银川市三甲医院职工医保总额预付制运行效果研究

目的 分析宁夏银川市三级甲等医院职工基本医疗保险总额预付制的基本运行情况以及综合实施效果变化,为更好的实施总额预付制提供合理的建议。方法 对7家三甲医院2012年以及2013年的出院人次、次均费用、次均医保支付、非医保支付指标进行统计对比,运用秩和比法综合评价7家三甲医院总额预付制实施的效果。结果 2013年7家三甲医院一共透支了34.88%,2013年较2012年次均费用、次均医保支付、非医保支付比例均呈现增长趋势,次均医保支付增长幅度与次均费用增长幅度不成比例,而且次均医保支付增长均远远高于次均费用增长。宁夏人民医院和宁夏医科大总院心脑血管病医院的RSR值小幅度增加,其余5家三甲医院的RSR值均降低。结论 7所三甲医院透支严重,医院承担很大超支的风险和压力,对医院的正常运营会有影响。总体来看,政策没有有效的控制医疗费用的增长,总额预付制的综合运行效果不明显。增强医保中心对医院的管理,医院内部要实行“总额控制、结构调整”的管理,健全信息系统,加强监督与管理。     

总额预付制下医保费用管理措施对医疗服务行为影响

目的 了解医院在总额预付制下所采取的费用管理措施以及这些措施对医生处方行为与患者诊疗结果的具体影响。方法 采用问卷调研的方法进行实证研究,并结合专家访谈的方法进行论证讨论。结果 研究发现,总额预付制下,目前医院医保费用管理措施在控制费用的同时对临床服务质量与患者满意度产生了一些意想不到的影响。结论 总额控费带来的相关问题应引起关注,建议可从保证医疗服务质量、优化医疗费用结构和控费方法精细化三方面对控费进行完善。     

总额预付背景下医院医保管理策略的调整与思考

目的 探寻总额预付制度对于三级综合医院医保管理工作的影响,并有针对性的提出改进措施。方法 采用访谈法、比较法等收集信息资料,并对相关数据进行统计处理和实施效果分析。结果 医院对管理策略的合理调整,有助于多种角度控制医疗费用增长,临床医务人员在诊疗行为方面趋于规范化,不合理用药现象减少。结论 总额预付制度的实施有助于医院医疗费用的控制,医保的管理意识得到强化。     

银川市职工基本医疗保险总额预付制实施效果分析

目的 了解银川市定点医疗机构总额预付制的实施效果,在此基础上探究总额预付制下不同方式下医保基金的控制与管理。方法 采用定性分析与定量分析相结合的方法,采用SPSS软件对数据进行分析,采用病例组合方法进行改进方法研究。结果 银川市总额预付制实施后费用控制效果不明显,次均费用等指标呈现上升趋势,同时也发现实施方案中存在一些问题。结论 针对总额预付实施方案中出现的问题,提出以病例组合平均费用作为总预付方案,控制费用的同时合理利用医疗资源,促进病人合理分流。     

医学影像科检查在医保总额预付改革政策下的变化

目的 探讨医保制对医院影像科检查量的影响以及应对的方法。 方法 对北京大学肿瘤医院医学影像科2012年度全年检查量数据进行统计分析,组间率的比较采用χ²检验或Fisher精确概率法。 结果 医保总额预付制前后放射科检查量总体情况变化不大。非医保群体中,各种检查的构成比情况变化不大。结论 医保总额预付制使医保病例的影像检查手段构成发生了积极变化,减少了病人的医疗支出,促进医疗资源的优化配置;放射科应针对变化采取相应措施,以保证临床医疗和科研工作的平稳开展。     

以医保预付制改革为抓手 加强医院内涵建设

目的 研究医院在医保总量既定条件下,应该采取怎样的改革措施和管理手段,来实现医保总量资金合理、有效的使用,谋求一种医保服务人次最大化和满意度较高的医疗服务模式。方法 采取代数方法计算各科室总量,将仁济医院2009年和2008年的医保各项具体指标进行比较分析。结果 仁济医院2009年完成医保总量61 549万元,比全年指标累计节余250万元。医保门急诊和住院服务人次与2008年同期相比分别上升7.6%和7.7%,均次费用控制较好。结论 医保总量预付制前提下,医院可以通过加强内部管理、提升内涵质量、调整费用结构、调动医务人员积极性,来实现医保资金的有效使用,最终达到多方共赢的局面。     

