调动农民参合积极性推进新型农村合作医疗健康可持续发展

2004年,章丘市68．9万农民参加合作医疗,参合率达82％,报销金额1365．7万元,受益农民43万人次,占参合农民的62．4％。2005年74．8万农民参加合作医疗,参合率达到91％,报销金额1996万元,受益农民达52万人次、占参加新农合农民群众的70％。近两年来,有23574人享受到大病报销,其中有156人报销金额在1万元以上。     

发挥中医药作用促进新型农村合作医疗

自2004年2月份被确定为山东省新型农村合作医疗试点县以来，我县积极探索如何更好的发挥中医药在新型农村合作医疗工作中的作用，为广大农民群众提供质优价廉、简便易行的中医药服务。试点工作以来，全县有51．8万农民参加合作医疗，参合率达85．2％，受益农民达48万人次，报销金额510万元，其中中医药服务报销数额112．5万元，中医门诊11．43万人次，住院中医治疗1109人次。     

关于平价医院的讨论与思考

1问题的提出在2006年1月7日召开的全国卫生工作会议上,国家卫生部部长高强在讲话中要求各地建立平价医院或平价病房,主要为参加新型农村合作医疗的农民、城市下岗职工、失业人员、低保人员、进城务工人员及老人和儿童提供医疗服务。并指出,要对“平价医院”实行预算式全额管理,     

新型农村合作医疗补偿模式的选择分析

目的：分析农民参加合作医疗的受益率、满意度以及对补偿模式的选择意愿。方法：应用多项logistic回归模型分析影响农民选择意愿的因素及其影响程度。结果：（1）参合农民的受益率不超过2．63％；（2）合作医疗基金的使用率为71．05％；（3）在农民对合作医疗不满意的原因中，选择费用补偿比例低、保障范围窄和模式单一化的比例分别为54．65％、87．21％和18．60％；（4）对农民选择意愿具有显著性影响的因素有家庭人口数、家庭收入和医疗支出、家庭所处区域以及了解合作医疗的程度。结论：合作医疗应重点解决农民的大病经济风险；适当兼顾一些多发病和常见病门诊费用，扩大受益面；合理制定补偿比例，控制基金结余；建立多层次的医疗保障体系，满足农户的多元化需求。     

霍山中荷扶贫项目农村合作医疗试点的中期评价

目的:了解霍山中荷扶贫项目合作医疗实施的情况及其效果.方法:随机抽取 603户农民,利用调查表入户调查.结 果:两试点乡镇农民合作医疗入保率为 65.1%,其中诸佛庵镇为 85.3%,落儿岭镇为 43.8%,两乡镇入保率差别有 统计学意义.农民家庭经济状况对是否参加合作医疗没有影响.在乡镇卫生院,参加合作医疗者次均住院费用为 935.29元,是未参加合作医疗者的 2.5倍.参加合作医疗者年住院率高于未参加合作医疗者. 54.8%的农户愿意 参加下一年的合作医疗.结论:要加强两试点乡镇合作医疗的基金管理,调整农民合作医疗入保金,积极引导农民 参加下一年的合作医疗.     

云南省禄丰县参合农民住院服务利用的公平性分析

通过对被调查地区不同收入参加新型农村合作医疗的农民(以下简称参合农民)对住院服务利用的变化及公平性分析显示:新型农村合作医疗实施后人群住院率较高,但不同收入参合农民卫生服务需要的满足程度存在不公平,而且住院服务可及性的公平性也有待于进一步加强。     

重庆市黔江区新型农村合作医疗需方受益分析

对重庆市黔江区新型农村合作医疗试点乡镇具体实施以及需方实际获益情况进行了调查分析.结果 表明,居民受益面、受益程度、服务利用情况良好,新型农村合作医疗对住院费用的补偿、降低农民疾病经济负担及减少因病致贫风险具有一定作用,且贫困居民从中受益较大.黔江区新型农村合作医疗制度中对门诊及住院费用的控制办法,低水平、广覆盖的门诊统筹模式,有利于贫困居民的住院补偿等做法和经验值得借鉴,同时,其参合率也有待进一步提高.     

