我国城乡居民健康公平性研究

本文采用历史的、比较的分析方法,运用基尼系数、洛伦茨曲线等分析工具,分别从筹资公平、服务提供公平和健康公平三个方面对我国城乡居民健康公平问题进行了定性与定量分析,得出了新型农村合作医疗制度的开展显著降低了城乡卫生服务筹资的基尼系数等一系列结果.根据研究结果,对城乡健康公平性与二元社会结构,与政府干预、市场调节之间的关系作了分析,并对提高城乡健康公平性提出了相关政策建议.     

Fraudster’s and victims’ profiles and loss predictors’ hierarchy in the mental healthcare industry in the US

Abstract

Background

Fraud- or theft-related crimes account for the highest number of crimes in the mental health industry in the US.     

失地农民参与新型农村合作医疗影响因素探析——基于江阴市临港新城H小区失地农民的调查

基于对发达地区江阴市临港新城H小区的调查,从微观视角关注失地农民群体中个体特征对新型农村合作医疗制度运行的影响,探讨失地农民群体对新型农村合作医疗制度的认知程度与其参与新型农村合作医疗的具体选择行为之间的相关性,深入考察新型农村合作医疗制度实施现状,探寻新型农村合作医疗制度在失地农民群体中实施存在的问题,以期对完善新型农村合作医疗保障制度建设提供参考。     

Cost impact of oral capecitabine compared to intravenous taxane-based chemotherapy in first-line metastatic breast cancer

Abstract

Objective: Few studies have examined the costs associated with differing first-line chemotherapy regimens in patients with metastatic breast cancer (MBC). This study compares the relative cost impact of women starting first-line chemotherapy with capecitabine versus taxanes.

Methods: Women receiving first-line chemotherapy for MBC from 1998 to 2002 were identified from a hybrid North Carolina Medicaid-claims-tumour registry linked database and Medicare records, and were followed through to 2005 with claims data. Statistical t- and chi-square tests were used to compare baseline characteristics between patients who received first-line chemotherapy with capecitabine versus taxanes. Projected mean costs for 12 months continuous eligibility were estimated using an ordinary least squares linear regression. Overall cost impact of capecitabine after start of therapy was then examined using a multivariate log-linear regression model.

Results: While patients starting taxanes had significantly lower total costs in the pre-index year than patients starting capecitabine (mean: $20,042 vs. $35,538, p<0.001), in the post-index year, the patients on taxanes experienced significantly higher healthcare utilisation and associated costs compared to patients on capecitabine (mean: $43,353 vs. $35,842, p=0.0089). The differences were primarily attributable to lower expenses in chemotherapy related claims and fewer visit days to outpatient settings for patients on capecitabine. After adjustment with propensity scores and other confounders, the capecitabine group was associated with 32% lower healthcare costs compared to the taxane group (p=0.0001).

Conclusions: In this population-based study, women who received capecitabine as first-line treatment for MBC had significantly lower costs compared to women starting taxane therapy.     

National Identity and the Challenge of Health Reform in Canada

Health reform remains the most contentious policy issue in Canada. Medicare is subject to the same political forces that demand state retrenchment in other areas, but it has escaped wholesale reorganization because of the commitment of Canadians to the principles of medicare, because the provinces and the federal government remain locked in a battle about provincial autonomy, and because the existing system serves the interests of various professional groups including organized medicine. Nevertheless, reform and, especially, expansion of coverage is essential if the existing system is to be sustained. The most encouraging aspect of current debate is the recognition that we can look beyond the U.S. for reforms more consistent with the underlying values of Canadians than is the U.S. system.     

澳大利亚基本医疗保险管理体静

澳大利亚拥有世界一流的健康服务体系。国民医疗保险作为政府主导下的全民医疗保险,保障了所有澳大利亚居民都可以获得必要的和高质量的治疗、药物及医院服务。澳大利亚政府的国民服务部负责国民医疗保险的具体管理并提供服务。同时,澳大利亚政府鼓励居民在国民医疗保险之外,积极参加私人医疗保险。94％以上的澳大利亚居民对基本医疗保险满意。通过介绍澳大利亚国民医疗保险及政府对其管理的基本情况,旨在为我国医疗保险制度的改革提供参考。     

论PPP模式在我国基本医疗保障体系建设中的运用

随着《医改方案》的实施,政府部门面临的挑战日益加大,单靠政府的力量难以承担;与此同时,在全民医保的大环境下,商业保险公司也在找机会进入社保领域。因而,在基本医疗保障体系建设中引入PPP模式(公私合作伙伴关系模式),让社会保障部门和商业健康保险公司充分合作,实现政府和市场的优势互补,是建立高质量医疗保障体系的关键。     

A preliminary look at readmission and mortality among chronically critically ill and other medically complex Medicare patients

Chronically critically ill and other medically complex patients (CCI/MC-Ps) are those who are hospitalized with long-term intensive care needs and require extended periods of hospital-level care. CCI/MC-Ps may be at higher risk for readmission and mortality than other populations due to the severe nature their illnesses. This article examines factors that lead to increased probability of hospital readmission or mortality among CCI/MC Medicare patients. Logistic regression analyses are used to examine mortality and readmissions among the CCI/MC population. Numerous factors including length of stay in the acute hospital, age and gender affect whether a patient is readmitted to the acute care hospital within 90 days of discharge or dies within 60 days following a hospital stay.     

The Challenge of Humanistic Economics

The Center for Medicare and Medicaid Services (CMS) created the Hospital Compare Program in 2003 to increase transparency between healthcare providers and consumers. Implemented in 2005, this transparency consists of hospitals' collecting and making publicly available a set of hospital quality score measures. The CMS induced participation by financially penalizing hospitals that did not publicly report a specific subset of these measures (called “starter” measures). Three years into the program, the penalty for non-reporting both the starter measures and other (“non-starter”) measures was increased. I use a difference-in-differences methodology to analyze the effect of the increased CMS penalty on the likelihood that a hospital publicly reported its starter and non-starter measure scores. I find that the penalty had an economically and statistically insignificant effect on the probability that a hospital publicly reported its starter scores, but a statistically significant 8.0 percent effect (p-value<0.01) on whether it reported its non-starter scores. These findings are robust to a series of alternative empirical specifications.