中低收入国家卫生质量管理方法及启示

通过文献复习,介绍了部分中低收入国家提高卫生质量的几种管理方法:标准化临床评估法、医疗记录保存法、卫生项目认证法,并分析了其面临的挑战及未来的发展方向。提出了改善我国卫生质量管理的建议:建立专业的卫生质量管理组织、建立科学化的卫生质量评价流程、加强卫生质量管理信息化建设、促进卫生服务多主体监管等。     

对低收入国家卫生事业状况的分析

我们正处在世纪之交。回顾过去,世界各国在经济领域均取得了长足的进展。人类生活质量不断提高,平均期望寿命不断延长,公众对卫生事业和保健等常规性服务由质到量的需求均在不断地增长。卫生、保健在一定意义上说已经超出了学科的范畴,进而涉及整个社会。一系列的卫生问题不断涌现,全球卫生事业正面临着新的挑战。面对这种趋势,世界各国都在从本国国情出发,已经或正在着手改革传统的卫生观念和运行机制,为提高国民的健康状况进行着积极的探索。在这方面经济发达的工业化国家已经走在了前面,而低收入的国家尽管也取得了一些成就,但相比之下他们面临     

低收入国家卫生事业投资困难

本介绍和分析了尼泊尔，乌干达，巴基斯坦，加纳和越南５个低收入国家在卫生事业上投资的困难，简要介绍了有关国家有关卫生事业建设的资金状况，未来的趋势，资金的运行和分配情况，及其拮据和捉襟见肘的困境。     

津巴布韦国家健康保险计划问题对我国的启示

津巴布韦是经济发展水平在南部非洲仅次于南非的一个发展中国家，１９８５年为了与正在进行立法程序的社会保障制度接轨，政府探索建立“国家健康保险计划”的可能性。由于该计划存在不少问题，因此始终未能提交国会讨论。这些问题对我国医疗保健制度改革有一定参考价值。     

国外罕见病国家政策分析及对我国的启示

系统梳理了英国、德国、法国、澳大利亚和印度的罕见病国家战略及行动计划的基本框架和内容,结合典型国家的罕见病国家政策和我国罕见病政策现状及存在问题,提出我国需进一步明确罕见病的定义、保障罕见病患者的基本权利、加快创新研究提升罕见病诊疗水平和运用PDCA循环方法对罕见病政策进行优化,为完善我国罕见病相关政策提供借鉴。     

描述中低收入国家疾病经济风险的指标综述

利用系统综述方法,对1990年1月1日至2008年1月1日间描述中低收入国家不同医疗保险制度抵抗经济风险能力的中英文文献,进行检索和分析,将52篇文章中反映疾病经济负担的指标归纳为2类11个指标。在应用中,建议同时考虑经济负担与卫生服务利用指标。     

中低收入国家的卫生体系

<正>过去10年来,全球卫生开始逐渐意识到卫生体系的重要性,包括制度、组织和资源(人力、物力、财力)等与卫生服务提供有关的要素,以更好的满足人群需求。而中低收入国家的卫生体系尤为重要,但这些国家缺乏足够资金改善卫生基础设施,一些特定的疾病项目主要依赖外部资金支持,尤其是药物     

母亲的药费

老母亲病后,药费开支越来越大。我在机关上班,挣的也是有限的几个钱,每月为母亲买药已成了不小的负担。 那天,乡下的大哥进城来了,他主动提出要与我分担母亲的药费。我一听就急了,当年为供我上大学,大哥多次忍痛放弃了当兵、招工的机会,自愿留在老家务农照顾二老。     

The relationship between health expenditures and the age structure of the population in OECD countries

The purpose of this study was to analyse national health expenditures of OECD countries relative to their age structures. Using econometric techniques designed to analyse cross-sectional time series data, the ageing of the population was found to affect health spending in several countries while having no effect in others. In addition, the effect of income on health spending was lower than that generally reported in the literature. These findings suggest that unobserved country-specific factors play a major role in determining the amount of resources allocated to health services in a country. Such factors also determine if the ageing of the population is associated with increased health spending.     

The impact of no-fault compensation on health care expenditures: An empirical study of OECD countries

Around the world, governments are faced with spiralling health care expenditures. This raises the need for further insight in the determinants of these expenditures. Existing literature focuses primarily on income, ageing, health care financing and supply variables. This paper includes medical malpractice system characteristics as determinants of health spending in OECD countries. Estimates from our regression models suggest that no-fault schemes for medical injuries with decoupling of deterrence and compensation reduce health expenditures per capita by 0.11%. Furthermore, countries that introduced a no-fault system without decoupling of deterrence and compensation are found to have higher (+0.06%) health care spending.     

Targeted social safeguards in the age of universal social protection: the IMF and health systems of low-income countries

In offering loans to low-income countries in exchange for policy reforms, the International Monetary Fund (IMF) typically sets the fiscal parameters within which health systems develop. In a recent report released by the organisation, the IMF claims that their programmes have promoted social protection, including access to health care. We revisit the findings presented in the IMF’s assessment. Drawing on material collected from the IMF and empirical analyses, we show that the report is methodologically flawed, unduly optimistic and potentially misleading. We conclude by reflecting on the IMF’s steadfast endorsement of targeted social assistance, despite a global tide turn towards universal social provision.     

