海南省卫生Ⅸ项目妇幼医疗救助资金管理探讨

目的:探讨卫生Ⅸ项目妇幼医疗救助资金管理办法。方法:随机对海南省3个项目市县进行工作调查,调查方法为信函调查、现场调研。结果:3个项目市县实筹扶贫资金均高于应筹资金,三亚市和昌江县的总支付补偿资金与实筹资金一致,保亭县总支付补偿资金高出实筹资金5.34万元(为实筹扶贫资金的126.99%)。扶贫资金覆盖率三亚市为6.51%,保亭县为5.57%,昌江县为4.9%。救助对象认为补偿比例合理的占61.9%,认为该项目能减轻家庭经济负担的占60.3%。结论:海南省卫生Ⅸ项目妇幼医疗救助资金管理办法有利于卫生Ⅸ项目妇幼医疗救助目标的实现。     

四川省贫困地区实施医疗救助现状及对策

1997-2005年,中国基本卫生服务项目(卫生VIII项目,QBHP)在世界银行贷款和其他国际组织赠款支持下,在中西部秦巴山区进行了开创性的贫困医疗救助实验^〔1〕。2006年1-6月,本研究对该项目在四川省贫困地区开展医疗救助8年来的情况进行了抽样调查。结果表明,贫困地区开展医疗救助取得一定成效^〔2〕,但是在一些关键问题上还需要加以改进。现将贫困地区实施医疗救助存在问题探讨如下,并提出相应对策。     

卫Ⅸ项目(南方项目省)特困人群妇幼医疗救助计划中期评估

特困人群的妇幼医疗救助计划是在世界银行贷款卫Ⅸ项目中改善贫困人口的妇幼卫生服务利用的一项重要项目内容。这个计划通过建立针对特困人口的医疗救助基金，并通过基金的补偿机制，提供给特困家庭妇幼医疗保健直接的经济援助，以提高特困家庭中妇女儿童医疗保健服务利用，改善妇幼健康状况。该计划从2000年开始，在5个项目省陆续展开。     

贫困地区人口实施医疗减免制度的效果评价

目的：了解法国无国界医生组织在广西壮族自治区边远地区贫困人口实施医疗减免制度的情况，从而对贫困人口实施医疗减免制度的效果进行评价。方法：对项目覆盖的9个村(人口8477人)，按减免类别分为A(非减免家庭)、B(半减免家庭)和C(全免家庭)类，计算分析各类人口的就诊数和所支付的医药费和治疗费。结果：减免制度涉及的村民平均每人花费1．70元／年，减免制度涉及的享有减免待遇(B类和C类)村民平均花费4．00元／年就可享受基本的医疗服务。结论：对贫困地区人口实施医疗减免制度是花钱少、见效快、使贫困边远山区的村民更容易获得基本医疗服务，同时，又是保证村卫生所保本经营，防止村民因贫致病、因病致贫的有效手段。     

贫困地区特困人口医疗救助利用情况分析

为了解重庆市黔江区贫困地区特困人口医疗救助利用情况，便于以后有针对性地进行干预活动，对重庆市黔江区医疗救助利用情况进行了调查。结果：显示自1999年7月在重庆市黔江区实施卫生Ⅷ支持性项目以来，改善了贫困地区特困人群对基本卫生服务利用的可及性，加快了卫生改革与发展的步伐，促进了卫生事业的发展。     

成都和沈阳医疗救助项目实施评价

中英城市卫生服务与贫困医疗救助项目(Chi- na-DfID Vrban Health and Poverty Project UHPP项目)的目标之一是通过城市贫困人口救助机制的创新性实践,探索建立多部门协调、全社会各方面参与、具有可持续性发展的城市贫困医疗救助制度。     

贫困地区医疗救助面临的问题与对策——基于四川秦巴卫生项目效果的实证分析

针对贫困者实施医疗救助是消除和减轻健康贫困的重要措施,当前中国正在逐步建立覆盖全果的贫困医疗救助制度。文章结合秦巴卫生扶贫项目在四川干预试点的调查结果．分析了贫困地区实施医疗救助所取得的极大成就和面临的实际困难,指出贫困地区需要更多的财政转移支付进行筹资,救助目的要建立在促进改善健康水平的基础上。作者认为促进救助资金的高效利用和改善管理与监督环节是贫困地区开展医疗救助制度的关键措施。     

我国城市医疗救助对象的卫生服务需求调查

城市贫困人口卫生服务公平性及可及性一直是政府及社会关注的问题。了解其主要的健康问题、影响健康的因素是改善贫困人口健康状况的基础和前提，可以使我国城市医疗救助制度的开展具有更强的针对性，做到有的放矢。     

