The healer or the druggist: effects of two health care policies in Taiwan on elderly patients’ choice between physician and pharmacist services

When both physicians and pharmacists in Taiwan prescribed and dispensed drugs, many elderly people considered the two types of health care providers more or less synonymous (i.e., close substitutes). Two policies mandated in the 1990s changed this perception: National Health Insurance (NHI), which provides insurance coverage to all citizens, and a separation policy (SP) that forbids physicians from dispensing and pharmacists from prescribing drugs. The author finds that by providing an economic incentive to the previously uninsured elderly, NHI raised the probability that they would visit physicians, relative to their continuously insured counterparts. In particular, some previously uninsured elderly who once only visited pharmacists were more likely to also visit physicians after NHI was implemented. Following this, the SP made it more likely that all elderly patients would only visit physicians and buy drugs from on-site pharmacists hired by physicians—a result different than its policy goal.      

新型冠状病毒肺炎疫情期间武汉市发热门诊运行机制及防控策略分析

 目的 发热门诊是做好传染病防控的第一道关口,通过总结分析新型冠状病毒肺炎（简称新冠肺炎）疫情下武汉市发热门诊运行中遇到的问题和难点,据此探讨我国发热门诊的运行机制和疫情防控改进方向。方法 调查2020年1月15日—3月15日武汉市所有开放发热门诊的医疗机构每日发热门诊就诊数据,结合国家、湖北省以及武汉市发布的应对新冠肺炎疫情防控和救治有关通知、政策及文件等信息,回顾和评价新冠肺炎疫情期间武汉市发热门诊就诊和运行情况。结果 调查期间武汉市先后部署共计76所二级及以上医疗机构开放发热门诊收治发热患者。2020年1月15日—3月15日武汉市发热门诊平均每日就诊量为6 070人次。1月15日发热门诊就诊量为1 625人次,1月24日达到顶峰（14 486人次）。1月30日—2月6日武汉市发热门诊接诊量几乎饱和。2月6日开始,就诊量呈现逐步下降趋势,3月15日降至585人次。武汉市中心城区的7个行政区中除洪山区外其他6个行政区日均就诊量均在千人以上,武昌区发热门诊就诊量普遍高于其他区域。结论 武汉市发热门诊在疫情期间未能充分发挥早期预警作用,在人员、物资和设施的配备等方面存在问题。医疗机构应从建立平战结合的公共卫生预警反馈机制、构建科学的一站式发热门诊、建立医疗应急供应保障体系以及组建复合型公共卫生应急队伍等四个方面优化发热门诊建设和管理,制定科学有效的疫情防控策略。     

The impact of change from copayment to coinsurance on medical care usage and expenditure in outpatient setting in older Koreans

Patient cost‐sharing change was implemented on August 1, 2007, for outpatient care in the clinic setting in Korea from copayment to coinsurance. This study aims to estimate the effect of the policy change on medical care usage and expenditure in older Koreans. By using national health insurance claims data from the Health Insurance Reimbursement Assessment Service, this study analyzed the entire 137 million claims for a total of approximately 4.1 million patients aged 60 to 69 years who had been diagnosed and/or treated for outpatient care in clinics from January 1, 2007, to December 31, 2008. Medical care usage was defined as the proportion of all beneficiaries in each group who visited clinics and the mean number of visit days per beneficiary. Medical care expenditure per visit day was expressed as total costs, reimbursed amount, and patient's out‐of‐pocket payment. Data on January through June of 2008 were analyzed as compared with the same months of 2007. Raw difference‐in‐difference and multiple regression analyses were performed. The interaction coefficients, which measured the impact of cost‐sharing change, was ?0.078 in model 1 and ?0.039 in model 2 (P < .0001). In conclusion, a cost‐sharing change from copayment to coinsurance reduced medical care usage and expenditure.     

The Impact of China’s National Essential Medicine Policy and Its Implications for Urban Outpatients: A Multivariate Difference-in-Differences Study

Objectives

To evaluate the effects of the National Essential Medicine Policy (NEMP) on outpatient service utilization and expenditure in Tianjin, China.

有关药事服务费的定义及其测算方法的探讨

目的:明确药事服务费的定义并对其进行测算.方法:通过对新医改政策的回顾、解读和国内外文献的检索,在明确药事服务费定义的基础上,采用2008年卫生部规划财务司<全国卫生财务年报资料>中的数据,分别以药品加成、药品支出减药品费和药品支出中的工资、福利支出,总门诊次数及总床日数等为目标值进行测算.结果:用上述三种方法测算得到...     

