中国卫生筹资公平性现状与挑战

结合国内外研究结果从筹资风险保护和资金筹集与分配公平两个维度分析我国卫生筹资公平状况与挑战。结果显示,当前卫生筹资公平的主要挑战是以公平为导向的卫生政策设计仍比较缺乏,政府补助和医疗保险针对脆弱人群的政策设计不够。实现广覆盖后,未来亟需关注不同医疗保险人群之间的公平,此外需要建立符合地区筹资公平原则的政府间卫生投入机制。     

西部某省医疗机构政府补助的受益归属分析

目的:选择西部某省为样本地区,测算医疗机构政府补助在不同经济收入水平人群中的受益分布状况,评价居民的受益公平程度.方法:利用受益归属分析方法,从相对公平和绝对公平角度,评价该地区医疗机构政府补助的受益分布的公平程度.结论:样本地区医疗机构政府补助的人群受益公平性欠佳,农村地区的不公平程度比城市地区严重,且随着经济社会的发展,不公平性未见明显改善.     

卫生筹资公平性研究方法综述

目的:对近年来卫生筹资公平性研究方法的进展进行总结分析。方法:利用文献检索收集国内外有关文献,并进行比较总结。从计算方法、适用范围、所需数据、结果价值、测算维度等方面对目前国内外常用的7种筹资公平性研究方法进行归纳。结果和结论:2000年世界卫生组织(WHO)推出的家庭卫生筹资贡献率(HFC)和筹资公平指数(FFC)计算方法需经调整,方能适用于中国;国内再分配效应(RE)的应用有一定困难,但kakwani指数被广泛采用;灾难性卫生支出家庭分析能部分反映就医风险保护,在我国极为重要,但不能用以反映卫生系统的筹资公平性。     

我国城乡卫生费用的公平性研究

就卫生而言，公平性主要包含3个方面的含义：健康公平，即不同收入、种族、性别的人群应具有相同或类似的健康水平；卫生服务提供的公平，包括具有同样卫生服务需求的人可以得到相同的服务和卫生服务需求多的人能够获得更多所需的服务；卫生筹资公平，包括具有同等支付能力的人应提供同等的支付和支付能力高的人提供更多支付。在我国现有卫生体制下，卫生筹资的公平是实现卫生公平的关键。本文从资金筹集、使用和政府财政投入的角度分析我国城乡卫生费用的公平性。     

天津市卫生筹资的垂直公平和水平公平研究

目的:从垂直公平和水平公平角度分析评价天津市卫生筹资系统的公平性。方法:利用国家卫生服务调查和卫生总费用数据,运用AJL收入再分配方法分析天津市卫生筹资公平性。结果:天津市卫生筹资系统呈现亲穷人,改善了卫生筹资前收入分配的不公平,但不同卫生筹资渠道收入再分配作用不同。结论:强化直接税收的再分配职能;统筹社会医疗保险,改善筹资公平性;谨慎解释个人现金卫生支出筹资的"伪公平性"。     

2008年广州市政府医疗机构补助受益分布研究

目的:分析2008年广州市政府医疗机构补助在不同经济水平人群中的分布并评价补助受益的公平性.方法:主要利用广州市2008年家庭卫生服务调查资料,运用受益归属分析方法分析人群获得政府医疗机构补助的情况.结果:从绝对公平角度分析,门诊补助、住院补助及医疗总补助的分布均向富裕人群倾斜;其中,20%最富裕人群获得42.7%住院补助而加%贫困人群仅享有19.8%,其集中指数为0.36,提示住院补助的公平性较差.从相对公平角度分析,门诊补助公平性较好,而住院补助分布情况与人群经济水平分布一致,没有很好的发挥缩小贫富差距的作用.健康脆弱人群中65岁及以上老龄人口住院补助Kakwani指数为正值说明相对公平性较差.结论:政府医疗补助应向农村倾斜,加强基层建设,针对贫弱人群.     

从公平的视角看上海市卫生筹资

描述了上海市卫生筹资公平现状,并与天津、黑龙江和甘肃等省市进行了横向比较。研究发现上海市卫生筹资人均水平较高,且宏观公平性较好;家庭卫生筹资渠道中,基本医疗保险支出和个人现金卫生支出呈累退性;家庭灾难性卫生支出和致贫影响相对其他省市低,但也集中发生在经济水平较低人群。针对这些问题,提出了要建立与收入挂钩的筹资机制、统筹医保资金和加强医疗救助等政策建议。     

浅析部分国家卫生筹资模式

纵观世界各国的卫生筹资,从大的方面讲,主要包括公共筹资、私人筹资和其他筹资三种渠道.进一步细分,公共筹资包括税收(国家)筹资和社会健康保险筹资;私人筹资主要包括现金支付和自愿健康保险;其他筹资方式主要是国际、国内捐赠和不属于公共和私人筹资部分的其他筹资方式[1].各个国家根据本国的实际情况,把不同的筹资渠道有机结合,以筹集更多的资金,为人群提供公平、可及的卫生服务,并保护人群尽可能减少因疾病所致的灾难性损失.     

新型农村合作医疗实施后卫生服务可及性和医疗负担的公平性研究

目的:通过对3个新农合试点县879户农民入户调查,研究在实施新型农村合作医疗后,不同收入组参合农民医疗费用负担及受益的公平性。方法:运用集中指数、灾难性卫生支出发生频率等方法,分析不同收入人群卫生服务需要和利用以及医疗费用支出和补偿水平,研究不同收入组受益程度和家庭医药负担的减轻程度。结果:在不同收入人群中,低收入组人群处于“高需要、低利用、高负担、低受益”状况;即两周患病率高,就诊率低,住院费用占家庭收入比例和灾难性卫生支出发生率高,受益比例低。新农合补偿住院费用后,低收入人群家庭负担依然沉重,占全年家庭收入的11.30%。结论:中低和低收入组的卫生服务利用明显低于高收入组;新农合补偿后,相对于补偿前,不公平程度有所缓解,但新农合改善医疗费用不公平的作用是有限的;单靠新农合不足以解决农民大病医药负担和因病致贫问题,对于低收入组这一问题更为突出。     

基于SHA 2011精准决策背景下四川省医院治疗费用分析

目的 :分析评价四川省医院治疗费用筹集、流向及受益人群情况。方法:基于卫生费用核算体系2011。结果:2016年四川省发生在医院的治疗费用为1 232.00亿元,占治疗费用总量的76.95%;筹资来源以公共筹资为主(54.46%),家庭卫生支出为辅(40.82%);主要流向综合医院(73.38%);集中分布在40～80岁人群(61.67%);消耗医院治疗费用最高的前五位疾病是肿瘤(11.77%)、循环系统疾病(11.49%)、呼吸系统疾病(11.05%)、消化系统疾病(10.67%)和损伤、中毒和外因某些其他后果(7.86%)。结论:医院就医负担较重,门诊服务、专科医院尤甚;治疗费用过度集中在综合医院,中医医院所占份额过小;不同类型医院受益人群分布存在重叠,也各具特色。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.