新型合作医疗试点政策前后关键问题的变迁

农村人口安居乐业需要建立医疗保障制度 农村稳定意味着我国69．1％的人口能安居乐业，因此三农(农村、农业、农民)问题的解决，是我国社会稳定和经济发展的重要保证。长期以来，由于我国城、乡二元社会结构的特征，与城镇居民相比，农村居民是社会的弱势群体；农村的医疗保障制度和卫生服务体系被重视的程度低、政策变化更快、动荡更大、问题更多、发展也更缓慢。     

完善我国农村医疗保障的法律机制探究

我国目前的农村医疗保障以合作医疗为主干，其在目标定位、体制选择以及组织管理上存在着一些弊端。本文拟通过对农村医疗保障的现状及制度缺陷进行剖析，借鉴国外农村医疗保障模式的有益经验，探索完善我国农村医疗保障的法律机制。     

农村医疗保障制度建设研究

基于我国城乡分治、二元经济的国情，我国农村医疗保障体系的建设要与农村的经济水平相适应，只有通过政府职能的转换和市场机制的运作。大力发展农村经济，培育和扩大农村市场，才能培育起多元化的农村医疗保障体系；只有通过市场优化配置农村医疗资源，才能缓解因病致贫现象。     

保农民健康建全面小康--对建立农村医疗保障制度的思考

党的十六大提出了全面建设小康社会的新目标 ,为了保障广大农民的健康 ,抓好农村医疗保障制度的建立至关重要。一、农村急需建立医疗保障制度过去 ,合作医疗遍及农村 ,尽管保障水平低、管理不完善 ,但对当时的贫困农民却是“雪中送炭”。而今 ,合作医疗大部分解体 ,农民失去了仅有的医疗保障 ,再加上医药费用的上涨 ,对于自费医疗的农民 ,无疑是“雪上加霜”。因此 ,建立农村医疗保障制度是当务之急。1.农民是人口众多的群体 ,必须有一个稳定的医疗保障制度。我国是一个农业大国 ,9亿人口在农村。据1998年第二次国家卫生服务调查显示 ,因经…     

关于发展和完善农村合作医疗的若干意见

一、农村合作医疗制度是适合我国国情的农民医疗保障制度 目前,在我国农村,传染病和地方病仍严重威胁着农民的健康,慢性非传染性疾病的危害日益加重,因病致贫、因病返贫的现象比较严重。我国农村人口多,经济还不够发达,解决农民的基本医疗保障问题,不可能由国家和集体全包下来,也不能完全靠农民个人自费医疗,只能走互助共济的合作医疗道路。党中央、国务院对发展和完善农村合作医疗十分重视,《中共中央关于建立社会主义市场经济体制若干问题的决定》提出“发展和完善农村合作医疗制度”。八届全国人大四次会议批准的《关于国民经济和社会发展“九五”计划和2010年远景目标纲要》要求因地制宜地发展和完善不同形式的农村合作医疗制度。《中共中央、国务院关于卫生改革与发展的决定》指出:“合作医疗对于保证农民获得基本医疗服务、落实预防保健任务、防止因病致贫具有重要作用”,“力争到2000年在农村多数地区建     

农村合作医疗保险和社区卫生服务的实践与思考

盐都县面积 12 94 .4平方公里 ,人口 86 .13万 ,其中农业人口 6 1.4 8万 ,现辖 16个镇、2 86个村 (居委会 ) ,是卫生部与“社区医疗保障实验”合作项目试点之一。该县农村合作医疗自 1991年恢复 ,1999年起全面实施合作医疗保险制度 ,并尝试家庭帐户与社会统筹相结合的管理模式 ,开展农村社区卫生服务 ,探索了健全农村医疗保障制度的途径。1　主要做法1.1　健全筹资政策县政府下发了《关于全面推行农村合作医疗保险制度的意见》和《农村合作医疗保险暂行办法》,合作医疗保险实行个人 ,集体 ,县 ,镇政府 ,县直指定医疗单位等五方投入政策。个…     

农村医疗保障制度形式比较与选择

为了探讨农村医疗保障制度的适宜形式,我们最近考察了河南、山东、江苏、上海等地部分县(市)的合作医疗工作,并参考近期有关文献,结合本地合作医疗的实际情况,对当前各种形式的农村医疗保障制度进行归类比较,从而为建立新时期合作医疗的优化模式提供依据。1 农村医疗保障制度形式比较1.1 传统型合作医疗 基本做法:传统型合作医疗制度产生于60年代末70年代初,以集体经济公有制为基础,集体投入为主,群众个人出资很少或不出资,筹资以工分或实物抵扣,群众就诊报销部分或全部医药费,又分合医合药,合医不合药,     

