山东省某县新农合住院病人支付方式及报销比例分析

目的：了解参加新型农村合作医疗的住院病人医疗相关信息,分析新农合住院病人的支付方式与报销比例,讨论该县新农合支付方式改革现状。方法：应用统计软件SPSS19.0,对病人特征、疾病构成作描述性分析,运用非参秩和检验分析报销比例及其影响因素,对住院病人住院自付费用进行多因素分析。结果：该县参加新农合住院病人的年龄分布以1～5岁以及51～60岁年龄段为主。参合住院病人报销比例的均值为42.12%,中位数为41.94%,患者性别、年龄、疾病为影响报销比例的显著因素。患者的自付金额均值为1 509.81,占住院费用均值（2 301.217）的65.6%。患者自身年龄、住院天数为影响自付金额的两大因素。结论：该县为新农合支付方式改革试点县,参加新农合的住院患者的保障有所提升,但是报销比例仍然较低,患者需自付的金额占该县农民年均收入的17.2%,政府需加大监管力度控制好医疗费用,力求最大限度地减轻农民的疾病经济负担。     

新农合73万住院病例高额费用的影响因素分析

[目的]研究新型农村合作医疗（NCMS）住院病例高额费用的影响因素。[方法]收集福建省2007年新农合73万个住院病例数据库（含27项指标）,用logistic回归分析产生高额住院费（定义为万元以上）的影响因素,分析有关因素的交互作用与联合作用。[结果]导致高额住院费用的因素依次是：＂不可报销费用＂高（OR=41.1）;＂药费＂高（OR=10.2）;＂检查费＂高（OR=4.5）;＂住院久＂（OR=3.6）;＂出县住院＂（OR=2.6）。交互作用均有显著性。[结论]控制范围外的不可报销药品与检查费用,加强县内医疗机构建设,力争实现＂小病不出乡,大病不出县＂,是控制高额住院费用的重点措施。     

金寨县参合农民新型农村合作医疗制度满意度分析

目的：为了解农民对新型农村合作医疗制度（新农合）的满意情况,分析其影响因素,并提出合理建议,对安徽省金寨县参合农民的满意度进行调查。方法：对安徽省金寨县的部分乡村采用分层抽样抽取了354位农民,运用有序Logistic回归模型分析相关因素。结果：与农民新农合满意度相关的因素有住院报销比例满意、医院服务质量和态度、定点医院付款时间、定点医院条件,统计学意义显著（P〈0.01）。结论：改善医院服务质量和态度,缩短定点医院付款时间,提高住院报销比例及改善定点医院的条件均可提高农民对新农合的满意度。     

耐多药肺结核诊疗费用在不同的医疗保障制度中的报销情况分析

目的了解中国全球基金耐多药肺结核防治项目覆盖的24省67地市患者诊疗费用在不同的医疗保障制度中的报销情况。方法设计专题调查表,以地市为单位收集24省67个地市2012年三种医疗保障制度（新型农村合作医疗制度、城镇居民基本医疗保险制度和城镇职工基本医疗保险制度）现况,计算住院和门诊费用能否报销和报销百分比,分别采用χ2检验和秩和检验对相应数据进行分析,P〈0.05为差异有统计学意义。结果住院费用纳入新农合、城居医保以及职工医保中报销的地市个数依次是60、58和55个;门诊费用纳入三种医保报销的地市个数依次是38、34和36个。住院费用在三种医保中的报销比例依次为70.00%（P25：65.00%,P75：75.00%）、70.00%（P25：60.00%,P75：70.00%）和80.00%（P25：72.00%,P75：87.00%）（χ2=36.10,P=0.000 1）;门诊费用在三种医保中的报销比例依次为60.00%（P25：27.00%,P75：70.00%）、60.00%（P25：43.00%,P75：70.00%）和80.00%（P25：50.00%,P75：85.00%）（χ2=11.26,P=0.003 6）。结论部分项目地区耐多药肺结核住院和门诊诊疗费用尚未纳入医疗保障中进行报销,报销比例有待进一步提高,尤其是门诊报销比例偏低,有待进一步加强。     

