城镇职工健康体检支付意愿及其影响因素分析

近年来，随着人们健康需求的不断提高，主动追求健康，定期健康体检成为越来越多的人的健康选择。但是，目前健康体检仍然是以单位组织和单位付费为主，自费体检比例较低。有关资料统计显示，体检人群中，约80％为单位体检，10％为招工体检，个人自费体检比例不到10％。怎样通过政策制定和调整，既满足人们不断增长的需求，又能控制费用的过快上涨，同时促进健康体检产业顺利发展，是需要研究的问题。鉴于此，本文对健康体检服务支付意愿及其影响因素进行分析，以期为健康体检付费制度改革及健康体检产业的规范和发展提供依据。     

加强管理，努力提高干部健康体检质量

为贯彻《国务院办公厅关于进一步加强领导认真做好干部健康体检的通知》文件精神,配合省委保健委做好沿淮、淮北地区的省直和中直单位的干部健康体检工作,我院针对有的部门和领导同志本人对定期健康体检的重要性认识不足或者有的单位经费紧缺体检经费不能到位而影响干部健康体检工作落实的情况,进行大力宣传,建立体检服务保障体系,并及时抽调先进的医疗仪器和设备、组织有关专家、教授进行上门服务,取得较好的社会效益。1 建立体检服务保障体系 《通知》是党和国家关心老干部,爱护老同志和第一线工作领导同志及广大中老年知识分子身体健康的具体体现,是贯彻     

体检并不等同于健康管理

现在，大多数单位都有定期组织员工去做健康体检的规定，每人的体检费用、体检项目差距也很大，以北京为例，体检普及率为全国之最，根据北京健康管理协会对206家会员单位健康体检工作量的统计，2012年我市对500多万人次进行了健康体检，健康状况可分为绿灯：基本健康：黄灯：有疾病风险因素；红灯：有疾病需要治疗。从体检结果来看，基本健康的只占人群的6％左右，大多数人的健康都亮起了黄灯，但目前能够自觉去进行健康管理的人群比例不足10％。     

城镇职工健康体检支付能力分析

目的了解城镇职工对健康体检的支付能力,为健康体检产业的持续健康发展提供政策性建议.方法采用目的抽样方法,自编调查问卷对1371名城镇职工进行调查.结果大多数城镇职工已经具有了较强的健康体检支付能力.结论应大力推行健康体检模式改革,调整消费结构,引导合理消费,促进健康体检的支付能力向支付意愿转化.     

浙江省参合农民健康体检存在问题与对策研究

目的：分析浙江省参合农民健康体检存在问题及原因,并提出政策建议;方法：每个地市各随机抽取1个县（市、区）,每个县（市、区）按比例抽取1/3的乡镇卫生院和社区卫生服务中心,开展问卷调查。结果：共收回有效问卷70份,＂基层卫生人员不足＂、＂体检经费标准太低＂、＂参合农民自己体检意识不强＂、＂体检对象在外打工不能回来＂、＂体检经费纳入绩效总量＂是当前制约农民健康体检工作主要困难和障碍。结论：提高经费标准,保障财政投入;加强能力建设,规范质量控制;转变农民意识,重视健康管理。     

浅谈健康体检管理

本文分析探讨当前健康体检存在的问题，主要是对健康体检内涵认识不足，体检中心不适应发展要求，体检不规范、服务不到位、单位追求经济效益、检后工作跟不上等。笔者结合本单位体检中心的工作经验，提出了做好健康体检必须转变观念、以规范化加速体检中心建设，做好检后健康管理工作，实施一体化服务，适应人们健康保健的需求。     

北京市成年人健康体检的频率和途径

目的 了解北京市成年人健康体检的途径和频率.方法 采用多阶段分层整群抽样的方法,对北京市18岁以上16 658例常住居民健康体检的途径和频率进行调查.结果 两年内,北京市成人中有60.8%的人至少接受了一次健康体检.年轻、文化程度高、家庭人均收入高、较好的医疗保险与健康体检的频率呈正相关.健康体检的途径依次为单位或集体常规健康体检(71.8%)、就业(包括办理健康证)和上学体检(14.2%)、自己主动体检(包括婚检,9.6%)、其他(4.4%).结论 北京市居民健康体检率较高,单位或集体常规体检是健康体检的主要途径.     

