基于机构流向法的省级中医药总费用核算方法研究

目的:研究省级中医药总费用机构流向法核算体系,为其他各省市的中医药总费用核算工作提供方法学支持。方法:机构流向法、个案库汇总法、系数分摊法。结果与结论:本研究首次构建基于个案库汇总的方法核算省级中医药总费用,方法创新,结果相对准确;可能高估了中医类机构费用;可能低估了非中医类机构的财政项目补助收入;核算工作需要数据量较大,需要多部门共同协作。     

基于机构流向法的北京市中医药服务利用情况研究

目的:研究北京市医疗卫生机构的中医服务利用情况。方法:基于比例系数的个案库汇总法。结果:北京市中医药服务发展较慢,中医药总费用发展速度慢于卫生总费用;基层医疗卫生机构与药品零售机构对中医药的利用较多,但发展缓慢。结论:加大对中医药事业的扶持力度,优化基层机构的中医医疗服务资源配置。     

北京市医改前后卫生总费用机构流向分析

目的:对比分析北京市医改前后卫生总费用机构流向。方法:个案库汇总法。结果:医改后北京市机构法卫生总费用增长加快,流向更加合理。结论:加强基层卫生服务体系建设,完善医疗保障制度。     

基于组合模型的北京市中医药总费用预测研究

目的:基于组合模型预测2022—2030年北京市中医药总费用的变化趋势,为政策制定和调整提供数据支撑和参考。方法:运用ARIMA模型和灰色GM （1,1）模型构建组合模型,对北京市中医药总费用机构流向构成部分及总量进行预测。结果:组合模型拟合精度明显优于GM （1,1）模型和ARIMA模型分别预测的结果;根据预测结果,北京市中医药总费用从2022年的826.23亿元增至2030年的1 447.13亿元,年均增速为7.26%,机构流向优化明显。结论:可探索利用组合模型来提高费用预测精度;突发公共卫生事件对中医药费用存在较大冲击;应合理看待预测研究结果,根据实际情况的变化不断优化预测模型。     

基于机构流向法的北京市医院中医药费用研究

目的:分析2013—2015年北京市医院中医药费用的机构流向及变化趋势。方法:采用个案库汇总法。结果:中医类医院的费用占医院中医药总费用主体;中医类医院收入增加,且增长较快;非中医类医院中医科收入较少,且增长缓慢;结论:中医类医院总体发展较快,但次均诊疗费用低于北京市医院总体平均水平,应合理调整中医服务价格体系;非中医类医院的中医科建设薄弱,应加快中医科室的建设。     

“十三五”期间北京市基层中医药发展现状研究:基于机构法中医总费用核算

目的：通过基层中医费用的发展变化及流向情况分析，研究“十三五”期间北京市基层中医药服务的发展状况。方法：采用基于比例系数的个案库汇总法。结果：“十三五”期间，基层中医药服务能力实现了与卫生系统的协调发展； 社区卫生服务机构是基层中医药服务提供的主体；基层中医药服务主要以提供药品服务为主。结论：北京市应借力发展契机，进一步提升基层医疗卫生机构中医药服务能力；多渠道并进，推动中医门诊部、诊所发展；发展基层中医特色技术服务, 提升基层中医药发展质量。     

山东省卫生总费用流向研究

目的:了解山东省卫生总费用流向情况。方法:采用机构流向法测算1998—2009年山东省卫生总费用数据,并对核算结果进行综合分析,反映、分析和评价山东省卫生资金机构流向的发展变化趋势,提供卫生政策的反馈信息。结果:山东省卫生总费用占GDP比重偏低;山东省卫生总费用机构流向不甚合理;药品收入依然是医疗机构的重要收入来源。结论 :加大政府卫生投入力度,建立长效卫生投入机制;积极引导卫生费用合理流动;稳步推进药品零差率销售,逐步改变"以药养医"的局面。     

基于中医总费用核算的北京市中医药服务能力发展状况研究

目的:分析北京市机构法中医总费用的总量、发展及结构等,研究北京市中医药服务能力的发展状况.方法:运用机构法中医总费用、机构法卫生总费用核算方法.结果:北京市中医医疗服务能力整体快于卫生服务的发展;中医药资源在机构间流向逐步优化;中医类医院提供了更多的中医药服务,非中医类医院中医资源发展缓慢;城郊中医药资源差异逐步减小;北京市对中医服务的利用整体优于全国.结论:深化中医医疗服务价格改革,平衡各方利益;引导中医优质资源下沉,使中医药费用继续向基层流动;加强非中医类医院中医科的建设发展;完善郊区中医资源配置,缩小城郊医院中医服务差距;引导社会资本进入中医医疗服务行业,形成多元化办医局面.     