大病救助全面推开

针对农村居民患重病时医疗费用高,新农合基础保障水平有限,个人负担较重的情况,2014年,湖北省将进一步筑牢新农合常规保障、重大疾病医疗保障、大病保险、医疗救助“四道保障线”,深入推进重大疾病保障、大病保险、门诊重症等相关政策,提高患者医疗保障水平。 武汉一位参合农民,患尿毒症,肾移植加血液透析,住院4次,医疗费用共计64．7万元。按照江夏区新农合基本医疗保险报销封顶线10万元后,还有54万元的自付部分,按照新农合大病保险报销政策,自付部分达到5万元以上的,还可再报销70％,30万元封顶。     

我国慢性病及危险因素监测的发展及挑战

  目的  分析中国2013年主要慢性病住院患者自付费用与报销费用,为缓解慢性病经济负担提供政策建议。  方法  收集2013年第五次国家卫生服务调查中6 978例癌症、糖尿病、心脑血管疾病、慢性呼吸道疾病住院患者相关数据,计算此四类主要慢性病住院患者的自付费用与报销费用。  结果  在自付费用上,癌症住院患者人均自付费用（城市4 553元、农村5 000元）与总自付费用（465.09亿元）均最高;在报销费用上,癌症住院患者人均报销费用最高（城市7 800元、农村4 800元）,心脑血管疾病住院患者报销总费用最高（887.87亿元）;在医疗总费用上,癌症住院患者的人均医疗总费用最高（城市13 000元、农村10 000元）,心脑血管疾病住院患者的医疗总费用最高（1 485.69亿元）;在慢性病整体报销比例上,基本医保中城镇居民基本医疗保险的报销比例最低（54.06 %）。  结论  癌症住院患者的人均自付费用和人均报销费用均最高,心脑血管疾病住院患者医疗总费用最高;基本医保中城镇居民基本医疗保险的保障力度最弱。     

基于Apriori算法的甲状腺恶性肿瘤患者高额住院费用关联规则分析

目的基于甲状腺恶性肿瘤患者住院费用的影响因素,挖掘各因素与高额住院费用之间的关联规则,为降低患者费用提供参考依据。方法收集中国西南地区某大型三级甲等综合医院2018—2019年甲状腺外科住院病例数据,在多元线性逐步回归筛选出住院费用影响因素的基础上,利用Apriori算法挖掘各因素与高额住院费用之间潜在的强关联规则。结果是否手术、肿瘤是否淋巴转移、材料费、检查费、药品费、住院天数、术前等待天数、肿瘤分型和年龄对住院费用具有显著影响(P0.001)。关联规则模型共挖掘出4条有意义的与高额住院费用相关的强关联规则。具有规则前项条件的患者发生高额住院费用的概率分别为整体高费用发生率的4.6、4.4、4.1和2.6倍。结论高额住院费用与是否淋巴转移、是否手术、材料费、药品费、住院天数、年龄强关联。个人应重视常规体检,增强预防意识;医院需要控制药材使用比例,优化医疗费用结构;同时提高运行效率,缩短平均住院日。     

夷陵区新农合肺结核患者医疗费用报销现状分析

目的分析湖北省宜昌市夷陵区2010-2011年新型农村合作医疗(简称"新农合")中肺结核患者医疗费用报销情况,探讨合理应用新农合经费,促进结核病防治工作。方法收集夷陵区新农合肺结核患者医疗费用报销相关文件、夷陵区2010-2011年新农合肺结核患者(含耐多药肺结核患者)门诊和住院费用结算资料、夷陵区2010-2011年结核病防治工作统计报表资料,经Excel统计分析肺结核患者门诊和住院医疗费用及报销情况。结果2010-2011年共有住院肺结核患者444例次,住院医疗费用2 538 530.08元,新农合报销目录内费用2 220 064.19元,除去门槛费117 100.00元后,农合可报销费用2 102 964.19元,按不同级别医院分段报销比例,实际报销医疗费用1 091 016.43元,占农合可报销费用的51.88%。结核病门诊治疗肺结核患者715例,落实国家免费政策后医疗费用280 388.00元,新农合报销86 494元,报销比例30.85%。结论科学制定肺结核患者门诊和住院费用总额控制标准和不同级别医院的报销比率,加强对肺结核患者的属地管理,严格把握肺结核患者的住院标准,认真执行结核病临床诊疗路径,让门诊和住院肺结核患者同样享有较高的医疗费用报销比率,鼓励轻症患者门诊隔离治疗,这些办法将有助于在减少农合费用开支的同时提高肺结核患者的医疗保障水平,让有限的农合经费发挥更大效益。     

