社会医疗保险对老人临终医疗服务利用的影响

本文利用2002-2014年CLHLS死亡人口数据,借助样本选择模型、两部分模型和bootstrap中介效应检验方法,首次比较全面深入地分析了社会医疗保险对老人临终总医疗费用支出和自负医疗费用支出的影响。研究发现,我国社会医疗保险既显著提高了老人临终医疗服务利用,也显著降低了自负水平。不同类型的社会医疗保险对临终医疗服务利用影响存在差异,医疗保险类型对临终医疗服务利用具有直接效应,医疗保险水平发挥了中介作用。医疗保险覆盖率在死亡年份影响临终医疗服务利用中发挥了中介作用。我国应该通过实行健康老龄化战略、加强死亡教育、发展临终关怀和完善医保监管等措施控制临终医疗支出增长以促进医疗保险可持续发展,并提升临终老人生存和死亡质量。     

我国医疗损害赔偿探析

医疗损害是指因医疗机构及其医务人员的故意或过失(即医疗过错),而对就医患者造成身体上或精神上的损害结果。在诉讼实践中,因医务人员的故意而造成患者医疗损害的,视情可构成刑法上的"医疗事故罪",则由刑法对其进行调整;因医务人员的过失而造成患者医疗损害的,属民事侵权行为,依据《侵权责任法》应由医疗机构承担医疗损害赔偿责任。本文将从医疗损害赔偿的概念、构成要件、内容和范围等几个方面对医疗损害赔偿的立法完善进行探究。     

基于关键事件技术的医疗服务失败类型与补救策略研究

本文运用关键事件技术对390例医疗服务投诉事件进行分析,对医疗服务失败的类型进行划分,并对医疗机构实际补救策略与患者期待补救策略进行比较。研究发现医疗服务失败类型主要包括医疗服务系统失败、医务人员问题行为和患者认知问题三大类。医疗机构实际补救策略与患者期待补救策略存在较大差距,在发生服务失败后医疗机构绝大多数情况下没有进行处理,没有期望、管理人员介入和舆论介入是患者最期望的三种补救措施。因此,规范医务人员服务行为、提高医务人员技术水平和保持通畅的医患沟通渠道是预防或减少医疗服务失败的重要途径。     

风险资本在中国医疗健康行业投资及退出情况研究

本文研究了近十年风险资本中国医疗健康产业的投资和退出情况。通过具体的统计数据,主要从投资(退出)金额及增长率、投资(退出)数量及增长率和单笔投资(退出)额及增长率来分析近10年的行业投资及退出情况。本文也将近十年中国股市的发展变化和医疗健康行业的投资退出进行了对比,发现了中国股市对医疗健康行业投资和退出的影响,同时也发现了医疗健康行业固有的行业特征。     

基于问卷调查的过度医疗理性思考

要减少过度医疗,给百姓安心、实惠的医疗服务需要政府的政策指引和资金支持,需要医疗行业自身的努力,也需要社会的监督、百姓的理解和支持近几年,各级政府正在强力推进医疗改革工作,在调节医疗资源供     

VSD治疗四肢软组织缺损创面的医疗成本分析

目的:通过对负压封闭引流技术(VSD)与传统换药(CDC)两种方法治疗四肢软组织缺损创面医疗成本进行分析,为医疗医疗决策提供理论依据.方法:收集西安交通大学附属第一医院创伤整形科2008年1月至2011年6月期间收治入院的四肢软组织缺损创面患者共216例,VSD治疗者106例,CDC治疗者110例.通过比较两组病人治疗过程中提供医疗服务所需直接医疗费用,进行医疗成本分析.结果:VSD组住院总费用高于普通换药组；VSD组手术费用低于CDC组,特殊耗材费用VSD组高于CDC组；VSD组换药费用低于CDC组.结论:与传统换药相比,VSD治疗皮肤软组织缺损创面总成本相对较高,临床效果优于CDC组,成本效果比相对较低,具有很好的卫生经济学前景.     

基于知识图谱可视化分析的医疗救助制度研究

将中国知网(CNKI)数据库中以医疗救助制度为主题的北大中文核心期刊和CSSCI期刊论文作为数据样本,本文运用CiteSpace软件对经过筛选的575篇论文的关键词进行共现分析、聚类分析和突变分析,并绘制可视化知识图谱,探索1994—2020年我国医疗救助制度研究的热点及发展趋势。结果表明:我国医疗救助制度得到学者们的广泛关注;相关研究随着制度建设实践的推进不断扩展和深化,共经历了萌芽、发展和成熟三个发展阶段;热点内容集中于保障范围、资金收支和制度衔接等方面。由此,本文从研究方法、研究视角、研究范围、理论与实践结合等方面对医疗救助制度研究进行展望。     

