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Yudong Miao Jianqin Gu Liang Zhang Ruibo He Sandeep Sandeep 《Journal of medical economics》2019,22(3):245-251
Objective: To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio.Methods: This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the control group, respectively. The Social Health Insurance Fund of the intervention group budgeted 600 yuan per capita per year to insured patients with third stage hypertension to cover their outpatient expenditures, while the outpatient expenditures of the control group were not covered by its Social Health Insurance Fund. The inpatient expenditure reimbursement policies in both groups were not adjusted during the study. Value improvement in this study was defined as reduction in medical costs and improvement in health outcomes within the pilot healthcare system. A propensity score matching model combined with a difference-in-differences model was used to estimate the changes in medical costs and health outcomes.Results: In total, 1,673 pairs of patients were enrolled into statistical analysis after the propensity score matching. The intervention increased per capita annual outpatient expenditure by 81.2 (+31.8%) yuan (p?>?.05), but decreased the per capita annual inpatient expenditure and total medical expenditure by 475.4 (–40.7%) yuan and 394.2 (–27.7%) yuan, respectively (p?.05). Accordingly, the per capita annual total medical expenditure reimbursement decreased by 192.3 (–28.5%) yuan (p?.05), and the per capita annual total out-of-pocket expenditure by 201.9 (–29.9%) yuan (p?.05). The diastolic blood pressure of the intervention group decreased significantly by 2.9?mmHg (p?.05), but no significant change was found in systolic blood pressure and prevalence of hypertension complications (p?>?.05).Conclusion: Increasing the outpatient expenditures, the reimbursement ratio was beneficial to the value of the healthcare system for hypertensive patients. Outpatient care for patients with chronic diseases should be prioritized for rural China and healthcare settings with inadequate health insurance funds. 相似文献
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基于保险公司客户满意度影响因素的多重性,在总结相关研究的基础之上建立了中国保险公司的客户满意度测评模型,并提出相应的测评指标体系。通过对长沙某保险公司进行问卷调查及因子分析法等分析方法的运用验证测评模型和测评指标的合理性和可靠性。 相似文献
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Joseph A. Sierra Mona Shah Max S. Gill Zachery Flores Hiten Chawla Francine R. Kaufman 《Journal of medical economics》2018,21(3):225-230
Background: It is estimated that one in 10 people in the US have a diagnosis of diabetes. Type 2 diabetes accounts for 95% of all cases in the US, with annual costs estimated to be $246 billion per year. This study investigated the impact of a glucose-measuring intervention to the burden of type 2 diabetes.Objective: This analysis seeks to understand how professional continuous glucose monitoring (professional CGM) impacts clinical and economic outcomes when compared to patients who are not prescribed professional CGM.Methods: This study utilized a large healthcare claims and lab dataset from the US, and identified a cohort of patients who were prescribed professional CGM as identified by CPT codes 95250 and 95251. It calculated economic and clinical outcomes 1 year before and 1 year after the use of professional CGM, using a generalized linear model.Results: Patients who utilized professional CGM saw an improvement in hemoglobin A1C. The “difference-in-difference” calculation for A1C was shown to be –0.44%. There was no statistically significant difference in growth of total annual costs for people who used professional CGM compared to those who did not ($1,270, p?=?.08). Patients using professional CGM more than once per year had a –$3,376 difference in the growth of total costs (p?=?.05). Patients who used professional CGM while changing their diabetes treatment regimen also had a difference of –$3,327 in growth of total costs (p?=?.0023).Conclusion: Significant clinical benefits were observed for patients who used professional CGM. Economic benefits were observed for patients who utilized professional CGM more than once within a 1-year period or who used it during a change of diabetes therapy. This suggests that professional CGM may help decrease rising trends in healthcare costs for people with type 2 diabetes, while also improving clinical outcomes. 相似文献
