深圳市社区公共卫生服务包运行的人力成本研究

目的 了解深圳市社区公共卫生服务包运行时需要投入的人力成本，包括人员经费与人员配备数量两部分。方法 按服务包工作流程和工作任务要求自行设计调查问卷，进行抽样调查。结果 完成服务包基本项目时，每万服务人口需要投入人员经费45.40万元，配备卫生技术人员4.30人。结论 每万服务人口人力货币成本与所需人力配备数据对于政府投入标准的制订具有较好的参考价值。     

深圳市社区公共卫生服务包运行的支持成本研究

目的 了解深圳市社区公共卫生服务包运行中除人力成本之外最基本的运行成本。方法 通过普查和抽样问卷调查2种方法，收集并计算管理、培训等几大类成本数据。结果 按每万服务人口计，服务包运行的基本支持与保障成本，如管理、培训、租金、折旧和水电维修成本分别为6.25万元、0.15万元、6.19万元、2.73万元和3.96万元。结论 每万服务人口的各类支持成本信息，使得各级财政在基本支持与保障成本的投入标准和方向的确定上具有参考价值。     

深圳市社区公共卫生服务包运行成本测算概述

2007年,深圳市在全国率先设计并试行了”社区公共卫生服务包”。为给政府制定财政投入政策和拟定人员配备标准提供科学的研究证据,参考了国内外成本核算研究的经验,根据深圳市社区健康服务发展的实际情况,将服务包运行成本分为人力成本和基本支持与保障成本2个部分并分别予以测算。前者通过收集服务流程时间,根据有效工作时间和当地行业人均收入折算成货币成本;后者主要包括管理、培训、业务用房租金、设备折旧、水电与维修费几个部分。结果发现保证社区公共卫生服务包的良好运行,政府只需按一般性财政支出约1%的比例拨付维持经费。     

深圳市社区公共卫生服务包成本测算的思路设计

基于深圳市特殊的社区健康服务运行机制、当地社区公共卫生服务包的试行经验,提出将服务包成本分为人力成本、基本支持与保障成本,并分别进行测算的成本研究思路。从服务包运行的服务流程以及社区公共卫生的工作要求出发,给出了人力成本计算的公式,同时提出了基本支持与保障成本中几种重要成本的测算方法。     

人工鱼礁构建对海洋生态系统服务价值的影响——以深圳杨梅坑人工鱼礁区为例

基于深圳杨梅坑人工鱼礁区2008年的研究和统计数据,采用生态系统服务价值方法,系统分析了杨梅坑人工鱼礁建设对海洋生态系统的影响.结果表明:与深圳附近海域相比,杨梅坑人工鱼礁构建后旅游娱乐服务价值所占比例由87%降至42%,食品供给服务价值所占比例由7%升至27%,原材料供给、气候调节、空气质量调节、水质净化调节、有害生物和疾病的生物调节与控制、知识扩展服务价值所占比例少许提高;2008年,深圳杨梅坑人工鱼礁区单位面积服务价值为1714.7万元.km-2,远高于深圳市近海海洋生态系统的平均值和全球近海生态系统的平均值.人工鱼礁生态系统影响并改变了区域海洋生态系统服务价值结构,提高了区域生态系统服务价值,对于合理开发与利用海洋资源、修复受损的海洋生态环境和渔业资源有着重要意义.利用生态系统服务价值方法对人工鱼礁构建区进行评价,可以更好地反映人工鱼礁构建效益,能有效促进我国人工鱼礁建设的发展、提高海洋生态系统管理水平.     

农牧交错带风蚀沙化区农业生态系统服务功能的经济价值评估

运用市场价值法、替代工程法、影子价格法和机会成本法等方法对内蒙古阴山北麓风蚀沙化区农业生态系统服务功能的价值进行了经济评估。结果表明 ,该地区农业生态系统总的服务价值为 4 6 5 4 5 381 0万元 ,其中产品服务价值为 2 9874 1万元 (占 0 0 6 % ) ,水土保持价值为 4 5 70 2 84 2万元 (占 9 7% ) ,涵养水源价值为 4 2 80 2 6万元 (占 0 0 9% ) ,气候调节价值为393411 8万元 (占 0 84 % ) ,营养物质循环价值为 4 1910 6 73 9万元 (占 89 2 7% ) ,从服务功能的价值比例来看 ,系统的环境服务价值要远远大于其产品服务的价值 ,表明该地区农业生产水平落后 ,同时也体现了在当地环境恶劣 ,农业经营粗放的前提下 ,系统环境服务价值是维系其不稳定农业生产的基础     

