长期护理保险第一批试点城市保险筹资方案比较分析

目前我国已全面开展长期护理保险制度试点。通过对第一批四个试点城市的长期护理保险筹资方案进行梳理,比较分析各城市保险的筹资性质、筹资来源、筹资水平、筹资公平性,发现长期护理保险筹资来源较单一、缺乏激励措施、筹资总体水平不高、筹资公平性有待改善等问题。为完善长期护理保险筹资方案制度设计,本文提出需要特别注意的几个问题:完善筹资来源,应逐步形成合理稳定的筹资来源,拓宽筹资渠道,提高筹资水平;改善筹资公平性,从完善参保制度、加强宣传等方面提高筹资公平性;理顺保险筹资管理体系。     

新疆农村家庭2003～2008年卫生筹资公平性变化分析

[目的]研究2003～2008年新疆农村不同经济水平家庭卫生筹资的公平性变化。[方法]利用新疆2003、2008年国家卫生服务调查相关数据,运用比例法和指数法测算农村不同经济水平家庭各项卫生筹资渠道的公平性。[结果]2003、2008年税收支出的集中指数分别为0.33、0.36,Kakwani指数分别为-0.05、-0.02筹资趋向等比例;社会医疗保险支出集中指数分别为-0.33、0.15,Kakwani指数分别为-0.71、-0.23;商业健康保险支出集中指数分别为0.64、0.58,Kakwani指数分别为0.25、0.20;现金卫生支出集中指数分别为0.43、0.50,Kakwani指数分别为0.04、0.12。[结论]税收卫生筹资公平性变化不大,相对可支付能力而言筹资均趋向等比例,新农合改善了农村居民社会医疗保障筹资的绝对公平性,贫困家庭支付商业健康保险增多,现金卫生支出向富裕家庭倾斜程度加大。     

我国西部典型地区卫生筹资公平性实证分析

目的:分析我国西部地区卫生筹资公平性及变化。方法:利用2013年和2015年我国基层卫生综合改革西部典型地区的居民家庭健康询问调查数据,结合中国统计年鉴中相关年份各省份的各种消费性支出税率,计算各消费性支出的直接税、间接税;计算直接税、间接税、社会医疗保险、商业健康保险、个人现金卫生支出的集中指数和Kakwani指数,反映五种卫生筹资渠道的公平性。结果:2016年西部典型地区直接税、间接税、社会医疗保险、商业健康保险和现金卫生支出的集中指数分别为0.615、0.366、0.285、0.423、0.262,Kakwani指数分别为0.256、0.007、-0.074、0.064、-0.097,与2014年相比,直接税和商业健康保险集中指数分别增加0.120和0.118,现金卫生支出降低0.028;直接税和商业健康保险Kakwani指数分别增加0.106和0.104,现金卫生支出减低0.042,其他筹资渠道集中指数和Kakwani指数变化不大。结论:西部典型地区卫生筹资公平性有所改善,直接税和商业健康保险累进程度进一步增高,对贫困人群有利;现金卫生支出筹资公平性趋好。     

农村居民大病保险的运行分析

通过对农村居民大病保险的运行情况分析,发现大病保险不仅影响了新农合的保障水平,其实际保障作用也十分有限,农村大病患者的自付经济负担仍较重。因此,建议明确大病保险的性质定位,建立与之相适应的筹资机制和管理体制。大病保险为补充保险,则应建立独立筹资机制;大病保险为基本医保,则应建立基本医保和大病保险的一体化管理体制。在城乡居民基本医保和大病保险整合过程中,可建立差异化的筹资机制,促进大病保险的公平性。     

新疆生产建设兵团卫生筹资累进性分析

目的:对新疆生产建设兵团全省、城市和农场卫生筹资公平性进行分析,测量各种卫生筹资渠道的累进性,反映卫生支出在不同社会经济群体之间的分布与公平程度。方法:利用兵团2004年第二次卫生服务调查数据,运用比例法和指数法对兵团家庭卫生筹资累进性进行分析。结果:从绝对分布看,兵团各种卫生支出的集中指数均为正,富裕家庭支付的多,贫困家庭支付的少;从相对分布看,税收支出的Kakwani指数为负,筹资分布表现为累退,社会医疗保险支出、商业健康保险支出和现金卫生支出的Kakwani指数均为正,筹资分布呈现出累进的特点。从兵团城市和农场各种卫生支出的绝对分布看,均是富裕家庭支付的多,贫困家庭支付的少;从相对分布看,城市和农场卫生筹资特点不完全相同。结论:新疆兵团卫生筹资的绝对分布是公平的;相对分布除社会医疗保险和个人现金卫生支出筹资机制表现出公平特点外,税收筹资表现出不公平性特点,商业健康保险卫生筹资是否公平不能判断,因为分城市和农场其表现出来的特征不同;4种卫生筹资机制公平性相比较,社会医疗保险支出的公平性最好,税收支出公平性最差。     

