医疗保险参保人员年龄结构老龄化的研究

城镇职工基本医疗保险已在全国各地推行,一种新型的职工医疗保险制度已基本建立。随着社会经济的发展,居民生活水平的改善和医疗技术水平的提高,居民的期望寿命不断提高,居民的年龄结构趋于老龄化,参保人员的年龄结构也逐渐向老龄化过渡,医保基金的支付压力越来越大,应及早对参保人员结构老龄化问题进行研究。笔者通过对镇江市参保人员年龄结构的分析,提出了缓解老龄化社会医疗保险基金支付压力的措施,供管理层决策参考。1镇江市参保人员结构分析调查显示,镇江市1995年的参保人数为273583人,其中,在职职工为216644人,占总参保人数的79.22%;…     

2014—2020年甘肃省基本医疗保险基金运行分析

目的：分析2014—2020年甘肃省基本医疗保险基金运行效率,为完善甘肃省医保政策提供参考。方法：使用数据包络分析法计算医保基金的纯技术效率、技术效率和规模效率。结果：2014—2020年甘肃省医保基金的支出增速高于收入增速,医保基金运行效率稳步提升;纯技术效率分数趋势平稳。结论：医保基金综合效率的变化和医保政策的改变相关,对规模效率的影响较大,纯技术效率基本不受医保政策变化的影响,建议甘肃省平衡医保基金收支,提高初级医疗机构服务质量和医疗保健水平,完善医保监管预警体系建设。     

参保人员老龄化对医保基金的压力与对策

老龄化给世界各国社会保险基金、特别是医疗保险基金带来了巨大的压力,这种压力随着社会年龄结构的不断老化正在逐渐加大。而我国医疗保险所面临的这种压力比世界大多数国家要大得多。我国是一个未富先老的国家,经济基础还很薄弱,医疗保险制度建立不久,基金没有多少积累;社会正处在转型时期,企业改革使社会保障制度经受巨大的考验。研究切实有效的对策缓解老龄化对医保基金的压力,对于医疗保险制度的可持续发展有很深远的现实意义。1参保人员老龄化对医保基金造成压力的客观原因在我国,参保人员老龄化对医保基金造成压力的原因有世界各国的…     

减少医保基金外流的分析与对策

镇江市推进城镇职工医疗保险已有10年。10年的实践表明,实行统账紧密结合的医疗保险基金在运行中,基金外流被他人所用的问题,一直成为医改需要迫切解决的课题。据我国南方某城市调查发现,借用参保人员的医疗卡,使用医保基金的比例达14%以上;用本人医疗卡为他人开药的占8%以上。医保基金如长期不规范使用,导致基金外流必将影响到医疗保险的公平性、公正性、安全性和持续性。现结合镇江市医疗保险实际,对如何减少医保基金的外流作一分析。     

城镇职工基本医疗保险基金的初步运行与思考

江苏省镇江市6年医改实践表明,现行城镇职工医保基金运行具有统账结合和当期现收现支的显著特征。其筹资渠道较少;医疗费用结算方法有待改进;使用医疗费环节多,管理难度大,道德风险高等问题,据此,笔者提出为提高医保基金的运行效率要扩大医保覆盖面,多种渠道筹集基金;建立全方位监管机制。探索建立医保基金保值增值机制等,进一步完善我国城镇职工基本医疗保险制度。     

城镇职工基本医疗保险基金的初步运行与思考

江苏省镇江市6年医改实践表明,现行城镇职工医保基金运行具有统帐结合和当期现收现支的显著特征,并存在着筹资渠道较少,医疗费用结算方法有待改进,使用医疗费环节多,管理难度大,道德风险高等问题。据此提出对策：为提高医保基金的运行效率要扩大医保覆盖面;要利用多种渠道筹集基金;要建立全方位监管机制;探索建立医保基金保值增值机制等,进一步完善我国城镇职工基本医疗保险制度。     

