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第二军医大学学报 2016年第10期37卷 1310-1313页

作者：滕海英孙宁陈千马玉琴第二军医大学基础部数理教研室上海200433 第二军医大学卫生勤务学系卫生事业管理学教研室上海200433

医疗支出型贫困人群,按目前通用的贫困测量标准（收入角度）不属于贫困人群。他们一旦遭遇疾病支出风险则陷入贫困,表现为不去就诊或者“因病致贫、返贫”。个人现金卫生支出使得贫困人口更加贫困,而对富裕人群影响不大。发达国家较早... 详细信息

医疗支出型贫困人群,按目前通用的贫困测量标准（收入角度）不属于贫困人群。他们一旦遭遇疾病支出风险则陷入贫困,表现为不去就诊或者“因病致贫、返贫”。个人现金卫生支出使得贫困人口更加贫困,而对富裕人群影响不大。发达国家较早意识到对医疗支出型贫困人群的外部有效资金帮助将具有更高的成本收益。

关键词：农村人口医疗支出型贫困医疗费用无力承担就医选择

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基于疗程费用测算耐药结核病患者药物负担

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中国防痨杂志 2019年第9期41卷 962-967页

作者：申丽君王艺曈李雪刘昭张帆赵琨刘跃华清华大学医院管理研究院深圳518055 国家卫生健康委卫生发展研究中心

目的从宏观层面上测算不同化疗方案与药品价格来源下耐药结核病患者治疗的疗程费用。方法基于中国《耐多药肺结核临床路径(2012年版)》和2018年WHO发布的《耐多药和利福平耐药结核病的治疗(更新版)》(以下简称“2012版中国指南”和“201... 详细信息

目的从宏观层面上测算不同化疗方案与药品价格来源下耐药结核病患者治疗的疗程费用。方法基于中国《耐多药肺结核临床路径(2012年版)》和2018年WHO发布的《耐多药和利福平耐药结核病的治疗(更新版)》(以下简称“2012版中国指南”和“2018版WHO指南”)推荐的治疗方案,分别测算中国大陆市场价格和WHO集中采购价格下耐药结核病治疗的疗程费用,以“灾难性卫生支出(指家庭现金支付医疗费用占家庭消费支出的比例≥40%)”为指标评估耐药结核病患者的药物可负担性。结果在2012版中国指南治疗方案及中国大陆市场价格下,耐药结核病治疗总疗程费用的区间为1.95万元(人民币,下同)/例~12.70万元/例,总疗程自付费用区间为5322元/例~78482元/例,其中,部分治疗方案下,仅药物费用的支出就产生灾难性卫生支出,城镇居民的卫生支出占比为2.19%~32.25%,农村居民为5.87%~86.60%。在相同治疗方案下(2018版WHO指南),中国大陆市场价格下的耐药结核病的全疗程自付费用为74.5万元/例~77.0万元/例,且所有治疗方案均导致灾难性卫生支出,而WHO集中采购价格下耐药结核病的全疗程自付费用为8.07万元/例~9.59万元/例。结论对比WHO集中采购价格,国内二线抗结核药物价格较为昂贵,耐药结核病治疗给患者带来了沉重的经济负担,且农村情况更为严峻。

关键词：结核抗药性费用药物医疗费用无力承担

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重庆市四区县肺结核患者经济负担分析

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中国防痨杂志 2022年第4期44卷 390-396页

作者：吴波刘英廖文平郑轶秦博杨静谢蕙蔓余雅重庆市结核病防治所综合防治科重庆400050 重庆市结核病防治所医教科重庆400050 重庆市黔江区疾病预防控制中心结核病防治所重庆409099 重庆市丰都县疾病预防控制中心结核科重庆408299 重庆市开州区结核病防治所防治科重庆405499 重庆市巫山县疾病预防控制中心传防科重庆404799 重庆市结核病防治所区县科重庆400050

目的:了解重庆市经济欠发达(简称“欠发达”)区县肺结核患者的经济负担,为优化肺结核患者医疗保险政策提供数据支持。方法:采用横断面的研究,选择重庆市黔江区、丰都县、开州区和巫山县结核病定点医院2019年6月至2020年6月间登记治疗的... 详细信息

