Violência urbana e política pública de prevenção: avaliação do Programa Fica Vivo! no estado de Minas Gerais, Brasil / Urban violence and public prevention policy: assessment of Program "Fica Vivo" (is alive), in the State of Minas Gerais, Brazil / Violencia urbana y política pública de prevención: evaluación del Programa "Fica Vivo" en el Estado de Minas Gerais, Brasil

A violência urbana no Brasil tem assumido proporções elevadas nos últimos anos. Somente em 2014, quase 60 mil pessoas foram vítimas de homicídios no Brasil, posicionando o país entre os mais violentos do mundo. O objetivo deste texto é apresentar os resultados da avaliação da implementação do Programa Fica Vivo! na cidade de Belo Horizonte, ao longo de 15 anos de execução. De maneira geral, pode-se dizer que o programa cumpriu sua finalidade e logrou êxito em reverter a tendência de crescimento das taxas de homicídio. A metodologia adotada para avaliar os impactos do Programa Fica Vivo! permitiu aferir os efeitos das políticas de prevenção e controle dos homicídios.

Urban violence in Brazil has reached high proportions in recent years. Only in 2014, almost 60 thousand people were victims of homicide in Brazil, positioning the country among the most violent in the world. The goal of this research note is to present the evaluation of the implementation of the Fica Vivo Program in the city of Belo Horizonte over 15 years of execution. In general, it can be said that the program has fulfilled its objective and has succeeded in reversing the growth trend of homicide rates. The methodology adopted to evaluate the impacts of the Fica Vivo Program allowed to assess the effects of policies of prevention and control of homicide.

La violencia urbana en Brasil ha asumido proporciones elevadas en los últimos años. Solo en 2014, casi sesenta mil personas fueron víctimas de homicidios en Brasil, lo que posicionó al país entre los más violentos del mundo. El objetivo de este artículo es mostrar el resultado de la evaluación de la implementación del programa Fica Vivo en la ciudad de Belo Horizonte a lo largo de sus 15 años de ejecución. En general, se puede decir que el programa ha cumplido su objetivo y que fue exitoso al revertir la tendencia de crecimiento de las tasas de homicidio. La metodología adoptada para evaluar los impactos del programa Fica Vivo permitió evaluar los efectos de las políticas de prevención y control de los homicidios.

The Impact of Global Budget on the Hospitalization Beneficial Degree under New Rural Cooperative Medical System / 中国卫生经济

Objective:To analyze the effect of global budget of New Rural Cooperative Medical System (NCMS) on the per-visit inpatient compensations,inpatient compensation ratios,per-visit inpatient out-of-pocket expenses and inpatient out-of-pocket rates.Methods:The difference in difference method was used to control the non-intervention factors and estimate the net impact of global budget.Results:Global budget of NCMS decreased the per-visit inpatient compensations by 14.37 yuan,but it had no statistical significance.The compensation ratio of hospitalization increased by 5.23％,the average hospitalization self-payment decrease by 141.51 yuan,the self-payment decreased by 5.23％,which all had statistical significance while there were differences on the effects for specific diseases.Conclusion:Global budget of NCMS increased the inpatient benefit,but the effect was varies by conditions.In addition,measurement of global budget's standard still needed to be scientific and reasonable.

Evaluation on the Policy Effect of the Chinese Pharmaceutical Price Reform Based on Difference-in-Difference Model / 中国卫生经济

Objective:To evaluate the policy effect of the pharmaceutical price reform which implemented in May 2015 and fill the vacancy of domestic empirical studies of the reform.Methods:Two difference-in-difference(DID) models were constructed by us ing pharmaceutical related price indexes between January 2011 and February 2017 for studying the policy effect of pharmaceutical price reform.Results:Two DID models of prices and fluctuation rate both had a significantly positive DID estimator.The drug price re form improved the prices and fluctuation rate of domestic drug.Conclusion:In the short-term,the reform could not reduce pharmaceu tical price and release medical burden.However,from the aspect of economics,market pricing brought market competition which could form a reasonable pharmaceutical price in the long-run and had positive impacts on the development of the medical market.

Analysis of a Community-based Intervention to Reduce Heat-related Illness during Heat Waves in Licheng, China: a Quasi-experimental Study / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To reduce health-related threats of heat waves, interventions have been implemented in many parts of the world. However, there is a lack of higher-level evidence concerning the intervention efficacy. This study aimed to determine the efficacy of an intervention to reduce the number of heat-related illnesses.</p><p><b>METHODS</b>A quasi-experimental design was employed by two cross-sectional surveys in the year 2014 and 2015, including 2,240 participants and 2,356 participants, respectively. Each survey was designed to include one control group and one intervention group, which conducted in Licheng, China. A representative sample was selected using a multistage sampling method. Data, collected from questionnaires about heat waves in 2014 and 2015, were analyzed using a difference-in-difference analysis and cost effectiveness analysis. Outcomes included changes in the prevalence of heat-related illnesses and cost-effectiveness variables.</p><p><b>RESULTS</b>Relative to the control participants, the prevalence of heat-related illness in the intervention participants decreased to a greater extent in rural areas than in urban areas (OR=0.495 vs. OR=1.281). Moreover, the cost-effectiveness ratio in the intervention group was less than that in the control group (US$15.06 vs. US$15.69 per participant). Furthermore, to avoid one additional patient, the incremental cost-effectiveness ratio showed that an additional US$14.47 would be needed for the intervention compared to when no intervention was applied.</p><p><b>CONCLUSION</b>The intervention program may be considered a worthwhile investment for rural areas that are more likely to experience heat waves. Meanwhile, corresponding improving measures should be presented towards urban areas. Future research should examine whether the intervention strategies could be spread out in other domestic or international regions where heat waves are usually experienced.</p>

The Impact of an Emergency Fee Increase on the Composition of Patients Visiting Emergency Departments / 예방의학회지

OBJECTIVES: This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. METHODS: We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. RESULTS: The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes. CONCLUSIONS: A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.

Discussion on Moral Hazard and Its Influences under China’s Health Care Reform / 中国卫生经济

It is a well-recognized difficult empirical task to disentangle the moral hazard effect from adverse selection impact by using the health insurance data in the empirical research of health economics. In the research, the unique social experiment in China’s health care reform, which enables cleanly identify moral hazard is applied. Using individual-level hospital patient data, it estimates the impact of the reimbursement rate increase on Chinese patients’ demand for health care service. Difference-in-Difference Propensity Score Matching approach and find strong evidence for moral hazard are approached. For instance: if the reimbursement rate increases by 5% while other factors remain the same, the corresponding health care service expenditure will increase by around 7%. The finding also has important implication for policy making. Chinese government pledges to lower the average individual out-of-pocket cost from the current 37.5% of total health care service cost to 30 % in 5 years. According to the former estimation, if the goal of the policy is successfully achieved, moral hazard problem itself will cost Chinese health care system around 200 billion yuan.

Evaluating the Effects of Urban Resident Basic Medical Insurance on Medical Service Utilization Based on Matching DID Model / 中国卫生经济

Objective: To identify the impact of Urban Resident Basic Medical Insurance (URBMI) on medical service utilization. Methods: Based on data of China Health and Nutrition Survey, matching DID model was used to compare the changes in medical service utilization between residents participated in this system and those not participated in this system in 2009. Results:In initial stage of implementation, URBMI in a certain extent promoted medical service utilization of residents participated in the system, but the impact level was still low. The promoting effect on inpatient service utilization was significant, but very limited on outpatient service utilization. Conclusion:Promoting outpatient service utilization and increasing compensation are future priorities for improving URBMI to implement the system.