Evaluation of a pilot cooperative medical scheme in rural China: impact on gender patterns of health care utilization and prescription practices.
Evaluation of a pilot cooperative medical scheme in rural China: impact on gender patterns of health care utilization and prescription practices.
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DOI：
10.1186/1471-2458-11-50
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发表时间：
2011-01-24
影响因子：
4.5
通讯作者：
Cherry N
中科院分区：
文献类型：
--
作者：
Jiang Q;Jiang Z;Zhao M;Tao J;Ling C;Cherry N
2003年，中国政府推出了自愿合作医疗计划（CMS），很快将在中国农村地区实施。选择参加的家庭作为一个单位参加，不知道这些新计划对家庭成员有什么不同的影响。本研究评估了安徽省合作医疗试点项目对5岁以下女童和65岁以上妇女医疗服务使用情况以及处方模式和费用的影响。在4个乡镇（1个实施干预乡镇和3个未实施干预乡镇）中提取了为期10年的合作医疗试点前、中、后卫生保健记录。通过logistic回归分析评估干预措施对就诊患者的年龄和性别分布以及某些药物处方的影响。还评估了干预期间之前、期间和之后的处方费用。已确定203，058份登记和643，588份处方记录。在干预期间，总体而言，干预部位患者为女性的可能性降低（OR = 0.92：95%CI 0.87 - 0.97）。在CMS期间，年龄< 5岁的女孩获得医疗保健的可能性增加（OR = 1.41：95%CI 1.23 - 1.59），但年龄≥ 65岁的妇女相对不利（OR = 0.84：95%CI 0.75 - 0.95）。对于≥ 5岁的患者，干预部位抗生素和全身性类固醇的使用不成比例地增加。在干预现场，乡镇医院的处方费用也增加了，特别是老年男性。这项评价表明，所有家庭成员并没有平等地从试点合作医疗制度中受益，65岁以上的妇女可能因通过合作医疗制度新提供的医疗保健费用补偿而处于不利地位。它指出，在今后的评价中，需要使用个人而不是家庭作为分析单位，以确定这种保健不平等是广泛存在和持续存在，还是从长远来看有所减少。研究结果也支持了早期的担忧，即新的资金来源对处方实践的影响以及监管营利性处方的必要性。
In 2003 the Chinese government introduced voluntary cooperative medical schemes (CMS), soon to be in place throughout rural China. Families who chose to enroll do so as a single unit and nothing is known about any differential effect of these new schemes on family members. This study evaluates the impact of one pilot CMS in Anhui Province on health care use by girls aged less than 5 years and women 65 years or older, and on the pattern and cost of prescriptions. Health care records were extracted covering a 10 year period, before, during and after the pilot CMS in 4 townships, one with the intervention and 3 comparison townships without. The impact of the intervention on the age and gender distribution of patients presenting for health care and on the prescription of certain drugs was assessed by logistic regression. The cost of prescriptions before, during and after the intervention period was also assessed. 203,058 registration and 643,588 prescription records were identified. During the intervention there was a reduced likelihood overall that a patient was female (OR = 0.92: 95%CI 0.87 - 0.97) at the intervention site. Girls aged < 5 years had an increased likelihood of health care (OR = 1.41: 95%CI 1.23 - 1.59) during the CMS, but women ≥ 65 years were relatively disadvantaged (OR = 0.84: 95%CI 0.75 - 0.95). The use of antibiotics and systemic steroids increased disproportionately at the intervention site for patients ≥ 5 years. Prescription costs at the township hospital also increased at the intervention site, particularly for older men. This evaluation suggests that all family members did not benefit equally from the pilot CMS and that women ≥ 65 years may be disadvantaged by the newly available reimbursements of health care costs through the CMS. It points to the need, in future evaluations, to use individuals rather than families as the unit of analysis, in order to determine whether such health care inequalities are wide-spread and persistent or are reduced in the longer term. The results also support earlier concerns about the influence of new funding resources on prescription practices and the need for regulation of for-profit prescribing.
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影响因子：
2.1
作者：
Lei, Xiaoyan;Lin, Wanchuan
通讯作者：
Lin, Wanchuan
DOI：
10.1016/s0140-6736(08)61364-1
发表时间：
2008-10-25
期刊：
Lancet (London, England)
影响因子：
--
作者：
Tang S;Meng Q;Chen L;Bekedam H;Evans T;Whitehead M
通讯作者：
Whitehead M
影响因子：
3.5
作者：
Wagstaff, Adam;Lindelow, Magnus;Qian Juncheng
通讯作者：
Qian Juncheng
影响因子：
5.4
作者：
Sun, Xiaoyun;Jackson, Sukhan;Sleigh, Adrian C.
通讯作者：
Sleigh, Adrian C.
影响因子：
12.7
作者：
Victora, CG;Habicht, JP;Bryce, J
通讯作者：
Bryce, J