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1.
J Infect Dev Ctries ; 13(12): 1101-1107, 2019 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-32088697

RESUMO

INTRODUCTION: Antibiotic consumption is associated with the development of antibiotic resistance. Our aim was to study the relationship between antibiotic consumption and carbapenem-resistant Klebsiella pneumoniae (CRKP) in three public general tertiary hospitals from 2011-2015 in the eastern, western and central regions of China. METHODOLOGY: Valid data were collected quarterly, and the antibiotic consumption data were expressed as the defined daily dose (DDD) per 100 inpatient days (ID). Bacterial resistance was reported as the percentage of resistant isolates among all tested isolates. Individual trends were calculated by linear regression, while possible correlations between antibiotic consumption and CRKP were evaluated by distributed lags time series analysis. RESULTS: Over the 5-year period, an overall significant increasing trend (P < 0.1, R2 > 0.3) of carbapenems consumption and the prevalence of CRKP was observed in all three hospitals. This correlated with the use of ceftazidime, cefoperazone/sulbactam, cefminox and meropenem at a hospital in eastern China, with the increased use of meropenem at a hospital in eentral China and with the increased use of doxycycline, ceftriaxone, ceftazidime, meropenem and biapenem at a hospital in western China. CONCLUSIONS: We report a high incidence of CRKP in all three hospitals and that an increase in carbapenem usage is associated with this. Further research is needed to elucidate which factors influence the increased consumption of carbapenems.

2.
Community Dent Oral Epidemiol ; 46(6): 576-585, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29968253

RESUMO

OBJECTIVES: The goal of this study was to investigate inequality in dental service utilization in Chinese middle-aged and senior adults and changes in inequality over time and to determine the sources of inequality. METHODS: The data included 17 648 individuals aged 45 years and older in 2013 and 15 450 individuals in 2015 who participated in the China Health and Retirement Longitudinal Study (CHARLS). The concentration index was used to quantify the degree of inequality. A decomposition method was employed to determine the sources of inequality, including need variables (demographic characteristics, self-reported health status, and presence of chronic diseases), living standard (measured by household consumption expenditure per capita), other non-need variables (education level, marital status, region of residence, urban-rural difference and type of health insurance plans). RESULTS: The better-off not only had a higher likelihood of using dental care services than did the worse-off but also used them more often than the worse-off. The concentration index for probability of dental care utilization increased from 0.074 to 0.112 between 2013 and 2015, and the concentration index for total number of dental visits increased from 0.085 to 0.127. Living standard, education, health insurance plans and urban-rural disparities showed a pro-rich contribution to the inequality. The living standard contributed about 70% to the pro-rich inequality. CONCLUSIONS: Dental care utilization in the Chinese middle-aged and older adults was concentrated in the better-off. Inequality in dental care utilization widened from 2013 to 2015. Achieving equity in dental care utilization remains a challenge for the healthcare system in China.


Assuntos
Assistência Odontológica , Disparidades em Assistência à Saúde , Idoso , China , Assistência Odontológica/estatística & dados numéricos , Feminino , Nível de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Socioeconômicos
3.
PLoS One ; 13(5): e0196668, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29723230

RESUMO

BACKGROUND: China has a high rate of antibiotic use. The Chinese Ministry of Health (MOH) established the Center for Antibacterial Surveillance (CAS) to monitor the use of antibacterial agents in hospitals in 2005. The purpose of this study was to identify trends, pattern changes and regional differences in antibiotic consumption in 151 public general tertiary hospitals across China from 2011-2014. MATERIALS AND METHODS: Valid data for antibiotic use were collected quarterly, and the antibiotic consumption data were expressed as the defined daily dose (DDD) per 100 inpatient days (ID). We compared the patterns of antibiotic use in different classes and geographical clusters. RESULTS: Total antibiotic use significantly decreased (P = 0.018) from 75.86 DDD/100 ID in 2011 to 47.03 DDD/100 ID in 2014. The total consumption of flomoxef sodium and cefminox increased from 1.31 DDD/100 BD in 2011 to 8.6 DDD/100 BD in 2014. Cephalosporins were the most frequently used antibiotics in all regions. Third-generation cephalosporins accounted for more than 45% of the cephalosporins used. Carbapenem use substantially increased (P = 0.043). Penicillin combinations with inhibitors accounted for 50% of the penicillin used, and prescribed meropenem accounted for most of the carbapenems used in all regions in 2014. The subclasses in each antibiotic group were used differently between the seven regions, and the total hospital antibiotic use in 2014 differed significantly by region (P = 0.014). CONCLUSION: Although the volume and intensity of total antibiotic use decreased, the antibiotic use patterns were not optimal, and broad-spectrum antibiotics were still the main classes. The aggregate data obtained during the study period reveal similar antibiotic consumption patterns in different regions. These findings provide useful information for improving the rational use of antibiotics. More detailed data on antibiotics linked to inpatient diseases need to be collected in future studies.


