The impact of the COVID-19 outbreak on Australia’s public health and medical industry in 2020

In 2020,the sudden new crown(COVID-19)virus swept the world.Countries have adopted different epidemic prevention measures.The COVID-19 has brought an extraordinary impact on the economic and social health of all countries.Australia,located in the southern hemisphere,promptly adopted the closure and other epidemic prevention policies in late January.The whole people mobilized to actively fight against the epidemic.Compared with the passive immunization of developed countries such as the United Kingdom and the United States,it has experienced several twists and turns and achieved relatively successful results.However,the epidemic has profoundly affected public health and medical care.They are mainly manifested in mental and psychological,hand hygiene,respiratory diseases,surgical spectrum,cancer screening,and changes in national leadership’s response methods and medical insurance policies.Australia’s early physical distancing measures,relatively high per capita testing rates,political stability,national wealth and geographic isolation are among the explanatory factors.The country’s response to the COVID-19 pandemic has,thus far,been among the most successful in the world.

An Analysis and Prediction of Health Insurance Costs Using Machine Learning-Based Regressor Techniques

One of the most significant annual expenses that a person has is their health insurance coverage. Health insurance accounts for one-third of GDP, and everyone needs medical treatment to varying degrees. Changes in medicine, pharmaceutical trends, and political factors are only a few of the many factors that cause annual fluctuations in healthcare costs. This paper describes how a system may analyse a person’s medical history to display their insurance plans and make predictions about their health insurance premiums. The performance of four ML models—XGBoost, Lasso, KNN, and Ridge—is evaluated using R2-score and RMSE. The analysis of medical health insurance cost prediction using Lasso regression, Ridge regression, and K-Nearest Neighbours (KNN), and XGBoost (XGB) highlights notable differences in performance. KNN has the lowest R2-score of 55.21 and an RMSE of 4431.1, indicating limited predictive ability. Ridge Regression improves on this by an R2-score of 78.38 but has a higher RMSE of 4652.06. Lasso Regression slightly edges out Ridge with an R2-score of 79.78, yet it suffers from an advanced RMSE of 5671.6. In contrast, XGBoost excels with the highest R2-score of 86.81 and the lowermost RMSE of 4450.4, demonstrating superior predictive accuracy and making it the most effective model for this task. The best method for accurately predicting health insurance premiums was XGBoost Regression. The findings beneficial for policymakers, insurers, and healthcare providers as they can use this information to allocate resources more efficiently and enhance cost-effectiveness in the healthcare industry.

Health performance assessment modeling and its application to compact medical communities in China

Some regions in China have already implemented capitation payment or capitation budget management for medical insurance funds.However,there remains a shortage of adequate tools and methodologies to accurately quantify differences in population health risks.Therefore,this paper constructs a health performance assessment model that comprises four steps.The first step is to categorize all participants into health risk groups based on whether they have contracted with a family doctor,their age,sex,and the type of consultation.The second step is to categorize health risk groups based on differences in healthcare resource utilization.The third step is to analyze health performance by examining healthcare resource utilization year over year.The fourth step is to apply the assessment results to assist local finance bureaus and medical insurance bureaus in developing incentive schemes.According to cost weights,the health risk groups are split into six classes:insured residents without health care visits,healthy insured person,slightly ill insured patients,ill insured patients,more seriously disease patients,and severely ill insured patients.We evaluate one compact medical community's health performance by examining changes in the proportion of resource usage group size and expense.From 2019 to 2021,both the proportion of patients with severe and ultra‐severe diseases and the proportion of costs in the sample increased,according to changes in resource utilization levels.This result indicates that the population's overall health has not improved and that the compact medical community is still primarily focused on treating diseases,with poor implementation of health maintenance measures and minimal improvement in health performance.

Enlightenment of German social health insurance system reform on China

According to the latest Chinese Healthcare Reform .Plan, the medical insurance system is one ofthe four components of the healthcare sector. The Healthcare financing and payment in China are mainly based on medical insurance. So it is important to learn the experiences of the developed countries. This paper examines the key issues of the German Healthcare system and reforms, with a particular emphasis on basic social medical insurance, which has the broadest coverage in Germany. It reviews the evolution of the background of the German social medical insurance system, describes how the system functions, and analyzes the existing and emerging problems with the system which push the Germany government to adapt a series of reforms.