目的:了解重庆市经济欠发达(简称“欠发达”)区县肺结核患者的经济负担,为优化肺结核患者医疗保险政策提供数据支持。方法:采用横断面的研究,选择重庆市黔江区、丰都县、开州区和巫山县结核病定点医院2019年6月至2020年6月间登记治疗的326例活动性肺结核患者,通过问卷调查,以及收集《医院信息系统》中的诊疗信息和费用信息,对患者因病发生的各项费用及个人负担进行分析。结果:326例患者平均疗程为180.0(178.0,210.0)d,确诊前的直接医疗费用为1600.0(920.0,3500.0)元,确诊后的直接医疗费用为2479.0(1218.9,5709.6)元。患病后的直接非医疗费用为1300.0(400.0,3000.0)元,因治疗肺结核损失的间接费用为3850.0(500.0,15000.0)元,总费用为14156.8(6904.7,28133.9)元。80.98%(264/326)的患者因治疗肺结核发生家庭灾难性支出。结论:重庆市欠发达地区的肺结核患者经济负担较重,现行医疗保险报销政策不能完全缓解患者经济负担,应考虑进一步完善重庆市结核病医疗保险报销政策,降低家庭灾难性支出。

关键词：结核,肺费用,医疗贫困区医疗费用无力承担小地区分析

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宁波市利福平耐药肺结核患者家庭灾难性医疗支出及其影响因素分析

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中国防痨杂志 2019年第11期41卷 1191-1196页

作者：杨天池陈琴陈同于梅林相浙江省宁波市疾病预防控制中心结核病防制所 315010 中国科学院大学宁波华美医院医疗保险办公室

目的了解利福平耐药肺结核患者家庭灾难性医疗支出发生情况及其影响因素。方法选取2016—2017年宁波市耐药结核病定点医院登记并治疗满12个月的92例利福平耐药肺结核患者(经结核分枝杆菌痰培养及临床分离株对利福平和异烟肼等药物敏感... 详细信息

目的了解利福平耐药肺结核患者家庭灾难性医疗支出发生情况及其影响因素。方法选取2016—2017年宁波市耐药结核病定点医院登记并治疗满12个月的92例利福平耐药肺结核患者(经结核分枝杆菌痰培养及临床分离株对利福平和异烟肼等药物敏感性试验确诊)进行疾病经济负担问卷调查。共发放问卷92份,回收有效问卷85份,有效率为92.4%。根据世界卫生组织给出的灾难性医疗支出建议,以自付费占家庭可支付费用(家庭年收入扣除食品支出后的部分)的40%作为阈值,计算患者家庭灾难性医疗支出发生率;灾难性医疗支出影响因素分析先进行单因素卡方检验,以α=0.10为检验水准筛选可疑因素,再以可疑因素为自变量、α=0.05为检验水准进行多因素logistic回归分析。结果71.8%(61/85)的被调查患者家庭因肺结核发生灾难性医疗支出。多因素logistic回归分析显示,与年人均收入低于1.5万元的家庭相比,年人均收入高(“2.5万元~”:OR=0.179,95%CI=0.035~0.906,P=0.038;“≥4.0万元”:OR=0.118,95%CI=0.023~0.605,P=0.010)患者家庭发生灾难性医疗支出的风险较低;因肺结核住院的患者家庭发生灾难性医疗支出的风险较高(OR=5.623,95%CI=1.739~18.178,P=0.004)。结论利福平耐药肺结核患者家庭灾难性医疗支出发生率高,因肺结核住院是发生灾难性医疗支出的危险因素,家庭年人均收入高是保护因素。

关键词：利福平结核抗多种药物性肺医疗费用无力承担因素分析统计学

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上海市奉贤区肺结核患者经济负担及其影响因素分析

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中国防痨杂志 2019年第9期41卷 974-984页

作者：徐春华刘清王紫纯邬勇上海市奉贤区疾病预防控制中心性结防科 201499 上海市奉贤区海湾镇社区卫生服务中心预防保健科

目的分析上海市奉贤区肺结核患者经济负担及其影响因素。方法搜集2018年上海市奉贤区疾病预防控制中心(简称“疾控中心”)登记并进行社区管理且符合入选标准的136例初复治肺结核患者,采用自行设计的调查问卷了解患者的基本资料(包括性... 详细信息

