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《L'Encéphale》2016,42(4):379-381
For 25 years work has been underway in France for the implementation of an alternative to public financing of health care. In the absence of progress, some regional health agencies are engaged in work related to the reallocation of public finances between psychiatric institutions. We propose a reflection with suggestion on the method proposed by the Provence Alpes Côte d’Azur Regional Health Agency. Without questioning the need for a reallocation of resources between psychiatric institutions, the method proposed here needs to evolve further to be applied in a legitimate and appropriate manner. There is a kind of urgency for a reallocation of resources between psychiatric institutions in France, but it implies a collective thinking and especially the definition of evaluation procedures for the selected models. These conditions are necessary to guarantee the quality of French psychiatry and equity in access to psychiatric care. 相似文献
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《Vaccine》2016,34(35):4213-4220
BackgroundIntroduction of new vaccines in low- and lower middle-income countries has accelerated since Gavi, the Vaccine Alliance was established in 2000. This study sought to (i) estimate the costs of introducing pneumococcal conjugate vaccine, rotavirus vaccine and a second dose of measles vaccine in Zambia; and (ii) assess affordability of the new vaccines in relation to Gavi’s co-financing and eligibility policies.MethodsData on ‘one-time’ costs of cold storage expansions, training and social mobilisation were collected from the government and development partners. A detailed economic cost study of routine immunisation based on a representative sample of 51 health facilities provided information on labour and vaccine transport costs. Gavi co-financing payments and immunisation programme costs were projected until 2022 when Zambia is expected to transition from Gavi support. The ability of Zambia to self-finance both new and traditional vaccines was assessed by comparing these with projected government health expenditures.Results‘One-time’ costs of introducing the three vaccines amounted to US$ 0.28 per capita. The new vaccines increased annual immunisation programme costs by 38%, resulting in economic cost per fully immunised child of US$ 102. Co-financing payments on average increased by 10% during 2008–2017, but must increase 49% annually between 2017 and 2022. In 2014, the government spent approximately 6% of its health expenditures on immunisation. Assuming no real budget increases, immunisation would account for around 10% in 2022. Vaccines represented 1% of government, non-personnel expenditures for health in 2014, and would be 6% in 2022, assuming no real budget increases.ConclusionWhile the introduction of new vaccines is justified by expected positive health impacts, long-term affordability will be challenging in light of the current economic climate in Zambia. The government needs to both allocate more resources to the health sector and seek efficiency gains within service provision. 相似文献
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Nguyen HT Hatt L Islam M Sloan NL Chowdhury J Schmidt JO Hossain A Wang H 《Social science & medicine (1982)》2012,74(7):989-996
With the ultimate goal of reducing maternal and neonatal mortality, many countries have recently adopted innovative financing mechanisms to encourage the use of professional maternal health services. The current study evaluates one such initiative - a pilot voucher program in Bangladesh. The program provides poor women with cash incentives and free access to antenatal, delivery, and postnatal care, as well as cash incentives for providers to offer these services. We conducted a household survey of 2208 women who delivered in the 6 months before the survey (conducted in 2009) in 16 intervention and 16 matched comparison sub-districts. Probit and linear regressions are used to analyze the effects of residing in voucher sub-districts on the use of professional maternal health services and associated out-of-pocket expenditures. Using information on birth history, we conducted sensitivity analyses employing difference-in-differences methods, comparing women's reported births before and after the program's initiation in the intervention and comparison sub-districts. We found that the program significantly increased the use of antenatal, delivery, and postnatal care with qualified providers. Compared to women in matched comparison sub-districts, women in intervention areas had a 46.4 percentage point higher probability of using a qualified provider and 13.6 percentage point higher probability of institutional delivery. They also paid approximately Taka 640 (US$ 9.43) less for maternal health services, equivalent to 64% of the sample's average monthly household expenditure per capita. No significant effect of vouchers was found on the rate of Cesarean section. Our findings therefore support voucher program expansion targeting the economically disadvantaged to improve the use of priority health services. The Bangladesh voucher program is a useful example for other developing countries interested in improving maternal health service utilization. 相似文献
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"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital''s facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.
Graphical Abstract
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浅析乡镇卫生院融资租赁适宜医疗设备的问题与对策 总被引:4,自引:0,他引:4
文章阐述了乡镇卫生院融资租赁适宜医疗设备的可及性和模式,根据模式参与方的现状和特点,指出乡镇卫生院融资租赁医疗设备所面临的问题.对策:政府在加大财政投入的同时,应加快乡镇卫生院的改革步伐,通过构建多元化的投入机制来改善乡镇卫生院的医疗设备落后的面貌. 相似文献
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目的为了反映黑龙江省卫生总费用的筹资水平、构成,对黑龙江省2006年卫生总费用进行测算,并对测算结果进行分析,进而提出相应的政策建议。方法本研究运用卫生总费用核算方法中的筹资来源法核算黑龙江省卫生总费用。结果黑龙江省的卫生总费用筹资总额2006年达到了264.98亿元,人均卫生总费用达到了693.12元;卫生总费用占GDP比重为4.28%;政府预算卫生支出占卫生总费用比重为16.11%;社会卫生支出占24.71%;居民个人现金卫生支出占59.18%。就卫生总费用占GDP比重和人均卫生总费用这两项指标来看,与全国相比,黑龙江省表现为双低现象。结论黑龙江省在发展经济的同时,应进一步增加政府对卫生事业的投入;调整黑龙江省卫生总费用筹资结构,平衡政府、社会以及个人在卫生筹资中的责任;进一步完善医疗保障制度,通过各种途径减轻城乡居民的疾病经济负担。 相似文献
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目的为了提高天津市妇幼卫生人群服务利用的可及性和健康公平,为政府决策部门提供妇幼卫生经费投入的科学数据。方法以功能法为核心,结合筹资法和机构法测算结果进行妇幼卫生费用的矩阵平衡分析。结果 2005年天津市妇幼卫生服务筹资以社会及个人筹资为主,占80.81%;妇幼保健机构的妇幼卫生服务总收入小于总支出,为收不抵支状况;收大于支服务项目以含有临床技术项目为主。结论应积极探索政府卫生经费投入方式,逐步量化公共卫生服务项目费用和投入,提高政府卫生资金的使用效率。 相似文献