医疗消费的致贫研究

医疗消费（特别是大额医疗支出）给居民带来很大的经济负担，对低收入人群来说更是如此，一方面需要支付大额医疗费，另一方面疾病使劳动能力降低或丧失，这就导致因病致贫、因病返贫。经济原因也是居民卫生服务利用率较低的主要因素之一。其中，卫生筹资和医疗消费的公平性是影响卫生支出导致贫困的重要因素。     

昆山市农村居民基本医疗保险存在的问题与对策

新型农村合作医疗制度是由政府组织、引导、支持。农村居民自愿参加，个人、集体和政府多方筹资，县、乡、村三级医疗机构提供医疗服务．以大病统筹为主的农村合作医疗互助供给制度。以大病统筹为主．是指新型农村合作医疗制度重点解决农村居民因患大病出现的因病致贫、因病返贫的问题．首先保证的是对农村居民大额医疗费用的补助。     

我国农村大病统筹医疗保险政策与关键技术研究的意义和背景

因病致贫问题 影响着我国农村地区的稳定。农村居民因病致贫的主要原因有两个：就医保障水平下降和就医经济宛险急增。因此,解决农村居民因病致贫的基本思路为,控制医疗费用过快增长以降低农村居民的就医经济风险,建立和完善医疗保障体制以增加农村居民的抗就医经济风险的能力。在医疗费用得以控制的前提下,“大病统筹”保险是目前及今后一段时期内增加农村居民抗就医风险能力的可行和适宜方案。如何让基层决策者理解因病在题的     

农村居民乡镇卫生院住院经济风险的测定

我国有九亿多人口生活在农村地区,虽然近些年来农村经济取得了较快发展,但医疗费用的增长速度大大超过农民收入的增长,农民疾病负担加重,就医的经济承受能力下降,家庭成员的一场大病,就可能导致全家贫困,由此因病致贫、因贫致病形成恶性循环。 要解决因病致贫问题,必须首先明了农民就医所担负的经济风险的大小。本文拟运用《农村居民疾病经济风险测定方法探索》一文中介绍的疾病经济风险     

农村居民的医疗消费与集资医疗资金估计

我国的农村集资医疗是群众在自愿原则的基础上,依靠自己的力量,组织起来的非营利性的医疗保障制度。对于满足农村居民的基本医疗需求,合理使用有限的卫生资源,防止因病致贫具有重大的意义。本次通过福建省农村居民的家庭卫生服务抽样调查,研究农村居民的医疗消费水平和集资医疗对医疗消费的影响,为确定农村集资医疗的有效性和集资基金筹集的估计提供依据。     

新型农村合作医疗可持续发展的策略思考

合作医疗曾经是我国农村居民的主要医疗保障形式,1978年开始的农村经济体制改革,使建立在农村集体经济基础上的合作医疗迅速滑坡。1998年第二次国家卫生服务调查显示,全国农村居民中合作医疗的比重仅为6.5%,90%的农村居民被排除在社会医疗保障制度之外,农村医疗保障问题日益突出。为减轻农村居民的疾病经济负担,2003年,国务院决定在全国范围内建立新型农村合作医疗制度。新型农村合作医疗制度是由政府组织、引导和支持,农村居民自愿参加,集体和政府多方筹资为主要内容的农村医疗互助共济制度,其目标是减少农村居民的“因病致贫”和“因病返…     

中国农村互助医疗

哈佛大学领导的项目小组在对中国西部农村问题进行了深入的诊断分析和原因分析之后，提出了通过建立农村互助医疗制度来解决中国西部农村基本卫生和因病致贫问题的初步设想。详细描述了农村互助医疗制度的理论基础和基本框架，并且深入探讨了如何通过试点获得可操作性知识和经验及其实施效果。目标是通过农村互助医疗制度的实施，降低农村居民享受基本医疗的成本，提高基本医疗的质量，减缓农村因病致贫的现象。     