中老年健康体检综合评估方法的研究

目的 研究制定一种结合中老年健康体检资料，进行综合的，定量的健康评估方法。方法 采用Delphi法确定健康体检评估体系，并对220例个体进行主观和客观评估的试用验证，采用Spearmen法进行相关性分析。结果 确定了含有生活方式和行为习惯，系统查体，辅诊检查，年龄及健康自我评价6个方面和40条中老年健康体检综合评估项目和方法。对个人或单位可进行定量或分类评估，纵向或横向的对比分析。通过试用验证，在主观和客观评估之间存在着显的相关性。结论 中老年健康体检综合评估方法是比较可靠和有效的，从定量和分类的角度比较准确地反映了中老年健康水平，操作简单，实用性强。     

2002年干部健康体检患病情况分析

目的：通过干部健康体检了解目前干部和高级知识分子患病情况及发展趋势。方法：2002年度3279名受检在三家省级医院由统一组织的医务人员进行常规健康体检，资料专人汇总。结果：前列腺增生、高脂血症，牙疾病，高血压和白内障为这些人群中患病较高的前五位，高脂血症中青年组高于老年组，前列腺增生和高血压则老年组显高于中青年组，高血压和前列腺增生随年龄增加而增加，高脂血症的患病率则随年龄变化不明显，结论：定期健康体检是早期防治疾病的有效方法，健康生活方式和适当药物治疗对防治心血管疾病十分重要。     

宝鸡市56579名从业人员健康体检结果分析

为了解我市直管单位近6年食品、公共场所、托幼机构从业相关人员健康体检情况，探讨预防性健康检查有效的组织管理办法，依据卫生部《预防性健康检查管理办法)的有关规定，开展相关健康检查活动，统计分析从业人员健康检查资料，结果表明：宝鸡市从业人员年均体检合格率为97．93％，HBsAg阳性检出率为1．83％，肠道致病菌检出率为0．20％，皮肤病检出率为0．02％，肺结核检出率为0．01％。提示：从业人员健康体检合格率总体至上升趋势，但相关工作须从严管理，以不断提高职业禁忌证的检出率。     

National Health Accounts in Developing Countries: Appropriate Methods and Recent Applications

Better information on the financing of the health sector is an essential basis for wise policy change in the area of health sector reform. Analysis of health care financing should begin with sound estimates of national health expenditure—total spending, the contributions to spending from different sources and the claims on spending by different uses of the funds. The member countries of the OECD have successfully established such comparative health expenditure accounts in terms of standardized definitions of the uses of funds and breakdowns by public and private sector sources. This has resulted in important research on health system differences which could explain variations in the level and composition of financing. The United States has developed a more detailed approach called National Health Accounts, which expands the OECD method into a more disaggregated ‘sources and uses’ matrix. In the developing countries, analysis of health expenditures has been much less systematic, despite several decades of calls by international researchers for more attention. This paper reviews previous work done in developing countries and proposes renewed attention to national health expenditures, adapting the recent experience of the United States. Because most developing countries have more pluralistic health financing structures than are found in most industrialized countries, an enhanced and adapted version of the ‘sources and uses’ matrix method is proposed. This method should be modified to address the relevant categories of expenditures prevalent in the developing countries. Examples of recent applications of such ‘national health accounts’ from the Philippines, Egypt, India, Mexico, Colombia and Zambia are presented. Experience to date suggests that development of sound estimates using this method in low and middle income countries is feasible and affordable. National health accounts estimates can significantly influence policy. They provide decision makers with a holistic picture of the health sector, showing the actual emphasis of spending and the roles of different payers. They also provide a consistent framework for modelling reforms and for monitoring the effects of changes in financing and provision. An easy to use software tool has been developed for training and data management. Regional networks of collaborating national groups are proposed as a first step in expanding use of the method and to gain both national and cross-national comparative benefits. © 1997 by John Wiley & Sons, Ltd.     

