中国妇幼卫生费用测算方法与分析

妇幼卫生费用是指妇女儿童为获得妇幼卫生服务所消费的各种费用总和。为了体现卫生总费用为政策服务的目的 ,中国卫生总费用核算小组采用实际使用法 ,测算了 1992、1997和 1998年全国妇幼卫生费用。文章介绍了妇幼卫生费用的测算目的、指标体系及测算方法与结果 ,并从妇幼卫生费用总量及其构成等方面进行初步分析 ,提出了有关的建议     

安徽省妇幼卫生费用研究报告

妇幼卫生费用是指妇女儿童为获得妇幼卫生服务所消费的各种费用的总和。为了体现卫生总费用的政策服务的目的,中国卫生总费用核算小组采用服务量法,测算了1997－1999年安徽省妇幼卫生费用。介绍了妇幼卫生费有的测算目的,指标体系及测算方法与结果,并从妇幼卫生费用总量及其构成,妇幼卫生业务收入及其构成,住院分娩费用因素分析等角度对测算结果进行初步分析,并与全国相关指标进行了对比,根据测算结果提出了有关的建议。     

我国卫生总费用分配流向测算与分析

本文以经济合作与发展组织(OECD)和世界银行1993年发展报告撰稿人提供的卫生总费用定义、口径和指标体系为指导,以我国各地国民经济统计、卫生统计和卫生财务报表的指标体系为核算依据,按照卫生总费用分配流向,测算了1994年我国各省市自治区卫生总费用,对测算结果进行了初步的分析评价,并提出有关政策建议。     

1995—2005年新疆卫生费用在不同卫生机构的分配及变化趋势研究

卫生费用分配总额测算是卫生总费用核算体系的第二个层次，是按照卫生服务机构分类对卫生总费用进行测算。从卫生职能机构划分，卫生费用表现为不同级别的医疗机构费用、公共卫生机构费用、药品零售机构费用、卫生行政管理机构费用及医学科研机构费用等，反映卫生资金在各级各类卫生机构的分配使用情况，可用来分析与评价卫生资源配置的效率与公平。     

中国卫生总费用分配流向研究报告

本文作者以经济合作与发展组织(OECD)和世界银行1993年发展报告撰稿人提供的卫生总费用定义、口径和指标体系为指导,以我国国民经济统计、卫生统计和卫生财务报表的指标体系为核算依据,按照卫生总费用分配流向,测算了从1978年到1994年中国卫生总费用(1995年中国卫生总费用是预测值),对测算结果进行了初步的分析评价,提出有关政策建议。     

医药费用控制指标体系的研究

为有效控制医疗机构的医药费用，促进医疗机构用比较低廉的费用提供比较优质的医疗服务．在文献分析和专家咨询的基础上，提出了从病人总体负担指标、成本指标、用药情况指标、检查费用指标和其他相关指标等5个方面建立医药费用监测评价指标体系（以下简称“体系”），并对该体系进行了初步分析探讨．体系的建立将对医药费用的控制起到重要的积极作用。     

医院卫生费用核算方法学研究

根据卫生费用核算的基本理论和方法,提出了医院卫生费用核算的基本概念,对在我国实行医院卫生费用核算的口径进行界定．并建立了符合我国实际情况的核算指标体系,讨论了实际操作中的数据收集方法和测算具体方法,对在我国建立医院卫生费用核算系统具有方法学指导意义。     

安徽省卫生总费用实际使用法研究报告

卫生总费用实际使用法是根据消费者所接受的各种卫生服务的数量和成本价格估算卫生总费用的一种测量方法。中国卫生总费用核算小组根据上述原则与方法测算了安徽省1997,1998卫生总费用。首次介绍了在安徽省应用实际使用法测算卫生总费用的目的，指标体系及其理论依据，测算方法及结果。从卫生总费用的总量及其构成，发展速度等方面与全国卫生总费用的相关指标进行了初步对比分析，并提出了有关的建议。     

2001年辽宁省卫生总费用测算结果及评价

1990—2000年,辽宁省一直采用筹资法测算全省卫生总费用,这对于进行卫生筹资结构和筹资来源变化趋势分析,为制定筹资政策提供了重要依据。但仅用这种核算方法不能反映卫生资源利用的合理性和卫生资金分配的公平性。从2001年起,我省同时采用筹资法和分配流向法进行卫生总费用的核算,现将测算过程、结果及其评价报告如下:1分配流向法涵义及指标体系分配流向法也称机构法。它是从中观上反映由社会筹集到的卫生资金在各种分配和补偿政策作用下,流向卫生部门各层次和各服务项目的情况。分配流向法指标体系由医疗机构费用、药品零售费用、公共卫生…     