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赵汴 《生态经济(学术版)》2008,(12)
和谐的保险生态,能推动保险业的跨越式发展,诚信建设则是营造良好保险生态的根本.由于保险服务的特殊性,保险公司提升消费者信任,建立良好的客户关系,对于优化保险生态至关重要.文章关注保险服务关系中的消费者信任,详细分析了影响消费者信任的主要因素,包括服务提供者的专业水平、产品的绩效、公司的信誉、满意和共同的价值观,提出了保险公司应营造信任的氛围来改善销售的效率和优化保险生态环境的策略. 相似文献
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医患关系是由医疗法律法规在调整患者与各级医疗单位之间的关系过程中所形成的权利义务关系。医患关系的法律属性和法律适用直接决定了医疗纠纷的归责和赔偿原则,也决定了医疗纠纷的处理模式,因此医患关系的法律属性是一个重大问题。医患关系作为兼具公法与私法性质的特殊的法律关系,需要采用国家干预民事主体私法自治相结合的调整方式,单纯的用公法的方式或是单纯的用私法的方式来调整都难于达到最佳的效果。新医改方案明确指出,要构建健康和谐的医患关系,加强医德医风建设,重视医务人员人文素养培养和职业素质教育,大力弘扬救死扶伤精神,在全社会形成尊重医疗卫生工作者、尊重患者的良好风气。而这些必须是建立在明确医患关系法律性质位之上的,也就是说明确公立医院医患关系的法律性质问题对于新医改制度体系的建立和完善具有重要的作用和意义。 相似文献
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本文以济南某三甲医院的263名医疗服务消费者(患者)为样本,对服务消费者的满意度、感知价值和消费忠诚之间的关系进行了实证研究。结果表明,满意度是感知价值影响消费忠诚的中介变量,感知价值是消费忠诚的最终来源。其应用意义在于,在医院管理中,不能仅停留于对患者满意度的测评,应在功能、情感、社会3个方面为患者提供高水平的服务。 相似文献
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企业的本质是生产要素之间交易的结合点,管理制度就是对企业主与员工之间的信任关系进行治理。作者构建一个制度建立最优时点选择模型,在模型中通过比较新旧制度对企业内部信任关系治理产生的交易收益大小,讨论企业制度建立的最优时点。通过对模型的扩展,文章还分析了社会文化、劳动力市场效率和企业主权威度对制度建立最优时点的影响。 相似文献
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We use the Australian National Health Survey to estimate the impact of private hospital insurance on the propensity for hospitalization as a private patient. We account for the potential endogeneity of supplementary private hospital insurance purchases and calculate moral hazard based on a difference-of-means estimator. We decompose the moral hazard estimate into a diversion component that is due to an insurance-induced substitution away from public patient care towards private patient care, and an expansion component that measures a pure insurance-induced increase in the propensity to seek private patient care. Our results suggest that on average, private hospital insurance causes a sizable and significant increase in the likelihood of hospital admission as a private patient. However, there is little evidence of an expansion effect; the treatment effect of private hospital insurance on private patient care is driven almost entirely by the substitution away from public patient care towards private patient care. We discuss the implications for policies that aim to expand supplementary private insurance coverage for the purpose of reducing excess demand on the public healthcare system. 相似文献
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产业集群内企业间的信任是集群存在和发展的基础。珠江三角洲地区产业集群内信任机制经历了从重人情向重制度的演变。基于组织层面的视角,本研究提出了产业集群内信任的四种形成机制,包括关系机制、过程机制、商誉机制和制度机制。珠江三角洲特殊的信任文化造就了家族企业,而关系型信任却制约着家族企业,影响产业集群的升级。本文从信任的角度分析了珠江三角洲家族企业“只大不强”的原因,指出信任扩展对家族企业的创新发展和产业升级至关重要,并从实践的角度对产业集群建构信任提出建议。 相似文献
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Mark C. Schug 《The Journal of economic education》2013,44(4):340-348
Health insurance policy is a current topic of concern for the United States. The classroom game discussed here provides students with a thorough understanding of some of the policy options under debate, in addition to demonstrating the classic problem of adverse selection. Students received probabilities of encountering a variety of medical expenses, based on their randomly assigned fictitious person’s age and health status. In each round, students made insurance decisions and then rolled dice to determine outcomes for each possible medical expense. The experiment considered insurance with an individual mandate, insurance without an individual mandate, insurance where students could purchase à la carte coverage mimicking proposed insurance riders for certain coverage, and insurance where pre-existing conditions were not covered. 相似文献
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中国正处于经济社会体制转型时期,利益分配格局被打破和再组合,医疗领域也发生了深刻的变化。要想取得医疗卫生体制改革的成功就必须客观公正和辨证地评价医患关系。现有医患关系是良莠并存、错综复杂的矛盾体。利用医患关系模型对医患关系作了技术层面的分析,从伦理学的视角剖析了医患关系的内在本质,分析了两种不和谐医患关系的表现和产生机理,结合\"新医改\"探索了构建和谐医患关系的制度理性。 相似文献
