沈阳市城镇参保职工个人账户认知与使用调查

摘要:目的　了解沈阳市城镇职工基本医疗保险个人账户认知与使用中存在问题并提出建议。方法　采用多级随机抽样方法抽取沈阳市7 087名城镇参保职工进行问卷调查,采用SPSS13.0建立数据库,使用描述性分析和卡方检验方法进行统计分析。结果　参保职工对个人账户相关信息知晓率不高,71.65%的人不知道医保卡可以累计并计息,73.15%的人不知道医保卡可以继承,不同年龄、性别、文化程度、单位类别的参保人员在知晓医保卡的划拨比例、缴纳住院门槛费、缴纳个人自付费用、可以继承等方面差异有统计学意义（P＜0.05）;个人账户使用情况较好,不同年龄、单位类别参保人员在去医院看病使用医保卡上差异有统计学意义（P＜0.05）;不同年龄、性别、文化程度、单位类别参保人员在去药店购药使用医保卡方面差异有统计学意义（P＜0.05）;改革意愿方面,39.18%的人认为应降低个人缴费比例,仅6.62%的人赞成取消个人账户。结论　应普及医保卡相关知识和政策,加强医疗保险个人账户的使用和管理监督,并扩大个人账户使用范围。     

企事业单位体检人群糖尿病和空腹血糖增高与高血压检出率及知晓率调查

目的分析2013年部分企事业单位在职职工体检中糖尿病和空腹血糖受损检出率、高血压检出率及知晓率,为糖尿病及高血压防治提供依据。方法选取2013年在我院健康管理中心体检的3646名企事业单位在职职工作为研究对象,从工作性质上分为两组,即事业单位组1652人,企业单位组1994人;男性1599人,女性2047人,年龄22～60岁。空腹血糖和餐后2h血糖测定用全自动生化分析仪（雅培C16000）。分别计算企事业单位和男女性别人群糖尿病、空腹血糖受损的检出率和高血压检出率及知晓率。应用x。检验进行率的比较。结果3646名企事业单位在职职工糖尿病、空腹血糖受损及高血压检出率分别为3．26％、7．16％和19．03％,企业单位职工分别为4．51％、5．77％和21．77％,事业单位职工分别为1．76％、8．84％和15．74％;男性职工分别为5．38％、9．38％和29．58％,女性职工检出率分别为1．61％、5．42％和10．80％。企业职工高血压知晓率为43．09％,事业职工为60．38％;男性职工为49．47％,女性职工为49．77％。企业单位职工糖尿病及高血压检出率高于事业单位,男性高于女性;事业单位职工空腹血糖增高检出率高于企业单位,男性高于女性;事业单位职工高血压知晓率高于企业单位,男女性别差异无统计学意义（P〉0．05）。结论健康理念与职业、环境密切相关。     

广铁职工恶性肿瘤患病状况与医疗费用负担分析

目的了解广铁集团广东地区职工(广铁职工)恶性肿瘤患病情况及医疗费用负担,为铁路职工恶性肿瘤防制提供依据。方法收集2015年参加铁路医疗保险的广铁职工人口学资料及医疗保险记录,分析不同年龄、性别、岗位职工恶性肿瘤患病率以及因恶性肿瘤就医而产生的医疗费用负担。结果共纳入98 107名广铁职工,患恶性肿瘤2 085例,患病率为2 125.23/10万,标化患病率为1 573.37/10万;其中男性1 383例,患病率为1 868.67/10万;女性702例,患病率为2 913.23/10万。患病率随职工年龄增加呈升高趋势(P0.05);70岁各年龄组男性患病率均低于女性,≥70岁组男性高于女性(P0.05)。非一线工作岗位职工的恶性肿瘤标化患病率相对较高,为1 748.59/10万;车辆检修岗位职工恶性肿瘤标化患病率相对较低,为1 226.48/10万。2015年广铁职工因恶性肿瘤就医5 518人次,总医疗费用约为1.66亿元,每人次平均医疗费用约为3.00万元,每人次平均自费5 128.50元。结论广铁职工恶性肿瘤患病率较高,医疗费用支出较大,恶性肿瘤已成为铁路集团及其职工的主要疾病负担之一。     