Redistributive effects of Swedish health care finance

This paper investigates the redistributive effects of the Swedish health care financing system in 1980 and 1990 for four different financial sources: county council taxes, payroll taxes, direct payments and state grants. The redistributive effects are decomposed into vertical, horizontal and ‘reranking’ segments for each of the four financial sources. The data used are based on probability samples of the Swedish population, from the Level of Living Survey (LNU) from 1981 and 1991. The paper concludes that the Swedish health care financing system is weakly progressive, although direct payments are regressive. There is some horizontal inequity and ‘reranking’, which mainly comes from the county council taxes, since those tax rates vary for each county council. The implication is that, to some extent, people with equal incomes are treated unequally. Copyright © 1998 John Wiley & Sons, Ltd.     

国际精神卫生筹资现状及对我国的启示

财政投入不足及资金使用效率不高是全球范围内精神卫生服务领域面临的共同困境。国际上普遍采取的精神卫生筹资渠道有税收、社会保险和自费等,其中政府是最主要的筹资主体。我国精神卫生筹资总体水平较低,公平性差,且资金分配机制不合理。本文认为,为完善我国精神卫生筹资政策,需将卫生筹资纳入精神卫生法和精神卫生工作纲要,并明确政府尤其是中央政府对精神卫生的财政投入责任,在资金分配中向社区倾斜,提高资金使用效率。     

基于“SHA2011”的湖南省预防费用分析

[目的]核算湖南省2017年预防费用,追踪不同来源资金的实际分配和使用情况。[方法]基于SHA2011框架核算湖南省预防费用总量、筹资方案、机构流向、服务功能等。[结果]2017年湖南省经常性预防费用总量为118.67亿元,占经常性卫生费用的6.62%,主要用于健康体检、免疫规划、孕产妇保健和传染病防治等项目。预防费用主要流向公共卫生机构和基层医疗机构;政府筹资、家庭卫生支出、企业筹资占比分别为55.25%、32.35%、12.40%。[结论]预防费用总体筹资结构较为稳定,但规模尚需扩大;部分预防项目家庭负担重,筹资公平性有待提高;重点领域投入相对较低,费用配置结构有待调整。     

农村公共卫生项目投入标准测算的思路与方法

借鉴成本核算思路与方法,研制了我国农村公共卫生项目投入标准的测算思路和方法及其所需要的资料来源途径,为进一步科学、合理地测算我国农村公共卫生项目投入标准提供了方法学依据。研究结果显示,农村公共卫生项目投入标准的测算思路包括界定公共卫生项目提供的"农村"范围、界定农村公共卫生服务项目、样本地区服务项目实际成本的测算、样本地区单位服务项目实际成本的测算、样本地区项目任务全部完成所需要标准成本和全国农村公共卫生项目投入标准测算等6步骤,资料来源途径和方法包括文献归纳分析、专家咨询论证、机构调查和常规报表资料的利用等。     

Community-based health insurance in low-income countries: a systematic review of the evidence

Health policy makers are faced with competing alternatives, and for systems of health care financing. The choice of financing method should mobilize resources for health care and provide financial protection. This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge. Overall, the evidence base is limited in scope and questionable in quality. There is strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending. There is evidence of moderate strength that such schemes improve cost-recovery. There is weak or no evidence that schemes have an effect on the quality of care or the efficiency with which care is produced. In absolute terms, the effects are small and schemes serve only a limited section of the population. The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing. To improve reliability and validity of the evidence base, analysts should agree on a more coherent set of outcome indicators and a more consistent assessment of these indicators. Policy makers need to be better informed as to both the costs and the benefits of implementing various financing options. The current evidence base on community-based health insurance is mute on this point.     

