Socioeconomic distribution of GP visits following patient choice reform and differences in reimbursement models: Evidence from Sweden

ObjectiveThis study aims to analyse changes in the socioeconomic distribution of GP visits following primary care patient choice reform, and to compare their magnitude and direction in pure capitation, versus capitation/activity-based mixed, provider reimbursement settings.MethodsWe compute absolute and relative concentration indices using total population registry data from three Swedish counties (N∼3.6 million) two years pre, to two years post, reform. We decompose the indices by the contribution of first, non-recurrent and recurrent visits, and compare their changes in the different provider reimbursement settings.ResultsIn all three counties, the number of visits increased for all population groups. Increases were larger, and distributional changes more pro-poor, in the county with mixed reimbursement. Visit increases were mostly driven by recurrent and, especially, non-recurrent, visits, which were increasingly pro-poor in all counties in absolute, but not in relative, terms. First visits either became decreasingly pro-poor, or did not change significantly. Exclusion of high users removed the pro-poor patterns in the two counties with pure capitation.ConclusionsThe reform led to increased access to GP visits, but implied small changes in their socioeconomic distribution. In combination with provider reimbursement models with incentives for higher visit volumes, changes were more pro-poor over time, but it is not clear whether this was at the expense of reduced visit length or content.     

“Not an afterthought”: Power imbalances in systemic partnerships between health service providers and consumers in a hospital setting

Contemporary health policies require consumers be involved at all stages of health service planning, implementation, delivery, and evaluation. The extent to which this policy is met, however, varies widely across the sector. One barrier to meeting policy requirements is power imbalances within systemic partnerships between consumers and other health professionals. Between September 2016 and February 2017, interviews were conducted with health care managers, clinicians, and consumers working on partnerships across various health service departments in one hospital. An exploratory, qualitative approach was used. Data were analysed using principles of discursive psychology, which focuses on the way power is constructed through participants' accounts of partnerships. The findings suggest providers have significant power over consumers in partnerships at the systematic level of health services. Managers were responsible for setting the parameters for partnerships, and consumers were seen more as a resource to be used by health services rather than as equal partners to work with. The findings suggest that although contemporary health policies require partnership with consumers, better guidelines are needed to specifically address and challenge power imbalances within these partnerships.     

中国三明市医改下药品费用影响因素分析

目的：探讨三明市医药卫生体制改革期间药品费用变化情况,并分析药品价格、药品用量和用药结构对药品费用变化的影响,以期为今后药品费用改革决策提供视角和参考。方法：收集三明市1家医院（实验组）和福建其他地区18家医院（对照组）在2011-2016年期间的药品采购数据,采用"A.M"指数体系进行因素分析。结果：自2011年起实验组药品总费用保持平稳,年均增长率为1.4%,对照组涨速较快,年均增长率为6.4%;实验组和对照组价格因素及用量因素变化趋势一致、变化速度相近;在结构因素方面,实验组保持平稳,对照组涨速较快。结论：三明市医改明显降低了药品价格并抑制了"同类别药品高价药替代低价药"的趋势,控制结构因素是抑制药品费用上涨的有效手段。     

Activation of phosphoinositide 3-kinase delta by antipsychotic drugs: Preliminary results

Background

Catalytic subunit delta of phosphoinositide 3-kinase, p110δ, encoded by the PIK3CD gene, was recently proposed as a target for pharmacological treatment of schizophrenia. Current antipsychotic drugs were found to decrease the mRNA expression of PIK3CD, but the mechanism of this process is not known. The aim of the study was to elucidate the mechanism by which antipsychotic drugs affect the mRNA expression of PIK3CD.

