我国卫生服务公平性对药品可及性的影响分析

目的:基于卫生服务公平性和药品可及性的内涵,分析卫生服务公平性对药品可及性的影响.方法:根据问卷调查数据,构建卫生服务公平性衡量指标体系,分析其与药品可及性的内在关系.结果与讨论:卫生服务公平性对药品可及性存在影响,应提高我国卫生服务公平性,完善卫生资源分配的公平性及筹资政策,以提高我国药品可及性.     

卫生筹资政策对公平性的影响

供方筹资政策和需方筹资政策是当今世界各国采取的主要卫生筹资政策,而这些政策或多或少都没有把公平性有机融合进去,由此产生了以下几方面的影响：健康不公平性明显,卫生公布不公平影响了卫生服务的可及性和可得性,医疗费用上涨造成新的不公平性等。为完善卫生筹资政策,增加社会公平性,应重视基本医疗服务和预防保健服务的提供;卫生筹资政策应更多地倾向于穷人和低收入者等脆弱人群,积极推行各种形式的预付制等。     

卫生筹资公平性研究

世界卫生组织在《２０００年世界卫生报告》中第一次提出了卫生系统的三个目标 :提高人群的健康水平、对个体普遍合理期望的认知和适当的反应、保证卫生筹资的公平性 ,以及在评价卫生系统目标实现程度方面发展了五项指标 :健康水平(ＤＡＬＥ)、健康水平的分布、卫生系统反应性、卫生系统反应性的分布和卫生筹资公平性指数。世界卫生组织根据卫生筹资公平性指数对１９１个会员国进行的排名 ,中国居１８８位。对此 ,国内许多专家对该评价结果提出异议。本文就卫生筹资公平性指数的计算方法、意义及存在的问题作一综述。一、卫生筹资公平性的概…     

关于改善我国卫生服务公平性的思考

卫生服务公平性问题是我国深化卫生改革中关注的焦点问题之一.该文从卫生服务公平性的概念及衡量出发,探讨目前我国卫生服务公平性低下的现状及其主要原因,并提出了相应的对策与建议.     

我国基本医疗保障制度卫生服务可及性实证研究

"看病难、看病贵"是当前社会反映强烈的热点问题,而其本质反应了卫生服务的可及性及其公平性较差。文章以陕西省眉县为实证研究现场,通过入户调查,采用集中指数和卫生服务可及性标准化等方法,对城镇职工、城镇居民和新型农村合作医疗等3种基本医疗保障制度参保人群卫生服务可及性及其公平性进行比较分析,探讨了3种基本医疗保障制度卫生服务可及性及其公平性的现状和差别,为完善我国基本医疗保障制度提供了科学依据。     

建立卫生筹资公平性新视角

我国曾被国际组织列为个人现金卫生支出占卫生总费用比重较高的国家之一.不但影响基本医疗保障制度全面覆盖,也容易导致因病致贫风险.调整卫生筹资结构是各级政府和卫生行政管理部门主要卫生工作任务.政府在服务提供、规制、筹资方面发挥强有力的作用,一定会实现卫生筹资的公平性.其实现目标是将个人卫生支出控制在卫生总费用30%以下.     

家庭卫生筹资公平性研究

目的　测算上海市郊区家庭卫生筹资公平性状况 ,并估计全国情况。方法　通过家庭入户调查获得卫生支出、政府卫生投入等数据 ,应用WHO所介绍的卫生系统绩效评价中的家庭卫生筹资公平性指标及其测量方法。结果　测算出家庭卫生筹资公平性系数为 0 735 ;合作医疗覆盖率能提高家庭卫生筹资公平性。结论　上海市郊区家庭卫生筹资公平性水平与WHO对我国的估计相符 ,而全国的筹资公平性水平要更低 ;WHO所推荐的卫生筹资公平性测算方法中 ,政府对家庭卫生补贴的测算不适合我国实情。     

卫生总费用和筹资公平性研讨会闭幕

历时3天的卫生总费用和筹资公平性研讨会于2003年1月24日在冰城哈尔滨结束。会议由国家卫生部卫生经济研究所举办、黑龙江省卫生厅承办,国家卫生部卫生经济研究所研究员赵郁馨主持了会议,并对此次会议召开的背景进行了说明:(1)国家卫生部卫生经济研究所受国家卫生部规划财务司委托,承担全国卫生总费用测算与信息发布工作,同时,承担国家卫生部关于卫生筹资公平性测算。经过专家论证,国家级卫生总费用测算结果已经纳入国家统计局信息发布系统,正式公布于     