新农合制度下参合人员住院费用现状及对策分析

目的：对陕西省某县参合人群的住院费用情况进行分析,为进一步完善新农合费用控制和补偿政策提供建议。方法以2011年某县全年参合患者住院人次变化、住院费用以及补偿费用等为研究指标,利用 SAS 统计分析软件进行数据分析。结果45岁以上人群住院人次构成比高于14%且呈上升趋势,住院费用较高;男性住院费用高于女性,在县外医疗机构尤其明显;单病种住院费用均值1323元(中位数851)低于非单病种3467元(中位数1780);家庭年住院次数集中于1~2次的占90.35%。结论45岁以上人群卫生服务利用率逐渐增多,县外住院费用偏高,且男性多于女性。单病种付费减轻了患者负担,但单病种数量相对较少。     

参保职工门诊慢性病管理办法满意度分析

目的了解宁夏银川市参保职工对门诊慢性病管理办法的满意度及影响因素。方法采用自编城镇职工基本医疗保险门诊慢性病管理办法满意度调查问卷对银川市2 029名企事业单位参保职工进行问卷调查。结果银川市参保职工对门诊慢性病管理办法总体满意度偏低(49.7%);男性满意度高于女性(χ2=26.045,P<0.001);未婚者满意度高于已婚及离婚/丧偶者(χ2=6.633,P<0.05);在职职工满意度高于退休职工(χ2=45.550,P<0.001);文化程度高的参保职工满意度较低(χ2=36.264,P<0.001);不同职业、不同个人月收入职工满意度比较,差异均有统计学意义(χ2=86.7536、7.977,P<0.001)。结论女性、已婚、退休、高文化程度、不同职业以及中等个人月收者对门诊慢性病管理办法满意度较低。     

银川市城镇职工医疗保险门诊大病利用及次均费用分析

目的分析银川市城镇职工门诊大病的利用情况。方法采用描述性统计分析、χ2检验和方差分析对职工门诊大病的利用情况进行分析。结果城镇职工医疗保险参保人员门诊大病次均费用与性别、年龄组、参保单位类型、在职状态、是否享受公务员医疗补助及缴费工资基数存在相关性。结论 (1)合理选择门诊大病病种,保证保障公平性;(2)完善重点病种的费用控制措施;(3)引导慢性病病人到社区医疗机构获得门诊服务。     

某事业单位2010-2014年在职职工血脂水平及动态分析

目的探讨事业单位职工血脂水平及动态分布状况,建议对血脂异常人群进行有效干预,预防心脑血管病的发生。方法选取某事业单位2010-2014年在职职工血脂检测结果,用SPSS 19.0软件对总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)进行回顾性分析。结果职工血脂四项比较,TG异常率较高为28.89%(P0.01),TC、HDL-C、LDL-C的异常率2014年均高于往年,LDL-C具有统计学意义(P0.01);血脂四项异常率男性均高于女性,TC、TG、HDL-C均具有统计学意义(P0.01);血脂异常率随年龄的增大而升高,51~60岁年龄组血脂异常率明显高于其他年龄组(P0.01);职工吸烟、饮酒率男性均高于女性,日常锻炼率男性均低于女性,均具有统计学意义(P0.05)。结论该单位职工血脂异常率较高,以TG异常升高为主,建议对血脂异常人群进行有效干预,预防心脑血管病的发生。     

医保定点药店购药影响因素分析

文章通过单因素和多因素分析,客观分析了影响参保人员到定点药店购药的影响因素.研究结果说明,定点药店主要为患小病的参保人员服务;参保人员在定点药店购药行为比较理性,减少了到相应医疗机构的就诊.     

门急诊医疗费用影响因素分析

该文通过对上海市 2 0 0 2年参保人员门急诊及相关数据的统计分析 ,发现个人年门急诊医疗费用受年龄、就医医院数、性别、单位性质、单位所在地、住院、门诊大病、家庭病床、药店购药等指标的影响。 85 6 0 %的就医人员在 3家及 3家以下医院就诊 ,且门急诊医疗费用随就医医院数的增加而增加 ,建议加强对年门急诊就医医院数较多的人员的管理 ,以控制门急诊费用 ,减少医疗保险基金的浪费。     

舟山市医用X射线诊断频率分析

通过对舟山市开展医用X线诊断的医疗卫生单位1996、1998年各种类型X线检查、人次数及构成和舟山医院2年X射线诊断受检者性别、年龄分布的调查.从而得出舟山市普通X线检查1996、1998年使用频率分别为297人次/千人、378人次/千人,X-CT则为19人次/千人、24人次/千人,二者检查频率均高于全省平均水平.全市2年照射类型以胸片构成比最高,1998年透视构成比高于1996年,受检者性别分布男性高于女性,与国内调查一致.年龄分布40岁以上＞16～40＞0～15岁组.     