Assuntos
Antibacterianos/uso terapêutico , Hospitais Gerais/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Antibacterianos/economia , Gestão de Antimicrobianos , China , Uso de Medicamentos/tendências , Humanos , Motivação , Padrões de Prática Médica/economia
4.
Artigo em Inglês | MEDLINE | ID: mdl-28933772

RESUMO

BACKGROUND: Equitable utilization of health care is a primary goal of the Chinese health system. This study aimed to examine horizontal inequity in health care utilization and identify the factors resulting in inequity among the middle-aged and elderly in China. METHODS: The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). We employed the concentration index (CI) and horizontal inequity (HI) to measure inequity in health care utilization. Non-linear regression models were used to decompose the CI into the contribution of each factor. RESULTS: The CIs for the probability of and total number of outpatient visits were 0.0642 and 0.0780, respectively, and those for inpatient visits were 0.1418 and 0.1471, respectively. The HIs were also significantly positive. Living standard was the most important contributor. The contribution of health insurance varied between plans. CONCLUSIONS: This study supported the presence of pro-rich inequity in health care utilization for both probability and frequency among the middle-aged and elderly in China. Narrowing the living standard gap and improving the health insurance benefit package for the elderly should help to resolve these inequities.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Idoso , China , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise de Regressão
5.
Int J Equity Health ; 14: 107, 2015 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-26616447

RESUMO

INTRODUCTION: There have been significant improvements in health outcomes in Tibet, health disparities between Tibet and the rest of China has been greatly reduced. This paper tests whether there was a positive association between good primary care and better health outcomes in Tibet. METHOD: A validated Tibetan version of the Primary Care Assessment Tool (PCAT-T) was used to collect data on 1386 patients aged over 18 years old accessing primary care. Self-rated health (SRH) was employed to measure health outcomes. A multiple binary logistic regression model was used to explore the association between primary care quality and self-rated health status after controlling for socio-demographic and lifestyle variables. RESULTS: This study found that primary care quality had a significant positive association with self-rated health status. Among the nine domains of PCAT-T, family centeredness domain had the highest Odds Ratio (OR = 1.013) with SRH. Patients located in rural area, with higher education levels, without depression, and less frequent drinking were more likely to self-rate as "good health" compared with the reference group. CONCLUSIONS: In Tibet, higher quality primary care was associated with better self-rated health status. Primary care should be much strengthened in future health system reform in Tibet.


Assuntos
Saúde/normas , Percepção , Atenção Primária à Saúde/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoavaliação Diagnóstica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inquéritos e Questionários , Tibet
6.
Complement Ther Med ; 23(5): 637-43, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26365442

RESUMO

OBJECTIVES: To describe the major factors influencing financial compensation in traditional Chinese medicine (TCM) and prioritize what TCM services should be compensated for. DESIGN AND SETTING: Two structured questionnaires-a TCM service baseline questionnaire and a service cost questionnaire-were used to collect information from TCM public hospitals on TCM services provided in certain situations and service cost accounting. The cross-sectional study examined 110 TCM services provided in four county TCM public hospitals in Shandong province. From the questionnaire data, a screening index system was established via expert consultation and brainstorming. Comprehensive evaluation of TCM services was performed using the analytic hierarchy process method. MAIN OUTCOME MEASURES: Weighted coefficients were used to measure the importance of each criterion, after which comprehensive evaluation scores for each service were ranked to indicate what services should receive priority for financial compensation. RESULTS: Economy value, social value, and efficacy value were the three main criteria for screening for what TCM services should be compensated for. The economy value local weight had the highest value (0.588), of which the profit sub-criterion (0.278) was the most important for TCM financial compensation. Moxibustion was tied for the highest comprehensive evaluation scores, at 0.65 while Acupuncture and Massage Therapy were tied for the second and third highest, with 0.63 and 0.58, respectively. CONCLUSIONS: Government and policymakers should consider offer financial compensation to Moxibustion, Acupuncture, Massage Therapy, and TCM Orthopedics as priority services. In the meanwhile, it is essential to correct the unreasonable pricing, explore compensation methods, objects and payment, and revise and improve the accounting system for the costs of TCM services.


