2001～2006年政府对卫生监督机构专项经费投入特征分析

目的评价2001～2006年间政府对卫生监督机构正常经费拨款的投入特征。方法通过全国系统抽样,获取卫生监督机构人员经费、公用经费和经常性业务经费等基本资料,从投入的总量和人均经费来反映政府投入的特征。结果就投入总量来说,3年建设前后人员经费、公用和经常性业务经费增长率分别为59.0%、45.4%;其中中部和西部地区的人均人员经费和人均业务经费较东部地区增长率高,体现了政府对中西部地区发展的关注和重视。     

Health care funding levels and patient outcomes: a national study

BACKGROUND: Health care funding levels differ significantly across geographic regions, but there is little correlation between regional funding levels and outcomes of elderly Medicare beneficiaries. Our goal was to determine whether this relationship holds true in a non-Medicare population cared for in a large integrated health care system with a capitated budget allocation system. METHODS: We explored the association between health care funding and risk-adjusted mortality in the 22 Veterans Affairs (VA) geographic Networks over a six-year time period. Allocations to Networks were adjusted for illness burden using Diagnostic Cost Groups. To test the association between funding and risk-adjusted three-year mortality, we ran logistic regressions with single-year patient cohorts, as well as hierarchical regressions on a six year longitudinal data set, clustering on VA Network. RESULTS: A 1000 dollar increase in funding per unit of patient illness burden was associated with a 2-8% reduction in three-year mortality in cross sectional regressions. However, in longitudinal hierarchical regressions clustering on Network, the significant effect of funding level was eliminated. CONCLUSIONS: When longitudinal data are used, the significant cross sectional effect of funding levels on mortality disappear. Thus, the factors driving differences in mortality are Network effects, although part of the Network effect may be due to past levels of funding. Our results provide a caution for cross sectional examinations of the association between regional health care funding levels and health outcomes.     

我国卫生政策与体系研究科研项目及经费现状分析

目的：描述我国卫生政策与体系研究领域科研项目及经费现状,分析存在的问题,为促进研究能力提高提供建议。方法：通过问卷调查和关键人物深度访谈,从科研项目数量及分布、主题情况等方面进行分析。通过公开资料梳理,从项目数量与分布、主题情况等方面对国家自然科学基金的资助情况进行分析。结果：2015—2017年平均每个机构每年开展科研项目26.25项,涉及主题为卫生筹资、服务提供、卫生人力等;平均每个机构每年的科研经费为529.00万元;63.16%的研究机构来自国内的经费资助多于来自国际的经费资助,政府来源经费占全部经费比例为44.23%;财务管理方面,科研经费通常由上一级机构的财务管理部门通过预决算机制进行管理。2008—2017年,共有116家机构获得国家自然科学基金资助,平均每个机构获得项目数为4.81项、所获得资助金额为169.06万元,主要研究为卫生服务提供相关主题。结论：我国卫生政策与体系研究科研项目数量及经费快速增长,但主要集中于发达地区的研究机构,存在地区不平衡现象;国际资助呈现下降趋势,国内来源占比越来越高;经费管理机制在逐步调整,但不同机构落实方面存在差异。     

基本公共卫生经费按项目成本付费方式研究

为探索合理、有效的公共卫生经费补偿方案、提高经费使用效率,本研究以北京市丰台区为例,选取7个社区卫生服务中心,通过台账登记的方式收集成本测算的各项数据,并对各项目成本进行整理与测算分析。结果显示：开展基本公共卫生服务的人均服务成本为40元,当前的公共卫生服务经费标准应根据物价水平进行调整。建议公共卫生经费应在保证公共卫生服务正常开展的基础上,按照不同的公共卫生项目,通过绩效考核方式进行拨付,使公共卫生服务经费使用效率最大化。     

The risk-adjusted vision beyond casemix (DRG) funding in Australia

Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.     

Do Capitation‐based Reimbursement Systems Underfund Tertiary Healthcare Providers? Evidence from New Zealand

One of the main concerns about capitation‐based reimbursement systems is that tertiary institutions may be underfunded due to insufficient reimbursements of more complicated cases. We test this hypothesis with a data set from New Zealand that, in 2003, introduced a capitation system where public healthcare provider funding is primarily based on the characteristics of the regional population. Investigating the funding for all cases from 2003 to 2011, we find evidence that tertiary providers are at a disadvantage compared with secondary providers. The reasons are that tertiary providers not only attract the most complicated, but also the highest number of cases. Our findings suggest that accurate risk adjustment is crucial to the success of a capitation‐based reimbursement system. Copyright © 2017 John Wiley & Sons, Ltd.     

Award-Winning Desk Speeds Prescription-Filling in Pharmacy

This paper examines the accreditation of mental health facilities and sources of funding. The funding sources examined are Medicare, Medicaid, Veterans Administration, private insurance, and client fees. Other factors included are the type of ownership of the facility. The conclusion is that accreditation is important. Different accreditations are important for different funding sources. The most important accreditations are state accreditations. Type of ownership is important, but relatively the least important.     

Impact of dental National Partnership Agreements on public dental service waiting lists in Queensland

Objective: Analyse the Queensland Dental Public Service waiting list from 2013 to 2015 while various funding agreements between the federal and state and territory governments were in place. Methods: Queensland Public Dental Service waiting list is open data and is updated monthly. This analysis reports on the changing number of people waiting for care and the percentage of people waiting beyond the reasonable period. Results: While the number of people waiting decreased when funding was specifically allocated to “blitz the dental public waiting list”, these have since increased back to pre‐blitz period numbers. The percentage now waiting beyond the reasonable period has decreased from 57% to 28% over the study period. Conclusions: While the ‘blitz’ was successful in reducing waiting list numbers, this was not sustained. The deferred federal funding to states/territories for dental services may have worsened the situation. Implications for Public Health: While an injection of funds to reduce the waiting list is important and has had an impact, to adequately address oral health will require not just continuing funding, but also a shift away from the current curative ‘downstream’ approach towards a health‐promotive ‘upstream’ approach. This will reduce not only the cost of treatment, but also waiting lists.