基本药物制度实施后村卫生室门诊服务变化比较——基于东、中、西部6省的抽样调查

目的：比较基本药物制度实施前后东、中、西部6省村卫生室门急诊人次、次均药品费用和次均医药总费用的变化。方法：收集6省130个村卫生室2009--2011年连续36个月的门诊服务监测数据,使用分段时间序列模型进行回归分析。结果：2011年与2009年相比,6省村卫生室门诊次均药品费用、次均医药总费用均下降,降幅约在15％-70％之间,东部的浙江和中部的安徽降幅最大;门急诊人次变化的瞬时水平和长期趋势各省均不相同。结论：国家基本药物制度在村卫生室实施后,各省村卫生室次均药品费用和次均医药总费用的下降幅度存在较大差异,门急诊人次的变化也不尽相同,可能与补偿模式、“新农合”报销范围、乡村一体化管理实施进度、基本药物配备情况、乡村医生待遇等多种因素有关。     

浅谈医药分业政策对医药费用控制的影响

近年来,国家推出一系列政策措施以控制医药费用的不合理上涨,但实际效果不佳.社会各界对医药分业寄予厚望,但该举措能否有利于控制医药费用尚需探讨.该文分析了医药分业政策的背景,预测了医疗机构对此政策的可能反应,认为仅将门诊药房分离未必会降低医药费用,并对如何保证该政策发挥良好的效果提出了建议.     

Separating financing from provision: evidence from 10 years of partnership with health cooperatives in Costa Rica

OBJECTIVE: This article examines the impact of contracting health care provision to health care cooperatives in Costa Rica. METHODOLOGY: The article uses a panel dataset on health care outputs in traditional clinics and cooperatives in Costa Rica from 1990-99. RESULTS: Controlling for community socioeconomic characteristics, annual time trends and clinic complexity, the cooperatives conducted an average of 9.7-33.8% more general visits (95% confidence interval), 27.9-56.6% more dental visits, and 28.9-100% fewer specialist visits. Numbers of non-medical, emergency and first-time visits per capita were not different from the traditional public clinics. These results suggest that the cooperatives substituted generalist for specialist services and offered additional dental services, but did not turn away new patients, refuse emergency cases, or substitute nurses for doctors as care providers. Cooperatives authorized 30.4-60.5% fewer sick days (95% confidence interval), conducted 24.7-37.2% fewer lab exams, and gave out 26.7-38.3% fewer medications per visit than the traditional public clinics. Real total expenditure per capita in cooperatives was 14.7-58.9% lower than in traditional clinics. CONCLUSIONS: The findings suggest that cooperatives might, with an appropriate regulatory framework and incentives, be able to combine advantages of public and private approaches to health care service provision. Under certain conditions, they might be able to maintain accessibility, a sense of mission and efficiency in service provision.     

Impact of a national medical fee schedule revision on the cessation of physician home visits among older patients in Tokyo: A retrospective study

As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January–February, February–March, March–April, and April–May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March–April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.     

上海市实施医疗机构药品零差率与相关补偿政策研究

目标:实证研究药品加价率下降后,医院经济运行及医药费用的变化,并提出实行药品零差率相关补偿政策。资料与方法:对上海市医疗机构2003—2008年财务报表数据(含复旦附属医疗机构)进行定量分析。结果:实证研究表明,2006年实施控制药品加价率政策后,上海市医疗机构的药品加价率从33%下降至17%;药品收入仍然是医疗机构主要的收入来源;随着药品收支结余的减少,有37%的医疗机构出现了亏损;医药费用并没有因药品加价率的降低而减少;若实行药品零差率政策,上海市医疗机构每年所需补偿约30亿元;经测算,不同补偿渠道的补偿结果将会对患者医药费用产生不同影响。建议:实行药品零差率后应采用综合补偿模式,通过政府财政出一点、医疗保险分担一点、药事服务收费补一点和医疗服务价格调一点,建立医疗机构主动合理控制药品费用的长效机制,既维护医院的正常运行,又减轻患者就医的经济负担。     

北京市郊区农村基层医疗卫生服务能力现状及问题分析

目的分析北京市郊区村巡诊和村卫生室建设现状,为完善农村基层医疗卫生服务体系建设提供参考。方法对北京市郊7个区中119个行政村进行实地观察,并对652名相关研究对象进行半结构化访谈,包括对巡诊和卫生室的满意度、基层医疗机构的服务质量等。结果村巡诊服务效率不高,不能满足居民实际医疗服务需求;村卫生室医疗人员短缺,基本药物配备不全,报销途径不畅通,村民就医行为更倾向于选择乡镇卫生院和县医院。结论为更好落实卫生领域重要民生项目,切实提升农村居民就医体验,应进一步落实和丰富村巡诊内容,加强基层全科医生培养力度,提升卫生费用投资的针对性和有效性,把村卫生健康服务情况纳入村干部工作考核指标,优化基本药物目录,扩大新农合定点报销覆盖范围等。