scholarly journals 中國農村貧困地區衛生保健問題及對策

1999 ◽  
Vol 2 (1) ◽  
pp. 139-152
Author(s):  
Wujing LUO
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Medical Care ◽  
Rural Areas ◽  
Financial Support ◽  
Annual Income ◽  
Health Care Insurance ◽  
Per Capita ◽  
Chinese Yuan ◽  
Basic Medical

LANGUAGE NOTE | Document text in Chinese; abstract also in English.中國農村貧困地區衛生保健面臨籌資與組織等方面的問題，尤其是貧困地區經濟發展滯後，嚴重影響了衛生保健需求的購買力，因而形成了因病致貧和因貧致病的惡性循環，嚴重阻礙着生產力的發展。儘管貧困地區的政府對衛生保健的投資力度不大，但衛生資源的利用極不充分，表現為人力過剩，業務量不足，設備閑置。調查中發現，貧困地區農民在煙酒、求神拜佛、請客送禮等方面的開支甚大，故仍存在保健籌資的潛力。在保健制度方面，合作醫療比例不大，婦幼保償制和免疫保償制覆蓋面低，病人流向在不同保健制度之間差別較大。調查中發現，經濟與保健有着雙向互制作用。衛生保健應與經濟發展同步。政府應承擔發展保健事業的主要責任，加大對保健的投入，引導農民調整消費結構，改善籌資環境，普及健康教育，同時採取分步到位的辦法，逐步建立合作性質的保健制度，並建立相應的法規。Approximately sixty million Chinese people live in China's poverty-stricken rural areas (annual income per capita is lower than 400 Chinese yuan, or US $50). Most people in these areas do not have any level of health insurance. About 72.6% of the individuals who need to visit physicians are not unable to do so because of financial difficulties. The death rate of newborns is as high as 10%. Many households are caught up in a vicious circle: they contract disease because of poverty, and they become poor because of disease.It is vitally important to establish a basic level of health care insurance for these people. According to our investigation and calculation, it requires about 18 hundred million Chinese yuan per year in total (based on medical prices in 1993) to provide a minimum amount of health care for these people, including four prenatal care visits and delivery service, vaccine shots for children (thirteen times total for every child before the age of 13), and basic medical care (including three clinic visits and half a day hospitalization per capita per year). In our investigation, most people in these areas support such a plan for basic health care insurance and express their willingness to pay part of premium.Currently, the average health care spending per capita per year in these areas is 17.40 yuan, or 3.75% of the annual income per capita. Accordingly, there should be no serious difficulty for everyone to pay 2.50% of their annual income for health insurance, except for those whose annual income is lower than 200 yuan. In addition, our investigation found that about 28% of the average household expenditures in these areas are spent for tobacco and liquor. Individuals can be encouraged to save this type of spending for their medical care. Currently, from individual premiums (2.50% of annual income), particular funds from villages and towns, and special government financial subsidies, the total amount of funding can reach about 10 hundred million yuan yearly. In order to obtain 18 hundred million yuan as required, about 8 hundred million yuan a year needs to be raised.China used to attempt to provide basic medical care for people by way of providing financial support to health care providers, i.e., hospitals and clinics, so that they could offer cheap medical care for patients. This has not turned out to be a good strategy. The government should, instead, directly provide financial support to health care recipients, especially those living in poverty-stricken rural areas, so that they will financially be able to set up basic health care insurance for themselves. In contemporary times, it is vitally important to help them establish a basic amount of health care insurance.DOWNLOAD HISTORY | This article has been downloaded 14 times in Digital Commons before migrating into this platform.

