The demand for private health care in the UK

Policy change has eroded the entitlement of UK residents to free state-provided health care, with a resulting rise in the use of the private sector. This paper examines the choice between public and private health care. It models the use of private health care as a function of its costs and benefits relative to state care and no care. The results indicate a difference between users of private care and other care, and the importance of past use as a predictor of current use. But they also show considerable movement between the public and private sectors, indicating a complex relationship in public and private sector use.     

The production of health and the demand for health care in Finland

A structural equation model of the determinants of health and of the demand for health care, treating health status as a latent variable, was developed using cross-sectional sample survey data representing the adult noninstitutionalized population (n = 10,712) of Finland in 1987. Attention was paid to evaluating the relative effects of different factors affecting health and demand for health care in order to make generalizations for health policy. The maximum likelihood estimates of MIMIC (multiple indicators and multiple causes) models are presented. The results indicate the important role of lifestyle variables as health production factors, and stress the importance of decreasing smoking and reducing overweight as targets for health policy. Under the assumptions of the model, smoking and overweight also have considerable effects on health care utilization. The socioeconomic variables--income, education and occupation--seem to have almost equal impacts on health, although their separate direct effects are somewhat smaller than the effects of the two lifestyle factors. The results of demand for doctor visits and prescribed medicines stress factors such as time cost and the supply of doctors as important determinants of utilization, and confirm the fact that a significant portion of health utilization depends on doctors decisions and is generated by patient-doctor contacts.     

The demand for private health care under national health insurance

This study explores the demand for private health care and supplemental health insurance in Israel, where universal national health insurance provides all inhabitants with a standard package of medical care. Our theoretical model and empirical study follow research previously conducted in four other countries. It was found that the self-employed in Israel demand more private health services and supplemental health insurance than wage-earners. Income, age, education, health status, marital status, origin, and profession were found to play a part in explaining these demands.     

The effect of disability insurance on health care demand

This paper examines the incentive effects of the growth in the Social Security Disability Insurance (DI) system in terms of its impact on individual health care demand. A simple model predicts that DI benefits will reduce the individual's demand for preventive health care (in order to increase their probability of acceptance) while the demand for acute care is not affected. Estimates of health care demand equations for males aged 58-63 confirm the non-effect of DI benefits on acute care, while significant (but small) negative effects of benefits on preventive care are found.     

The demand for care and systems of access in primary health care]

The aim of the investigation was to assess variations in the demand for medical care in the primary care centre of Ciudad Badia (Barcelona, Spain). The records of attendance were analysed over a period of seven years. During this period, some changes were made which affected the way the centre was used by patients, such as the creation of systems which required notice of medical and nursing appointments, the reduction of spontaneous attendance, and the introduction of a card for medication for the chronically sick. These changes were accompanied initially by a decrease, then a stabilisation, and afterwards a slight increase in total number of visits. All visits (with notice) rose from 5.3% in 1983 to 45.2% in 1989. Similarly, nursing visits (with notice) increased from 4% to 9.5 of total activity. Emergency visits in the same period rose from 3.4% to 8%. It is concluded that changes that were introduced raised the level of commitment of the staff to medical work-both preventive and therapeutic, as well as the improvement of the organisation of attendance at the centre and a higher satisfaction of users of the centre and the medical staff.     

Incidence and management of male urethritis in the district of Tunis

BACKGROUND: The aim of the study was to evaluate the incidence of male urethritis and the relative frequency of the different etiological agents in order to adapt standard case management. METHODS: The incidence of urethritis has been estimated with a postal study made on a sample of druggists (1/10) of the area. The total observation period was four weeks. The relative frequency of the etiological agents and the positive predictive value (PPV) of the therapeutic approach based on antibiotic treatment of gonorrhoea and Chlamydia trachomatis was achieved on 92 cases of male urethritis attending general physicians in two polyclinics. RESULTS: The annual incidence of male urethritis was estimated at 680 per 100,000. The relative frequency of etiological agents was as 34.7% for Neisseria gonorrhoea, 7.6% for Chlamydia trachomatis and was found at 3.3% for Trichomonas vaginalis; the PPV was only 43% because of the high proportion of negative results reported by the laboratory. CONCLUSION: Gonococcal urethritis incidence tends to decrease regarding non gonococcal urethritis and the therapeutic approach appears to be warranted.     

