• 【收费或避难所:哪种方法对昆虫对Bt转基因Bt玉米的抗药性可持续管理更好?】 复制标题 收藏 收藏
    DOI:10.1098/rsbl.2005.0418 复制DOI
    作者列表:Vacher C,Bourguet D,Desquilbet M,Lemarié S,Ambec S,Hochberg ME
    BACKGROUND & AIMS: :The evolution of resistance in insect pests will imperil the efficiency of transgenic insect-resistant crops. The currently advised strategy to delay resistance evolution is to plant non-toxic crops (refuges) in close proximity to plants engineered to express the toxic protein of the bacterium Bacillus thuringiensis (Bt). We seek answers to the question of how to induce growers to plant non-toxic crops. A first strategy, applied in the United States, is to require Bt growers to plant non-Bt refuges and control their compliance with requirements. We suggest that an alternative strategy is to make Bt seed more expensive by instituting a user fee, and we compare both strategies by integrating economic processes into a spatially explicit, population genetics model. Our results indicate that although both strategies may allow the sustainable management of the common pool of Bt-susceptibility alleles in pest populations, for the European corn borer (Ostrinia nubilalis) one of the most serious pests in the US corn belt, the fee strategy is less efficient than refuge requirements.
    背景与目标: :害虫抗性的演变将危害转基因抗虫农作物的效率。当前建议的延迟抗性进化的策略是在设计为表达苏云金芽孢杆菌(Bt)细菌毒性蛋白的植物附近种植无毒作物(避难所)。我们寻求有关如何诱使种植者种植无毒作物的问题的答案。在美国应用的第一个策略是要求Bt种植者种植非Bt避难所并控制其对要求的遵守。我们建议另一种策略是通过收取使用费来提高Bt种子的价格,然后将经济过程整合到空间明确的种群遗传模型中,比较这两种策略。我们的结果表明,尽管这两种策略都可以对害虫种群中常见的Bt敏感性等位基因进行可持续管理,但对于欧洲玉米bore(Ostrinia nubilalis)是美国玉米带中最严重的害虫之一,收费策略是效率比避难所要求低。
  • 【将用户费用减免与培训和监督相结合,有助于维护布基纳法索的药品处方质量。】 复制标题 收藏 收藏
    DOI:10.1093/heapol/czs100 复制DOI
    作者列表:Atchessi N,Ridde V,Haddad S
    BACKGROUND & AIMS: :To improve access to health care services, an intervention was implemented in Burkina Faso granting full exemption from user fees. Two further components, staff training and supervision, were added to support the intervention. Our aim in this study was to examine how this tripartite intervention affected the quality of drug prescriptions. Using a mixed methodology, we first conducted an interrupted time series over 24 months. Nine health centres were studied that had previously undergone a process analysis. A total of 14 956 prescriptions for children 0-4 years old were selected by interval sampling from the visit registries from 1 year before to 1 year after the intervention's launch. We then interviewed 14 prescribers. We used three World Health Organization (WHO) indicators to assess drug prescription quality. Analysis was carried out using linear regression and logistic regression. The prescribers' statements underwent content analysis, to understand their perceptions and changes in their practice since the subsidy's introduction. One effect of the intervention was a reduced use of injections (odd ratio (OR) = 0.28 [0.17; 0.46]) in cases of acute lower respiratory tract infections (ALRTI) without comorbidity. Another was a reduction in the inappropriate use of antibiotics in malaria without comorbidity (OR = 0.48 [0.33; 0.70]). The average number of drugs prescribed also decreased (coefficient = -0.14 [-0.20; -0.08]) in cases of ALRTI without comorbidity. The prescribers reported that their practices were either maintained or improved. The user fees exemption programme, combined with health staff training and supervision, did not lead to any deterioration in the quality of drug prescriptions.