目的分析上海市奉贤区肺结核患者经济负担及其影响因素。方法搜集2018年上海市奉贤区疾病预防控制中心(简称“疾控中心”)登记并进行社区管理且符合入选标准的136例初复治肺结核患者,采用自行设计的调查问卷了解患者的基本资料(包括性别、年龄、有无医疗保险、家庭灾难性卫生支出、有无并发症等),并记录诊疗过程中所有的直接费用、间接费用。采用SPSS17.0软件进行数据的统计学分析及最优尺度回归分析,以P<0.05为差异有统计学意义。结果剔除疗程中因病死亡和医疗费用数据不全者各1例,最终收集到完成抗结核药物治疗且资料完整的134例患者,其中户籍患者88例,非户籍患者46例。肺结核患者例均年收入55181.46元(人民币,下同),平均家庭收入112937.91元。例均总支出费用32035.99元,包括例均直接费用24363.97元和间接费用7672.02元;户籍患者的总支出费用中位数(四分位数)[M(Q1,Q3)]为25635.25(8361.82,45314.05)元,与非户籍患者[18847.43(9016.25,31894.65)元]比较,差异无统计学意义(Z=-0.984,P=0.325),但直接费用[19336.34(7756.65,36700.57)元]高于非户籍患者[11658.03(6716.38,20072.61)元](Z=2.329,P=0.020),而间接费用[1000.00(0.00,4075.00)元]低于非户籍患者[3000.00(75.00,13500.00)元](Z=-2.773,P=0.006)。例均医疗保险报销经费占总支出费用的23.75%(7607.26/32035.99),政府减免经费占4.55%(1458.03/32035.99),自付费用占71.70%(22970.70/32035.99),且自付费用占家庭年均收入的20.34%(22970.70/112937.91);户籍患者医疗保险报销金额[2703.00(1024.00,10917.00)元]及政府减免金额[1210.50(820.25,1721.75)元]与非户籍患者[分别为179.00(0.00,1218.00)元和1480.50(1328.75,1802.50)元]差异均有统计学意义(Z值分别为-5.291和-2.962;P值分别为0.000和0.003)。最优尺度回归分析结果显示,患者就诊区级机构[11535.48(6622.96,22741.41)元]、每日规范服药[14147.86(6878.47,27395.80)元]、无住院治疗[6395.98(4425.99,8878.89)元]、住院天数0d[6395.98(4425.99,8878.89)元]、无住院次数[6395.98(4425.99,8878.89)元]、疗程时间≤8个月[11474.18(6563.88,22880.65)元]、自评病情程度重[8726.80(4666.35,20642.64)元]、无家庭灾难性卫生支出[11474.18(6818.67,22880.65)元]、无医疗保险[7074.25(4741.36,8660.69)元]的直接医疗费用均明显低于就诊市级机构[15550.02(8456.05,37171.31)元]、不规律服药[15107.08(8901.53,34197.84)元]、有住院治疗[19982.64(9676.31,35013.72)元]、住院天数>30d[56713.89(37977.08,101972.01)元]、住院次数3~5次[53899.46(36421.73,113670.87)元]、疗程时间>8个月[18925.76(8616.10,36823.34)元]、自评病情程度轻[20070.70(9456.83,44849.70)元]、有家庭灾难性卫生支出[35562.35(20704.26,55516.06)元]、有医疗保险[14907.71(7335.28,29653.38)元](F值分别为5.794、5.983、6.346、11.102、70.825、8.087、11.636、31.912、5.851,P值分别为0.044、0.037、0.034、0.021、0.000、0.036、0.011、0.000、0.039)。结论奉贤区肺结核患者的诊治经济负担较重,患者负担费用高低与主要就诊机构、每日规范服药、住院治疗、累计住院天数、住院次数、疗程时间、有无医疗保险、自评病情程度、有无家庭灾难性卫生支出有关。

关键词：结核,肺患病代价问卷调查费用,医疗医疗费用无力承担小地区分析因素分析,统计学

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Internal Fixation of Mandibular Angle Fractures: A Comparison of 2 Techniques