人口老龄化对卫生健康水平的影响研究

目的:模拟人口老龄化背景下卫生健康指标的变化趋势,提出不同的应对策略。方法:构建动态随机一般均衡模型和卫生指标估算程序,采用基于贝叶斯估计的模型比较法及比较静态分析法,估算不同老龄化程度下的卫生健康指标值;通过调整相应的参数,模拟提高医保报销比例和实行老龄人口健康管理的政策效果。结果:在人口老龄化程度不断加深的过程中,社会医疗负担不断增长,卫生筹资公平性和社会福利水平呈先恶化后好转的趋势。政策模拟结果表明,提高医保报销比例会提升整体健康水平和福利水平,但可能增加社会医疗负担和健康不公平;实行老龄人口健康管理会在维护全民健康的同时,避免社会医疗负担和健康公平性的恶化。结论:加快构建面向预防、健康管理的医疗体系,推进“健康老龄化”建设,同时加强对医保基金使用的监管,提高医疗保障政策的针对性和实效性。     

减少医保基金外流现象的对策与思考

镇江市实施城镇职工基本医疗保险已有10年。实践表明，在实行统账结合的医疗保险基金的运行中，基金外流现象一直成为医改需要迫切解决的课题。据我国南方某城市调查发现，借用参保人员医疗卡所发生的医疗费用占医保基金的比例达14％以上；用本人医疗卡为他人开药的占8％以上。医保基金如长期不规范使用，必将影响到医疗保险的公平性、公正性、安全性、持续性。现结合镇江市实际，对如何减少医保基金的外流提出相关对策。     

2009—2022年我国基本医保收支结存状况及风险警戒分析

目的：分析新医改以来我国基本医保收支结存状况及风险警戒情况，为我国基本医保基金可持续发展提供理论依据。方法：收集2009—2022年我国基本医保数据并进行描述性统计分析，依据风险警戒区间进行基金结存风险警戒分析。结果：2009—2022年，我国职工医保参保人中退休人员占比持续增大，统筹基金尚有一定累计结存；居民基本医保参保人数自2020年开始减少，基金支出增速高于基金收入增速，基金结存呈减少趋势。结论：基本医保基金中长期平衡存在一定的风险，可能是由我国人口老龄化、筹资机制及待遇水平等因素导致。     

对减少医保基金外流现象分析和对策的几点思考

镇江市推进城镇职工医疗保险已有10年时间。10年的实践表明，实行统帐紧密结合的医疗保险基金在运行中出现的基金外流被他人所用的问题，一直成为医改需要迫切解决的课题。据我国南方某城市调查发现，借用参保人员的医疗卡，使用医保基金的比例达14％以上；用本人医疗卡为他人开药的占8％以上。医保基金如长期不规范使用，导致外流必将影响到医疗保险的公平性、公正性、安全性、持续性。现结合镇江市医疗保险的实际情况，对如何减少医保基金的外流作一分析。     

Aging and the market in the United States.

Current Social Security reform proposals in the United States presume that, as long as the cash income of future retirees is secure, private businesses will take care of producing just the goods and services an aging population requires. However, the performance of private nursing homes, assisted-living complexes, pharmaceuticals, health, insurance, and transportation services for the elderly raises serious questions about the ability of markets to cater to the needs of a vulnerable population. Industries that specialize in goods and services for the old face repeated accusations of fraud, overcharging, poor service, and deceptive practices. The article reports on research on the performance of a number of industries that serve the aged. A careful look at these markets should caution us against relying too heavily on private markets to serve an aging population. The surplus funds flowing into Social Security might be better employed financing the kinds of public services for the elderly that private markets have so far failed to deliver.     