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In the American health care system the cost of health insurance is underwritten by all three sectors of the economy: 1) households; 2) employers; and 3) government. However, while costs are shared, responsibility is not. The retreat of private firms and government from assuming a substantial share of the burden of health care costs is based on the presumption that health care is an individual’s responsibility, while the contributions of government and the private sector are basically optional - a matter of benevolence rather than responsibility. The outcome of the current debates over health care reform will depend on this issue of responsibility. Who should pay for health care? Is it a collective responsibility or an individual one? In this paper, we explore the economics of responsibility as it applies to health care. In the institutionalist framework, any reallocation of costs must be driven by an underlying philosophy of shared responsibility. 相似文献
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解决低保户看病难问题事关社会底线公平。文章基于2005年三个西北城市的17 690个样本对低保户就医问题展开实证研究,分析结果表明,由于中国医疗机构扭曲的激励机制和偏重住院报销的给付结构,低保户和非低保户两个群体都倾向于自己购药处理日常病患,而减少了门诊利用,经常面临生存危机的低保户由此拖延病情直至病情严重;个人账户既不能横向分散不同人群的疾病风险,也不能纵向分散个人在生命周期不同阶段的疾病风险;职工基本医疗保险能够显著增加中青年低保户对住院服务的利用,但对老龄低保户没有效果。 相似文献
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The objective of this article is to examine whether having health insurance reduces illness-related absenteeism among older workers. A nationally representative sample of 1780 workers in the United States, aged 52–64, are drawn from the 2004–2006 Health and Retirement Study (HRS). Binary logistic regressions and censored Tobit models are estimated for workers’ likelihood of missing work days due to illness and the number of illness-related work days missed, respectively, while explicitly addressing the possibility of insurance-selection effects. The findings suggest that over a 12-month period, older workers without health insurance are as likely as insured workers to miss work days due to illness and there are no differences in the number of days missed between insured and uninsured workers. However, there is strong evidence that poor baseline health, onset of new diseases and longer hospitalization significantly increase an older worker's absenteeism at work. These results suggest that having health insurance does not affect illness-related absenteeism among older workers in the US. Future research examining other aspects of worker productivity, such as ‘presenteeism’, and the longer term effects of insurance on productivity can extend our understanding of the role of health insurance in the workplace. 相似文献
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虚拟企业是一种新的组织形式,在虚拟企业中伙伴关系的管理十分重要。传统的方法如契约方法已不能保证虚拟企业的成功,必须在合作伙伴问建立信任的关系。本文介绍了在整个虚拟企业生命周期中伙伴信任关系的源泉,并在分析我国背景情况的基础上从宏观和微观层面上提出了建立虚拟企业伙伴信任关系的一些建议。 相似文献
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Chenglin Shen 《中国经济评论(英文版)》2006,5(6):34-37
Managing supply chain partnerships for competitive advantage is receiving considerable recognition among both academic researchers and industry executives. Trust is an essential factor for a company to collaborate with its partner through supply chain (SC). In this paper we analyze the factors of trust relationship in green supply chain (GSC). A conceptual model of determinants of trust in GSC is presented. Finally, research propositions are discussed. 相似文献
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随着中国社会结构和社会规范的变迁,社会信任和诚信危机逐步成为社会的焦点。非营利组织是一种新型的社会组织,有别于企业和政府,在交织着关系网络的社会环境中,其诚信问题已然成为组织能否存续和发展的关键,因而,研究非营利组织的诚信问题对构建社会主义和谐社会具有重要的理论和现实意义。 相似文献
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本文以日用品产品危机为研究情景,以品牌关系质量作为衡量品牌关系性质的重要变量,进而探讨品牌关系质量对消费者购买行为的影响,同时进行中外品牌的比较。研究发现,在危机情境下,品牌关系是影响消费者购买行为的一个重要心理变量,对顾客满意与购后行为倾向有强烈的正向影响;国外品牌与国产品牌相比,明显地具有更高的社会价值表达、自我概念联结及相互依赖评价,其中社会价值表达对顾客满意具有最大的影响力;而在承诺、真有与应有之情及信任三个构面,国产品牌较国外品牌具有显著优势。结论在很大程度上解释了目前多数情况下,中国消费者仍推崇国外品牌的原因。同时,本文对本土企业如何在危机情境下提升品牌竞争力提出了管理建议。 相似文献
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采用2006年在北京宣武、天津和平、山东即墨、浙江德清和安徽居巢五县区的生殖健康项目的调查数据,对生殖健康/计划生育优质服务中服务对象的感知控制、感知质量与满意度之间的关系进行分析。服务对象的满意度显著高于感知质量;感知控制显著正向影响其对服务质量的感知和对服务的满意度。感知控制越高,感知质量和满意度越高;感知控制对两者的影响并无显著差异。感知控制对满意度的影响和感知质量对满意度的直接影响并无显著差异,但是感知控制调节感知质量与服务满意度之间的关系,感知控制高时,感知质量对服务满意度的影响相对减弱。 相似文献