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OBJECTIVE To provide reference for the access to medical insurance for rare diseases in China based on the existing access pathway and framework by analyzing the access policy of medical insurance for rare diseases in the United Kingdom （UK）. METHODS After collecting relevant guidelines and policy documents related to drug use for rare diseases in the UK， content analysis method was used to analyze the evaluation mechanism of drug use for rare diseases， reimbursement decision- making standards， stakeholder participation， coping strategies for dealing with uncertainties and risks， and policy implementation effects， and extract the key points of medical insurance access for drug use for rare diseases in the UK， to provide some suggestions for the establishment of medical insurance access system for rare diseases in China. RESULTS & CONCLUSIONS From the perspective of access， the UK had adopted a separate approach and clear criteria to assess and reimburse drugs for rare diseases. From the perspective of evaluation mechanism， multi-stakeholders such as doctors， patients and applicants participated in the decision-making process in the UK. The UK addressed uncertainty and risk by gathering better clinical evidence and using the patient access programme. After the implementation of the policy related to drug use for rare diseases， the UK had achieved remarkable results in terms of funding for drug use for rare diseases， the reimbursement rate of drug application， and the number of funded patients. It is suggested that in the process of establishing and improving the evaluation and reimbursement system for rare diseases drugs in China， the availability of rare diseases drugs should be improved by establishing a separate access assessment path for rare diseases drugs and involving more stakeholders.
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The positive interaction between medical treatment system and medical insurance system is of great significance to promote the reform of medical and health care system. Due to the complexity of the relationship between them, it is difficult to explain it comprehensively with a single theoretical method. The authors analyzed the relationship between medical treatment system and medical insurance system by applying system theory, game theory and synergy theory, and then put forward policy suggestions to optimize the linkage reform of medical treatment system and medical insurance system, so as to better promote the reform of " three medical linkage" and promote the construction of healthy China. The suggestions included optimizing the allocation of health resources, accelerating the construction of medical insurance legislation and health technical evaluation system, strengthening the construction of multi-level medical insurance system, promoting the inter regional information interconnection between medical care and medical insurance, improving the coordination mechanism, negotiation mechanism, incentive and constraint mechanism between medical care and medical insurance.
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Starting from the development of palliative treatment in China and the United States, this paper compared the development mode, the medical insurance system, the public acceptance, the system of volunteer service and the way of disease notification between China and the United States, and explored the worthy enlighten-ment to China' s palliative treatment in the comparison of the differences: establishing primary palliative treatment services and treating palliative treatment as an independent subject; introducing palliative treatment relevant laws and regulations and incorporating it into the category of medical insurance; promoting palliative treatment to en-hance the death education;improving the volunteers service system of palliative treatment and establishing volun-teers pre-job training;choosing the way of disease notification according to the patients' psychological enduring capacity;establishing a palliative treatment ward with the combination mode of medicine and recuperation.
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Objective:To evaluate the impact of the establishing universal basic medical insurance system(UMIS) on pharmaceutical industry in China.Methods:Based on the accumulated main business income data of China's pharmaceutical industry from 2002 to 2014,the influence change of UMIS on China's pharmaceutical industry before and after 2008 was analyzed by the segmented regression model.Results:Segmented regression model showed that the slope rate of development trend of main business income of China's pharmaceutical industry was 1.03×107 thousand yuan per quarter(P=0.000) before the implementation of UMIS in 2008.After the implementation of UMIS in 2008,the slope rate of development trend of main business income of China's pharmaceutical industry was 2.75× 107 thousand yuan per quarter (P=0.000) and trend increased 1.72× 107 thousand yuan per quarter(P=0.000).Conclusion:The UMIS had impact on the structure,sales volume of pharmaceutical products and sale costs of China's pharmaceutical industry.UMIS had a significant effect on the increase of China's pharmaceutical industry.