Assuntos
Terapia por Acupuntura , Reembolso de Seguro de Saúde , Massagem , Medicina Tradicional Chinesa , Terapia por Acupuntura/economia , Terapia por Acupuntura/estatística & dados numéricos , Estudos Transversais , Humanos , Massagem/economia , Massagem/estatística & dados numéricos , Medicina Tradicional Chinesa/economia , Medicina Tradicional Chinesa/métodos
7.
Int J Equity Health ; 14: 45, 2015 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-25971748

RESUMO

INTRODUCTION: This paper assesses both patients' perspectives on the differences in primary care quality between traditional Tibetan medicine (TTM) hospitals and western medicine (WM) hospitals and the efficacy of the government's investment in these two Prefecture-level primary care structures in Tibet. METHOD: A validated Tibetan version of the Primary Care Assessment Tool (PCAT-T) was used to collect data on 692 patients aged over 18 years old, who reported the sampling site was their regular source of health care. T-tests were performed to compare the separate and total primary care attributes between WM hospitals and TTM hospitals. Multiple linear regression analysis was conducted to examine the association of the health care setting with primary care attributes while controlling for socio-demographic, health service use and health status characteristics. RESULTS: Compared to WM hospitals, the results showed that TTM hospitals had patients who were older (15.8 % versus 8.4 % over 60 years); with lower education levels (66.0 % versus 35.8 % with below junior high school ) and income levels (46.9 % versus 26.5 % with annual household income below 30,000RMB); more likely to be married (79.2 % versus 60.5 %); made less frequent health care visits; and had higher self-rated health status. Overall, patients assessed the primary care performance in TTM hospitals significantly higher (80.0) than WM hospitals (74.63). There were no differences in health care assessment by patient gender, age, income, education, marital status and occupation. CONCLUSIONS: TTM patients reported better primary care experiences than patients using WM hospitals, which validated the government's investment in traditional Tibetan medicine.


Assuntos
Medicina Tradicional Tibetana , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Ocidente , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inquéritos e Questionários , Tibet
8.
Biomed Res Int ; 2015: 206709, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25861619

RESUMO

OBJECTIVE: To compare the primary care quality among different health care structures in Tibet, China. METHODS: A self-administered questionnaire survey including Primary Care Assessment Tool-Tibetan version was used to obtain data from a total of 1386 patients aged over 18 years in the sampling sites in two prefectures in Tibet. Multivariate analysis was performed to assess the association between health care structures and primary care quality while controlling for sociodemographic and health care characteristics. RESULTS: The services provided by township health centers were more often used by a poor, less educated, and healthy population. Compared with prefecture (77.42) and county hospitals (82.01), township health centers achieved highest total score of primary care quality (86.64). Factors that were positively and significantly associated with higher total assessment scores included not receiving inpatient service in the past year, less frequent health care visits, good self-rated health status, lower education level, and marital status. CONCLUSIONS: This study showed that township health centers patients reported better primary care quality than patients visiting prefecture and county hospitals. Government health reforms should pay more attention to THC capacity building in Tibet, especially in the area of human resource development.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Tibet
9.
J Pharm Policy Pract ; 7(1): 12, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25317336

