我国病毒性肝炎住院费用灰色关联分析

基于2004年～2008年<中国卫生统计年鉴>和第三次国家卫生服务调查有关数据,计算病毒性肝炎现惠指标,并运用灰色关联法对住院费用进行定量分析.结果显示,我国病毒性肝炎发病率为108.44/10万,病死率为0.09/10万;平均住院天数呈逐渐递减趋势;药品费用是影响住院费用的主要因素.因此,控制住院费用的增长应重点控制药品费用.     

某市医保恶性肿瘤患者住院费用分析

通过对城职恶性肿瘤患者住院费用分析,寻找控制恶性肿瘤住院患者费用的方法,同时为恶性肿瘤医保政策调整提供依据。利用EXCELL和SPSS 16.0对数据进行统计分析。结果发现:性别、年龄、是否手术、医院等级、住院天数对发生金额和申请金额均有不同程度的影响;药品费所占比例最大;不同病种间的统筹申请/发生金额的比例差异较大。故认为缩减住院天数和减少药品比例是控制费用的主要手段;建议在临床路径的基础上推行病种付费;普及编码培训,规范数据采集。     

论非正常死亡

“非正常死亡”概念带模糊性、悖论性、封闭性和诡辩性,并不科学。现实的死亡率千差万别。中国内地自杀死亡率16．78／10万,事故死亡率57．91／10万,他杀死亡率2．33／10万,自然死亡率535．9／10万,一切原因死亡率612／10万。一切原因死亡率较港澳高,自杀与事故死亡率较港澳低。澳门的一切原因死亡率特低(165．0／10万),自杀死亡率特高(40．9／10万)。     

药物经济学及其在药品费用控制中的作用

近年来,我国的医疗费用每年以30%的速度增长,如何控制医疗费用的迅速增长已成为大家关心和需要解决的问题,而医疗费用的控制焦点之一就是如何控制药品费用的迅速增长。造成药品费用迅速增长的因素主要有两个方面:一是合理因素即不可控因素,如人口增加和老龄化,慢性病增加等;二是不和理因素,如价格管理存在漏洞,医院补偿机制不完善和不合理用药等。药品费用控制的核心是合理使用有限的卫生资源,保证卫生服务的公平性和特需性。目前国内外在控制药品费用方面采取了许多切实可行的方法,如药物利用评价,改革城镇职工医疗制度即费用共担以及职业…     

药物经济学及其在药品费用控制中的作用

近年来,我国的医疗费用每年以30%的速度增长,如何控制医疗费用的迅速增长已成为大家关心和需要解决的问题,而医疗费用的控制焦点之一就是如何控制药品费用的迅速增长.造成药品费用迅速增长的因素主要有两个方面:一是合理因素即不可控因素,如人口增加和老龄化,慢性病增加等;二是不和理因素,如价格管理存在漏洞,医院补偿机制不完善和不合理用药等.     

广西肝恶性肿瘤患者住院费用的研究

为探讨肝恶性肿瘤患者住院总费用情况,对广西2010年～2012年间肝恶性肿瘤患者的住院费用资料进行统计学分析,比较肝恶性肿瘤患者3年住院总费用的变化情况,并采用多重线性回归分析方法,分析肝恶性肿瘤患者住院总费用的影响因素.结果显示广西肝恶性肿瘤住院患者逐年增多,住院费用逐年增高;住院天数、有无手术、有无合并症、有无院内感染、性别、年龄6个因素是住院总费用的影响因素.我们应加大预防控制肝恶性肿瘤的力度,建立单病种诊疗规范和费用控制标准,推进临床路径管理,以减轻患者的经济负担.     

走出慢性乙型、丙型病毒性肝炎诊断的误区

我国病毒性肝炎是一个非常重要的肝病,病毒性肝炎的诊断不仅依靠临床表现,肝功能指标的改变,也依赖于病毒标志物的检测。病毒血清学检查是确定诊断的唯一标准。乙、丙、丁型病毒性肝炎的血清标志物项目繁多,临床意义相差较大,正确理解能为诊断提供很大帮助。     

走出慢性乙型、丙型病毒性肝炎诊断的误区

我国病毒性肝炎是一个非常重要的肝病,病毒性肝炎的诊断不仅依靠临床表现,肝功能指标的改变,也依赖于病毒标志物的检测.病毒血清学检查是确定诊断的唯一标准.乙、丙、丁型病毒性肝炎的血清标志物项目繁多,临床意义相差较大,正确理解能为诊断提供很大帮助.     