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JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY 2008年第11期66卷 2254-2260页

作者： Mehra, Pushkar Murad, Haitham Boston Univ Sch Dent Med Dept Oral & Maxillofacial Surg Boston MA 02118 USA Boston Med Ctr Dept Dent & Oral & Maxillofacial Surg Boston MA USA

Purpose: To compare treatment outcomes between rigid extraoral fixation and semirigid intraoral fixation for the management of isolated mandibular angle fractures, and to develop a protocol for successfully managing these fractures in an indigent population. Materials and Methods: This study involved a retrospective analysis of mandibular angle fracture patients treated at Boston Medical Center from 1999 to 2006. All patients were treated by a single attending surgeon, with oral and maxillofacial surgery residents. Data were collected by a review of pertinent inpatient and outpatient clinic records, and radiographic and laboratory results. The criteria for inclusion into the study comprised: 1) patients with isolated unilateral or bilateral mandibular angle fractures;2) surgical treatment provided within 7 days of injury via I of the 2 following techniques: a) open reduction and internal fixation via an intraoral approach (single monocortical miniplate), or b) open reduction and internal fixation (ORIF) via an extraoral approach (inferior border plate with at least 2 holes on either side of the fracture line and bicortical screws);3) the presence of decayed, partially bony, or full bony impacted third molars requiring removal at time of surgery;4) the use of postsurgical maxillomandibular fixation (MMF) for 1 week (extraoral rigid-fixation cases) and 2 weeks (intraoral semirigid-fixation cases) and 5) a 1-week duration of postsurgical oral antibiotic therapy. Results: The patient sample ranged in age from 17 to 55 years, with an average age of 24.8 years. The average follow-up was 12.3 weeks (range, 8 to 64 weeks). In total, 98 fractures were treated with intraoral miniplate fixation, whereas 65 fractures underwent rigid fixation using an extraoral approach. The presence or absence of bone gaps in radiographs immediately after surgery had no correlation with surgical success. None of the patients in either group required further surgical intervention in the operatin

关键词： Adolescent Adult External Fixators Fracture Fixation Internal Humans 成年人外固定器骨折固定术内内固定器颌骨固定技术下颌骨折医疗费用无力承担 Fracture Fixation Adolescent Adults Internal Fracture Fixation, Internal Operative Surgical Procedures Angle of mandible Third Molar rupture line External Fixators

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Low use of breast conservation surgery in medically indigent populations

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AMERICAN JOURNAL OF SURGERY 1999年第6期178卷 470-473页

作者： Dolan, JT Granchi, TS Miller, CC Brunicardi, FC Baylor Coll Med Dept Surg Div Gen Surg Houston TX 77030 USA

BACKGROUND: Breast conservation surgery (BCS) with radiation is an acceptable treatment for early-stage breast cancer. METHODS: Data were obtained from hospital cancer registries on women surgically treated for Stage 0 to II breast cancer from 1993 to 1997, Data on 1,747 patients were analyzed for surgical treatment, hospital type (private versus public), disease stage, and ethnic origin. RESULTS: In this study, 34% of women received BCS, Women treated in private hospitals received BCS more often than women treated in public hospitals. Women with stage II disease received BCS less often than women with earlier stage disease. Hospital type (public versus private) and disease stage were strong, independent predictors for use of BCS. When hospital type and disease stage were statistically controlled, no treatment differences across ethnic groups were identified. CONCLUSIONS: Use of BCS in this study was low compared with National Cancer Database statistics. Women treated in publicly funded hospitals and those with stage II disease were significantly less likely to receive BCS. Am J Surg. 1999;178: 470-474, (C) 1999 by Excerpta Medica, Inc.

关键词：乳腺肿瘤/流行病学乳腺肿瘤/外科学医院县医院私立乳房切除术区段/统计学和数值数据乳房切除术区段/利用医疗费用无力承担医师诊疗模式/统计学和数值数据社会经济因素得克萨斯/流行病学女(雌)性人类

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Why don't all Americans get the best available cancer care?

