Cost-Utility Analyses in Diabetes: A Systematic Review and Implications from Real-World Evidence

ObjectivesTo systematically review the cost-effectiveness of diabetes interventions, identify high-value diabetes services, and estimate potential gains from increasing their utilization.MethodsThe study consisted of two steps. First, we reviewed cost-utility analyses (CUAs) related to diabetes published through the end of 2012, using the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org). We used logistic regression to examine factors independently associated with favorable cost-effective ratios. Second, we used the Humedica electronic medical records to estimate potential savings and health benefits gained by shifting patients currently receiving low-value services to high-value alternatives.ResultsWe identified 196 diabetes CUAs, of which 55% examined pharmaceuticals. Most (70%) diabetes CUAs focused on treatment rather than prevention. Most used a health care payer perspective and were industry-sponsored. Of the 497 published cost-utility ratios, 82% examined an intervention recommended by diabetes guidelines. Approximately 73% of the interventions were cost-saving or below $50,000 per quality-adjusted life-year. Logistic regression analysis showed that higher-quality CUAs, CUAs conducted from the US perspective, surgical interventions, and guideline-recommended interventions were more likely to report favorable ratios. Of the 7907 eligible patients with diabetes in our sample, up to 7117 could in principle be shifted to cost-saving treatments, reducing costs by $12.5 million and gaining more than 1938 quality-adjusted life-years over a lifetime.ConclusionsMost diabetes interventions evaluated by CUAs are recommended by practice guidelines and may provide good value for money. Our results indicate that patients with diabetes and the health care system could potentially benefit from shifting to the greater use of high-value services.     

发展社区卫生服务是实现医改目标的基础

过去30年,我国医疗卫生事业发展出现了一系列的矛盾和问题,如何实现卫生事业的健康发展,更有效地保护全体人群的健康权益,成为我国卫生事业改革的重要目标。从分析我国卫生改革不成功的原因入手,以及分析实现我国新医改"到2020年覆盖城乡居民的基本医疗卫生制度基本建立"目标的关键因素,探讨发展社区卫生服务与实现人人享有基本卫生保健之间的关系,通过分析,认为大力发展社区卫生服务是实现我国新医改目标的重要基础。     

宁夏卫生资源和卫生服务发展分析

目的:了解宁夏地区卫生资源配置情况,为制定合理的区域卫生规划和提高卫生服务能力提供建议.方法:收集整理2012-2019年宁夏的卫生资源和卫生服务数据,分析其变化状况.结果:2012-2019年,宁夏卫生资源总量充足,卫生人员总数、医疗机构总数、每千人口医疗机构床位数均有所增长;卫生服务的发展在逐年优化,具体表现为医院...     

社区卫生服务培训需求调查

目的：分析成都、沈阳两项目市(城市社区卫生与贫困医疗救助)社区卫生服务的培训需求，为项目设计培训计划提供参考。方法：社区卫生服务机构与人员的问卷调查、卫生人员专题小组讨论、机构领导深入访谈。结果：卫生人员的背景和所具知识、技能尚不能完全胜任社区卫生服务，卫生人员本身和领导都表示了培训的需求，并对培训内容、方式、对象、费用等提出了具体看法和希望。结论：加强两项目市杜区卫生人员的培训有必要也有可能。注意周密、完善培训计划；社区卫生管理人员和技术人员的培训齐抓并管；岗位任务分析；因地制宜；多种形式结合，注重社区实践。     

Changes in How Health Plans Provide Behavioral Health Services

Health plans appear to be moving toward less stringent management, but it is not known whether behavioral health care arrangements mirror the overall trend. To improve access to and quality of behavioral health services, it is critical to track plans’ delivery of these services. This study examined plans’ behavioral health care arrangements and changes over time using a nationally representative health plan survey regarding alcohol, drug abuse, and mental health services in 1999 (N = 434, 92% response) and 2003 (N = 368, 83% response). Findings indicate health plans’ behavioral health service provision changed significantly since 1999, including a large increase in contracting with managed behavioral health care organizations. Some evidence of loosening administrative controls such as prior authorization implies easier access to services. However, increased prevalence of higher levels of cost sharing suggests financial barriers have grown. These changes have important implications for enrollees seeking care and for providers working to meet patients’ needs. This study was supported by the National Institute of Drug Abuse grant #R01DA10915 and the National Institute on Alcohol Abuse and Alcoholism grant # R01AA10869. The 1999 round was also supported by the Substance Abuse and Mental Health Services Administration contract #98M-0028601.     