北京市卫生总费用来源法与机构法结果差异原因分析

目的:深入分析北京市卫生总费用来源法和机构法两种核算方法产生差异的原因,为北京市区域卫生政策制定提供参考。方法:筹资来源法,机构流向法。结果:北京市卫生总费用两种核算方法的差异主要是由于军队驻京机构数据、医保基金结余数据和外地居民来京费用等原因引起。结论:完善信息统计制度;深入分析,为政策服务;京津冀医疗卫生协同发展,缓解就医压力。     

山东省总费用分配下的公共卫生机构筹资研究

目的:了解山东省卫生总费用下的公共卫生机构筹资情况.方法:利用机构流向法测算1998-2012年山东省卫生总费用结果,结合山东卫生财务年报资料,采用定量和对比分析等方法,研究山东省公共卫生机构筹资情况,进而提出解决的方法和相关政策建议.结果:山东省公共卫生机构费用在总费用中的比例偏低;公共卫生筹资模式不合理;公共卫生资源的利用效率不高.结论:继续加强政府在优化卫生资源分配方面的主导作用;逐步改革和优化公共卫生筹资模式;重点提升政府卫生资金分配和绩效管理水平.     

Total energy expenditure in the elderly

Chronic diseases and disabilities increase with age, affecting more than 60% of those over 75 y, and limiting activities in about half of them. Therefore, total energy expenditure (TEE) and its components are assessed separately in health and disease. An analysis of 568 doubly labelled water measurements in 'healthy' subjects (184 measurements in subjects over 65 years) suggests that there is a decrease of 0.69 and 0.43 MJ/day/decade respectively in men (standard weight 75 kg) and women (standard weight 67 kg). Physical activity (PA) accounted for 46% of the decrease in TEE, basal metabolic rate (BMR) for 44% of the decrease and thermogenesis (T) for the remaining 10%. TEE was found to be 10.79+/-2.09 and 8.62+/-1.49 MJ/day in 150 men and 100 women aged over 60 y, respectively. Of the total variance in TEE, measured with doubly labelled water over a 2 week period, 69% was considered to be due to differences between individuals, and 31% to differences within individuals. The variance due to PA plus T was threefold greater than that due to BMR. Physiological factors were far more important than methodological factors in influencing measurements of TEE, BMR and PA+T. An analysis of 136 measurements of TEE (doubly labelled water and bicarbonate-urea methods) in free-living elderly patients suffering from a variety of diseases suggests a frequent decrease in TEE, which may occur despite an increase in BMR. This is largely due to a reduction is PA (eg up to approximately 50% reduction), but in some cases it is also due to a reduction in BMR (loss of body weight). More comprehensive information is required about TEE and its components, partly because of a probable selection bias in recruitment of subjects participating in specific tracer studies, and partly because of the variable effects of different diseases and factors that operate at different times in the course of the same disease.     

Variations in provider conceptions of integrative medicine

Consumers often turn to complementary and alternative medicine (CAM) and use it concurrently with conventional medicine to treat illnesses and promote wellness. However, prior studies demonstrate that these two paradigms are often not combined effectively. Consumers often do not tell physicians about CAM treatments or CAM practitioners about conventional treatments that they are using. This can lead to inefficient care and/or adverse interactions. There is also a lack of consensus about the structure and practice of integrative medicine among the various types of practitioners. This qualitative study aimed to identify key domains and develop a conceptual model of integrative medicine at the provider level, using a grounded theory approach. Purposive sampling was used to select 50 practitioners, including acupuncturists, chiropractors, internists/family practitioners, and physician acupuncturists in private practice and at academic medical centers in Los Angeles. We conducted semi-structured, in-depth interviews with practitioners and then identified core statements that describe practitioners' attitudes and behaviors toward integrative medicine. Core statements were free pile sorted to ascertain key domains of integrative medicine. Four key domains of integrative medicine were identified at the provider level: attitudes, knowledge, referral, and practice. Provider age, training, and practice setting also emerged as important factors in determining clinicians' "orientation" toward integrative medicine. "Dual-trained" practitioners, such as physician acupuncturists, exemplified clinicians with a greater orientation toward integrative medicine. They advocated an open-minded perspective about other healing traditions, promoting co-management with and making referrals to practitioners of other paradigms, and treating patients with both CAM and conventional healing modalities.     

基于时间序列数据的北京市卫生筹资水平、构成趋势研究

目的:分析评价北京市基于时间序列的卫生筹资总额、结构变化等。方法:卫生总费用筹资来源法。结果:2000—2016年北京市卫生筹资总额从166.72亿元增长到2 048.99亿元,平均增长速度为13.00%,人均卫生总费用从1 222.65元增长到9 429.73元,卫生总费用占GDP的比重从5.27%增长到7.98%,城乡居民就医负担总体呈下降趋势,但城乡差异较大。结论:北京市卫生总费用变化体现宏观政策变化,社会卫生支出高速增长,政府对卫生筹资贡献的影响力减弱,个人现金卫生支出占总筹资比重下降,城乡居民就医负担有所缓解。建议:保证政府卫生投入的可持续性,规范发展商业健康保险,引导社会资本流入医疗,拓宽社会筹资渠道,控制个人现金卫生支出占比。