"看病贵、看病难"的经济分析和对策研究

中国社会科学院社会学所发布的社会蓝皮书<2007年:中国社会形势分析与预测>指出,我国城乡居民认为"看病贵、看病难"是最突出的社会问题."看病贵"的根本原因是医疗资源(尤其是城市优质医疗资源)提供的医疗服务价格高于一般患者的经济支付能力和心理承受能力;"看病难"的根本原因是农村基本医疗服务提供不足以及城市优质医疗资源有限,不能满足广大患者的医疗需求.本文通过大量的统计数据对"看病贵、看病难"进行了经济分析,并在此基础上提出了缓解该问题的对策建议.     

我国农村医疗救助的筹资需求测算

文章利用第三次国家卫生服务调查和民政统计数据对我国农村医疗救助的筹资需求进行测算,测算结果表明:在中长期内,实现农村医疗救助由目前的"大病救助"模式向"综合救助"模式转型,在财政筹资能力上是完全可行的.     

互助医疗与新型农村合作医疗缓解"因病致贫"的效果比较

目的:比较新型农村合作医疗和农村互助医疗2种医疗保障制度在缓解卫生服务利用人群"因病致贫、因病返贫"方面的效果。方法:资料来源于2005年11月对陕西省镇安县高峰镇和铁厂镇的入户调查数据和样本人群医疗服务利用报表数据,贫困测量指标选用贫困发生率、贫困距指数、收入差距比率、森的贫困指数、补偿资金的使用效率和供给率。结果:农村互助医疗制度缓解卫生服务利用人群"因病致贫"的效果好于新型农村合作医疗制度。建议:新型农村合作医疗制度取消门诊个人账户,对住院和门诊服务利用均进行一定程度的补偿。     

甘肃两县农村中低收入群体医疗服务需求的调查分析

目的:了解甘肃农村中低收入家庭医疗服务需求和利用,分析农村医疗服务面临的基本问题,为完善基层医疗卫生服务体系建设提供参考。方法:对甘肃农村中低收入家庭医疗服务需求进行问卷调查和定量分析。结果:农村中低收入家庭慢性病的发病率较高;私人诊所、私人药店和乡镇卫生院成为其主要的就诊机构;医疗负担较重,药品支出所占比例较大。建议:加强农村慢性病防治工作,在费用控制的同时提高服务质量和建立农村医疗卫生服务需求表达机制。     

培育农村医疗服务市场的难点及对策探析

农村医疗服务市场正处于发育、发展中,在医疗服务需求、医疗服务资源市场流动、医疗服务供给主体利益风险以及农民医疗消费行为等方面有许多难点问题亟待解决.为此,加大政府对农村医疗卫生事业的投入、加快建设农村药物供给系统、保证基层医务人员的收入以及不断改善农民的医疗消费行为至关重要.     

嘉定区华亭镇家庭医生管健康管费用工作效果评价*

为了深入推进家庭医生制服务工作,上海市嘉定区华亭镇在2012—2014年探索了家庭医生管健康管费用工作。通过开展家庭医生"一三五"服务模式,推出"三扩大二落实"举措,积极打造优秀的健康管理团队,巧用"借"之诀,提高"五个率",开展基线调查,掌握居民健康状况和服务需求。经过3年的实践,中心家庭医生服务知晓率、有效服务利用率逐年提高,高血压、糖尿病管理率和控制率逐年提高,患者医疗费用合理管控。建议:提高偏远农村地区全科医生待遇,进一步推进卫生信息化建设,通过家庭医生将基本医疗等各项服务下沉到社区,让居民能够享受到便捷的医疗服务,构建分级诊疗体系,形成有序就诊。     

"看病贵、看病难"的原因分析和对策研究

中国社会科学院社会学所发布、社会科学文献出版社出版的社会蓝皮书《2007年:中国社会形势分析与预测》指出,我国城乡居民认为"看病贵、看病难"是最突出的社会问题。导致"看病贵、看病难"的因素包括医保制度、药品价格、医疗收费、贫困救助、农村合作医疗、社区服务、医德医风等。缓解"看病贵、看病难"的根本是要确立医疗服务必须面向普通大众的方针,并且始终坚持卫生医疗事业为群众服务的宗旨和公益性原则。     

