中英城市社区卫生服务与贫困救助项目（UHPP）

中英城市社区卫生与贫困救助项目(China/UK Urban Health and Poverty Project,UHPP)是中英两国政府在发展城市社区卫生服务和贫困人口医疗救助方面的第一个合作项目,也是我国社区卫生服务的第一个重要国际合作项目。目的是探索建立经济适宜并能可持续发展的社区卫生服务体系和贫困人口医疗救助机制,以贫困人口等弱势人群为重点,改善全体居民的基本卫生服务可及性,提高健康水平。     

在中国农村建立贫困人口医疗救助制度研究

中国是一个拥有12.65亿(2000年)人口的大国,其中农民占63.78％(8.07亿人)。尽管政府在农村扶贫方面做出了极大的努力,但在经济欠发达地区贫困问题依然严重,即使是在经济较富裕的农村地区,绝对贫困问题也仍然存在。     

关于建立我国医疗救助制度的思考

我国市场经济体制还不够完善，社会保障还处在很低的层次上，医疗救助还处在起步阶段，建立适合我国国情的医疗救助制度势在必行。文章分析了我国医疗救助的特点和存在的主要问题，提出了建立和完善我国医疗救助制度的具体途径。     

沈阳市和成都市贫困医疗救助项目实施效果评价

利用家庭入户调查资料,采用比值法评价贫困医疗救助年度实施效果。相对基线调查,低保家庭与普通家庭的患病率比值下降,就诊比例比值及就诊率比值上升,住院率比值有升有降,医疗支出占总收入(或总支出)比重比下降,对社区卫生服务的利用率增加。结论:贫困医疗救助项目实施1年后,贫困人口就医的经济负担减轻,卫生服务利用率增加。     

以社区卫生服务为基础的贫困医疗救助制度设计

贫困医疗救助制度的目标一方面是提高贫困人口医疗服务的公平性和可及性，保障贫困人口享受基本医疗服务的权利，改善贫困人群的健康状况；另一方面是建立以社区卫生服务为基础、多部门协调配合、全社会参与、具有可持续发展的贫困医疗救助制度。但是，国内现行的医疗救助模式无论在制度设计还是具体实施中都存在许多缺陷。为此，本研究提出了构建以社区卫生服务为基础的贫困医疗救助制度总体思路。     

成都和沈阳医疗救助项目实施评价

中英城市卫生服务与贫困医疗救助项目(Chi- na-DfID Vrban Health and Poverty Project UHPP项目)的目标之一是通过城市贫困人口救助机制的创新性实践,探索建立多部门协调、全社会各方面参与、具有可持续性发展的城市贫困医疗救助制度。     

我国城市贫困人口医疗救助现状分析

随着我国经济体制的转轨和产业结构不断调整，社会经济结构正处于转型时期，城市相对贫困人口日益增加。对城市贫困人口进行医疗救助，已经成为稳定社会、防止因病致贫和返贫的重要措施之一。本文利用现有资料对我国医疗救助的现状进行评价和分析。     

广州市贫困人口医疗救助现状分析

目的 对广州市贫困人口医疗救助现状进行分析,为完善广州市医疗救助政策提供参考.方法暋采用分层分类抽样方式,从广州市贫困人口中抽取408户贫困家庭进行问卷调查,实际有效样本为307户;并对20名广州市医疗救助管理部门有关工作人员进行访谈.结果 广州市医疗救助的人次和金额呈不断上升趋势,人均救助医疗费用1141元/年·人,资助社会医疗保险费用132元/年·人;个人负担比例的人次均值和中位值在10%～21%之间,且呈逐年下降趋势;贫困人口中89.9%的人参加了医疗保险,通过与广州市第四次卫生服务调查城市普通居民参保情况比较,两人群的参保率差异有统计学意义（χ2=2194.84P〈0.001）;贫困人口政策知晓度为48.8%,获知政策的渠道中,比例最高的是通过街道工作人员获取的,达47.9%.结论 广州市医疗救助提高了贫困人口医疗保障水平,降低了贫困人口的医疗负担,但需进一步提高救助金使用率、贫困人口参保率和政策知晓度;在政策知晓度的提高方面,基层工作人员这种面对面、一对一的宣传方式能较快地引起贫困人群的注意,比较适合贫困人口的人群特征。     