Payment for medical care based on per capita standards: organization and accounting

2020 ◽  
pp. 7-15
Author(s):  
Elena Nikolaevna Dombrovskaya
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Medical Care ◽  
Russian Federation ◽  
Financial Support ◽  
Primary Health ◽  
Organizational Mechanism ◽  
Medical Institutions ◽  
The Russian Federation ◽  
Per Capita

The article is devoted to the features of the organization and accounting of payment for medical care provided by medical institutions. The article highlights the trends in reforming the system of payment for medical care, which include the use of per capita payment based on the principles of Fund maintenance. The review of the current regulatory framework in the field of financial support of medical care was conducted. Based on the analysis of models of per capita financing of primary health care in the subjects of the Russian Federation, their insufficient focus on achieving final results is noted. The article deals with the organizational mechanism and accounting mechanism of payment for medical care in health care institutions.

scholarly journals Financing of Medical Care in Russia: Sources and Problems of Their Evaluation

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Tatyana Faiberg ◽  
Irina Scherbakova
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Medical Care ◽  
Financial Support ◽  
Health Care Expenditures ◽  
Healthcare Sector ◽  
Medical Services ◽  
Effective Mechanism ◽  
The Russian Federation ◽  
Financing Health Care

To form an effective mechanism for financial support of health care in Russia, it is necessary to introduce into scientific and practical activities clearly-defined concepts that characterize medical services and sources of their financing. The analysis of the definitions such as «medical care» and «medical services» described in this article showed a lack of orderliness in basic terminology, as well as the possibility of replacing these concepts in practice. The article discusses the types of medical services in relation to the Program of state guarantees for providing citizens with free medical care. The sources of financial support for medical services in Russia are systematized and their features are highlighted. The research of the problems of financing health-care expenditures from various sources made it possible to suggest the main criteria for sharing these expenditures among the budgets of the budget system of the Russian Federation. The volume of budget financing of healthcare in Russia, compulsory and voluntary health insurance, and paid services in the healthcare sector are evaluated in the article, and also, the problems of estimating the volume of medical care in total from all sources, including the income of private medical organizations are identified.

Racial disparities and medical care accessibility in cancer statistics.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18510-e18510
Author(s):  
Noha Soror ◽  
Amany Keruakous
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Cancer Diagnosis ◽  
Health Care Disparities ◽  
Financial Burden ◽  
P Value ◽  
Annual Income ◽  
History Of ◽  
Prevalence Of Cancer ◽  
History Of Cancer

e18510 Background: Cancer is one of the leading causes of death worldwide. It continues to be the second leading cause of death in the United States despite all national efforts aiming to reduce cancer burden and mortality. Delays in medical care and subsequently age-appropriate screening leads to increased cancer burden which reflect on the overall prognosis. Medical care accessibility has been a challenge that is reported by approximately one third of the USA adult population. We aimed to identify health care disparities and its correlation with prevalence of cancer as well as delays in medical care due to financial challenges among Texas residents. Methods: We analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) 2017. We measured specific health care disparities including patient’s gender, age, race/ethnicity, body mass index (BMI), annual income, alcohol consumption, history of cancer, and delays in medical care due to financial burden, among respondents to the 2017 BRFSS survey from Texas. We computed the difference between our comparison groups using chi-square test for categorical variables and t-test for continuous variables. Results: We analyzed the differences in health care disparities among respondents with and without history of cancer. We report results from 11,165 adult respondents who reside in Texas, among which nine percent were diagnosed with cancer. We noticed a higher proportion of females than males among participants with a history of cancer (64% females p < 0.0001). Age did differ between both groups, with the majority of participants with cancer are aged 50 years and older. Interestingly, BMI did not differ between both groups (p-value = 0.6930). Although annual income did not differ between both groups, twelve percent of participants with cancer diagnosis suffered from delays in medical care due to financial burden. Racial disparities were statistically different between participants with or without cancer (p < .0001). Seventy seven percent of patients with cancer diagnosis were White and non-Hispanic with a cancer prevalence rate of 12% in that racial group. On a stratified analysis to compute the relationship between delayed medical care due to financial burden and cancer diagnosis among all ethnic groups, it was not statistically different (p-value = 0.1063). We showed that prevalence of cancer among multiracial participants and other racial minorities was higher in the group of participants who reported delays in medical care due to financial burden (11% versus 7%). Conclusions: Racial and ethnic disparities could affect accessibility to medical services. Race is a significant variable that is associated with cancer, with higher prevalence of cancer in White and non-Hispanic. Delayed medical care due to financial burden is more pronounced in multiracial population and racial minorities and should be targeted in future quality improvement projects.

