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Australian children living with rare diseases:health service use and barriers to accessing care

World Journal of Pediatrics 2023年第7期19卷 701-709页

作者： Suzy Teutsch Yvonne Zurynski Guy DEslick Marie Deverell John Christodoulou Helen Leonard Troy Dalkeith Sandra LJJohnson Elizabeth JElliott Faculty of Medicine and health Discipline of Child and Adolescent HealthThe University of SydneySydneyNSWAustraliaAustralian Australian Paediatric Surveillance Unit Kids ResearchSydney Children's Hospitals NetworkWestmeadNSWAustralia Australian Institute of health Innovation Center for Healthcare Resilience and Implementation Scienceand NHMRC Partnership Centre in Health System SustainabilityMacquarie UniversitySydneyNSWAustraliaFaculty of Medicine and HealthDiscipline of Child and Adolescent HealthThe University of SydneySydneyNSWAustralia Government Department of health Western Australia PerthWAAustralia Murdoch Children's Research Institute and Victorian Clinical Genetics services Royal Children's HospitalParkvilleVICAustralia Department of Paediatrics The University of MelbourneParkvilleVICAustralia Telethon Kids Institute The University of Western AustraliaNedlandsWAAustralia Genetic Metabolic Disorders service Sydney Children's Hospitals NetworkWestmeadNSWAustralia

Background Children with rare diseases experience challenges at home and school and frequently require multi-disciplinary *** aimed to determine health service utilization by Australian children with rare diseases and barriers to access-ing *** Parents completed an online survey on health professional and emergency department(ED)presentations,hospi-talization,and barriers to accessing *** barriers to service access included residential location(city,regional,remote)and child health-related functioning,determined using a validated,parent-completed measure-of-function *** Parents of 462 children with over 240 rare diseases completed the *** with the general population,these children were more likely to be hospitalized[odds ratio(OR)=17.25,95%confidence interval(CI)=15.50-19.20]and present to the ED(OR=4.15,95%CI=3.68-4.68)or a family physician(OR=4.14,95%CI=3.72-4.60).Child functional impairment was nil/mild(31%),moderate(48%)or severe(22%).Compared to children with nil/mild impair-ment,those with severe impairment were more likely to be hospitalized(OR=13.39,95%CI=7.65-23.44)and present to the ED(OR=11.16,95%CI=6.46-19.27).Most children(75%)lived in major cities,but children from regional(OR=2.78,95%CI=1.72-4.55)and remote areas(OR=9.09,95%CI=3.03-25.00)experienced significantly more barriers to healthcare access than children from major *** included distance to travel,out-of-pocket costs,and lack of specialist medical and other health *** Children with rare diseases,especially those with severe functional impairment have an enormous impact on health services,and better integrated multidisciplinary services with patient-centered care are *** must be improved for children living in rural and remote settings.

关键词： Access health functioning health service use Rare diseases

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Impact of an innovative tuberculosis financing and payment model on health service utilization by tuberculosis patients in China:do the poor fare better than the rich?

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Infectious Diseases of Poverty 2019年第3期8卷 101-101页

作者： Di Dong Wei-Xi Jiang Qian Long Fei Huang Hui Zhang Jia-Ying Chen Li Xiang Qiang Li Sheng-Lan Tang Henry Lucas 不详 National Center for Tuberculosis Control and Prevention China CDCBeijingChina Duke Global health Institute Duke UniversityDurhamNCUSA

Background:Tuberculosis(TB)prevalence is closely associated with poverty in China,and poor patients face more barriers to *** an insurance-based approach,the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients,particularly among the *** study aims to assess the program effects on service use,and its equity impact across different income ***:Data from 788 and 775 patients at baseline and final evaluation were available for analysis *** and outpatient service utilization,treatment adherence,and patient satisfaction were assessed before and after the program,across different income groups(extreme poverty,moderate poverty and non-poverty),and in various program cities,using descriptive statistics and multi-variate regression *** stakeholder interviews were conducted to qualitatively evaluate program implementation and ***:After program implementation,the hospital admission rate increased more for the extreme poverty group(48.5 to 70.7%)and moderate poverty group(45.0 to 68.1%),compared to the non-poverty group(52.9 to 643%).The largest increase in the number of outpatient visits was also for the extreme poverty group(4.6 to 5.7).The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other *** rates were high in all *** feedback from stakeholders also suggested that increased reimbursement rates,easier reimbursement procedures,and allowance improved patients'service *** of case-based payment made service provision more compliant to clinical ***:Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group,indicating improved equity in TB service *** pro-poor design of the pr

关键词： health service use Tuberculosis Financing and payment model Case-based payment

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中国医疗保险的地区差异及其对就医行为的影响

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社会保障制度 2017年第2期

作者：牛建林齐亚强

中国社会医疗保险在经历快速扩张后，于2010年前后实现了对全国城乡各地区的制度性全面覆盖。在这一背景下，各地居民实际拥有的医疗保险资源是否还存在突出差异？医疗保险资源是否会影响各地居民的医疗服务利用行为以及有病不医现象的... 详细信息

中国社会医疗保险在经历快速扩张后，于2010年前后实现了对全国城乡各地区的制度性全面覆盖。在这一背景下，各地居民实际拥有的医疗保险资源是否还存在突出差异？医疗保险资源是否会影响各地居民的医疗服务利用行为以及有病不医现象的严重程度？围绕这些问题，文章以中老年人群为例，利用全国性抽样调查数据进行了实证分析。研究发现，2011年，全国约有7％的中老年人没有任何医疗保险。未参保人群既包括社会经济资源相对匮乏者，也包括健康状况较好、预期医疗需求较低的个人。总体而言，医疗保险提高了参保人利用医疗服务的可能性；但不同医保项目的效应强度存在显著差异。新农合与城镇居民医保项目的促进作用相对较小，城镇职工医疗保险的效应明显更大，与商业医保的效应强度接近。值得一提的是，各地居民有病不医的现象主要取决于个人健康状况，医疗保险资源对有病不医现象的直接影响相当有限。研究认为，现阶段社会医疗保险项目的统筹层次较低，这在各地医疗卫生资源分布不均衡的现实背景下，极有可能制约医疗保险资源对于缓减看病贵、有病不医问题的实际效应，并在客观上增加保险的运行和管理成本。鉴于此，进一步改革医疗保险应当提高保险统筹层次，正视医疗卫生资源的分布差异，促进医有所保目标的真正实现。

关键词：医疗保险制度性全覆盖医疗服务利用有病不医地区差异 health insurance institutional full coverage health service use unmet medical needs regional disparity

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