云南省卫Ⅵ扶贫项目及南华县妇幼人口医疗救助基金计划效果评价

为了调查综合性妇幼卫生保键项目中扶贫医疗救助实施完成情况 ,在抽样调查点采用自评、问卷、访谈、小组讨论、文件阅读和入户调查等方法 ,定量调查扶贫资金筹集情况、补偿比例和服务利用率等。云南省孕产妇扶贫对象年覆盖率 (3.5%～ 5.6% ) ,低于抽样县孕产妇扶贫对象年覆盖率 (4.9%～ 1 4 .4% ) ,而儿童扶贫对象年覆盖率(1 .5%～ 3.4% )与抽样县儿童扶贫对象年覆盖率 (1 .4%～ 3.5% )相近。抽样乡年孕产妇和儿童扶贫对象覆盖率最高为 1 3.4% ,最低为 0。云南省扶贫资金以孕产妇保健年补偿最高 (45.8%～ 89.7% ) ,以高危住院分娩最低 (2 0 .3%～35.1 % )。平均补偿额以产科合并症抢救最高 ,年平均为 2 37.6～ 673.3元 ,以孕产期保健平均补偿额最低 ,为 3.7～ 1 3.3元。扶贫基金的使用大幅度地降低了贫困孕产妇和 5岁以下儿童死亡率。扶贫基金的利用、配套基金的落实和现场各种组织实施需要各级政府和卫生行政部门大力支持与督导     

对"特困救助"实施效果的评价

目的：通过对河南省“卫VⅢ”项目县特困救助户和非特困救助户的住院需求、利用及满足程度的比较分析，对特困救助的实施效果进行评价，进而找出特困救助实施过程中存在的问题及解决办法。方法：入户调查收集资料，用FOXPRO软件建立数据库，然后用SAS6.12软件进行统计分析。结果：在同等的住院服务需求下，非救助组的应住院率而未住院率高于特困救助组，在未住院原因构成中，因经济困难而未住院的原因构成非救助组高于救助组。结论：特困救助是一种有效地解决贫困人群就医困难的办法，但尚需不断改革和完善。     

State responses to new flexibility in medicaid

CONTEXT: States have long lobbied to be given more flexibility in designing their Medicaid programs, the nation's health insurance program for the low-income, the elderly, and individuals with disabilities. The Bush administration and the Deficit Reduction Act of 2005 have put in place policies to make it easier to grant states this flexibility. METHODS: This article explores trends in states' Medicaid flexibility and discusses some of the implications for the program and its beneficiaries. The article uses government databases to identify the policy changes that have been implemented through waivers and state plan amendments. FINDINGS: Since 2001, more than half the states have changed their Medicaid programs, through either Medicaid waivers or provisions in the Deficit Reduction Act of 2005. These changes are in benefit flexibility, cost sharing, enrollment expansions and caps, privatization, and program financing. CONCLUSIONS: With a few important exceptions, these changes have been fairly circumscribed, but despite their expressed interest, states have not yet fully used this flexibility for their Medicaid programs. However, states may exercise this newly available flexibility if, for example, the nation's health care system is not reformed or an economic downturn creates fiscal pressures on states that must be addressed. If this happens, the policies implemented during the Bush administration could lead to profound changes in Medicaid and could be carried out relatively easily.     

The impact of an innovative reform to the South Carolina dental medicaid system

OBJECTIVE: To evaluate the effectiveness of an innovative reform in 2000 to the Dental Medicaid program in South Carolina. DATA SOURCES/STUDY SETTING: South Carolina Medicaid enrollment data and dental services utilization data from 1998, 1999, and 2000. STUDY DESIGN: The study was observational and retrospective in nature. Quarterly data were used in general linear regression models to examine time trends in the percent of Medicaid enrollees ages 21 and younger who received dental services. Trends in the total number of dental procedures provided per Medicaid enrollee were also analyzed, with sub-analyses performed on the four most frequent categories of procedures. DATA COLLECTION/EXTRACTION METHODS: Data were provided by the state's Quality Improvement Organization. PRINCIPAL FINDINGS: From 1998 to 1999, there was a downward trend in the number and percent of Medicaid enrollees ages 21 and younger receiving dental services and in the total number of services provided. This trend was dramatically reversed in 2000. CONCLUSIONS: The January 2000 dental Medicaid reform in South Carolina had marked impact on Medicaid enrollees' access to dental services.     

中部崛起背景下的城市社区卫生资源优化策略研究

通过中部某市7个中心城区社区卫生机构的资源状况调查，在对其发展中的主要问题及其原因分析基础上，提出了若干可行的优化策略，旨在为管理决策、促进社区卫生服务可持续发展提供信息支持服务。     

The effect of the MassHealth hospital pay-for-performance program on quality

Objective

To test the effect of Massachusetts Medicaid''s (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP).

