RESUMO
Objective:To evaluate the effect of urban-rural integrated medical insurance on rural households'catastrophic health expenditure(CHE),thereby proposing targeted optimization strategies for the integration.Methods:Based on the five tracking data of the China Household Tracking Survey(CFPS)from 2010 to 2018,Process Specification Model-Dynamic Integrity Dimension(PSM-DID)was used to empirically test the impact of urban-rural integrated medical insurance on rural households'catastrophic health expenditures.Results:The urban-rural integrated medical insurance system significantly reduces the incidence of CHE in ru-ral households.Mechanism testing indicates that health levels,human capital expenditures,and household asset accumulation are important channels of action.Conclusion:It is suggested to continuously promote the urban-rural integrated medical insurance sys-tem,formulate comprehensive policies for medical insurance according to local conditions,and incorporate catastrophic health indi-cators into the detection and warning indicator system for rural residents returning to poverty.
RESUMO
Objective:To sort out the medical service price management in provinces of the Yangtze River Delta, and identify problems in the process of promoting the integration of medical insurance in the said region.Methods:The service price reform policies and current medical service price items specifications as of December 2020 were collected from the official websites of the reform and developmet committees, health comissions and health insurane bureaus of these provinces. Descriptive analysis using R 4.0.2 software were conducted.Results:Given the reform of medical service prices advanced in these provinces successively, the current medical service price items were not yet unified. In terms of the numbers, Jiangsu topped the rest by 4 457 basic items, while Zhejiang ranked the lowest at 3 914. In terms of decomposed items, Zhejiang topped the rest by 1 988, 17.6 times that of Anhui province. In terms of pricing level, the average price of medical services in Shanghai topped the rest by 1 041.6 yuan, while Jiangsu province was the lowest at 768.6 yuan. The price of some items varied by more than 20 times among these provinces.Conclusions:The provinces in the Yangtze River Delta had significant gaps in medical service price items setup and price levels. It is necessary to promote the regional coordinated specifications of medical service price items, further optimize the price levels, improve the methodological system of medical service price comparison, and promote the integration of medical insurance in the Yangtze River Delta.
RESUMO
Objective To explore the cognitive level and demand of chronic disease prevention and treatment integration in the County hospitals and primary health care institutions. Methods A stratified cluster sampling method was used to investigate the medical staff of five county-level hospitals and 39 community health service centers in Liandu District, Yunhe County and Jingning County, and qualitative interviews and on-site questionnaire survey were carried out among 573 medical staff from August to October in 2016. Results A total of 252 medical personnel at the county level or above, accounting for 43.98％, and 321 medical personnel in primary health care institutions, accounting for 56.04％. And 96.86％ of the medical staff thought it is necessary to integrate medical treatment and prevention. Only 32.98％ think that the local medical and anti-integration were the real ones and only 36.13％ have contacted the"top five prevention and control offices" at the county level. Two-way referral of key chronic patients and promotion of grassroots promotion of appropriate technology were better. And 77.38％ of medical staff at medical institutions above the county level and 75.70％ of medical personnel of primary medical institutions participated in the two-way referral work, with 66.67％ of county level medical staff of above medical institutions and 93.46％ medical staffs of primary medical institutions participated in the promotion of grassroots workplaces for appropriate technologies. And 82.72％ of the medical staff held or participated in appropriate technical training courses for chronic diseases within one year, but the proportion of holding or participating in ≥3 times was only 24.08％. Conclusion The work that county level five platform to promote chronic disease prevention and control of chronic disease prevention and treatment of medical integration still need to be strengthened. We should use the appropriate training mode to improve comprehensive prevention and treatment of chronic diseases among primary medical staff.