兵团城镇职工基本医疗保险覆盖人口的医疗服务利用变化分析

目的:分析新疆生产建设兵团城镇职工基本医疗保险参保人口医疗服务利用的变化情况,为进一步发展和完善兵团城镇职工基本医疗保险提供依据。方法:利用兵团2004年和2010年两次卫生服务调查资料,对参保人口的卫生服务需要、卫生服务利用和医疗费用变化进行分析。结果:2004年与2010年相比,参保职工两周患病率由211.8‰上升到390.2‰,两周就诊率由81.6‰上升至95.0‰,年住院率由106.9‰上升至145.9‰,未住院率由19.4%下降到14.1%,经济困难是未利用住院服务的主要原因,次均就诊费用年增长率为4.1%,次均住院费用年增长率为5.7%。结论:兵团城镇职工基本医疗保险制度一定程度地促进了职工对门诊及住院医疗服务的利用,但医疗费用增长较快,补偿水平不高,尚不能完全保障职工合理的医疗服务需求。     

经济收入和医疗保健制度对卫生服务公平性的影响

文章应用“利用/需要比“(Le Grand法)对南通和淄博两市职工家庭卫生服务利用的公平性进行分析发现,家庭经济收入对卫生服务公平性影响不大,不同医疗保健制度人群间存在不公平性,自费医疗限制了卫生服务利用,且与宏观经济状况和卫生服务体系改革有密切的关系.建议完善卫生服务体制改革,关注城市自费人群的卫生服务利用,提高卫生服务公平性.     

梁山县农民住院卫生服务利用及其影响因素

目的:了解山东梁山县农村卫生现状,评价目前农村居民住院服务利用情况.方法:采用分层整群抽样的方法,抽取5870名农民进行家庭卫生健康问卷调查.描述农村居民的卫生服务需求和利用情况,分析影响农村居民住院服务利用的影响因素.结果:梁山县两周患病率130.83‰,住院率和未住院率分别为13.63‰和47.37%,年龄等因素对两周患病及住院率有影响.结论:当地卫生主管部门应探索、发展和完善适合农村居民的医疗保障制度,尽量满足农村居民的卫生服务需求.     

西部农村居民卫生服务利用公平性研究

目的:研究西部农村居民卫生服务利用公平性及其影响因素。方法:采用对陕西省镇安县1545户农村居民入户调查的数据,利用集中指数分解法分析数据。结果:门诊和住院服务利用的水平不公平指数分别0.0440和0.1557,影响门诊服务利用不公平性的主要因素是1月患病情况,影响住院服务利用不公平性的主要因素是居民经济水平。结论:为了提高卫生服务利用公平性,建议政府部门采取措施提高贫困人群经济水平、缩小贫富差距,同时加强疾病预防工作、降低居民疾病患病率。     

贫困农村卫生服务利用的公平性研究

本文通过分析贫困农村2722户家庭卫生服务调查的材料,研究了农户收入差别对其卫生服务利用的影响。研究结果表明:贫困、中等、富裕三组农户对门诊和住院服务的需要较为近似;对门诊服务的利用差别较小;住院服务的利用差距较大。富裕组年住院率及自报次均住院费用均明显高于贫困组。这表明随着农户经济收入差别的扩大,贫困农村卫生服务利用的公平性受到一定的损害,特别是对生活在贫困线以下的农户有较大的影响。     

广州市城区居民两周患病及就诊状况分析

目的了解广州市城区居民卫生服务需求和利用情况,为更好地制定卫生资源配置政策提供依据。方法采用2003年全国第三次卫生服务调查中广州市城区有关居民健康状况、居民卫生服务需求和利用情况等资料进行分析。结果广州市城区居民的两周患病率为149.5‰,是否患慢性病是最主要的影响因素;两周就诊率为161.1‰,家庭人均收入是最主要的影响因素。两周患病率和两周就诊率均比1998年第二次卫生服务调查降低。结论居民卫生服务的需要量和门诊服务利用均出现下降,后者幅度较前者大。居民对门诊卫生服务的需求受到约束和抑制。降低慢性病患病率,提高居民收入及医疗保障水平有利于提高居民的健康水平。     