总额预付制度下三级专科公立医院的管理策略分析

?????? 目的 旨在探讨总额预付改革形势下的三级公立医院,特别是专科公立医院所应作出的管理策略调整,为进一步深化公立医院改革提供参考依据。方法 通过文献复习、专题讨论等定性分析,结合医院信息系统、市医疗保险事务管理中心的资料,对医院数据纵向对比,对综合、中医、专科三类医疗机构医保数据横向对比。结果 总额预付工作达到了试点要求,提升着医院医保工作管理水平。结论 在继续推动总额预付工作的同时,应适度重视对专科医院的政策倾斜,专科医院也应强化内部基金分配使用和绩效考核的管理,注重单一限额下增强医疗机构的内生活力,将输血与造血有机结合,共葆医保基金的可持续循环。     

西北某医院老年性白内障不同付费方式患者费用构成分析

目的:通过对比分析,总结西北某医院老年性白内障自费、医保、新农合三类付费方式患者医疗费用差异及其原因。方法:提取西北地区某医院2010-2012年老年性白内障患者的基本病例信息及住院费用清单,利用EXCEL2007软件和SPSS18.0软件对数据进行统计分析。结果:本院老年性白内障患者人均住院总费用最高为自费患者,其次是医保患者,最低为新农合患者。其中,药品费用差异悬殊是导致三类患者住院总费用差异的最主要原因。结论:不同付费方式对医疗收费行为产生不同影响,医保和新农合政策的制定应兼顾效率与公平。     

对医保定点医疗机构支付方式改革的思考

医保对定点医疗机构支付方式改革势在必行,应由传统的被动支付向管理型支付方向发展。在需方对医疗机构支付方式上,应确定与参保对象承受能力相适应的费用分担比例,同时组合应用多种支付方式;在医保对医疗机构支付方式上,应由后付制转向预付制、由单一的支付方式转向混合型支付方式。支付方式改革要辅之以加强对医疗机构的监管、加快卫生信息化建设、建立医保谈判机制和注重配套政策支撑等。     

单病种限价收费标准研究

目前按病种付费已经是大趋势。参照国外医保基金付费方式,研究我院单病种限价收费标准:即如何选择单病种和确定单病种价格,制定出一套适合我院单病种限价收费标准。实践表明按单病种限价收费,既降低了病人的医疗费用,提高了社会效益,又因收治病人数增加,同时也提高了医院的经济效益,对于医患双方是"双赢"。因此我院单病种费用收费标准的制定将为我省医疗单位和医疗保险业单病种费用收费标准的制定起着积极的推动作用。     

Costs associated with gunshot wounds in Canada in 1991.

OBJECTIVE: To estimate the costs (in 1993 dollars) associated with gunshot wounds in Canada in 1991. DESIGN: Cost analysis using separate estimates of gunshot incidence rates and costs per incident for victims who died, those who survived and were admitted to hospital and those who survived and were treated and released from emergency departments. Estimates were based on costs for medical care, mental health care, public services (i.e., police investigation), productivity losses, funeral expenses, and individual and family pain, suffering and lost quality of life. SETTING: Canada. OUTCOME MEASURES: Costs per case, costs by type of incident (e.g., assault, suicide or unintentional shooting) and costs per capita. RESULTS: The total estimated cost associated with gunshot wounds was $6.6 billion. Of this, approximately $63 million was spent on medical and mental health care and $10 million on public services. Productivity losses exceeded $1.5 billion. The remaining cost represented the value attributed to pain, suffering and lost quality of life. Suicides and attempted suicides accounted for the bulk of the costs ($4.7 billion); homicides and assaults were the next most costly ($1.1 billion). The cost per survivor admitted to hospital was approximately $300,000; this amount included just over $29,000 for medical and mental health care. CONCLUSION: Costs associated with gunshot wounds were $235 per capita in Canada in 1991, as compared with $595 in the United States in 1992. The differences in these costs may be due to differences in gun availability in the two countries. This suggests that increased gun control may reduce Canada''s costs, especially those related to suicide.     

县级公立医院的治理型市场化改革模式创构

模式的选择关系到县级公立医院改革结果的成败。依据公益性和积极性的关系和权重,县级公立医院主要存在两种改革模式,第一种是绩效性行政化改革模式：公益性和积极性均衡化改革模式;第二种是治理型市场化改革模式：积极性和公益性均衡化改革模式。治理型市场化改革模式是县级公立医院综合改革的必然选择。县级公立医院治理型市场化改革模式,以医药卫生费用虚高为基本假设,以医疗保险补偿机制为后续制度,以医疗保险控费机制为关键制度。医疗保险预付费方式是县级公立医院治理型市场化改革模式的支点,预付费方式不仅可以撬动公立医院管理体制创新,也可以撬动公立医院运行机制重构。     

Costs of paediatric diabetes care in Germany: current situation and comparison with the year 2000

Diabet. Med. 29, 1327-1334 (2012) ABSTRACT: Aims To estimate direct costs of paediatric Type 1 diabetes care and associated factors in Germany for the year 2007 and to compare results with the costs for the year 2000. Methods Our study includes clinical data and charges for any diabetes-related health care service of 14?185 continually treated subjects with paediatric diabetes aged 相似文献   

Economic Burden of Hypoglycemia in Patients with Type 2 Diabetes Mellitus from Korea

Background

Hypoglycemia is a very serious complication in patients with type 2 diabetes mellitus (T2DM) and affects the economic burden of treatment. This study aims to create models of the cost of treating hypoglycemia in patients with T2DM based upon physician estimates of medical resource usage.

