基于面板数据模型的政府卫生支出及影响因素研究

目的:分析我国政府卫生支出规模的影响因素.方法:利用1997-2009年各省市的数据,采用面板数据回归模型对我国政府卫生支出进行分析.结果:各省市政府卫生支出对国内生产总值的弹性估计,除海南省外,均保持了0.01以上的显著性水平;对财政支出的弹性估计,在0.1的水平下,8个省市具有显著性.结论:国内生产总值为我国政府卫生支出的主要影响因素.     

经济增长背景下政府与个人卫生支出划分的国际经验与中国现状

目的：促进我国政府与个人卫生费用支出分担比例的合理化.方法：以世界卫生组织100多个成员国的数据为基础,采用回归分析方法,探寻经济发展水平与卫生支出以及政府与个人卫生支出分担比例的发展规律.结果：从世界范围来看,人均卫生总费用和人均政府卫生支出的需求收入弹性均大于1,人均个人卫生支出的需求收入弹性小于1.2000-2010年,中国人均卫生总费用、人均政府卫生支出的实际值都始终低于回归预测值.结论：“十二五”期间人均财政卫生支出的增长速度应达到10.2％左右,人均个人卫生支出的增长速度应达到7％.     

城镇化、老龄化及政府卫生支出对我国卫生总费用的影响研究

目的:分析我国城镇化、老龄化、政府卫生支出对我国卫生总费用的影响,并从我国整体、东部、中部和西部比较各因素影响程度的差异,为保障卫生总费用合理增长提供依据。方法:利用历年"中国统计年鉴"和"中国卫生和计划生育统计年鉴",以人均GDP作为控制变量构建面板数据模型,并采用最小二乘法对影响因素进行分析。结果:从我国整体情况来看,人均GDP和人口老龄化对人均卫生总费用的回归系数分别为1.18和0.40。人均GDP、城镇化和人口老龄化程度对东部地区人均卫生总费用的影响显著为正,回归系数分别为1.57、0.95和0.19,政府卫生支出的影响为负向。城镇化、人均GDP和人口老龄化对中部人均卫生总费用具有影响,回归系数分别为1.26、0.94和0.30。政府卫生支出对西部地区人均卫生总费用的影响最大,回归系数为0.66。结论:我国人均卫生总费用受经济增长水平影响最大,城镇化水平在中部地区的影响最大,老龄化在短期内对人均卫生总费用带来的影响相对较小,政府卫生支出对西部地区人均卫生总费用有较大影响。各省应根据自身实际情况具体分析,针对不同影响因素采取措施使卫生总费用合理增长。     

中美卫生费用地区公平性的比较研究

目的 :以美国卫生费用地区公平性水平为参照对象,考察中国卫生费用地区公平性的现状、自身特点与改进方向,为中国卫生政策的制定、卫生资源的配置提供实证依据。方法 :对中国各省1981—2013年以及美国各州1981—2009年的人均卫生费用和人均国内生产总值(GDP)的横断面数据和面板数据,进行σ和β收敛性分析,并进行两国间的比较。结果 :中国1981—2013年以及美国1981—2009年间各省(州)的人均卫生费用均不存在σ收敛。横断面数据和面板数据的收敛性分析结果显示,中国1981—2013年以及美国1981—2009年间各省(州)的人均卫生费用存在绝对β收敛。以各省(州)人均GDP的期初水平为协同变量,美国数据存在条件β收敛,而中国数据不存在条件β收敛。期初人均GDP水平对于中国各省人均卫生费用的年均增长速度具有正向作用,但期初人均GDP与期初人均卫生费用间存在负交互作用。结论 :与美国相比,中国1981—2013年各省的人均卫生费用未出现明显的收敛趋势,省份间人均卫生费用的差距仍有待进一步缩小,需在资源配置、政策引导等方面加强改进,以实现地区间卫生费用的协同发展。     

解析我国财政卫生支出的不平等——基于回归的分解

用泰尔指数和基尼系数对1997年至2009年各省市人均财政卫生支出的不平等状况进行了分析,结果表明,区域间(东部-中部-西部)和省份之间人均卫生支出的不平等逐渐下降。文章采用差分GMM对各省市财政卫生支出动态面板模型进行了估计,并采用基于回归的分解方法测算了相关影响因素对不平等的贡献程度。分解结果表明,地方财政卫生支出不平等状况降低的原因在于公共服务均等化政策初具成效、各地经济的增长、医疗设施状况的改善以及人口结构老龄化带来的卫生支出增加。     

