福建省助产技术队伍人力资源现状分析及对策

目的了解助产技术队伍人力资源配置现状，为进一步研究助产士人力资源配置的合理性提供依据。方法采用自制问卷调查表，对全省开展产科医疗服务的机构进行问卷调查。结果从事助产技术人员年龄主要分布在25～34岁；47．01％（3919／8336）为助产专业毕业；助产士学历低，有81．84％（3370／4118）为中专学历；助产士职称水平低，初级及以下（未定级）职称占76．08％（3133／4118）；省市级医院助产士和护士在岗人数中31．27％（288／921）为非正式聘用。结论医学院校应加大助产专业人才的培养，提高办学层次，加强在职助产士的继续教育，提高她们的学历；有关行政部门应制定相应政策，对不同等级医院配置不同学历的助产专业人才；逐步实行助产士单列职称；开展对助产士人力资源的配置标准的研究。     

Development and status of health insurance systems in China

Health insurance programs have changed rapidly over time in China. Among rural populations, insurance coverage shifted from nearly universal levels in the 1970s to 7% in 1999; it stands at 94% of counties in 2009. This large increase is the result of a series of health reforms that aim to achieve universal access to healthcare and better risk protection, largely through the rollout of the health insurance programs and the gradual increase in subsidies and benefits over time. In this paper, we present the development of the rural and urban health insurance programs, their modes of financing and operation and the benefits and reimbursement schemes at the end of 2009. We discuss some of the problems with the rural and urban residents' schemes including reliance on local government capacity, reimbursement ceilings and rates, and incentives for unnecessary care and waste in the design of the programs. Recommendations include increasing financial support and deepening the benefits packages. Strategies to control cost and improve quality include developing mixed provider payment mechanisms, implementing essential medicines policies and strengthening the quality of primary-care provision.     

Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat,India: current experiences and challenges

OBJECTIVE: To assess the Self Employed Women's Association's Medical Insurance Fund in Gujarat in terms of insurance coverage according to income groups, protection of claimants from costs of hospitalization, time between discharge and reimbursement, and frequency of use. METHODS: One thousand nine hundred and thirty claims submitted over six years were analysed. FINDINGS: Two hundred and fifteen (11%) of 1927 claims were rejected. The mean household income of claimants was significantly lower than that of the general population. The percentage of households below the poverty line was similar for claimants and the general population. One thousand seven hundred and twelve (1712) claims were reimbursed: 805 (47%) fully and 907 (53%) at a mean reimbursement rate of 55.6%. Reimbursement more than halved the percentage of catastrophic hospitalizations (>10% of annual household income) and hospitalizations resulting in impoverishment. The average time between discharge and reimbursement was four months. The frequency of submission of claims was low (18.0/1000 members per year: 22-37% of the estimated frequency of hospitalization). CONCLUSIONS: The findings have implications for community-based health insurance schemes in India and elsewhere. Such schemes can protect poor households against the uncertain risk of medical expenses. They can be implemented in areas where institutional capacity is too weak to organize nationwide risk-pooling. Such schemes can cover poor people, including people and households below the poverty line. A trade off exists between maintaining the scheme's financial viability and protecting members against catastrophic expenditures. To facilitate reimbursement, administration, particularly processing of claims, should happen near claimants. Fine-tuning the design of a scheme is an ongoing process - a system of monitoring and evaluation is vital.     

长期照护保险资金筹措:现状、困境与对策思考

本文以资金筹集为切入点,从筹资方式、渠道和水平三个层面,对青岛等试点城市和北京市海淀区的相关文件进行梳理。结果发现,目前各地以不同的划拨标准,将符合条件的医保参与人员自动纳入长期照护保险范畴;虽然不少地方的老年人已开始受益,但存在代际不公平、民众参与感低、对医疗保险依赖过度等问题,尚未形成可在全国推广的经验。为此,必须合理选择筹资方式,确保稳定的资金来源;明确政府、单位与个人角色,合理分担照护责任;采取定额筹资和按比例筹资相结合的形式,科学厘定筹资水平,以保障长期照护保险基金的持续运营。     

The current status of occupational health in China

Objective  

This study aimed to summarize the major health problems among Chinese workers, the strategies and measures for occupational hazards control, the network and organizations of occupational health administration, and the achievements and current challenges of occupational health in China.     

我国商业医疗保险的现状及发展策略

在卫生费用不断增长的今天，我同商业保险公司面对需求旺盛的医疗保险市场却出现了停滞不前的情况。本文对此展开探讨，分析其原因，并对商业医疗保险的进一步发展提出看法。     

医改:医疗保险的机遇和挑战

国家新医改方案的出台,迅速引起了社会各界的广泛关注,成为时下最为热门的话题,探讨其对江苏省乃至全国的基本医疗保险的影响,并结合当前医保改革发展的实际,提出进一步完善医疗保险制度的对策。     