商业健康保险在医疗卫生服务中的作用

本文阐述商业健康保险作用于医疗卫生服务的理论基础,分析商业健康保险对医疗卫生服务的作用及其不足的原因,对商业健康保险发挥在其医疗卫生服务中的作用提出对策建议,为发展商业健康保险促进医疗卫生服务提供了理论借鉴。     

西宁、银川两市社区卫生服务提供现状分析

目的通过调查UHPP项目试点市的社区卫生服务机构的服务提供情况来了解其卫生服务发展的实际情况．分析存在的问题，为服务功能的进一步完善及贫困医疗救助的开展提供依据。方法采用定量与定性调查相结合的方法．了解机构的一般情况、人力资源的配置及服务提供等情况。结果服务项目开始朝着社区卫生服务的六大功能方向发展．但项目多少、服务量多少不一，还是以医疗为主。不同机构由于规模、环境及运行状况不同．年服务量差异较大．结论社区卫生服务机构提供的服务内容不断拓展，但机构的功能定位和人员的观念有待加强，需要进一步从医保及医疗服务市场的管理等相关配套政策和资金上支持社区卫生服务的开展，推进双向转诊工作．合理开发和利用健康档案．     

医保政策对社区卫生服务筹资作用的潜力分析

目的探索医保政策在社区卫生服务筹资方面的作用及潜力。方法采用描述性统计分析的方法对医保在社区卫生服务利用和业务收入方面的作用及情况进行描述和比较。结果 3年间社区卫生服务利用者医疗费用支付方式的构成有显著性差异;参保居民优先选择医保定点机构的比例高于非参保居民;医保定点后社区卫生服务机构收入有所增长;启动医保补偿机构的医保收入占业务收入的比例总体呈上升趋势,但仍较低。结论参保居民就诊比例逐年上升;医保定点是影响参保居民选择就诊机构的重要因素;医保政策筹资效用显现,但仍有较大潜力。     

社区卫生服务模式新探

介绍了上海市浦东新区上钢街道医院根据上海市政府关于社区建设的要求重新确定一级医院的功能位置,探索社区卫生服务模式的情况。该模式以建立社区卫生服务网络和居民健康管理系统,试行家庭医生制度为主要内容,体现了以下特点:医疗服务突破坐等病人上医院看病和局限于临床医学旧模式;医疗模式由以病为中心转向以人为中心;技术措施由以治为主转向以防为主;参与人员由医务人员转向医社结合;服务对象由病人个体转向社区群体;服务目标由医疗指标转向健康指标;医患关系由松散关系转向密切关系。作者还从医疗体制、补偿机制、人才结构等方面论述了社区服务面临的困难和挑战。     

新时期居民健康服务需要发展与演化分析

随着城镇化、人口老龄化、信息化以及疾病谱的变化,我国居民的健康服务需要演化明显,而现行的服务供给体系存在明显的供给不足与供需失衡问题,在未来的政策制定中应考虑如何提升居民健康服务需要的满足程度,增加居民服务利用的满意度和改善居民的健康状况。     

黑龙江省卫生资源分布与服务利用状况分析及其改善策略思考

根据黑龙江省历年的卫生统计数据以及国家第三次卫生服务调查黑龙江省扩点调查数据库,对黑龙江省主要卫生资源的分布以及服务利用状况进行了分析,提出了在卫生资源配置和利用方面存在的主要问题及改善卫生资源分布与利用公平性和效率的策略思考。