以社区卫生服务为基础的贫困医疗救助制度设计

贫困医疗救助制度的目标一方面是提高贫困人口医疗服务的公平性和可及性，保障贫困人口享受基本医疗服务的权利，改善贫困人群的健康状况；另一方面是建立以社区卫生服务为基础、多部门协调配合、全社会参与、具有可持续发展的贫困医疗救助制度。但是，国内现行的医疗救助模式无论在制度设计还是具体实施中都存在许多缺陷。为此，本研究提出了构建以社区卫生服务为基础的贫困医疗救助制度总体思路。     

福州市区贫困人口医疗救助实施情况调查研究

目的：为了了解福州市区贫困人口医疗救助制度具体实施情况，从中发现问题，为医疗救助政策的进一步完善提供参考。方法：采取问卷与访谈相结合的方法，对医疗救助相关负责人及医疗救助对象进行访谈调查，并对调查结果进行分析。结果：福州市4个区都已建立了贫困人口医疗救助的相关政策，并具备了实施医疗救助的一定资源，在医疗救助对象的确定、医疗救助资金来源、实施医疗救助措旌等方面也有了具体的规定，但医疗救助程度还很有限。结论：福州市区医疗救助政策与具体实施措施还不够完善．如何建立适应福州市区实际情况的医疗救助制度还有待进一步探讨和研究。     

浅谈我国城市贫困人口医疗救助的现状、问题及对策建议

随着中国社会结构的变化，如何解除城市贫困人口的医疗困境便成为救助城市贫困人口的主要内容之一。主要介绍了我国城市医疗救助的发展、实施现状及当前存在的主要问题，并提出进一步完善医疗救助制度的建议。     

新疆农村贫困人口卫生服务利用与医疗救助现状分析

目的:了解新疆农村贫困人口健康状况,分析新疆农村医疗救助制度试点现状,为完善新疆农村贫困医疗救助制度提供客观依据.方法:利用2008年新疆第四次卫生服务调查数据,运用访谈法收集有关农村贫困医疗救助的统计资料.结果:因病致贫是新疆农村贫困的重要原因之一,新疆农村贫困人口以少数民族为主占97.2％.贫困人口卫生服务需求量和利用量低于全国农村居民;农村医疗救助资金持续增长,主要依赖中央政府财政投入;以资助参合为基础,以住院救助为重点;人均救助水平不断提高,筹资水平偏低,资金的供给不能满足实际需求,但同时出现救助资金沉淀现象.结论:新疆农村医疗救助制度在改善贫困人口健康方面发挥着积极的作用,需要继续完善新疆农村医疗救助制度,加强医疗救助制度与新农合的衔接,逐步解决贫困人口的基本医疗问题.     

上海市贫困人口医疗救助政策实践评价

随着中国社会经济的发展，市场经济的不断深入，城市贫困问题也日益凸现。城市贫困人口医疗救助制度是城市反贫困体系重要组成部分，也是避免陷入发展的“贫困”陷阱的有力举措之一。上海是中国最早开始实施贫困医疗救助的城市之一，对于促进上海城市的社会稳定做出了积极的贡献。对贫困人口医疗救助制度进行系统评价，对于进一步完善贫困医疗救助制度，更好地促进上海社会经济发展和率先实现现代化具有重要的现实意义。     

对我国城镇贫困人口医疗救助的思考

20世纪90年代以来，我国经济体制向市场化转轨，城镇地区也出现一定数量的贫困人口，现行的“低保”及职工基本医疗保险制度已不能解决城镇贫困人口的医疗困境。对城镇贫困人口实施医疗救助，一定程度上缓解了贫困人群因病致贫和因病返贫的问题。但是，我国开展医疗救助的时间还不长，仍然有许多工作要开展，包括明确政府职责，加强医疗救助资金的筹集与管理，提供多种形式的医疗救助，以及增加公共卫生投入、开展社区卫生服务等。     

社区实施医疗救助的优势分析与建议

医疗救助制度的目标是提高贫困人口医疗服务的公平性和可及性。以社区为基础，实施医疗救助是达到这一目标的最好途径。通过对我国社区医疗救助的实施现状，社区实施医疗救助的优势进行了分析，并就现状和优势分析提出了可持续发展的建议。     

新疆城市贫困人口卫生服务需求与医疗救助现状分析

目的:了解新疆城市贫困人口健康状况和医疗救助现状,为完善新疆城市贫困医疗救助制度提供客观依据。方法:利用2008年新疆第四次卫生服务调查数据,运用访谈法收集有关城市贫困医疗救助统计资料。结果:新疆城市贫困人口以少数民族为主占78.8%,其文化程度较低,无业或失业占54.3%,相当部分人医疗保险缺失,对卫生服务利用不足。救助资金主要依赖政府财政投入,筹资水平偏低,救助人数逐年增长,救助病种范围小、程序复杂、救助资金沉淀突出。结论:新疆城市贫困医疗救助成效初步凸现,需要进一步关注少数民族贫困人口,继续完善城市医疗救助制度。     

对城市贫困人口医疗救助管理机制的思考

城市贫困问题在我国日益突出.对贫困人口实施医疗救助,已引起社会各界的关注.而科学的管理机制是医疗救助制度能够顺利实施的重要因素,也是医疗救助效果得到巩固的前提条件.文章就我国城市贫困人口医疗救助管理机制的现况、存在的问题进行分析和思考,并提出建议.     