Does health insurance coverage lead to better child health?Evidence from China

Using data from the China Health and Nutrition Survey,this study investigated the impact of health insurance coverage on children’s health in China.To address the potential endogeneity between insurance and health,we adopted the instrumental variable probit model.We found that insurance enrollment significantly improved the health of children,especially urban children,but there was no significant insurance effect across gender.After using the propensity score matching method,an alternative measure of child health,and a sub-sample of children aged above 10,our major finding of the insurance effect on child health is verified and robust.We further conducted the path analysis by identifying three potential paths through which medical insurance improved child health.We found that child health behaviour and nutritional intake are the effective paths between insurance enrollment and health status.These results provided implications for policy makers in constructing and developing the supportive system of child medical insurance in China.

A Study on the Public Awareness of Hierarchical Medical System in Taiwan

The purpose of hierarchical medical system is to lead in terms of improving efficiency, differentiating healthcare services and promoting labor division by changing the healthcare seeking behavior. The purpose of this research aims to discuss the public awareness of hierarchical medical system in Taiwan for the reference of health policy makers. We obtained our research data using a questionnaire survey;the total number of qualified patients was 1340. This research finds that more subjects agreed to the hierarchical medical system and medical referral system, but many people still disagreed with changes to their healthcare seeking choices due to policy promotion. Subtle changes, therefore, are observed that imply a crisis in terms of the trust in healthcare. The healthcare seeking behavior will not change if there is a difference between the medical awareness of patients and policy implementation, and the government needs to be concerned with this result when making policies.

专利计量视域下医疗与健康保险机构间数据交互技术探析

目的/意义探析相关专利技术,为医疗与商业健康保险机构打通数据交互堵点、建构多层次医疗保障体系提供经验借鉴。方法/过程采用专利计量方法,围绕相关专利技术的时间趋势、地域分布、类别分布、文本聚类4方面分析医疗与健康保险机构之间的数据交互专利技术。结果/结论中国应重视数据交互在医疗与健康保险机构深化合作中的作用,增进高质量专利的申报、授权、运用和保护,重视跨界融合与技术驱动,创新专利布局以顺应技术发展和社会需求等。

DIP改革背景下负向医疗行为成因及治理策略分析

从医保管理部门、医疗机构和参保患者三个维度对医保支付方式改革背景下负向医疗行为的成因进行分析,发现以下问题:医保管理部门的法律制度不健全、部门联动缺失、双向沟通机制不完善,医疗机构的管理精细化程度不够、绩效考核体系落后、双向转诊落实不理想,部分参保患者存在负向就医行为。因此,避免负向医疗行为发生的治理策略包括:医保管理部门应健全法律制度体系、建立部门联动机制、拓展双向沟通渠道,医疗机构应推进管理精细化程度、调整绩效考核体系、建立分级诊疗秩序,参保患者应提高道德感使命感,共同维护医保基金安全。

中国社会医疗保险制度未来发展的挑战与创新建议

中国社会医疗保险制度发展至今,已覆盖了95%以上的人口,筹资和报销待遇都达到了与国民经济所处的中等收入国家地位相称的水平,但也存在不同人群待遇相差悬殊、医保基金使用效率不高的问题。未来需要从实现公平的国民待遇、进行科学的医保筹资规划、制定统一的医疗服务价格、设计合理的医保报销政策、明确划分中央与地方政府的职责等方面,正视挑战,创新发展,避免医保制度发展的中等收入陷阱。

医保支付方式由治病向健康转型—先期探讨研究

为系统讨论医保支付方式改革驱动由治病向健康转型的可能性和实践模式,以目标—发展重点透视矩阵作为分析框架,以慢性病为切入点,基于安徽省医共体慢性病打包支付的案例,探讨中国情境下的以健康为导向的医保支付方式改革的路径和方法。研究发现,伴随人口结构和社会需求的变化,在理念层面上,医保支付政策已体现出由治病向健康转型的态势,医保支付政策的内容、形式、载体趋向多样化。目前中国复合式医保支付框架已经建立,但改革内容和进展不平衡,尚未发挥向健康转型的激励引领作用。持续推进医保支付方式改革并对改革内容进行适应性调整,将是下一阶段工作的重点。

