支付意愿测量方法在医疗保险领域的应用探讨

支付意愿用于测量消费者对一定数量某种物品所愿意支付的最高价格,以此衡量消费者对物品的评价。支付意愿的测量方法主要包括条件价值评估法、联合分析法、选择试验法等。支付意愿被广泛应用于卫生领域,如疫苗的研制与开发、医疗保险保费测算等,但在医疗保险领域的应用才刚刚开始,有待进一步探索。     

北京市东城区居民接受家庭病床服务的意愿性调查

目的了解东城区居民对家庭病床服务的看法，探讨居民接受家庭病床服务意愿性的影响因素．方法在东城区随机抽取900户家庭进行问卷调查，了解东城区居民的慢性病患病情况、对家庭病床的了解和看法、对家庭病床服务对象和好处的认识：结果东城区居民的慢性病患病率为23．8％，不再接受家庭病床服务的主要原因是病情好转．影响居民接受家庭病床服务意愿性的因素主要是居民的文化水平、家庭收入、认为家庭病床服务对病人有疗效和对家庭病床收费标准的评价。结论东城区居民对家庭病床服务的服务对象和好处有较深的认识，大多数居民愿意接受家庭病床服务。     

Impact of Heat Wave in 2005 on Mortality in Guangzhou,China

ObjectiveTo assess the impact of the heat wave in 2005 on mortality among the residents in Guangzhou and to identify susceptible subpopulations in Guangzhou, China.MethodsThe data of daily number of deaths and meteorological measures from 2003 to 2006 in Guangzhou were used in this study. Heat wave was defined as ≥7 consecutive days with daily maximum temperature above 35.0 °C and daily mean temperature above the 97th percentile during the study period. The excess deaths and rate ratio (RR) of mortality in the case period compared with the reference period in the same summer were calculated.ResultsDuring the study period, only one heat wave in 2005 was identified and the total number of excess deaths was 145 with an average of 12 deaths per day. The effect of the heat wave on non-accidental mortality (RR=1.23, 95% CI: 1.11-1.37) was found with statistically significant difference. Also, greater effects were observed for cardiovascular mortality (RR=1.34, 95% CI: 1.13-1.59) and respiratory mortality (RR=1.31, 95% CI: 1.02-1.69). Females, the elderly and people with lower socioeconomic status were at significantly higher risk of heat wave-associated mortality.ConclusionThe 2005 heat wave had a substantial impact on mortality among the residents in Guangzhou, particularly among some susceptible subpopulations. The findings from the present study may provide scientific evidences to develop relevant public health policies and prevention measures aimed at reduction of preventable mortality from heat waves.     

互联网医疗平台用户医疗知识付费意愿及影响因素研究

采用问卷调查法分析互联网医疗平台用户医疗知识付费意愿现状及其影响因素,构建结构方程模型并进行路径分析。结果显示互联网医疗平台用户医疗知识付费意愿不高,且在健康和经济情况方面存在显著差异;绩效期望、社会影响和知觉价值显著正向影响互联网医疗平台用户医疗知识付费意愿等。     

昆山市流动人口医疗保险现状及其参保意愿分析

目的了解昆山市流动人口参加医疗保险现状,探讨影响其参加医疗保险意愿的因素。方法采用整群抽样的方法从昆山市随机抽取10个工厂,对999名流动人口进行问卷调查。结果流动人口参保率为33.16%;影响其参加医疗保险意愿的因素主要有文化程度、打工时间、是否参加了医疗保险(P<0.05)。结论昆山市流动人口医疗保险参保率不高,他们对自身的健康风险认识不足,参加医疗保险意识不强,需加大医疗保险宣传力度,增强个人的医疗保险意识。     