湖北省新健康扶贫政策实施效果分析——以咸宁市4县为例

目的：探究湖北省新健康扶贫政策的实施影响,为“十四五”时期调整医疗救助制度提供科学依据和政策建议。方法：使用咸宁市所有4个县2018年7月—2020年9月月度建档立卡农村贫困人口（简称“农村贫困人口”）住院报销数据,应用间断时间序列分析方法,从救助支出、就医行为和救助效果三个维度分析医疗救助制度运行情况的变化。结果：政策实施后,医疗救助总支出显著减少;农村贫困人口在三级、二级医疗机构就诊人次占比显著减小,在一级及以下医疗机构、县域内医疗机构、县域内医疗机构或指定转诊医疗机构就诊人次占比显著增加;农村贫困人口人均实际负担费用显著减少,灾难性医疗卫生支出发生人数占比显著下降。结论：新健康扶贫“985”政策节省了救助支出,规范了农村贫困人口就医行为,改善了救助效果。下一步应科学设定医疗救助标准、适度拓展救助对象,同时规范救助管理体制,提高县域内基层医疗卫生服务水平,进一步优化医疗救助制度。     

There's something about Medicaid

In the thirty-seven years since its creation, Medicaid has grown in terms of whom it covers and what it costs. Current rates of Medicaid enrollment and cost growth are high relative to state budget capacity, but not by historical standards. The current Medicaid fiscal crisis is a result of weak state fiscal conditions and the gradual accretion of populations and services covered by Medicaid. States view Medicaid as an essential part of their current strategies to provide insurance to their low-income populations, cover the chronic care needs of people with disabilities and the elderly, and finance the health care safety net. Medicaid has accomplished much, and it can continue to do so if the underlying fiscal pressures and tensions built into it are addressed.     

Implications of the Medicaid Undercount in a High-Penetration Medicaid State

Research Objective. This study investigates the impact of misreporting by Medicaid recipients on estimates of the uninsured in Louisiana, and is based on similar work by Call et al. in Minnesota and Klerman, Ringel, and Roth in California. With its unique charity hospital system, culture, and high poverty, Louisiana provides an interesting and unique context for examining Medicaid underreporting.
Study Design. Results are based on a random sample of 2,985 Medicaid households. Respondents received a standard questionnaire to identify health insurance status, and individual records were matched to Medicaid enrollment data to identify misreporting.
Data Sources. Data were collected by the Public Policy Research Lab at Louisiana State University using computer-assisted telephone interviewing. Using Medicaid enrollment data to obtain contact information, the Louisiana Health Insurance Survey was administered to 2,985 households containing Medicaid recipients. Matching responses on individuals from these households to Medicaid enrollment data yielded responses for 3,199 individuals.
Conclusions. Results suggest relatively high rates of underreporting among Medicaid recipients in Louisiana for both children and adults. Given the very high proportion of Medicaid recipients in the population, this may translate up to a 3 percent bias in estimates of uninsured populations.
Implications. Medicaid bias may be particularly pronounced in areas with high Medicaid enrollments. Misreporting rates and thus the bias in estimates of the uninsured may differ across areas of the United States with important consequences for Medicaid funding.
Funding Source. Louisiana Department of Health and Hospitals.     

Vaccination benefits and cost-sharing policy for non-institutionalized adult Medicaid enrollees in the United States

Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs’ policies related to benefit coverage and, copayments for adult enrollees. Our study was completed between October 2011 and September 2012 using a document review and a survey of Medicaid administrators that assessed coverage and cost-sharing policy for fee-for-service programs. Results were compared to a similar review, conducted in 2003. Over the past 10 years, Medicaid programs have typically maintained or expanded vaccination coverage benefits for adults and nearly half have explicitly prohibited copayments. The 17 programs that cover all recommended vaccines while prohibiting, copayments demonstrate a commitment to providing increased access to vaccinations for adult enrollees. When developing responses to fiscal and political challenges, the programs that do not cover all ACIP recommended adult vaccines or those that permit copayments for vaccinations, should consider all strategies to increase vaccinations and reduce costs to enrollees.     