参加新型农村合作医疗农村贫困人口和非贫困人口卫生服务利用的调查研究

目的通过对榆树市贫困与非贫困农民新型农村合作医疗（简称新农合）参加情况、利用情况、花费情况、住院费用和补偿情况进行比较分析,为评价新农合的实施效果和完善新农合制度提供科学依据。方法采用分层随机抽样的方法抽取3个乡镇143 322人,通过当地民政部门获取该3个乡镇的贫困人口名单,通过新农合管理系统获取该3个乡镇的就医情况,比较分析农村贫困人口和非贫困人口新农合利用、花费和补偿情况。结果贫困人口门诊就诊率低于非贫困人口,住院率高于非贫困人口,其差异均有统计学意义（P〈0.05）。贫困参合人口门诊及慢性病就诊人数所占比例均较非贫困人口低,差异均有统计学意义（P〈0.05）。贫困和非贫困参合人口门诊的次均费用和次均补偿金额比较差异均有统计学意义（P〈0.05）;两组人口住院次均费用和住院费用比较差异均无统计学意义（P〉0.05）;在慢性病方面,贫困组和非贫困组人口次均费用和次均补偿比较差异均无统计学意义（P〉0.05）。两组人口中住院患者住院天数和在三个级别医院分布情况比较差异有统计学意义（P〈0.05）。结论在制定相关贫困人口医疗救助政策时,应加大对高龄、丧偶这部分人群的补偿力度。     

农村合作医疗面临的问题和对策

为了使新农合可持续发展,通过分析新农合运行中存在的一些问题,如医疗管理部门对新农合制度运行中存在的各种困难认识不足,医疗服务机构对新农合惠民服务理念认识不足;单纯使农民受益的报销政策,一定程度上刺激了医疗费用的增长,住院人数大,基金支出大幅增长,面临基金透支风险.提出加强领导、强化管理、完善制度,适时提高筹资的水平,改革新农合报销政策、探索新农合的管理机制、合理分配卫生资源,控制医疗费用不合理增长.合理分配新农合基金,设立门诊统筹基金,激发定点医疗机构在新农合管理主动性等措施.     

Implausible birth weight for gestational age

Various rules have been proposed to identify and exclude live births with implausible values of birth weight for gestational age from large perinatal data sets. The authors carried out a preliminary evaluation of common rules by examining the frequency and nature of rule-based exclusions among live births in Canada (excluding Ontario) between 1992 and 1994. There were 625 (0.09%), 133 (0.02%), 170 (0.02%), and 2,858 (0.40%) live births identified for exclusion by a median birth weight for gestational age +/-4 standard deviations (SD) rule, a +/-5 SD rule, a rule based on expert clinical opinion, and a modification of Tukey's rule, respectively. The birth weight and gestational age distribution of the exclusions depended on the particular rule used; for example, 12.1% and 0.3% of live births of > or =4,500 g were excluded under Tukey's rule and the rule based on expert opinion, respectively. Infant mortality rates among those excluded were 8-13 times higher than among all live births. Current rules for identifying implausible birth weight for gestational age tend to flag live births at high risk for infant death. Such rules may erroneously attenuate temporal trends in important perinatal outcomes.     

The Outcomes of an Alcohol Prevention Program on Parents’ Rule Setting and Self-efficacy: a Bidirectional Model

Most adolescents have their first encounter with alcohol in early or middle adolescence. Parents’ rule setting about alcohol has been shown to be important to delay the onset and reduce the frequency of adolescents’ alcohol drinking, but less is known about the potential role of parents’ beliefs about their competence in and ability to influence their adolescents’ drinking habits (i.e., parental self-efficacy [PSE], Bandura (Psychological Review, 84, 191–215, 1977). In this study, we examined the direction of influence between parents’ rule setting and PSE as outcomes of the program “Prevention of Alcohol use in Students” (PAS), a prevention program aiming to reduce underage drinking by targeting parents and adolescents both separately and in a combined intervention. We tested two mediation processes in which the program would (a) have a direct effect on PSE, which in turn would increase parents’ rule setting or (b) have a direct effect on parents’ rule setting, which in turn would increase PSE. To examine these processes, we used a sample of 2562 parent-adolescent dyads (age 12 at baseline), followed annually over 3 years. The results showed that the combined intervention increased PSE via an increase in parents’ rule setting. No significant effect of the intervention on rules about alcohol via PSE was found. This is the first study to test the mediation processes involving PSE and parental rule setting in an experimental context where parenting practices are being actively changed. The results suggest that giving parents concrete advice on how to deal with alcohol drinking in their adolescents and at the same time helping adolescents to develop healthy attitudes about alcohol drinking have a positive influence on parents’ self-efficacy.     