Health Care Financing for the Child With Catastrophic Costs

PEDIATRICS ◽  
1987 ◽  
Vol 80 (5) ◽  
pp. 752-757
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Medical Care ◽  
Insurance Coverage ◽  
Chronically Ill ◽  
Medical Needs ◽  
Structural Problems ◽  
Medical Care Costs ◽  
Private And Public ◽  
Care Costs

PURPOSE Historically, health insurance has not treated children fairly. Insured services have been oriented to the medical needs of adults, with children's unique needs given poor coverage or, in the instance or preventive care, rare coverage. These biases inherent in private and public health insurance also manifest themselves in the coverage of catastrophic care for children. The objectives of the following recommendations are to rectify some of the structural problems of health insurance that are faced by children, to ensure access to all needed health care services for all children, and to protect families from overwhelming out-of-pocket medical care costs. PRINCIPLES To address the needs of children through 21 years of age with illnesses that lead to catastrophic costs, all insurance plans must (1) be available to all children (and pregnant women) without regard to race, religion, national origin, economic status, health or functional status, or existing health insurance coverage; (2) include participation of both private and public sectors; (3) support the development of comprehensive, community-based systems of personal health care for the chronically ill child; (4) cover a broad array of child-specific health services; (5) contain costs through managed care and other means; and (6) require some financing from the child's family in proportion to their ability to pay. DEFINITION OF CATASTROPHIC NEED The American Academy of Pediatrics (AAP) defines catastrophic need by relative economic distress. Generally, a child whose family's out-of-pocket medical care costs reach a maximum of 10% of their annual adjusted gross income as reported to the Internal Revenue Services is one who, regardless of health status, income level, or existing insurance coverage, is in need of financial support for further medical expenses.

Model of interaction between medical organizations based on the principles of Fund management – a way to improve the efficiency of primary health care

2020 ◽  
pp. 3-11
Author(s):  
R. A. Halfin ◽  
◽  
M. V. Avksentieva ◽  
D. N. Muravyov ◽  
S. A. Orlov ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Insurance ◽  
Business Processes ◽  
Practical Implementation ◽  
Fund Management ◽  
Primary Health ◽  
Partial Filling ◽  
Compulsory Health Insurance ◽  
Per Capita

The article analyzes the experience of per capita financing of primary health care based on the principles of stock provision in the system of compulsory health insurance (MHI). The article shows the features of practical implementation of Fund-forming models of per capita financing, their impact on the final results of the activities of medical organizations of Fund-holders. A unified scheme of interaction between the MHI participants (medical organizations, insurance medical organizations, territorial MHI Fund) (medical and economic model of business processes) is proposed for the implementation per capita financing of primary health care, with provision of decoding with partial filling of the Fund for the implementation of a patient-oriented model of medical care.

scholarly journals Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Chaofan Li ◽  
Chengxiang Tang ◽  
Haipeng Wang
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Utilization ◽  
Concentration Index ◽  
Care Utilization ◽  
Control Group ◽  
Positive Effects ◽  
Basic Medical Insurance ◽  
Outpatient Visits ◽  
Basic Medical

Abstract Background The fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China. Methods The data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization. Results The integration had no significant effects on probability of outpatient visits (β = 0.01, P > 0.05), inpatient visits (β = 0.01, P > 0.05), and unmet hospitalization needs (β =0.01, P > 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P < 0.05) and inpatient visits (β = 0.39, P < 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P < 0.05) and inpatient visits (β = 0.49, P < 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P < 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P > 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011. Conclusions The findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.