我国医疗救助制度研究

(一)我国医疗救助的对象 我国医疗救助对象分两大部分,一是城市贫困人口的医疗救助;二是农村贫困人口的医疗救助。 农村贫困人口是根据1998年统计,我国农村的贫困标准为人均年纯收入635元,目前,有贫困人口4 200万人。特别是西部和中部部分地区是我国贫困人口密集地区,其中西部地区贫困人口占全国贫困人口的比重为48.2％。医疗救助的重点应放在中西部地区。     

The poverty-reducing effect of Medicaid

Medicaid provides health insurance for 54 million Americans. Using the Census Bureau's Supplemental Poverty Measure (which subtracts out-of-pocket medical expenses from family resources), we estimated the impact of eliminating Medicaid. In our counterfactual, Medicaid beneficiaries would become uninsured or gain other insurance. Counterfactual medical expenditures were drawn stochastically from propensity-score-matched individuals without Medicaid. While this method captures the importance of risk protection, it likely underestimates Medicaid's impact due to unobserved differences between Medicaid and non-Medicaid individuals. Nonetheless, we find that Medicaid reduces out-of-pocket medical spending from $871 to $376 per beneficiary, and decreases poverty rates by 1.0% among children, 2.2% among disabled adults, and 0.7% among elderly individuals. When factoring in institutionalized populations, an additional 500,000 people were kept out of poverty. Overall, Medicaid kept at least 2.6 million—and as many as 3.4 million—out of poverty in 2010, making it the U.S.’s third largest anti-poverty program.     

美国医疗救助制度沿革及其对我国的启示

对贫困人口的医疗救助，目前引起了社会各界尤其是卫生领域的关注。通过介绍美国医疗救助制度的产生及其基本内容，医疗救助费用和救助对象的变化，进一步借鉴美国医疗救助制度，使其对我国贫困人口的医疗救助工作起到积极的理论指导作用。     

医疗救助制度模型设计与可行性研究

本文从居民健康、保障形式、保障程度和国民待遇等问题出发，研究了我国建立医疗救助制度的必要性。继而对医疗救助对象、筹资、补偿、管理主体、医疗服务配套政策进行了研究，并对建立起以红十字会为管理机构、以社区筹资为主体的医疗救助制度的可行性进行研究。     

The Effects of Express Lane Eligibility on Medicaid and CHIP Enrollment among Children

Objective

To estimate the impact of Express Lane Eligible (ELE) implementation on Medicaid/CHIP enrollment in eight states.

Data Sources/Study Setting

2007 to 2011 data from the Statistical Enrollment Data System (SEDS) on Medicaid/CHIP enrollment.

Study Design

We estimate difference-in-difference equations, with quarter and state fixed effects. The key independent variable is an indicator for whether the state had ELE in place in the given quarter, allowing the experience of statistically matched non-ELE states to serve as a formal counterfactual against which to assess the changes in the eight ELE states. The model also controls for time-varying economic and policy factors within each state.

Data Collection/Extraction Methods

We obtained SEDS enrollment data from CMS.

Principal Findings

Across model specifications, the ELE effects on Medicaid enrollment among children were consistently positive, ranging between 4.0 and 7.3 percent, with most estimates statistically significant at the 5 percent level. We also find that ELE increased combined Medicaid/CHIP enrollment.

Conclusions

Our results imply that ELE has been an effective way for states to increase enrollment and retention among children eligible for Medicaid/CHIP. These results also imply that ELE-like policies could improve take-up of subsidized coverage under the ACA.     