Politics and medicine: The case of Israeli national health insurance

The paper focuses on the attempts to introduce a national health insurance system in Israel. So far all these attempts advanced through six public committees and various legislative initiatives have been futile. The major actors involved in the process of NHI formulation are (a) the sick funds, the largest of which (KH) nearly monopolizes the health services; (b) political parties which are affiliated with the sick funds; (c) the Israeli medical association. The labor oriented parties and sick funds aimed for the introduction of an NHI system which would strengthen KH and preserve its autonomy. The right wing parties and sick fund advocated nationalization of the NHI. The IMA took a mid-way position not identifying with either of the parties. By allying with a small coalition party it was effective in impeding the legislative process that was initiated by the Labor Party. The vigorous opposition of KH has hindered the adoption of the Likud's version of the NHI. Hence, the issue, torn between conflicting parties, reached a stalemate which is not likely to be resolved in the near future.     

Differences by age groups in health care spending.

This paper presents differences by age in health care spending by type of expenditure and by source of funds through 1978. Use of health care services generally increases with age. The average health bill reached $2,026 for the aged in 1978, $764 for the intermediate age group, and $286 for the young. Biological, demographic, and policy factors determine each age group's share of health spending. Public funds financed over three-fifths of the health expenses of the aged, with Medicare and Medicaid together accounting for 58 percent. Most of the health expenses of the young age groups were paid by private sources.     

突发公共卫生事件健康促进联动机制的探索

在当前健康教育工作人员不足、经费紧张的状况下,如何应对突发公共卫生事件的挑战是一个值得深思和研究的课题。探索建立跨行政区域的健康促进应对联动机制,集中相邻或周边行政区域的健康教育工作人员和队伍,形成健康教育协作区,有效提高应对突发公共卫生事件的能力。     

"Midwife's mandarin madness": walking the Great Wall of China for charity

The author, a midwife, describes how she accomplished a strenuous, organised trek in China to raise funds for the charity The Foundation for the Study of Infant Deaths. The experience was a challenge which taught many of the participants more about themselves as well as about the country they visited.     

"Crowd-out": what it means for children's health insurance

As states finalize proposals for the federal Title XXI Children's Health Insurance Program (CHIP), consumers, advocates, legislators, and policymakers across the country are facing the issue of "crowd-out." How can they prevent CHIP's new public funds from "crowding out"--or supplanting--private funds now used to insure children? This issue of States of Health looks at research on crowd-out and reviews what some states have learned as a result of previous Medicaid expansions. Their experiences shed light on the challenge of making sure that Title XXI health care dollars reach the intended consumers, children who lack adequate insurance.     

A novel synthetic adjuvant effectively enhances the immunogenicity of the influenza vaccine

Influenza vaccination is a key intervention to reduce morbidity and mortality provoked by this disease. To date, the challenge of improving its efficacy remains unmet. The immunogenic synthetic peptide GK1 from Taenia crassiceps cysticerci was tested herein in its capacity as adjuvant, co-administered with the inactivated anti-influenza vaccine before and after challenge with influenza virus in both young and aged mice. Co-administration of GK1 with the influenza vaccine increased levels of anti-influenza antibodies in aged mice before and after infection, reduced the local inflammation that accompanied influenza vaccination itself and favored virus clearance after infection in both young and aged mice.     

集团化医院财务管理探讨

随着医疗市场的开放,国际资金进入我国医疗行业的可能性日益增大,市场竞争日益激烈,为了应对挑战,抵御风险,笔者认为集团化医院管理和经营,将成为医院发展的趋势。     

Word-of-mouth marketing: low-cost technique proves an effective way to promote teen clinic

From the outset, the team at the Longmont (CO) Teen Clinic faced a two-fold marketing dilemma. The first problem was a small budget. As a nonprofit with limited funds, the staff knew that they would have to get creative to effectively reach their target audience and fulfill the clinic's mission of battling unwanted teen pregnancies and sexually transmitted diseases (STD) among area women aged 19 and younger.     

新形势下医院开设OTC药房的优势

本文阐述了在医疗改革的新时期，处方药与非处方药分类管理制度实施的形势下，医院开设ＯＴＣ药房的优势。