广西北部湾经济区参加新型农村合作医疗农村居民新农合同城化的意愿调查分析

目的 了解参加新型农村合作医疗(新农合)的农村居民对北部湾经济区新农合同城化的意愿,为制定完善新农合政策,提升新农合统筹层次,促进北部湾经济区同城化提供参考依据.方法 采用多阶段随机抽样方法抽取在南宁、钦州、北海、防城港四市辖区的乡镇卫生院,对其参加新农合的农村居民进行新农合制度的认知及评价、新农合同城化态度等调查.采用logistic回归模型分析新农合同城化态度的影响因素.结果 共调查656人,男性325人,女性331人,年龄(43.8±l7.9)岁.赞成新农合同城化有568人(86.6％),不赞成38人(5.8％),不清楚50人(7.6％).影响参合农村居民同城化意愿的因素有区域、知晓缴费标准、对缴费标准的态度、对提高缴费的意愿以及对医疗服务水平评价.结论 区域经济水平、参合农村居民对新农合政策的了解程度会影响新农合同城化的意愿,城镇化、科学的补偿政策、稳定的筹资机制、基层医疗机构服务能力提升更有利于新农合同城化的推进.     

武汉市某医院护士工作满意度调查

摘要目的：研究医院护士工作满意度并探讨影响护士工作满意度的相关因素,为提高护士工作满意度提供参考依据。方法：采用一般资料调查表和工作满意度量表对143名护士进行调查。结果：护士工作满意度得分为151．83±27．22分,影响因素按照对工作满意度作用的大小,从大到小排列依次是薪酬及考核公平、领导艺术、管理制度、工作氛围、工作压力、福利待遇、继续教育机会、和病人的关系及家庭支持。结论：护士工作满意度不高,建议从护士的薪酬、考核的公平性、工作氛围、工作压力及继续教育机会等方面予以改善和提高,管理者也有必要提高自身的管理艺术。     

我国居民签约家庭医生意愿率的Meta分析

背景2016年我国开始在医联体内推行家庭医生签约服务制度,期望改变基层医疗卫生服务模式,提升基层服务能力。目前,我国居民签约家庭医生的意愿不清,了解当前居民签约家庭医生的意愿情况,分析其影响因素,有利于我国家庭医生签约制度的推行。目的系统评价我国居民签约家庭医生的意愿率,分析其影响因素。方法计算机检索中国知网、万方数据知识服务平台、维普网、PubMed、EMbase、The Cochrane Library等数据库,收集我国居民签约家庭医生意愿相关的文献,检索时限为2009-01-01至2018-06-01。由2名研究者独立筛选文献并提取数据,对纳入研究偏倚风险进行评价。采用Stata 12.0统计软件进行Meta分析。结果共纳入34篇文献,调查时间范围2011—2017年,包括32 326例居民,有签约意愿的居民人数为20 344例,签约意愿率为62.9%[95%CI(56.7%,68.6%)]。根据地区、调查时间、性别、民族、年龄、文化程度、职业、是否知晓家庭医生服务及健康状况进行亚组分析,结果显示,民族、是否了解家庭医生服务是影响居民签约意愿的因素(P<0.05)。居民不愿签约的原因主要有:(1)不了解家庭医生服务;(2)不信任全科医生的能力;(3)怕自己就医受限;(4)担心社区设备差或药品受限;(5)不清楚签约的好处;(6)担心签约费用;(7)医生服务的态度差;(8)没有需求。结论我国居民签约家庭医生意愿率为62.9%,民族、是否了解家庭医生服务是影响居民签约意愿的因素。     

Effectiveness of Adherence to Standardized Hypertension Management by Primary Health Care Workers in China:a Cross-sectional Survey 3 Years after the Healthcare Reform

正The standardized hypertension management provided by primary health care workers is an important part of China’s recent health care reform efforts.Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012,this study found that adherence to standardized hypertension management is associated with positive effects on hypertension-     

Analysis of a Community-based Intervention to Reduce Heat-related Illness during Heat Waves in Licheng,China:a Quasi-experimental Study

