2保障＋2保险：国际医保模式新解读

免费医疗保障 免费医疗保障模式，也称国家医疗、全民医疗保障模式，是指医疗保障资金主要来自税收，政府通过预算分配方式，将由税收形成的医疗保障基金有计划地拨给有关部门或直接拨给公立医院，医疗保障享受对象看病时基本上不需要支付费用的制度。实行免费医疗保障模式的国家，基本上由国家开办医院，提供医疗服务。在公立医院工作的医务人员的工资直接由国家分配。     

应尽快建立完善的农村老年医疗保障体系

我国已进入老龄化社会,而且是“未富先老”,所以老年保障问题面临严峻考验,尤其是农村老年医疗保障。因此必须尽快建立与我国农村经济社会发展状况相适应的农村老年保障医疗体系。1农村老年医疗保障的历史与现状在我国,老年医疗保障从属于全民医疗保障,没有相对独立的专门针对老年人口的医疗保障制度,并且实行的是城乡分割,在城镇实行的是公费医疗和劳保医疗,在农村则实行合作医疗,它们共同组建了城乡医疗保障体系。合作医疗制度是我国农村社会的基本制度之一,它是在各级政府支持下,按照参加者互助互济的原则组织起来的,为农村社会人群提供…     

基于医疗保障制度的中英医患关系比较与分析

近年来,医疗纠纷日趋严重让我们不得不反思国内医疗体制的不足。在反思自身医疗体制不足之时,学习国外的先进医疗制度也显得尤为重要。英国在全球首先实行全民医疗免费服务,医患关系比较稳定,学习和借鉴英国在医患纠纷方面的经验,对于促进我国医患关系的发展具有积极的意义。本文通过对中英医疗保障制度和医患关系的比较与分析,提出了完善我国医疗保障制度和改进我国医患关系的建议。     

泰国农村的健康保障制度及其对我国的借鉴

2001年，泰国成为世界上为数不多的实现全民健保的中低收入国家，这主要得益于它以全民健康为目标的医疗保障制度，通过对不同人群实行不同的医疗保障计划实现了覆盖全民的医疗保障目标。尤其是它针对农村居民实行的“30铢计划”值得我国在新型农村合作医疗制度建设中借鉴。     

健康公平视角下新冠病毒感染疫情医疗费用保障存在的问题与对策

新冠病毒感染疫情暴发以来,医疗保障应急政策对于新冠病毒感染患者及时救治、免疫屏障快速建立、社会经济健康发展起到了重要支撑作用。从健康公平视角对医疗保障应急政策及实施效果进行分析,发现我国新冠病毒感染医疗费用保障方面仍然暴露出医保基金风险不平等、法律框架体系不完善及界定机制不健全等问题;阐释了重大疫情医疗费用保障“全民免费”和“社会共担”的逻辑;提出了建立全国层面、互助共济的公共化制度应对重大疫情“灾难性”医疗费用风险的对策,在现有医疗保障体系基础上建立全国统一、“普惠制”的重大疫情应急医疗保障机制,明确“全民免费”总体原则、政府财政主体责任及来源和医疗保障系统应急管理的实施机制。     

开展新型农村合作医疗构筑城乡一体化的医疗保障体系

在构建和谐社会的思想理念指导下,我国的医疗保障制度改革正逐步地深入发展,不论是城镇,还是农村都在建立和完善适应城乡人民群众需求的医疗保障制度,探索和研究具有中国特色的城乡一体化的医疗保障体系,促进全民的身体健康,推进经济建设的可持续发展。     

开展新型农村合作医疗构筑城乡一体化的医疗保障体系

在构建和谐社会的思想理念指导下，我同的医疗保障制度改革正逐步碰深入发展，不论是城镇，还是农村都在建立和完善适应城乡人民群众需求的医疗保障制度，探索和研究具有中国特色的城乡一体化的医疗保障体系，促进全民的身体健康，推进经济建设的可持续发展。     

英国的医疗保健体制

免费医疗制度和医疗保健网踏上大不列颠岛,我们首先了解英国的医疗保健体制和机构,然后参观了几所不同类型的医院,以加深对这一体制的了解。英国从1948年开始实行全民免费医疗制度,经费来自国家税收。居民生了病住院治疗,不仅住院     

英国医保改革:引入内部市场机制

英国的医疗保障制度 ,又称国家卫生服务制度 (ＮａｔｉｏｎａｌＨｅａｌｔｈＳｅｒｖｉｃｅ ,ＮＨＳ) ,属典型的全民医疗制度 ,是在 1942年著名的贝弗里奇报告基础上 ,依据英国“国家卫生服务法”于 1948年建立起来的。1991年梅杰政府上台后 ,继承了撒切尔夫人的改革思路 ,按照美国恩多芬教授的建议 ,为提高患者权利和经济效率 ,对全民医保体制进行了根本性变革 :引手内部市场机制。这次改革坚持“以一般税收为基础 ,政府分配预算 ,向全社会国民免费提供医疗服务”的原则 ,同时引入竞争原则 ,导入内部市场 (模拟市场 ) ,实现了医疗服务中“…     

加快推进全民医保的六项政策建议

目前，城镇职工医保、城镇居民医保、新型农村合作医疗和医疗救助共同组成基本医疗保障体系，分别覆盖城镇就业人口、城镇非就业人口、农村人口和城乡困难人群。从政策层面上来看，多数人都可以找到自己所对应的医疗保障制度，全民医保的基本制度框架已经初步建立。但是，本文作者认为，     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.