鞘内注射甲基强的松龙治疗多发性硬化研究

目的:探讨鞘内注射甲基强的松龙治疗急性期多发性硬化(MS)的疗效.方法:将70例MS按主要治疗方法分为鞘内注射甲基强的松龙(MPS)组32例和MPS冲击组38例,比较治疗后2组不同时间的Kurtzke神经功能障碍量表(EDSS)评分减少数、住院总费用、日均住院费用、药品比例及平均住院天数.结果:鞘内注射MPS组5d时的EDSS评分减少数较MPS冲击组多,差异有统计学意义(P＜0.05);15d时评分差异无统计学意义(P＞0.05);鞘内注射MPS组的平均住院总费用、日均住院费用、平均住院天数、药品比例少于MPS冲击组,差异均有统计学意义(P＜0.05).结论:鞘内注射甲基强的松龙治疗MS,神经功能改善较快,住院天数及费用也较少.     

天津市居民腹泻症状发生情况及就医行为调查分析

目的 调查 2013 年天津市居民腹泻症状发生情况及腹泻后的就医行为, 为今后开展居民腹泻症状监测提供参考。 方法 采用等比例分层随机抽样法, 随机抽取天津市和平区、西青区、汉沽区和宝坻区共 4 028 例居民,对其腹泻发生情况、就医和购药行为、发病后的就诊意向进行调查。 结果 2013 年内出现腹泻症状的人次数为 324 人次, 腹泻发生率为 8.04%。 腹泻发病主要集中在 5—10 月共 241 例（74.38%）, 60~74 岁组腹泻发生率最高, 其次是75~岁和 0~14 岁, 15~29 岁组腹泻发生率最低。 腹泻患者选择就医 121 例（47.08%）, 选择购药 78 例（30.35%）, 未做任何处置 58 例（22.57%）。 腹泻患者选择到一级及以下医疗机构就诊比例最高为 68.59%（83/121）, 二级和三级医疗机构分别为 14.05%（17/121）、17.36%（21/121）。 患者腹泻就医中位费用为 60（20, 200）元, 购药费用为 20（11, 50）元, 就医费用大于购药（Z=2.412, P < 0.05）。 在二级和三级医疗机构就医费用均明显高于一级医疗机构（Z=50.709,P＜ 0.05）; 宝坻、西青、汉沽和和平区患者腹泻就医费用依次升高（Z=74.282, P＜ 0.05）; 不同年龄、有无医保患者腹泻就医费用差异无统计学意义。 结论 15 岁以下和 60 岁以上人群腹泻发生率高, 居民患腹泻选择自行服药和一级及以下医疗机构就医为主。     

User fees and health service utilization in Vietnam: how to protect the poor?

OBJECTIVES: Vietnam started its health reform process two decades ago, initiated by economic reform in 1986. Economic reform has rapidly changed the socio-economic environment with the transition from a centrally planned economy to a market-oriented economy. Health reform in Vietnam has been associated with the introduction of user fees, the legalization of private medical practices, and the commercialization of the pharmaceutical industry. This paper presents the user fees and health service utilization in Vietnam during a critical period of economic transition in the 1990s. STUDY DESIGN: The study is based on two national household surveys: the Vietnam Living Standard Survey 1992-1993 and 1997-1998. METHODS: The concentration index and related concentration curve were used to measure differences in health service utilization as indicators of health outcomes of income quintiles, ranking from the poorest to the richest. RESULTS: User fees contribute to health resources and have helped to relieve the financial burden on the Government. However, comparisons of concentration indices for hospital stays and community health centre visits show that user fees can drive people deeper into poverty, widen the gap between the rich and the poor, and increase inequality in health outcomes. CONCLUSIONS: An effective social protection and targeting system is proposed to protect the poor from the impact of user fees, to increase equity and improve the quality of healthcare services. This cannot be done without taking measures to improve the quality of care and promote ethical standards in health care, including the elimination of unofficial payments.     