我国医疗药品费用分析

本文根据1990～1997年我国医疗药品费用估算结果和增长变化趋势,对医疗药品费用增长因素进行分析,建议从宏观角度强化政府的经济干预、行政管理和法律规范,进行行业的全面综合治理。     

Easy cuts,easy rebound: Drug expenditures with massive price cuts in Korea

Backgrounds

Since 2012, the Korean government has introduced 46.5% price cut for off-patent medicines in order to reign everescalating drug expenditure. This study sought to appraise the impact of the price cut measure (in the context of Korean National Health Insurance system).

浙江省农村低保户农民卫生保健状况调查

目的 :了解浙江省农村低保户卫生保健状况及医疗卫生费用。方法 :采用分层整群抽样 ,抽取浙江省开展新型农村合作医疗的试点县和非试点县 343户低保户进行了入户调查。结果 :低保户家庭因病致贫现象严重 ,农民疾病经济负担比较重 ,卫生保健状况令人担忧。结论 :新型农村合作医疗对解决低保户的医疗费用 ,维护其卫生保健有重要意义     

江西省低保户农民对新型农村合作医疗认知的调查研究

目的 了解新型农村合作医疗(简称新农合)实施以来.低保户农民对其认知情况,为正确评价新农舍在低保户农民中的实施效果提供科学依据.方法 采用多阶段分层整群抽样法抽取江西省3个县、9个乡镇和27个行政村,共入户调查低保户375户.结果 在所有被调查的375户低保户中,99.7%的低保户都参加了新农合,30.1%的低保户报销过门诊费用,48.5%的低保户知道怎样报销住院费用.58.9%的低保户知道国家为其参加合作医疗出资,但只有13.9%的低保户知道国家为每人出多少钱,有21.1%的低保户或家人报销过住院费用,并有78.9%的低保户知道周围有人报销过住院费用.所有报销过住院费用的低保户农民都认为合作医疗住院费用报销方便,有31.7%的低保户认为报销时服务人员的态度很好,有83.7%的低保户认为新农合制度是公平、公正、公开的,有75.2%的低保户农民知道新农合报销情况定期张榜公布,有99.5%的低保户表示愿意继续参加下一年的新农合.低保户农民对新农合可能带来的好处的认识,前3位分剐是"生欠病有一定保障"、 "医药费可报销一些"和"政府会补贴一些".在对新农合的意见和担心中."报销比例低"、"看病更贵"和"报销手续繁琐"占前3位.结论 新农合开展以来,低保户农民对新农合有一定的认识和了解,并在一定程度上缓解了低保户农民看病难、看痛贵的问题,但还有部分低保户农民对新农合制度不了解,甚至存在一定的误解和顾虑,应进一步加强新农合制度的宣传工作.     

多项政策对低保农民医疗保障作用的研究

对怀柔区已实施新型农村合作医疗制度的14个镇乡、286个行政村的2005年底前低保农民致贫原因、参加农民大病统筹制度后医疗保障程度进行了调研,发现低保农民因病致贫现象严重,医疗需求低,疾病经济负担沉重,医疗保健状况令人忧虑。多年来政府及相关部门虽然采取了多项政策,但低保农民医疗保障严重不足,低保农民从民政部门出台的政策中得到的实惠甚微,患大病就医住院后从医疗机构得到的优惠不确定。多项政策出自多部门,但最终对低保农民的医疗保障程度责任在政府,应由政府将多项政策合并为一个政策,由相关部门负责落实。     

Household income and health care expenditures in Mexico

The purpose of this paper is to examine the determinants of household health expenditures in Mexico. Our analysis involves the estimation of household monetary health care expenditures, using the economic and demographic characteristics of the household as covariates. We pay particular attention to the impact of household income on health expenditures, estimating the elasticity of health care expenditures with respect to income for different income groups and according to health insurance status. For the empirical analysis, we use the Mexican National Survey of Income and Expenditures of 1989. Our principle findings show that monetary health expenditures by Mexican households are sensitive to changes in household income levels and that the group which is most responsive to changes in income levels in the lower-income uninsured group. This suggests that in times of economic crisis, these households reduce cash expenditures on health care by proportionately more than higher-income and insured households.     

Out of pocket health expenditures in Turkey following introduction of co-payments along with improved primary care services

In 2002, Turkey started to implement reforms in health care aiming to improve access and increase efficiency. Reforms increased health insurance coverage and resulted in higher number of outpatient and inpatient treatments at both public and private hospitals. Later, to change preference towards the use of secondary and tertiary care over primary care and rein in increasing health expenditures, a series of co-payments were instituted along with an extension of primary care services through a family-medicine system that provided free access to all. This work aims to measure the impact of these two simultaneous policy measures on out-of-pocket expenditures. We find that while contributory payments resulted in higher OOP health expenditures, especially for lower income households, the impact was small. We also observe that inability to consult a physician and to visit a hospital, especially for monetary reasons, was reduced after the policy change.