新型农村合作医疗上门收取个人筹资方式研究

上门收取是目前新型农村合作医疗农民个人筹资的主导方式。通过对上门收取个人筹资方式的产生背景、操作过程和存在问题等进行分析与评价,提出在现阶段上门收取个人筹资方式具有一定的可持续性。     

新型农村合作医疗不同个人筹资方式农民意向调查

农民个人筹资只有充分考虑农民的需求才能顺利进行。比较分析上门收取、协议委托和滚存式筹资3种不同个人筹资方式下的参加新型农村合作医疗农民对筹资方式以及参合的意愿,提出了农民参合的几点影响因素。     

新型农村合作医疗个人参合费实行信用社代收代缴的实践

<正>新型农村合作医疗(简称新农合)制度是政府为民办实事工程,是中央深化医药卫生体制改革的重要举措。近年来筹资难一直困扰着新农合的健康发展,特别是群众个人缴纳费用的筹集,过去一直采取村组干部逐户上门收取的办法解     

六合区新农合“三定”筹资基本做法与筹资效果评价

南京市六合区自2003年实施新农合制度以来,筹资标准逐年增加,一直采用村干部上门收缴、村集体经济代缴等传统方式筹集农民新农合参保资金,造成筹资时间长、成本投入大、农民依赖性强。2012年我们对农民个人筹资机制进行了创新改革,探索实施定筹资时间、定送缴地点、定缴费金额的“三定”筹资方式,建立起了“区统筹、镇负责、村为主、组配合、户自愿”的新农合筹资工作新格局,取得了一定成效和经验。     

山东省新型农村合作医疗筹资水平调查研究

探索新型农村合作医疗人均筹资水平和参合农民个人筹资水平测算方法,并对山东省6个试点县进行了调查和测算。其中,崂山、招远、广饶和五莲4县人均标准筹资和个人标准筹资平均高出人均实际筹资和个人实际筹资5-10元,而青州和临邑2县标准筹资与实际筹资水平基本一致。建议在明确动态费率的基础上,根据筹资水平和政策导向合理确定实施方案;并以筹资水平为基础,考虑各方面的影响因素,确定最佳实际筹资水平。     

浙江省新型农村合作医疗试点评价

调查浙江省三个不同经济发展水平试点县的新型农村合作医疗试点情况，为完善新型农村合作医疗制度提供依据。通过对参保、筹资、经费使用和受益等有关指标分析表明，不同经济水平试点县（市、区）因地制宜，积极探索，建立起了与当地实际相适应的新型农村合作医疗制度，但仍存在低水平筹资和高保障要求的矛盾，笔者建议应建立长效筹资机制，及时调整补偿方案，适度提高农民个人筹资水平，提高保障水平。     

山东省新型农村合作医疗筹资水平与农民需要调查研究

通过对山东省6个新型农村合作医疗试点县的调查和测算,崂山、招远、青州和广饶4县人均筹资标准平均高出个人实际筹资5～10元,而临邑和五莲的个人筹资标准与实际筹资水平基本一致.利用扩展线性支出系统研究表明,当年人均收入在1 805元以上时,对合作医疗有支付能力;农户合作医疗的参加意愿与其支付能力存在着不一致性.建议从需方角度考虑各方面因素降低农民筹资风险.     

强化经办机构建设提高新农合服务水平

赣榆县自2003年被确定为江苏省首批新农合试点县以来，在推进新农合试点过程中，注重加强合管办建设，充分发挥经办机构组织管理功能，积极探索，勇于创新，努力提高新农合管理和服务水平，其创设的滚动筹资预缴费制度已在全国推广。2007年，赣榆县采取以滚筹与“双定”相结合的筹资方式，已顺利完成2008年人均20元个人缴费任务，全县参合率达到99．6％。     