导言:中国儿童癫痫诊治现状与专家共识

癫痫是神经系统常见疾病之一，是一种致残率高、病程长和临床反复发作为特点，严重威胁患者身心健康的疾病。国外不同地区发病率约24～114／10万／年，患病率为4‰～8‰.左启华等对全国六省二市85170名0岁～14岁儿童的流行病学调查显示，儿童癫痫（不含热性惊厥）的发病率为151／10万／年，患病率为3．45‰。我国2000年人群调查显示癫痫患病率7‰。癫痫的起病与年龄有密切关系，临床上许多癫痫综合征呈年龄依赖性特征。     

南京市某三甲医院人工全髋关节置换术住院费用分析

了解该院人工全髋关节置换术开展情况,明确其住院费用的结构和影响住院费用的主要因素,为合理控制住院费用提供参考依据。本研究收集2012年~2013年人工全髋关节置换术患者的住院病历信息,分析住院费用的变化趋势和结构比例,并分析其主要影响因素。结果显示该院住院费用总体呈上升趋势,且结构不尽合理,人工假体的使用是影响住院费用的主要因素。应该控制人工假体价格虚高,合理使用不同类型的人工假体,积极探索按病种付费模式,从而控制住院费用增长。     

The ethics of the pharmaceutical industry and the need for a dual market system

In an era of increasing medical costs and cries for health care reform in the United States, the pharmaceutical industry has come under intense scrutiny. Ethical issues are inherent in the pharmaceutical marketplace, and there is a need to address the moral rights and responsibilities of drug manufacturers consumers, health care professionals, and governmental agents in the production, distribution, regulation, and use of these products. A dual market system protecting individual rights to access and autonomy without placing an undue strain on societal resources would provide an adequate and equitable framework for an ethical pharmaceutical industry.     

Shooting the Messenger: The Case of ADHD

Medicating ADHD is a controversial subject that was acutely inflamed in 1995 when high rates of ADHD diagnosis and treatment were documented in southeastern Virginia. Psychologists in southeastern Virginia formed a regional school health coalition to implement and evaluate interventions to address the problem. Other professionals with strong ties to the pharmaceutical industry launched ad hominem attacks on the coalition’s research and work. These attacks contributed to the work being terminated in 2005. In the ensuing years, ADHD drug treatment continued to escalate. Today, the national rate of ADHD diagnosis exceeds all reasonable estimates of the disorder’s true prevalence, with 14 % of American children being diagnosed before reaching young adulthood. Notable key opinion leaders continue to claim that there is no cause for concern, but with a message shift from “the prevalence is not too high” to “high prevalence is not too concerning.” This paper provides an object lesson about how innovative research can be derailed to the detriment of sound medical and mental health care of children when industry interests are threatened. Tenure may be the only option for protecting innovative research from specious attacks. The authors offer a summary of the data on ADHD drug treatments, suggest judicious use of such treatments, and add their voices to others who are once again sounding a cautionary alarm.     

The Role Of Attributions and Perceived Control In Recovery From Rape

Abstract

It is fitting that a volume on post-traumatic stress includes chapters on sexual assault given both the prevalence of sexual assault and its effects. Specifically, in terms of prevalence, approximately one woman in five in the United States will be raped in her lifetime (Koss, 1993).¹ In terms of the effects of sexual assault, victims experience heightened fear, anxiety, and depression for several months, and sometimes years, following an assault (see Frazier & Borgida, 1997, and Resick, 1993, for reviews). Sexual victimization affects physical health as well and is a more powerful predictor of physician visits and outpatient medical costs than other factors (e.g., age, smoking, alcohol use) known to be related to health problems (Koss, Koss, & Woodruff, 1991). Finally, sexual assault is one of the traumatic events that is most likely to lead to posttraumatic stress disorder (PTSD) (Breslau, Davis, Andreski, & Peterson, 1991; Norris, 1992; Ullman & Siegel, 1994). In a recent national study of trauma exposure and PTSD by Kessler and his colleagues (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), almost half of the women who said that a rape was their worst trauma met lifetime criteria for PTSD. This is in comparison, for example, with a PTSD prevalence rate of 5% for those whose worst event was a natural disaster.     