家庭卫生筹资公平性研究

目的　测算上海市郊区家庭卫生筹资公平性状况 ,并估计全国情况。方法　通过家庭入户调查获得卫生支出、政府卫生投入等数据 ,应用WHO所介绍的卫生系统绩效评价中的家庭卫生筹资公平性指标及其测量方法。结果　测算出家庭卫生筹资公平性系数为 0 735 ;合作医疗覆盖率能提高家庭卫生筹资公平性。结论　上海市郊区家庭卫生筹资公平性水平与WHO对我国的估计相符 ,而全国的筹资公平性水平要更低 ;WHO所推荐的卫生筹资公平性测算方法中 ,政府对家庭卫生补贴的测算不适合我国实情。     

长期护理保险筹资问题的研究综述

从学者的研究中试图提炼相关焦点和关注趋势,为下一步开展长期护理保险筹资及可持续性的研究奠定基础。长期护理保险渐进成熟和完善,已成为国内外学者关注的焦点。学界认为筹资机制是关系长期护理保险有效运行的关键,国外学者对该问题的研究逐渐从关注公平性、效率性过度到基金的可持续性;国内学者从长期护理保险的探索之初到统一规范阶段多角度关注了基金筹资问题,从政府责任到多元化来源、从筹集步骤到筹资模式、从独立筹资到调整机制等问题均进行了探讨。     

山西省新型农村合作医疗家庭筹资公平性分析

目的：探索山西省新型农村合作医疗试点县卫生筹资公平性以及灾难性卫生支出家庭对筹资公平性的影响。方法：采用WHO《2000年世界卫生报告》中所介绍的卫生服务筹资公平性方法。结果：山西省新型农村合作医疗试点县卫生筹资贡献率HFC0为26．91％，卫生筹资公平性指数FFC为0．6828；剔除灾难性卫生支出家庭后．榆社、娄烦县的HFC均有所下降。筹资公平性分别提高了7．32％和7．40％。结论：山西省试点县农民家庭合作医疗筹资公平性相当于国内平均水平；灾难性卫生支出家庭是影响新型农村合作医疗筹资公平性的因素。     

广西壮族自治区城镇居民卫生筹资公平性研究

目的研究广西城镇居民各种卫生筹资渠道的公平程度。方法利用比例法、累进性分析(集中曲线、kakwani指数)等方法分析广西城镇居民各种卫生筹资渠道的公平性。结果广西卫生总费用中个人卫生支出的比例过高。2000～2008年广西城镇居民现金卫生支出筹资的公平性优于通过税收筹资的公平性。税收和现金卫生支出的kakwani指数均为负值,表现为累退性,卫生筹资的公平性较差。结论政府应加大卫生投入,拓展社会筹资渠道,降低个人卫生支出的比例。加强利用税收进行卫生筹资,从而提高卫生筹资的公平性。     

中等收入国家长期护理保险研究:韩国与日本及德国的比较

许多面临人口迅速老龄化的中等收入国家,对于长期护理(LTC)的筹资以及护理服务供给越来越关注。该文研究韩国、日本和德国的制度,这三个国家都用社会保险支付医疗服务,并且都有发达的长期护理保险系统(LTCI)。这些国家采用不同的方法将LTCI建立到社会保险的框架体系之内。对三个国家的筹资体系,保障水平以及准入机制进行比较。据调查,当人口老龄化问题还未突显,这些中等收入国家有必要及早发展LTCI制度并加大投入力度。大多数中等收入国家缺乏支持长期护理服务的基础设施,制度早期筹资和服务提供也需要有时间去适应和调整。一种方法是先从有限的保障和严格的准入制度做起,逐步扩大,让国家积累充分的经验并发展更多的筹资渠道。这三个国家都使用了费用分摊机制来抵御过度医疗,并对贫困人口实行补助来维护公平性。一个主要的政策导向是选择现金补贴还是提供服务,这一政策会对女性产生很大的影响。     