浅析医疗改革进程中医疗收费对医院的影响

医疗收费政策的调整是新一轮医疗改革的重要组成部分,不仅影响人民群众的就医负担,同时影响医院的经营行为及临床诊疗行为。本文通过分析医疗收费政策及医疗改革对医院的影响,提出解决问题的建议与对策。     

肿瘤精准医疗平台"至本医疗科技"获数亿元人民币B轮融资

至本医疗科技(上海)有限公司(以下简称至本医疗科技)正式宣布完成数亿元人民币B轮融资本轮融资由远翼资本领投,pre-A轮投资方苇渡资本跟投一本轮融资将用于下一阶段的研发投入及扩大中国最全面的肿瘤精准医疗数据平台在临床领域的影响力.此前,至本医疗科技于成立之初,获得了由1DG领投的天使轮投资.跟投机构包括火山石资本和松禾资本.     

浅谈知情同意例外情形中的医疗特权

近年来,医疗过程中涉及患者知情同意权的纠纷越来越多,本文主要就知情同意适用的例外情形中的医疗特权问题进行分析,主要从医疗特权的概念、法律属性及适用的限制三个方面进行剖析,以求合理限制医疗特权的适用,从而最大限度的保障患者的知情同意权。     

Testing Alternative Regression Frameworks for Predictive Modeling of Health Care Costs

Predictive models of health care costs have become mainstream in much health care actuarial work. The Affordable Care Act requires the use of predictive modeling-based risk-adjuster models to transfer revenue between different health exchange participants. Although the predictive accuracy of these models has been investigated in a number of studies, the accuracy and use of models for applications other than risk adjustment have not been the subject of much investigation. We investigate predictive modeling of future health care costs using several statistical techniques. Our analysis was performed based on a dataset of 30,000 insureds containing claims information from two contiguous years. The dataset contains more than 100 covariates for each insured, including detailed breakdown of past costs and causes encoded via coexisting condition flags. We discuss statistical models for the relationship between next-year costs and medical and cost information to predict the mean and quantiles of future cost, ranking risks and identifying most predictive covariates. A comparison of multiple models is presented, including (in addition to the traditional linear regression model underlying risk adjusters) Lasso GLM, multivariate adaptive regression splines, random forests, decision trees, and boosted trees. A detailed performance analysis shows that the traditional regression approach does not perform well and that more accurate models are possible.     

Can patients drive the future of health care?

As the traditional system of health care in the United States gives way to a regime run increasingly by the private sector, a powerful force is emerging: the patient. According to Harvard Business School professor Regina Herzlinger, health care is much like other service industries. Providers that hope to survive must cater to increasingly demanding and well-educated consumers. In a review of Herzlinger's book Market-Driven Health Care: Who Wins, Who Loses in the Transformation of America's Largest Service Industry, Alexandra Wyke, managing editor at the Economist Intelligence Unit, argues that the path to consumerism in medicine will be longer and bumpier than Herzlinger suggests. Consumers of medicine don't simply want health care to be more convenient; they want cures for all ills. How can providers gratify this appetite for ever better medicine? Furthermore, patients are not always capable of making sound decisions about their medical care. And health care professionals, who emphasize the complex nature of decision making in medicine, are doing their best to keep patients from holding the health care steering wheel. Herzlinger has written a bullish book on the virtues of market-driven health care, but, Wyke contends, she has overlooked the far-reaching effects that emerging technology could have in shaping medicine--especially in reducing the need for specialists. She also has given short shrift to the young managed-care industry, which has succeeded in controlling costs and is now under competitive pressure to meet patients' needs better.     

How do low-income enrollees in the Affordable Care Act marketplaces respond to cost-sharing?

The Affordable Care Act requires insurers to offer cost-sharing reductions (CSRs) to low-income consumers on the marketplaces. We link 2013–2015 All-Payer Claims Data to 2004–2013 administrative hospital discharge data from Utah and exploit policy-driven differences in the actuarial value of CSR plans that are solely determined by income. This allows us to examine the effect of cost-sharing on medical spending among low-income individuals. We find that enrollees facing lower levels of cost-sharing have higher levels of healthcare spending, controlling for past healthcare use. We estimate demand elasticities of total health care spending among this low-income population of approximately −0.12, suggesting that demand-side price mechanisms in health insurance design work similarly for low-income and higher-income individuals. We also find that cost-sharing subsidies substantially lower out-of-pocket medical care spending, showing that the CSR program is a key mechanism for making health care affordable to low-income individuals.     

Went Fundholding, Going Commissioning? Some Evidence-Based Reflections on the Prospects for Primary Care Groups

Following the publication of the White Paper, 'The New NHS: Modern, Dependable' (Cm 3807), the Labour Government has abolished GP fundholding. Family doctors retain a lead role for primary care in planning health care with the creation of Primary Care Groups (PCGs). In due course, it is expected that health authorities will relinquish direct commissioning of care to PCGs. Although fundholding is ending, its operation provides useful evidence about how GPs approach participation in the planning of health care. This article reflects on the prospects for PCGs, drawing on original research into the reasons why practices volunteered to 'go fundholding' and how those practices selected their 'lead' partner, on whom much of the fundholding burden fell.     