城乡居民基本医疗保险对中老年人卫生服务利用的影响

目的 探究城乡居民基本医疗保险对中老年人卫生服务利用的影响,为我国医疗保障制度优化提供循证依据。方法 利用中国健康与养老追踪调查(CHARLS)2018年数据,基于Andersen理论模型框架,分别建立Probit、Tobit和Biprobit回归模型,分析城乡居民医保对中老年人就诊选择和就诊次数的影响,以及门诊服务对住院服务的影响。结果 共调查中老年人8753例,其中门诊、住院比例分别为18.83%、19.75%,城乡居民医保的参加率为96.38%。参加城乡居民医保对中老年人住院服务利用有影响(P<0.05),住院概率平均上升11.2%,住院次数平均提高0.232次,但对门诊服务未产生影响(P>0.05),门诊和住院之间存在正相关关系。此外,60岁及以上人群和非农户口人群的住院服务利用较高。结论 城乡居民医保提高了中老年人的住院服务利用率,但存在过度利用住院服务的问题,而且在不同年龄段、户口类型人群中城乡居民医保对住院服务利用的影响存在差异。政府应进一步完善城乡居民医保的报销机制,引导居民合理就医,提高卫生服务利用的公平性。     

东营市城乡居民住院服务利用及其影响因素分析

目的　了解山东省东营市城乡居民住院服务利用程度及其影响因素。方法　于 2 0 0 2年在全市范围内进行了卫生服务调查研究。在对资料进行描述性分析的基础上 ,利用logistic回归分析方法 ,对住院概率的影响因素进行了分析。结果　东营市城乡居民的住院率平均为 5 7‰ ,未住院率平均为4 2‰ ,均高于全国平均水平 ;城市地区人口住院率为 76‰ ,农村地区为 4 6‰ ,城市地区明显高于农村地区。影响住院概率的因素主要有性别、年龄、收入及医疗保险制度等。结论　建议加快区域卫生规划进程 ,实施医疗保障制度和医疗救助制度。     

新型农村合作医疗改善卫生服务公平性效果评价

文章利用陕西省第四次国家卫生服务入户调查数据,以特征分数配比法匹配后的新型农村合作医疗参保和未参保居民为研究对象,采用集中指数法和集中指数分解法分析了新型农村合作医疗对卫生服务利用公平性的影响效果。结果显示,新型农村合作医疗提高了农村居民住院服务利用公平性,但同时也扩大了低收入居民和高收入居民门诊服务利用的差距。建议新型农村合作医疗对门诊和住院服务均实施按一定比例报销的补偿模式。     

新型农村合作医疗实施前后福建省农民卫生服务利用调查分析

目的了解新型农村合作医疗实施前后福建省农村居民卫生服务利用现状及影响因素。方法使用第四次国家卫生服务调查设计的家庭健康询问调查表进行问卷调查。结果两周就诊率为163.56‰,住院率为54.03‰,与2003年卫生服务调查相比,两周就诊率差别无统计学意义,住院率差别有统计学意义(P<0.001)。结论农民卫生服务利用受个体内在因素(疾病、性别、年龄、文化程度、职业及经济状况等)和外部环境(新型农村合作医疗)的影响。     

The Philippines' National Health Insurance Act: a German perspective

Through the recent National Health Insurance Act (NHIA), the Philippines have committed themselves to introducing a social health insurance with universal coverage within 15 years. Germany was the first country to introduce a social health insurance system more than 100 years ago. Its system is based on the principles of corporatism, federalism and a mandate for equity. Based on a long-term German experience with equity, quality, cost and efficiency issues, the Philippines' NHIA is analysed concerning the entitlement to benefits and the benefit package, the organization of the health insurance programme, health insurance financing, and provider payment mechanisms. It is suggested that the Philippines could profit from including preventive and promotive services as well as pharmaceuticals in the benefits package. The organization of the health insurance system could be decentralized using the 13 regions as its principal units. To achieve financial equity between regions and health funds, a contribution compensation scheme is proposed. To prevent over-utilization in over-served areas and to promote utilization in under-served areas, a relative value scale for fee-for-service payments seem advisable.     

广州市社会医疗保险制度的公平性研究

在社会调查和相关统计资料的基础上,从独立统筹区之间参保、医保制度之间待遇水平、参保人与全人群之间卫生服务利用、医患道德风险行为影响等4个方面,评价广州市社会医疗保险制度的公平性状况.针对公平性建设中的不足,提出几点合理化建议:继续扩大社会医疗保险的覆盖面,加快医保制度之间的统筹协调发展步伐,推行以预付制为主的医方补偿机制,确定合理的医疗费用患方分担机制.     

影响门诊和住院病人流向的社会经济因素研究

文章分析了居民门诊、住院服务在医疗机构中分布,为制定医疗保险改革方案提供依据.南通市54%门诊量、60.2%住院量和58.7%人均医疗费用集中在三级医院;淄博市15.6%门诊量、43.8%住院量和33.3%医疗费用集中在三级医院.说明社区卫生服务功能在南通市相当薄弱.建议加强发展社区卫生服务,按大病进医院小病进社区的原则重组医院功能.     