2022年中国卫生总费用核算结果与分析

目的：核算2022年我国卫生总费用,分析“十三五”以来卫生筹资主要变化趋势,总结当前卫生筹资面临的主要问题和挑战,提出政策建议。方法：基于来源法、机构法及卫生费用核算体系2011的核算结果,分析我国卫生总费用及经常性卫生费用变化情况。结果：2022年,我国卫生总费用为85 327.49亿元,占GDP比重为7.05%,人均卫生总费用为6 044.09元;其中,个人卫生支出占卫生总费用比重降至26.89%,政府卫生支出占比升至28.17%,社会卫生支出占比降至44.94%,筹资结构继续优化。结论：我国卫生费用总规模持续增长,但卫生筹资系统韧性有待加强,需加快健全多层次医疗保障体系,提升筹资保障水平与人民群众获得感,优化卫生资金配置,提升卫生费用的效率效能。     

The costs of schizophrenia in Puerto Rico

Mental illnesses generate social costs by reducing the productive capacity of manpower and increasing government and private expenditure in mental health services. The social costs associated with a mental illness depend on several factors: the level of impairment caused; the type of specialized service required, such as medical treatment; the chronicity of the disorder; and the age of onset of the disorder. Finally, the total cost to society depends on the size of the population affected by the disorder. Results confirm those of other research, which has found schizophrenia to be a costly illness. Annual loss of income represents 3.7% of the annual gross national product of the island. The expenditures for mental health services are 26.8% of the total budget of the Mental Health Secretariat. The large human capital cost caused by the disorder justifies more funds for research and treatment for people who are schizophrenic.     

National health expenditures, 1988. Office of National Cost Estimates

Every year, analysts in the Health Care Financing Administration present figures on what our Nation spends for health. As the result of a comprehensive re-examination of the definitions, concepts, methods, and data sources used to prepare those figures, this year's report contains new estimates of national health expenditures for calendar years 1960 through 1988. Significant changes have been made to estimates of spending for professional services and to estimates of what consumers pay out of pocket for health care. In the first article, trends in use of and expenditure for various types of goods and services are discussed, as well as trends in the sources of funds used to finance health care. In a companion article, the benchmark process is described in more detail, as are the data sources and methods used to prepare annual estimates of health expenditures.     

我国城乡居民医疗保健支出现状分析

目的 了解我国城乡居民卫生费用及医疗保健支出情况,为完善卫生系统筹资战略提供客观依据.方法 采用1999年至2007年统计年鉴数据,对我国城乡居民卫生费用及医疗保健支出现状及变化趋势进行分析.结果 城乡卫生费用筹资额定比增长了200%;城乡居民人均医疗保健支出增长幅度差异明显(城市为152.86%,农村为172.77%);居民医疗保健支出随人均收入变化而稳步增长,但健康消费总体水平仍很低,尤其是农村居民;2003年以来农村居民医疗保健支出收入弹性比城镇居民大,相对差距正逐步缩小.结论 应重点增加农村居民收入,提高社会边际医疗保健支出倾向;改善医疗卫生服务条件,扩大医疗保障覆盖面,带动城乡居民医疗保健的合理消费;重视文化因素的作用,提高全民健康投资意识和自我保健能力.     

Mental Health Services for Children in Large, Employer-Based Health Plans, 1999

This study examines 1999 data from Medstat's MarketScan database of privately insured employees of US firms and their dependents. Of enrolled children and adolescents ages 2-18, 6.6% had claims for mental health services. Average outpatient expenditures per user were $651. Of children/adolescents with claims for mental health services (MH claimants), 3.4% had inpatient MH services, with an average length of stay of 8.9 days and average MH-related inpatient expenditure per user of $7,048. One half of MH claimants who had pharmacy benefit data had claims for psychotropic medications, with average expenditures per user of $328. Whereas children/adolescent mental health users comprised 8.3% of all service users, expenditures for their care were 20.5% of all service expenditures for children/adolescents in private health plans. Results also highlight the importance of including data on psychotropic medication in analysis of children's MH services utilization, as well as the need to consider the use of psychotropic medications among children/adolescents who do not utilize other MH services.     

State public health agency expenditures: categorizing and comparing to performance levels.

For optimal effectiveness, assessments of public health agency and system performance should include analysis to measure the amount of financial resources consumed to achieve performance levels. This pilot study was conducted to test a methodology in a state health department for comparing financial resources consumed to performance scores in each of the 10 Essential Public Health Services categories. An additional feature was to quantify the percentage of total agency expenditures utilized for administrative functions as well. The allocation of all fiscal year 2004 expenditures to the 10 Essential Public Health Services and administration categories was based on assessments of employee job functions and scope of services performed under agency contracts. Performance scores were obtained through a 2-month process of completing self-assessment surveys with system partners using the National Public Health Performance Standards Program Assessment Instrument. Investigators found no clear consistency between performance scores and agency expenditure levels. Two categories, essential service 5 (develop policies and plans) and essential service 10 (research), did have low performance and low expenditure levels. Overall though, categories with high performance scores consumed low percentages of agency expenditures and expenditure patterns were relatively high in categories with low performance scores. The study did quantify that the percentage of expenditures in the administration category was low compared to previous studies in other health departments. This knowledge was particularly useful for informing policymakers.     