血尿酸水平对冠心病的影响分析

目的讨论男、女性患者的血尿酸水平与冠心病存在的内在联系。方法通过对比患者与非患者血尿酸水平值,采用SPSS12.0统计软件对不同年龄区间冠心病患者的血尿酸水平进行分析并且利用多元Logistic回归手段对血尿酸和年龄2种因素进行统计。结果年龄(OR=1.038)、性别(OR=0.296)及血尿酸水平(OR=1.001)。年龄、性别及血尿酸水平与冠心病发病呈独立相关性,冠心病患者的血尿酸水平明显高出非冠心病患者。结论血尿酸水平可以作为冠心病治疗的项目之一,对治疗冠心病及防治都有十分重要的意义。     

农民参加新型农村合作医疗影响因素分析

目的 了解黑龙江省农村居民参加新型农村合作医疗的影响因素.方法 采用分层抽样方法抽取黑龙江省9个县9 741名农村居民为研究对象进行入户调查,并对数据进行统计分析.结果 参加新农合的农村居民9 207人(94.5%);了解新农合的基本药物目录者1 525人(15.7%),了解新农合基金个人每人每年筹资数额者7 260人(74.5%),了解新农合缴费标准者6 254人(64.2%);对新农合个人缴费满意和非常满意者占40.7%,对医疗机构设置满意和非常满意者占23.4%.多因素结果显示,文化程度(OR=0.630)、收入(OR=1.323)、最近一年医药费用(OR=2.027)、离家最近的卫生机构在15分钟内能否到达(OR=0.474)、是否了解新农合基金个人每人每年筹资数额(OR=0.313)、是否了解新农合缴纳保费的标准(OR=0.514)、对新农合个人缴纳费用是否满意(OR=0.608)、对新农合规定的就医机构设置是否满意(OR=0.549)是农村居民参合的影响因素.结论 农村居民参合率低于全省平均水平;农民参加新型农村合作医疗受文化程度、家庭医药费用、对“新农合”相关知识的了解及对新农合的满意度等因素影响.     

新型农村合作医疗农户续保风险管理探析

鉴于我国新型农村合作医疗制度自愿性和低受益性,农户续保风险将不可避免会影响新农合制度的可持续发展。只有把续保风险管理系统纳入新农合系统管理之中,建立管理平台,构建农户续保意愿管理、受益管理、服务利用管理和医疗机构监管机制,才能及时识别和规避新农合续保风险,确保新农合制度平稳发展。     

Shiftwork and metabolic risk factors of cardiovascular disease

We conducted this study to examine the relationship between shift work duration and the metabolic risk factors of cardiovascular disease among shift workers. The study population consisted of 226 female hospital nurses and 134 male workers at a firm manufacturing diapers and feminine hygiene materials, whose mean ages were 28.5 yr for the nurses and 29.1 yr for the male workers. The fasting blood sugar level, serum cholesterol, blood pressure, height and weight, waist and hip circumferences (only for the nurses), and numbers of walks during work (as a measure of physical activity) were measured. Using the Karasek's job contents questionnaire, job stress was assessed. Information about the years of work, shift work duration, past medical and behavioral history, including smoking, was obtained by a self-administered questionnaire. With definitions of hypertension as systolic blood pressure (SBP) > or =160 or diastolic blood pressure (DBP) > or =90 mmHg occurring at least once, hypercholesterolemia as serum total cholesterol > or =240 mg/dl, obesity as body mass index (BMI) > or =25 kg/m(2) and as waist to hip ratio (WHR) > or =0.85, we examined the prevalences of metabolic risk factors among subjects. Regression analyses to show the relationships between shift work duration and metabolic risk factors were performed using simple and multivariate models stratified by age, and adjusted for smoking, drinking, job strain and physical activity. Duration of shift work was significantly associated with SBP or cholesterol level among male workers aged 30 or more. Among female nurses, it was inversely associated with DBP (in those who were below 30 yr old) and cholesterol (in those who were aged 30 or more). BMI was non-significantly associated with the duration of shift work in both male workers and female nurses who were 30 yr old or more. WHR in female nurses increased slightly according to increasing duration of shift work. Fasting blood sugar was not significantly associated with the duration of shift work in either sex regardless of age-group. These results suggest an association between shift work duration and the metabolic risk factors of cardiovascular disease.     

