Unobserved health care expenditures: How important is censoring in register data?

Accurate information on individuals' health service use is important for evaluating health policies and analyzing health care demand. Although register data are considered to be more reliable than survey data, little is known about the extent and effect of censoring of the expenditure distribution in register data. We exploit a recent change in the health provider remuneration system in several Swiss cantons to empirically investigate whether censoring occurs when individuals do not have to disclose their health service use below their deductible level. Applying a difference‐in‐differences approach, we find that between CHF 6.70 (1.7%) to CHF 9.64 (2.4%) of all health service use paid out‐of‐pocket are not observed (per capita per year). This effect seems to be driven by high‐deductible plans where observed out‐of‐pocket expenditures declined by CHF 30.34 (7.6%) after the change. Although statistically significant, these effects are almost negligible in economic terms. We therefore concluded that, if anything, censoring is a very limited issue in Swiss health insurance claims data.     

Re‐examination of accelerometer data processing and calibration for the assessment of physical activity intensity

This review re‐examines the use of accelerometer and oxygen uptake data for the assessment of activity intensity. Accelerometers capture mechanical work, while oxygen uptake captures the energy cost of this work. Frequency filtering needs to be considered when processing acceleration data. A too restrictive filter attenuates the acceleration signal for walking and, to a higher degree, for running. This measurement error affects shorter (children) more than taller (adults) individuals due to their higher movement frequency. Less restrictive filtering includes more movement‐related signals and provides measures that better capture mechanical work, but may include more noise. An optimal filter cut‐point is determined where most relevant acceleration signals are included. Further, accelerometer placement affects what part of mechanical work being captured. While the waist placement captures total mechanical work and therefore contributes to measures of activity intensity equivalent by age and stature, the thigh and wrist placements capture more internal work and do not provide equivalent measures. Value calibration of accelerometer measures is usually performed using measured oxygen uptake with the metabolic equivalent of task (MET) as reference measure of activity intensity. However, the use of MET is not stringent and is not a measure of activity intensity equivalent by age and stature. A candidate measure is the mass‐specific net oxygen uptake, VO₂net (VO₂tot ? VO₂stand). To improve measurement of physical activity intensity using accelerometers, research developments are suggested concerning the processing of accelerometer data, use of energy expenditure as reference for activity intensity, and calibration procedure with absolute versus relative intensity.     

基于“卫生费用核算体系2011”的北京市中医类医院治疗服务受益人群分析

目的分析2018年北京市中医类医院治疗服务的受益人群情况,为控制治疗费用提供依据。方法使用基于“卫生费用核算体系2011”的我国卫生费用核算方法,结合北京的实际情况,核算并分析中医类医院受益人群分布。结果北京市中医类医院2018年治疗费用总额为245.13亿元,提供的门诊服务相对较多;非传染性疾病治疗费用远高于其他各类疾病;循环系统疾病治疗费用在各疾病类别中最高;55~<65岁人群治疗费用最高;不同疾病治疗费用的年龄构成有所不同,不同年龄组人群的疾病构成也有区别。结论中医类医院承担了相对较多的非传染性疾病的治疗任务;应针对不同人群不同疾病进行干预,降低疾病费用,发挥中医药特色和优势;循环系统疾病和65岁及以上人群是中医类医院费用控制的重点。     

Construction of a modest-but-adequate food budget for households with two adults and one pre-school child: a preliminary investigation

• 1 A food budget which is modest-but-adequate rather than subsistence in concept has been constructed for households with 1 man, 1 woman and 1 child aged 1–4 years old. National Food Survey and Family Expenditure Survey data provided the initial points of reference with regard to food consumption patterns and expenditure.
• 2 The budget reflects current food consumption patterns in the median income group and incorporates guidelines for healthy eating. It is based on low but not minimum prices, and so allows for individual variations in food preferences and availability.
• 3 The estimated cost of home food consumption at July 1988 prices was £9.64 per person per week. Additional expenditure was required for sweets and soft drinks (73 p) and foods purchased and eaten away from home (£1.49), giving a total weekly expenditure of £11.86 per person per week, or £35.58 for the household.
• 4 The estimated increase in food costs between 1983 and 1988 was 20% using the Retail Price Index but 36% using 1988 supermarket prices. Any up-dating of budgets should therefore be based on current prices rather than on changes in the RPI.
• 5 £35.58 represents 52% of the income of a 2 adult, 1 child family on Income Support (£68.35). This is substantially in excess of the poverty line suggested by Orshansky (1965) (no more than 30% of net income spent on food). The purchase of a modest-but-adequate and healthy diet is likely to be out of the financial reach of the majority of families living on low incomes in the UK.