Objective To reduce health-related threats of heat waves, interventions have been implemented in many parts of the world. However, there is a lack of higher-level evidence concerning the intervention efficacy. This study aimed to determine the efficacy of an intervention to reduce the number of heat-related illnesses.
Methods A quasi-experimental design was employed by two cross-sectional surveys in the year 2014 and 2015, including 2,240 participants and 2,356 participants, respectively. Each survey was designed to include one control group and one intervention group, which conducted in Licheng, China. A representative sample was selected using a multistage sampling method. Data, collected from questionnaires about heat waves in 2014 and 2015, were analyzed using a difference-in-difference analysis and cost effectiveness analysis. Outcomes included changes in the prevalence of heat-related illnesses and cost-effectiveness variables.
Results Relative to the control participants, the prevalence of heat-related illness in the intervention participants decreased to a greater extent in rural areas than in urban areas (OR=0.495 vs. OR=1.281). Moreover, the cost-effectiveness ratio in the intervention group was less than that in the control group (US$15.06 vs. US$15.69 per participant). Furthermore, to avoid one additional patient, the incremental cost-effectiveness ratio showed that an additional US$14.47 would be needed for the intervention compared to when no intervention was applied.
Conclusion The intervention program may be considered a worthwhile investment for rural areas that are more likely to experience heat waves. Meanwhile, corresponding improving measures should be presented towards urban areas. Future research should examine whether the intervention strategies could be spread out in other domestic or international regions where heat waves are usually experienced.     

Uptake of HIV Self-testing among Men Who have Sex with Men in Beijing,China: a Cross-sectional Study

Objective To examine HIV self-testing uptake and its determinates among men who have sex with men(MSM) in Beijing, China. Methods A cross-sectional online survey was conducted in Beijing, China in 2016. Participants were users of a popular Chinese gay networking application and had an unknown or negative HIV status. Univariate and multivariate logistic regression analyses were conducted to examine factors associated with HIV self-testing based on adjusted odds ratio(AOR) and 95% confidence interval(CI). Results Among the 5,996 MSM included in the study, 2,383(39.7%) reported to have used HIV self-testing kits. Willingness to use an HIV self-test kit in the future was expressed by 92% of the participants. High monthly income(AOR = 1.49; CI = 1.10-2.02; P = 0.010), large number of male sex partners(≥ 2: AOR = 1.24; CI = 1.09-1.43; P = 0.002), sexual activity with commercial male sex partners(≥ 2: AOR = 1.94; CI = 1.34-2.82; P = 0.001), long-term drug use(AOR = 1.42; CI = 1.23-1.62; P 0.001), and long-term HIV voluntary counseling and testing(VCT) attendance(AOR = 3.62; CI = 3.11-4.22; P 0.001) were all associated with increased odds of HIV self-testing uptake. Conclusion The nearly 40% rate of HIV self-testing uptake among MSM in our sample was high. In addition, an over 90% willingness to use kits in the future was encouraging. HIV self-testing could be an important solution to help China achieve the global target of having 90% of all people living with HIV diagnosed by 2020.     

Baseline,Cross-sectional Survey of Knowledge,Attitudes, and Practices Related to Efficient Use of Government Resources in the Health Sector in Malawi

BackgroundMisuse of government resources is a challenge within the health sector that can be addressed by increasing public demand for accountability, reporting suspected misuse of resources, and other client-driven changes. This study was led by the USAID/Health Communication for Life Project to inform the design of social accountability communication messages and interventions. The study also established baseline data on Malawians'' knowledge, attitudes, and practices related to efficient use of government resources in the health sector.MethodsThis baseline, formative research study used a non-experimental, cross sectional survey design. Sampling for the mobile survey was conducted using the random digit dialing technique. Data were collected via mobile phone using interactive voice response technology. Our sample included 1,425 respondents, 67% of whom were male and 33% were female. Respondents were mostly 35 years old or younger, with more than half of female respondents reporting their age as 18–24 years.ResultsOur findings indicate that Malawians believe misuse of government resources is pervasive in Malawi. Seventy percent of men and nearly 60% of women reported having noticed, found, or seen drugs believed to be from a government health facility being sold elsewhere. Few respondents who had observed or experienced misuse of government health sector resources reported the incident. When asked the likelihood that they would report a request for a bribe, gift, or favor in exchange for health services in the future, 68% of respondents said they would report it.ConclusionsSocial and behavior change communication could serve a key role in motivating those who are aware of misuse of public sector health resources to report the issues they observe and providing them with the information needed to follow through. Further research is needed to understand the best approaches to mitigate underlying factors that drive misuse of resources and underreporting.     