The provision of basic medical care Health microplanning: a systems approach to appropriate technology

1977 ◽  
Vol 199 (1134) ◽  
pp. 61-68
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Delivery System ◽  
Health Care Delivery ◽  
Systems Approach ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Appropriate Technology ◽  
Care Health ◽  
Basic Medical

A method of detailed technological planning is described in which a subsystem of the total health care delivery system is identified, and the components within it created and integrated with one another. The components produced are termed a microplan, since they concern planning for technical detail. A project for microplanning in Indonesia is discussed, and some of the promising features of the new method described.

scholarly journals IMPACT OF RESOURCE MANAGEMENT QUALITY ON ACCESS TO HEALTH CARE

2020 ◽  
Vol 15 (3) ◽  
pp. 88-93
Author(s):  
Sergey Budarin ◽  
Yuliya El'bek
Keyword(s):  
Health Care ◽  
Resource Management ◽  
Health System ◽  
Medical Care ◽  
Rural Areas ◽  
Financial Management ◽  
Access To Health Care ◽  
Importance Value ◽  
Management Quality

The potential for improving the efficiency of medical organizations that provide medical care to the population in conditions of limited resources largely depends on an objective and comprehensive assessment of their use. In this regard, the research of methodological and practical approaches to assessing the efficiency and rational use of resource potential, which are important for different levels of the organization of the health system, including the provision of medical care to citizens living in rural areas, is of particular relevance. The purpose of the study was to determine the relationship between indicators for assessing the quality of resource management and indicators of access to medical care of medical organizations of the state health system in Moscow that provide primary health care to adults in 2019. The quality of resource management was assessed using 27 indicators selected for the purpose of the study in 4 areas of resource management (financial management, procurement management, property management, personnel management), provided by the methodology of the resource management quality standard (RMQS). For each indicator, the calculated score based on the importance value (weight value) a normative criterion of evaluation and the degree of difficulty, and by summing up of scores obtained a composite score. The assessment of the availability of medical care is also calculated using the method of point estimates based on 7 indicators developed through the use of the methodology of performance audit. The article presents the results of a study based on data from 9 Moscow city polyclinics, which confirmed the existence of a correlation between the selected indicators of the quality of resource management and the availability of medical care. The total score for 2019 for the selected indicators of resource management quality varies from 9.62 points to 13.92 points, availability-from 5.54 to 11.63 points, and the correlation coefficient was 0.612

scholarly journals Development of voluntary medical insurance in the Russian Federation

2019 ◽  
Vol 100 (5) ◽  
pp. 796-801
Author(s):  
E V Arsentyev
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Medical Care ◽  
Russian Federation ◽  
Medical Insurance ◽  
Insurance Policy ◽  
Labor Migrants ◽  
Voluntary Health Insurance ◽  
Legislative Framework ◽  
The Russian Federation

Aim. To analyze the dynamics of the development of voluntary medical insurance in the Russian Federation. To identify the factors hindering the development of this insurance sector in modern conditions. Methods. In the course of the study, analysis was conducted of the legislative framework for organizing medical care for the population of the Russian Federation in the system of voluntary medical insurance. The problem-chronological, systematic, and analytical research methods were used. Results. It has been established that, despite the development of voluntary medical insurance system over the past 25 years, the availability of this type of insurance for citizens of the Russian Federation still remains very low. The policy of voluntary medical insurance is mainly available only to working citizens, and only in those large enterprises where the employer is interested in preserving and protecting the health of its employees. For most citizens of the Russian Federation, the voluntary health insurance policy remains inaccessible due to the high cost of the policy, as well as due to relatively low incomes. At the same time, a voluntary health insurance policy is required by law for labor migrants to obtain a patent for employment in the Russian Federation. However due to the absence of legislative framework for voluntary health insurance, organization of medical care for labor migrants is not always standardized. Conclusion. For the further development of voluntary medical insurance, it is necessary to develop the measures for decreasing the cost and increasing the availability of a voluntary medical insurance policy for citizens of the Russian Federation; to optimize organization of health care for labor migrants it is necessary to primarily develop regulatory framework of emergency health care.

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