Medicine and pharmacy — facts and myths about the development of an innovative pharmaceutical industry in Poland

Innovation is fundamental to the pharmaceutical industry and a key to improvements in healthcare. Its effectiveness depends on huge, constant investments in research. This innovative industry directly affects the course of studies in healthcare and medicine. Its efforts translate directly into the length and quality of our lives. For several years now, the progress underway in pharmaceutical industry has produced measurable benefits. Doctors have new pharmaceuticals at their disposal, including many types of antibiotics and anti-viral drugs, vaccines and a wide range of drugs which save lives or make them more comfortable. In the near future, ever more efficient cures for neoplastic, rheumatic, neurological, psychic, metabolic, circulatory or respiratory diseases can be expected. Innovation is necessary. The human population is ageing, and the task of an innovative pharmaceutical industry is to keep it in a good condition. The use of innovative drugs can translate directly into lowering the costs of illness. A continuous reduction in spending on healthcare has been observed. The costs of inventing an innovative drug are enormous though (US$ 800 million), and studies on a new drug last between 10 and 13 years. An essential element in recovering the incurred costs and ensuring funds needed for new research is protection by patent. Innovative pharmaceutical companies in Poland are committed to increasing the competitiveness and sustaining the development of not only the market, but also the entire pharmaceutical sector. It is a group of companies of crucial importance to the Polish healthcare system, as it influences improvement in the quality of medical services. Through their investments and spending on research and development, innovative companies accelerate economic growth. In Poland, the innovative pharmaceutical industry is represented by the Association of Pharmaceutical Companies Representatives in Poland (SPFFwP). An earlier version of this paper was presented at an international conference, “The Ethics of Intellectual Property Rights and Patents,” held in Warsaw, Poland on 23–24 April, 2004.     

2010~2020中国内地小学生心理健康问题检出率的元分析

我国小学生心理健康问题的检出率莫衷一是, 为整合调查结果并分析其原因, 对2010~2020年来检索到的相关研究进行了元分析。结果显示：(1)小学生心理健康问题的检出率由高到低依次是睡眠问题(25.2%, 95% CI = [0.16, 0.37])、抑郁(14.6%, 95% CI = [0.12, 0.18])、焦虑(12.3%, 95% CI = [0.06, 0.23])、攻击行为(4.1%, 95% CI = [0.02, 0.10])、退缩(3.8%, 95% CI = [0.02, 0.06])、违纪行为(3.7%, 95% CI = [0.02, 0.07])、躯体化(3.6%, 95% CI = [0.02, 0.07])。(2)测量工具、检出标准、检出时间是导致小学生心理健康问题检出率不一致的关键因素。总体而言, 我国小学生除了睡眠问题、抑郁和焦虑检出率偏高外, 整体心理健康状况尚可。未来应开发适合中国小学生的心理健康状况测评工具及检出标准, 为心理健康问题的预防和精准干预提供支持。     

Counting the stitches that count: Preventive intervention promises and public health

Continued public support for the design, implementation, and dissemination of preventive interventions depends on achievement of four major criteria: (a) Reductions in the incidence or prevalence rates of diagnosable emotional and behavioral disorders, (b) reductions in the need for mental health services through effective primary and secondary interventions, (c) enhancement of the effectiveness of obtained services as screening and early detection efforts are implemented, and (d) reductions in the nation's health care costs associated with emotional and behavioral dysfunctions. Strategies including risk reduction, risk avoidance, health promotion, empowerment, and resource development are preventive insofar as they contribute to achievement of the aforementioned outcomes.     

Health Care Expenditure and Economic Growth in SAARC Countries (1995–2012): A Panel Causality Analysis

The aim of this paper is to investigate the relationship between health care expenditure (HCE) and economic growth and to the causality between HCE and economic growth in the selected South Asian Association for Regional Cooperation (SAARC) countries by employing the Panel cointegration and panel causality analysis over the period 1995–2012. Per capita income, labor force, literacy rate, and elderly population of age 65 and above are used an independent variables, as these variables are considered as main indicator of human and physical capital. For examining the time series properties of the data and long run relationships between HCE and economic growth, the panel unit root and panel cointegration tests are employed. The panel Dynamic Ordinary Least Squares (DOLS) method is used to estimate long run parameters, whereas the Seemingly Unrelated Regression (SUR) method is employed to estimate the short run parameters. For the panel causality among HCE and per capita GDP, a new technique developed by Dumitrescu and Hurlin (2012) is used. The results reveal that income elasticity of HCE is less than unity in the long run as well as in the short run. Furthermore, there is an evidence of unidirectional causality running from per capita GDP to HCE in the South Asian countries in the short run. Two-way causation between per capita GDP, labor force, literacy rate, and elderly population of age 65 and above is also observed. We also found two-way causality between labor force, elderly population of age 65 and health care expenditure.     

拉丁美洲国家医疗保障制度探析

拉丁美洲国家的经济发展水平较高,公共健康开支和私人健康开支也比较高,医疗保障制度覆盖面较大,财政的健康开支公平性较高。但是国别之间,健康开支水平与经济发展水平之间以及健康开支水平与财政负担的公平性之间缺乏紧密的联系。这说明,社会医疗保险制度模式、收入差距等因素制约了医疗保障制度的作用的发挥和财政负担公平性的实现。