医疗费用支付方式、成分、支付能力与居民就医状况的相关性分析

通过对医疗保险制度改革实施后,医院就诊病人医疗费用、费用构成及自负比例等方面变化的统计分析,阐述了医疗保险制度改革的积极效果,提出在深化医疗保险制度改革的同时,还要照顾到弱势群体,同时医院应加强对自费病人的管理。适宜的医疗费用支付方式能调节医疗服务供方、需方和保险方的利益关系,影响供方行为,控制费用不合理增长。     

新型农村合作医疗中医疗服务供方管理与费用控制

加强对医疗服务供方的管理与控制医疗费用的不合理增长是确保新型农村合作医疗试点工作稳步发展的重要措施.因此,湖北省积极采取措施,通过强化行政部门的管理职能、落实监督审核制度和强化定点医疗机构的管理等措施,严格规范医疗服务供方的行为,控制医疗费用的不合理增长,降低了例均住院费用,切实维护了参合农民的利益.     

医疗保险运行中的医疗服务管理

由于卫生服务过程中存在着信息不对称、代理消费、需求价格弹性小等特征，使卫生服务市场成为供方主导的市场，医疗服务供给方的偏好、倾向和决策决定了需方在卫生服务过程中的选择。因此，在医疗保险运行中加强医疗服务管理、确保医疗供方行为的合理、规范，对于控制卫生费用的不合理上涨，推动医疗保险的良性发展具有决定性意义。笔者认为，在医疗保险运行中，     

医疗费用支付方式改革-DRGs简介

医疗费用控制是个世界性难题，其不合理增长已成为我国医疗卫生改革及构建和谐社会所必须面对与亟待解决的重要问题。卫生服务支付方式会影响到医疗服务供方的医疗行为，并对费用控制、资源配置、医疗质量以及卫生服务过程中的效率、公平产生明显的导向或者制约作用。而按诊断相关分组预付费（DRGs-PPPS）是当前国际上应用较为广泛的一种医疗服务预付制方式，在控制医疗费用增长、规范医疗行为、激励医院加强内部管理等方面表现出一定的优越性，值得研究和借鉴。     

医疗保险参保人住院医疗费用影响因素调查分析

<正>随着医疗体制改革的逐步深入和不断完善,医疗费用过快增长已成为社会普遍关注的问题,分析医疗保险参保人住院医疗费用影响因素,对医院制定有效的医疗保险医疗服务管理措施,抑制医疗费用的增长,在医疗保险改革下医院可持续发展、医疗保险工作顺利进行有积极意义。本文对我院2006～2008年参保患者出院医疗费用构成进行分析,找出影响住院医疗费用的主要因素,为医院建立合理费用控制机制和措施提供依据。     

医疗保险费的控制

目前正在运行的职工医疗保障制度改革试点工作的目的之一，是要遏制医疗费用过快增长的趋势。通过各种途径，控制不合理开支，最大限度减少浪费，对提高医疗保险的运行效率，促进医疗保险制度良性运行和持续发展起积极作用。控制医疗保险费的主要途径有：对需方的控制；对供方的控制；对医疗保险各要素进行有效的监督；加强预防保健，防止、减少疾病的发生和政府履行控制费用的职责等。     

试析支付方式对卫生服务供给的影响

卫生费用支付方式是患者(需方)或医疗保险机构对医疗服务提供者(供方)支付医疗服务费用的方式。医疗费用的支付方式是医疗保险制度改革的重要环节，也是影响医疗目标实现的重要因素之一，对医疗机构的医疗服务行为具有一定的影响。如何有效地改革和完善医疗费用支付方式，在供方、需方、医疗保险机构之间形成有效的利益约束机制，使基本医疗服务费用保持在当地适当水平，从而有效地使用有限的卫生资源，确保满足需方的基本医疗需求、     

供方道德风险与不合理医疗费用增长控制

在社会医疗保险中,供方道德风险导致的不合理医疗费用快速增长问题是管理者最为头痛的.在医疗费用的控制上,德国、加拿大和美国在采用需方成本分担制度的同时,注重对供方的约束,取得了不少成功经验,特别是在医药分离、药品价格控制、医疗设施数量控制和医疗保险付费方式改革等方面,对我国有着借鉴意义.     

医疗费用供方支付方式概述

建立科学的医疗费用供方支付方式不仅是合理控制医疗费用的关键,而且可以对医疗保障制度的完善、公立医院改革、社区卫生服务等基层卫生组织的建设及发展等多个方面产生积极影响,因此是新一轮医药卫生体制改革的重点与突破口。本文对国内外医疗费用供方支付方式的研究进展进行综述,并在分析研究现状的基础上,提出了今后我国医疗费用供方支付方式的发展趋势。     

医疗费用影响因素分析与对策研究

文章从医院管理方式、人口老龄化、疾病流行病学模式、医疗设备及新技术的应用、医疗服务价格、医疗保险制度、患者医疗需求等八个方面分析了影响医疗费用的因素,并提出了控制医疗费用的对策.     

