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HEALTH-CARE FINANCING - HOW MUCH REFORM IS NEEDED

ISSUES IN SCIENCE AND TECHNOLOGY 1992年第3期8卷 42-49页

作者： OKEEFFE, JE AMER PSYCHOL ASSOC WASHINGTONDC USA

The call for the reform of the US health care system is discussed. Most of the proposals offered thus far will not guarantee access to affordable, comprehensive care for everyone.

关键词：保险统计分析综合保健/经济学费用分担残疾人经济竞争卫生政策/经济学卫生服务易得程度/经济学保险选择偏倚保险健康/经济学保险健康/立法和法学美国

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Genitourinary medicine and sexually transmitted infections in the 21st century

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INTERNATIONAL JOURNAL OF STD & AIDS 2000年第1期11卷 1-7页

作者： Thin, RNT Guys & St Thomas Hosp Trust Dept Genitourinary Med London England

In 1990 the first editorial review of the journal briefly considered some current problems in genitourinary medicine (GUM) and future developments. This paper will consider some of the changes of the past 10 years and discuss possible developments in the 21st century. Developments among the commoner infections includes: HIV infection, Genital herpes simplex infection, Human papillomavirus infection, Syphilis, Gonorrhoea, Genital Chlamydia trachomatis infection.

关键词：妇科学/发展趋势卫生服务易得程度/经济学卫生服务易得程度/发展趋势国家卫生规划/经济学国家卫生规划/发展趋势性传播疾病泌尿科学/发展趋势女(雌)性人类男(雄)性

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Improving access for Medicaid-insured children: Focus on front-office personnel

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第3期130卷 365-373页

作者： Lam, M Riedy, CA Milgrom, P Univ Washington Dept Dent Publ Hlth Sci Seattle WA 98195 USA

Background-Access to dental services for low-income children is limited. Front-office personnel paly a role regarding dentists' participation in the Medicaid program. Methods. Subjects (N = 24) represented general dental offices in Spokane County, Wash., and included participants and nonparticipants in the Access to baby and Child Dentistry, or ABCD, program, a dental society/community program aimed at expanding dental services provided to Medicaid-insured children. The authors stratified the participants according to the number of claims their practices submitted to Medicaid for ABCD children: non-ABCD, low-ABCD and high-ABCD. Five two-hour focus group sessions were conducted to determine participants' beliefs about, attitudes toward and experiences in serving this population. Results. The authors' data analysis consisted of a comprehensive content review of participants' responses from transcripted audiotapes. They synthesized frequently mentioned concepts and ideas into relevant themes. The major factors affecting practices' participation in Medicaid were office policy on seeing Medicaid-insured patients;staff members' personal connection to Medicaid-insured patients;staff members' attitudes about Medicaid-insured patients;and staff members' perceptions of Medicaid-insured patients' barriers to care. Conclusions-The data suggest that factors affecting dentists' participation in the Medicaid program are more complex than the often-stated dissatisfactions with low reimbursement fees and hassles with paperwork. Clinical Implications. Efforts to increase dentist participation in serving Medicaid-insured patients will continue to be relatively ineffective until many of the concerns raised by this study's subjects are better understood and addressed.

关键词：行政管理人员/心理学医务工作者的态度牙科辅助人员/心理学儿童口腔保健/经济学牙科工作人员/心理学牙医病人关系集中研讨小组卫生服务易得程度/经济学 Medicaid 组织方针试点项目单亲/心理学美国华盛顿儿童人类

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The paradox of the cost and affordability of traditional and government health services in Tanzania

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HEALTH POLICY AND PLANNING 2000年第3期15卷 296-302页

作者： Muela, SH Mushi, AK Ribera, JM Swiss Trop Inst Dept Epidemiol & Publ Hlth CH-4002 Basel Switzerland Ifakara Hlth Res & Dev Ctr Ifakara Tanzania Univ Autonoma Barcelona Dept Antropol Social E-08193 Barcelona Spain