关于加强农村大额合作医疗工作的探讨

20 0 3年全国卫生工作会议上提出 :开展新型农村合作医疗制度试点工作的各项政策已经明确。搞好农村大额合作医疗工作 ,是重点解决农民因病致贫、返贫的一项重要工作。我市现有人口 81 5万 ,农村人口近 60万 ,应参加农村大额合作医疗的人数为 5 4 2万人。我市虽属经济较发达地区 ,但因病致贫、返贫现象还是存在 ,特别是已经丧失了劳动能力的老人 ,子女也无力承担医疗费用而放弃治疗的现象时有发生。我市的农村大额合作医疗 ,从 1991年至今已有 12个年头 ,在管理上已逐步规范。 1997年以来 ,我市实行了“四个统一” :大额合作医疗基金统一管…     

以大病统筹方法解决农村居民因病致贫的可行性研究

研究结果表明,在中等发达地区,三种农村合作医疗制度中,“大病统筹”较为可行。1.解决“因病致贫”、维护农村稳定,必须降低“大病”经济风险。2.“保大病”为医疗服务各方所认同,方案实施可行;①农村居民普遍接受合作医疗“保大病”方案,存在着开展基础;②医疗服务供方、组织方赞同实施“保大病”方案,易形成共识、获得支持;③较低的筹资水平可以维持“保大病”的正常运作,农民愿意且能够负担。3.“保大病”方案能够切实解决农民“因病致贫、因病返贫” 问题,具有较强的抗经济风险能力。     

宁波市农村贫困人口卫生服务研究

目的：了解宁波市农村地区贫困人口的卫生服务现状，为制定有效缓解农民因病致贫、因病返贫的措施提供依据。方法：以宁波市辖区内六区、五县的农村贫困家庭居民为研究对象，采用多阶段分层整群随机抽样的方法抽取样本。结果；49．2％的贫困户认为自己的贫困是疾病损伤所致，贫困人口中有近八成的人没有任何医疗保障，人均收入中位数仅为560元。人均医疗卫生药品支出占生活消费支出的53．0％。其卫生服务需要量较一般人群大而实际卫生服务利用较低。结论：慢性病和残障给贫困人口造成了严重的健康损害和沉重经济经负担，而缺乏医疗保障，高额的医疗费用又限制了其对医疗服务的利用。为缓解农村人口“因病致贫，因病返贫”的现状。应加快农村医疗保健体制改革，建立和完善新型农村合作医疗制度。     

The Impact of Medical Home on Selected Children's Health Outcome

Medical Home practice has been shown to deliver effective health care to children. This practice model calls for providing patient-centered care that is compassionate, culturally effective, coordinated, integrated, safe, of high quality, and accessible. This study shows that children in the states with a higher amount of Medical Home received childhood vaccinations at a higher rate than others. However, Medical Home had a limited effect on the rate of children receiving dental/medical services, mental health services, or number of overweight children.     

我国卫生支出经费来源的结构分析

本文着重从卫生经济学角度对我国九十年代的卫生总费用来源变化情况进行实证分析,提出：随着市场经济的发展,我国的卫生经费来源结构也发生了相应的变化,已经由过去的单一国家投入变成了现在的多元化投入相结合的涛资模式。出现了政府预算卫生支出的规模和力度相对减弱,公共卫生服务经费的增长速度低于政府预算卫生支出增长速度,企业效益持续滑坡,无力支付日益膨胀的劳保医疗费用,居民个人卫生支出的负担比例增长过快等新情况     

The Communication Infrastructure as a Social Determinant of Health: Implications for Health Policymaking and Practice

Policy Points

• Persistent communication inequalities limit racial/ethnic minority access to life‐saving health information and make them more vulnerable to the effects of misinformation.
•  Establishing data collection systems that detect and track acute gaps in the supply and/or access of racial/ethnic minority groups to credible health information is long overdue.
• Public investments and support for minority‐serving media and community outlets are needed to close persistent gaps in access to credible health information.

     

Policy Commercializing Nonprofits in Health: The History of a Paradox From the 19th Century to the ACA

Policy Points:

• Health policy in the United States has, for more than a century, simultaneously and paradoxically incentivized the growth as well as the commercialization of nonprofit organizations in the health sector.
• This policy paradox persists during the implementation of the Affordable Care Act of 2010.