灾难性支出家庭对卫生筹资公平性的影响

在家庭支出中,有一些家庭由于疾病,必须支付大量的医疗费用。当所支付的医疗费用超过一定程度时,会影响家庭的其他支出,甚至是正常的生活。当卫生保健支出占家庭可支配收入的比例超过5 0 %时,WHO就把这类家庭称之为灾难性支出家庭(catastrophicexpenditurehousehold) [1] 。灾难性支出家庭与低收入家庭是两个不同的概念:灾难性支出家庭反映的主要是卫生支出对一个家庭的影响,这种家庭,单纯从收入水平看,可能处于中等收入,甚至是高收入水平。但对于任何一种家庭,如果其卫生支出在家庭可支配收入中的比例大于5 0 % ,都可以认为卫生服务已经…     

卫生筹资公平性评价方法浅析

国际现有的卫生筹资公平性评价方法主要有:家庭卫生筹资贡献率的计算、对卫生筹资渠道累进性的分析、个人现金卫生支出致贫影响分析等。文章通过对这几种方法的分析进而讨论我国卫生筹资公平性研究方法的现状。     

新医改以来我国卫生筹资的进展、问题与面临的挑战

新医改四年来,我国各级政府大规模增加卫生事业的财政投入,卫生公共筹资体系建设成效显著,然而亦存在一些突出问题,卫生筹资的可持续性面临挑战。当前我国新医改进入“提质增效”的第二季,需要以转变政府管医办医职能为统领,协同配套推进体制机制改革,多渠道增加卫生资源,提高卫生投入绩效,实现卫生筹资的可持续发展。     

卫生筹资的区域公平性研究

研究我国卫生筹资区域公平性的现状及其与医疗资源和服务利用产业内集聚的关系。公立医院事实上的“民营化”引致了卫生筹资区域不公平问题的产生,医疗资源的产业内集聚在其中起了重要的作用,而累退的财政补贴又加剧了这种不公平性。因而有必要改变医疗服务的市场化道路,加大政府对基层医疗服务的转移支付力度。     

Regulation versus practice--the impact of accessibility on the use of specialist health care in Norway

In Norway specialized health services are provided both by public hospitals and by privately practicing specialists who have a contract with the public sector. A patient's co-payment is the same irrespective of the type of provider he visits. The ambition of equity in the allocation of medical care is high among all political parties. The instruments for auditing whether these goals are fulfilled are not equally ambitious. The objective of the present study is to explore whether laws and regulations that govern the allocation of specialist health care resources in fact are fulfilled. Panel data from the Survey of Living Conditions are merged with data on capacity and spatial access to primary and specialist care. We find that accessibility and socio-economic variables play a considerable role in determining both the probability of at least one visit and the number of visits to a private specialist. A person with a higher university degree living in a municipality with the highest value of the geographical accessibility index has a 46%-points higher probability of at least one visit to a private specialist compared with a person with junior high living in a municipality with the lowest value of the accessibility index. With regard to visits to a hospital outpatient department these variables are not found to have significant effects.We conclude that public ambitions and regulations are fulfilled for specialist services provided by public hospitals. With regard to the provision of services provided by publicly financed private specialists we find a discrepancy between public goals and surveyed practice.     

中国西部农村卫生服务可及性综合评价研究

目的 科学评价西部农村卫生服务可及性存在的问题.方法 利用2003年卫生部第三次国家卫生服务调查的家庭健康询问调查数据.以收入、教育、到医疗机构时间或距离、医疗服务价格和费用、医疗保险等为指标.分析评价西部11个省(自治区、直辖市)农村居民卫生服务可及性.结果 西部各省受教育程度普遍较低.西北各地参加医疗保险制度的指标均较差,西南各地的参保情况参差不齐.尽管不同地区某些指标较好,但是由于各种影响因素的综合作用,也会影响到其卫生服务的可及性.结论 中国西部农村地区的基本卫生服务可及性较低,需要综合考虑各方面的因素,有针对性地制定社会卫生政策,有效提高西部农村地区基本医疗卫生服务的可及性.     

Utilization of health care services by immigrants and other ethnic/cultural groups in Ontario

Objectives. This study assesses the accessibility of health care services by immigrants and other ethnic/cultural groups in Ontario, using the 1990 Ontario Health Survey.

Methods. The population sample of 38 519 adults aged 16–64 is weighted to represent the entire non‐institutionalized population of the province. Outcome measures were whether the study participants visited a general practitioner's office, a specialist's office, or a hospital's emergency department during the past 12 months.