沈阳：全面建成“老有所养”保障体系

目前，从沈阳市政府了解到，沈阳市已全面建成“老有所养”保障体系，目前全市退休老人已全部参加职工医疗保险，其中56000多名老人获得低保救助，23万农村老年人参加了农村新型合作医疗。受益于老工业基地的振兴，沈阳市对社会保障投入逐年增多，老年人养老和医疗保障水平显著提高，目前全市退休人员养老金月均超过900元，其中70岁以上老人的低保标准近年已增长了20％。沈阳市每年斥资3620万元，     

不同人群新型农村合作医疗受益情况分析

新型农村合作医疗在保障农村居民基本医疗方面发挥越来越大的作用,农村居民对基本医疗服务的利用,特别是对住院服务的利用明显提高。本研究通过对不同人群新型农村合作医疗受益情况分析,为进一步强化全体农村居民公平享有基本医疗服务和提高新型农村合作医疗受益程度提供依据。     

山东省某县新型农村合作医疗受益公平性研究

目的研究农村居民从新型农村合作医疗制度中的受益公平程度。方法应用受益归属分析方法对政府补助分配的合理性进行研究，用集中指数和人群五分位组来评价农民从新型农村合作医疗制度中受益的公平程度。结果从居民受益角度看，总补助的集中指数是负值，贫困人群获得补助的比重高于其人群比重，而富裕人群获得补助的比重低于其人口比重。但是，有10％左右的最贫困人群的集中曲线位于公平线下方。从不同医疗服务看，门诊和住院补助的分布也存在差异，住院的公平程度好于门诊。结论在提高新型农村合作医疗受益公平性方面，应在提高补偿水平、完善家庭门诊账户及扩大“基本医疗安全服务包”覆盖范围等方面进行改进。     

Community-based health insurance in poor rural China: the distribution of net benefits

The collapse of China's Cooperative Medical System (CMS) in 1978 resulted in the lack of an organized financing scheme for health care, adversely affecting rural farmers' access to health care, especially among the poor. The Chinese government recently announced a policy to re-establish some forms of community-based insurance (CBI). Many existing schemes involve low premiums but high co-payments. We hypothesized that such benefit design leads to unequal distribution of the "net benefits" (NB)--benefits net of payment--because even though low premiums are more affordable to poor farmers, high co-payments may have a significant deterrent effect on the poor in the use of services in CBI. To test this hypothesis empirically, we estimated the probability of farmers joining a re-established CBI using logistic regression, and the utilization of health care services for those who joined the scheme using the two-part model. Based on the estimations, we predicted the distribution of NB among those who joined the CBI and for the entire population in the community. Our data came from a household survey of 4160 members of 1173 households conducted in six villages in Fengshan Township, Guizhou Province, China. Three principal findings emerged from this study. First, income is an important factor influencing farmers' decision to join a CBI despite the premium representing a very small fraction of household income. Secondly, both income and health status influence enrollees' utilization of health services: richer/sicker participants obtain greater NB from the CBI than poorer/healthier members, meaning that the poorer/healthier participants subsidize the rich/sick. Thirdly, wealthy farmers benefit the most from the CBI with low premium and high co-payment features at every level of health status. In conclusion, policy recommendations related to the improvement of the benefit distribution of CBI schemes are made based on the results from this study.     

In setting doctors' Medicare fees, CMS almost always accepts the relative value update panel's advice on work values

To calculate physicians' fees under Medicare--which in turn influence the physician fee schedules of other public and private payers--one of the essential decisions the Centers for Medicare and Medicaid Services (CMS) must make is how much physician time and effort, or work, is associated with various physician services. To make this determination, CMS relies on the recommendations of an advisory committee representing national physician organizations. Some experts on primary care who are concerned about the income gap between primary and specialty care providers have blamed the committee for increasing that gap. Our analysis of CMS's decisions on updating work values between 1994 and 2010 found that CMS agreed with 87.4 percent of the committee's recommendations, although CMS reduced recommended work values for a limited number of radiology and medical specialty services. If policy makers or physicians want to change the update process but keep the Medicare fee schedule in its current form, CMS's capacity to review changes in relative value units could be strengthened through long-term investment in the agency's ability to undertake research and analysis of issues such as how the effort and time associated with different physician services is determined, and which specialties--if any--receive higher payments than others as a result.     