The quality of diabetic care in a London health district.

In order to assess the quality of care in a community-wide sample of diabetic patients, a study was performed on 217 such patients identified in three group practices in an east London health district. Only 46% of the patients were currently attending a hospital. In the two years before review, 64% of patients had had their blood pressure recorded and 59% had had retinal examinations. Levels of glycosylated haemoglobin were significantly higher in patients on insulin than in those on oral regimes (P = 0.0004). The mean level of glycosylated haemoglobin was higher in patients from Social Classes III, IV, and V than in patients from Social Classes I and II (P = 0.005), but there was no difference in level between those patients attending hospital and those attending their general practitioners after accounting for differences in these two populations (P = 0.19). Over 50% of all diabetic patients in this study had levels of glycosylated haemoglobin which may indicate vulnerability to microvascular disease.     

上海市虹口区离休干部医疗需求与利用情况分析

[目的] 了解与分析上海市虹口区离休干部医疗服务需求与利用现状。[方法] 采用一对一入户问卷调查的方式,对社区常住的离休干部进行整群随机抽样调查,获得有效问卷1 576份。[结果] 离休干部2周患病率和慢性病患病率分别为37.4%和87.1%,2周就诊率和年住院率分别为85.2%和34.2%。[结论] 离休干部医疗服务需求大,建议将其医疗保健工作下沉至社区,慢性疾病管理作为管理重点,建立家庭病床。     

妇女围绝经期症状及保健需求调查

目的:了解上海妇女围绝经期症状发生情况、对围绝经期的认识及围绝经期的保健需求,以指导干预。方法:以社区为基础进行抽样,采用入户面访的方式进行问卷调查。结果:平均绝经年龄(49.96±3.13)岁,围绝经期症状发生率为62.37%。50~和55~岁年龄组症状发生率分别为61.99%和62.85%。9.5%的人认为有必要进行定期的妇科检查,只有32.52%的人近两年做过妇科检查,对各种妇女保健知识需求选择“是”的均在70%以上,有52.13%的人希望医生来居委会提供服务。结论:妇女围绝经期症状发生比例较高,保健意识还有待提高,对社区的围绝经期卫生保健服务及有关知识需求较高。     

Shifting the demand for emergency care in Cuba's health system

Cuba has developed a programme of quality improvement of its health services, which includes an extramural emergency care system in which polyclinics and general practitioner networks play an important role. Using routine health information from the decentralised first line emergency units (FLES) and from the hospital emergency service (HES) for the period 1995-2000, we evaluated the effects of the emergency care subsystem reform on the utilisation rates of first line and hospital services in Baracoa and Cerro, a rural and a metropolitan municipality, respectively. In the self-contained health system of Baracoa, the reform of the emergency subsystem resulted in a first phase of increased utilisation of the FLES, followed by a second phase of gradual decrease, during which there was an increased utilisation of general practitioners. In contrast, the overall results of the reform in Cerro were unclear. The proximity to a hospital seems to be the most important element in the patient's decision on which entry point to the Cerro health system to use. A potential adverse effect of the reform is an increased emergency services utilisation in situations where GP care remains below patients' expectations. Given the current world-wide trends in health-care reform, the organisational alternatives developed in the Cuban health system might remain specific to the local contextual setting.     

Unobserved heterogeneity and censoring in the demand for health care

In this paper we estimate a demand for private medical services equation based on the tradition of Grossman′s model of demand for health using data for a panel of Spanish households. The econometric specification accounts for the censored nature of the data, which arises from no participation and infrequency of purchases, and the existence of unobserved heterogeneity, which arises from the non-observability of health states. Our evidence suggests that ignoring these features can have a significant impact on the size, sign and significance of the model estimates. The estimates for the participation and consumption processes also suggest that the deduction of expenditures on health care currently applicable in the Spanish tax system are positively associated to income and fertility. © 1998 John Wiley & Sons, Ltd.     