肺康复运动训练对慢性阻塞性肺疾病的影响

目的:观察分析肺康复运动训练对慢性阻塞性肺疾病(COPD)患者几项客观指标的影响,评价肺康复运动训练在COPD防治中的效果和远期效应。方法:取稳定期中重度COPD患者60例随机分成2组,观察组中度COPD15例,重度COPD15例,对照组中度CPOD15例,重度COPD15例。观察组进行肺康复运动训练12周。观察训练前后患者6min步行距离(6MWD)、肺功能的变化和COPD急性发作(AECOPD)年次数并与对照组比较。结果:观察组在训练前后自身对照并与对照组比较6MWD、AECOPD年发作次数均有明显差异,具有统计学意义(P<0.01～0.05)。肺功能改变无明显差异,不具有统计学意义(P>0.05)。结论:肺康复运动训练可以提高COPD患者6MWD,减少AECOPD年发作次数,对改善肺功能无明显作用。     

Validation of the Simplified Chinese-character Version of the International Physical Activity Questionnaire-Long Form in Urban Community-dwelling Adults: a Cross-sectional Study in Hangzhou,China

Objective To assess the test-retest reliability and criterion validity of the Simplified Chinese-character version of the International Physical Activity Questionnaire Long form (IPAQ-L) in urban community-dwelling adults in Hanghzou, China. Methods A total of 158 eligible participants aged 25-59 years from 6 neighbourhoods in two central districts of Hangzhou completed the IPAQ-L questionnaire twice within a 7-day interval. Half of the subjects wore pedometers during the first 7 days. Test-retest reliability was examined by comparing the first (Day 1) and the second (Day 9) survey of IPAQ-L. Criterion validity was assessed by comparing IPAQ-L with pedometer data. Results Modest to good test-retest reliability was found with intraclass correlation coefficients of 0.67 for total PA, 0.37 to 0.73 for specific dimensions, and 0.56 to 0.71 for different intensities of PA. Total PA measured by IPAQ-L was moderately correlated with exercise levels (partialr= 0.27,P= 0.020) and walking distance (partialr= 0.31,P= 0.007), which were measured by a pedometer, after adjusting for gender, age, educational attainment and employment status. Conclusion Our Results indicate that the IPAQ-L is a reliable and validated measure for assessing physical activity levels in this population and possibly the adult population in other mainland Chinese cities.     

新医改背景下北京市居民基层就诊行为变化特征：基于2013年和2018年国家卫生服务调查数据

背景新医改以来,北京市采取了一系列措施促进患者到基层医疗卫生机构就诊,尤其是在北京市医药分开综合改革后,但其实施效果尚缺少需方证据支持。同时,下沉到基层医疗卫生机构就诊的患者特征尚不明确,若下沉的主要是低社会经济地位的患者,这将带来医疗服务公平性的问题。目的从需方角度分析北京市居民就诊机构选择的变化及特征,为进一步推动分级诊疗提供参考依据。方法2020年7—9月,利用全国第五次（2013年数据）和第六次（2018年数据）卫生服务调查中北京市居民的调查数据,将调查对象中年龄≥15周岁、在过去两周内有过就诊经历的居民作为研究对象,以安德森卫生服务利用行为模型为理论框架,采用多元Logistic回归和Chow检验,分析北京市居民基层就诊行为的变化特征。结果在≥15岁的北京市调查居民中,基层就诊率从2013年的60.89%（1 527/2 508）上升到2018年的64.40%（4 125/6 405）,差异有统计学意义（χ2=9.61,P=0.002）。2018年女性、≥60岁、居住在城区、非低收入家庭、具有城镇职工医保、患≥2种慢性病者基层就诊率高于2013年,差异有统计学意义（P<0.05）。多元Logistic回归分析结果显示,年龄、居住地区、医保类型、慢性病患病情况是2013年北京市居民就诊机构选择的影响因素（P<0.05）,性别、年龄、家庭人均收入水平、医保类型、慢性病患病情况是2018年北京市居民就诊机构选择的影响因素（P<0.05）。Chow检验结果显示,基层就诊率增加的居民主要是具有城镇职工医保的居民〔OR（95%CI）=1.56（1.24,1.97）〕和居住在城区的居民〔OR（95%CI）=1.27（1.01,1.58）〕（P<0.05）。结论2013—2018年,北京市居民基层就诊率升高,主要是城区居民、具有城镇职工医保的居民基层就诊行为增加。     