    背景与目标: :为了改善获得医疗保健服务的机会,在布基纳法索实施了一项干预措施,准予完全免除使用费。添加了两个其他部分,即员工培训和监督,以支持干预措施。我们在这项研究中的目的是检验这种三方干预如何影响药物处方的质量。使用混合方法,我们首先进行了24个月的中断时间序列。研究了九个以前进行过过程分析的卫生中心。从干预开始前1年到开始1年间,从访视登记处定期抽取14 956张0-4岁儿童的处方。然后,我们采访了14位处方者。我们使用了三个世界卫生组织(WHO)指标来评估药物处方质量。使用线性回归和逻辑回归进行分析。开具处方后,对处方者的陈述进行了内容分析,以了解他们对补贴实施以来的看法和做法的变化。干预的效果之一是在无合并症的急性下呼吸道感染(ALRTI)病例中减少了注射剂量的使用(比值比(OR)= 0.28 [0.17; 0.46])。另一个是减少无合并症的疟疾中抗生素的不当使用(OR = 0.48 [0.33; 0.70])。在没有合并症的ALRTI情况下,开出的平均处方药数量也减少了(系数= -0.14 [-0.20; -0.08])。开处方者报告说他们的做法得以维持或得到改善。豁免使用费的计划,加上卫生人员的培训和监督,并未导致药物处方质量的任何下降。
  • 【灵活的内窥镜吞咽评估(FEES),以确定神经科重症监护患者的口服饮食。】 复制标题 收藏 收藏
    DOI:10.1080/17549507.2020.1744727 复制DOI
    作者列表:Braun T,Juenemann M,Viard M,Meyer M,Reuter I,Mausbach S,Doerr JM,Schirotzek I,Prosiegel M,Schramm P,Kaps M,Tanislav C
    BACKGROUND & AIMS: :Purpose: Dysphagia is common in critically ill neurological patients and is associated with a high mortality and morbidity. Data on the usefulness of flexible endoscopic examination of swallowing (FEES) in neurological intensive care unit (ICU) patients are lacking, raising the need for evaluation.Method: FEES was performed in neurological intensive care patients suspected of dysphagia. We correlated findings with baseline data, disability status, pneumonia and duration of hospitalisation, as well as a need for mechanical ventilation or tracheotomy.Result: This analysis consisted of 125 patients with suspected dysphagia. Most of the patients (81; 64,8%) suffered from acute stroke. Dysphagia was diagnosed using FEES in 90 patients (72%). FEES results led to dietary modifications in 80 patients (64%). The outcome at discharge was worse in dysphagic stroke patients diagnosed by FEES as compared to non-dysphagic stroke patients (p = 0.009). Patients without oral diet had higher need for intubation (p = 0.007), tracheotomy (p = 0.032) and higher mortality (p < 0.001) in comparison to patients with at least small amounts of oral intake.Conclusion: As the clinical assessment of the patients often classified the dysphagia incorrectly, the broad use of FEES in ICU patients might help to adequately adjust patients' oral diet. This knowledge might contribute to lower mortality and morbidity.
    背景与目标: 目的:吞咽困难在重症神经病患者中很常见,并且与高死亡率和高发病率有关。缺乏灵活的内窥镜下吞咽检查(FEES)在神经内科重症监护病房(ICU)患者中有用性的数据,因此需要进行评估。方法:对怀疑有吞咽困难的神经内科重症监护患者进行FEES检查。我们将研究结果与基线数据,残疾状况,肺炎和住院时间以及是否需要机械通气或气管切开术相关联。结果:该分析由125名疑似吞咽困难的患者组成。大多数患者(81; 64.8%)患有急性中风。使用FEES诊断吞咽困难的患者有90例(72%)。 FEES结果导致80例患者的饮食发生改变(64%)。与非吞咽困难的中风患者相比,通过FEES诊断的吞咽困难的中风患者出院时的结果较差(p = 0.009)。与口服摄入量最少的患者相比,不口服饮食的患者对插管(p = 0.007),气管切开术(p = 0.032)和死亡率(p <0.001)的需求更高。患者经常将吞咽困难归类为不正确,在ICU患者中广泛使用FEES可能有助于充分调整患者的饮食。这些知识可能有助于降低死亡率和发病率。
  • 【加拿大和澳大利亚的制药公司用户费用与药品批准之间的关系:一项假设产生的研究。】 复制标题 收藏 收藏
    DOI:10.1345/aph.1H117 复制DOI
    作者列表:Lexchin J
    BACKGROUND & AIMS: BACKGROUND:Since the early- to mid-1990s, drug companies have paid fees for a variety of activities carried out by the Therapeutic Products Directorate in Canada and the Therapeutic Goods Administration in Australia. OBJECTIVE:To explore whether changes in approval times for new active substances and in the percentage of new drug submissions receiving positive decisions coincided with the level of user fees. METHODS:Data were collected from a range of Canadian and Australian government publications on the following topics: total funding for and workload of the regulatory agencies, the percentage of income that came from tax revenue and user fees, the percentage of new drug submissions that received a positive decision, and-for Canada only-the percent of submissions that were approved on first review. RESULTS:In both countries, there was a moderate-to-strong positive association between the level of industry funding and the percent of submissions that received a positive decision and a moderate-to-strong (Canada) and moderate (Australia) negative association between the level of industry funding and approval times. CONCLUSIONS:Changes observed in both countries are favorable to the pharmaceutical industry. Other than user fees leading to a pro-industry bias in the regulatory authorities, other possible explanations include a more efficient use of resources, a smaller workload (Canada), an improvement in the quality of drug submissions (Canada), and more resources (Australia). Further research strategies are needed to either confirm or refute the hypothesis that the level of industry funding affects decisions made in drug regulatory systems.