青岛市农村居民医疗费用及影响因素分析

①目的 调查青岛市农村居民的医疗费用及其影响因素。②方法 采用整群抽样与随机抽样相结合的方法，对7个自然村的3700名18岁以上居民进行了问卷调查。③结果 青岛市农村居民门诊次均就诊费用中位数是24．39元，患有慢性病的居民、有残障的居民次均就诊费用较高，文盲、半文盲组居民的次均就诊费用低于其他组。居民因病住院的直接费用中位数：乡镇卫生院653元、县级医院2075元、市级医院3476元。居民住院费用的主要影响因素为是否患慢性病及有无残障等。④结论 青岛市农村居民医疗费用支出基本合理，居民医疗费用受多种因素影响。     

冠状动脉旁路移植术临床路径实施效果分析

目的探讨临床路径在行冠状动脉旁路移植术病人中的实施状况和效果。方法采用回顾性调查方法,在2012年1月-2013年6月实施临床路径的行冠状动脉旁路移植术病例中随机选取120例作为路径组,在同期未实施临床路径的同病种病例中随机选取120例作为对照组,对两组的住院费用、住院天数等情况进行统计分析。结果路径组病人的术前住院天数、总住院天数、住院总费用、药费、检查费、护理费比对照组少,差异均有统计学意义（t=3．63～8．98,P〈0．05）,手术费、材料费等差异无统计学意义（P〉0．05）。结论该病种实施临床路径管理可以减少病人住院天数,降低住院费用,减轻病人经济负担。     

降低患者医疗费用提高医院经济效益的几个问题探讨

降低患者医疗费用，提高医院经济效益，始终是国家、医院和患者都十分关注的大事，也是医院多年来不断探索研究的问题。本文从提高认识人手，着重从端正思想认识、扩大门诊业务、缩短住院天数、开设日间病房、发展社区医疗、发挥经济管理科作用等6个主要途径和需要处理好的几个关系等方面进行了重点阐述，努力减轻国家负担，使医、患双方受益。     

Supply Decisions among Dentists Working within a Fixed-fee System of Dental Care Provision

In Norway fees for dental treatment did not increase at the same rate as prices for other goods and services during the 1980s. The aim of this study was to examine how this decrease in fees in real terms has influenced dentists' work decisions with respect to supply of services. Data on characteristics of the dentist and the dental practice were collected for 1979, 1984, and 1986. The dependent variable was supply of dental services, measured as the number of patient care hours worked per annum. The hourly fee for dental care was equivalent to dentists hourly wage rate. Supply increased as fees decreased. This could be explained either as a response of the patient or the dentist to reduced fees. Although the data did not give conclusive evidence as to which effect was most important, the authors have put forward the view that the main effect was dentists' response to reduced fees. The main argument put in favor of this view is that dentists have an overall knowledge of the effect of a change in fees on their income. The impact of a change in fees is much greater on the provider who supplies the services to many individuals over a long period of time, than on an individual consumer who buys the services once or twice a year. It was concluded that, in the short run, a fixed-fee schedule may not be very effective in limiting costs for dental care.     

Abolition of cost-sharing is pro-poor: evidence from Uganda

OBJECTIVE: To document the effects of the abolition of user fees on utilization of health services in Uganda with emphasis on poor and vulnerable groups. METHODS: A longitudinal study using quantitative and qualitative methods was carried out in 106 health facilities across the country. Health records were reviewed to determine trends in overall utilization patterns and use among vulnerable groups. A modification of wealth ranking as defined by the Uganda Poverty Participatory Assessment Project was used to categorize households by socio-economic status in order to compare utilization by the poor against that of other socio-economic groups. FINDINGS: There was a marked increase in utilization in all population groups that was fluctuating in nature. The increase in utilization varied from 26% in public referral facilities in 2001, rising to 55% in 2002 compared with 2000. The corresponding figures for the lower level facilities were 44% and 77%, respectively. Increase in utilization among the poor was more than for other socio-economic categories. Women utilized health services more than men both before and after cost-sharing. Higher increases in utilization were noted among the over-five age group compared with the under-fives. There were no increases in utilization for preventive and inpatient services. With respect to quality of care, there were fewer drug stock-outs in 2002 compared with 2000 and 2001. There was no deterioration of other indicators such as cleanliness, compound maintenance and staff availability reported. CONCLUSION: The study suggests that there is a financial barrier created by cost-sharing that decreases access to services, especially among the poor in Uganda. However, further studies are needed to clarify issues of utilization by age and gender.