麻风防治服务成本测算与筹资

本文依据医院医疗服务项目成本计算办法，结合麻风防治工作的实际情况，首先提出了麻风防治服务成本的计算方法，对山东省三地区的麻风防治服务成本进行了计算和分析，定量分析了随着麻风病人数的减少与防治经费减少的比例关系，对成本与筹资作了比较，并对未来几年的麻防服务成本进行了预测，结果显示：1995年三地区麻防服务成本与筹资分别为2162380．89元和1232976．40元．筹资水平明显低于成本，筹资占成本的57．02％。三地区每减少一个病人，机构麻防服务成本会比1995年降低0．05％，平均每病人的机构服务成本是10401．35元，预测2000年三地区麻防服务成本将减至2006689．46元。作者认为，当前山东省三地区麻防服务的经费投入远不能覆盖成本，麻防经费不宜盲目减少；麻防经费的减少应该考虑成本下降的比例，而不仅按患病人数。     

医院如何降低筹资成本

在市场经济条件下,筹集和使用资金必须支付筹资成本,因此如何选择最佳的筹资渠道和筹资方式、统筹安排资金、降低资金成本成了医院融资管理的重点。以下从目前非营利性医疗机构使用的几种筹资方式入手,对如何降低资金成本提出几点粗浅的看法。     

新型农村合作医疗筹资成本影响因素分析

目的:掌握新农合筹资成本的影响因素,为采取措施降低筹资成本和完善筹资机制提供依据。方法:以武陟县为研究对象,通过调查获取新农合筹资情况,并结合政策研究和报表分析,进行筹资成本的影响因素研究。结果:随着参合率的升高和筹资总额的降低,筹资成本逐渐降低;经济水平差地区的筹资成本较高;人员经费是新农合筹资成本的重要构成部分。结论:参合率、筹资总额和经济水平是筹资成本的重要影响因素,要根据具体情况选择合适的筹资方式,并减少不必要的人员经费来降低新农合筹资成本。     

不同经济水平地区计划免服务成本的筹资现状分析

目的了解我国计划免疫筹资现况,为补偿政策的制定提供参考依据。方法运用卫生经济学成本核算的基本原理,采用现况调查的方法,选择东、中、西部3个省,对省、地区、县、乡、村五级计划免疫服务成本与筹资进行测算。结果省、地区、县、乡、村五级政府投入比例为6%~89%,呈逐级降低的趋势;与人均成本相比,人均财政缺口比例为12%~91%,县、乡、村三级普遍存在缺口,并且缺口比例较高。结论计划免疫的政府筹资主渠道作用弱化,政府对计划免疫的筹资责任未得到充分体现;政府在计划免疫筹资上的缺位,导致社会筹资成为计划免疫的主要筹资渠道。建议加强政府对计划免疫服务筹资责任,丰富筹资渠道,建立计划免疫的成本核算制度,并深入研究成本效率。     

论公立医院筹资模式的构建

在当前医疗环境下,公立医院资金短缺,严重制约医院的发展。如何分散资金压力,筹集充足资金,降低资金成本已成为医院财务管理的重点。本文分析公立医院筹资管理中存在的问题,介绍并探讨公立医院可行的筹资模式。医院应立足于单位实际情况,进行科学的筹资决策,选择最优的筹资方案。     

谈医院扩张经营的筹资策略

医院的经营活动离不开资金。面对逐渐开放的医疗市场，医院在符合区域卫生规划前提下的扩张经营将是大势所趋，这就要求医院想方设法进行筹资。而在多种筹资渠道和筹资方式下，选择何种筹资渠道，利用何种筹资方式去获取资金，才能达到降低筹资成本、提高筹资效益，保证医院经营顺利进行，这就是筹资的策略。     

我国医学高校筹资、成本和效率评价--基本框架和概述

“中国高等医学院校筹资、成本分析和经济效益评价研究”是国家教育部高教司和卫生部科教司立项课题，共产出5篇论文。主要分析研究课题的基本框架，重点介绍研究背景、研究思路、研究目的、资料来源与调查方法，以及产生出的几篇论文的安排。     

农村公共卫生服务项目效果、成本和筹资政策研究之三：公共卫生服务项目筹资政策分析

为了解决卫生筹资和服务系统存在的问题,在筹资政策方面,已有很多改革措施和政策建议。世界银行曾于1996年对我国提出了“一揽子”筹资改革建议,并预测了这些改革将对卫生服务系统产生的潜在影响。在建议中,全额资助主要公共卫生服务项目和为低收入人群提供基本卫生服务补助被认为是最重要的两条,它们将在提高居民的健康水平、促进公平性、提高效率和控制成本等方面发     

