次均医疗费用增长中诱导服务研究

中等发达地区次均医疗费用的过快增长与诱导服务密切相关。文章提出了计算次均医疗费用中诱导服务成分的方法，并以中等发达地区为产本地区测算了次均医疗费用中诱导服务比例，研究结果表明，我国中等发达地区次均医疗费用增长中存在一定比例的诱导服务，由此使得1998年次均医疗费用中诱导服务比至少在15．30％以上。研究建议通过改变医院支付方式，控制诱导服务和次均医疗费用的过快增长。     

运用医疗费用合理增长率测算方法评价我国医疗费用增长状况

运用课题组研制的4类增长率计算方法，测算了1991－1998年年我国中等发达地区医疗费用合理增长率，并将其与医疗费用，次均医疗费用实际增长率比较，结果表明，在1991－1998年期间，以中等发达地区为样本：（1）各样本地区的医疗费用总量增长基本都在合理增长的范围内，没有证据表明医疗费用总量呈现过快增长；（2）与此同时，样本地区的次均医疗费用增长迅速，成为我国医疗费用变化的新特征，与之相伴，居民的医疗需求呈现大幅度萎缩态势，研究建议，在目前阶段，合理控制医疗费用的重点应放在次均医疗费用上。     

医疗费用增长过快的原因和对策

目前，医疗费用增长过快的问题，已广泛引起国内外专家的关注，普遍认为有其合理的一面，也有不合理的一面。本文就此问题作一粗浅的探讨。一、医疗费用增长过快的原因分析１、药品费用增长过猛是医疗费用增长过快的关键因素。(１）药品价格上涨过快。随着我国社会主义市场经济体制的逐步形成，药品生产、经营企业已步入市场经济，药品价格市场化。近十年来，许多主要药品价格已翻了几番，以杭州市１９９４年的药品调价情况为例，一年中，药品调价共３１次，其中有一个月就调了４次，上涨幅度前１０位的常用药品平均增幅为１０９．７７％。(…     

广州某三甲医院人均医疗费用增长情况与特点分析

目的 了解某院人均医疗费用的增长情况,从医院的角度探讨如何控制医疗费用过快增长. 方法 对该院近10年的人均医疗费用进行描述性分析,并与广州市同期社会经济指标及同级医院进行对比分析. 结果 该院近10年人均医疗费用基本上呈增长趋势,近5年人均医疗费用增长基本上高于居民消费价格指数、商品零售价格指数和同级医院的平均水平.近2年,该院门诊人均医疗费用增长过快,超过了居民可支配收入的增长. 结论 必须采取有效措施,控制医疗费用过快增长.     

医疗费用增长的原因及对策思考

从人类寿命延长，老年化趋势加快，疾病谱的改变，卫生服务技术复杂性增加，新药新材料的不断使用等6个方面分析了我国医疗费用增长过快的原因，并提出了控制医疗费用快过增长的6条措施。     

“总量控制 结构调整”政策控制医疗费用过快增长作用析

“总量控制　结构调整”政策控制医疗费用过快增长作用析王龙兴，周剑萍，孙让春，周海洋，郑树忠，王锦福，王金承，郝模，吴延风，王志锋，王永龙，郑益川＂总量控制、结构调整＂政策，针对医疗费用过快增长的根本原因，期望从理顺医院补偿机制入手，遏制住医疗费用上涨...     

如何控制医疗费用过快增长

近年来,我国与其他国家一样面临着医疗费用过快增长的问题。我院门诊均次费用从2006年的109.24元增加到2012年的154.96元,增幅为41.85%,出院病人均次费用从2006年的3866.23元增加到2012年的7479.37元,增幅为93.45%。控制医     

群众医疗费用负担过快增长的问题研究

近年来，群众看病难、看病责已成为社会关注的热点，政府和医院应采取有力措施控制疗费用过快增长。那么造成群众医疗费用负担过快增长的原因在哪里呢？政府和医疗又应采取哪些措施来控制医疗费用过快增长呢？本文对此作简要论述。     

群众医疗费用负担过快增长的问题研究

近年来群众医疗费用负担过快增长，已引起了社会各方面的广泛关注，是老百姓最为关心的问题之一。据调查，67％的群众对当前医疗费用不满意，19％的群众认为基本满意，只有4％的群众认为满意。那么什么原因导致医疗费用过快增长，政府和医院应采取哪些措施来控制医疗费用过快增长呢？笔者对此作了专门调查研究。     

