Decomposing differences in health and inequality using quasi-objective health indices

People in Canada and the United States often make claims regarding whose country has a better health system. Several researchers have attempted to address this question by analysing subjective health measures in the two countries, thus assuming a common definition of ‘good’ health. Using data from the Joint Canada/US Survey of Health, which provides rich and comparable health information for the two countries, I generate two quasi-objective health indices and show that Canadians and Americans define ‘good’ health differently. After controlling for cross-country reporting heterogeneity, health differences between Americans and Canadians are eliminated for intermediate health statuses, while health differences at the tails of the health distribution lead to slightly better average population health in Canada. With respect to health inequality, my results show that income and education gradients increase steeply with poor health in both countries. Hence, considering differences along the health distribution is crucial when assessing population health or health inequality.     

维护公共健康期待公民的责任自觉

公共健康是一个群体性的健康问题。传染病、生活方式和环境卫生都是影响公共健康的重要因素。防止传染病的扩散和生活方式病的产生以及环境卫生的优化都需要公民的责任自觉。依靠公民的责任自觉可以尽量地减少人为因素造成的公共健康问题,这不仅可以提高所有公民的生活质量,而且无形中为政府节省大批的公共健康治理成本。从健康利益与责任的公平分配来看,公民的责任自觉是实现健康公平的一个重要途径。     

欧洲卫生技术评估网络发展概况

面对医疗技术更新、民众医疗服务需求提升和医疗投入有限等多重卫生系统压力,欧洲国家力图在其卫生政策制定、管理、报销或监管过程中利用卫生技术评估（Health Technology Assessment,HTA）方法,在充分进行医疗组织、经济、社会和伦理等方面论证的基础上,综合透明、科学和可靠的证据,确定卫生政策优先领域,推动卫生体系的健康可持续发展。欧洲在卫生技术评估方面的有益经验,对我国强化卫生技术评估理念和做法,支持卫生政策制定,具有积极的借鉴意义。     

Efficiency of health care delivery systems: effects of health insurance coverage

Health insurance expansions may increase the demand for care-creating incentives for health systems to increase input consumption. The possibility remains that added capacity and personnel will have little effect on health outcomes, decreasing the technical efficiency of health care delivery systems. We estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1.3 percentage points, translating into approximately 50 billion dollars in additional health expenditures. This finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur.     

Ex Post Welfare under Alternative Health Care Systems

The implications of a societal aversion to inequality for the optimal structure of the health care system are studied. The agents are assumed to be ex ante identical, but to differ ex post in the state of their health. Inequality aversion is introduced by postulating a strictly concave ex post social welfare function. It is shown that the optimal public health care system allocates health care differently than would private health insurance; specifically, people who are relatively unhealthy with and without treatment receive more health care, and people who are relatively healthy with and without treatment receive less health care. The aggregate quantity of health care under the optimal public health care system can be either greater or smaller than under private health care insurance. If the public health care system is optimally designed, allowing agents to purchase supplementary private health care insurance cannot raise social welfare and is likely to decrease it.     

新时代儿童健康教育体系协同治理研究

儿童健康是国家健康的起点与基础,是提升劳动力素质与人口质量的关键环节,而开展儿童健康教育是实现儿童健康的必要路径。在新时代背景下,从健康资本、健康均等受益维度出发,构建与完善协同发展的儿童健康教育体系,加大政府、学校、家庭、社会融合协调的参与力度,充分发挥针对儿童的健康教育机制作用,对促进儿童的健康成长,实现健康国家战略具有重要的意义。本文在对我国儿童健康教育的发展现状进行全面概括的基础上,深入剖析我国儿童健康教育体系发展所面临的困境与挑战,并相应提出了我国儿童健康教育体系协同治理及发展的政策建议：(1)将大健康的儿童健康教育理念渗入到儿童健康教育长远规划中去;(2)建立促进多元主体共同协同治理的机制,建立以儿童为中心的儿童健康教育协同发展体系;(3)优化儿童健康教育的协同治理路径,完善一体化儿童健康教育体系构建的协同治理工具;(4)科学的识别机制,细分儿童健康教育服务需求;(5)完善儿童健康保障相关的法律规范,建立儿童健康教育体系的监督反馈评估机制;(6)提升儿童健康教育服务能力,尤其关注儿童心理及社会健康教育,建立健全儿童健康教育服务递送体系。     

Economic considerations of health literacy

Illiteracy is a critical economic and health care problem in the United States. People with low health literacy are more likely to report poor health, have an incomplete understanding of their health problems and treatment, and are at greater risk of hospitalization. Strategies and incentives for population health improvement affected by health literacy are recommended. Potential economic factors are discussed. Major nursing roles in the area of health literacy are reviewed.     