    背景与目标: 背景:自1990年代初至中期以来,制药公司已为加拿大治疗产品管理局和澳大利亚治疗产品管理局进行的各种活动付费。
    目的:探讨新活性物质批准时间的变化以及收到积极决定的新药提交百分比与使用费水平是否相符。
    方法:从加拿大和澳大利亚政府一系列有关以下主题的出版物中收集数据:监管机构的总资金和工作量,税收和使用费收入的百分比,收到的新药提交的百分比一个积极的决定,并且仅对加拿大而言,是首次审核所批准的提交书中所占的百分比。
    结果:在这两个国家中,行业资金水平与收到肯定决定的投稿百分比之间存在中等到强的正相关关系,而在加拿大和加拿大之间则存在中等到强的负相关关系。行业资助水平和批准时间。
    结论:两国观察到的变化都对制药业有利。除了使用费会导致监管部门出现行业偏见外,其他可能的解释包括更有效地利用资源,更小的工作量(加拿大),药品提交质量的提高(加拿大)和更多的资源(澳大利亚)。需要进一步的研究策略来确认或驳斥行业资金水平会影响药物监管系统决策的假设。
  • 【住院卒中患者的康复费用,住院时间和效率:基于功能相关人群的初步研究。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Lin JH,Hsiao SF,Liu CK,Lin YT
    BACKGROUND & AIMS: The purpose of this study was to examine the relationships between severity of disability and factors such as rehabilitation fees, length of stay and efficiency for hospitalized stroke patients. One hundred and seven first-time stroke patients were studied consecutively for this study. They were recruited from a rehabilitation ward in a university medical center during 1997. Functional ability was evaluated using the Functional Independence Measure (FIM) instrument on admission and discharge. Stroke patients who presented with similar degrees of disability were put together using the admission FIM score (FIM Function-Related Groups, FIM-FRGs) for further analysis. Twenty-eight (26.2%) patients examined were categorized as severely disabled (scored 18-36), 48 (44.8%) moderately disabled (scored 37-72) and 31 (29.0%) mildly disabled (scored 73-126). The average expense on rehabilitation fees, for the average rehabilitation length of stay (LOSR) of 34.7 +/- 16.7 days, was NT$ 27,645 +/- 13,812. The FIM score improved from 56.8 +/- 24.2 on admission to 76.6 +/- 26.2 at discharge, with a rehabilitation efficiency index (EIR) of 0.7 +/- 0.7. Further analysis indicated that there were significant differences among the three disability groups on rehabilitation fees and LOSR while EIR was unaffected. The findings of this study suggest that FIM-FRGs can differentiate different rehabilitation needs in terms of rehabilitation fees and LOSR; therefore, a prospective case payment system based on FIM-FRGs is suggested for stroke rehabilitation reimbursement scheme in the future.