江苏省陆地和生态红线区域生态系统服务价值

生态红线是最为关键的生态保护区域边界,是生态安全的底线。以2013年江苏省划定的生态红线区域为研究对象,在土地利用现状分析的基础上,对生态系统服务价值进行了评价。结果显示:江苏省陆域生态红线区域的生态系统服务价值为564.15亿元/a,占全省陆地生态系统服务总价值的48.69%,其中水体的生态系统服务价值最大,占生态红线区域的比例高达78.34%;生态红线区域的土地平均生态系统服务单位面积价值为2.47万元/hm~2,是全省平均的2.18倍,其中湿地最高,生态系统服务单位面积价值达5.55万元/hm~2,是全省平均的4.89倍,其次是水体、林地和草地;在已划定的生态红线区域中,各类生态系统占全省相应土地类型的面积比例排序与生态系统的单位面积价值排序完全一致,显示出生态系统类型的单位面积价值越大,受保护的程度越高。     

基层医疗卫生机构住院医疗服务诊疗范围探究

??????? 目的 探究基层医疗卫生机构的住院医疗服务诊疗范围,为基本医疗服务范围的界定及其相关的基本药物目录、基本诊疗目录、基本设施目录提供理论支持和参考。方法 通过专家咨询和实地调查的方法,按照疾病就诊人数降序排列,筛选出覆盖基层医疗卫生机构就诊人数超过90%的疾病。结果 全国和各地区就诊人次比例占90%的疾病,不同地区的数量不同,其所占的住院费用百分比也不同;不同地区筛选出的疾病与全国的疾病有差异; 确定各地区均有的14种疾病为基层医疗卫生机构住院医疗服务诊疗范围。 结论 在制定全国的诊疗范围基础之上,根据不同地区的疾病谱和服务水平作适当调整。     

深圳市院办院管模式运行现状及改革试点措施研究

目的 全面了解深圳市院办院管模式的运行现状,分析社区健康服务中心改革试点措施的实施效果。方法 对3个区共计65家社区健康服务中心进行问卷调查,同时深入访谈相关知情人。结果 深圳市社区健康服务中心诊疗服务量占全市诊疗量的比重由2004年的20.0%上升至2010年度的31.3%,门诊次均诊疗费用则由2005年的59.1元下降至2010年的45.6元。调研地区2009年门诊次均费用水平均低于全国平均水平,差异具有统计学意义（P=0.000）。结论 深圳市社区健康服务中心网络已基本实现社区全覆盖和人口全覆盖,社区健康服务中心改革试点进一步完善了院办院管模式的运行机制和管理架构。     

西藏河谷地区人工种草的投入产出比较分析

分析了西藏河谷地区六种草地的经济投入、产出和生态系统服务价值,模拟了投入增加下村落草地利用结构的改变与经济、生态产出的响应。结果表明:草地恢复管理中,围栏草地成本最低,为67元/hm~2,是一年生人工刈割草地的0.9%。围栏等草地恢复管理的经济产出为772元/hm~2,其中补贴收入占14.6%,另85.4%来自打工收入;而多年生人工放牧和一年生人工刈割草地的经济产出为4250元/hm~2与13135元/hm~2。相比经济产出,不同草地管理方式下生态系统服务价值差距有限,最大仅为27%。草地投入增加下,天然放牧草地转变为围栏草地及一年生人工刈割草地,并最终保持约1∶1的面积比。合理配置围栏草地与一年生人工刈割草地,可以实现区域较大的经济收入增长和生态系统服务的保障。     

Medical Expenditure for Chronic Diseases in Mexico: The Case of Selected Diagnoses Treated by the Largest Care Providers

Background

Chronic diseases (CD) are a public health emergency in Mexico. Despite concern regarding the financial burden of CDs in the country, economic studies have focused only on diabetes, hypertension, and cancer. Furthermore, these estimated financial burdens were based on hypothetical epidemiology models or ideal healthcare scenarios. The present study estimates the annual expenditure per patient and the financial burden for the nine most prevalent CDs, excluding cancer, for each of the two largest public health providers in the country: the Ministry of Health (MoH) and the Mexican Institute of Social Security (IMSS).

Methods

Using the Mexican National Health and Nutrition Survey 2012 (ENSANUT) as the main source of data, health services consumption related to CDs was obtained from patient reports. Unit costs for each provided health service (e.g. consultation, drugs, hospitalization) were obtained from official reports. Prevalence data was obtained from the published literature. Annual expenditure due to health services consumption was calculated by multiplying the quantity of services consumed by the unit cost of each health service.

Results

The most expensive CD in both health institutions was chronic kidney disease (CKD), with an annual unit cost for MoH per patient of US$ 8,966 while for IMSS the expenditure was US$ 9,091. Four CDs (CKD, arterial hypertension, type 2 diabetes, and chronic ischemic heart disease) accounted for 88% of the total CDs financial burden (US$ 1.42 billion) in MoH and 85% (US$ 3.96 billion) in IMSS. The financial burden of the nine CDs analyzed represents 8% and 25% of the total annual MoH and IMSS health expenditure, respectively.

