Analysis of Family Clustering of Inpatient Service Utilization in Rural Areas of Hubei Province / 中国医院管理

Objective To analyze family clustering of inpatient service utilization in rural areas of Hubei Province.Method Inpatient service information of all families in rural areas of sample counties was obtained on the basis of New Cooperative Medical System (NCMS) inpatient database;Lorentz curve was drawn by area graph and scatter diagram of Excel 2010,so was Gini coefficient;descriptive statistic,variance analysis and so on were carried by IBM SPSS Statistic 20.0.Result 3％ family takes up 19％ inpatient service,and rural family's Gini coefficient of inpatient service utilization is 0.366;high inpatient service utilization family(HIUF) uses less outpatient service(29.2±26.9) than middle inpatient service utilization family (31.7±23.5).Inpatient member of HIUF used more inpatient service than other families,except the low inpatient service utilization member(NHH9.2＞NMH4,NHM2.4＞NMM2.2＞NLM1.7);HIUF use least time to reach county hospital(tH44.3＜tM44.9＜tL45.2),have more inpatient members than others (NM＞4.5＞NH4.4＞NL3.9).Conclusion Great family clustering of inpatient service utilization exists in rural area,and irrationality exists in some way;more outpatient service utilization may reduce inpatient service utilization.

The Influencing Factors of Inpatient Care Utilization among the Elderly in China Based on SEM / 中国卫生统计

Objective To examine the utilization and cost of inpatient care and their influencing factors among the eld-erly in China from the view of social-ecology and to estimate the conditional and the unconditional cost,so as to provide refer-ence for allocating health resource efficiently among the elderly. Methods We build a social-ecological model( SEM) of the in-patient services utilization to estimate personal,familial and community circumstance factors of inpatient service utilizing a two-part model. Using joint modeling of likelihood and cost of inpatient care to estimate the parameter and predict the conditional and unconditional cost of inpatient. Data were extracted from Chinese longitudinal healthy longevity survey ( CLHLS) in 2011 on 8483 men more than 60 years old. Results The average cost of the elderly,24. 6% of whom actually utilize the services,is￥8082. 8. There are many reasons account for the utilization of inpatient care. In micro system,it was found that the elderly with chronic condition,having bad self-reported health and worse sleep quality have higher proportion of utilization and more cost of inpatient services. In mezzo system,the married men are more likely use inpatient services and spend more money curing disease than other groups. In macro system,the man who reside in the city or own more than one kind of social security have higher pro-portion and cost of inpatient care utilization. The predicted conditional and unconditional cost of inpatient service is ￥8397. 32,￥2478. 92,respectively. The male are higher than the female,theurban are higher than others. The elderly from 80 to 89 years old have the most expense in conditional predicted cost and 70~79 years old have most expense in unconditional predicted cost. Conclusion Social-ecological factors influence the behaviors of inpatient care utilization. Having chronic disease,self-reported health,sleep quality,marital status,residence and social security levels from different aspects are the primary factors which influ-ence proportion and expenditure of inpatient service utilization. The elderly with different characteristics have different conditional costs and unconditional costs,we should allocate health resources efficiently to promote the equity in health care utilization.

The Influencing Factors of Inpatient Care Utilization among the Elderly in China Based on SEM / 中国卫生统计