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Objective:To analyze the health service utilization and burden on medical expenses of outpatients with chronic kidney diseases in Wuhan,to understand the security effects of patients with chronic kidney diseases under the basic medical insurance system,put forward suggestions to the development strategies and optimizing suggestions on strengthening the comprehensive management of chronic kidney diseases.Methods:Questionnaires were used to investigate 267 CKD outpatients of 6 first-class hospitals in Wuhan.Expert consultation method was used to interview the kidney doctors.Descriptive analysis method was used to analyze the utilization of health services,disease economic risk,catastrophic expenditure phenomenon and medicare satisfaction.Results:CKD patients had more frequent utilization of outpatient services,average outpatient expenditures of Urban Employer Medical Insurance outpatients were higher than the others,drug expenditures of New Rural Cooperative Medical System(NCMS) patients were significantly higher than the others.Most patients believed that the current medical outpatient policy could not meet the demand.Conclusion:More attention needed to be paid for NCMS,to strengthen prevention education and early management,improve the management of chronic kidney disease outpatient insurance policy.
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Objective:Under the premise of the policy of everybody has medical insurance,it discussed the integration plan of the basic medical insurance system for urban and rural residents in Tibet about the problems and the countermeasures.Methods:Descriptive and contrastive methods were used to analyze the status of urban and rural medical system operation in Tibet.Results:The problem of unbalanced development of urban and rural medical and health services in Tibet and the management of post-merger were put forward.Conclusion:It was necessary to put forward policy recommendations from the aspects of horizontal co-ordination,multi-sectoral collaborative management,unified medical insurance information management system,hierarchical diagnosis and treatment mechanism,perfect Tibetan medicine reimbursement catalog,one system and multiple files and vertical co-ordination,and gradually realize the urban and rural medical insurance in Tibet System integration.
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Objective:To investigate the policy changes of medical insurance for urban and rural residents in Urumqi before and after the integration,so as to provide suggestion for the development of urban and rural medical insurance whole as plan.Methods:The health care financing after integration standards,reimbursement ratio and the changes of management methods were analyzed.Results:The personal financing standard and the starting line for patients who participated New Rural Cooperative Medical Insurance in tertiary hospitals raised after medical insurance,which effected the medical choice of patients participated the medical insurance to a certain extent.The gap between urban and rural areas affected the integration of urban and rural residents health care work.Conclusion:The level of individual pay cost should be consistent with the level of treatment in the design of ginseng protect personnel It needed to increase the government support,payment standard and treatment standard reference or innovation.
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Objective:To comprehensively evaluate the urban and rural residents' basic integrated medical in-surance system,taking Tianjin,Chongqing and Ningxia as case study areas,to provide policy suggestions to relevant government departments. Methods:The evaluation index system for urban and rural residents' basic integrated medi-cal insurance system was constructed and made use of the scatter degree method for the evaluation of the effect of the system. Results:(1) Fairness and policy guarantee are higher relatively,while the medical service and sustainability are still running short for the urban and rural residents' basic integrated medical insurance; (2) Effect of the urban and rural residents' basic integrated medical insurance system of three municipalities is obviously different due to the difference in their respective population size, economic development, etc. Conclusions: Reasonable policy sugges-tions put forward to the pilot cities to improve the urban and rural residents' basic integrated medical insurance sys-tem,such as strengthening the top-level design of policy,increasing fiscal subsidies and improving the mechanism of fund-raising and reimbursement and strengthening the supervision of the medical insurance fund.
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Objective:To study the health equity and explore the influencing factors of health inequities among those insured in New Rural Cooperative Medical System and to provide theoretical and factual basis for improvement of medical insurance system through .Method:Using concentration index decomposition to explore the sources of inequity in health outcomes and the degree of horizontal inequity in health outcomes .Results:Economical level leads that the concentration indexes of two week prevalence favor the poor , i.e.the worse the health outcome of the rich is.Economical level leads that the concentration indexes of chronic disease prevalence and self -reported health defective rate favor the rich , i.e.the worse the health outcome of the poor is .Conclusion:Economic level is the primary factors affecting two weeks prevalence , age, culture level, the employment situation is the factors al-leviate health outcomes unfair .Increase people′s economic level and cultural level , improve the situation of em-ployment is important to the health equity .