The long-term health impacts of Medicaid and CHIP

This paper estimates the effect of US public health insurance programs for children on health. Previous work in this area has typically focused on the relationship between current program eligibility and current health. But because health is a stock variable which reflects the cumulative influence of health inputs, it would be preferable to estimate the impact of total program eligibility during childhood on longer-term health outcomes. I provide such estimates by using longitudinal data to construct Medicaid and CHIP eligibility measures that are observed from birth through age 18 and estimating the effect of cumulative program exposure on a variety of health outcomes observed in early adulthood. To account for the endogeneity of program eligibility, I exploit variation in Medicaid and CHIP generosity across states and over time for children of different ages. I find that an additional year of public health insurance eligibility during childhood improves a summary index of adult health by .079 standard deviations, and substantially reduces health limitations, chronic conditions and asthma prevalence while improving self-rated health.     

Problems with quality monitoring for Medicaid managed care: Perceptions of institutional and private providers in New York City

The study objective was to examine quality oversight efforts by Medicaid managed care organizations (MCOs) for children in a sample of ambulatory care institutions and private practices in New York City. This was a cross-sectional study of quality assurance priorities and strategies of MCOs and their impact date in institutions in New York City. Data were from structured interviews administered in 1997 to medical directors in the eight largest MCOs; and medical directors, heads of ambulatory pediatrics, and institutional pediatricians in a random sample of 15 institutions and 20 private office-based providers. Medical directors in MCOs reported that their main priority areas were the preventive care measures (e.g., immunization and lead screening) that they must report to the state. Knowledge of these MCO priority areas and monitoring activities was high for medical directors in the random sample, but decreased from these medical directors to heads of ambulatory pediatrics to institutional pediatricians, with the differences between the medical directors and institutional pediatricians significant (P<.05). However, 96% of the institutional pedians reported knowing their own institution's priorities and monitoring activities. In contrast, most private pediatricians reported they knew MCO priorities and monitoring activities (80%). Less than 33% of any group reported activities as “very effective” or felt any incentive to improve performance. There was a high level of overlap in provider networks, with institutions and private providers having children in many MCOs, and MCOs having children in many sites. This study was funded by the Centers for Disease Control and Prevention through contract 97B2644 between researchers and the New York City Department of Health. This paper was presented at the 1999 Health Services Research Symposium sponsored by the Greater New York Hospital Association/United Hospital Fund on November 16, 1999.     

The association between state Medicaid expansion and human papillomavirus vaccination

Increased vaccination against human papillomavirus (HPV) is recommended to reduce the incidence of anogenital and oropharyngeal cancers. This study aims to evaluate the impact of Medicaid expansion by states on HPV vaccination uptake among adolescents ages 13–17 in the United States. This study analyzed data from the National Immunization Survey (NIS) – Teen from 2011 to 2017 using a cross-sectional design. The adjusted difference-in-difference estimate of Medicaid expansion on HPV vaccine initiation was statistically significant (β = 0.031, 95% CI [0.016, 0.046]). There were significant increases in HPV vaccination after states expanded their Medicaid program. The largest increase occurred in those individuals below the federal poverty level and a modest increase occurred in those above the federal poverty level but below $75,000 of annual family income. Further research should be conducted to analyze the combined effect of multiple policies on HPV vaccination.     

The effect of Medicaid eligibility expansions on fertility

In the United States, pregnant women and children’s eligibility for Medicaid was expanded dramatically during the 1980s and early 1990s. By lowering pregnancy and child health care costs, the Medicaid expansions may have increased the incentives for women to have children. To investigate this possibility, we examine whether state-level birth and abortion rates are related to the extent of states’ Medicaid eligibility expansions and the fraction of women eligible for Medicaid, controlling for economic and demographic factors, during the period 1982 to 1996. We examine birth rates by race, marital status and education as well as overall abortion rates. We find little evidence that the Medicaid expansions led to changes in birth rates or abortion rates. However, some results do suggest that the Medicaid expansions boosted the birth rate among white women who have not completed high school. We find that restrictions on Medicaid funding of abortions decrease abortion rates and increase birth rates. The results thus do not provide definitive evidence that expansions in public health insurance eligibility have sizable effects on women’s fertility.