E公司的预约定价研究

预约定价制是用来解决关联企业间转让定价问题的一种新制度,在借鉴国际经验的基础上,我国对实施预约定价也进行了一些尝试.本文通过对预约定价在企业中应用的案例研究,对公司实施预约定价提出了若干建设.     

The next big thing in health benefits: consumer choice

Consumers are the only ones who can affect all decision points that drive health care cost and quality. As a result, consumers' health and financial security depend on their taking more responsibility for their health care decisions and having the tools and information needed to do so successfully. This article explains the five key decision points that drive health care cost and quality, how technology aids marketplace innovations, and how employers can help advance consumer choice in order to push the health care system to deliver better care and keep inflation in check.     

The quality improvement customers didn't want

Is investing in new technology always the right choice for a company and its customers? Allan Moulter, the CEO of Quality Care, isn't sure he wants to invest in the computerized reception system that consultant Jack Zadow has outlined for him. But in this HBR case study, the argument Zadow makes is impossible to ignore. Quality Care's rivals have invested in similar systems or are planning to do so. The new system promises to take care of routine busywork, freeing staff up for other interactions with patients. It seems as if the competition hasn't even cut staff and is counting on increased customer retention to pay for the investment. And yet, Quality Care's surveys of its own customers show that they prefer the human touch when checking in. How would customers feel if the first ?person? they met when they came in the door turned out to be a machine? Moulter prides himself on his responsiveness to customers. And with 86% of Quality Care's customers either satisfied or completely satisfied, aren't things fine as they are? Has Moulter considered all the facets of his predicament? How will Quality Care's staff be affected by a decision one way or another? What about the costs of upgrading the system? Can Quality Care maintain its standing without going high-tech? Would customers rebel when confronted with the proposed reception area or would they appreciate the increased efficiency? Six experts weigh the costs and benefits of technology in a service industry.     

Self‐Funding of Health‐Care Plans by Small Firms: Risks and Reforms

Small employers that offer health insurance have usually offered fully insured products through traditional health plans. Recently, the Patient Protection and Affordable Care Act (ACA) has created new requirements for fully insured products that will entice more small firms to fund their own health‐care benefits. However, self‐funding poses significant risks to these small firms, their employees, and state exchanges. To mitigate some of these risks within current political realities, we recommend advance disclosures—to small firms of material changes in their stop‐loss policies, and to their employees that premium subsidies are available only on ACA exchanges. We also suggest strengthening Small Business Health Options Program exchanges by broadening the availability of subsidies and building partnerships with brokers. Finally, we recommend an expanded role for brokers and third‐party administrators in helping small firms improve their choice of health‐care insurance.     

Tax‐efficient irregular payout methods: The case of B share schemes and capital repayments via a court‐approved scheme of arrangement

Advance corporation tax (ACT) increased the tax cost to UK firms of distributing cash to shareholders. We demonstrate how the tax cost arising from ACT payments affected the channels through which UK firms returned capital to shareholders. In particular, we document and describe two unconventional irregular payout methods that enabled firms to avoid paying ACT. Firms choosing these methods are associated with significantly greater ACT problems than a control sample of firms that opted for conventional self‐tender offers and special dividends. Event study tests indicate that the decision to adopt tax‐efficient payout methods created significant additional value for shareholders beyond the basic cash distribution decision.     

Family planning and health: the Narangwal experiment

The findings of a 7-year field experiment conducted in the Indian Punjab show that integrating family planning with health services is more effective and efficient than providing family planning separately. The field experiment was conducted between 1968 and 1974 at Narangwal in the Indian State of Punjab. It involved 26 villages, with a total population of 35,000 in 1971-72. The demographic characteristics of the villages were found to be typical of the area. 5 groups of villages were provided with different combinations of services for health, nutrition and family planning. A control group received no project services. A population study was made of the effects of integrating family planning with maternal and child health services. A nutritional study looked at the results of integrating nutritional care and health services. The effectiveness of integration was evaluated by identifying it both with increased use of family planning and improved health. Efficiency was judged by relating effectiveness to input costs. Distribution of the benefits was also examined. The effectiveness of these different combinations of services on the use of family planning was measured: 1) by all changes in the use of modern methods of family planning, 2) by the number of new acceptors, 3) by the changes in the proportion of eligible women using contraceptives, and 4) by how many people started to use the more effective methods. Results showed the use of family planning increased substantially in the experimental groups, whereas the control group remained constant. It was also found that, though the services combining family planning with maternal health care stimulated more use of family planning, they were more costly than the more integrated srevices. The Narangwal experiment provides significant evidence in favor of combining the provision of family planning and health services, but its potential for replication on a large scale needs to be studied.