Does income influence demand for medical services despite Japan's "Health Care for All" policy?

OBJECTIVES: We examined the impact of household income on the use of medical services in Japan, where there is a "health care for all" policy, with important, centralized influence by the national government designed to ensure universal access. METHODS AND SUBJECTS: All healthcare societies operating in 2003 were included in the study, representing 14,776,193 insured adults and 15,496,752 insured dependents. The mean case rate (the average number of monthly bills per patient), the mean number of service days per person, and the mean medical cost per person served as indicators of medical service use. Multiple regression analysis was performed by the forced entry method using case rate, the number of service days, and medical cost as outcome variables, and average monthly salary, dependent ratio, average age, and premium rate as the explanatory variables. RESULTS: In the multiple regression analyses, average monthly salary showed a high positive correlation of outpatient and dental indicators, including case rate, the number of service days, and medical cost. If the average monthly salary were reduced 20 percent lower than the mean, the estimated changes (95 percent CI) in case rate for the insured were -7.49 (-8.14 approximately -6.84) percent for outpatient visits and -8.16 (-8.77 approximately -7.56) percent for dental services. CONCLUSIONS: Average monthly salary intensifies the effects of copayments on the case rate, the number of service days, and medical cost in the "Employees Health Insurance" in Japan. Thus, a low salary appears to discourage patients from seeking medical and dental services.     

How profitable is a voluntary deductible in health insurance for the consumer?

To counteract moral hazard in health insurance, insured can be offered a voluntary deductible (VD) in return for a premium rebate. In the Dutch mandatory basic health insurance however, only 11 per cent of the insured opted for a VD in 2014. Several determinants could affect the decision to opt for a VD. This paper examines one of these determinants: the financial profitability. A VD is profitable for the consumer if the out-of-pocket expenses do not exceed the offered premium rebate. The empirical analyses, based upon individual-level data on costs and characteristics of over 800,000 Dutch insured, show that a VD of €500 on top of the mandatory deductible of €360 would have been financially profitable for 48 per cent of the Dutch insured given the average premium rebate of € 240 in 2014. If the whole population had a VD, most insured would obtain either the maximum loss (44 per cent) or the maximum gain (41 per cent). A VD is profitable for males, young insured, healthy insured and insured with few healthcare expenses in the past. To further reduce moral hazard, the following strategies can be used to increase the number of insured opting for a VD: provide insured with information regarding the VD and introduce a shifted deductible.     

Does a mandatory telemedicine call prior to visiting a physician reduce costs or simply attract good risks?

This paper aims to estimate empirically the efficiency of a Swiss telemedicine service introduced in 2003. We used claims' data gathered by a major Swiss health insurer, over a period of 6 years and involving 160 000 insured adults. In Switzerland, health insurance is mandatory, but everyone has the option of choosing between a managed care plan and a fee‐for‐service plan. This paper focuses on a conventional fee‐for‐service plan including a mandatory access to a telemedicine service; the insured are obliged to phone this medical call centre before visiting a physician. This type of plan generates much lower average health expenditures than a conventional insurance plan. Reasons for this may include selection, incentive effects or efficiency. In our sample, about 90% of the difference in health expenditure can be explained by selection and incentive effects. The remaining 10% of savings due to the efficiency of the telemedicine service amount to about SFr 150 per year per insured, of which approximately 60% is saved by the insurer and 40% by the insured. Although the efficiency effect is greater than the cost of the plan, the big winners are the insured who not only save monetary and non‐monetary costs but also benefit from reduced premiums. Copyright © 2010 John Wiley & Sons, Ltd.     

Perceived satisfaction with health services under National Health Insurance Scheme: Clients' perspectives

The study aims to explore the perceived satisfaction of insured clients in financing health services through National Health Insurance in Ghana. A quantitative method was used to recruit 380 respondents, selected by multistage cluster sampling. Data were collected through the administration of questionnaires. More than half, 57.9%, of respondents were males, and the average age was 34 years. Most respondents, 74.3%, were insured. Overall, 53.12% of insured clients were dissatisfied with the services of providers. Factors, such as benefit package of insurance, willingness to pay higher premium, and perceived discrimination were significantly associated with poor satisfaction with health services. The current advocacy for and awareness about the use of health insurance as a prepayment plan should be prioritised in policy initiatives. The benefit package for the insurance should be increased in order to cover all disease conditions that afflict the Ghanaian population.     

