界定与测量农村居民因病致贫:新型农村合作医疗保险方案研制思路之四

借鉴世界银行评价社会贫困状况的方法:(1)将因病致贫界定为农村居民支付超过最大支付能力的医疗费用后致贫的社会现象;(2)从广度和深度两个角度测量因病致贫,采用因病致贫率指标评价广度,采用因病致贫总缺口和因病致贫平均缺口指标评价深度。在此基础上,利用样本地区数据验证了因病致贫界定和测量方法的科学性和合理性。上述方法为新农合管理者合理把握因病致贫,明确回答"消除因病致贫需要筹多少钱"、"因病致贫风险能否解决"提供了技术支撑,为实现"消除因病致贫"的制度目标提供了重点人群。     

居民现金卫生支出致贫影响分析：基于社区卫生综合改革典型城市居民健康询问调查

目的：比较8个社区卫生综合改革典型城市卫生筹资政策对居民现金卫生支出致贫的影响。方法：采用相关分析,探讨城镇居民人均可支配收入、卫生筹资结构与贫困发生率的关系。结果：现金卫生支出致贫影响最大人群是最贫困人群。结论：城市居民“因病致贫”随着卫生筹资结构中个人筹资的减少而得到缓解;居民现金卫生支出使贫困人群更加贫困,对富裕人群影响不大。     

安徽省新农合制度抗疾病风险能力探析

目的:描述安徽省参合农民因病致贫情况,分析安徽省新农合制度抗疾病风险能力的变化,为完善新农合制度提供建议。方法:在安徽省随机抽取3个县,结合新农合制度在参合率、筹资水平和补偿比方面的变化,从因病致贫率、因病致贫解决程度、因病致贫缓解程度等方面入手,分析2013—2014年新农合制度的抗疾病风险能力。结果:2013—2014年安徽省新农合制度抗疾病风险能力有所提高,但提升有限。结论:应通过改革支付方式、控制病人外流、完善多层次保障体系等手段,逐渐减少农民因病致贫。     

风险视角下"后贫困"时期因病致贫续存问题评析

目的:在绝对贫困基本被消除的"后贫困"时期,因病致贫因具有突发性而将持续存在,旨在通过评估验证问题的存在性。方法:参考风险评估方法构建因病致贫风险评估模型,基于城镇居民数据评估其因病致贫风险水平。结果:部分重大疾病的确会导致因病致贫问题;因病致贫风险分布存在区域性差异、疾病别差异。结论:因病致贫威胁的对象不限于具有"贫困"身份的人群;甘肃等地区应该强化医疗救助支持;循环系统疾病等几类疾病应该提高医疗保险支付替代率。     

研制补偿方案：新型农村合作医疗保险方案研制思路之七

为最大程度实现新农合制度目标,根据“特定人群就医概率-就医费用-就医经济风险-特定风险筹资水平-特定筹资下的补偿设计”的动态关系,形成了方案研制的思路与步骤：首先,在收支平衡的原则下,确保消除因病致贫所需的筹资额;其次,选择方案的风险保障性质,属于“风险型”、“福利型”还是“福利风险型”;最后,根据确定的风险保障范围,明确补偿方案的风险共担约束机制,包括起付线、补偿比和封顶线,并确保分段补偿时消除特定风险后基金不透支。     

中国农村贫困地区卫生保健筹资与组织分析和政策建议

本文是对30个贫困县的政策分析报告.作为中国农村贫困地区的卫生保健筹资和组织研究的一部分,分析了贫困农村因贫致病和因病致贫现状,卫生机构服务效率低下,建立合作医疗的可行性以及多渠道筹资等.     

新型农村合作医疗制度筹资与补偿最优方案的Monte Carlo模拟设计

目的 对新型农村合作医疗制度筹资与补偿的最优方案进行设计与测评.方法 结合现场调查结果,应用Monte Carlo技术进行设计测评.结果 设计了人均筹资水平40～300元共8个层次13个补偿方案.其中,人均筹资80元与150元补偿方案的因病致贫缓解率分别为33.02%和55.53%,住院费用补偿率为31.64%和49.08%,总医药费用补偿率为20.96%和38.32%.基金结余率为1.37%和1.22%.结论 本方法设计的筹资与补偿最优方案能在一定程度上缓解因病致贫现象,提高受益程度,因此具有较高的推广价值.     

居民个人现金卫生支出的致贫影响研究

本文通过对全国和部分省个人现金卫生支出的致贫影响研究，进一步分析卫生筹资机制对居民因病致贫的作用，以及卫生筹资在国家扶贫工作中的重要性。研究发现个人现金卫生支出是致贫的重要影响因素，而且在城乡之间、不同经济水平人群之间的致贫影响存在巨大差异。研究还发现经济的快速发展不能自发地解决贫困问题，需要制定政策进行必要的干预。     

苏州市农村大病合作医疗的实践与思考

调查了苏州6市3区农村大病合作医疗情况,对基金来源,筹资方式、补偿范围、手续、方法等进行比较。认为建立农村大病合作医疗可以提高农村合作医疗的参保率,缓解农民群众因病致贫,因病返贫的状况,有利于促进农村经济的发展和社会的稳定,并对农村合作医疗的立筹资机补偿和加强管理等问题作了进一步探讨。     

对现阶段新型农村合作医疗的一些看法

自2003年起,我国出台了由政府组织、引导、支持,农民自愿参加,个人、集体和政府多方筹资,以大病统筹为主的新型农村合作医疗的惠农政策,旨在改善广大农村缺医少药的状况,提高农民健康水平,减少农民因病致贫、因病返贫的现象,统筹城乡发展.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.