慢性病门诊费用纳入新型农村合作医疗大病统筹基金管理的费用界定

目的:探求新型农村合作医疗个人不同筹资额度下将门诊费用纳入大病统筹基金的慢性病病种,核算慢性病门诊费用纳入大病统筹基金后的筹资增加额与原有新型农村合作医疗基金结余额的缺口。方法:采用费用等级迭代的方法确定慢性病的病种,将基金增加额与原有新型农村合作医疗基金结余额进行比较。结果:测算出不同筹资额下纳入的慢性病病种及对应的筹资额度的增加额。结论:采用迭代方法确定出慢性病门诊费用纳入大病统筹基金管理具有可行性。     

门诊费用纳入新型农村合作医疗大病统筹基金的慢性病筛选

目的:探索将门诊费用纳入新型农村合作医疗大病统筹基金的慢性病病种的筛选方法,并对该方法的可行性与合理性进行论证。方法:将疾病负担尺度与费用尺度相结合,取二者交集,从最终的疾病谱中选取10种慢性病作为拟纳入的病种;通过测算参合者个人在原先交费基础上多缴纳的费用额度,来论证疾病纳入的合理性。结果:选取了10种慢性病作为拟纳入的病种;测算出10种慢性病不同补偿比下参合者个人在原先基础上多交纳的费用额度。结论:将慢性病人门诊费用纳入新型农村合作医疗大病统筹基金管理具有可行性。     

农村居民慢性病门诊费用纳入大病统筹面临的矛盾分析

为解决农民的慢性病门诊费用负担,探讨其合理的补偿方式,文章分析了农民慢性病门诊费用纳入大病统筹所面临的矛盾,包括:提高筹资水平与农民经济收入较低的矛盾,门诊和住院费用经济负担如何平衡解决的矛盾,扩大受益面与大病补偿经济能力削弱的矛盾,提高基金管理能力和实际操作困难的矛盾等。另外,还提出了解决相应矛盾的有关建议。深入分析、解决这些矛盾,对完善新型农村合作医疗制度是一个积极有益的探讨。     

医保病人门诊大病就诊费用统筹支付的分析与探讨

分析了江苏省南通市2001--2003年纳入统筹基金支付的7种门诊大病的患病、就诊、费用与补偿情况，发现慢性痛的门诊就诊次均费用一般不高，但年累计就诊费用要占个人年工资的30.00％以上，按“板块式”基金管理方式，个人账户一般无法承担如此高额的费用、由统筹基金支付较好地解决了慢性病高额费用负担问题：可以减少参保者为了获得统筹支付而住院的比例，对提高基金使用效率、缓解慢性病人费用负担均有较好的作用。建议采取有效措施，加强监管与诊断审查，控制非支付范围内的疾病冒用统筹基金.     

农村慢性病病人家庭的疾病经济风险分析

当前，慢性病正在成为危害农村居民健康和生命的主要卫生问题，慢性病的疾病经济负担也成为农村居民因病致贫的主要诱因之一。因此，新型农村合作医疗制度对慢性病门诊费用的补偿方式与程度，对减轻农村居民经济负担具有重要影响，也是影响新型农村合作医疗可持续发展的重要因素。山东大学卫生管理与政策研究中心尹爱田等在对山东、甘肃两省抽样调查基础上，分析了农村慢性病病人家庭的疾病经济风险，探讨了慢性病门诊费用纳入新型农村合作医疗大病统筹基金管理的必要性。同时，通过对慢性病病种的筛选、人均筹资增加额的测算，论证了慢性病门诊费用纳入新型农村合作医疗大病统筹基金管理的可行性。最后，提出了慢性病纳入后的管理模式和策略。现将他们的研究成果一起奉上。供大家讨论和参考。[编者按]     

门诊费用纳入新型农村合作医疗大病统筹的慢性病筛选

将农村居民慢性病门诊费用纳入大病统筹基金的报销范围，需要考虑所纳入的慢性病病种的标准以及报销比例。纳入标准是可行性的前提，而报销比例的确定则是操作合理性的基础，更是统筹基金高效运作的保证。对于纳入疾病的选择既要考虑人群的整体负担状况，又要兼顾个体的经济承受力。因而，对于纳入标准应有病种尺度（严重程度）和费用尺度（经济负担程度）之分，选择合理的尺度对于方案的可行性至关重要；而对于门诊费用报销比例的问题则存在更多的级差，不同的级差就意味着农村居民缴费的不同，必须从农村居民经济负担的可接受性角度考虑方案的可行性。因此，我们采用如下方法对慢性病病种进行筛选，并通过定量测算，论证其门诊费用大病统筹基金的合理性。     

个人账户保健康 社会统筹保风险——兼议职工医疗保险基金统账分割

在确定统筹基金和个人账户支付范围时,其指导原则应是“个人账户保健康,统筹基金保风险”。个人账户主要支付门诊一般疾病的诊疗费用,统筹基金支付门诊大病、慢性病和住院的费用,两者只在支付门诊大病、慢性病时才互相贯通。     

宁夏六县新型农村合作医疗门诊统筹实施情况的研究

选择宁夏的6个新型农村合作医疗样本县,调查分析其门诊统筹方案和补偿办法,门诊统筹运行情况和乡村两级医疗机构费用情况,研究门诊统筹实行的效果和问题。结果认为,样本县门诊统筹方案规范完整,但存在手续繁琐、参合农民利用不足、基金沉淀过多和医疗机构分解处方等问题。建议门诊统筹尝试总额付费支付方式,粗线条管理,进一步规范慢性病和特殊大病,确定合理的门诊统筹基金分配比例,并根据参合农民医疗服务需求和定点医疗机构服务能力等情况,确定较为合理的补偿比,找到门诊和住院补偿的最佳结合点,最终实现门诊和住院总体统筹的目的。     