Methods

Using a literature review and personal advice from endocrinologists and emergency physicians, we developed several models for managing patients with hypoglycemia. The final model was approved by the consulting experts. We also developed 3 unique surveys to allow endocrinologists, emergency room (ER) physicians, and primary care physicians to evaluate the resource usage of patients with hypoglycemia. Medical costs were calculated by multiplying the estimated medical resource usage by the corresponding health insurance medical care costs reported in 2014.

Results

In total, 40 endocrinologists, 20 ER physicians, and 30 primary care physicians completed the survey. We identified 12 types of standard medical models for secondary or tertiary hospitals and 4 for primary care clinics based on the use of ER, general ward, or intensive care unit (ICU) and patients’ status of consciousness and self-respiration. Estimated medical costs per person per hypoglycemic event ranged from $17.28 to $1,857.09 for secondary and tertiary hospitals. These costs were higher for patients who were unconscious and for those requiring ICU admission.

Conclusion

Hypoglycemia has a substantial impact on the medical costs and its prevention will result in economic benefits for T2DM patients and society.     

Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka

Background

Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector.

Methods

We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches.

Results

The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting.

Conclusions

This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka.     

医疗保险预付费方式控制医疗费用的机制研究

医疗保险以控制医疗费用为重要职能,以预付费方式为主要手段。医疗保险预付费方式实际上是一种“定额”付费方式,以“超支自负和结余归己”的固定结算制度为控费机制。目前,部分地区的医保机构对医疗机构采取“超支分担、结余奖励”的弹性结算制度,部分地区对医疗机构采取“超支自负、结余归人”或“超支分担、结余归己”的半固定半弹性结算制度。这些结算制度不是“定额”付费方式,而且“限额”付费方式,原本是为了既控制医疗费用又防范医疗风险,结果是既不能控制医疗费用又不能防范医疗风险。     

Medicine's Role in Health Care Cost Containment

During the 20th century, medicine has confronted a series of problems threatening health care delivery in the United States. Historically, crises developed related first to quality of care, later to access and finally to the current issue of cost. Factors responsible for the large increases in health care expenditures in the United States during the last decade include increased medical care costs, population and demand for care. Additionally, economy-wide inflation, advanced medical technologies, an aging population, the growth of health care facilities, expansion of third-party payment systems including Medicare and Medicaid and rising incomes per capita have occurred. Programs now exist, and others are being planned, through which physicians, individually in private practice and collectively through organized medicine, may confront this major challenge now threatening the very foundations of health care delivery in the United States.     

Direct Diabetes-Related Costs in Young Patients with Early-Onset,Long-Lasting Type 1 Diabetes

Objective

To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany.

Research Design and Methods

Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0–4 years of age within the years 1993–1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors.

Results

Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943–4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs.

Conclusions

Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.     

National Health Insurance Development in China from 2004 to 2011: Coverage versus Benefits

BackgroundThe simultaneous improvement of the security capability of China Health Insurance System and its development in the last decade remains uncertain. This study measures the status and trends of reimbursement levels of the China Health Insurance System, as well as to offer policy advice to subsequent insurance reforms.MethodsThe National Reimbursement Ratio was created to determine the reimbursement level of the national health insurance system based on total health expenditure and the covered population. Chinese total health expenditure data from 2004 to 2011 were extracted from China’s Health Statistics according to the standards of the International Classification for Health Accounts by Healthcare Financing.ResultsIn 2011, the medical expenditure per capita in China was USD 130.95 and the National Reimbursement Ratio was 26.39%. The National Reimbursement Ratio showed an intense transition from 2004 to 2011, with a sharp decrease from 98.51% in 2004 to 22.44% in 2009, and then a small increase to 26.39% in 2011.ConclusionThe National Reimbursement Ratio was effective in revealing the reimbursement level of the national health insurance system and in predicting its trends. The challenge to China’s healthcare reform is to switch from increasing insurance coverage to guaranteeing a steady increase in government input and building a powerful supervision mechanism.