Objective To examine the utilization and cost of inpatient care and their influencing factors among the eld-erly in China from the view of social-ecology and to estimate the conditional and the unconditional cost,so as to provide refer-ence for allocating health resource efficiently among the elderly. Methods We build a social-ecological model( SEM) of the in-patient services utilization to estimate personal,familial and community circumstance factors of inpatient service utilizing a two-part model. Using joint modeling of likelihood and cost of inpatient care to estimate the parameter and predict the conditional and unconditional cost of inpatient. Data were extracted from Chinese longitudinal healthy longevity survey ( CLHLS) in 2011 on 8483 men more than 60 years old. Results The average cost of the elderly,24. 6% of whom actually utilize the services,is￥8082. 8. There are many reasons account for the utilization of inpatient care. In micro system,it was found that the elderly with chronic condition,having bad self-reported health and worse sleep quality have higher proportion of utilization and more cost of inpatient services. In mezzo system,the married men are more likely use inpatient services and spend more money curing disease than other groups. In macro system,the man who reside in the city or own more than one kind of social security have higher pro-portion and cost of inpatient care utilization. The predicted conditional and unconditional cost of inpatient service is ￥8397. 32,￥2478. 92,respectively. The male are higher than the female,theurban are higher than others. The elderly from 80 to 89 years old have the most expense in conditional predicted cost and 70~79 years old have most expense in unconditional predicted cost. Conclusion Social-ecological factors influence the behaviors of inpatient care utilization. Having chronic disease,self-reported health,sleep quality,marital status,residence and social security levels from different aspects are the primary factors which influ-ence proportion and expenditure of inpatient service utilization. The elderly with different characteristics have different conditional costs and unconditional costs,we should allocate health resources efficiently to promote the equity in health care utilization.

The Introduction Of Subsidised Health Insurance For The Poor In The City Of Padang, Indonesia: Does The Gap On Health Payment And Health Service Utilisation Still Exist?

Indonesian government secures the access of the poor towards health services through subsidised schemes. This study is aimed to describe the pattern of health expenditure by households and to describe the pattern of health service utilisation across household’s socioeconomic level in the city of Padang after seven years of the introduction of subsidised schemes. A household survey was conducted involving 918 households, with multistage random sampling method. The proportion of out-of-pocket (OOP) health spending as a share of household’s capacity to pay was regressive across consumption quintiles. The proportion of households with catastrophic health expenditure was 1.6% while 1.1% faced impoverished health expenses. Among those who need health care, the utilisation among the rich was higher than the poor. Health insurance schemes in Padang provides financial protection, however with regards to household’s capacity to pay, the poor has the higher burden of health payment. The gap on health service utilisation between the poor and the better-offs was still apparent for outpatient services and it has been narrowed for inpatient care. This study suggests that the subsidised schemes for the poor are highly needed and the possibility of the leakage of subsidies to the rich should be considered by the government.

Analysis of characteristic excessive demand for elderly inpatient service and causes covered by NRCMS / 中华医院管理杂志

Objective Understanding the current elderly people’s excessive demand for inpatient services under NRCMS,summarizing characteristics and analyzing causes so to provide inspiration and support for the rational use of health services in rural areas.Methods 1 665 medical records of seniors were randomly selected from medical institutions of county and township levels in 2012.Based on such data,135 household surveys were made,comparing the reasonableness of their hospitalization.Results The unreasonable rate at county level is 14.29%,and 30.10% at township hospitals;The unreasonable rate of internal medicine,surgery and other sections at county level hospital are 1 7.65%、10.38%、9.49%,the unreasonable hospitalization rate of internal medicine,surgery and other sections at township hospitals are 31.98%, 1 9.77%,and 45.83% respectively;The unreasonable hospitalization rate of circulatory system,skeletal muscle type,injury and poison at county level hospital are 20.55%、24.00%、4.76%,the unreasonable rate of the circulatory system,skeletal muscle type,injury and poison at township hospitals are 35.69%,44.74%and 10.91%respectively.Elderly people’s excessive demand for inpatient services varies with their living condition,physical condition,the NCMS compensation policy and other factors.Conclusion To reduce the excessive demand,we put forward effective control measures from the service system,security system and social support,so as to effectively meet reasonable hospitalization demands in rural areas and social problems so incurred.