德国医疗保障体系改革及启示

德国是世界上最早建立社会医疗保障制度的国家,其医疗保障体系以法定医疗保险为主,私人医疗保险为辅,基本实现了全民覆盖。本文在梳理德国医疗保障体系三次改革的基础上,阐述德国当前医保管理模式、医疗保险体系、医疗服务体系以及对弱势人群进行保障的现状特点,归纳德国医疗保障体系在发挥市场机制、医保福利包设计、提供均等医疗服务、实行家庭医生制度、注重质量和效率的具体经验,进而提出厘清政府和市场的关系、适时调整医保福利包、逐步建立分级诊疗模式、保障公平的医疗服务以及合理控制医药费用等建议。     

Changes in community health and welfare services with introduction of the long-term care insurance system in Japan

OBJECTIVE: In Japan, a long-term care insurance system for elderly people was introduced in April, 2000. We have conducted a survey using a questionnaire in order to explore consequent changes in community health and welfare services. METHODS: We sent questionnaires to all municipal governments (671 cities, 1,991 towns, 567 villages and 23 wards) in Japan in November, 2001, and obtained replies from 441 cities (response rate: 65.7%), 800 towns (40.2%), 197 villages (34.9%), and 16 wards (69.6%). The questionnaire included questions concerning the budget and manpower for community health and welfare services, the state of the long term care insurance system, and the activities of public health nurses. RESULTS: A total of 57% of all municipal governments was found to be carrying out the long term care insurance program in collaboration with other governments. In order to clarify the changes in welfare services for elderly people from the budgetary viewpoint, we calculated the ratios of the 2000 and 2001 fiscal budgets applied for welfare services for elderly people, in comparison with the 1999 fiscal year. The budgets for elderly people declined to about 40% in 2000 and 2001 compared with 1999, since the budget for care services was transferred to the account of the long term care insurance system. The activities of public health nurses employed by municipal governments were not affected by the introduction of long term care insurance system. About 80% of all municipal governments suggested that both the amounts of care services received by each elderly people and the number of elderly people who received care services were increasing, and about 70% indicated that the quality of care services was improved with introduction of the long term care insurance system. DISCUSSION: Most municipal governments consider that introduction of the long term care insurance system has had a good influence on community health and welfare services. Moreover, our results suggest that the long term care insurance has a beneficial impact on care services themselves.     

Parity for mental health and substance abuse care under managed care

BACKGROUND: Parity in insurance coverage for mental health and substance abuse has been a key goal of mental health and substance abuse care advocates in the United States during most of the past 20 years. The push for parity began during the era of indemnity insurance and fee for service payment when benefit design was the main rationing device in health care. The central economic argument for enacting legislation aimed at regulating the insurance benefit was to address market failure stemming from adverse selection. The case against parity was based on inefficiency related to moral hazard. Empirical analyses provided evidence that ambulatory mental health services were considerably more responsive to the terms of insurance than were ambulatory medical services. AIMS: Our goal in this research is to reexamine the economics of parity in the light of recent changes in the delivery of health care in the United States. Specifically managed care has fundamentally altered the way in which health services are rationed. Benefit design is now only one mechanism among many that are used to allocate health care resources and control costs. We examine the implication of these changes for policies aimed at achieving parity in insurance coverage. METHOD: We develop a theoretical approach to characterizing rationing under managed care. We then analyze the traditional efficiency concerns in insurance, adverse selection and moral hazard in the context of policy aimed at regulating health and mental health benefits under private insurance. RESULTS: We show that since managed care controls costs and utilization in new ways parity in benefit design no longer implies equal access to and quality of mental health and substance abuse care. Because costs are controlled by management under managed care and not primarily by out of pocket prices paid by consumers, demand response recedes as an efficiency argument against parity. At the same time parity in benefit design may accomplish less with respect to providing a remedy to problems related to adverse selection.     

改革机制加强管理抑制医疗费用过快增长

近年来,医疗费用持续快速增长的问题日益突出。分析了医疗费用快速增长的不合理因素主要是由于医疗卫生机制不完善造成的,如医疗服务补偿机制、医疗机构运行机制、医疗保险付费机制和医疗卫生筹资机制等。因此,控制医疗费用的快速增长既需要发展社区卫生服务,建立新型卫生服务体系,加强政府的宏观管理,理顺补偿机制,也需要医院加快内部机制改革,走可持续发展道路,同时,还应扩大医保范围,建立合理的付费方式。     

美国管理式医疗保险与传统医疗保险的比较与借鉴

管理式医疗保险正在逐渐成为美国主流的医疗保险模式.它与传统医疗保险的不同点在于:二者的经济模型不同;消费者(患者)选择供给者的自主性不同;医生的经济风险不同;对利用评估的影响不同;对医生临床决策的影响不同.管理式医疗只能从成本约束的角度影响或限制医生的医疗自主权,并不能从根本上代替医生做临床决策.在管理式医疗模式下,医生的执业风险与消费者的健康利益都受到了明显的负面影响,同时,由于市场本身的原因,它正面临着越来越难的发展局面.管理式医疗在我国的运用应慎重.     