广东省农民对新型农村合作医疗认知程度的抽样调查

[目的]了解广东省农村居民对新型农村合作医疗（新农合）的知识、态度以及参加情况,为正确评价新农合实施效果提供科学依据。[方法]2005年8月,采用分层整群随机抽样方法,在广东省7个市抽取20个行政村,对部分村民进行问卷调查。[结果]调查923人,50．6％参加了新农合,9．2％对新农合“很清楚”,大部分通过“电视传媒宣传”、“宣传单”、“村干部上门动员”的途径了解新农合;11．6％对新农合“很信任”,74．2％对新农合“一般信任”,33．6％认为新农合能解决住院需要的高额费用,54．3％愿意继续参加明年的新农合;对市、县政府信任的分别占61．0％、15．4％,对市级以上和县级医院信任的分别占71．3％、11．8％;认为新农合可能带来的好处主要是“医药费可报销一些”、“生大病有一定保障”、“生病可以及时看”的分别占37．6％、30．1％、12．4％;认为新农合“报销比例太低”、“报销手续太繁琐”、“不看病也要交钱”的分别占40．4％、21．1％、16．8％。[结论]新农合在广东省农村产生了一定的影响,农民对新农合有了一定的认识和了解。     

A study on a reduction in visits to physicians after introduction of 30% co-payments in the employee health insurance in Japan

The purpose of the study is to evaluate influences of the introduction of 30% co-payments on potential visit behavior using a questionnaire in order to determine whether "employment state of the spouse" and "number of dependent children", as indicators of economic backgrounds, affect visits to physicians in a health insurance society. The subjects were 1,674 insured consisting of 1,165 males and 509 females, who underwent a regular health examination in July 2002, in a health insurance society. In the survey, they were asked whether the subject "will reduce" or "will not reduce" visits to physicians due to the increase in co-payments in the health insurance system scheduled in 2003. Multivariate analyses showed that "employment state of the spouse" was significantly related to the reduction in visits for myocardial infarction or stroke, cancer or heart disease, and hypertension and diabetes mellitus. Concerning "number of dependent children", it was related to the risk of reducing visits to physicians for myocardial infarction or stroke, trauma or fracture, cancer or heart disease, and low back pain or knee pain. Finally, upper limit expenditures of co-payments of physicians to visits due to hypertension and diabetes mellitus were related to "number of dependent children". The study results suggest that "employment state of the spouse" and "number of dependent children" are significant factors to affect potential visits to physicians after the introduction of 30% co-payments.     

Privatisation & marketisation of post-birth care: the hidden costs for new mothers

Introduction

Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries.

Methods

Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care.

Results

In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance.

Conclusions

China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance.     

Child access to health services during the economic crisis: An Indonesian experience of the safety net program

Child health has been a serious problem in Indonesia for several decades. The prolonged Indonesian economic crisis in 1997 had a tremendous impact on poor children who suffered due to malnutrition. In 1998, the Indonesian government launched a broad social safety net program to protect the poor from becoming poorer. In the health sector this took the form of Jaring Pengaman Sosial Bidang Kesehatan (JPS-BK) or the Social Safety Net in Health Sector program. Adopting the model of health services utilization of Andersen and Newman, I examine the extent to which JPS-BK contributed to better health services for poor children in four provinces, by using a simplified version of Andersen and Newman's model of health services utilization which emphasizes the importance of contextual determinants. Variables used in the study included child outpatient visits, health card possession, household income, and poverty status. Using data sets from the JPS-BK longitudinal study, I compared utilization of health services between baseline data collection at Rounds One and Three, which was taken a year afterward. In addition, I used the Village Potentials data set from the Indonesian Bureau of Statistics and employed factor analysis to raise one variable representing the village/neighborhood developmental level. Basic statistics were used to examine possible changes between study rounds and logistic regression was used to examine the effect of health card possession on child health services utilization. Two significant improvements occurred during the first year of the program: (i) more sick children visited outpatient facilities and (ii) more children lived in households possessing health cards. The JPS-BK increased the "potential access" that was demonstrated by the significant increase in health card possession regardless of the visit, and "realized access" that was demonstrated by the significant increase in child outpatient visits regardless of health card possession. Further research needs to be undertaken to explore the dynamics of outpatient visits and the actual use of health cards.     