对农村医疗保障制度构建的理论思考

适应我国城乡分治、二元经济的现实,确立政府对农民医疗保障经济责任与当地经济水平相适应的观念;适应我国医疗费用上升,医疗风险日益突出的现状,确立农村医疗保障的重点是缓解因病致贫;针对农村基层医疗卫生机构资源优化的趋势,确立农村医疗保障供方多元化的观念;同时应建立家庭帐户和统筹基金相结合的农村医疗保险模式,以适应农村经济以家庭联产承包制为基础的背景。     

构建符合中国农村经济新特点的医疗保障制度的设想

构建符合中国广大农民需要的医疗保障制度，是中国农村卫生工作的重要任务。在对中国农村新时期经济发展特征和农村医疗保障现状进行分析的上，提出在农村实施医疗保险制度的设想。     

农村合作医疗发展探析

多年来,农村合作医疗一直被提倡为农村医疗保障制度的主要形式,随着农村卫生改革深化,农村合作医疗应当如何发展,确实值得研究.我认为,当前发展农村合作医疗应从以下方面入手:     

The frequency rate of rural residents' requesting medical assistance from obstetric nursing assistance at health centers

The accessibility of patient-care facilities is one of the key issues related with the structure of medical-care rendered to rural resident, therefore, while studying the medical-care structure in the Leningrad Region, the opinion of visitors to obstetrician's assistant facilities was primarily taken into consideration.     

基于改进Kano模型的四川省医养结合型养老机构老年人服务需求分析

目的:调查四川省医养结合型养老机构老年人服务需求属性及特征差异,为医养结合型养老机构实现对老年人服务需求满足的"靶向精准"提供参考。方法:采用便利抽样抽取成都市、攀枝花市、泸州市、自贡市27家医养结合型养老机构内773名老年人为调查对象,采用一般资料调查表,自制《医养结合型养老机构老年人服务需求Kano属性问卷》进行问卷调查。结果:在改进Kano模型划分下,医养结合型养老机构老年人在整体层面对47项养老服务具有一定的需求;64项服务中有30项|DSI|≥0.5,33项SI>|DSI|;重要度矩阵划分结果显示,11项服务划分在第一象限,归属于期望属性,26项服务划分在第二象限,归属于魅力属性,10项服务划分在第三象限,归属于无差异型属性;17项服务划分在第四象限,归属于必备属性。结论:医养结合型养老机构老年人的养老服务需求整体上呈现出"高依赖性"和"高期待性"倾向,据此提出,医养结合型养老机构在持续保障必备型需求服务,稳步提供期望型需求服务,努力丰富魅力型需求服务,客观分析无差异型需求服务的同时还应该采取"必备型需求(M)>期望型需求(O)>魅力型需求(A)>无差异型需求(I)"的需求满足策略。     

应用综合指数评价医院为社会服务的程度

本文介绍了病区社会服务工作效率指数、社会服务工作强度指数、社会服务综合指数的指标构成、计算和应用的方法，井在此基础上进行了讨论．运用杜会服务指数可以分析和评定卫生技术干部在单位时间内为社会服务的工作效率和工作负荷程度;可以了解卫生技术人员、设备、技术、物资的利用情况,同时也能反映医院管理方面的成效和问题，在实行工作与奖惩挂钩的过程中．起到了较好的效果。     

Application of a single sampling plan for auditing medical-claim payments made by Taiwan National Health Insurance

National Health Insurance (NHI) has been implemented in Taiwan for nearly a decade. Owing to growing demand for medical-care, effective sampling auditing is a key factor in obtaining reasonably priced medical-care services. This investigation proposes a conceptual framework "medical-claim payment auditing (MCPA) procedure" based on the "Military Standard 105E (MIL-STD-105E) single sampling plan" for establishing an objective criterion for making medical-claim payments fairly. The MCPA procedure contributes to the following: (1) meeting international standards of sampling technology; (2) reducing the sampling ratio and consequently auditing costs; and (3) encouraging healthcare providers to honestly apply their medical-claim payments thus avoid wasting medical resources.     

A comparative description of the formation of population's demand for medical care

One hundred and twenty seven patients of 24-hour and day-time patient-care facilities (Stavropol Region) were questioned. Problematic situations were denoted in the medical-care system, which are related with a shaping demand for medical care rendered to patients under such service conditions.     

Costs of smoking among active duty U.S. Air Force personnel--United States, 1997

Smoking is the leading cause of preventable disease and death in the United States (1). The health consequences of smoking impose a substantial economic toll on persons, employers, and society. Smoking accounts for $50-$73 billion in annual medical-care expenditures, or 6%-12% of all U.S. medical costs (2-5). The costs associated with lost productivity also are extensive (2). In 1997, approximately 25% of male and 27% of female active duty Air Force (ADAF) personnel aged 17-64 years were smokers (6). A 1997 retrospective cohort study was conducted among ADAF personnel to estimate the short-term medical and lost productivity costs of current smoking to the U.S. Air Force (USAF). This report summarizes the results of the study, which indicate that current smoking costs the USAF approximately $107.2 million per year: $20 million from medical-care expenditures and $87 million from lost workdays.     