河北省老年人病死率调查及补充医疗保险的作用研究

目的探讨河北省老年人病死率的情况以及补充医疗保险对老年人健康状况的作用,为提高老年人健康水平和制定相关政策提供科学依据。方法采用分层多阶段整群抽样方法,从河北省11个省辖市进行抽样,研究对象为2020至2022年死亡的老年群体,统计死亡率、是否参加补充医疗保险、医疗服务获得情况、医疗费用支出等。结果循环系统、肿瘤和消化是老年人死亡的主要原因,三者合计占所有疾病死亡人数的70.6%,循环系统是老年人死亡的首要原因;老年人死亡率随着年龄的增长而逐渐增加;入院治疗的70~79岁的老年人数量最多,但是60~69岁的老年人的次均住院费用和自付比例均最高,≥80岁的老年人的次均自付费用和自付比例均最低;补充医疗保险使老年人死亡率显著降低。结论补充医疗保险对老年人的健康状况产生积极的作用,可以降低老年人的病死率,并提供额外的医疗保障,减轻老年人的经济负担,从而更容易获得医疗服务和治疗。针对老年人的健康状况、生活习惯、医疗保障状况等方面的调查也有助于制定相关政策,提高老年人的健康水平。

医保政策与健康伦理的冲突与对策分析

针对现行医保政策与患者健康伦理的冲突现象进行原因分析,汇总原因如下:医保基金的可持续发展状况堪忧、医保管理体系有待完善、医保管理部门与医疗机构协商谈判机制不健全、医疗卫生资源配置和人民群众的卫生服务需求不匹配。针对上述原因,应从调整医保基金筹资机制、构建多层次医疗保障体系、健全医保管理体系、建立医保管理部门与医疗机构协商谈判机制、促进医疗机构精细化管理程度等方面入手,维护医保基金安全,提高患者就医满意度。

2018—2022年天津市第二人民医院国家医保谈判药品使用情况分析

目的 了解天津市第二人民医院国家医保谈判药品(以下简称“谈判药品”)使用情况,为优化与调整医院药品目录提供参考。方法 回顾性分析该院2018年1月1日—2022年12月31日谈判药品的使用情况,比较谈判药品谈判前后药品单价、销售数量及销售金额、用药频度(DDDs)、日均费用(DDC)等变化情况。结果 2018—2022年医院使用的谈判药品品种从原来的5种增加至24种,分析比较的13个药品中有11个药品经谈判后单价降低,7个药品经谈判后纳入医保及医保门诊特定病支付目录。DDC平均降幅36.43%,DDDs平均增幅1 770.31%,该项政策施行提高了患者用药的可及性,销售数量显著增加。结论 通过降低药品单价、纳入医保支付范围等方式实现谈判药品销售数量显著增加。谈判药品经济性提高,有效减轻患者负担,促进医院用药合理化,提高药品可及性和效率。

健康中国视角下医保基金与公卫资金统筹使用路径研究

医保基金和公卫资金的统筹使用是促进服务融合、持续推进“健康中国”建设的驱动力。依据协同优势理论与PCIC理论,本研究提出了推动医保基金与公卫资金统筹使用的三大路径,即理顺购买内容、优化购买方式和强化购买能力。基于上述路径视角的研究发现,目前国内统筹使用的探索实践已取得一定成效,但也存在资金来源不明确、购买服务范围不清晰、多主体考核激励协调性不足,与健康产出关联性不强、成本核算与健康测量考核能力不足、信息系统互联互通不足等问题。建议完善顶层设计,建立与健康结果相关的考核支付激励机制,实现资金扩容与信息化的动态建设。

商业医疗保险的收入再分配效应研究

本文使用2019年中国家庭金融调查(CHFS)数据,实证分析了商业医疗保险的收入公平分配效应,并对其作用机制进行了探讨。研究表明:商业医疗保险有助于促进群体间的正向收入再分配,显著缩小个体收入差距。商业医疗保险主要通过灾难性医疗支出控制路径、身体健康状况提升路径缓解居民收入差距,而商业保险补偿在提升身体健康状况路径上呈现相反影响。本文以存在问题为导向,借鉴新加坡、荷兰、美国、芬兰等国相关实践经验,为提升商业医疗保险的收入公平分配效果,提出挖掘民众参保需求、完善产品设计开发、健全政府机构和市场主体的医疗控费机制、落实以预防为主的多层次健康管理战略等优化建议。