Judging doctor supply--market or health criteria?

Large rural areas of developing countries show severe shortages of physicians, graduate nurses, and other trained health personnel. Countries have tried to alleviate this problem in several ways, including requiring all new medical graduates to 1st undertake periods of service in rural areas, the use of mobile clinic teams from small towns to visit outlying villages on a regular basis, and the use of air ambulances to transport seriously ill persons from isolated places to hospitals in cities. Perhaps the most significant strategy has been the use of trained community workers to provide primary health care for rural and low-income urban populations. Unfortunately, weak supervision of the community workers has often led to unsatisfactory performances. Surprisingly, a recent international congress claimed that many developing countries are training too many doctors, that some developing countries have, or will soon have, 1000s of unemployed physicians. However, comparison with developed countries shows that the "diagnosis" of a country's doctor supply situation may not depend on a universal standard, but on that job market's capacity for absorption of personnel. If specific public health goals are to be reached however, commercial criteria cannot be applied to the evaluation of a nation's health manpower; instead social need must be analyzed and strategies designed to meet them. Policy is shaped by the priority public authorities give to services. Of the 7 developing countries which reported a surplus of doctors, only Colombia and Mexico reported spending more on public health than on the military. In addition, in the other 5 countries, 40% or less of the overall public and private expenditures on health came from the government. When military expenditures absorb a high share of government funds, public support for health services is adversely affected, and individuals and families must depend on their own expenditures to obtain health services. Health services should be recognized as a basic human right, and, therefore, as an obligation of society. To meet this obligation necessary strategies are 1) increase public support, not only by increasing the health share of the general budget, but by other sources such as social security and community financing, 2) require 5-10 years of social service for all medical school graduates, 3) ensure that renumeration for doctors in public service is adequate to support a decent standard of living, 4) continue to train community health workers, but ensure physicians are qualified to supervise them, and, 5) health services and health manpower should be guided by principles of social justice, not by those of commercial market dynamics.     

基于“卫生费用核算体系2011”的北京市治疗服务费用核算结果

目的:基于"卫生费用核算体系2011"核算、分析北京市治疗服务费用。方法:以"卫生服务核算体系2011"为基础,结合北京市实际情况,从筹资方案、机构流向、服务功能等维度核算北京市治疗费用。结果:北京市治疗费用总量为1 185.24亿元,占经常性卫生总费用比重为73.41%,占GDP比重为5.16%,门诊和住院服务费用比例约为6:4,治疗服务主要由医院提供。结论:疾病治疗是卫生服务消费主体;治疗服务资金的筹集渠道呈多元化,筹资结构尚待优化;提供治疗服务的消耗主要发生在医院;治疗服务以提供门诊服务为主,门诊和住院筹资方案略有差异。     

Does non‐profit health insurance reduce financial burden? Evidence from the Vietnam living standards survey panel

Many low-income countries are implementing non-profit medical insurance to increase access to health services, especially among low-income households, and to raise additional revenue for financing public health services. This paper estimates the effect of insurance on out-of-pocket health expenditures using the Vietnam Living Standards Surveys for 1993 and 1998 and appropriate models for panel data. Our findings suggest that health insurance reduces health expenditure when unobserved heterogeneity is accounted for. Failure to capture unobserved heterogeneity produces contrary results that are consistent with previous cross-sectional studies in the literature. Health insurance is found to reduce out-of-pocket expenditure between 16 and 18% and the reduction in expenditure is more pronounced for individuals with lower incomes. At mean income, the effect of health insurance is to reduce health expenditures between 28 and 35%.     

The impact of public voluntary health insurance on private health expenditures in Vietnam

As a financing mechanism with the potential to raise additional funds for health services, whilst improving access to services amongst the poor, non-profit health insurance has become increasingly attractive to health policy-makers. Using data from a household survey in Vietnam, out of pocket health expenditure are compared between members and eligible non-members of the government-implemented voluntary health insurance scheme. Expenditures are analysed for individuals who sought care during their most recent illness. Using an endogenous dummy variable model to control for bias resulting from self-selection into the scheme, we find that health insurance reduces average out-of-pocket expenditures by approximately 200%. Whilst income inelastic, health expenditures are found to be significantly influenced by an individuals level of income, irrespective of insurance status. Despite this, insurance reduces expenditures significantly more for the poor than for the rich.