森林旅游引入心理保健功能的可行性分析

随着我国经济体制的转型和社会现代化程度的提高,国民心理健康问题也日益突出。当前,我国心理保健事业的发展与人民群众日益增长的心理保健需求之间还存在差距。本文运用多学科的相关理论,分析了我国传统心理保健技术问题、传统森林旅游对身心健康的关注、森林心理保健的物理条件。最后进行森林旅游引入心理保健功能的受众分析,提出了森林旅游引入心理保健的模式,并从改善心理保健技术、开发森林心理保健旅游产品等方面提出可行性建议。     

The Role of the Health System in Health Biotechnology in Developing Countries

This paper examines the role of local health systems in developing countries in health biotechnology innovation. The heath systems encompass the final users of health biotechnology products and services. In innovation studies in general, users have been identified as playing vital roles as sources for innovation and in shaping the innovation process. It is therefore of interest to cast light upon the role of users in the health biotechnology innovation in developing countries. This paper briefly reviews literature on science and technology based health innovation in both industrialised and developing countries. It then examines to what extent the focus of developing countries is on their local health problems and explores the linkages between the organisations involved in research and development of health biotechnology products and services with the local health system, and thereby identifies the main roles of their own health systems in the innovation process. The paper bases this analysis on research on publication patterns and case studies on leading developing countries in health biotechnology and focuses particularly on health biotechnology development in Brazil, Cuba and India.     

人口转变、经济发展与卫生支出增长——以人口普查为基础的因素分解

采用因素分解方法考察中国卫生支出在过去近30年的增长特点,将卫生总费用增长及卫生总费用占GDP比重的变化,分解为人口数量增长、人口结构变动、健康模式变化和非人口学因素影响四个独立可比的部分。结果显示,尽管非人口学因素决定着卫生总费用增长,人口学因素却主导着卫生总费用占GDP比重的变化。人口学因素中,人口总量缓慢增长和人口结构快速转变推动着卫生支出规模不断上升,但健康模式变化显著削弱了这种趋势。     

临床护理路径在耐多药肺结核患者健康宣教中的作用

目的评价临床护理路径在耐多药肺结核患者健康宣教中的作用。方法选取耐多药肺结核患者113例按就诊顺序分为研究组57例和对照组56例。对照组患者给予常规健康宣教,研究组患者给予临床护理路径健康宣教。对比两组患者健康知识的知晓情况及患者对健康宣教工作的满意度。结果研究组患者健康知识的知晓得分为（97±9）分,对照组得分为（83±8）分（P〈0.01）;研究组患者对健康宣教工作的满意度得分为（93±7）分,对照组得分为（82±7）分（P〈0.01）。结论耐多药肺结核患者实施临床护理路径健康宣教可有效提高患者对健康知识的掌握,提升护理人员健康宣教工作的质量。     

中国城镇医疗体制改革前后的医疗融资比较

The health financing schemes is the foundation for the nation’s health care system, and the health insurance is a main one of some options for financing health care. This article compares two health care financing schemes in urban areas before and after the health reform, and targets at the impacts facing coverage groups, the financing methods, decision-making power or financial management (i.e. the distribution of responsibility and rights between the central government and local governments), payment arrangement and cost containment of health care financing mechanisms. Prior to reform, the equal access and universal coverage of health care services were implemented through the employment-based health insurance in a state-controlled economy with guaranteed full employment and central control in general. The decentralization reforms of fiscal system and tax sharing reforms disrupts the past economic foundation, the rebuilding health insurance system which still benefits the employed bring the limited coverage. The next trend is to make transition from health insurance covering only part of the employed population to what are in effect national health services covering the whole population in urban areas.      

The determinants of the demand for private health insurance under Medicare

Since the introduction of Medicare in 1984, the proportion of the Australian population with private health insurance has declined considerably. Insurance for health care consumption is compulsory for the public health sector but optional for the private health sector. In this paper, we explore a number of important issues in the demand for private health insurance in Australia. The socio-economic variables which influence demand are examined using a binary logit model. A number of simulations are performed to highlight the influence and relative importance of various characteristics such as age, income, health status and geographical location on demand. A number of important policy issues in the private health insurance market are highlighted. First, evidence is provided of adverse selection in the private health insurance pool, second, the notion of the wealthy uninsured is refuted, and finally it is confirmed that there are significant interstate differences in the demand for private health insurance.     

Effects of Health on Wages of Australian Men

This study uses the Household, Income and Labour Dynamics in Australia (HILDA) survey to investigate the effect of health on wages of working-age Australian men. A simultaneous equation model of health and wages is estimated to account for the endogeneity of health. The results confirm the findings in the literature that health has a significant and positive effect on wages; it is also found that treating health as exogenous underestimates the effect substantially. Although the reverse effect of wages on health is found to be insignificant, there is evidence on the endogeneity of health arising from unobserved factors.     