McAllen And El Paso revisited: Medicare variations not always reflected in the under-sixty-five population

Medicare spending for the elderly is much higher in McAllen, Texas, than in El Paso, Texas, as reported in a 2009 New Yorker article by Atul Gawande. To investigate whether this disparity was present in the non-Medicare populations of those two cities, we obtained medical use and expense data for patients privately insured by Blue Cross and Blue Shield of Texas. In contrast to the Medicare population, the use of and spending per capita for medical services by privately insured populations in McAllen and El Paso was much less divergent, with some exceptions. For example, although spending per Medicare member per year was 86 percent higher in McAllen than in El Paso, total spending per member per year in McAllen was 7 percent lower than in El Paso for the population insured by Blue Cross and Blue Shield of Texas. We consider possible explanations but conclude that health care providers respond quite differently to incentives in Medicare compared to those in private insurance programs.     

Health care costs in the last year of life--the Dutch experience

Health expenditure depends heavily on age. Common wisdom is that the age pattern is dominated by costs in the last year of life. Knowledge about these costs is important for the debate on the future development of health expenditure. According to the 'red herring' argument traditional projection methods overestimate the influence of ageing because improvements in life expectancy will postpone rather than raise health expenditure. This paper has four objectives: (1) to estimate health care costs in the last year of life in the Netherlands; (2) to describe age patterns and differences between causes of death for men and women; (3) to compare cost profiles of decedents and survivors; and (4) to use these figures in projections of future health expenditure. We used health insurance data of 2.1 million persons (13% of the Dutch population), linked at the individual level with data on the use of home care and nursing homes and causes of death in 1999. On average, health care costs amounted to 1100 Euro per person. Costs per decedent were 13.5 times higher and approximated 14,906 Euro in the last year of life. Most costs related to hospital care (54%) and nursing home care (19%). Among the major causes of death, costs were highest for cancer (19,000 Euro) and lowest for myocardial infarctions (8068 Euro). Between the other causes of death, however, cost differences were rather limited. On average costs for the younger decedents were higher than for people who died at higher ages. Ten per cent of total health expenditure was associated with the health care use of people in their last year of life. Increasing longevity will result in higher costs because people live longer. The decline of costs in the last year of life with increasing age will have a moderate lowering effect. Our projection demonstrated a 10% decline in the growth rate of future health expenditure compared to conventional projection methods.     

社区高血压患者健康管理药物治疗和直接医疗费用分析

目的 调查社区高血压患者健康管理的药物治疗费用、住院费用及直接医疗费用的现状,为进一步评估国家基本公共卫生服务项目中的社区高血压患者健康管理是否具有卫生经济学上的成本效益奠定基础.方法 通过整群抽样的方法在5省10个调查点调查了8326例高血压患者,其中参与社区高血压患者健康管理1年以上的管理组对象3967例,未参与该管理的对照组4359例.通过问卷调查收集研究对象基本信息,并回顾性收集其在过去1年内(2009年11月至2010年11月)的医疗成本信息.分别对比分析两组患者的年度药物治疗费用、住院治疗费用和直接医疗费用.结果 高血压患者年均药物治疗费用为(621.50±1337.78)元,管理组为(616.13±1248.40)元,对照组为(626.44±1414.30)元.高血压服药患者年均药物治疗费用为(702.05±1401.79)元,管理组为(688.50±1300.70)元,对照组为(714.64±1489.60)元.城市高血压服药患者年均药物治疗费用[(731.88±1403.31)元]高于农村[(407.44±1171.44)元].高血压患者的年住院率为12.2%(1014/8326),高血压住院患者年人均住院费用为(9264.47±18 088.49)元,管理组[(7583.70±13 267.00)元]低于对照组[(11 028.00±21 919.00)元].高血压患者年人均住院费用为(1064.87±6804.83)元,管理组[(936.73±5284.90)元]低于对照组[(1181.50±7937.90)元].高血压患者年人均直接医疗费用为(2275.08±8225.66)元,管理组为(2165.10±6564.60)元,对照组为(2375.20±9487.60)元;城市地区患者年人均直接医疗费用[(2801.06±9428.54)元]高于农村[(1254.70±4990.27)元].结论 高血压社区健康或规范化管理能降低高血压服药患者年均药物治疗费用和患者年人均住院费用约26元和245元;节省高血压患者年人均直接医疗费用约210元.国家医疗卫生体制改革和发展中,应进一步加强和推广社区高血压患者健康或规范化管理.