家庭化人口迁移、医保社商合作政策与商业健康保险消费

在家庭化人口迁移趋势愈加明显以及中国医保政策不断推进的背景下,商业健康保险在多层次医疗保障体系中的作用逐渐凸显。通过构建医保社商合作政策的“目标—工具—执行”评价体系,搭建政策编码数据库,对各省份医保社商合作政策的推进力度进行测度。在此基础上利用CHFS2019年数据,全面探讨家庭化人口迁移和医保社商合作政策对商业健康保险消费的影响。回归结果显示,随着家庭化人口迁移程度的加深,家庭对商业健康保险的消费意愿和消费程度均会显著增加;同时中国各地医保社商合作政策能够明显刺激家庭商业健康保险消费,而且将进一步扩大家庭化人口迁移对商业健康保险消费的拉动作用。由异质性分析可知,家庭化人口迁移和医保社商合作政策对商业健康保险消费的拉动影响在东中部地区、健康状况较好的家庭以及户主文化水平在高中及以上的家庭中更为明显。

医保真实世界数据研究面临的挑战

目的:本研究基于英国国家卫生与服务优化研究院(NICE)的真实世界数据(RWD)应用案例,分析药品医保准入中RWD的角色与挑战,为我国政策制定提供借鉴。方法:采用案例研究法,分析NICE体系下药品准入与管理准入计划(MAA)的实施细节。结果:英国医保体系通过NICE实施的MAA,利用RWD评估药品疗效与成本效益,促进了创新药品快速进入国家医疗服务体系(NHS)。结论:我国可借鉴英国经验,完善RWD相关政策与标准,加强国际合作,推动RWD在医保体系的广泛应用与深入发展,为医疗资源的优化配置与患者的医疗保障提供更加坚实的支撑。

城乡医保统筹影响流动老人医疗服务利用、医疗负担及健康损耗的机制分析和实证检验

利用中国健康与养老追踪调查(CHARLS)2013—2020年四期数据,采用固定效应模型实证城乡医保统筹对流动老人医疗服务利用、医疗负担及健康损耗的影响效应。研究结果表明:与新农合相比,城乡医保统筹提高了流动老人的就诊次数,降低了流动老人的医疗负担,并对流动老人的认知损耗有显著抑制作用,但未对其住院次数和行动损耗产生显著影响。通过工具变量法回归后,城乡医保统筹一定程度上降低了流动老人的行动损耗。进一步分析发现:城乡医保统筹对女性流动老人、有家庭照料的流动老人、健康状况较差的流动老人就诊次数和认知损耗的影响更大,也显著减少了无家庭照料流动老人的住院次数。基于此,提出相应对策建议。

在京部属高校医保制度的调查与思考

随着我国医疗保险覆盖面的逐步扩大,医保制度使居民享受到更高质量的医疗服务、医保实时结算等一系列实实在在的实惠以及更大的就医便利度,“全民医保”已然成为大趋势和共识。为探索在京部属高校医保制度改革前景,改变当前在京部属高校师生就医困难、选择受限、无法享受优质医疗资源,以及在京部属高校未被纳入医保系统、医患矛盾日益加重等困境,笔者调查相关高校实施医保政策制度经验,提出医疗改革可渐进式由公费医疗并入医保,或增加定点医疗机构的形式,以期早日为在京部属高校师生提供更便利、更优质的医疗服务。

基本医疗保险参与增强居民家庭经济韧性了吗?

基于中国家庭追踪调查(CFPS)2014—2020年共4期数据,利用贫困陷阱理论和非线性动力学理论测度居民家庭经济韧性,厘清基本医疗保险参与增强居民家庭经济韧性的机理。研究发现,基本医疗保险参与能显著增强居民家庭经济韧性,并且这一结果具有稳健性。改善家庭成员健康状况和减轻家庭医疗负担是基本医疗保险参与增强居民家庭经济韧性的重要渠道。按照基本医疗保险发挥边际效果的特征,居民家庭可划分为高效型、低效型、无效型等类型,其中无效型和低效型家庭经济韧性较强、医疗负担较低。随着居民家庭经济韧性的增强,基本医疗保险参与的边际效果逐渐下降。低收入家庭基本医疗保险参与增强居民家庭经济韧性的效果最显著,高收入家庭则无显著效果。