新疆新型农村合作医疗试点县运行情况分析

目的分析新疆部分新型农村合作医疗制度试点县实施情况,针对存在问题提出相应对策。方法对收集到的数据进行统计描述,并用经济学的有关知识进行分析。结果13个试点县中,共筹集资金8036.38万元。资金筹集以伊宁县筹资最多,焉耆县筹资最少,分别为1104.03万元,414.31万元。2005年13个试点县中,资金支出总额为4514.62万元,结余3521.76万元。国家补助资金全部到位,均为20元,地方各级政府补贴总额除个别1,2个县外,均〉20元的补助标准。新疆新型农村合作医疗制度试点县总筹资较为合理,但部分试点县筹资水平与补偿比例不尽合理。结论新型农村合作医疗制度为解决农民就医发挥了巨大作用,应进一步完善筹资机制和补偿比例,促进新型农村合作医疗顺利发展。     

以政府为主导的合作医疗个人筹资研究

以政府为主导的新型农村合作医疗个人筹资形式为多数试点县所采用.阐述了政府主导的必要性,描述了其操作过程,分析评价了在运行中存在的一些问题与不足,并提出了一些改进与完善的可行性建议.     

新型农村合作医疗农民协议委托筹资方式研究

为探索适宜的个人筹资方式,对安徽省东至县新型农村合作医疗试点的协议委托筹资方式通过现场关键人物访谈和相关利益者小组座谈,探讨了协议委托筹资方式产生的背景、操作过程及运作效果,并进行了分析与评价,对存在的风险提出了可行的规避措施。     

浙江省新型农村合作医疗试点地区农村居民意向评价

目的:从农村居民意向角度评价新型农村合作医疗。方法:从筹资水平、满意程度、未参合农村居民的意愿和已参合农村居民(以下简称参合农民)续保情况4个方面评价2个试点县(秀洲区、开化县)和1个对照县 (常山县)3地的新型农村合作医疗实施情况。结果:(1)98．8％的农村居民能够承受目前的筹资水平,其中秀洲区为 99．0％,开化县为99．3％,常山县为98．8％;(2)对新型农村合作医疗不满意、持否定态度的农村居民比例仅为2．8％, 其中秀洲区和开化县皆为1．8％,对照县常山县略高,为5．1％;(3)40．5％的参合农民认为新型农村合作医疗能解决倾家荡产问题,其中秀州区为39．2％,开化县为39．3％,常山县为43．0％;(4)未参合农村居民期望新型农村合作医疗报销要方便,其中秀洲区未参合农村居民更为强调方案解决因病致贫的效果:(5)大部分新型农村合作医疗参合农民表达了续保意愿,明确表示不续保的比例仅为3．0％,其中秀洲区为1．5％,开化县为1．8％,常山县为5．7％。结论: (1)秀洲区、开化县农村居民对新型农村合作医疗有较高评价,常山县次之;(2)新型农村合作医疗有必要增加筹资,而且增加筹资是可行的。     

House call practices among young family physicians

Once a major part of medical practice, physician house calls have declined in frequency over the years. Recently, it has been suggested that house calls are increasing. This study examined the current self-reported house call practices among recent graduates of family practice residency programs in the United States. A questionnaire was mailed to a cross-sectional, random national sample of 301 family physicians who are members of the American Academy of Family Physicians and who completed a residency between 1981 and 1986. There was a 66% response rate to three mailings, with 197 questionnaires analyzed. Sixty-two percent of the physicians reported they were making house calls. The majority (53%) made less than one house call per month. Fewer than 15% made house calls on a weekly basis. There was a downward trend by residency year in the percentage of physicians making house calls when comparing graduates from 1981 to 1986. House calls do not appear to be a significant part of the practice of young family physicians.     