“四导向”教学模式在酶工程教学实践中的应用

本文结合酶工程课程的教学特点,从实践教学经验出发,对酶工程的教材选择、教学实施、教学改革与课程发展规划进行思考和探索,在教材选择上提出深入简出,严肃活泼教材适用原则,在教学实施上提出“四导向”的教学模式,并对酶工程教学改革做出了展望和思考,以期对高等医学院校酶工程的教学改革提供一定的思路和参考,更好的促进高校酶工程的教学实践,培养熟练掌握酶工程理论和应用知识的人才。     

miRNA调控乳腺癌多药耐药机制的研究进展

乳腺癌是女性发病率最高的恶性肿瘤之一。化学治疗是乳腺癌临床治疗的主要手段之一,然而乳腺癌细胞对化疗药物产生的MDR成为乳腺癌治疗的瓶颈。miRNA是一种存在于真核生物中的内源性非编码短链RNA,广泛参与到增殖、凋亡等多种生理过程。近年来,有关miRNA在乳腺癌MDR中的作用及机制研究取得了诸多进展,因此就miRNA调控乳腺癌MDR分子机制的研究进展做一综述。     

How primary care reforms influenced health indicators in Manisa district in Turkey: Lessons for general practitioners

Background: Turkish health reforms began in 2003 and brought some significant changes in primary care services. Few studies in Turkey compare the shift from health centres (HC) to family physicians (FP) approach, which was initiated by reforms.

Objectives: This study compares health status indicators during the HC period before reforms (2003–2007) and the FP period after reforms (2008–2012) in Turkey.

Methods: This study encompasses time series data consisting of the results of a 10-year assessment (2003–2012) in Manisa district. All the data were obtained electronically and by month. The intersection points of the regression curves of these two periods and the beta coefficients were compared using segmented linear regression analysis.

Results: The mean number of follow-up per person/year during the HC period in infants (10.5), pregnant women (6.6) and women (1.8) was significantly higher than the mean number of follow-up during the FP period in infants (6.7), pregnant women (5.6) and women (0.9). Rates of BCG and measles vaccinations were significantly higher during the FP period; however, rates of HBV and DPT were same. The mean number of outpatient services per person/year during the FP period (3.3) was significantly higher than HC period (2.8). Within non-communicable diseases, no difference was detected for hypertension prevalence. Within communicable diseases, there was no difference for rabies suspected bites but acute haemorrhagic gastroenteritis significantly decreased. The infant mortality rate and under five-year child mortality rate significantly increased during the FP period.

Conclusion: Primary care services should be reorganized and integrated with public health services.     

深圳市罗湖区医改政策分析

区级医改是中国医药卫生体制改革中重要但却经常被忽视的改革环节。2015年以来,深圳市罗湖区依据国家政策导向,结合辖区内的医疗卫生需求与问题,以推进"罗湖医院集团"建设为基本策略,进行了一系列富有成效的改革措施。罗湖区的改革在有利的政策时机和外部条件下,区级政府部门探索创新,走出了一条具有特色的区级医改之路,也体现了区级政府完全可能也应该成为中国地方医改中的一个积极的行动主体。当然,罗湖医改仍在继续,很多改革效果仍待观察,但其改革经验对于其他城市的医改具有重要借鉴意义。     

四川省常用药品使用及储备情况入户调查

目的：从需求侧的角度分析新医改多重政策实施背景下四川省家庭药品可及性改善情况和抗菌药物的使用现状。方法：参考世界卫生组织推出的《药品可及性及药品使用情况入户调查指南》,在四川省抽取成都、绵阳、内江、南充、广安、巴中6个市,在每个市的2个城区、2个县城以及2个乡镇共抽取1 080户家庭为样本进行问卷调查,调查四川省常用药品使用及储备情况,并对收集的数据进行统计分析。结果：总体上,本次研究实际收集到1 103份有效问卷,458户受访家庭最近2周有成员患有急性病,521户受访家庭有成员患有慢性病。90%以上的急慢性病患者获得了药物治疗,受访家庭月均药品费用支出为334.33元,占每月家庭总支出的9.3%,不足20%的急慢性病患者获得了药品医保报销。40.1%的急性病患者使用了抗生素,并且47.5%使用的抗生素来自公立医疗机构。79.7%的受访家庭家里备有药品,且乡镇家庭储备药品的比例低于城区、县城家庭。结论：新医改多重政策实施背景下四川省常用药品可及性较好,急慢性病药品可负担性情况良好,但在医保报销水平和家庭抗生素合理使用方面需要不断完善。