中国农村基本医疗服务需求弹性经济学模型研究

通过１９９３年全国卫生服务总调查获取关于我国农村基本医疗服务需求量（Ｘ），医疗服务价格（Ｐ）和年人均收入（Ｉ）的资料，本研究在我国运用经典的经济学对数线性模型，首次对全国农村基本医疗服务需求进行了定量研究。结果表明，我国农村基本医疗服务需求的收入弹性为０；１６５６，价格弹性为─０．４７７９，模型配合的复相关系数为０．４８８５。这一研究结果定量反映出我国农村基本医疗服务随价格和个人收入变化而变化的一般规律，即价格每增加一倍，基本医疗服务需求将减少４７．７９％，而个人收入每增加一倍，基本医疗服务需求只增加１６．５６％。这一结果还表明农村基本医疗服务的商品性略小于它的福利性，因为其价格弹性的绝对值为０．４７７９＜０．５００，即市场价格对农村基本医疗服务的影响小于５０％。医疗服务的价格和收入弹性模型分析结果有助于国家在政策和战略层次对农村医疗卫生服务，尤其是最基本的服务进行规划指导；也有助于各级卫生行政和业务部门对农村各级医疗卫生服务部门的具体工作进行管理。     

浅谈无锡农村卫生人才现状与对策

目的探讨无锡市乡镇卫生院及社区医疗服务中心的卫生服务需求状况及解决方法。方法对无锡市452家乡镇卫生院及社区医疗服务中心的卫生服务需求状况的调查。结果现有的农村乡镇卫生院及社区医疗服务中心管理人才素质不高、卫生人员短缺、公共卫生人才缺乏是导致农民群众看病难的主要原因。结论为适应当前农村合作医疗及社区卫生事业改革的需要,必须加强农村卫生人才队伍建设,提高乡镇卫生院和社区医疗服务卫生中心的服务能力,加强市级医院与社区医疗服务卫生中心的紧密联系,满足农民群众日益增长的健康与保健需求。     

试析"看病难、看病贵"成因及缓解对策

1"看病难"难在哪里,"看病贵"责到何种程度 "看病难",难在哪里?目前,农村大多数乡镇卫生院和村卫生室医疗设备落后,人才匮乏,难以提供合格的医疗服务,导致农民就近看病困难.在城市,街道社区医疗机构病人很少,而大医院挂号、就诊、化验、取药等处都排着长队,患者苦不堪言.     

农村居民医疗服务需求及其影响因素分析

该文分析目前农村居民医疗服务需要、需求及其影响因素.采取家庭健康询问调查方法,获取调查地区居民2周患病、就诊与住院、未就诊与未住院等情况及其影响因素.采用定性与定量分析法,研究农村居民医疗服务需求与需要及其影响因素,为政府有关部门制定政策提供依据.结果显示,农村居民医疗卫生服务需要、需求水平低,人口学特征和经济因素是主要影响因素.     

农村医疗保障制度的建立势在必行

利用全省卫生服务调查资料。分析了农村医疗保障制度现状,揭示了其给农村居民日常生活。医疗保健需求和卫生服务利用来带来的影响,并对农村居民在建立医疗保障制度方面的愿望作了一些讨论。指出由于农村医疗保障制度的建立与全省经济增长不相适应,一定程度上制约了农村居民医疗保健需求的增长和卫生服务利用的提高,为建设一条具有地方特色的、与现阶段生产力发展水平相适应的现代农村医疗保障制度的路子提供参考意见。     

Is hospital discharge administrative data an appropriate source of information for cancer registries purposes? Some insights from four Spanish registries

Background

Complementary and alternative medicine (CAM) use - of which naturopathy constitutes a significant proportion - accounts for approximately half of all health consultations and half of out-of-pocket expenditure in Australia. Data also suggest CAM use is highest amongst rural Australians. Unfortunately little is known about the grass-roots reality of naturopathy or other CAM use in rural regions.

Methods

Semi-structured interviews were conducted with 20 naturopaths practising in the Darling Downs region of South-East Queensland to assess their perceptions and experiences of rural patients and demand for their services.

Results

Naturopaths described strong demand in rural areas for their services and perceived much of this demand as attributable to cultural traits in rural communities that served as pull factors for their naturopathic services. Such perceived traits included a cultural affinity for holistic approaches to health and disease and the preventive philosophy of naturopathy and an appreciation of the core tenet of naturopathic practice to develop closer therapeutic relationships. However, cost and a rural culture of self-reliance were seen as major barriers to naturopathic practice in rural areas.

Conclusions

Demand for naturopathic services in rural areas may have strong underlying cultural and social drivers. Given the apparent affinity for and increasingly large role played by CAM services, including naturopathic medicine, in rural areas it is imperative that naturopathic medicine and the CAM sector more broadly become a core focus of rural health research.     