白三烯C4合成酶基因多态性与儿童哮喘易感性及孟鲁司特疗效关联研究

目的 研究白三烯C4合成酶(LTC4S)基因 rs730012、rs3776944两个单核苷酸多态性位点(SNPs)与儿童哮喘易感性和孟鲁司特疗效的关系,以指导哮喘早期预防及精准治疗。方法 选取2016年5月-2017年8月沈阳军区总医院就诊的哮喘患儿215例为病例组,228例非哮喘儿童为对照组,应用聚合酶链反应(PCR)及测序法对所有研究对象LTC4S rs730012、rs3776944位点进行基因分型,并于孟鲁司特治疗前后进行肺功能、尿LTE4儿童哮喘控制测试问卷(C-ACT)评分。结果 1)病例组与对照组在rs730012及rs3776944 位点基因型频率差异均无统计学意义(χ²=0.079、0.617,P均＞0.05)。2)中重度哮喘组A/C+C/C基因型频率明显高于对照组和轻度哮喘组,差异有统计学意义(χ²=4.129、6.088,P均＜0.05)。3)A/C+C/C基因型哮喘患儿在经过孟鲁斯特钠治疗后FEF50、FEF75改善率明显高于A/A型患儿(P均＜0.05),而单纯应用布地奈德组患儿差异无显著性(P均＞0.05)。4)A/A基因型患儿应用孟鲁司特疗效更佳,较A/C+C/C基因型尿液LTE4改变率高,rs730012和rs3776944位点差异均有统计学意义(P均＜0.05)。结论 LTC4S rs730012 SNP与哮喘严重程度有关,rs730012及rs3776944 SNPs野生型应用孟鲁司特疗效更佳。     

Do Medicaid Home and Community Based Service Waivers Save Money?

This article estimates the potential savings to the Medicaid program of using 1915c Home and Community Based Services (HCBS) waivers rather than institutional care. For Medicaid HCBS waiver expenditures of $25 billion in 2006, we estimate the national savings to be over $57 billion, or $57,338 per waiver participant in 2006 compared with the cost of Medicaid institutional care (for which all waiver participants are eligible). When taking into account a potential 50% “woodwork effect” (for people who might have refused institutional services), the saving would be $21 billion. This analysis demonstrates that HCBS waiver programs present significant direct financial savings to Medicaid long-term care (LTC) programs.     

Monitoring COVID-19 vaccine use in Italian long term care centers: The GeroCovid VAX study

The COVID-19 pandemic has changed routine care practice for older persons, especially in those with frailty living in long term care (LTC) facilities. Due to the high mortality rates of Nursing home (NH) residents during the first wave of the COVID-19 pandemic, priority for COVID-19 vaccinations was given to this vulnerable population. However, the safety and efficacy of such vaccines in older frail elders remains questionable due to the fact that initial randomized clinical trials (RCTs) for such vaccines did not include this population. This type of discrimination in patient participation in RCTs continues and has been recognized in the literature. Nevertheless, in the context of a worldwide emergency, COVID-19 vaccination in older persons living in LTC facilities may provide a solid basis to protect against negative outcomes, such as COVID-19 infection and death. In this report, we present the protocol of the GeroCovid Vax study, an Italian study that began in February 2021 which is aimed at investigating the safety and efficacy of the anti-SARS-CoV-2 vaccinations in older persons living in LTCs. This protocol specially aims to continuously and closely monitor events related to- and following- the anti-SARS-CoV-2 vaccination in elderly living in LTC facilities. In this report, we will provide information related to the study protocol and describe baseline characteristics of the sample.     

A comparative trial of Mefloquine and Fansidar in the treatment of falciparum malaria: failure of Fansidar

Falciparum malaria in 104 Thai patients was treated with either Mefloquine or Fansidar and patients were examined for parasitaemia for the next 28 days. All but one of the 40 patients treated with Mefloquine were cured, but the cure rates for Fansidar were only 9·1% for the two-tablet regimen and 19·4% for the three-tablet regimen. Most failures were classified as RII. Serum sulpha levels indicated that the Fansidar was being absorbed. Immediate steps should be taken to eliminate this focus of resistance and to protect against further resistance to Fansidar by using it in combination with another effective anti-malarial and by vigorous vector control measures.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.