    背景与目标: 这项研究的目的是检查残疾严重程度与住院卒中患者康复费用,住院时间和效率等因素之间的关系。这项研究连续研究了107名初次卒中患者。他们是在1997年从大学医疗中心的康复病房招募的。使用入院和出院的功能独立性评估(FIM)仪器对功能能力进行了评估。表现出类似残疾程度的中风患者使用入院FIM评分(FIM功能相关组,FIM-FRG)进行汇总以进行进一步分析。被检查的二十八(26.2%)位患者被分类为严重残疾(评分18-36),中度残疾(48-44.8%)(评分37-72)和轻度残疾(31-29.0%)(评分73-126)。平均康复时间(LOSR)为34.7 /-16.7天,平均康复费用为NT $ 27,645 /-13,812。 FIM评分从入院时的56.8 /-24.2提高到出院时的76.6 /-26.2,康复效率指数(EIR)为0.7 /-0.7。进一步的分析表明,在EIR不受影响的情况下,三个残疾人群体在康复费用和LOSR方面存在显着差异。这项研究的结果表明,FIM-FRG可以根据康复费用和LOSR区分不同的康复需求。因此,建议将来使用基于FIM-FRG的预期病例支付系统来进行中风康复报销计划。

  • 6 Physician fees and managed care plans. 复制标题 收藏 收藏

    【医师费用和管理式护理计划。】 复制标题 收藏 收藏
    DOI:10.5034/inquiryjrnl_39.2.184 复制DOI
    作者列表:Zwanziger J
    BACKGROUND & AIMS: One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

    背景与目标: 管理式护理组织(MCO)的目标之一是降低医疗保健支出(包括医师费)的增长率。然而,由于缺乏数据,没有人能够确定MCO是否成功地鼓励了医师服务市场价格竞争的增长,从而减缓了医师费用的增长。这项研究使用了独特的国家级数据集来确定哪些因素影响了MCO在1990-92年期间协商的医师费用。最有影响力的特征是医生的供应和管理的渗透率,这表明将竞争引入医疗保健市场是降低医生费用的有效力量。

  • 【对临床实践研究数据链(CPRD)进行回顾性,多队列分析,以确定药物浪费,配药费用和开具处方药时间短的费用之间的差异(】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2017-019382 复制DOI
    作者列表:Doble B,Payne R,Harshfield A,Wilson ECF
    BACKGROUND & AIMS: OBJECTIVES:To investigate patterns of early repeat prescriptions and treatment switching over an 11-year period to estimate differences in the cost of medication wastage, dispensing fees and prescriber time for short (<60 days) and long (≥60 days) prescription lengths from the perspective of the National Health Service in the UK. SETTING:Retrospective, multiple cohort study of primary care prescriptions from the Clinical Practice Research Datalink. PARTICIPANTS:Five random samples of 50 000 patients each prescribed oral drugs for (1) glucose control in type 2 diabetes mellitus (T2DM); (2) hypertension in T2DM; (3) statins (lipid management) in T2DM; (4) secondary prevention of myocardial infarction; and (5) depression. PRIMARY AND SECONDARY OUTCOME MEASURES:The volume of medication wastage from early repeat prescriptions and three other types of treatment switches was quantified and costed. Dispensing fees and prescriber time were also determined. Total unnecessary costs (TUC; cost of medication wastage, dispensing fees and prescriber time) associated with <60 day and ≥60 day prescriptions, standardised to a 120-day period, were then compared. RESULTS:Longer prescription lengths were associated with more medication waste per prescription. However, when including dispensing fees and prescriber time, longer prescription lengths resulted in lower TUC. This finding was consistent across all five cohorts. Savings ranged from £8.38 to £12.06 per prescription per 120 days if a single long prescription was issued instead of multiple short prescriptions. Prescriber time costs accounted for the largest component of TUC. CONCLUSIONS:Shorter prescription lengths could potentially reduce medication wastage, but they may also increase dispensing fees and/or the time burden of issuing prescriptions.
