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本研究通过阐述我国现阶段贫困慢性病患者疾病负担的现状及精准扶贫政策的核心要义,旨在研究分析我国健康精准扶贫政策在实施过程中存在的问题和现实困境,并为制定相关健康精准扶贫政策提供建议。分析发现,我国健康精准扶贫政策在实施过程中存在的问题主要有:贫困人口识别不精准;动态管理与考核机制不精准;扶贫资源配置不精准。针对这些问题,提出如下建议:建立多维贫困识别体系,完善贫困户建档立卡信息;健全精准扶贫动态监管与考核体系;合理配置扶贫资源,推进各项配套政策和制度的创新。 相似文献
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河南省商丘市U隹阳区在脱贫攻坚精准脱贫工作中,以卫生医疗和保健工作为中心,想群众之所想、急群众之所急,确保了建档立卡贫困户的医疗健康保障工作。强化医疗保障体系建设。为建档立卡贫困人口全额支付了医保参保费用,实现贫困人口参保率100%,按照每人230元标准购买了医疗保障扶贫保险和人身意外伤害保险,在辖区定点医院每年可享受至少一次免费体检. 相似文献
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正"坚持问题导向和目标导向,不松劲、不懈怠,持续在精准施策、精准推进、精准落地上下功夫。"2018年,青海省将以"实施健康中国战略"引领全省卫生计生工作,统一思想,明确方向,把握重点,狠抓落实。为切实做好健康扶贫工作,首先要精准发力促攻坚,认真实施好健康扶贫重病兜底保障、大病救治慢病签约扩面提质等"十大工程",切实抓好贫困地区健康扶贫工作。其次,瞄准重点抓突破,扎实做好农牧区建档立卡贫困户家庭医生签约服务工作,全面落实"双签约" 相似文献
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This study aims to examine poverty, chronic illnesses, health insurance, and health care expenditures, within the context of a political economy of aging perspective. Subsamples of 1,773 older adults from the Medical Expenditure Panel Survey were selected for analyses. The results showed that chronic illnesses influenced out-of-pocket health care costs. Older persons with more than one health insurance spent less on out-of-pocket health care costs. The results have implications for health care social workers concerned with the growing costs of chronic illnesses, implementing integrated care, and advocating for extending public health insurance coverage especially for our most impoverished older adults. 相似文献
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South Korea introduced mandatory social health insurance forindustrial workers in large corporations in 1977, and extendedit incrementally to the self-employed until it covered the entirepopulation in 1989. Thirty years of national health insurancein Korea can provide valuable lessons on key issues in healthcare financing policy which now face many low- and middle-incomecountries aiming to achieve universal health care coverage,such as: tax versus social health insurance; population andbenefit coverage; single scheme versus multiple schemes; purchasingand provider payment method; and the role of politics and politicalcommitment. National health insurance in Korea has been successfulin mobilizing resources for health care, rapidly extending populationcoverage, effectively pooling public and private resources topurchase health care for the entire population, and containinghealth care expenditure. However, there are also challengesposed by the dominance of private providers paid by fee-for-service,the rapid aging of the population, and the public-private mixrelated to private health insurance. 相似文献
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The lack of health insurance coverage could be a potentially important deterrent to the use of preventive health care by older adults with high rates of chronic co-morbidities. We use survey data from 12 100 Mexican adults ages 50 and older who participated in the 2001 Mexican Health and Aging Study (MHAS) to analyze the relation between health insurance coverage and the use of preventive health-care services in Mexico. Uninsured adults were less likely to use preventive screenings for hypertension, high cholesterol, diabetes and (breast, cervical and prostate) cancer than insured adults. After adjusting for other factors affecting preventive care utilization in a logistic regression model, we found that these results still hold for high cholesterol and diabetes screening. Similar results hold for the population not working during the survey week and for adults earning below 200% of the poverty line. Our results suggest that insured adults are in a relatively better position to detect some chronic diseases - and have them treated promptly - than uninsured adults because they have better access to cost-effective preventive screenings. Recent public policy initiatives to increase health insurance coverage rates in Mexico could lead to substantially higher preventive health-care utilization rates and improvements in population health. 相似文献
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Using Vietnam's latest National Household Survey data for 2001-2002 this paper assesses the influence of individual, household and commune-level characteristics on a woman's decision to seek prenatal care, on the number of prenatal visits, and on the choice between giving birth at a health facility or at home. The decision to use any care and the number of prenatal visits is modeled using a two-part model. A random intercept logistic model is used to capture the influence of unobserved commune-specific factors found in the data regarding a woman's decision to give birth at a health facility rather than at home. The results show that access to prenatal care and delivery assistance is limited by observed barriers such as low income, low education, ethnicity, geographical isolation and a high poverty rate in the community. More specifically, more prenatal visits increase the likelihood of giving birth at a health facility. Having compulsory health insurance increases the odds of giving birth at a health facility for middle and high income women. In contrast, health insurance for the poor increases the likelihood of having more prenatal visits but has little effect on the place of delivery. These results suggest that the existing safe motherhood programs should be linked with the objectives of social development programs such as poverty reduction, and that policy makers need to view both the individual and the commune as appropriate units for policy targeting. 相似文献
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[目的]对比分析农村贫困人口与非贫困人口住院费用及疾病负担情况,为在脱贫攻坚阶段完善健康扶贫政策,预防脱贫人口因病返贫提供借鉴参考。[方法]收集华东地区某大型三级甲等综合医院,应用可解脱弹簧圈栓塞介入治疗颅内动脉瘤破裂的农村贫困人口与非贫困人口的一般人口学、住院费用水平及明细、医保报销数据等资料,运用SPSS 17.0统计软件分析。[结果]贫困人口较非贫困人口自付费用均值降低35,926.94元,报销比例为96.20%,较非贫困人口组高26.77个百分点,其中大病保险支付比例、民政救助支付比例,较非贫困人口组分别高12.05个百分点、8.34个百分点。[结论]该省健康扶贫政策大幅减轻了贫困人口就医负担,医疗费用负担对于非贫困农村居民属灾难性医疗支出,贫困人口消耗了更多的医疗资源。 相似文献