2007-2011年湖北省政府卫生投入研究简

目的：研究湖北省政府2007—2011年卫生投入水平和配置情况,分析存在的问题并提出相应对策。方法：采用Excel2010和SPSS17．0对数据进行整理分析,运用筹资来源法对2007—2011年湖北省政府卫生支出进行测算,并和全国（大陆地区）水平比较。结果：2007—2011年,湖北省政府卫生支出从80．82亿元上升至278．05亿元,占国内生产总值（GDP）、卫生总费用和财政支出比重总体呈上升趋势,政府卫生支出的增长速度高于财政支出的增长速度。结论：近几年湖北省政府卫生投入发展趋势较好,政府卫生投入与经济水平基本协调;与全国各省份比较,人均政府卫生支出水平较低。下一步工作中,需优化政府卫生投入结构,提高政府卫生投入的针对性,实现政府卫生投入的公平性。     

1999—2007年我国城乡居民卫生保健筹资的趋势比较分析与启示

采用1999-2007年数据对我国城乡居民卫生费用筹资水平、结构及个人医疗保健支出的变化趋势进行比较分析。结果：城乡卫生费用筹资总额所占百分比与人口比例逐年呈现“倒置”现象,农村居民人均卫生费用维持在城镇居民的1／3左右;城镇居民人均医疗保健支出保持为农村居民的3-4倍,二者占人均卫生费用的比重均呈上涨趋势;城乡居民人均医疗保健支出占人均可支配（纯）收入的比重稳步增长（2007年趋于一致：5．07％）,但健康消费总体绝对值水平仍很低,尤其是农村居民;2003年以来农村居民医疗保健支出收入弹性大于城镇居民,城乡相对差距正逐步缩小。基于以上研究提出：重点增加农村居民收入,提高社会边际医疗保健支出倾向;明确政府在医疗卫生领域的经济和监管责任,控制医疗费用快速上涨;改善医疗卫生服务条件,扩大医疗保障覆盖面,带动城乡居民医疗保健合理消费;重视文化因素的作用,提高全民健康投资意识和自我保健能力。     

基于2012 - 2016年短面板数据的省级人均卫生费用影响因素与结构优化的研究

目的 了解人均卫生费用的影响因素,分析其省级差异性,为降低人均卫生费用提出政策建议。方法 基于《中国统计年鉴》和《中国卫生和计划生育统计年鉴》中省级人均卫生费用的相关面板数据,利用STATA软件构建固定效应模型,探究影响我国人均卫生费用的因素,并分析2012 - 2016年我国人均卫生费用的变化趋势和区域差异性。结果 社会卫生支出占卫生总费用比例、65岁及以上老年人口比、性别比、城镇人均可支配收入、农村人均可支配收入、人均DGP、每千人口床位数、每千人口卫生技术人员数以及医疗机构数对我国人均卫生费用的影响通过了显著性检验。结论 政府应加大卫生支出的力度,同时要因地制宜,加强监管;优化卫生资源的配置结构并完善卫生人力资源配置体系;关注老龄人口的健康,提高老年人医疗保障水平。     

2010—2014年重庆市卫生总费用筹资状况研究

目的：结合2010-2014年重庆市卫生总费用的相关数据,着重分析重庆市卫生总费用筹资总体水平,结构调整和变化趋势,并与全国的平均数据进行比较,提出改善建议。方法：运用筹资来源法对重庆市2010-2014年的卫生总费用进行了测算,并对测算结果进行分析。结果：重庆市卫生总费用和人均卫生总费用呈逐年递增趋势,个人现金支出比重在2014年降到29.97%,政府卫生支出,社会卫生支出,个人现金支出结构较合理。结论：继续加大政府和社会卫生筹资力度,降低居民个人支出,减轻居民疾病负担,使卫生筹资机制趋于合理化。     

政府卫生支出健康效率测算及分析

目的：测算和分析中国1990年、2000年和2010年政府卫生支出的健康效率及其影响因素。方法：运用DEA和Tobit测算政府卫生支出的健康效率,评估效率值的影响因素。结果：政府卫生支出的健康生产效率在波动中有所提高,不同年度处于前沿面的省份基本一致,远离前沿面的省份存在较大差别;该效率在各区域间的差异较显著,东部地区政府卫生支出的健康生产效率高于中、西部地区;财政分权与政府卫生支出健康效率存在显著负相关关系。结论：财政分权制度的改革与完善是提高政府卫生支出健康效率的重要途径。     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.