我国居民健康档案的建立及利用情况：基于东中西三省份的需方调查

背景居民健康档案建设是深化医药卫生体制改革提出的重点任务,是促进基本公共卫生服务均等化的重要举措。目前,我国关于健康档案的研究多局限在某个城市或社区内,基于全国范围的从需方角度开展的跨省份研究相对缺乏。 目的 了解居民健康档案的建立及利用情况。 方法 基于"基本公共卫生服务项目"的服务人群,将调查对象分为0~6岁儿童、孕产妇、≥65岁老年人、高血压患者、糖尿病患者、一般人群6类。于2019年11—12月,采用多阶段抽样法,在我国东、中、西部各抽取1个省份（浙江省、山西省、重庆市）的1个区和1个县,在相应区（县）内随机抽取2家社区卫生服务中心/乡镇卫生院及其所辖社区卫生服务站和村卫生室。最终抽取20家社区卫生服务中心/乡镇卫生院,对前来机构就诊的居民开展问卷调查,调查内容包括居民健康档案建立情况、可查看情况、查看方式及满意度。 结果 最终纳入居民10 067例,9 119例自述已建立健康档案,建档率为90.58%。其中,0~6岁儿童的建档率为94.09%（2 787/2 962）、孕产妇的建档率为95.60%（956/1 000）、≥65岁非高血压/糖尿病老年人的建档率为87.87%（616/701）、≥65岁高血压患者的建档率为88.87%（1 414/1 591）、<65岁高血压患者的建档率为92.91%（747/804）、≥65岁糖尿病患者的建档率为89.41%（895/1 001）、<65岁糖尿病患者的建档率为92.72%（471/508）、一般人群的建档率为82.20%（1 233/1 500）。在建立了健康档案的居民中,67.02%（5 990/8 938）可以随时查看健康档案,12.40%（1 108/8 938）反映不能查看健康档案,20.59%（1 840/8 938）表示从未查看过健康档案。5 990例可随时查看健康档案的居民中,查看方式以纸质健康档案居多〔4 538例（75.76%）〕。83.31%（4 352/5 224）的居民对健康档案服务表示满意。不同省份、区（县）类型、家庭人均月收入、学历、人群类别居民的建档率、健康档案可查看率比较,差异有统计学意义（P<0.05）;不同省份、就诊机构类型、区（县）类型、家庭人均月收入、学历、人群类别居民对健康档案建立与利用情况的满意度比较,差异有统计学意义（P<0.05）。 结论 近年来,我国居民健康档案建档率有明显提高,利用率有所改善但仍有待提高,居民满意度尚可。     

2000-2002年北京、上海和广州儿童肺炎链球菌携带及抗生素耐药性监测

目的了解当前我国儿童携带肺炎链球菌情况,及该菌对常用抗生素的敏感性分布,为临床合理用药提供依据。方法2000-2002年于北京、上海和广州3家儿童医院门诊就诊的年龄为1个月至5岁急性上呼吸道感染儿童鼻咽部分离肺炎链球菌,采用纸片扩散法和E-test法检测菌株对10种抗生素的敏感性。结果肺炎链球菌分离率24．9％。肺炎链球菌对青霉素的不敏感率达39．9％,耐药率6．4％;20．4％的菌株对头孢克洛耐药;19．0％的菌株对头孢呋辛不敏感;肺炎链球菌对阿莫西林／克拉维酸和头孢曲松的敏感率分别为98．5％和97．2％。对红霉素、复方新诺明和四环素的不敏感率都在80．0％以上。98．0％的菌株对环丙沙星敏感。3城市肺炎链球菌抗生素敏感性变化有各自的特点。耐药模式分析表明多重耐药率达88．7％,青霉素不敏感肺炎链球菌（PNSP）较青霉素敏感菌（PSSP）更为多见（99．1％和78．8％,P〈0．01）;红霉素不敏感菌株较红霉素敏感菌株也更为多见（95．8％和17．1％,P〈0．01）。结论我国肺炎链球菌对抗生素的耐药状况已很严峻,不同地区肺炎链球菌的耐药性变化具有不同特点。必须加强各地肺炎链球菌耐药性和抗生素使用情况的监测,及时调整经验用药方案和公共卫生策略。     