Acceso a la atención sanitaria mediante seguros de salud comunitarios entre migrantes de Senegal

ObjectiveTo evaluate the determinants of healthcare access financing and the role of a particular class of informal financing known as tontine, a community-based health insurance among Senegalese immigrants.MethodData were retrieved through qualitative techniques, semi-structured interviews (n = 14) and discussion group (n = 10) in a population of Senegalese migrants residing in Granada between October and November 2019. Key participants were from a tontine.ResultsThe lack of work or economic resources, as well as the condition of undocumented immigrant constitute barriers to adherence to public and private health insurance. Participants consider that public health care does not take into account the importance of following treatment close to their relatives in their country of origin or having the alternative of traditional medicines. The tontine helps to protect the most vulnerable people such as undocumented immigrants and allows financing services of cultural importance.ConclusionsThis study was the first to provide an understanding of a financing mechanism typical of an immigrant community quite unknown to Spanish society. Tontines continue a long tradition whereby disadvantaged and vulnerable communities resist multiple sources of discrimination and inequality by self-help, trust and solidarity.     

Evidences on weaknesses and strengths from health financing after decentralization: lessons from Latin American countries

OBJECTIVE: The main objective was to identify trends and evidence on health financing after health care decentralization. STUDY DESIGN: Evaluative research with a before-after design integrating qualitative and quantitative analysis. Taking into account feasibility, political and technical criteria, three Latin American countries were selected as study populations: Mexico, Nicaragua and Peru. DATA SOURCES: The methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country. FINDINGS: The trends and evidence reported in all five financing indicators may identify major weaknesses and strengths in health financing. CONCLUSIONS: Weaknesses: a lack of human resources trained in health economics who can implement changes, a lack of financial resource independence between the local and central levels, the negative behavior of the main macro-economic variables, and the difficulty in developing new financing alternatives. Strengths: the sharing between the central level and local levels of responsibility for financing health services, the implementation of new organizational structures for the follow-up of financial changes at the local level, the development and implementation of new financial allocation mechanisms taking as a basis the efficiency and equity principles, new technique of a per-capita adjustment factor corrected at the local health needs, and the increase of financing contributions from households and local levels of government.     

从公平的视角看上海市卫生筹资

描述了上海市卫生筹资公平现状,并与天津、黑龙江和甘肃等省市进行了横向比较。研究发现上海市卫生筹资人均水平较高,且宏观公平性较好;家庭卫生筹资渠道中,基本医疗保险支出和个人现金卫生支出呈累退性;家庭灾难性卫生支出和致贫影响相对其他省市低,但也集中发生在经济水平较低人群。针对这些问题,提出了要建立与收入挂钩的筹资机制、统筹医保资金和加强医疗救助等政策建议。     

医改以来省级卫生总费用比较分析

目的：通过省级卫生总费用核算结果,分析2009年医药卫生体制改革以来我国卫生筹资的变化趋势与特征,为完善卫生筹资政策提供参考和依据。方法：选取2009—2012年全国20个省份的卫生总费用核算数据进行纵向和横向对比分析。结果：20个省份中,卫生总费用增幅最大的是安徽（82.97%）,政府卫生支出增幅最大的是宁夏（108.71%）。2012年社会卫生支出占卫生总费用比重超过40%的省份全部位于东部地区。个人卫生支出占卫生总费用比重在40%以上的地区减少至5个。结论：各地区卫生总费用均保持增长趋势,但在地区经济水平匹配程度方面存在差异;筹资结构明显优化,但地区间筹资特点不同,部分省份个人卫生支出占卫生总费用比重的压力仍然较大。建议：在提高筹资水平的前提下,注重调整筹资结构,发挥公共筹资的作用,降低居民个人卫生支出负担。