农村公共卫生服务项目效果、成本和筹资政策研究之二：公共卫生服务项目成本和累积成本

在《农村公共卫生服务项目效果、成本和筹资政策研究之一》文中,明确了农村主要公共卫生服务项目。有效地实施和开展这些项目,将在很大程度上保证农村居民的身心健康。因此,这些项目应当是政府公共支出优先支持的重点。由于政府对卫生公共支出的能力受到经济发展水平的影响,在多数农村地区不可能全额资助所有已经开展和将来可能开展的公共卫生服务项目,只能资助那些更为重要的服务项     

成本计量在计划免疫中的应用

成本计量在卫生政策、策略制定中发挥着重要作用.由于不同时期需要不同,我国计划免疫成本计量研究经历了不同的研究角度,早期研究主要是回答计划免疫是否值得投入、何种服务方式最佳等问题,后来出现评价资源利用效率、实施成本控制的研究.随着卫生体制及系统内部变革,为筹资政策服务的成本研究成为当前的热点.一些筹资政策研究已在成本项目分类和测算方法上做了有益的尝试,但针对计划免疫筹资的专门研究亟需进行.建议计划免疫的成本研究采用统一的成本测算方法和成本项目,以便于比较;要充分考虑计划免疫的特性,合理定义项目成本,以获得可靠的成本数据为政策服务.     

Global budgeting of hospitals in Hong Kong.

Policy-makers in industrialized countries face the dilemma of having to contain soaring hospital costs while resisting any reduction in the quality and quantity of hospital services. Among the many hospital financing systems, centralized control via global budgeting is advocated by some to be the most effective in containing hospital costs. Containing hospital costs, however, is but one aspect of the trade-off between cost containment and quality of care. The hospital financing system of Hong Kong provides some insights into the extent to which cost control can be achieved through global budgeting; and its impact on the accessibility of hospital care. The case of Hong Kong highlights three necessary conditions for effective cost control: (1) the payer must have a clear policy stance on overall public spending; (2) the payer must have a clear policy stance on the importance of hospital care relative to other goods and services; and (3) the payer must also have the will and ability to limit hospital spending within finalized global budgets. However, successful cost containment in Hong Kong affects the accessibility of hospital care. In a time of population growth and economic prosperity, new community needs seem to have preceded government plans and actions to build hospital facilities.     

Financing of recurrent health costs in Mali

After giving a broad picture of the main characteristics ofthe Malian health system, and of this particular study, theauthors present the essential results obtained: trends in thehealth system financing, composition of the recurrent expendituresat the public health sector facilities, distribution of expendituresbetween districts, hospitals and national administrative boards,and distribution of recurrent and investment expenditures betweennational and foreign funding. They then examine more closelythe most important household expenditures on health services(traditional healing and medicines, drugs, private fees andhealth-related transport). A summary table of the main sourcesof funds for recurrent costs financing in the health sectoris presented for 1986. The paper concludes with a brief discussionof some proposals to solve the recurrent cost financing problemthat have recently been considered by the Ministry of Health.     

Medicaid coverage of abortions in New York City: costs and benefits

New York was among the first states to provide Medicaid financing of abortions for needy women. This was begun in July 1970 when the liberalized state abortion law took effect. Each year since, nearly 40% of the New York City abortion patients have been funded by Medicaid. There is evidence that Medicaid funding of abortions for indigent women has had a favorable impact on improving the health and welfare of these women. There are attempts nationwide to cut off or restrict Medicaid financing for abortions. Results of a cutback on funding will be 1) many septic and incomplete illegal abortions, 2) an increase of 10,000-15,000 births in New York City, and 3) added costs to federal, state, and local relief funds for delivery services, foster care, welfare payments, and day care facilities for these added births. Additional costs to government health and welfare organizations in the first year would be from 7-10 times what Medicaid coverage of abortions would cost.     

Analysis of hospital costs as a basis for pricing services in Mali

In a move to achieve a better equity in the funding of access to health care, particularly for the poor, a better efficiency of hospital functioning and a better financial balance, the analysis of hospital costs in Mali brings several key elements to improve the pricing of medical services. The method utilized is the classical step-down process which takes into consideration the entire set of direct and indirect costs borne by the hospital. Although this approach does not allow to estimate the economic cost of consultations, it is a useful contribution to assess the financial activity of the hospital and improve its performance, financially speaking, through a more relevant user fees policy. The study shows that there are possibilities of cross-subsidies within the hospital or within services which improve the recovery of some of the current costs. It also leads to several proposals of pricing care while taking into account the constraints, the level of the hospital its specific conditions and equity.     

Intramural health care budgeting.