重庆市卫生保健需求发展趋势预测

卫生保健需求的货币形式表现为卫生保健费用的实际支出,即卫生总费用。因此,通过研究和预测卫生总费用可以把握卫生需求。笔者利用重庆市卫生总费用测算过程中已经掌握的历史数据,分别采用回归预测、弹性预测、计量经济预测方法对重庆市2007—2016年的卫生总费用进行趋势预测,以达到为重庆市卫生事业决策提供宏观信息的目的。     

The impact of financing and quality changes on health care demand in Niger

This paper assesses the demand effects of a cost recovery and quality improvement pilot study conducted in Niger in 1993. Direct user charges and indirect insurance payments were implemented in government health care facilities in different parts of the country, and were preceded or accompanied by quality changes in these facilities. Decision-making by patients is modelled as a three-stage process of reporting an illness, seeking treatment and choice of provider; and multinomial nested logit techniques are used to estimate the parameters of the decision-tree. Overall, the results give a reasonably favourable impression of the policy changes. In neither case is there evidence of serious reductions in access or increases in cost. Particularly notable is that despite an increase in formal user charges, the observed decline in rates of visits is statistically insignificant, suggesting the success of measures to improve quality of health care in public facilities. The observed increase in the probability of formal visits in the district with indirect payments is also striking. Both contrast with the control region of Illela, where neither user charges were introduced nor were any efforts made to improve quality. The data suggest that higher utilization of formal care, probably due to improvements in quality, outweighed the decrease in utilization that may have come about due to introduction of cost recovery, so that the net effect of the policy changes was an increase in utilization. Quality considerations appear to be important in ensuring the long-term success of cost sharing.     

杭州市萧山区电焊工职业卫生服务需求现状调查

目的：了解萧山电焊工职业卫生服务需求现状,为职业健康教育工作提供基线资料,为企业提高自身职业卫生管理水平提供依据。方法：采取整群抽样的方法,对萧山地区4家钢结构制造和金属家具制造行业的312名电焊工人进行问卷调查,使用Epidata建立数据库,SPSS16．0软件进行统计分析。结果：①萧山区电焊工人对自身岗位职业病危害因素知晓率不同的文化水平有显著性差异（r=12．936,P=0．012）,职业病危害因素知晓率随着工龄的增长而增加（x^2=13．637,P-0．009）②随着文化程度的增加紧张压抑率和感觉疲劳率均有增加（P=0．000;P=0．005）,紧张压抑率并未随着工龄增加而增加（X^2=0．624,P=0．732）．而感到疲劳的人数有随着工龄的增长有增加的趋势（X^2=5．901．P-0．052）⑧电焊工的需求排在前五位的依次是：工资比其他厂高、车间工作环境好、工作时间短不用老是加班、劳保用品配发齐、购买养老保险和医疗保险,而工人对所在企业该5项的认可率分别为51．9％、56．4％、48．8％、59．1％和38．1％。结论：电焊工职业卫生知识水平较低,不同文化程度电焊工的危害因素知晓率不同,对紧张和疲劳的感受也不同,工人对所在的企业提供条件的认可程度与自身需求存在差异,职业健康教育工作可结合文化水平和工龄分层次进行。     

我国医疗卫生服务需求趋势的人口统计因素分析——劳动力人口应成为疾病防治的重点人群

随着我国医疗卫生体制改革的逐步深化,覆盖全民的医疗保障体系正在逐步形成.老龄人口、孕产妇、婴幼儿等人群受到了普遍的关注,健康水平有了很大的提高.而由于我国社会经济的飞速发展,生活节奏、工作方式、工作压力、环境污染等因素的影响,劳动力人群正在成为疾病高风险人群.文章根据1993,2003,2008年卫生统计年鉴数据,对比分析了我国居民两周患病率、就诊率以及医院分科门诊人次的数据变化,根据相关数据之间的人口年龄构成、职业状况分析,得出我国劳动力人口已经成为疾病高风险人群的结论.进一步讨论了劳动力人口的疾病防治与老龄化人口的疾病预防之间的关系.