Medicaid expansion

AIDS Action has requested that Medicaid be expanded to cover HIV-related medical care for low-income people. They are asking that Medicaid conform to current standards for treating HIV infections, which recommend treating HIV before it progresses to AIDS. This request is in response to the recent Supreme Court ruling in Bragdon v. Abbott. The ruling does not have any legal effect on the Medicaid program, but it has altered the way government should view HIV disease.     

The poverty-reducing effect of Medicaid

Medicaid provides health insurance for 54 million Americans. Using the Census Bureau's Supplemental Poverty Measure (which subtracts out-of-pocket medical expenses from family resources), we estimated the impact of eliminating Medicaid. In our counterfactual, Medicaid beneficiaries would become uninsured or gain other insurance. Counterfactual medical expenditures were drawn stochastically from propensity-score-matched individuals without Medicaid. While this method captures the importance of risk protection, it likely underestimates Medicaid's impact due to unobserved differences between Medicaid and non-Medicaid individuals. Nonetheless, we find that Medicaid reduces out-of-pocket medical spending from $871 to $376 per beneficiary, and decreases poverty rates by 1.0% among children, 2.2% among disabled adults, and 0.7% among elderly individuals. When factoring in institutionalized populations, an additional 500,000 people were kept out of poverty. Overall, Medicaid kept at least 2.6 million—and as many as 3.4 million—out of poverty in 2010, making it the U.S.’s third largest anti-poverty program.     

Keeping Medicaid viable. Interview by Terese Hudson Thrall

As the Medicaid program enters its fourth decade, it remains a safety net for Americans in need and for the nation itself, says Barbara Lyons, deputy director of the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. In a question-and-answer interview, Lyons discusses whether it can stay that way--and why it must.     

Hospital service areas and Medicaid access in Maryland

The study defines a service area (rather than a market area) of an individual hospital. Based on patient origin data, algorithms have been developed to select zip codes on the basis of their contributions to a hospital's discharges, and their ability to fulfill a contiguity principle along with a dependence criterion. The service area concept is also used to evaluate the performances of hospitals in terms of the access to care for Medicaid patients. The analysis shows that the hospital's performance in serving Medicaid patients does not significantly depend on its location, nor does it matter whether it is the only hospital in its jurisdiction.     

Adjusted clinical groups: predictive accuracy for Medicaid enrollees in three states

Actuarial split-sample method were used to assess predictive accuracy of adjusted clinical groups (ACGs) for Medicaid enrollees in Georgia, Mississippi (lagging in managed care penetration), and California. Accuracy for two non-random groups--high-cost and located in urban poor areas--was assessed. Measures for random groups were derived with and without short-term enrollees to assess the effect of turnover on predictive accuracy. ACGs improved predictive accuracy for high-cost conditions in all States, but did so only for those in Georgia's poorest urban areas. Higher and more unpredictable expenses of short-term enrollees moderated the predictive power of ACGs. This limitation was significant in Mississippi due in part, to that State's very high proportion of short-term enrollees.     

Accomplishments and challenges in Medicaid mental health

Although Medicaid was not designed as a mental health program, it is now a major source of financing for mental health services and care, especially for the chronically mentally ill. This paper examines the role Medicaid plays today for the low-income population with mental health needs and then reviews some of the current pressures and challenges in the program that could reshape this role.     

An Examination of the Medicaid Undercount in the Current Population Survey: Preliminary Results from Record Linking

Objective. To assess reasons why survey estimates of Medicaid enrollment are 43 percent lower than raw Medicaid program enrollment counts (i.e., "Medicaid undercount").
Data Sources. Linked 2000–2002 Medicaid Statistical Information System (MSIS) and the 2001–2002 Current Population Survey (CPS).
Data Collection Methods. Centers for Medicare and Medicaid Services provided the Census Bureau with its MSIS file. The Census Bureau linked the MSIS to the CPS data within its secure data analysis facilities.
Study Design. We analyzed how often Medicaid enrollees incorrectly answer the CPS health insurance item and imperfect concept alignment (e.g., inclusion in the MSIS of people who are not included in the CPS sample frame and people who were enrolled in Medicaid in more than one state during the year).
Principal Findings. The extent to which the Medicaid enrollee data were adjusted for imperfect concept alignment reduces the raw Medicaid undercount considerably (by 12 percentage points). However, survey response errors play an even larger role with 43 percent of Medicaid enrollees answering the CPS as though they were not enrolled and 17 percent reported being uninsured.
Conclusions. The CPS is widely used for health policy analysis but is a poor measure of Medicaid enrollment at any time during the year because many people who are enrolled in Medicaid fail to report it and may be incorrectly coded as being uninsured. This discrepancy should be considered when using the CPS for policy research.