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Through viewing the employee medical insurance system, problems were found as below: ( 1) The content of system did not match the name of “urban workers” and “basic medical insurance”. (2) In financing system, some business units and participated people had heavy burden; personal accounts shunt exceed 60% of the total health insurance fund and constituted a reverse subsidy;retirees did not assume the obligation of payment while they could obtain unjust enrichment through the personal accounts of the possible. (3) System inefficient and risky fund cost overruns. (4) Insurance coverage is low within the system. Recommendations: (1) To build a unified national basic medical insurance based on merger residents and new rural cooperative medical insurance. (2) Abolish workers’ medical insurance system, put urban workers into the universal basic medical insurance. ( 3) Introduce “medical expenses surtax”, establish supplementary medical aid fund or direct universal basic medical insurance fund. ( 4) To develop commercial health insurance and build a comprehensive health care system.
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By analyzing the operation characteristic of community cooperative medical system in Guangzhou and the existing problem of basic medical insurance system in China, it provides the important value of exploring the implement of medical insurance system in China. Under the background of the low security level of basic medical insurance system in China is relative low, the disease risk is uncertain, medical needs diversification, medical cost inflation and the aging tendency of population, it is revealed to encourage the cooperative medical treatment of community with economic strength and enterprise development with similar enterprise annuity, as the supplement of the basic medical security system would help to compensate the lack of basic medical insurance system and meet the demand of diversified medical treatment.
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Objective To understand the performance of the basic medical security system in Guangxi for decision-making support on the development planning of the system during the 12th FiveYear Plan in Guangxi.Methods Descriptive statistics were made to analyze the annual report data of Guangxi's basic medical security system during 2009 to 2011,regarding the basic medical security for urban workers and that for urban residents,as well as those of the new rural cooperative medical system.Results The survey found that the three basic medical security systems in Guangxi have almost achieved full coverage; the compensation ratio keeps rising as the inpatient expenses of urban residents was up to 62.21％,64.96％ and 66.96％ respectively from 2009 to 2011,and that for urban residents up to 34.26％,39.96％ and 49.68％ respectively; the ratio for those covered by the new rural cooperative medical system has been maintained at 45％ for the three years; the coverage of the systems keeps expanding.Conclusion Recommend to integrate pilots of the three security systems and carry out serious diseases pilot programs; encourage reform of the payment system at institutions at or above county level; reform the risk-pooling of disease management of at primary medical institutions; strengthen the information systems of basic medical insurance system,in an effort to ensure the sound development of the basic medical insurance system.
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Before 2002, the three existing basic medical security systems of Thailand covered 30% of the population, and the surplus population participated in the universal coverage(UC)policy of medical security system which promulgated in 2002. Since the implement of UC policy, it has improved the equity of medical service application and health financing, reduced Catastrophic Health Payments and low-income groups have obtained more benefits. The incidence rate of Catastrophic Health Payments decreased and the spending burden of catastrophic health expenditure in low-income groups decreased from 6.11%(2000)to 4.65%(2002).
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Objective: To clarify the meaning and definition method of low-income group, summarize the current economic risk of disease for rural low-income group and the risk pooling effect of medical insurance system. Methods: Using literature research method to systematically review the relevant studies of economic risk of disease for low-income group in rural areas. Results: The risk pooling effects of various medical insurance systems are different. Conclusion: On the basis of defining low-income group scientifically, it is necessary to promote the economic risk protection effect of medical security schemes for low-income group in rural area.