Since the introduction of user fee systems in the government health facilities of most African countries, which shifted part of the burden of financing health care onto the community, affordability of basic health care has been a much discussed topic. It is sometimes assumed that in areas where high levels of spending for traditional treatments are common, people would be able to pay for basic health care at governmental facilities, but may not be willing to do so. However, examining willingness to pay and ability to pay in the broader context of different types of illness and their treatment leads us to a very different conclusion. in the course of a medical-ethnographic study in south-eastern Tanzania, we found evidence that people may indeed be willing, but may nevertheless not be able, to pay for biomedical health care - even when they can afford costly traditional medicine. In this article, we suggest that the ability to pay for traditional treatment can differ from ability to pay for hospital attendance for two main reasons. First, many healers - in contrast to the hospital - offer alternatives to cash payments, such as compensation in kind or in work, or payment on a credit basis. Secondly, and more importantly, the activation of social networks for financial help is different for the two sectors. For the poor in particular, ability to pay for health care depends a great deal on contributions from relatives, neighbours and friends. The treatment of the 'personalistic' type of illness, which is carried out by a traditional healer, involves an extended kin-group, and there is high social pressure to comply with the requirements of the family elders, which may include providing financial support. In contrast, the costs for the treatment of 'normal' illnesses at the hospital are usually covered by the patient him/herself, or a small circle of relatives and friends.

关键词：社区卫生服务/经济学费用分担卫生保健费用卫生服务易得程度/经济学医院公立/经济学医院公立/统计学和数值数据医学传统病人接受卫生保健的程度/心理学社会支持坦桑尼亚人类

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Unofficial fees in Bangladesh: price, equity and institutional issues

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HEALTH POLICY AND PLANNING 1999年第2期14卷 152-163页

作者： Killingsworth, JR Hossain, N Hedrick-Wong, Y Thomas, SD Rahman, A Begum, T Minist Hlth & Family Welfare Hlth Econ Unit Dhaka Bangladesh Maxwell Stamp Plc London England Data Int Dhaka Bangladesh Univ Cape Town Hlth Econ Unit ZA-7700 Rondebosch South Africa

The widespread collection of unofficial fees at health facilities is a common form of rent-seeking behaviour in Bangladesh. Typically, unofficial fees come in the form of cash payments for the performance of required services, for direct purchase of drugs and medical-surgical requisites, and for service access. Using observational and interview methods, this study explores linkages between official and unofficial fees at three Bangladesh health facility levels: primary care Thana Health Complexes, secondary or district hospitals, and medical college hospitals. The study estimates payment levels for different income classes and different payor types at these facilities, thereby highlighting potential equity, price and institutional questions associated with unofficial fees. Not only does the practice have clear income and equity effects, there also appear to be direct effects upon patient satisfaction, perception of quality, and the ability to pay for health services. The article concludes with a discussion of 'rent capture' processes at Bangladesh facilities and the effect of unofficial fees in six areas of health sector reform: displaced official policies, reduced merit goods production, upward income redistribution, distorted human resource development, growth of facility inefficiency, and obstruction of market reforms.

关键词：孟加拉国发展中国家筹资个人卫生服务易得程度/经济学卫生服务研究医院收费医院区/经济学医院区/标准病人满意度卫生保健质量问卷调查社会正义社会经济因素人类

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A feasibility study of realtime telemedicine in Croatia using Internet videoconferencing

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JOURNAL OF TELEMEDICINE AND TELECARE 2000年第3期6卷 172-176页

作者： Ostojic, V Stipic-Markovic, A Tudman, Z Zivkovic, N Cvoriscec, B Trajbar, T Donnelly, CL Grgic, M Matek, P Lusic, M Iskra, M Univ Zagreb Gen Hosp Sveti Duh Dept Clin Immunol & Pulmonol Zagreb 10000 Croatia Ambulance Selca Brac Isl Croatia Dartmouth Hitchcock Med Ctr Dept Child Psychiat Lebanon NH 03766 USA Croatian Inst Brain Res Zagreb Croatia

We explored the feasibility of realtime telemedicine in Croatia using Internet videoconferencing. A 33 kbit/s link was established between a team of specialists in the General Hospital 'Sveti Duh' in Zagreb and a general practitioner's clinic in Selca, on the island of Brac. During a two-week study, 16 patients (median age 51 years) were studied. Twenty-one teleconsultations (seven initial and 14 follow-up visits) were conducted, 13 with a specialist in internal medicine, six with a surgeon and two with a neurologist. In 18 cases (86%) telemedicine successfully replaced hands-on examination. The mean duration of the teleconsultations was 7.2 min (initial visits 7.4 min, follow-up visits 7.1 min). Each computer system cost about US$700. The total connection cost for the study was US$4.95. The teleconsultations saved the patients US$272 in travel costs. We suggest forming a permanent on-line specialist service connected to networked clinics via the Internet to improve access to health-care in Croatia.