Satisfaction with and access to community care of the chronically ill in Israel's health system

One goal of Israel's National Health Insurance Law was to improve services for vulnerable populations. However, it was feared that this goal would not be reached for the chronically ill, due to the regulations governing health plan reimbursement and to amendments to the law that authorize additional co-payments for services. OBJECTIVE: To examine the satisfaction with and organizational and financial access to services of chronically ill patients, and compare them to those of healthy consumers. METHODS: In autumn 2001, telephone interviews were conducted with a random sample of 1790 permanent residents of Israel over age 22, 512 (28%) of whom reported having a chronic illness. RESULTS: No significant differences were found between chronically ill and healthy respondents in satisfaction with services, and few differences were found in organizational access to services. However, differences were found in financial access to services. Specifically, chronic illness had an independent positive effect on the burden of co-payments for health services and the likelihood of forfeiting care or medication due to cost. CONCLUSIONS: Increased co-payments for services may restrict access to care. To lighten the burden on vulnerable populations, it is necessary to consider discounts and lower ceilings on co-payments.     

Let's stick together: The role of self-interest and ideological beliefs for supporting a ‘solidaristic’ health policy in Norway

Previous studies of health system legitimacy have almost exclusively paid attention to patterns of service satisfaction and preference for state involvement. These two dimensions are related to substantial and procedural justice; i.e. the value of a certain policy and the way it is implemented. This study contributes to the research field by focusing on a third dimension that have been little studied so far: the willingness of citizens to contribute on a solidaristic basis. This dimension was captured through three health policy preferences: public healthcare spending willingness, opposition to co-payments and opposition to private health insurance. Building on the literature on welfare state legitimacy, the empirical model distinguished between two sets of predictors to explain individual differences: self-interest and ideological belief. Old age, poor health and poor economy is positively associated with opposition to co-payments for “self-inflicted” diseases, while low education and poor health is positively related to support for more public spending. Increasing age is furthermore positively associated with opposing co-payments and easier uptake of insurance. Liberal-conservative voters are less willing to spend more on healthcare but more willing to increase the use of co-payments and insurance.     

Is Personality Associated with Health Care Use by Older Adults?

Context

The patterns of health care utilization in the United States pose well-established challenges for public policy. Although economic and sociological research has resulted in considerable knowledge about what influences the use of health services, the psychological literature in this area is underdeveloped. Importantly, it is not known whether personality traits are associated with older adults’ use of acute and long-term care services.

Methods

Data were collected from 1,074 community-dwelling seniors participating in a Medicare demonstration. First they completed a self-report questionnaire measuring the “Big Five” personality traits: Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. During the next two years, the participants maintained daily journals of their use of health care services. We used regression models based on the Andersen behavioral model of health care utilization to test for associations.

Findings

Our hypothesis that higher Neuroticism would be associated with greater health care use was confirmed for three services—probability of any emergency department (ED) use, likelihood of any custodial nursing home use, and more skilled nursing facility (SNF) days for SNF users—but was disconfirmed for hospital days for those hospitalized. Higher Openness to Experience was associated with a greater likelihood of custodial home care use, and higher Agreeableness and lower Conscientiousness with a higher probability of custodial nursing home use. For users, lower Openness was associated with more ED visits and SNF days, and lower Conscientiousness with more ED visits. For many traits with significant associations, the predicted use was 16 to 30 percent greater for people high (low) versus low (high) in specific traits.

Conclusions

Personality traits are associated with Medicare beneficiaries’ use of many expensive health care services, findings that have implications for health services research and policy. Accordingly, person-centered interventions, population-based translational effectiveness programs, and other personalized approaches that leverage the profound advances in personality psychology in recent decades should be considered.