Abstract：

Objective To investigate the current situation of drug cost,hospitalization cost and direct medical expense in community health management of hypertensive patients,in order to lay foundation for evaluating whether the community health management in basic public health service has cost-effect in Health Economics.Methods A total of 8326 hypertensive patients from 10 survey pilots in 5 provinces were selected by cluster sampling methods,including 3967 patients who took part in community health management for over 1 year as management group and 4359 cases who have never taken part in community health management as control group.The essential information of research objects were collected by questionnaire; and the medical cost information in the last year(from November 2009 to November 2010) were collected retrospectively.The different annual medical treatment cost,hospitalization cost and direct medical expense in the two groups were compared and analyzed.Results The average annual drug cost in hypertension was(621.50±1337.78) yuan per patient; while the cost was(616.13±1248.40) yuan in management group and(626.44±1414.30) yuan in control group respectively.The average annual drug cost of hypertensive patients who took medicine therapy was(702.05±1401.79) yuan per person,while the cost in the management group ((688.50±1300.70)yuan) was much lower than it in control group ((714.64±1489.60)yuan).The annual average drug cost in urban was(731.88±1403.31) yuan per person,which was higher than it in rural as(407.44±1171.44) yuan per person.The average hospitalized rate was 12.2%(1014/8326),and the average annual cost among the hospitalized patients was(9264.47±18 088.49) yuan per person; while the cost was(7583.70±13 267.00) yuan in management group,which was lower than it in control group as(11 028.00±21 919.00) yuan.The average annual hospitalized cost in hypertensin was(1064.87±6804.83) yuan per person; while the cost was(936.73±5284.90) yuan in management group,which was lower than it in control group as(1181.50±7937.90) yuan.The average annual direct medical expense in hypertension was(2275.08±8225.66)yuan per person; while the expense was(2165.10±6564.60)yuan in management group and(2375.20±9487.60)yuan in control group.The average annual direct medical expense in urban((2801.06±9428.54)yuan per person) was higher than it in rural((1254.70±4990.27)yuan per person).Conclusion The community health or standardized managment of hypertensive patients can reduce the average annual drug cost and hospitalization cost (around 26 yuan and 245 yuan separately); and thereby save the annual direct medical expense per capita in hypertension (around 210 yuan). In the reform and development of national medical health system, we should enhance and promote the standardized community health management of hypertensive patients.     

Examining the types and payments of the disabilities of the insurants in the national farmers' health insurance program in Taiwan

Background  

In contrast to the considerable body of literature concerning the disabilities of the general population, little information exists pertaining to the disabilities of the farm population. Focusing on the disability issue to the insurants in the Farmers' Health Insurance (FHI) program in Taiwan, this paper examines the associations among socio-demographic characteristics, insured factors, and the introduction of the national health insurance program, as well as the types and payments of disabilities among the insurants.     

A description of outpatient drug use in rural China: evidence of differences due to insurance coverage

This paper describes the effects of health financing systems (insurance) on outpatient drug use in rural China. 1320 outpatients were interviewed (exit interview) in the randomly selected county, township and village health care facilities in five counties in three provinces of central China. The interview was face to face. Questions were asked by a trained interviewer and were answered by patient him/herself. The main finding was that health insurance appeared to influence drug use in outpatient services. The average number of drugs per visit was 2·56 and drug expenditures per visit was 16·9 yuan. Between insured and uninsured (out‐of‐pocket) groups, there were significant differences in the number of drugs and drug expenditures per visit. The insured had a lower number of drugs and a higher drug expenditure per visit than the uninsured, implying the use of more expensive drugs per visit than the uninsured. There were also significant differences in the number of drugs and drug expenditures per visit between the types of insurance. One third of the drugs were anti‐infectives, most of which were penicillin, gentamycin and sulfonamides. The results imply that uninsured patients do not receive the same care as the insured do even if they have the same needs. The fee‐for‐service financing for hospitals and health insurance have changed health providers' and consumers' behaviour and resulted in the increase of medical expenditure. Copyright © 1999 John Wiley & Sons, Ltd.