医疗费用迅速增长:各国医疗保险的共性问题及改革

医疗费用的迅速增长是世界各国医疗保险面临的一个共性问题,导致保险基金支付压力越来越大,各国医疗保险制度面临重大挑战.分析医疗费用迅速增长的原因主要为:医药科技的发展、人口老龄化、传统偿付制度的缺欠等.因此,积极改革医疗保险偿付制度、发展"管理保健"和扩大医疗保险基金收入成为各国医疗保险的改革趋势.     

The Oregon Health Plan and public health

The Oregon Health Plan would provide all Oregonians with health insurance through a combination of Medicaid expansion, employer mandates and high-risk coverage, with services delivered largely through managed care. The role of public health in a managed care environment is an important national issue, and one which has received much attention in Oregon. "Cultural" differences between Medicaid and public health have arisen over issues such as whether eligibility assures access, whether the private medical model will provide integrated care, the potential for exploitation of vulnerable populations in a capitated system, and the loss of cost-based Medicaid reimbursement to public clinics. In 1991, legislation required that Oregon's Medicaid managed care plans enter agreements with local health departments to assure their continued participation in providing certain public health services; these agreements are now being implemented. Oregon's experience suggests that any national health system will require a continuum of community and individual health services, with an important role for public health departments.     

Health care needs of Hispanic Americans and the responsiveness of the health care system

The Hispanic population in the United States is growing rapidly but this population has many health care needs that are not being met. The findings from recent research on the current health status of Hispanic people who live in the United States are presented. An assessment of how accessible and available medical care services are to Hispanic people is made. Serious gaps exist in the delivery of medical care services to this group. Human service providers, particularly social workers, can help make the current health care system more responsive to the needs of this group by helping Hispanic individuals who have no health insurance coverage to find employment that includes health insurance benefits or some other form of insurance, by establishing community-based health care centers in Hispanic communities, by developing counseling programs tailored to the alcohol and drug abuse problems of the Hispanic population, and by advocating for government agencies to improve existing sources of data on the health of this group.     

Commentary: Medicaid reform issues affecting the Indian health care system.

Substantial numbers of Indian people rely on Medicaid for their primary health insurance coverage. When state Medicaid programs enroll Indians in managed care programs, several unintended consequences may ensue. This paper identifies some of the perverse consequences of Medicaid reform for Indians and the Indian health care system and suggests strategies for overcoming them. It discusses the desire of Indian people to receive culturally appropriate services, the need to maintain or improve Indian health care system funding, and the duty of state governments to respect tribal sovereignty. Because of their relatively small numbers, Indians may be treated differently under Medicaid managed care systems without significantly endangering anticipated program savings. Failure of Medicaid programs to recognize the uniqueness of Indian people, however, may severely weaken the Indian health care system.     

Health care reform as perceived by first year medical students

Our study objective was to evaluate the attitudes of first year medical students toward the health care system using a self administered questionnaire to all first year medical students at the medical schools in the University of California system. Of 631 students surveyed, 94% comleted the instrument. Students were asked about their attitudes toward and familiarity with concepts in health services, access to care, and managed care. Our findings indicated that most students were unfamiliar with concepts related to health services. Students were concerned about access to care; sixty-six percent of students favor a national health insurance plan. A majority of students supported allowing patients access to the current health care system regardless of the cost or utility of a medical test or procedure. Thirty-nine percent felt that rationing health care in any form (transplants, access to the intensive care unit, etc.) is contrary to the way medicine should be practiced. 72% felt that practicing physicians had a major responsibility to help reduce health care costs. When asked about specific changes intended to control health costs, students identified reform of medical malpractice system (63%) and increased spending on preventive health (60%) as the two proposals most likely to be effective. Students generally held negative attitudes toward managed care organizations; only 10% would chose to receive their care in HMOs. We conclude that first year medical students generally have little understanding of the health care system. Despite this, they hold strong opinions about access to care, managed care organizations and strategies intended to reduce health care spending. It is up to medical educators to find creative methods of introducing these content areas into an already bulging curriculum.Funds for this study were generously provided by the L.K. Whittier Foundation. Samuel A. Skootsky's salary was in part supported by Southern California Edison.