上海郊区卫生资源配置和利用的公平与效率分析

目的 :通过对上海郊区卫生资源配置和利用的分析 ,指出卫生资源配置和利用中存在的公平和效率问题 ,并提出政策建议。方法 :对上海郊区不同经济发展时期和不同经济发展水平地区的比较分析。结论 :1.上海郊区政府对卫生事业经费的投入采取了一定的倾斜政策 ,公平性得到了相应提高 ,但三类地区人均卫生事业经费仍然较低 ;2 .上海郊区每千人口医生数和每千人口护士数较低 ,均低于全市的平均水平 ,尤其是三类地区 ;3.三类地区平均每人每年诊疗次数及每千人口每年住院次数相对较低 ;4 .上海郊区尤其是经济发展水平较低的地区医疗卫生服务利用效率较低。政策建议 :1.建立健全多种形式的医疗保障制度 ,提高医疗保障的社会化程度 ;2 .开展社区卫生服务 ,改革上海郊区医疗卫生服务功能 ;3.实施区域卫生规划 ,合理配置卫生资源 ;4 .大力加强卫生人才建设 ,提高医疗卫生服务质量     

Privatisation & marketisation of post-birth care: the hidden costs for new mothers

Introduction

Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries.

Methods

Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care.

Results

In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance.

Conclusions

China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance.     

城市不在业者卫生服务利用及影响因素分析

目的探索城市不在业者卫生服务利用情况及其影响因素,为有关部门制定政策提供依据。方法从2003年国家卫生服务调查数据库中抽取8412名城市不在业者进行深入分析。结果影响城市不在业者卫生服务利用的主要因素有年龄、文化程度、医疗保障状况。结论需要提高城市不在业者的医疗保障覆盖率。     

Equity in utilization of cancer inpatient services by income classes

Equity in health care services has been prioritized on the Korean government's policy agenda since the government-driven national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiaries. The purpose of this study is to identify disparities in the utilization of health care services, especially cancer inpatient services among different income groups in Jeju Island of South Korea. We analyzed the national health insurance data about qualification of beneficiaries and utilization of health care services consumed by Jeju Island's residents for 1 year of period (from January to December 2000) and acquired their utilization features of cancer inpatient services. The independent variable was 10 different income levels according to the national health insurance fee imposed on each household in 2000. The dependent variable was the volume of cancer inpatient services utilized, that was measured by admission days and costs for treatment. The utilization of cancer inpatient services in the 10 different income groups was analyzed in three geographical categories of medical institutions: (1) within Jeju Island; (2) outside Jeju Island; (3) South Korea in total. We calculated the concentration-indices of cancer inpatient services utilization in admission days and cost as a pair amongst these three geographical categories each. Both of the concentration-indices were negative for the category of 'within Jeju Island', positive for that of 'outside Jeju Island', and positive for that of 'South Korea in total'. These results suggest the relatively poor experience considerable inequality in the utilization of cancer inpatient services in Jeju Island, because lower income groups have higher incidence rates in most cancers and inevitably have more needs in health services.     

Health care services utilization and access inequalities in the Sao Paulo Metropolitan Region

This paper presents case study findings in five municipalities in the S?o Paulo Metropolitan Region. Inequalities in access to health care services and their utilization were described through advanced tabulation data from the 1998 SEADE Life Conditions Survey. The variables analyzed were: owning or not owning private health care insurance, income and age brackets. The health care service attributes studied were: health care services coverage by a health insurance plan, health services demands and average waiting time to receive health care. Compared with other studies, using the 1998 IBGE PNAD, the results allowed us to confirm interregional imbalances which can only be detected in shorter special scale studies: the municipalities. Despite showing the high private health insurances coverage the S?o Paulo Metropolitan Region has a great inner heterogeneity. The inequalities in private health care insurance, access, waiting time, and type of insurance coverage were observed through income quintiles and age classes analyses. Findings suggest that an expansion of the State's regulation capacity is necessary in order to empower the Brazilian Health Care System principles of universality and equity to be qualified to offer Brazilians the right to access health care services.     

A survey of mental health service coverage within health maintenance organizations.

This 1978 national survey of all operating Health Maintenance Organizations (HMOs) provided information on the current status of mental health services utilization and service coverage within HMOs. It achieved a 68 per cent response rate. Approximately 90 per cent (108) of the HMOs offered mental health services through basic or supplemental coverage plans; HMO organization characteristics reflected relative heterogeneity; the mean monthly costs for basic health plan coverage (physical and mental health services) were $33.85 (for individuals) and $95.15 (for families); HMOs reported lower physical and mental health hospital utilization and higher ambulatory utilization when compared to more traditional forms of health insurance coverage. The present coverage and uitlization of mental health services within HMOs reflect greater variability of benefits and utilization within HMOs. There is need for further studies of mental health utilization in relation to organizational structure and delivery pattern relationships within HMOs.