新型农村合作医疗筹资水平与筹资能力分析

2006年,全国新型农村合作医疗制度对住院费用的平均补偿水平为23.2%,补偿水平低是新型农村合作医疗制度普遍缺乏吸引力的原因之一。提高补偿水平的基础是提高筹资水平,文章研究的目的是探索目前年人均10.0元的个人筹资标准进一步增加的可行性与可能性。研究在山东和宁夏的各3个县中进行,定量调查6147户居民,定性访谈127组对象。研究发现,人均10.0元的筹资水平占居民人均纯收入的0.2%～0.3%;各县分别有20.8%～63.9%的参合家庭愿意多缴纳参合费,这部分家庭愿意缴纳的参合费平均额为24.5～63.5元;各县人均愿意缴纳参合费的最高额为200.0～1000.0元;各县购买商业医疗保险的人口比例为5.7%～28.0%,年人均缴纳的商业保险费用为280.1～844.2元。不同的利益相关者都认为进一步提高个人筹资额是可行的,作者认为将参合费提高到50.0元是可行的。     

基于锡尔系数的广东省2008-2017年健康险区域差异分析

[目的]对广东省健康险近10年的发展概况和区域发展差异的分析,为健康险的区域均衡发展提出方法建议。[方法]计算广东省2008-2017年保费收入和保险密度的锡尔系数,并对锡尔系数进行分解。[结果]健康险保费收入、保险深度和保险密度不断增长,2016年保费收入比2008年增长6.5倍,2017年底保险深度为0.59%、保险密度为486.86元,比2008年分别增长7.38倍、6.6倍,四大区域市场格局占比差距比较大,珠三角地区一直占市场的80%以上;在保费收入方面,广东省健康险的区域发展较为不平衡,区域内部各市县发展的不平衡已成为健康险区域整体发展不平衡的主要原因;在保险密度方面,广东省各市县发展迅速,但是各市县之间发展不均衡问题较为突出,保险密度值已经从273.5元增长至990.63元。[结论]2008-2017年广东省健康险保费收入、保险深度和保险密度不断增长,但保费深度、人均保费仍较低,各区域间及区域内发展不平衡。     

The influence of a nurse practitioner on out of hours work intensity for surgical house officers.

We have prospectively studied the influence of a nurse practitioner service on out of hours work intensity of surgical house officers. Data collection was achieved by prospective audit. The study was set in the surgical wards in a large teaching hospital. The main outcome measures were; 1) the nature and frequency of overnight calls to the nurse practitioner, and 2) the outcome of these calls (doctor not bleeped, telephone advice given by doctor or doctor attended ward). A total of 645 calls were made over the 75 night study period (8.6 calls/night). Two hundred and ninety-six calls were managed by the nurse practitioner alone. This represents a 46% reduction in work intensity for the surgical house officer. This study illustrates the benefits of a nurse practitioner service and also identifies important areas for undergraduate education in preparing medical students for the common problems encountered during the surgical on-call period.     

Local house prices and mental health

This paper examines the impact of local (county-level) house prices on individual self-reported mental health using individual level data from the United States Behavioral Risk Factor Surveillance System between 2005 and 2011. Exploiting a fixed-effects model that relies on within-county variations, relative to the corresponding changes in other counties, I find that while individuals are likely to experience worse self-reported mental health when local house prices decline, this association is most pronounced for individuals who are least likely to be homeowners. This finding is not consistent with a prediction from a pure wealth mechanism but rather with the hypothesis that house prices act as an economic barometer. I also demonstrate that the association between self-reported mental health and local house prices is not driven by unemployment or foreclosure. The primary result—that lower local house prices have adverse impact on self-reported mental health of homeowners and renters—is consistent with studies using data from the United Kingdom.     

Incentive-compatible guaranteed renewable health insurance premiums

Theoretical models of guaranteed renewable insurance display front-loaded premium schedules. Such schedules both cover lifetime total claims of low-risk and high-risk individuals and provide an incentive for those who remain low-risk to continue to purchase the policy. Questions have been raised of whether actual individual insurance markets in the US approximate the behavior predicted by these models, both because young consumers may not be able to "afford" front-loading and because insurers may behave strategically in ways that erode the value of protection against risk reclassification. In this paper, the optimal competitive age-based premium schedule for a benchmark guaranteed renewable health insurance policy is estimated using medical expenditure data. Several factors are shown to reduce the amount of front-loading necessary. Indeed, the resulting optimal premium path increases with age. Actual premium paths exhibited by purchasers of individual insurance are close to the optimal renewable schedule we estimate. Finally, consumer utility associated with the feature is examined.