广西容县农村居民卫生服务需要、需求与特别是利用调查

目的了解广西容县农村居民卫生服务需要、需求和利用现状。方法采用分层抽样的方法,对广西容县3个乡镇6个行政村445户2 283名居民进行家庭健康询问调查。结果调查地区农村居民的两周患病率为223.8‰,慢性病患病率为16.0%;两周就诊率为32.9%;住院率为7.4%。92.9%的患者就诊时选择村卫生室或乡镇卫生院;57.7%的住院者住院医疗机构选择县级医院。22.9%的未就诊病人与71.4%的未住院病人是缘于经济困难。结论农村居民的卫生服务需要、需求和利用程度较高,就医流向基本趋于合理;疾病经济负担仍是影响农村居民卫生服务利用的主要因素。     

Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making

Background

Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required.

Methods

A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities.

Results

Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision.

Conclusions

The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.

     

县医院对乡镇卫生院进行“重管理、造血式”托管模式研究

为深化丰都县农村医疗卫生体制改革,推进丰都县城乡卫生统筹发展,丰都县人民医院在农村医疗卫生体制改革过程中,结合县情,拓宽思路,积极探索,大胆创新,推行县乡村卫生一体化管理,对丰都县高镇中心卫生院实行托管,同时开展托管模式的研究,为深化农村医疗卫生体制改革、促进城乡卫生统筹发展这一课题探索出了"重管理、造血式"的医院托管模式。     

Estimating rural households’ willingness to pay for health insurance

In many developing countries limited health budgets are a serious problem. Innovative ways to raise funds for the provision of health services, for example, through health care insurance, have a high priority. Health care insurance for rural households shields such patients from unexpected high costs of care. However, there are questions about whether, and how much, rural households are willing to pay to purchase such insurance, as well as the factors determining willingness to pay. In recent years the Iranian government has tried to improve health and medical services to rural areas through a health insurance program. This study was conducted to estimate rural households demand and willingness to pay for health insurance. A contingent valuation method (CVM) was applied using an iterative bidding game technique. Data has been collected from a sample of 2,139 households across the country.     

山东省农村卫生"三项建设"评估

山东省农村卫生“三项建设”工作启动10年以来,全省各地各级单位坚持依此为契机积极推进农村卫生建设与发展,共筹集资金227524．47万元。一方面,乡镇卫生院、县级卫生防疫站和妇幼保健站危房得到改造、卫生人员队伍壮大、人员素质提高、设备不断更新、服务能力提高,农村基本卫生服务供给状况有了很大的改善;另一方面,我省农村卫生建设工作仍然存在一些不足的地方,需要继续增加投入,进一步促进其发展与完善。     

Attracting Doctors to Rural Areas: A Case Study of the Post-Graduate Seat Reservation Scheme in Andhra Pradesh

Background:

Attracting doctors to rural posts is an ongoing challenge for health departments across different states in India. One strategy adopted by several states to make rural service attractive for medical graduates is to reserve post-graduate (PG) seats in medical colleges for doctors serving in the public sector.

Objective:

This study examines the PG reservation scheme in Andhra Pradesh to understand its role in improving rural recruitment of doctors and specialists, the challenges faced by the scheme and how it can be strengthened.

Materials and Methods:

Qualitative case study methodology was adopted in which a variety of stakeholders such as government officials, health systems managers and serving Medical Officers were interviewed. This was supplemented with quantitative data on the scheme obtained from the Health, Medical and Family Welfare Department in Andhra Pradesh.

Results:

The PG reservation scheme appears to have been one of the factors responsible in attracting doctors to the public sector and to rural posts, with a reduction in vacancies at both the Primary Health Centre and Community Health Centre levels. Expectedly, in-service candidates have a better chance of getting a PG seat than general candidates. However, problems such as the mismatch of the demand and supply of certain types of specialist doctors, poor academic performance of in-service candidates as well as quality of services and enforcement of the post-PG bond need to be resolved.

Conclusion:

The PG reservation scheme is a powerful incentive to attract doctors to rural areas. However, better monitoring of service quality, strategically aligning PG training through the scheme with the demand for specialists as well as stricter enforcement of the financial bond are required to improve the scheme''s effectiveness.     

博弈中的农村医患关系--对某镇医疗纠纷利益相关者行动策略的“过程-事件分析”

农村医患关系具有现代社会医患关系的一般性特征,但由于中国农村“半乡土”的社会性质,以及当前农村医疗卫生政策仍然有别于城市医疗卫生政策,中国农村医患关系有其自身特征。以具体的医疗纠纷为个案,采用和借鉴“过程-事件分析”方法,在关注、描述和分析事件过程的基础上,分析利益相关者的行为策略,探讨农村医患关系的现状。