医疗保险风险调剂机制在全民医保制度构建中的应用

自荷兰、德国等国发端的医疗保险风险调剂机制在世界“全民医保”浪潮中越来越受到重视,并逐渐成为各国政府整合分散医保基金的重要手段。我国以“全民医保”为目标的新一轮医改是建立在财政分权、县域统筹等制度背景下的,医疗保险基金“碎片化”问题十分突出。科学引入医疗保险风险调剂机制,改变现有粗放的“调剂金”管理模式,有助于我们既兼...     

少数民族聚居地区基本医疗卫生资源配置的困境与出路

基本医疗卫生资源与农牧民健康水平密切相关.新农合制度实施以来,少数民族聚居地区基本医疗卫生水平明显得到改善,但与“人人享有基本医疗卫生服务”目标仍相差甚远.应坚持少数民族聚居地区基本医疗卫生资源的公益性、加大中央政府责任、进行科学合理的规划,实施充足、有效的配置,这对于提高农牧民健康水平、增进民族团结、维护社会稳定等具有非常重要的现实意义.     

新医保政策背景下大学生参保行为的研究——以广西壮族自治区南宁市为例

本文通过个案研究的方式,将广西首府南宁市作为调研地点,针对大学生医疗保险参与意愿进行了问卷调查和访谈,找出影响他们行为和意愿的相关因素。发现大学生受制度环境影响较大,并且制度参与的能动性不强,体现出一种有限的理性。另外,政策制定者（政府）、政策执行者（学校）、政策受益者（学生）之间的互动关系不强,也影响了学生的参保意愿。本文认为,大学生医疗保险参保积极性的提高,要注意强制与自愿、制度环境配套、相关主体互动三方面的问题,并从政府、学校、市场、学生个人方面加以改善。     

城乡基本医疗保险制度一体化研究——以厦门市为例

在厦门市全民医保政策框架下,从覆盖范围到缴费标准,其实只是一个碎片化的制度安排。鉴于此,本文从覆盖范围和缴费标准入手来对厦门市基本医疗保险一体化的制度安排进行初步的设计和探讨,对现有制度安排进行重新整合和改革,淡化对参保人身份的人为划分,而更为简单地将所有参保对象划分为有单位和无单位两部分群体,相应的在缴费标准上分为职工缴费率和居民缴费率两个档次,职工和居民还可以根据自己的情况自行选择缴费档次。     

藏区农牧民医疗救助体系运行效果及其评价指标设计——以甘肃甘南藏族自治州为例

因病致贫已经成为制约藏区经济社会发展的主要因素之一,实施制度化的医疗救助以帮助藏区农牧民尽快摆脱贫困,成为政府做好民族工作的重要任务。本文全面阐述了贫困与民族发展之间的密切关系,认识到藏区农牧民医疗救助由于经济、社会等因素的影响,导致医疗救助体系运行不规范,未能达到既定的目标和预期效果,迫切需要对藏区农牧民医疗救助体系的运行效果进行评价,逐步提高藏区农牧民医疗救助的水平。本文运用层次分析方式,选择具有藏区典型特征的甘肃甘南藏族自治州为研究对象,采用鱼骨图来表述藏区农牧民医疗救助体系运行效果,并以此为依据设计评价指标,以期能够更好地保障该体系的良好运行,促进藏区经济社会的稳步发展。     

广西医疗旅游资源的开发整合研究

医疗旅游是一个横跨旅游产业和卫生产业两大行业的新型行业。针对这一特征,文章从旅游资源和卫生资源两大方面分析广西医疗旅游资源的种类及其具体分布情况,并在此基础上对广西医疗旅游资源进行开发整合研究,提出了五大主题八条旅游线路保健休闲养生线路。     

尿毒症透析治疗价格谈判机制研究

随着尿毒症患病率的增加,尿毒症给患者和社会带来沉重的经济负担,临床上诱导需求客观存在,给医保基金的运营也带来一定的挑战。本文就医疗保险机构建立尿毒症透析治疗价格谈判的必要性、可行性及谈判机制的构建做一些理论探讨,以期推动医疗保险机构和医疗机构尽快建立尿毒症透析治疗价格谈判机制。     

Assessment of the Partnership Quality between Travel Agencies and Health Care Organizations on the International Medical Tourism Market in Taiwan

The medical tourism literature lacks insight into related issues of these types of partnerships. Those that integrate multiple perspectives into one research framework are especially rare. This study evaluated and compared the influence of external environment uncertainty, trust, and resource dependence perspectives on the quality of interorganizational partnerships in the international medical tourism market and quantified these elements using external environment uncertainty assessment on the international medical tourism development. The research sample was based on a survey from 161 travel agency managers in Taiwan. This study found that external environment uncertainty has direct negative impact on trust and resource dependence has a positive influence on interorganizational partnership. Moreover, trust has a significant impact on partnership quality while resource dependence does not. Therefore, medical travel agents should extend their network of trustworthy health care organization partners in order to improve performance, decrease their self-risk, collect information, and avoid missed opportunities.     

Treatment patterns,complications, and direct medical costs associated with ankylosing spondylitis in Chinese urban patients: a retrospective claims dataset analysis

Aim: To describe treatment pattern, complications, and direct medical costs associated with ankylosing spondylitis (AS) in Chinese urban patients.

Methods: The 2013 China Health Insurance Research Association (CHIRA) urban insurance claims database was used to identify patients with AS. The identified patients were stratified by AS treatments for the comparisons of well established AS-related complications and direct medical costs. Conventional regression analyses adjusted the collected patient baseline characteristics to confirm the impact of treatments on complications and direct medical costs.

Results: Of the identified 1299 patients with AS, 18.0% received non-steroidal anti-inflammatory drugs (NSAID), 11.2% received immunosuppressant, 48.2% received NSAID plus immunosuppressant, 4.6% received biologic agents, and 17.9% received medications without indication for AS. Biologic group was associated with the lowest proportion of AS-related complications (8.3%) that was confirmed by multiple logistic regression analysis (odds ratio = 0.200, p?=?.017). The biologic group was also associated with highest direct medical costs (median: RMB?=?14,539) that were confirmed by the multiple generalized linear model (coefficient = 1.644, p?Conclusions: Biologics were not commonly used for AS in Chinese patients likely due to their high cost. Future studies are needed to confirm the potential long-term clinical benefits associated biologic treatment for AS.     

医疗机构从零售药店购进药品所涉及的法律问题

目的：理清医疗机构从零售药店购进药品所涉及的相关法律问题，为正确适用法律提供参考。方法：案例研究、探索性的逻辑分析和法条分析方法。结果与结论：医疗机构从零售药店购进药品不具有违法性，不需要承担法律责任。零售药店在医疗机构要求的情况下，向医疗机构销售少量药品，也不具有违法性，不应当进行处罚。这一结论也适用于零售药店从其他零售药店购进药品的处理。