农村健康保险的精算体系

本文提出了我国农村健康保险的精算体系和测算保险费、管理费、储备金、预防保健费、保险因子、增加系数、医药费及其补偿比的实用方法。     

Human tonsil,blood and bone marrow in vivo-induced B cells capable of spontaneous and high-rate immunoglobulin secretion in vitro: Differences in the requirements for factors and for adherent and bone marrow stromal cells,as well as distinctive adhesion molecule expression

Human B cells capable of spontaneous IgG secretion are commonly found in circulation and in lymphoid tissues such as tonsil and bone marrow (BM). The present study compares the mechanisms that regulate tonsil, blood and BM B cells capable of spontaneous IgG secretion. The BM cell subset produced IgG during a markedly longer period of time (14 days) than did tonsil and blood cell subsets (2–3 days). Blood and BM, but not tonsil, B cell IgG secretion depended on the presence of adherent cells, as demonstrated by adherent cell depletion and re-addition experiments. Stromal BM cells supported linear IgG secretion by non-adherent BM cells for 2 weeks, but were unable to prolong the short-term IgG secretion by tonsil and blood cells. Different factors induced IgG secretion in each of the three B cell populations as optimal IgG secretion by tonsil, blood or BM cell subsets required either tumor necrosis factor-α, interleukin-6 or fibronectin + interleukin-6, respectively. Finally, these populations also showed differences in the expression of adhesion molecules; the tonsilar cell subset was PNA^+/? CD44⁺ CD49d⁺ CD49e^? Leu-8^+/?, the blood cell subset was PNA^? CD44^+/? CD49d⁺ CD49e^? Leu-8⁺ and the BM cell subset was PNA^? CD44^+/? CD49d⁺ CD49e^? Leu-8^?. These results suggest that the mechanisms controlling the final differentiation and the expression of adhesion molecules in these B lymphocytes exhibit territorial specificity.     

Fine particulate matter exposure during pregnancy and infancy and incident asthma

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通过医保支付推进医疗质量管理的经验及启示

目的通过介绍典型国家及地区经验,阐述医保如何通过经济手段促进医疗服务质量提升,供我国大陆地区参考。方法采用文献分析法。采取主题词与分类号组合的检索方式,收集美国、英国及我国台湾地区有关医保与医疗服务质量的文献。结果美国实行基于价值支付的奖惩机制,包括医院服务价值购买计划、再入院扣费计划、医院获得性疾病扣费计划;英国实行提升基层医疗服务质量的激励机制;我国台湾地区实行结合医院评价体系的总额预付制。结论为促使我国大陆地区通过医保支付进一步推进医疗质量管理,建议建设卫生主管部门与医保部门有机融合的医疗质量考核系统,采用质量指标的多元计分方式,设计与质量联动的奖惩机制等。     

我国医保支付改革下按病种分值付费的探讨与建议

医保支付方式作为引导医疗服务行为、调节资源配置的杠杆,对实现医保基金可持续发展,提升医院精细化管理水平具有重要作用。近年来,我国积极探索医保支付改革,以DRG和DIP为代表的支付方式已成为主要方向。文章从改革的现实出发,对DIP相较于DRG的实施优势、问题与挑战进行比较分析,并提出政策建议。     

美国医保支付制度改革对我国康复护理服务的启示

梳理了美国医保支付制度改革进程,总结了捆绑支付模式内涵及其对康复护理服务的影响。结合我国国情,借鉴美国医保支付制度改革经验,认为我国应建立基于价值评价的康复护理服务医保支付制度,充分发挥医保基金的引导和保障作用,健全多元化的复合型医保支付体系,创建“以人民的健康为中心”的连续型医疗服务保障体系。     

我国医保医用耗材管理机制变革及对医疗机构的影响分析

近年来,我国医用耗材管理机制改革不断深入。基于对我国医用耗材管理现况和新医保政策动向的分析,探讨了既往管理模式的弊端和医保部门在耗材目录、定价、采购、支付、监管等方面的政策进展。建议医疗机构和医务人员要正视耗材改革的推进,积极优化临床诊疗工作流程,追求医疗质量和成本控制之间的平衡,以适应新的政策环境,促进我国医疗卫生事业健康发展。