The Economic Value of Childhood Varicella Vaccination in France and Germany

OBJECTIVE: To determine the economic impact of childhood varicella vaccination in France and Germany. METHODS: A common methodology based on the use of a varicella transmission model was used for the two countries. Cost data (2002 per thousand) were derived from two previous studies. The analysis focused on a routine vaccination program for which three different coverage rates (CRs) were considered (90%, 70%, and 45%). Catch-up strategies were also analyzed. A societal perspective including both direct and indirect costs and a third-party payer perspective were considered (Social Security in France and Sickness Funds in Germany). RESULTS: A routine vaccination program has a clear positive impact on varicella-related morbidity in both countries. With a 90% CR, the number of varicella-related deaths was reduced by 87% in Germany and by 84% in France. In addition, with a CR of 90%, routine varicella vaccination induces savings in both countries from both societal (Germany 61%, France 60%) and third-party payer perspectives (Germany 51%, France 6.7%). For lower CRs, routine vaccination remains cost saving from a third-party payer perspective in Germany but not in France, where it is nevertheless cost-effective (cost per life-year gained of 6521 per thousand in the base case with a 45% CR). CONCLUSION: Considering the impact of vaccination on varicella morbidity and costs, a routine varicella vaccination program appears to be cost saving in Germany and France from both a societal and a third-party payer perspective. For France, routine varicella vaccination remains cost-effective in worst cases when a third-party payer perspective is adopted. Catch-up programs provide additional savings.     

广东省中医院的经济学评价

对广东省中医院的资源状况、潜在竞争力和经营业绩进行了初步的分析 ,根据这些指标的变化情况分析评价广东省中医院的经营状况、发现存在的问题 ,为医院的进一步发展提供建议。     

经济转型期的膳食营养和慢性病预防——挑战和机遇并存

据世界卫生组织统计，在2001年非传染性慢性疾病，包括肥胖、糖尿病、心血管病、高血压、脑血管病和某些肿瘤等导致的死亡已占全球5650万例死亡的60％，占全球疾病负担的46％。估计到2020年，慢性病负担将增加到57％。慢性病死亡的一半归因于心血管病，肥胖和糖尿病也呈增加趋势。非传染性慢性疾病不仅是经济     

所有权与经营权分离是城市公立医院改革和发展的途径

传统卫生管理体制承袭了计划经济的所有特征,价格扭曲的宏观政策环境、资源的集中计划配置体制与公立医院在微观上的缺乏经营自主权三者并存.这种制度安排越来越不适应市场经济条件下卫生改革和发展的需要,而卫生经济体制改革始自微观经营机制,核心是两权分离和放权让利,这是自然的,同时也是正确的改革方向.     

对医疗同意书若干问题的思考

医疗同意书是指在医疗过程中,医院对病人实施某种可能危险的医疗行为时,由病人和医生签字的同意书.但在实践中,对其法律性质在病人和医生中存在歧义.作者试对这一医疗文书做法律上的分析,指出同意书在法律上的性质.     

Changes in the Household Calorie Supply during the 1994 Economic Crisis in Mexico and Its Implications on the Obesity Epidemic

To characterize the effects of the 1994 economic crisis on calorie sources of Mexican households, five nutrition surveys done every leap year (1992–2000) in national representative samples (> 10,000 households) were analyzed. Each household was visited during 7 days to collect data on foods purchased, exchanged or home-grown and their monetary value. We selected 88 food items to calculate kilocalories/ person/day and cost in pesos/megacalorie (CPMC) for rural-urban strata (localities <2500, ≥2500). The food items were classified in 8 groups and the summation of kilocalories and CPMCs of items in each group were our units of analysis. Linear regressions for 1992–2000 were performed, and slopes and intercepts were used to characterize changes. Available calories showed very little change at the height of the economic crisis. Expensive calories (meat in ur-bans, eggs and milk in rurals, and industrialized meat and soft drinks in both) tended to increase, whereas the most inexpensive staples (cereals, legumes, sugars) decreased their share in both strata. An increase in obesigenic calories was seen, notably in soft drinks, despite a cost increase second only to meat. Main conclusions were: (1) the economic crisis did not affect total calories availability in Mexican households; (2) the 1992–2000 trends in calorie sources were contrary to any crisis effect in rurals and urbans (i.e., expensive foods increased and inexpensive staples decreased); (3) there were sizable rural-urban differences in number, source, and cost of calories; and (4) obesigenic calories increased and soft drinks emerged as a food with its own dynamic.     