    背景与目标: 目的:调查11年期间的早期重复处方和治疗转换的模式,以估计短(<60天)和长(≥60天)的处方时间的药物浪费,配药费用和开药时间的差异英国国家卫生服务局的观点。
    地点:来自临床实践研究数据链的基础护理处方的回顾性,多队列研究。
    参与者:5万名患者,每人随机抽取5份口服药,用于(1)控制2型糖尿病(T2DM)中的血糖; (2)T2DM中的高血压; (3)T2DM中的他汀类药物(脂质管理); (4)心肌梗死的二级预防; (5)抑郁症。
    主要和次要治疗措施:对早期重复处方和其他三种治疗开关造成的药物浪费量进行了量化和成本计算。还确定了配药费和开药时间。然后比较了与<60天和≥60天的处方相关的总不必要成本(TUC;药物浪费成本,配药费和开药时间),将其标准化为120天。
    结果:更长的处方时长与每张处方中更多的药物浪费相关。但是,当包括配药费和开药时间时,较长的处方时间会导致TUC降低。这一发现在所有五个队列中都是一致的。如果发出单个长处方而不是多个短处方,则每120天每张处方可节省8.38英镑至12.06英镑。开处方者的时间成本占TUC的最大部分。
    结论:更短的处方长度可能会减少药物浪费,但也可能增加配药费用和/或开具处方的时间负担。
  • 【估算山地车手的越野特性,进出费用和站点关闭的变化所带来的收益和成本:选择实验和收益转移。】 复制标题 收藏 收藏
    DOI:10.1006/jema.2001.0513 复制DOI
    作者列表:Morey ER,Buchanan T,Waldman DM
    BACKGROUND & AIMS: :Mountain biking is an increasingly popular leisure pursuit. Consequences are trail degradation and conflicts with hikers and other users. Resource managers often attempt to resolve these problems by closing trails to mountain biking. In order to estimate the impact of these developments, a model has been devised that predicts the effects of changes in trail characteristics and introduction of access fees, and correlates these with biker preference on trail selection. It estimates each individual's per-ride consumer's surplus associated with implementing different policies. The surplus varies significantly as a function of each individual's gender, budget, and interest in mountain biking. Estimation uses stated preference data, specifically choice experiments. Hypothetical mountain bike trails were created and each surveyed biker was asked to make five pair-wise choices. A benefit-transfer simulation is used to show how the model and parameter estimates can be transferred to estimate the benefits and costs to mountain bikers in a specific area.
    背景与目标: :山地自行车是一种越来越受欢迎的休闲活动。后果是步道退化以及与远足者和其他使用者的冲突。资源管理者通常试图通过关闭通往山地自行车的路线来解决这些问题。为了估计这些发展的影响,已经设计了一个模型,该模型可以预测步道特性变化和使用费的影响,并将这些与骑自行车的人对步道选择的偏好相关联。它估计了与实施不同政策相关的每个人的乘车消费者剩余。盈余随每个人的性别,预算和对山地自行车的兴趣而变化很大。估计使用陈述的偏好数据,特别是选择实验。创建了假想的山地自行车道,并要求每位接受调查的骑自行车的人做出五个成对选择。利益转移模拟用于说明如何将模型和参数估计值转移到特定区域的山地车手,以估计其收益和成本。
  • 【计划生育方法的用户费用:孟加拉国城市避孕药具的支付行为分析。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Routh S,Thwin AA,Kane TT,Hel Baqui A
    BACKGROUND & AIMS: The study was carried out to review the experience with the existing user-fee (pricing) strategies and examine the socioeconomic and demographic factors associated with payment behaviour among contraceptors in urban Bangladesh for selected contraceptive methods, such as injectables, pill, and condom. Data for the study were drawn from a survey of more than 5,000 married women of reproductive age in Zone 3 of Dhaka city, Bangladesh, within the sample frame of the Urban Panel Survey of the ICDDR,B's former Urban MCH-FP Extension Project. The findings of the study showed that most (80%) urban contraceptors have been paying for selected family-planning services. This indicates the existence of a notable demand for contraceptives which suggests that there is scope for improved financial sustainability of the family-planning programme through charging appropriate user-fees for contraceptives with proper analyses of willingness-to-pay among the contraceptors and price elasticities of demand. Higher socioeconomic status of households, marked by higher levels of education and house rent, and location of residence in non-slum areas, is predictive of paying for contraception. Households having 1-3 living child(ren) are also more likely to make payment for the selected contraceptive services.