河南省医疗服务价格调整对医疗费用结构影响的评价*

目的:比较河南省医疗服务价格调整对医疗费用构成的影响,为评价医疗服务价格调整政策提供依据。方法:调查98所医疗机构,对医疗服务价格调整前后的医疗费用进行比较。结果:一是门诊次均费用增长率为-2.48%,住院次均费用增长率为0.26%;二是药品费用有大幅下降,门诊次均药品费用下降5.68%,住院次均药费下降4.75%;三是工作量较2005年有所增加。结论:现行医疗服务价格调整政策抑制了医疗费用的过快增长。     

医疗、医保、医药三方发展失调的恶性循环模型

分析了次均费用过快增长的原因和作用机制，并将之用于补充课题组前期研制的医院补偿机制恶性循环模型，提出了医疗、医保，医药三方发展有失协调的恶性循环模型，研究认国，基于医疗费用这一纽带，医疗保障制度，医院，药品生产和营销商处于同一系统中，彼此之间相互影响，任何一方的操作失当必将引起其他方面的联动反应，正由于这样一种联动反应，导致医疗，医保，医药三方处于恶性循环当中。     

基于ProModel仿真建模的医保基金收支预测研究：以黑龙江省为例

目的:在医保基金收支压力持续增加的背景下,探讨通过构建医疗保障制度Pro Model仿真模型,模拟并预测未来五年医保基金的收支状况。方法:构建医疗保障制度Pro Model仿真模型。以2010—2014年黑龙江省医保数据为基础数据,同时以2014年数据为基准,保持各变量2010—2014年间增长趋势,预测未来五年的医保收支状况。结果:模拟预测显示,2018年黑龙江三大医保基金整体收支面临失衡风险,新型农村合作医疗及城镇居民医保将入不敷出;城镇职工医保虽然保持收支平衡,但结余额也逐渐减少。结论:加强医保基金收支风险管理是当前医保制度管理的重点。     

中国医疗费用增长有失合理

为评价我国医疗费用增长情况,文章运用1991年-2008年全国卫生财务年报和中国统计年鉴等资料,定量分析发现:从需方角度来看,18年来我国医疗费用增长明显超过需方需求0.02～5.82个百分点,特别是过快增长的费用负担主要由个人一方承担,个人支出部分占50.1%,导致医疗需求平均萎缩高达8.1%。上述事实意味18年间45.3%的医疗费用增长不能合理解释。总之,我国医疗费用增长有失合理。     

The Disease and Economic Burdens of Esophageal Cancer in China from 2013 to 2030: Dynamic Cohort Modeling Study

BackgroundEsophageal cancer (EC) is the sixth leading cause of tumor-related deaths worldwide. Estimates of the EC burden are necessary and could offer evidence-based suggestions for local cancer control.ObjectiveThe aim of this study was to predict the disease burden of EC in China through the estimation of disability-adjusted life years (DALYs) and direct medical expenditure by sex from 2013 to 2030.MethodsA dynamic cohort Markov model was developed to simulate EC prevalence, DALYs, and direct medical expenditure by sex. Input data were collected from the China Statistical Yearbooks, Statistical Report of China Children’s Development, World Population Prospects 2019, and published papers. The JoinPoint Regression Program was used to calculate the average annual percentage change (AAPC) of DALY rates, whereas the average annual growth rate (AAGR) was applied to analyze the changing direct medical expenditure trend over time.ResultsFrom 2013 to 2030, the predicted EC prevalence is projected to increase from 61.0 to 64.5 per 100,000 people, with annual EC cases increasing by 11.5% (from 835,600 to 931,800). The DALYs will increase by 21.3% (from 30,034,000 to 36,444,000), and the years of life lost (YLL) will account for over 90% of the DALYs. The DALY rates per 100,000 people will increase from 219.2 to 252.3; however, there was a difference between sexes, with an increase from 302.9 to 384.3 in males and a decline from 131.2 to 115.9 in females. The AAPC was 0.8% (95% CI 0.8% to 0.9%), 1.4% (95% CI 1.3% to 1.5%), and –0.7% (95% CI –0.8% to –0.7%) for both sexes, males, and females, respectively. The direct medical expenditure will increase by 128.7% (from US $33.4 to US $76.4 billion), with an AAGR of 5.0%. The direct medical expenditure is 2-3 times higher in males than in females.ConclusionsEC still causes severe disease and economic burdens. YLL are responsible for the majority of DALYs, which highlights an urgent need to establish a beneficial policy to reduce the EC burden.     