关键词：克罗地亚卫生服务易得程度/经济学卫生服务易得程度/组织和管理因特网病人满意度远程医学/经济学远程医学/方法远程医学/标准青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类男(雄)性中年人

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Undertriage, overtriage, or no triage? In search of the unnecessary emergency department visit

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ANNALS OF EMERGENCY MEDICINE 2001年第3期38卷 282-285页

作者： Asplin, BR Regions Hosp Dept Emergency Med St Paul MN 55101 USA Univ Minnesota Emergency Med Program HealthPartners Res Fdn Minneapolis MN USA

[Asplin BR. Undertriage, overtriage, or no triage? In search of the unnecessary emergency department visit. Ann Emerg Med. September 2001;38:282-285.]

关键词：卫生保健辅助人员/经济学费用控制误诊急诊室医院/经济学卫生保健公平提供/经济学卫生服务易得程度/经济学伤病员分拣美国非必要的操作/经济学人类

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THE COSTS OF MEDICARE PATIENTS IN NURSING-HOMES IN THE UNITED-STATES - A MULTIPLE OUTPUT ANALYSIS

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JOURNAL OF HEALTH ECONOMICS 1989年第3期8卷 253-270页

作者： DOR, A URBAN INST WASHINGTONDC 20037 USA

The reluctance of nursing homes to admit Medicare beneficiaries is well recognised. A possible explanation is that under the current Medicare reimbursement policy, nursing homes do not have adequate incentives to increase admissions. This paper examines that hypothesis. Using a national sample of nursing homes, Medicare-specific marginal costs were estimated from a flexible form of the cost function. In most cases, Medicare-specific marginal costs were well above Medicare reimbursement rates. From an investigation of economies of scale and economies of scope, it appears that reimbursements may be sufficient only in nursing homes that specialize in Medicare beneficiaries. Unless Medicare reimbursements are brought in line with costs, access of Medicare beneficiaries to the nursing homes will remain limited.

关键词：成本及成本分析/统计学和数值数据卫生服务易得程度/经济学 Medicaid/经济学 Medicare/经济学模型统计学回归分析偿还途径技术性护理设施/经济学统计学(主题) 美国

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Is low income a constraint to contraceptive use among the Pakistani poor?

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JOURNAL OF BIOSOCIAL SCIENCE 2000年第2期32卷 161-175页

作者： Agha, S Populat Serv Int Div Res Washington DC 20036 USA

This paper examines whether low income is a barrier to contraceptive use in Pakistan, a country in which economic conditions are deteriorating at a time when the private sector is becoming a ml,re important supplier of contraception. Multivariate regression analysis performed using the Pakistan Contraceptive Demand Survey suggests that low income is a deterrent to modern contraceptive use in Pakistan. This is particularly the case for contraceptive methods supplied through the private sector. It is concluded that, if the aim of family planning programmes is to reach low-income people, the prices of contraceptives supplied through the private sector should be kept as low as possible.

关键词：避孕/经济学避孕/心理学避孕/利用避孕行为/心理学避孕行为/统计学和数值数据计划生育服务/组织和管理健康知识态度实践卫生服务易得程度/经济学 Logistic模型多元分析需求估价巴基斯坦贫困/心理学贫困/统计学和数值数据私营部门问卷调查青少年成年人女(雌)性人类

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Urban and Rural Differences in Health Insurance and Access to Care

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The Journal of Rural Health 1994年第2期10卷 98-108页

作者： Hartley, David Quam, Lois Lurie, Nicole Rural Health Research Center University of Washington Department of Geography Seattle Washington United States Institute for Health Services Research Department of Internal Medicine University of Minnesota in Minneapolis Minneapolis Minnesota United States

This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub‐samples of 400 group‐insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies. Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P<0.01). These differences were confirmed by multivariate analysis. Rural residents with group insurance have higher out‐of‐pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment‐based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：卡方分布绝对免赔额与共同保险/统计学和数值数据地理学卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据保险赔偿费/统计学和数值数据保险健康/统计学和数值数据采访最小二乘法分析 Logistic模型未参加医疗保险者/统计学和数值数据明尼苏达多元分析农村卫生/统计学和数值数据城市卫生/统计学和数值数据成年人人类

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