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JOURNAL OF THE NATIONAL CANCER INSTITUTE 2000年第17期92卷 1378-1379页

作者： Newman, P

Large disparities in cancer death rates have led the President’s Cancer Panel to sponsor a series of regional meetings around the country to look at the challenges of providing quality cancer care to all Americans and whether community-based or national programs can alleviate problems of access to appropriate care. The panel is chaired by Harold P. Freeman, M.D., chief executive officer and president of the North General Hospital in New York City. Research has shown, Freeman said, that poverty results in a host of challenges for uninsured and medically underserved patients and their health care providers. In a recent report to President Clinton, Freeman applauded the scientific accomplishments of the National Cancer Program but told the president that the United States must do more than research to beat cancer. At meetings taking place around the country in the next 9 months, the panel is asking patients, physicians, and other health care providers in all 50 states to identify the populations underserved for cancer care in their state and bring attention to successful programs at the community or state level that help people receive appropriate care. “Poverty places people in social circumstances leading to less information, poor living conditions, risk-promoting lifestyles, and lack of access to preventive care services,” Freeman said at a recent meeting in Omaha. “The way people live, combined with a lack of resources and knowledge, culture, attitudes, lifestyles and behavior, have an influence on what diseases occur, as well as on the way they respond when they have a disease.” Access to timely cancer health care can be difficult or lacking not only for the indigent, but also for people who are sole providers for their families, those living in rural areas, the elderly, and immigrant populations. Results of the regional meetings will be consolidated into a report to the president containing specific recommendations for policies and national and local activities t

关键词：卫生服务易得程度保险健康医疗费用无力承担肿瘤/经济学肿瘤/治疗贫困社会经济因素美国人类

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INCORPORATING MOBILE MAMMOGRAPHY UNITS INTO PRIMARY-CARE - FOCUS GROUP INTERVIEWS AMONG INNER-CITY HEALTH-CENTER PATIENTS

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HEALTH EDUCATION RESEARCH 1995年第2期10卷 179-189页

作者： SKINNER, CS ZERR, AD DAMSON, RL INDIANA UNIV SCH MEDDEPT MEDDIV GEN INTERNAL MEDINDIANAPOLISIN 46202 MARION CTY HLTH DEPT DIV CHRON DISINDIANAPOLISIN 46205

Mammography screening is underutilized, especially among women of lower socioeconomic status (SES). Mobile mammography units reduce cost and patient burden of mammography, and therefore might enhance screening rates among underserved populations. Few studies have explored factors associated with the acceptability of mobile mammography;none have targeted low-SES women. To explore these issues, we conducted focus group interviews in five university-affiliate urban primary-care clinics, The forty-three participants were 74% African-American, ranged in age from 40 to 70 years and most (67%) had household incomes below $15 000. A trained moderator led the groups of eight to 12 women through standardized, open-end interview questions exploring perceptions of mobile mammography. Findings suggest mammography vans are acceptable under only certain circumstances, including advance notice and assurance of privacy and quality. Convenience was important;53% related being more likely to have mammograms if scheduled in conjunction with primary-care visits. Participants felt strongly that vans were inappropriate for public forums such as shopping centers. Association with primary-care health centers seemed to legitimize mammography vans and to allay concerns. If mammography screening is to become more widespread among low-income populations, these exploratory findings must be addressed in research and intervention development.

关键词：非洲大陆世系人群乳腺肿瘤/预防和控制乳腺肿瘤/心理学乳腺肿瘤/放射摄影术集中研讨小组健康教育健康知识态度实践乳房X线摄影术普查医疗费用无力承担巡回卫生队病人接受卫生保健的程度初级卫生保健社会环境市区人口成年人老年人女(雌)性人类中年人

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新形势下医疗欠费的原因及风险规避

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华北国防医药 2008年第2期20卷 33-34页

作者：赵宁志高茗陈新庄伟解放军359医院江苏镇江212001 南京军区南京总医院南京210002 南京医科大学附属南京市第一医院南京210002

随着卫生事业的不断发展，医疗收入的不断增长，医疗欠费问题也越来越突出。医疗欠费直接影响服务质量与服务水平，甚至关系到医院的生存与发展。因此，应加强医疗欠费的管理。

关键词：医院,综合费用,医疗医疗费用无力承担费用控制

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