温州市不同社会经济特征职工对补充医保的意愿参保分析

根据温州市基本医疗保险覆盖范围,该文设计了与之对应的5个补充医疗保险方案,并测算了不同社会经济特征职工对不同方案的意愿参保情况.结果发现,职工对方案A和方案B的意愿参保率较高;高年龄者对所有方案的参保率较低;文化程度较高者和高收入者对所有方案的意愿参保率较高.自认健康状况差的职工关注大病重病费用风险,对方案A意愿参保率较高.     

我国补充医疗保险的内涵及其运作方式比较

补充医疗保险是我国多层次医疗保障体系中的重要一环。在全面推进城镇职工基本医疗保险制度改革的同时,明确界定补充医疗保险的内涵,选择适宜的补充医疗保险运作模式,是改革实践中面临的重要课题。一、补充医疗保险的内涵《中共中央、国务院关于卫生改革与发展的决定》(中发[1997]3号)提出:“要在搞好试点、总结经验的基础上,基本建立起城镇职工社会医疗保险制度,积极发展多种形式的补充医疗保险”。《国务院关于建立城镇职工基本医疗保险制度的决定》(国发[1998]44号)指出:“为了不降低一些特定行业职工现有的医疗消费水平,在参加基本医疗…     

温州市补充医疗保险的需求及其影响因素研究

根据温州市职工基本医疗保险覆盖范围 ,笔者设计了与之对应的 5个补充医疗保险方案 ,调查了职工对这些补充医疗保险方案的意愿支付情况。结果表明 :5种方案的需求价格弹性在 0 .88～ 1 .3 4之间。覆盖特需医疗服务的方案D和E需求价格弹性较大 ,覆盖大病重病的方案A接受程度最高 ,价格弹性最小 ,应优先考虑加以推广。个人经济状况、医疗服务利用及对基本医疗保险的了解程度影响补充医疗保险需求。     

黑龙江省城镇职工补充医疗保险需求调查与影响因素分析

目的:了解黑龙江省城镇职工对补充医疗保险的需要、需求及影响因素.方法:采用分层抽样法,自制问卷对黑龙江省城镇职工补充医疗保险的需求进行个人调查.结果:只有18.2%的受访者了解补充医疗保险:29.67%受访者防范未知医疗疾病风险以个人存款为主要途径,还有16.92%没有任何准备;80.4%受访者愿意参加城镇职工补充医疗保险.在补充医疗保险的举办方式上,选择社会医疗保险机构举办的自愿性补充医疗保险居多,占45.5%.结论:政府医疗保障部门和商业医疗保险机构应该关注城镇职工的补充医疗保险需求,并要参考城镇职工实际需求意愿,制定适宜的城镇职工补充医疗政策和实施方案.     

广东省商业保险承办大病医疗保险的实践研究

总结了广东省在探索商业保险公司承办大病医疗保险的过程中,涌现出的湛江模式、珠海模式、江门模式等创新模式中的运作方式、盈利限制、经营收益等方面的共同点以及覆盖范围、筹资标准、模式特色等方面的差异性。提出多种大病医疗保险运营模式本质上都是一种政府购买服务,商业保险公司通过保险合同的方式参与社会医疗保险的运作,因各地对商业保险公司的盈利都做出了限制,目前商业保险公司的运营基本属于亏损,对制度的可持续运行也提出了挑战。建议进一步明确大病医疗保险的定位,慎重考虑大病医疗保险的未来发展方向,完善顶层制度设计。     

温州市高收入职工对特需服务补充医疗保险的需求分析

笔者设计了覆盖基本医疗保险药品目录以外药品费用和特需服务的补充医疗保险方案1和2,通过对温州市高收入职工的意愿参与和意愿支付调查,发现收入、保险价格、对保险的认知、职业情况、罹患慢性病及其对基本医疗保险的了解程度等是影响高收入者对这两种方案意愿参保的主要因素;需求价格弹性分别为-1.07和-1.29。覆盖特需服务的补充医疗保险应注重个性化和多样化需求,并需注意逆向选择。     

推进与进一步深化城镇职工医疗保险制度改革的思考

近年在研究国家公费医疗管理与社会医疗保险中所发现的问题 ,参照国家医疗保险制度改革的有关政策 ,提出了在现阶段推进与进一步深化城镇职工医疗保险制度改革有待于深入研究与规范的问题。即 :医疗保险的启动资金 ,医疗保险的组织机构 ,医疗保险费用的偿付 ,医疗保险的保障范围 ,医疗保险的覆盖范围 ,基本医疗保险与补充医疗保险的关系等 ,并就以上问题阐述了作者的看法     

推行与进一步深化城镇职工医疗保险制度改革的思考

近年在研究国家公费医疗管理与社会医疗保险中所发现的问题,参照国家医疗保险制度改革的有关政策,提出了在现阶段推进进一步深化城镇职工医疗保险制度改革有待于深入研究与规范的问题。即：医疗保险的启动资金,医疗保险的组织机构,医疗保险费用的偿付,医疗保险的保障范围,医疗保险的覆盖范围,基本医疗保险与补充医疗保险的关系等,并就以上问题阐述了作者的看法。     

南通市城乡居民补充医疗保险:问题、根源与对策

南通市在推动基本医疗保险全面发展的基础上大力发展补充医疗保险,不仅优化和完善了南通市的居民医疗保障体系,同时也有效缓解了老百姓的"看病难、看病贵"问题.但调查发现,南通市现行补充医疗保险在覆盖范围、理赔流程、管理运行、保障水平等方面还存在诸多问题.本文在分析导致上述问题的根源并借鉴国内相关实践经验的基础上,从明确供给定位、培养专业人才、强化监管职能、拓宽筹资渠道及推动机构发展等方面,提出助推补充医疗保险高质量发展的若干对策建议.     

中国、美国、泰国三国医疗保险制度比较分析

文章通过对高度市场化运作的美国医疗保险体系和泰国覆盖全民的"30珠医疗保险计划"的分析,结合当前我国医疗保险体系的运行现状,尤其是新型农村合作医疗的发展状况,从医疗保险制度、管理主体、筹资主体和支付模式等不同层面对3个国家的医疗保险体系进行比较分析,最终为我国医疗保险体系的建设和完善提出了合理化建议和对策.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

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.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.