两种医疗支付方式博弈理论分析

我国医疗保险支付方式改革的重点之一是将过去的按服务项目付费转变为按病种付费。通过建立两种医疗支付方式下医患、医院与医保局双方的博弈模型,分析了2种支付方式下博弈各方的行为特点。分析表明,按病种付费在控制不合理医疗费用上相较于按服务项目付费更优。不论在哪种支付方式下,优化医保监督管理方式使得监管难度降低的同时,增大处罚力度也是遏制医院不合理医疗的有效途径。     

深圳市不同医保类型人群就医经济风险研究

目的：分析深圳市不同医保类型人群就医经济风险,为实现医疗保障公平性,并科学合理配置卫生资源提供科学依据。方法从深圳市2003-2010年基金运行数据库中提取队列人群数据,采用队列寿命表法计算不同医保类型人群的就医经济风险变化情况,分析造成其差异的原因。结果综合医保人群就医经济风险持续增长,至64岁达到峰值;住院医保人群自61岁起风险出现大幅波动;农民工医保人群风险无明显变化。结论深圳市特殊医保政策以及户籍制度是导致其不同医保类型人群就医经济风险差异的最主要原因,因此需要破除户籍制度的束缚,提高医疗保障扶持力度,满足农民工、非户籍人群的医疗需求,实现医疗保障的公平性。     

Association between EGF +61 A>G Polymorphism and Gastric Cancer Risk: A Meta-analysis

Previous studies suggested an association between the EGF +61 A>G polymorphism and susceptibility to gastric cancer, but the results have been inconsistent. To draw a more precise risk estimation of the association, we performed a meta-analysis of published studies. Pub Med, EMBASE, Google Scholar and the Chinese Wanfang databases were systematically searched to identify relevant studies. There were 7 studies involving 1992 cases of gastric cancer and 3202 controls in this meta-analysis. Our study showed that, overall, the EGF +61 A>G polymorphism was significantly associated with the increased risk of gastric cancer in allele model(G vs. A: OR=1.18, 95% CI=1.00–1.39), dominant model(GG + GA vs. AA: OR=1.28, 95% CI=1.05–1.55), homozygous model(GG vs. AA: OR=1.31, 95% CI=1.06–1.63) and heterozygous model(GA vs. AA: OR=1.25, 95% CI=1.01–1.53). The stratified analysis by ethnicity revealed a significant association between EGF +61 A>G polymorphism and gastric cancer risks in Asians. This meta-analysis indicates that EGF +61 A>G polymorphism may increase the risk of gastric cancer, especially in Asians. Large-sized, well-designed studies involving different ethnic groups should be conducted to confirm this association.