The attitude of farmers to the New Rural Cooperative Medical Scheme in Northwest China one year after its introduction: a cross-sectional study

Aim

The implementation of the Chinese New Rural Cooperative Medical Scheme (NRCMS) spread fast since a county pilot trial in 2003. The purpose of this survey is to guide policy-makers on how to improve the current national NRCMS policy.

Subject and methods

Cross-sectional survey of 1,978 farmers in 50 villages in Huxian Shaanxi Province on their attitudes towards the NRCMS administered door-to-door in 2005.

Results

Most farmers hold a positive attitude towards the NRCMS. However, they do not trust the scheme management. Farmers place more trust in village doctors rather than village cadres for fund collection. More than two thirds of farmers seek care in county hospitals directly, bypassing village clinics and township hospitals. Not all hospitals and doctors fully comply with the NRCMS rules, and supplier-induced demand is still widespread. More than half of farmers worry that the NRCMS is not sustainable. Importantly, the survey showed a high enrolment rate of 92% (95% CI, 91; 93) in a voluntary insurance scheme.

Conclusion

A number of remedial actions in health financing, planning and management to counteract the identified issues are proposed.     

新型农村合作医疗制度的问题与对策研究

新型农村合作医疗试点已经取得了阶段性的成就,目前探讨影响合作医疗可持续发展的问题具有特别重要的现实意义。笔者在调研的基础上,探讨分析了试点中暴露出来的诸多制度和运行中的问题。针对这些问题,文章提出了解决问题的对策建议以促进合作医疗制度的可持续发展。     

三峡移民与当地居民生活满意度、健康状况与医疗服务利用比较

目的：了解移民与当地居民在健康状况和医疗服务利用方面是否有明显差别,提出改善移民健康水平的建议及措施。方法：使用定性深入访谈和定量问卷相结合的方法,对三峡移民的健康状况和医疗服务利用情况进行调查,以当地居民作为对照。结果：除少数地区外,三峡移民身体健康状况、医疗服务利用以及医疗费用、新型合作医疗报销比例与当地居民差距不大。但移民对家庭经济改善、住房改善及人际关系的满意度较低,显示存在心理健康问题。建议：深入宣传新农合章程,说服未参加新农合的移民参合,组织当地居民、医生与移民交流,及时解决移民房屋的质量问题,持续对缺乏劳动技术的移民进行培训,吸收满足条件的移民进入村委会、教师队伍等。     

中国中老年人群慢性病现状调查与共病关联分析

  目的  利用关联规则研究我国中老年人群慢性病共病模式，探索慢性病间的关联性和关联强度。  方法  采用中国健康与养老追踪调查(China health and retirement longitudinal study，CHARLS)2015年的数据，纳入我国9省市45岁以上中老年人患14种慢性病情况，利用R 3.4.3软件中的Apriori算法对数据进行分析，挖掘慢性病共病情况。  结果  17 796名调查对象中，至少患有一种慢性病人数为12 245(68.81%)，同时患有两种及以上慢性病的人数为7 321(41.15%)。在筛选出的关联规则中，按照支持度排序，最常见的三种慢性病共病模式为血脂异常和心脏病、糖尿病和血脂异常、哮喘和慢性肺部疾病，规则支持度分别为6.77%、5.27%、4.28%，规则置信度分别为34.38%、43.14%、70.81%。关联规则结果多项指向心脏病、血脂异常、慢性肺部疾病。75岁以上年龄组强关联规则最多。  结论  心脏病存在于多种共病模式中，应加强对其的筛查与预防。血脂异常与糖尿病、高血压具有强关联性，且男性患者更易共患血脂异常。随着年龄增长，慢性病共患更普遍更复杂。