The Impact of Hospital Distance on the Chinese Inpatient Service Demand in Rural Areas：The Application of Discrete ;Choice Model / 中国卫生经济

It is always an important academic and policy issue to understand the impact of hospital distance on Chinese inpatient service demand in rural areas. It employs household survey data collected from 97 villages in Shandong in 2006 and 2008, and investigates the influences of hospital distance on the demand of famars in rural areas. The discrete choice model is constructed to estimate the inpatient service demand function for patients in rural areas. The empirical analysis finds that the hospital distance is significantly affecting Chinese inpatient service demand in the rural areas. The longer the distance increases, the lower the visiting rate drops. In addition, the impact changes with the changes of hospital level; the lower the primary hospital is, the higher the impact would be. It paper provides new evidence for the understanding of the geographical characteristics of medical health care.

Estratégia para a implementação de um serviço de tratamento da dor no hospital das clínicas da universidade federal de Goiás / Strategy to implement a pain management service in the clinicas hospital, federal university of Goiás.

JUSTIFICATIVA E OBJETIVOS: Apesar do sintoma dor ser considerado o 5º sinal vital e seu controle influenciar positivamente na boa evolução dos pacientes, o Hospital das Clínicas da Universidade Federal de Goiás não dispõe de um serviço de tratamento das síndromes álgicas. O objetivo deste estudo foi por meio de um projeto piloto estruturar o Serviço de Dor neste hospital, por meio de palestras educativas, bem como orientar os médicos residentes no diagnóstico e tratamento das síndromes álgicas.MÉTODO: O projeto se desenvolveu em três etapas: educação, avaliação dos pacientes selecionados e análise dos dados. Foram realizadas cinco aulas para os médicos residentes e antes do início da aula eles responderam um questionário confidencial sobre conhecimentos básicos, avaliação e tratamento da dor. Na segunda etapa, uma equipe de dois médicos residentes de Anestesiologia e dois anestesiologistas com formação complementar em dor foi estruturada para atender e orientar o tratamento do paciente com dor. Na terceira etapa foram analisadas as fichas e os resultados foram estratificados e analisados, sendo os resultados apresentados em percentuais. RESULTADOS: Apenas 37% dos residentes referiram possuir algum estágio ou formação em terapêutica da dor, 68,9% referiram que usavam rotineiramente algum método de avaliação da dor e apenas 3,4% deles não conheciam a escala analógica visual, sendo que a dor como 5º sinal pela ainda não é rotina e, respectivamente, 70% e 81% dos médicos prescrevem rotineiramente opioides e anti-inflamatórios não esteroides (AINES) de horário. Todos concordaram que o tratamento da dor é fundamental para a boa evolução dos pacientes.CONCLUSÃO: O projeto mostrou a necessidade de educação sobre a fisiopatologia e terapêutica da dor e da estruturação do Serviço de Dor no Hospital das Clínicas da Universidade Federal de Goiás

BACKGROUND AND OBJECTIVES: Although pain being considered the fifth vital sign and controlling it influences positive evolution of patients, Clinicas Hospital, Federal University of Goiás does not have a service to manage painful syndromes. This study aimed at structuring a Pain Service in this hospital through a pilot project, educational presentations as well as at orienting resident physicians on how to diagnose and manage painful syndromes.METHOD: The project was developed in three stages: education, evaluation of selected patients and data analysis. Five classes were ministered to resident physicians and before beginning of the class they have answered a confidential questionnaire about basic pain knowledge, evaluation and management. In the second stage, a team of two Anesthesiology resident physicians and two anesthesiologists with additional qualification in pain was structured to assist and orient the treatment of painful patients. In the third stage records were analyzed, results were stratified and analyzed and results were presented in percentages. RESULTS: Only 37% of residents have referred some training or qualification in pain therapy, 68.9% have referred routine use of some pain evaluation method and only 3.4% of them were not familiar with the visual analog scale. Pain as the fifth vital sign is still not routine and, respectively, 70% and 81% of physicians routinely prescribe opioids and time non steroid anti-inflammatory drugs (NSAIDS). All agreed that pain management is paramount for the positive evolution of patients.CONCLUSION: The project has unveiled the need for education on pain pathophysiology and therapy and for the structuring of the Pain Service in the Clinicas Hospital, Federal University of Goiás