Reliability of a Store Observation Tool in Measuring Availability of Alcohol and Selected Foods

Alcohol and food items can compromise or contribute to health, depending on the quantity and frequency with which they are consumed. How much people consume may be influenced by product availability and promotion in local retail stores. We developed and tested an observational tool to objectively measure in-store availability and promotion of alcoholic beverages and selected food items that have an impact on health. Trained observers visited 51 alcohol outlets in Los Angeles and southeastern Louisiana. Using a standardized instrument, two independent observations were conducted documenting the type of outlet, the availability and shelf space for alcoholic beverages and selected food items, the purchase price of standard brands, the placement of beer and malt liquor, and the amount of in-store alcohol advertising. Reliability of the instrument was excellent for measures of item availability, shelf space, and placement of malt liquor. Reliability was lower for alcohol advertising, beer placement, and items that measured the “least price” of apples and oranges. The average kappa was 0.87 for categorical items and the average intraclass correlation coefficient was 0.83 for continuous items. Overall, systematic observation of the availability and promotion of alcoholic beverages and food items was feasible, acceptable, and reliable. Measurement tools such as the one we evaluated should be useful in studies of the impact of availability of food and beverages on consumption and on health outcomes.     

建立手术项目医疗风险和医疗技术系数完善医院补偿机制

医疗服务是高风险、高技术服务,为健全医院补偿机制,采用专家咨询方法对１２１９种手术项目闻医疗风险、医疗技术系数表,并计算求出含医疗风险、医疗技术的手术项目收费价格。     

医疗服务项目实际成本与收费标准比较研究

通过对北京市4所三级甲等综合医院20个医疗服务项目的实际成本进行调查分析，主要包括平均实际成本分析、收费标准与成本的差量分析和收费标准与成本差量的极值分析、收费覆盖率分析、收费覆盖率极值分析。调查分析发现大部分项目的实际成本高于现行收费标准。为此，应完善医疗服务项目价格形成机制和健全医疗服务项目价格调整机制，建立科学有效的医疗服务项目价格评价指标体系，以确保其价格的调整效果。     

Multi stakeholders of health and industries perspectives on medicine price transparency initiative in private health care settings in Malaysia

IntroductionMedicine price transparency initiatives provide public or government on information about the product's prices and the components that may influence the prices, such as volume and product quality. In Malaysia, medicine price transparency has become part of the government's strategies in ensuring adequate, continuous and equitable access to quality, safe, effective and affordable medicines. Since the effect of medicine price transparency depend critically on how prices are presented, this study aims to evaluate the stakeholders' perspective of medicine price transparency practice in the private healthcare system in Malaysia.MethodsThis study was conducted as face-to-face, semi-structured interview. Respondents from private pharmaceutical industries, community pharmacists, general practitioners, private hospital pharmacists, governments, academicians and senior pharmacist were recruited using purposive sampling. Using phenomenological study approach, interviews were conducted, and audio recorded with their consent. Data were transcribed verbatim and analysed using thematic analysis with Atlas.ti 8 software and categorised as strengths, weaknesses, opportunities and threats (SWOT).ResultsA total of 28 respondents were interviewed. There was a mixed perception regarding the price transparency implementation in Malaysia's private healthcare settings. The potential strengths include it will provide price standardization, reduce price manipulation and competition, hence allowing the industry players to focus more on patient-care services. Moreover, the private stakeholders were concerned that the practice may affect stakeholders' business and marketing strategy, reduce profit margin, increase general practitioner's consultation fees and causing impact on geographical discrepancies. The practice was viewed as an opportunity to disseminate the truth price information to consumer and strengthen collaboration between healthcare industries and Ministry of Health although this may become a threat that affect the business survival.ConclusionPrice transparency initiatives would benefit the pharmaceutical industries, consumer and countries, but it needs to be implemented appropriately to prevent price manipulation, market monopoly, and business closure. Future study may want to evaluate the impact of the initiatives on the business in the industry.     

药品价格指数的方法学综述

目的:综述药品价格指数的研究方法,为药品价格指数实证研究提供方法学借鉴。方法:以近年来的国内外研究文献为基础,从指数方法(公式)、药品产品的定义、价格和数量计量单位三个方面进行综述,并对选择不同方法的优缺点以及测量偏倚进行评析。结果:价格指数的结果会随着指数公式所选择的权重、产品的定义以及价格和数量计量单位的不同而不同。在指数公式的选择中是否考虑了新产品上市和老产品退市的产品更新换代问题以及产品的质量变化问题等同样会使得指数结果具有较大差异。结论:药品价格指数的研究方法还有待进一步研究完善,学术界应致力于对价格指数进行更深入的研究,以达到更精确的测量。在实证分析中尽可能采用多种方法进行计算,以更加准确地反映药品价格水平的变化。     

医疗服务价格水平差异评价及政策启示——以四川省为例

本文构建了医院医疗服务价格水平差异指数HPDI作为量化评价工具,对四川省18家公立医院价格水平及影响因素进行评价分析。结果表明,区域内公立医院价格水平管制合理、有效,内部因素中医技和临床类项目影响显著,外部因素中等级与规模因素影响显著。建议价格主管部门更加科学化、精细化研究价格水平问题,合理把握价格调整尺度、做好价格改革方案。     

Usability of Hospital Price Estimators for Lumbar Spine MRI

PurposeThe aim of this study was to evaluate the usability of online hospital price estimators for a common imaging examination using surrogate patients.MethodsUsing the Amazon Mechanical Turk platform, the authors recruited adult English-speaking US residents as surrogate patients to find the cash price for a noncontrast lumbar spine MRI examination for a self-pay patient using price estimator tools at four hospitals. All were asked to view a 3-min tutorial video and report their experiences with the task, including the System Usability Scale (SUS) for the estimator, through a paid survey. Participants were queried about demographics, insurance, prior imaging exposure, and assessed health literacy and health insurance literacy using validated measures. Multivariable analysis for correct price identification and price estimator SUS were performed.ResultsOf 660 respondents, 476 met eligibility criteria (72.7% <45 years of age, 41.7% female, 86.1% white); 76.9% found all four estimators, and 9.2% were unable to locate any. Only 27.7% found the correct price at all four hospitals, with 67.4% being able to find at least one correct cash price. Average SUS score for the hospitals’ estimators ranged between 62.4 and 77.5. The hospital with a similar estimator to that used in the tutorial video had the highest SUS score. Accuracy of price identification improved with later tasks. Higher health insurance literacy was associated with higher identification of at least one correct price (odds ratio, 1.21; 95% confidence interval, 1.02-1.44) and higher SUS score (B = 1.68; 95% confidence interval, 1.07-2.29).ConclusionsSurrogate patients were able to locate hospital price estimators but unable to effectively use them to obtain correct prices. Tutorial videos improved SUS score, but correct price identification improved with practice.     

我国实现分级有序医疗的障碍及对策

本文简要概述了当前就医行为错位、混乱和无序的现象,说明存在卫生资源匮乏与相对富余的结构性矛盾,从政策制定与实施过程中的问题以及制度本身所固有的缺陷、市场发育和健康社会文化等方面初步分析了上述现象产生的原因,提出了理顺医疗服务价格机制、建立与恢复转诊制度、增强公众对基层医疗卫生服务的信心以及通过健康教育推动健康社会文化建设等方面的政策建议,以实现分级有序医疗,改善资源利用效率,确保我国医改预期目标的实现。