4地儿科临床分离革兰阳性球菌2000-2006年耐药性监测

目的探讨我国不同地区医院儿科主要革兰阳性球菌耐药的情况。方法对2000年1月1日至2006年12月31日5所儿童专科医院检验科报送检标本分离出的4种革兰阳性球菌用Kirby-Bauer琼脂扩散法进行抗生素敏感实验。结果5所医院临床分离出金黄色葡萄球菌共7825株,其中耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)的检出率为6.87%,红霉素总耐药率为66.39%,并且有逐年上升趋势,未发现对万古霉素耐药或中度敏感菌株。分离出肺炎链球菌4781株,其中青霉素不敏感肺炎链球菌(PNSP)的平均检出率为68.64%,红霉素耐药率为90.80%,两者耐药率均逐年上升。分离出1301株β溶血性链球菌,对青霉素全部敏感,对红霉素的耐药率为80.94%,且耐药率在逐年增加。分离出肠球菌共2216株,对万古霉素的中度敏感率为3.11%,氨苄西林的耐药率为48.03%,红霉素的耐药率高达86.47%。结论除β溶血性链球菌外,多数革兰阳性菌对广谱青霉素的耐药率都偏高;对红霉素的耐药率居高不下并有逐年上升的趋势,革兰阳性菌对万古霉素和环丙沙星的敏感率较高。MRSA仍在较低水平,本研究未发现耐万古霉素金黄色葡萄球菌(VRSA),但出现对万古霉素中度敏感耐药的肠球菌。因此要加强对革兰阳性球菌耐药性和抗生素使用情况的监测,合理使用抗生素。     

全面二孩政策背景下安徽省中小城市30岁及以上二孩孕妇的生育意愿与心理健康状况研究

背景　随着全面二孩政策实施,育龄妇女生育意愿受到全社会的关注,但对于超过最佳生育年龄的孕妇的生育意愿和心理健康状况的影响因素的研究却鲜见报道。目的　了解安徽省中小城市30岁及以上二孩孕妇的生育意愿和心理健康状况,为二孩政策的实施及配套政策的完善提供参考。方法　2018年4-8月采用多阶段整群抽样法,随机选取安徽省中小城市中的铜陵市、淮南市、六安市作为研究地点,选择在妇幼保健院建立妊娠期保健卡的30岁及以上的二孩孕妇作为研究对象。收集其一般人口学资料、生育意愿及生育相关特征、总体幸福感量表（GWBS）评分。采用多因素Logistic回归模型分析生育意愿、心理健康状况的影响因素。结果　共发放问卷647份,回收有效问卷618份,有效回收率为95.5%。不同年龄、身体健康状况、理想生育子女数目、周围人群生育情况、生育决定权、二孩性别期待的孕妇生育意愿比较,差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,年龄、周围人群生育状况、生育决定权、二孩性别期待是孕妇生育意愿的影响因素（P<0.05）。不愿意生育孕妇的精力、对生活的满足和兴趣、忧郁或愉快的心境、对情感和行为的控制、松弛与紧张得分、GWBS总分低于愿意生育的孕妇（P<0.05）。不同GWBS评分孕妇身体健康状况、生育意愿、生育决定权和生育政策知晓情况比较,差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,身体健康状况、生育意愿、生育决定权是GWBS评分的影响因素（P<0.05）。结论　安徽省中小城市30岁及以上二孩孕妇总体生育意愿较强,孕妇心理健康状况主要受生育意愿影响。相关部门应采取综合性措施,以应对政策变化带来的挑战。