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Migrant workers incur the challenges of linkage and compatibility of medical insurance systems for their migration across regions and change of identities. To identify a medical insurance system adaptable to their needs, the paper recommends the following: Take their medical insurance into the national account of medical insurance; build a linkage mechanism between cities and villages, and that between cities as well; make the medical insurance system more compatible and portable, in order to safeguard their right of health.
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For medical insurance systems, medical expense examination is a key measure to keep medical expenses under control. In 1948, Japan established an examination authority of legal person status to operate the medical expense examination. Based on years of modifications and improvement in the organizational system and operation mechanism, the system is running smoothly by now. Authors of this paper made a detailed introduction to the specific operations of such a system, and to China's local features as well. On such basis, the study proposed to build in China a third-party medical expense examination institution as a legal entity, and practice the reexamination system and information disclosure system, in an effort to safeguard legitimate rights of insurance organizations and medical institutions.
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Issues of Chinese medical health reform are analyzed and approached associated with the US federal medical health system. We made the suggestions that establish the public health service system covering both urban and country residents, push on the reform of medical insurance, drug circulation and medical system. We advocate that implement the scientific development view and hold the opportunity, impel the medical health reform in general.
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OBJECTIVE: To provide reference for the implementation of Essential Drug System. METHODS: According to the contents of Essential Drug System and Basic Medical Insurance System in the New Medical Reform, the relationship between Essential Drug System and Basic Medical Insurance was analyzed. RESULTS: Essential Drug System and Basic Medical Insurance System were important aspects of New Medical Reform in China, which complemented each other. Basic Medical Insurance System improved the implementation of Essential Drug System, while Essential Drug System promoted the realization of policy targets of Basic Medical Insurance System. CONCLUSION: Basic Medical Insurance System should play a promotion role in the implementation of Essential Drug System.
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PURPOSE: This study was done to help provide patients with information on medical insurance cost through medical insurance education for nurses, to increase effective management, check on omissions in treatment and appropriateness and accuracy of fees, and to contribute to the economic growth of hospital by providing nurses with necessary knowledge about medical insurance cost. METHOD: The participants in this study were clinical nurses in general hospitals. The study instrument was a questionnaire developed by the researcher through reference to data for medical insurance education. The data were analyzed with percentages, means, ANOVA, and Duncan method using SPSS PC+10. RESULT: The results on knowledge of medical insurance according to general characteristics of the nurses showed that there were significant differences according to age (p=.0036) highest level of education (p=.0007), position (p=.0010) and place where education on medical insurance was received (p=.0093). CONCLUSION: Continuous in-service education for clinical nurses is reflected in increased knowledge about medical insurance costs but special attention needs to be given to younger nurses and nurses with less education, as well as staff nurses, and those nurses who only received education on medical insurance during their schooling. Accordingly, in-service education is necessary for nurses at the time of orientation so that they have knowledge on standards for recuperation allowance, guidelines to calculate material costs, and guidelines to calculate drug rates. In addition, as medical insurance cost frequently change, all nurses need continuous in-service education.
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Humans , Economic Development , Education , Fees and Charges , Hospitals, General , Insurance , Surveys and QuestionnairesABSTRACT
Objective To grasp the basic situation concerning visits by emergency outpatients to big urban hospitals before the implementation of reform in the medical insurance system in our city. Methods An investigation was made by means of profile survey questionnaires into the form of medical security of emergency outpatients, the sources of patients, referrals of patients, and the evaluation of doctors. Results Current emergency outpatient services in big urban hospitals have the following features: fairly great medical demands and attraction, widespread sources of patients, and pretty strong advantages in comprehensive clinical treatment. At the same time, before the implementation of reform in the basic medical insurance system, existing medical security setups, which are in the stage of transition, are characterized by a variety of types, a pretty narrow coverage in the provision of medical security and a rather high proportion of self-paying patients. Conclusion It is imperative to actively promote reform of the medical insurance system, formulate regional health plans that conform to the situation in our country, and expand the functions of community medical healthcare.