Data

Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N = 62) and other states (N = 3,676) and American Hospital Association data on hospital characteristics from 2005.

Study Design

Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics.

Principal Findings

Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (−0.67 percentage points, p>.10) and SIP (−0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications.

Conclusions

Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation.     

流动人口孕产妇分娩救助探讨

目的:调查流动人口孕产妇分娩限价救助标准及效果评价,探索流动人口贫困孕产妇分娩救助方法。为政府制定措施提供依据。方法:采用回顾性病历分析研究方法,抽取北京市城乡结合部三所试点医院分娩的流动人口孕产妇的分娩资料,选择接受基本服务项目并且住院阴道分娩费用≤1000元的275例产妇为研究组,选择同期孕期检查正常、阴道分娩费用>1000元的312例产妇为对照组。对两组孕产妇分娩费用进行分析。结果:分娩数2004年比2003年平均增加80.3%。研究组总费用平均为909.15元,对照组平均为2102.56元。研究组主要费用花在必须利用的医疗服务上。对照组费用增加主要是药费、床位费、治疗费。由于实施本研究规定的正常分娩基本服务项目及收费,三家医院产科及相关科室收入减少。结论:本项目实施的分娩服务项目及费用对贫困流动人口是可行的,对她们的经济负担影响不大,是可接受的。但救助对试点医院存在显著影响,而且医疗风险增加。所以要实现现行救助方式的可持续性,政府应予以医院补贴及政策支持。     

The Medicaid expansion did not crowd out access for medicaid recipients with disabilities in Oregon

BackgroundThe Affordable Care Act (ACA) substantially increased the number of Medicaid enrollees, which could have reduced access to health care services for those already on Medicaid before the expansion.ObjectiveTo examine the association of the ACA expansion on health care access and utilization for adults ages 18–64 years who have qualified for Supplemental Security Income (SSI) in Oregon.MethodsWe used Oregon Medicaid claims and enrollment data from 2012 to 2015 and information from the American Community Survey and the Local Area Unemployment Statistics. Multivariate regressions compared changes in health care access and utilization before and after the expansion among Medicaid recipients who qualified for SSI across counties in Oregon with higher and lower Medicaid enrollment increases due to the expansion. Health care access and utilization outcome measures included: primary care visits, non-behavioral health outpatient visits, behavioral health outpatient visits, emergency department (ED) visits and potentially avoidable ED visits.ResultsThe Medicaid expansion led to an uneven increase in Medicaid enrollment across Oregon’s counties (mean increase from the first quarter of 2012 to the third quarter of 2015: 12.4% points; range: 7.3 to 18.6% points). Access and utilization outcomes for SSI Medicaid recipients were mostly unaffected by differential enrollment increases. ED visits increased more in counties with a larger Medicaid enrollment increase (estimate: 1.8, p < 0.05), but adjusting for pre-expansion trends eliminated this association.ConclusionsWe did not find evidence that an increase in Medicaid enrollment due to the ACA negatively impacted access and utilization for adult Medicaid recipients on SSI, who were eligible for Medicaid prior to expansion.     

Asthma in medicaid managed care enrollees residing in New York City: Results from a post-world trade center disaster survey

The collapse of the World Trade Center on September 11, 2001, released a substantial amount of respiratory irritants into the air. To assess the asthma status of Medicaid managed care enrollees who may have been exposed, the New York State Department of Health, Office of Managed Care, conducted a mail survey among enrollees residing in New York City. All enrollees, aged 5–56 with persistent asthma before September 11, 2001, were surveyed during summer 2002. Administrative health service utilization data from the Medicaid Encounter Data System were used to validate and supplement survey responses. A total of 3.664 enrollees responded. Multivariate logistic regression models were developed to examine factors associated with self-reported worsened asthma post September 11, 2001, and with emergency department/inpatient hospitalizations related to asthma from September 11, 2001, through December 31, 2001. Forty-five percent of survey respondents reported worsened asthma post 9/11. Respondents who reported worsened asthma were significantly more likely to have utilized health services for asthma than those who reported stable or improved asthma. Residence in both lower Manhattan (adjusted OR=2.28) and Western Brooklyn (adjusted OR=2.40) were associated with self-reported worsened asthma. However, only residents of Western Brooklyn had an elevated odds ratio for emergency department/inpatient hospitalizations with diagnoses of asthma post 9/11 (adjusted OR=1.52). Worsened asthma was reported by a significant proportion of this low-income, largely minority population and was associated with the location of residence. Results from this study provide guidance to health care organizations in the development of plans to ensure the health of people with asthma during disaster situations.     

The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits

Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p < 0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p < 0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p < 0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p < 0.01) less likely to have a functional limitation due to vision.