    背景与目标: 这项研究的目的是回顾现有用户收费(定价)策略的经验,并研究孟加拉国城市中避孕药的支付行为与社会经济和人口统计学因素有关,这些避孕方法包括注射剂,药丸和避孕套等选定的避孕方法。该研究的数据来自对孟加拉国达卡市3区5,000多名育龄已婚妇女的调查,该调查是在ICDDR的城市小组调查(B的前城市MCH-FP扩展项目)的样本框架内进行的。该研究的结果表明,大多数(80%)城市避孕者一直在为选定的计划生育服务付费。这表明对避孕药具的需求显着,这表明通过向避孕药具收取适当的使用者费用,并对避孕药具的支付意愿和价格弹性进行适当分析,可以改善计划生育计划的财务可持续性。要求。以较高的教育水平和房租以及在非贫民区的居住地点为特征的家庭较高的社会经济地位,可以预料要为避孕买单。有1-3个活着的孩子的家庭也更有可能为选定的避孕服务付款。

  • 【保健利用中的横向公平和卫生筹资的公平性:卢旺达的小额医疗保险和使用费的比较。】 复制标题 收藏 收藏
    DOI:10.1002/hec.1014 复制DOI
    作者列表:Schneider P,Hanson K
    BACKGROUND & AIMS: :This paper uses two methods to compare the impact of health care payments under insurance and user fees. Concentration indices for insured and uninsured groups are computed following the indirect standardisation method to evaluate horizontal inequity in utilisation of basic health care services. The minimum standard approach analyses the extent to which out-of-pocket health spending contributed to increased poverty. The analysis uses cross-sectional household survey data collected in Rwanda in 2000 in the context of the introduction of community-based health insurance. Results indicate that health spending had a small impact on the socio-economic situation of uninsured and insured households; however, this is at the expense of horizontal inequity in utilisation of care for user-fee paying individuals who reported significantly lower visit rates than the insured.
    背景与目标: :本文使用两种方法来比较医疗保险支付对保险和用户费用的影响。按照间接标准化方法计算被保险人和非被保险人的浓度指数,以评估基本医疗服务利用中的水平不平等。最低标准方法分析了自付费用的医疗支出在多大程度上加剧了贫困。该分析使用了2000年卢旺达在引入基于社区的健康保险的背景下收集的横断面家庭调查数据。结果表明,卫生支出对无保险和有保险家庭的社会经济状况影响很小;然而,这是以牺牲了看病率明显低于被保险人的用户付费个人的护理利用中的横向不平等为代价的。
  • 【医疗费。在澳大利亚如何给医生付款的历史。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Dammery D
    BACKGROUND & AIMS: :Medical fees are an important part of medical practice, yet they have always been a bone of contention. This article is the first in a series of three that will look at the way the doctor was paid. It examines the role of medical fees in early medical practice in Australia.
    背景与目标: :医疗费用是医疗实践的重要组成部分,但始终是争论的焦点。本文是三部分中的第一篇,将探讨医生的付款方式。它研究了医疗费用在澳大利亚早期医疗实践中的作用。
  • 12 The Economics of Residency Application Fees. 复制标题 收藏 收藏

    【居留申请费的经济学。】 复制标题 收藏 收藏
    DOI:10.1097/ACM.0000000000001842 复制DOI
    作者列表:Maroongroge S
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【突然取消用户费用:布隆迪一线经理的观点。】 复制标题 收藏 收藏
    DOI:10.1093/heapol/czr061 复制DOI
    作者列表:Nimpagaritse M,Bertone MP
    BACKGROUND & AIMS: :In May 2006, the President of Burundi announced the removal of user fees in all health centres and hospitals for children under 5 and women giving birth. As other studies also point out, the policy was adopted extremely suddenly, without much reflection on its ultimate aims and on the operational dimension of its implementation. From the perspective of a frontline manager, this paper provides a descriptive case study of the abolition of user fees in the Muramvya District and a first-hand account of the effects of the sudden reform in the management of a district and a district hospital. The analysis highlights the challenges that the district and hospital teams faced. The main issues were: the reduction of financial flows, which prevented the possibility of investments and caused frequent drugs stock-outs; the reduced quality of the services and the disruption of the referral system; the motivation of the health staff who saw the administrative workload increase (not necessarily because of increased utilization) and faced 'ethical dilemmas' caused by the imprecise targeting of the reform. Undoubtedly, the removal of user fees for certain groups was an equitable and necessary measure in an extremely poor country such as Burundi. However, the suddenness of the decision and the lack of preparation had critical and long-lasting consequences for the entire health system. This analysis, performed from the frontline perspective, clarifies the importance of a rigorous planning of any reform, as well as of involving peripheral actors and understanding the complex challenges that they face.