Conclusions/Significance

The financial burden from the nine most prevalent CDs, excluding cancer, is already high in Mexico. This finding by itself argues for the need to improve health promotion and disease detection, diagnosis, and treatment to ensure CD primary and secondary prevention. If the status quo remains, the financial burden could be higher.     

深圳双向转诊的利益相关者分析

利用利益相关者理论分析我国深圳社区健康中心与医院双向转诊中的各方利益者,包括主要利益相关者、次要利益相关者和外部利益相关者。社区居民、社区健康服务中心能获得预期利益,但是由于这些利益集团动用资源能力较弱,所以双向转诊仍然需要发挥政府的主导作用。     

Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State,India

BackgroundGeneration of resources for providing health care services is an important issue in developing countries. User charges in the form of Surgical Package Program (SPP) were introduced in all district hospitals of Haryana to address this problem. We evaluate the effect of this SPP program on surgical care utilization and out-of-pocket (OOP) expenditures.MethodsData on 25437 surgeries, from July 2006 to June 2013 in 3 districts of Haryana state, was analyzed using interrupted time series analysis to assess the impact of SPP on utilization of services. Adjustment was made for presence of any autocorrelation and seasonality effects. A cross sectional survey was undertaken among 180 patients in District hospital, Panchkula during June 2013 to assess the extent of out of pocket (OOP) expenditure incurred, financial risk protection and methods to cope with OOP expenditure. Catastrophic health expenditure, estimated as any expenditure in excess of 10% of the household consumption expenditure, was used to assess the extent of financial risk protection.ResultsUser charges had a negative effect on the number of surgeries in public sector district hospitals in all the 3 districts. The mean out-of-pocket expenditure incurred by the patients was Rs.4564 (USD 74.6). The prevalence of catastrophic expenditure was 5.6%. A higher proportion among the poorest 20% population coped through borrowing money (47.2%), while majority (86.1%) of those belonging to richest quintile paid from their monthly income or savings, or had insurance.ConclusionThere is a need to increase the public financing for curative services and it should be based on the needs of population. Any form of user charge in public sector hospitals should be removed.     

Reform of mental health care in Serbia: ten steps plus one

Disastrous events in the country and the region caused a 13.5% increase in the prevalence of mental and behavioral disorders in Serbia in the last few years, thus making them the second largest public health problem. Due to prolonged adversities, the health system has deteriorated and is facing specific challenges. However, the reform of mental health care has been initiated, with a lot of positive movements such as the preparation of a national policy for mental health care and a law for protection of mentally ill individuals. The transformation of mental health services has started, with an accent on community care, antistigma campaigns and continuing education. Based on an assessment carried out by the National Committee on Mental Health, service provision, number of professionals working in services, funding arrangements, pathways into care, user/carer involvement and other specific issues are reported.     

江西省公立医院经济运行现状分析

调查分析江西省12所不同等级、不同地区公立医院2000—2007年的经济运行数据。结果发现,江西省12所公立医院8年来经济运行状况明显改善,发展趋势良好,但是仍然存在政府投入不足、收支结构不合理、“以药养医”现象严重、营利能力不强等突出问题。建议加大政府对公立医院的监管和财政补助力度,优化卫生资源配置,改革以药养医的经济运行机制,调整医药价格体系,提高医疗服务水平和效率。     

Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study

The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods.     

基于结构方程的公共卫生服务提供效果影响因素研究

为了分析公立医院提供公共卫生服务效果的影响因素,通过问卷调查,收集了黑龙江省102家公立医院公共卫生服务相关数据。运用软件SPSS18.0和AMOS7.0对数据进行统计分析,建立公立医院提供公共卫生服务效果影响因素结构方程模型,探讨公共卫生服务提供效果的影响因素。研究发现,财政补偿与政府监管、医院管理、医院投入对公共卫生服务提供效果具有促进作用。     

Recession, debt and mental health: challenges and solutions

Background During the economic downturn, the link between recession and health has featured in many countries' media, political, and medical debate. This paper focuses on the previously neglected relationship between personal debt and mental health.Aims Using the UK as a case study, this paper considers the public health challenges presented by debt to mental health. We then propose solutions identified in workshops held during the UK Government's Foresight Review of Mental Capital and Wellbeing.Results Within their respective sectors, health professionals should receive basic 'debt first aid' training, whilst all UK financial sector codes of practice should - as a minimum - recognise the existence of customers with mental health problems. Further longitudinal research is also needed to 'unpack' the relationship between debt and mental health. Across sectors, a lack of co-ordinated activity across health, money advice, and creditor organisations remains a weakness. A renewed emphasis on co-ordinated 'debt care pathways' and better communication between local health and advice services is needed.Discussion The relationship between debt and mental health presents a contemporary public health challenge. Solutions exist, but will require action and investment at a time of competition for funds.