In the last years endeavours have been made in several health systems to get a firm grip on the explosive cost development in hospitals which amounts to nearly half of all health care expenditures. The fee-for-service system for doctors coupled with the professional autonomy leads to expansion of quality and quantity of services provided. In many systems hospitals are financed on basis of output items as patient days, examinations and therapies. As hospital costs are in the short run preponderantly constant prices fixed at average costs are higher than marginal costs. This situation favours expansion of services as in that case marginal revenue exceeds marginal cost. Inversely the decrease of services provided generates losses for the hospital. In systems, where financing takes place in the way of budgets like the U.K., Denmark and Italy, the authorities have more influence on the cost development in the system. In systems where the hospitals are financed by social security on basis of output, arrangements are now made to bring budgetary elements in the financing of these institutions. In France the "Budget Global" will be applied to services financed by the Sécurité sociale. In Belgium arrangements have been made to contain the amount of patient days allowed for reimbursement and in the Netherlands in 1983 budget-financing has been introduced for all general and teaching hospitals. In 1984 this system also applies to all other intramural institutions. If a way has been found to focus the financing mechanism of these institutions on budgeted costs, the way is open for budgeting these institutions. A very important problem in this context is the budget formula, which will be used to determine the budgets. In this respect a distinction can be made between internal and external budgeting. Internal budgeting is understood here as a process whereby the hospital itself puts a limit to the use of resources or adapts its resources to budget constraints coming from the outside. External budgeting can be defined as the budgetary constraint given from the outside by third parties to the hospitals. Of course, both internal and external budgeting are narrowly interrelated. The distinction between these two ways of budgeting should be sought in the character of the budget formula. External budgeting should be based on global indications whilst internal budgeting should be more differentiated than the external budget formula.(ABSTRACT TRUNCATED AT 400 WORDS)     

Funding gap for immunization across 94 low- and middle-income countries

Novel vaccine development and production has given rise to a growing number of vaccines that can prevent disease and save lives. In order to realize these health benefits, it is essential to ensure adequate immunization financing to enable equitable access to vaccines for people in all communities. This analysis estimates the full immunization program costs, projected available financing, and resulting funding gap for 94 low- and middle-income countries over five years (2016–2020). Vaccine program financing by country governments, Gavi, and other development partners was forecasted for vaccine, supply chain, and service delivery, based on an analysis of comprehensive multi-year plans together with a series of scenario and sensitivity analyses.Findings indicate that delivery of full vaccination programs across 94 countries would result in a total funding gap of $7.6 billion (95% uncertainty range: $4.6–$11.8 billion) over 2016–2020, with the bulk (98%) of the resources required for routine immunization programs. More than half (65%) of the resources to meet this funding gap are required for service delivery at $5.0 billion ($2.7–$8.4 billion) with an additional $1.1 billion ($0.9–$2.7 billion) needed for vaccines and $1.5 billion ($1.1–$2.0 billion) for supply chain. When viewed as a percentage of total projected costs, the funding gap represents 66% of projected supply chain costs, 30% of service delivery costs, and 9% of vaccine costs. On average, this funding gap corresponds to 0.2% of general government expenditures and 2.3% of government health expenditures.These results suggest greater need for country and donor resource mobilization and funding allocation for immunizations. Both service delivery and supply chain are important areas for further resource mobilization. Further research on the impact of advances in service delivery technology and reductions in vaccine prices beyond this decade would be important for efficient investment decisions for immunization.     

DRG-related prices applied in a public health care system--can Finland learn from Norway and Sweden?

In the early 1990s, DRG based hospital financing was introduced into some hospital districts in Finland. The 1993 state subsidy reform decentralising all hospital financing to municipalities, and the aim of improving productivity, were the driving forces for introducing DRG. This study addresses the pros and cons of DRG in hospital financing in the Finnish health care system and puts forward several solutions to avoid potential problems. We consider the objectives and optimal features of hospital financing systems in the context of the public health care system, where the public sector owns and finances hospitals. We analyse impacts of introducing different types of DRG based hospital financing systems, taking into account earlier experiences in countries such as Sweden and Norway, as well as Finnish system specific features. DRG could assist the Finnish municipalities to compare quality, costs and prices of services between hospitals, and related cost information might help them budget expenditure more accurately. System specific features mean that traditional uses of DRG in hospital pricing are not feasible in Finland. But some benefits of DRG could be exploited, for instance in the controlled contracts between municipalities and hospitals.     

Quality and Cost in Healthcare

Debate over healthcare often focuses on two key issues: quality and cost. However, because of the unique characteristics of healthcare, this relationship is not as simple as it might seem. A recent Supreme Court of Canada judgement directly addressing aspects of quality of care, combined with related government policy, provides an impetus for a review of research on quality as it affects costs of care. Our premise is that quality problems may not be the result of financing constraints but rather quality issues are a significant contributor to funding pressures. Theoretical and empirical evidence is reviewed and the implications for decision makers are discussed. A managerial focus on cost minimisation strategies makes implementing priority setting processes challenging because it calls for behaviours that typically counter professional self-interest. We suggest that a focus on quality would ultimately provide an effective strategy to contain costs, not to mention having a positive impact on patient well-being.