Context

For more than a century, policy in the United States has incentivized both expansion in the number and size of tax-exempt nonprofit organizations in the health sector and their commercialization. The implementation of the Affordable Care Act of 2010 (ACA) began yet another chapter in the history of this policy paradox.

Methods

This article explores the origin and persistence of the paradox using what many scholars call “interpretive social science.” This methodology prioritizes history and contingency over formal theory and methods in order to present coherent and plausible narratives of events and explanations for them. These narratives are grounded in documents generated by participants in particular events, as well as conversations with them, observing them in action, and analysis of pertinent secondary sources. The methodology achieves validity and reliability by gathering information from multiple sources and making disciplined judgments about its coherence and correspondence with reality.

Findings

A paradox with deep historical roots persists as a result of consensus about its value for both population health and the revenue of individuals and organizations in the health sector. Participants in this consensus include leaders of governance who have disagreed about many other issues. The paradox persists because of assumptions about the burden of disease and how to address it, as well as about the effects of biomedical science that is translated into professional education, practice, and the organization of services for the prevention, diagnosis, treatment, and management of illness.

Conclusions

The policy paradox that has incentivized the growth and commercialization of nonprofits in the health sector since the late 19th century remains influential in health policy, especially for the allocation of resources. However, aspects of the implementation of the ACA may constrain some of the effects of the paradox.     

社区健康小屋对部队卫生服务建设启示

健康小屋作为一种系统、全面的健康自测体系,对社区卫生服务建设发挥着重要作用。一定程度上,部队相当于一个封闭的社区,基层部队卫生机构相当于营区里的社区卫生服务站点,在部队中进行健康小屋的建设,可以更好地发展和完善部队卫生服务。     

The effect of new insurance coverage on the health status of low-income children in Santa Clara County

OBJECTIVE: To examine whether providing health insurance coverage to undocumented children affects the health of those children. DATA SOURCES/STUDY SETTING: The data come from a survey of 1235 parents of enrollees in the new insurance program ("Healthy Kids") in Santa Clara County, California. The survey was conducted from August 2003 to July 2004. STUDY DESIGN: Cross-sectional study using a group of children insured for one year as the study group (N=626) and a group of newly insured children as the comparison group (N=609). Regression analysis is used to adjust for differences in the groups according to a range of characteristics. DATA COLLECTION: Parents were interviewed by telephone in either English or Spanish (most responded in Spanish). The response rate was 89 percent. PRINCIPAL FINDINGS: The study group-who were children continuously insured by Healthy Kids for one year-were significantly less likely to be in fair/poor health and to have functional impairments than the comparison group of newly insured children (15.9 percent versus 28.5 percent and 4.5 percent versus 8.4 percent, respectively). Impacts were largest among children who enrolled for a specific medical reason (such as an illness or injury); indeed, the impact on functional limitations was evident only for this subgroup. The study group also had fewer missed school days than the comparison group, but the difference was significant only among children who did not enroll for a medical reason. CONCLUSIONS: Health insurance coverage of undocumented children in Santa Clara County was associated with significant improvements in children's health status. The size of this association could be overstated, since the comparison sample included some children who enrolled because of an illness or other temporary health problem that would have improved even without insurance coverage. However, even after limiting the study sample to children who did not enroll for a medical reason, a significant association remained between children's reported health and their health coverage. We thus cautiously conclude that Healthy Kids had a favorable impact on children's health.     

城市居民卫生知识、行为分析及社区健康教育对策探讨

目的　了解社区居民卫生知识水平 ,探索社区健康教育、健康促进工作对策。方法　采取随机抽样方法 ,以问卷方式进行入户调查 ;心理调查采用SCSQ法。结果　社区居民卫生知识知晓率为 4 9.0 1%。其中大学文化程度者为 5 7.5 7% ,文盲群体仅达 2 8.5 1% ,差异有显著性意义。卫生行为形成率平均为 5 5 .2 3%。调查对象心态稳定型占 4 6 .19% ,偏常型占 2 5 .89% ;在职职工心态偏常型占 2 2 .14 % ,下岗待业人群心态偏常型占 39.6 6 % ,差异有显著性意义。结论　居民卫生知识知、行为水平较低。下岗职工心理卫生问题应予以重视。