The determinants of health care expenditure in Australia

The objective of this article is to examine the long-run relationship and short-run dynamics of the health care expenditure in Australia during the period 1960–2003. Consistent with the conventional findings, the income elasticity for health care is found to be greater than one, suggesting that health care is a luxury good in Australia. Demographic structure is found to exert a significant positive impact on health care expenditure. An increase in the accessibility to health care services is associated with higher per capita real health care expenditure. Finally, public funding of health care appears to have a contributory effect on the formation of health care expenditure in Australia.     

MUTUAL HEALTH ORGANIZATIONS AS FACILITATORS AND/OR BARRIERS TOWARDS THE SUCCESSFUL IMPLEMENTATION OF NHIS IN GHANA

There are many constraints to implementing comprehensive health insurance in the context of Sub‐Saharan Africa. Mutual health organizations are under pressure to resolve the inadequacies, accordingly. The objective of this study is to explore the extent to which the mutual health organizations constitute facilitators and/or barriers to the successful implementation of the health insurance scheme nationwide. Data were gathered through interviews and review of literature. The findings of the empirical data were analyzed using theories of health seeking behaviour and reflexive communities. The findings of the paper suggest that the mutual health organizations are beneficial to their communities as they have broadened the understanding of the community members, regarding what the concept of health insurance was in Ghana, a country where it was a relatively new concept in public health financing and delivery. However, the paper also observes that the mutual health organizations are facing problems that are likely to affect sustainability overtime under a national health insurance scheme. Therefore, the need for continuous public education to sustain the enthusiasm among community members is recommended.     

Health spending,savings and fertility in a lifecycle‐dynastic model with longevity externalities

We investigate health spending, savings, fertility and policy implications in a lifecycle‐dynastic model with longevity externalities in annuity returns. We show that such externalities engender not only excessive health spending but also under‐saving and excessive fertility. Social security and health subsidization increase health spending and savings but reduce fertility from laissez‐faire levels. A publicly funded universal health system under labour‐income taxation raises fertility. Taxing health spending or using social security and public health together can obtain socially optimal health spending, savings, longevity and fertility. Numerical results based on US observations suggest substantial variations among these cases, especially in old‐age health spending.     

基于卫生资源利用效率视角下的健康公平实现研究

面对卫生资源利用效率低下导致健康不公平的现实,从医疗资源利用效率角度运用数据包络分析方法,对我国31个省级行政区的卫生资源利用效率进行了比较分析。由各省份在技术效率、投入冗余和产出不足三个方面参差不齐的表现,提出了DEA非有效省份与DEA有效省份健康差距的缩小主要依赖于控制卫生机构规模、缩减不必要的资源配置、使卫生产出与需求保持平衡,并根据实际情况探索提高效率的途径,促进健康公平。     

The impact of the correlation between health expenditure and survival probability on the demand for insurance

This paper studies the effects of health shocks on the demand for health insurance and annuities, along with precautionary saving in a dynamic life-cycle model. I argue that when the health shock can simultaneously increase health expenses and reduce longevity, rational agents would neither fully insure their uncertain health expenses nor fully annuitize their wealth because the correlation between health expenses and longevity provides a self-insurance channel for both uncertainties. That is, when the agent is hit by a health shock (which simultaneously increases health expenses and reduces longevity), she can use the resources originally saved for consumption in the reduced period of life to pay for the increased health expenses. Since the two uncertainties partially offset each other, the precautionary saving generated in the model should be smaller than in a standard model without the correlation between health expenses and longevity. In a quantitative life-cycle model calibrated using the Medical Expenditure Panel Survey dataset, I find that the health expenses are highly correlated with the survival probabilities, and this correlation significantly reduces the demand for actuarially fair health insurance, while its impact on the demand for annuities and precautionary saving is relatively small.     

健康性别不平等与政府卫生预算的社会性别分析

从社会性别的角度分析了我国不同性别之间的健康需求、预算配置和服务受益情况。(1)我国女性人口卫生服务需求高于男性,且经济欠发达地区女性卫生服务利用受到一定程度抑制;(2)性别问题并非当前预算体制下卫生预算分配的主要关注点,但目前已有促进两性平等利用卫生服务的实际行动和措施;(3)在当前公共卫生投入政策下,两性公共卫生服务受益差异不明显。(4)现有统计信息系统大多不归集分性别资料,尤其是预算数据,因此尚无法对政府卫生预算开展深入的性别分析。要推进性别预算观念和分性别统计工作,逐步建立和完善我国的性别预算框架和操作规范,将社会性别纳入健康政策主流,使健康政策和政府卫生预算增加社会性别公平。