中国1996-2015年食管癌经济负担研究的系统综述

目的 探讨中国1996-2015年食管癌经济负担研究开展情况。方法 采用经济负担、费用等作为关键词,全面检索PubMed、中国知网和万方数据库1996-2015年间发表的文献,对纳入文献行信息摘录和统计分析。采用美国卫生保健质量和研究机构推荐包含11条目的横断面研究质量评价标准,由双人独立对纳入的研究进行评价。以中国医疗保健消费价格指数对费用数据进行统一贴现,采用平均增长速度计算年均增长率。结果 最终纳入23篇文献（个体研究21篇和群体研究2篇）,其中12篇发表于近5年。21篇个体研究中,有17篇为个体患者病案摘录,纳入文献质量一般,数据多为单一直接医疗费用,分析指标以例均、次均和日均费用等多见。1996-2012年中国食管癌患者例均费用中位数为7 463～37 647元（年均增长率为7.68%）,1996-2013年次均费用中位数为6 851～57 554元（年均增长率为11.89%）,1996-2010年日均费用中位数为225～1 319元（年均增长率为12.53%）。直接医疗次均费用存在地区差异,以北京、山西和湖北较高。无论个体还是群体研究,对直接非医疗费用和间接费用造成的经济负担报道均较少。结论 中国食管癌经济负担评价数据仍有限且结果可比性一般,尤其是人群层面和间接负担的研究较少。直接医疗费用呈上升趋势,且地区差异较大。     

The relationship between undergoing a basic health checkup based on the Health and Medical Services Law for the Aged and medical expenditure covered under the National Health Insurance in Japan

OBJECTIVES: This study examined the relationship between undergoing the basic health checkup based on the Health and Medical Services Law for the Aged among urban residents and medical expenditure covered under the National Health Insurance in Japan. METHODS: The subjects were all residents of a city with a population of three hundred and fifty thousand, covered by National Health Insurance and over forty years of age. Medical expenditure was compared by age and sex between examinees who had undergone the basic health checkup for the past three years running and non-examinees who had had no checkup. In addition, from the results of a questionnaire survey of randomly sampled citizens, we compared the living habits of the above two groups, the examinees and non-examinees. RESULTS: For outpatients, the medical expenditure per case, the medical expenditure per capita for seniors, and the medical expenditure per day were lower, and the number of examination days per case and the examination rate (the number of receipts per capita) were higher in the examinee group than in the non-examinee group. For inpatients, the medical expenditure per case, the medical expenditure per capita, the medical expenditure per day for seniors, the number of examination days per case, and the examination rate were lower in the examinee group compared to the non-examinee group. The increase in medical expenditure with age was less in the examinee group than in the non-examinee group. In men, the examinees had significantly better living habits (especially exercise and meals) than the non-examinees. No differences in living habits were found in women. CONCLUSIONS: Medical expenditure was lower among examinees than non-examinees. In men, regular examinees had better living habits than non-examinees.     

归因分析医疗费用过快增长的责任归属

为明确医疗费用的过快增长中,财政、物价和医疗机构的责任大小,依据全国卫生财务年报资料等常规统计数据分析发现,18年来,财政和物价承担着主要的责任,归因责任分别达到了56.9%～100.8%和23.1%～64.1%,扣除财政和物价对医疗费用增长作用后,医疗机构所起作用除1992年外各年份均为明显的负值(-1.9%到-50.0%)。这表明在目前的医疗费用增长中,医疗机构并没有完全补足财政投入萎缩和服务成本的增加。     

Factors affecting the increase in hospitalized medical care expenditure in Japan: analysis of national data in all 47 prefectures]

To clarify factors affecting the increase in annual expenditure for hospitalized medical care in Japan, the effects of the following four variables in all 47 prefectures were analyzed: (1) the hospitalized medical care expenditure per day per inpatient, (2) the number of admissions per population base, (3) average length of stay of patients in hospital per year and (4) the number of hospital beds per population base. The annual expenditure for hospitalized medical care per population base was correlated most significantly with the number of hospital beds per population base. The annual expenditure was also significantly correlated positively with the number of admissions per population base and average length of stay of patients in hospital per year, and inversely with the hospitalized medical care expenditure per day per inpatient. Hospitalized medical care expenditure per day per inpatient was inversely correlated with average length of stay of patients in hospital and the number of hospital bed per population base. Results from stepwise multiple regression analysis indicated that the number of hospital bed per population base and the hospitalized medical care expenditure per day per inpatient are the only two variables which have significant effects on the annual expenditure for hospitalized medical care per population base. The annual rate of increase for annual expenditure for hospitalized medical care per population base from 1980 to 1986 was 6.1%. Similarly, the rate of increase in the hospitalized medical care expenditure per day per inpatient was 3.5%; that of the number of admissions per population base was 3.1%.(ABSTRACT TRUNCATED AT 250 WORDS)