Patient Capacity in Mental Health Care: Legal Overview

The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in which the law may further adapt to a more functional assessment of capacity, because the nature of law shows that legal reforms usually take place only when new methods have been accepted by the field. This is not yet the case today.     

深圳市世界银行贷款结核病控制绩效评价

目的 对深圳市为期8年的全人口世行贷款结核病控制项目工作进行绩效评价。探讨 项目绩效评价的方法。方法 收集1993～2001年深圳市全人口结核病控制项目周期内转诊、可疑者接诊、涂阳患病、痰菌阴转、治愈情况等及费用筹集和使用的有关资料，并在项目实施前后进行结核病流行病学调查和耐药监测。从服务公平性、健康可及性、项目效果、项目效益、项目效率等方面对该项目进行评价。结果 (1)服务公平：将外来人口纳入结核病控制项目管理，实施全人口控制策略，并取得了与户籍人口一致的效果；(2)健康可及：健全了市、区、镇三级防治网络。全面实施归口管治。推行全程督导管理方式(DOTS)策略；(3)效果明显：减少了1．5万新发病人。患病率下降超过50％，初始涂阳耐多药率下降7％；(4)效益巨大：直接经济效益1．42亿元，间接经济效益挽回GDP损失30．6亿元，减少个人收入17．6亿元；(5)效率高：2月末痰菌阴转率88．8％。3月末痰菌阴转率96．0％。结论 该项目实施8年绩效明显。政府承诺保证该项目可持续发展是非常必要的。     

湖北省新型农村合作医疗试点县农民疾病经济风险分析

通过对疾病家庭的疾病经济风险、特定人群疾病经济风险、超过致贫线住院家庭相对疾病经济风险的分析显示：低收入农民疾病经济风险是高收入家庭的3．09倍；大部分家庭都处于低疾病经济风险中，但15、09％的家庭疾病经济风险较高；县和县级以上医院住院家庭疾病经济风险分别是乡镇卫生院住院家庭的2、40倍和6、20倍。提出：在新型农村合作医疗方案设计中需考虑低收入家庭疾病经济风险分担、合理引导卫生服务利用、保障力度和受益面的矛盾等问题。     

混合血清检测在寄生虫病血清流行病学调查中的应用

目的 通过旋毛虫病、弓形虫病血清学检测，探讨了混合血清检测（混检）在寄生虫病血清流行病学调查中的应用及对成本-效果的影响。方法 根据二项分布原理，探讨混合血清检测的可行性。旋毛虫病或弓形虫病血清学检测，采用3、5、10份等三种混检方法。同时对血清样品逐一检测和混合检测进行了成本-效果评价。结果 只要混有1份弱阳性血清，旋毛虫病或弓形虫病的三种混检都呈阳性结果。如果混合的血清全部是阴性，旋毛虫病3、5、10份阴性血清样品混合各检测24组，全部呈阴性；弓形虫病3、5份阴性血清样品混合，检测12组，都呈阴性，10份阴性血清样品混合，检测18组中16组呈阴性，2组呈阳性。旋毛虫病或弓形虫病混检显示，混检效率与待检寄生虫血清学阳性率有关，血清学阳性率在10％时，4份混检效率较高，血清学阳性率在1％时，以10份混检效率较高，而当血清阳性率在0．1％时，增加混检样品数可明显减少检测次数，但前提条件是要保证混检样品中只要有1份阳性样品，混检时都能测出阳性，而且若全部是阴性样品混检，也不出现阳性。结论 运用卫生经济学成本-效果分析，表明寄生虫病血清流行病学调查，混检成本低，尤其是对预期血清学阳性率较低（≤1％）的调查，混检可节省大量成本。