Results. The results showed that while the percentages of participants who ever visited a general practitioner's office during the past 12 months were slightly higher in immigrants and other ethnic/cultural groups, the rates of visits to the specialist's office were quite similar, and the rates of hospital emergency department's visits were often lower (except for aboriginals), than for Canadians. These differences in the utilization of health services across different immigrant and ethnic/cultural groups remained unchanged after controlling for health status (as measured by self‐reported health problems) and age differences. However, because the sample sizes in some immigrant and ethnic/cultural groups were small, many of the differences were not statistically significant.

Conclusions. We conclude that while immigrants and other ethnic/cultural groups in Ontario usually had equal access to regular services (e.g., visits to general practitioner's office), they often had lower utilization of hospital emergency departments. However, general purpose surveys have limited utility in assessing reasons of health care utilization amongst different ethnic/cultural groups.     

The impact of vouchers on the use and quality of health care in developing countries: A systematic review

Abstract

One approach to delivering healthcare in developing countries is through voucher programmes, where vouchers are distributed to a targeted population for free or subsidised health care. Using inclusion/exclusion criteria, a search of databases, key journals and websites review was conducted in October 2010. A narrative synthesis approach was taken to summarise and analyse five outcome categories: targeting, utilisation, cost efficiency, quality and health outcomes. Sub-group and sensitivity analyses were also performed. A total of 24 studies evaluating 16 health voucher programmes were identified. The findings from 64 outcome variables indicates: modest evidence that vouchers effectively target specific populations; insufficient evidence to determine whether vouchers deliver healthcare efficiently; robust evidence that vouchers increase utilisation; modest evidence that vouchers improve quality; no evidence that vouchers have an impact on health outcomes; however, this last conclusion was found to be unstable in a sensitivity analysis. The results in the areas of targeting, utilisation and quality indicate that vouchers have a positive effect on health service delivery. The subsequent link that they improve health was found to be unstable from the data analysed; another finding of a positive effect would result in robust evidence. Vouchers are still new and the number of published studies is limiting.     

浙江省卫生总费用筹集与医疗保障机制

卫生总费用的筹集直接关系到医疗保障机制的改革与完善,近年来随着国民经济的发展和人民生活水平的提高,浙江省卫生总费用筹资机制不断完善,提升了公民医疗保障水平,但也存在一些问题。本文通过浙江省卫生总费用筹集现状和问题分析,提出解决对策,以促进浙江省医疗保障机制的进一步完善。     

The impact of S-CHIP enrollment on physician participation in Medicaid in Alabama and Georgia

OBJECTIVE: To assess whether increasing enrollment in State Children's Health Insurance Programs (S-CHIPs) has an impact on the number of office physicians participating in Medicaid and the extent of their participation. Effects are measured for a freestanding S-CHIP program with an open provider panel and an S-CHIP program that uses the state's Medicaid provider panel. DATA SOURCES: Children's Medicaid claims data for primary care services were used to measure physician participation in the program; census and enrollment data were used to describe market area characteristics. Study Design. This is a time series study of communities in two states, measuring physician Medicaid participation quarterly between 1998 and 2001, controlling for changes in community characteristics and children's program enrollment as well as other factors by quarter. DATA COLLECTION/EXTRACTION: Office physician participation is measured by practice site. Claims data are aggregated to the level of the community and reflect the number of limited practice sites, the ratio of Medicaid office sites to the number of primary care physicians in the community as reported by the American Medical Association (AMA), and the mean number of Medicaid office visits made to physician sites in the community in the quarter. FINDINGS: In Alabama, the state with a freestanding S-CHIP program, there is little association between increased S-CHIP enrollment and physician participation in Medicaid. In Georgia, where the same provider network serves both programs, increases in S-CHIP enrollment are associated with a decline in office-based physician participation in Medicaid in urban areas. CONCLUSION: Linkage of S-CHIP and Medicaid programs through the use of the same provider network, in the absence of market conditions that encourage the expansion of the network, can lead to a negative impact on access for Medicaid enrollees.     

1998—2010 年山东省卫生总费用筹资状况分析

目的 分析山东省1998-2010年卫生总费用主要构成及其变化趋势,提出改善卫生筹资的建议.方法:运用筹资来源法对山东省1998-2010年的卫生总费用进行了测算,并对测算结果进行分析.结果:山东省卫生总费用和人均卫生总费用呈现逐年增长趋势,个人卫生支出从55.40％～38.72％,结构不太合理.结论:建议适当提高卫生总费用占GDP的比例,加大政府卫生投入力度,降低居民个人卫生支出,建立合理的卫生筹资机制.