    背景与目标: :2006年5月,布隆迪总统宣布取消所有健康中心和医院的5岁以下儿童和分娩妇女的使用费。正如其他研究还指出的那样,该政策突然被采纳,而对其最终目标和实施的运作层面却没有太多的思考。从一线经理的角度出发,本文提供了有关在Muramvya区取消使用费的描述性案例研究,以及对区和区医院管理突然改革的影响的第一手资料。分析强调了地区和医院团队面临的挑战。主要问题是:资金流动减少,这阻止了投资的可能性并导致经常的药品缺货;服务质量下降和推荐系统中断;卫生人员的动力,他们看到行政工作量增加了(不一定是因为利用率提高了),并且面临着由于改革目标不明确而造成的“道德困境”。无疑,在某些极端贫困的国家(例如布隆迪),免除某些群体的使用费是一项公平而必要的措施。但是,决策的突然性和缺乏准备对整个卫生系统造成了严重而持久的后果。从前线角度进行的这一分析阐明了对任何改革进行严格规划的重要性,并需要让外围参与者参与并理解他们面临的复杂挑战。
  • 【1975年至1995年的牙科手术费:已更改了多少?】 复制标题 收藏 收藏
    DOI:10.14219/jada.archive.1998.0427 复制DOI
    作者列表:Brown LJ,Lazar V
    BACKGROUND & AIMS: A shift toward diagnostic and preventive dentistry in the last two decades is evident from the change in the number of dental procedures performed, as well as the change in the percentage of time spent performing different types of procedures. During the period 1975 through 1995, the average nominal fees for selected dental procedures increased. Once inflation was taken into account, however, the increase in the average real fees charged was more modest.

    背景与目标: 从执行的牙科程序数量的变化以及执行不同类型的程序所花费的时间百分比的变化可以明显看出,过去二十年来向诊断和预防牙科的转变。在1975年至1995年期间,某些牙科手术的平均名义费用有所增加。但是,一旦考虑到通货膨胀,平均实际收费的增加幅度就较小。

  • 【流血的心,奸商或两者皆有:不受管制的市场中的专科医生费。】 复制标题 收藏 收藏
    DOI:10.1002/hec.3317 复制DOI
    作者列表:Johar M,Mu C,Van Gool K,Wong CY
    BACKGROUND & AIMS: :This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist physicians charge their high-income patients AU$26 more than their low-income patients. While this gap equates to a 19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the largest fee gap between the high-income and low-income patients. Several possible channels for deducing the patient's income are examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination among the low-income patients but are less relevant for the high-income patients. Copyright © 2016 John Wiley & Sons, Ltd.
    背景与目标: :这项研究表明,在不受监管的费用设定环境中,专科医生根据患者的收入状况实行价格歧视。我们的结果与专家的利润最大化行为一致。这些发现基于与行政医疗索赔记录相关联的大规模人口调查。我们发现,在初步咨询中,专科医生向高收入患者收取的费用比低收入患者高出26澳元。虽然这一差距意味着最贫困患者的费用降低了19%(家庭收入分配的最低25%),但不可能消除他们在获得专科护理方面面临的巨大财务障碍。各专业之间差异很大,神经科医师在高收入和低收入患者之间的费用差距最大。研究了几种推断患者收入的可能途径。我们发现,诸如年龄,健康优惠卡状态和私人健康保险状态之类的患者特征均被专家用作收入状态的代理。这些特征对于在低收入患者中进一步实行价格歧视特别重要,但与高收入患者的相关性较小。版权所有©2016 John Wiley&Sons,Ltd.

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