山东省某市新农合大病保险补偿20类大病费用分布情况及效果评价

目的分析山东省某市新农合大病保险所补偿20类大病患者费用分布情况,并对大病保险防止家庭灾难性卫生支出效果进行评价,为今后大病保险测算工作提供依据。方法运用SPSS19.0对40617名大病患者的医疗费用及补偿情况进行描述性统计分析,并对大病与年龄、医疗费用进行对应分析。结果大病保险基金补偿在不同年龄组人群、大病病种间差异较大,以老年人和慢性病为主;保险补偿后的部分大病患者家庭灾难性卫生支出发生率仍在40%以上。结论在按病种补偿机制不变条件下,建议大病医疗保险按年龄别和疾病别划分不同补偿比例,实施"分档补偿",在医保基金有限的条件下,可考虑划分出"老年人群大病保险补偿比例"等。     

奉贤县合作医疗大病住院统筹费用分析

1997年起,奉贤县在实行镇办镇管农村合作医疗7年的基础上,实施全县大病住院统筹合作医疗。门诊和住院5000元以下费用由镇级合作医疗结报补偿,住院医药费5000元以上部分由县合作医疗办公室统一补偿。在解决大病重病病人困难中起到了积极的作用。现就1997年度大病统筹工作以及全年结报的1129位病人的大额医疗费用作一综合分析如下。 1 县、镇两级合作医疗概况 1.1 筹资方法 1.1.1 镇级合作医疗坚持镇办镇管的原则,依据各镇的实际情况作出筹资规定。参加者每人投入个人资金50至96元不等,镇、村企业职工由集体上交每人60至120元,组成镇级合作医疗资金。1997年全县21个镇共筹集资金1832万元,其中152万元上交县大病统筹资金。     

Screen-detected gallstone disease and cardiovascular disease

Knowledge about temporal associations for screen-detected gallstone disease and cardiovascular disease is limited. The objective of this study was to determine if screen-detected gallstones or cholecystectomy was associated with development of cardiovascular disease. A cohort study of three randomly selected groups from the general population of Copenhagen was performed. Participants (n = 5928) were examined 1982–1992 and underwent abdominal ultrasound examination to detect gallstone disease and were not informed of their gallstone status. Participants were followed up for occurrence of cardiovascular disease through nationwide registers until December 2014. Multivariable Cox regression analyses were performed including traditional cardiovascular disease risk factors and apolipoprotein E genotype. Gallstone disease was identified in 10% (591/5928) of participants at baseline of whom 6.8% had gallstones and 3.2% had cholecystectomy. The study population was followed for a period of 32 years with only 1% lost to follow-up. Gallstone disease was associated with all cardiovascular disease (hazard ratio (HR) 1.36, 95% confidence interval (CI) [1.17;1.59]) and to the subgroups coronary artery (HR 1.34, 95% CI [1.10;1.64]), cerebrovascular (HR 1.22, 95% CI [0.97;1.52]), and peripheral artery disease (HR 1.57, 95% CI [1.15;2.13]). No differences in estimates were identified for gallstones detected at ultrasound or cholecystectomy. Adjustment did not change estimates substantially. Gallstone disease seems to be independently associated to cardiovascular disease. Associations cannot be explained through traditional cardiovascular disease risk factors, apolipoprotein E4 allele, or detection bias. Future studies should explore the link between gallstone and cardiovascular disease further and gut microbiota may be a candidate mechanism.     

Infectious bursal disease (Gumboro disease)

Infectious bursal disease (IBD) (Gumboro disease) has been described throughout the world, and the socio-economic significance of the disease is considerable world-wide. Various forms of the disease have been described, but typing remains unclear, since antigenic and pathotypic criteria are used indiscriminately, and the true incidence of different types is difficult to determine. Moreover, the infection, when not fatal, leads to a degree of immunosuppression which is often difficult to measure. Finally, the control measures used are subject to variations, and seldom follow a specific or standardised plan. In the context of expanding international trade, the authors provide an overview of existing knowledge on the subject to enhance available information on the epidemiology of IBD, the identification of reliable viral markers for diagnosis, and the implementation of specific control measures to ensure a global and co-ordinated approach to the disease.     

From gene to disease; Gaucher disease

Gaucher disease is an autosomal recessive inherited lysosomal storage disorder due to mutations in the glucocerebrosidase gene located on chromosome 1q21. Hepatosplenomegaly and bone disease due to massive accumulation of undegraded glucocerebroside in macrophages found in the liver, spleen and bone marrow dominate the clinical picture in type 1 disease. In rare instances (type 2 and 3 disease) the central nervous system is involved. Phenotype-genotype correlations are poor. Diagnosis is possible by enzyme assay at clinical genetic centres in the Netherlands. The availability of effective therapies emphasizes the need for early recognition of the disease.     

Niemann-pick disease type C and Crohn's disease

A five-year-old girl with Neimann-Pick disease type C subsequently developed Crohn's Disease. This association has only been presented once previously in the literature. This report discusses the options for managing one chronic disease in the presence of another life limiting condition.     

Alzheimer's disease

The current knowledge of the neuropathology, neurochemistry and genetics of Alzheimer's disease is reviewed. The hallmarks of neuropathology, namely neuritic plaques and neurofibrillary tangles, are described. The search for the aetiological agent(s) and a therapeutic strategy are briefly described and the location of a genetic locus for Alzheimer's disease on chromosome 21 is discussed. Future directions for research are suggested.