我国不同地区非耐药肺结核患者医疗保障现状调查

目的了解我国不同地区非耐药肺结核患者的医疗保障现状及疾病经济负担,为国家制定相关政策提供参考依据。方法 2009年8月在东北、中部、东南沿海和西部地区分别选择一个地市,由培训合格的调查员使用统一设计的调查表在当地结核病防治机构随机抽取非耐药肺结核患者开展诊疗费用报销及社会经济状况调查。结果不同地区的医疗保险政策都不同程度地忽视门诊费用的报销,而是倾向于住院费用的报销,保障力度从高到低依次为职工医保、居民医保和新农合。尽管住院费用报销的实际执行力度高于门诊费用报销,但两者的执行力度均较弱。肺结核患者住院费用中约有12%～33%,门诊费用中约有24%～56%应报销但却未报销。目前,医疗保险政策对减轻患者疾病经济负担的作用仍不明显。非耐药肺结核患者实际支付医疗费用占家庭非食品性支出的比例约为54%～74%。结论我国不同地区非耐药肺结核患者的医疗保障水平有待提高,医疗保险政策的实际执行力度需要加强,以切实减轻患者的疾病经济负担。     

Moving towards universal health insurance in China: performance, issues and lessons from Thailand

China is now in the course of implementing a new round of health system reforms. Universal health insurance coverage through the basic social medical insurance system is high on the reform agenda. This paper examines the performance of China's current social medical insurance system in terms of revenue collection, risk pooling, the benefit package, and provider payment mechanisms based on a literature review and publicly available data. On the basis of critical assessment, the paper attempts to address the issues challenging China as it moves towards universal coverage. Focusing in particular on the reform experience in Thailand as it implemented universal coverage, the following policy implications for further reform in China are articulated, taking into account China's particular circumstances: firstly, the gaps in the benefit package across different schemes should be further reduced; secondly, the prevailing fee-for-service payment system needs to be transformed; thirdly, the primary health care delivery and referral system needs to be strengthened in coordination with the reform of the health insurance system; and fourthly, raising the risk pooling level and integrating fragmented insurance schemes should be long-run objectives of reform.     

Public health engineering education in India: current scenario, opportunities and challenges

Public health engineering can play an important and significant role in solving environmental health issues. In order to confront public health challenges emerging out of environmental problems we need adequately trained public health engineers / environmental engineers. Considering the current burden of disease attributable to environmental factors and expansion in scope of applications of public health / environmental engineering science, it is essential to understand the present scenario of teaching, training and capacity building programs in these areas. Against this background the present research was carried out to know the current teaching and training programs in public health engineering and related disciplines in India and to understand the potential opportunities and challenges available. A systematic, predefined approach was used to collect and assemble the data related to various teaching and training programs in public health engineering / environmental engineering in India. Public health engineering / environmental engineering education and training in the country is mainly offered through engineering institutions, as pre-service and in-service training. Pre-service programs include diploma, degree (graduate) and post-graduate courses affiliated to various state technical boards, institutes and universities, whereas in-service training is mainly provided by Government of India recognized engineering and public health training institutes. Though trainees of these programs acquire skills related to engineering sciences, they significantly lack in public health skills. The teaching and training of public health engineering / environmental engineering is limited as a part of public health programs (MD Community Medicine, MPH, DPH) in India. There is need for developing teaching and training of public health engineering or environmental engineering as an interdisciplinary subject. Public health institutes can play an important and significant role in this regard by engaging themselves in initiating specialized programs in this domain.     

Self-care among chronically ill African Americans: culture, health disparities, and health insurance status

Little is known about the self-care practices of chronically ill African Americans or how lack of access to health care affects self-care. Results from a qualitative interview study of 167 African Americans who had one or more chronic illnesses found that self-care practices were culturally based, and the insured reported more extensive programs of self-care. Those who had some form of health insurance much more frequently reported the influence of physicians and health education programs in self-care regimens than did those who were uninsured. It is concluded that the cultural components of self-care have been underemphasized, and further, that the potential to maximize chronic illness management through self-care strategies is not realized for those who lack access to health care.     

Relationships between welfare status,health insurance status,and health and medical care among children with asthma

OBJECTIVES: This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma. METHODS: Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices. RESULTS: Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured. CONCLUSIONS: Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes.     

Legal status and health insurance among immigrants

The foreign-born represent a disproportionate share of nonelderly U.S. adults without health insurance. Using data from Los Angeles County, we find that most of the insurance disparities between the foreign-born and native-born can be explained by traditional socioeconomic factors. Undocumented immigrants, however, have lower rates of coverage-both private and public-even after a wide array of factors are controlled for. Applying Los Angeles County rates to the U.S. population implies that undocumented immigrants account for one-third of the total increase in the number of uninsured adults in the United States between 1980 and 2000.     

家庭健康：概念、测度与中国现状

本研究对家庭健康的框架和维度进行了介绍;基于中国版家庭健康简易评价量表,评价我国家庭健康的分布以及不同家庭特征下的异质性;并通过分析家庭健康对个体健康相关生命质量的影响论证家庭健康的重要性。我国家庭健康均分为37.99分（总分50）;家庭健康存在显著的城乡差异;家庭经济水平越高,家庭健康水平越高;核心/主干/联合家庭的家庭健康水平高于其他家庭类型;残疾人家庭健康评分低于非残疾家庭。家庭健康对于个体生命质量存在显著的正向效应。家庭健康为制定卫生政策、执行健康干预提供了一个更为全面的跨学科综合指标,在健康中国建设中应予以充分关注。