Measuring medical cost and life expectancy impacts of changes in cigarette sales

A change in cigarette sales triggers changes in medical-care costs and in years of life expectancy. Changes in sales result from changes in excise tax policy, agricultural policy, cigarette design, smoking behavior, or anti-smoking laws. The model uses data on medical costs, life expectancy, cigarette price elasticity, and smoking demographics to estimate medical-cost and life-year impacts for any change in cigarette sales. It takes into account the medical costs incurred by quitters over their extra years of life, the asymmetry of impacts for increases and decreases in sales, and the delayed medical effects for ages not yet subject to the health risks of smoking. For example, a 1% decrease in U.S. cigarette sales increases life expectancy in the United States by 1.45 million years and increases medical-care costs by $405 million for ages 25 to 79. This amounts only to $280 in added medical costs for each extra year of life. By generating aggregate health impacts at the margin, the model becomes a valuable tool for evaluating programs that affect smoking.     

Costs of First-Line Doublet Chemotherapy and Lifetime Medical Care in Advanced Non–small-Cell Lung Cancer in the United States

ObjectivesThe purpose of this study was to identify total lifetime medical-care costs and costs associated with first-line chemotherapy treatment among older patients with stage IIIB/IV non–small-cell lung cancer treated with commonly used two-drug chemotherapy (“doublet”) regimens in the United States.MethodsStudy patients included individuals aged 65 years and older who received a diagnosis of stage IIIB/IV non–small-cell lung cancer in a Surveillance, Epidemiology and End Results cancer registry between 1997 and 2002 and who received first-line treatment with commonly used doublet regimens. Patients were followed retrospectively in the Surveillance, Epidemiology and End Results—Medicare database to evaluate lifetime medical-care costs and costs while on first-line chemotherapy treatment. Pairwise comparisons of treatment costs were estimated by using nonparametric bootstrap methods.ResultsLifetime medical-care costs totaled approximately $70,000 and on-treatment costs for first-line chemotherapy totaled approximately $30,000 among study patients and were dominated by hospitalization and physician costs. Lifetime costs were significantly higher among patients treated with first-line cisplatin/carboplatin (platinum) plus a taxane compared with those who received platinum plus gemcitabine [difference: $4781 ($1558–$8039)] or other doublet therapy [difference: $5961 ($2333–$9614)]. Total on-treatment costs for first-line chemotherapy were significantly higher among patients treated with platinum plus a taxane compared with those who received platinum plus gemcitabine [difference: $5825 ($3872–$7770)], platinum plus another agent [difference: $5968 ($3995–$7975)], or another doublet therapy [difference: $3663 ($1620–$5740)].ConclusionsThere is a cost differential between first-line doublet regimens in terms of lifetime and on-treatment costs. Although doublet therapy with platinum and a taxane was the most frequently utilized regimen, it was associated with the highest lifetime and on-treatment costs.     

可持续发展视角下新型农村合作医疗制度建设的思考

新型农村合作医疗自2003年试点以来,取得了举世瞩目的成绩。但在推进过程中,制度内外也出现了一些新的问题和矛盾,影响了新型农村合作医疗制度的可持续发展。因而,需要采取增加政策支持、建立法律保障、强化监管、优化农村卫生服务体系等来改善新型农村合作医疗制度的运行环境;建立稳定的筹资与增长机制、科学的补偿机制、有效的费用控制机制和严格的管理机制来优化新型农村合作医疗制度建设。     

Health promotion in primary medical care: problems and potential

Problems related to health promotion in primary medical care are reviewed within the framework of five characteristics of current medical practice: physician attitudes and beliefs, the economic structure of medical care, the structure of the medical-care encounter, the state of the art of health promotion, and physician knowledge and skills. The potential for integrating health promotion activities into the primary medical-care environment is based on the principles of pediatrics, general internal medicine, family practice, and obstetrics/gynecology. In the primary-care setting, both the roles and the expectations of physicians and patients are conductive to health promotion activities. Twelve practice principles for the primary physician are discussed, touching on such issues as style of communication, recognition of the "teachable moment," utilization of the longitudinality of the physician-patient relationship, coordination of care, and causes of failure. Issues for the future are reviewed, including the need for restructuring fee schedules, pursuing the knowledge base required for effective health promotion, and integrating training in health promotion methods and techniques in medical school curricula. The complex interactions during the next decade of three trends related to health promotion are discussed as determinants of the role of primary care as a substrate for health promotion.