     

新型农村合作医疗参合农民住院费用的地区差异分析-以陕西省为例

目的：分析陕西省2011-2014年新型农村合作医疗参合农民的住院费用、自付住院费用地区差异的月度变化情况,为进一步完善新农合政策提供实证支持。方法：抽取陕西省榆林市和商洛市新农合系统内2011-2014年的住院补偿人次、住院总费用、住院补偿费用,采用时间序列分析方法进行建模分析。结果： 2011年以来,不发达地区与发达地区的次均住院费用、次均自付费用比都呈现显著上升趋势,且次均自付费用的地区差异更大。结论：新医改以来,新农合政策的不断调整和变化在改善不同地区居民医疗费用公平性方面的效果欠佳。建议新农合医保补偿政策向欠发达地区倾斜,加强对欠发达地区医疗机构的监督以及医疗机构的合理用药知识培训,严格控制欠发达地区的医疗费用。     

血糖稳定的2型糖尿病患者的静息能量消耗

目的观察血糖控制良好的2型糖尿病患者静息能量消耗（REE）的特点。方法采用代谢车测量45例血糖稳定的2型糖尿病患者的REE，记录其一般情况、生化指标、Harris-Benedict和Owen公式计算基础能量消耗预测值，并进行比较分析。结果血糖稳定的2型糖尿病患者的静息能量消耗实测值与Harris-Benedict及Owen公式预测值比较差异无统计学意义（P〉0．05），相关分析显示REE与性别、年龄、体重、身高、体表面积、去脂组织显著相关（P〈0．05），与体重指数、脂肪组织、空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、三酰甘油、总蛋白、白蛋白、血红蛋白无相关性（P〉0．05），多元逐步回归分析显示去脂组织和年龄与REE关系最密切。结论血糖良好的2型糖尿病患者的REE并不增高，决定其REE的因素与健康个体相似，测定REE能更好地指导糖尿病的医学营养治疗。     

儿童青少年能量需要量

目的儿童青少年的能量需要不同于成人,生长发育是其能量需求的必需因素之一。最新研究结果表明,在生长阶段平均每增加一克体重储存在新生组织中的能量大约是8.6kJ。2004年的人类能量需要量报告根据近20年来双标水法、心率监测等方法的研究结果,提出了不同身体活动水平的儿童青少年的能量需要量。本文针对1～18岁儿童青少年能量需要量方面的研究进展进行了综述,便于在今后的工作中制定我国儿童青少年的膳食能量推荐摄入量,以防止营养不良和超重、肥胖的发生,确保儿童青少年的健康成长。     

某军队医院军地人均住院费用分析

目的通过对军地人员人均住院费用多层次对比分析,寻求军地人员住院费用内在规律,促进军队医疗保障制度改革进一步深化。方法对2002/2008年军地住院人员的住院费用信息,应用Excel和SPSS13.0软件进行统计分析。结果①军队保障的总体人员与地方人员在人均住院总费、人均住院药品费中差异无统计学意义,人均住院检查检验费、日均住院费差异有统计学意义。②军队保障内军人与地方人员在人均住院总费、人均住院药品费、日均住院费中差异无统计学意义,人均住院检查检验费差异有统计学意义。③军队保障内非军人（职工和家属）与地方人员在人均住院总费、人均住院药品费、日均住院费中差异有统计学意义,人均住院检查检验费差异无统计学意义。④军队保障内军人与非军人在人均住院总费、人均住院药品费、人均住院检查检验费、日均住院费中差异均有统计学意义。结论①军队人员人均住院费用增加明显,军地＂同病同治＂原则得到落实。②军队人员分类保障模式运行良好,重点保障目的基本实现。③军队人员就医和费用管理机制需要完善。