that there is a strong need for empirical work to explore how CBHI schemes and the broader health care financing system interact, and that even if individual schemes achieve their own objectives (in terms of equity, efficiency etc.), this does not necessarily imply that such objectives will be achieved at the system level.     

Trainees' experiences of multidisciplinary public health training schemes in England

From 1999 onwards most English NHS regions launched multidisciplinary public health training schemes. These schemes were open to those from backgrounds other than medicine and followed on from the announcement of a new multidisciplinary Public Health Specialist post-a post equivalent to the traditional medical Consultant in Public Health Medicine. This article documents the issues arising during the first few years of the multidisciplinary public health training schemes. It also includes a number of case studies from trainees who have passed through the training schemes, examining the positive and negative experiences of these trainees. The paper reveals how the schemes initially varied considerably by region, in respect of pay and other terms and conditions. The case studies from ex-trainees reveal a number of positive and negative features of the training schemes.     

Evaluating the comparability of different grouping schemes for mortality and morbidity

Comparison of mortality and morbidity is a commonly used method in health related studies. The International Classification of Disease (ICD) consists of thousands of codes for classifying cause of death and disease categories. A grouping scheme is needed to cluster related categories into a meaningful and manageable number for comparative purposes. Different kinds of grouping schemes have been used; nevertheless, little is known about the comparability among different grouping schemes. In this study, we compared seven grouping schemes; five for mortality and two for morbidity. We found poor comparability between different grouping schemes. Different schemes covered different ranges of codes. Some schemes used the same title, but included different ranges of codes. Features of newly developed grouping schemes were to group disease categories of similar characteristics across traditional ICD chapters and to group disease categories based on health care needs, instead of those based merely on etiology or organ system. Different grouping schemes were developed to reveal the unique mortality and morbidity pattern of different geographical areas. Different grouping logic was used by different grouping schemes. Therefore, it is difficult to make a good comparison between different schemes. An investigator tabulating the mortality or morbidity figures based on a given grouping scheme should explicitly define the exact ICD codes included. Any user of data derived from different grouping schemes, especially for comparisons between countries, should be cautious about the comparability problems.     

Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia

Objective

To evaluate the effect of vouchers for maternity care in public health-care facilities on the utilization of maternal health-care services in Cambodia.

Methods

The study involved data from the 2010 Cambodian Demographic and Health Survey, which covered births between 2005 and 2010. The effect of voucher schemes, first implemented in 2007, on the utilization of maternal health-care services was quantified using a difference-in-differences method that compared changes in utilization in districts with voucher schemes with changes in districts without them.

Findings

Overall, voucher schemes were associated with an increase of 10.1 percentage points (pp) in the probability of delivery in a public health-care facility; among women from the poorest 40% of households, the increase was 15.6 pp. Vouchers were responsible for about one fifth of the increase observed in institutional deliveries in districts with schemes. Universal voucher schemes had a larger effect on the probability of delivery in a public facility than schemes targeting the poorest women. Both types of schemes increased the probability of receiving postnatal care, but the increase was significant only for non-poor women. Universal, but not targeted, voucher schemes significantly increased the probability of receiving antenatal care.

Conclusion

Voucher schemes increased deliveries in health centres and, to a lesser extent, improved antenatal and postnatal care. However, schemes that targeted poorer women did not appear to be efficient since these women were more likely than less poor women to be encouraged to give birth in a public health-care facility, even with universal voucher schemes.     

Impact of Community‐based Health Insurance on Access and Financial Protection: Evidence from Three Randomized Control Trials in Rural India

Since the 1990s, community‐based health insurance (CBHI) schemes have been proposed to reduce the financial consequences of illness and enhance access to healthcare in developing countries. Convincing evidence on the ability of such schemes to meet their objectives is scarce. This paper uses randomized control trials conducted in rural Uttar Pradesh and Bihar (India) to evaluate the effects of three CBHI schemes on healthcare utilization and expenditure. We find that the schemes have no effect on these outcomes. The results suggest that CBHI schemes of the type examined in this paper are unlikely to have a substantial impact on access and financial protection in developing countries. Copyright © 2015 John Wiley & Sons, Ltd.     

Rural health prepayment schemes in China: towards a more active role for government

A large majority of China's rural population were members of health prepayment schemes in the 1970's. Most of these schemes collapsed during the transition to a market economy. Some localities subsequently reestablished schemes. In early 1997 a new government policy identified health prepayment as a major potential source of rural health finance. This paper draws on the experience of existing schemes to explore how government can support implementation of this policy. The decision to support the establishment of health prepayment schemes is part of the government's effort to establish new sources of finance for social services. It believes that individuals are more likely to accept voluntary contributions to a prepayment scheme than tax increases. The voluntary nature of the contributions limits the possibilities for risk-sharing and redistribution between rich and poor. This underlines the need for the government to fund a substantial share of health expenditure out of general revenues, particularly in poor localities. The paper notes that many successful prepayment schemes depend on close supervision by local political leaders. It argues that the national programme will have to translate these measures into a regulatory system which defines the responsibilities of scheme management bodies and local governments. A number of prepayment schemes have collapsed because members did not feel they got value for money. Local health bureaux will have to cooperate with prepayment schemes to ensure that health facilities provide good quality services at a reasonable cost. Users' representatives can also monitor performance. The paper concludes that government needs to clarify the relationship between health prepayment schemes and other actors in rural localities in order to increase the chance that schemes will become a major source rural health finance.     

Risk sharing arrangements for pharmaceuticals: potential considerations and recommendations for European payers

Background

There has been an increase in 'risk sharing' schemes for pharmaceuticals between healthcare institutions and pharmaceutical companies in Europe in recent years as an additional approach to provide continued comprehensive and equitable healthcare. There is though confusion surrounding the terminology as well as concerns with existing schemes.

Methods

Aliterature review was undertaken to identify existing schemes supplemented with additional internal documents or web-based references known to the authors. This was combined with the extensive knowledge of health authority personnel from 14 different countries and locations involved with these schemes.

Results and discussion

A large number of 'risk sharing' schemes with pharmaceuticals are in existence incorporating both financial-based models and performance-based/outcomes-based models. In view of this, a new logical definition is proposed. This is "risk sharing' schemes should be considered as agreements concluded by payers and pharmaceutical companies to diminish the impact on payers' budgets for new and existing schemes brought about by uncertainty and/or the need to work within finite budgets". There are a number of concerns with existing schemes. These include potentially high administration costs, lack of transparency, conflicts of interest, and whether health authorities will end up funding an appreciable proportion of a new drug's development costs. In addition, there is a paucity of published evaluations of existing schemes with pharmaceuticals.

Conclusion

We believe there are only a limited number of situations where 'risk sharing' schemes should be considered as well as factors that should be considered by payers in advance of implementation. This includes their objective, appropriateness, the availability of competent staff to fully evaluate proposed schemes as well as access to IT support. This also includes whether systematic evaluations have been built into proposed schemes.     

Exploring payment schemes used to promote integrated chronic care in Europe

The rising burden of chronic conditions has led several European countries to reform healthcare payment schemes. This paper aimed to explore the adoption and success of payment schemes that promote integration of chronic care in European countries. A literature review was used to identify European countries that employed pay-for-coordination (PFC), pay-for-performance (PFP), and bundled payment schemes. Existing evidence from the literature was supplemented with fifteen interviews with chronic care experts in these countries to obtain detailed information regarding the payment schemes, facilitators and barriers to their implementation, and their perceived success.