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Ferrer RL 《Annals of family medicine》2007,5(6):492-502
PURPOSE Long-term shifts in specialty choice and health workforce policy have raised concern about the future of primary care in the United States. The objective of this study was to examine current use of primary and specialty care across the US population for policy-relevant subgroups, such as disadvantaged populations and persons with chronic illness.METHODS Data from the Medical Expenditure Panel Survey from 2004 were analyzed using a probability sample patients or other participants from the noninstitutionalized US population in 2004 (N = 34,403). The main and secondary outcome measures were the estimates of the proportion of Americans who accessed different types of primary care and specialty physicians and midlevel practitioners, as well as the fraction of ambulatory visits accounted for by the different clinician types. Data were disaggregated by income, health insurance status, race/ethnicity, rural or urban residence, and presence of 5 common chronic diseases.RESULTS Family physicians were the most common clinician type accessed by adults, seniors, and reproductive-age women, and they were second to pediatricians for children. Disadvantaged adults with 3 markers of disadvantage (poverty, disadvantaged minority, uninsured) received 45.6% (95% CI, 40.4%–50.7%) of their ambulatory visits from family physicians vs 30.5% (95% CI, 30.0%–32.1%) for adults with no markers. For children with 3 vs 0 markers of disadvantage, the proportion of visits from family physicians roughly doubled from 16.5% (95% CI, 14.4%–18.6%) to 30.1% (95% CI, 18.8%–41.2%). Family physicians constitute the only clinician group that does not show income disparities in access. Multivariate analyses show that patterns of access to family physicians and nurse-practitioners are more equitable than for other clinician types.CONCLUSIONS: Primary care clinicians, especially family physicians, deliver a disproportionate share of ambulatory care to disadvantaged populations. A diminished primary care workforce will leave considerable gaps in US health care equity. Health care workforce policy should reflect this important population-level function of primary care. 相似文献
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农村贫困家庭健康风险及其干预策略 总被引:1,自引:0,他引:1
贫困与健康的关系已经被很多文献很好地论述了。健康贫困实则为贫困的一个重要部分.农村贫困家庭应对健康风险时具有很强的脆弱性,如果缺乏有效的健康风险处理机制,则很容易进入健康贫困状态。而传统健康保障模式在解决贫困家庭健康风险问题上可能产生以下方面的问题:过分强调公共部门的作用和政府目标:过分强调疾病成本和支出从而忽略可持续发展的健康促进;容易混淆不同部门问的职责,降低相互支持度。基于社会风险管理的理论框架描述了农村贫困家庭健康风险管理预防、缓和及应对策略。 相似文献
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《Global public health》2013,8(6):561-574
Abstract There is increasing evidence of rising levels of inequality in health care utilisation in the post-socialist countries of Central Asia and the Caucasus. Against this backdrop, we investigate the determinants of accessibility and affordability of health care utilisation in Tajikistan. A modified version of the Andersen Behavioural Model is used to conceptualise the determinants of health care utilisation in Tajikistan. Poisson and Ordered Logit regression models are performed to estimate the determinants of health care utilisation. Empirical results demonstrate that poverty, chronic illness and disability are the most important determinants of health care utilisation and affordability in Tajikistan. Other significant determinants include gender, the level of education of the household head, and the availability of medical personnel at a given population point. These findings suggest an urgent need for health care reform in order to ensure equality in accessibility and affordability for the entire population. 相似文献
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Households obtaining health care services in developing countriesincur substantial costs, despite services generally being providedfree of charge by public health institutions. This constitutesan economic burden on low-income households, and contributesto deepening their level of poverty. In addition to the economicburden of obtaining health care, the method of financing thesepayments has implications for the distribution of householdassets. This effect on resource-poor households is amplifiedsince they have decreased access to health insurance. Recentliterature, however, ignores the importance of the method offinancing health care payments. This paper looks at the caseof Nepal and highlights the impact on households of paying forhospital-based care of Kala-azar (KA) by analysing the catastrophic,impoverishment and economic consequences of their coping strategies.The paper utilizes micro-data on a random selection of 50% ofthe KA-affected households of Siraha and Saptari districts ofNepal. The empirical results suggest that direct costs of hospital-basedtreatment of KA are catastrophic since they consume 17% of annualhousehold income. This expenditure causes more than 20% of KA-affectedhouseholds to fall below the poverty line, with the remaininghouseholds being pushed into the category of marginal poor;the poverty gap ratio is more than 90%. Further, KA incidencecan have prolonged and severe economic consequences for thehousehold economy due to the mechanisms of informal sector financingto which households resort. A heavy burden of loan repaymentscan lead households on a downward spiral that eventually becomesa poverty trap. In other words, the method of financing healthcare payments is an important ingredient in understanding theeconomic burden of disease. 相似文献
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HEIDI ALLEN BILL J. WRIGHT KRISTIN HARDING LAUREN BROFFMAN 《The Milbank quarterly》2014,92(2):289-318