RESUMO

OBJECTIVES: The rapid increase in drug expenditure has become a major source of public criticism in China. In 2009, the National Essential Medicine System (NEMS) was launched in China to control drug prices and improve access to medicines. This study investigated whether and to what extent the prices of essential medicines were reduced after the introduction of NEMS. METHODS: Data were obtained from 149 public primary healthcare centers (PHCs) in four Chinese provinces (Shandong, Zhejiang, Anhui and Ningxia) using a facility-based survey. In total, 10,988 essential medicines were investigated. Individual price differences and a price index were used to measure price changes for three different lists: 2009-2010, 2010-2011, and 2009-2011. RESULTS: In the comparison between 2009 and 2010, a median decrease of 34.4% [95% confidence interval: 30.4%-39.1%] was observed in drug prices and the number of drug sales increased by 1.5%. The higher the retail price in 2010, the more the drug sales increased compared with 2009 (χ (2) = 75.9, p < 0.01). The drug revenues in 100 of the 149 surveyed PHCs decreased by an average of 39%. Where the available data allowed price changes for 2009-2011 to be assessed, drug prices were reduced significantly in 2010, but a modest decrease was seen in 2011. The Laspeyres index was less than 100 and the Paasche index was larger than the Laspeyres index in 2010 and 2011, which indicated that the frequently prescribed drugs usually had higher prices and any price reduction was milder. CONCLUSIONS: The introduction of NEMS in PHCs in China led to price reductions in essential medicines. However, more-expensive drugs were preferred in the postreform period. Most PHCs had less drug revenue and could encounter financing dilemmas after the implementation of NEMS. Policy options such as improving the compensation mechanism and rational use of drugs should be further promoted in PHCs.

10.
BMC Health Serv Res ; 14: 507, 2014 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-25344413

RESUMO

BACKGROUND: The National Essential Medicine System (NEMS) is a new policy in China launched in 2009 to improve the appropriate use of medications. This study aims to examine the outcomes of the NEMS objectives in terms of the rational use of medicines in primary health care facilities in China. METHODS: A total of 28,651 prescriptions were collected from 146 township health centers in four provinces of China by means of a field survey conducted in 2010-2011. Indicators of rational drug use were extracted and compared using a pre/post design and then evaluated with regard to the World Health Organization (WHO) Standard Guidelines and data from previous research. RESULTS: The average number of drugs per prescription decreased from 3.64 to 3.46 (p < 0.01) between 2009 and 2010. Little effect was found for the NEMS on the average number of antibiotics per prescription, but the percentage of prescriptions including antibiotics decreased from 60.26 to 58.48% (p < 0.01). Prescriptions for injections or adrenal corticosteroids also decreased, to 40.31 and 11.16% of all prescriptions, respectively. All these positive issues were also recorded in 2011. However, each of the above values remained higher than WHO standards. The percentage of drugs prescribed from the Essential Drug List increased after the implementation of the NEMS (p < 0.01). Where the available data allowed changes in costs to be assessed, the average expense per prescription increased significantly, from 25.77 to 27.09 yuan (p < 0.01). CONCLUSIONS: The NEMS effectively improved rational medicine use in China. However, polypharmacy and the over-prescription of antibiotics and injections remain common. There is still a large unfinished agenda requiring policy improvements. Treatment guidelines, intensive support supervision, and continuing training for both professionals and consumers are the essential actions that need to be taken.


Assuntos
Prescrições de Medicamentos/economia , Prescrições de Medicamentos/estatística & dados numéricos , Medicamentos Essenciais/economia , Medicamentos Essenciais/normas , Sistemas de Medicação/estatística & dados numéricos , Sistemas de Medicação/normas , Atenção Primária à Saúde/normas , China , Guias como Assunto , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Organização Mundial da Saúde
11.
Biomed Res Int ; 2014: 308739, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24967349

RESUMO

OBJECTIVE: To develop a primary care assessment tool in Tibetan area and assess the primary care quality among different healthcare settings. METHODS: Primary care assessment tool-Tibetan version (PCAT-T) was developed to measure seven primary care domains. Data from a cross-sectional survey of 1386 patients was used to conduct validity and reliability analysis of PCAT-T. Analysis of variance was used to conduct comparison of primary care quality among different healthcare settings. RESULTS: A 28-item PCAT-T was constructed which included seven multi-item scales and two single-item scales. All of multi-item scales achieved good internal consistency and item-total correlations. Scaling assumptions tests were well satisfied. The full range of possible scores was observed for all scales, except first contact and continuity. Compared with prefecture hospital (77.42) and county hospital (82.01), township health center achieved highest primary care quality total score (86.64). CONCLUSIONS: PCAT-T is a valid and reliable tool to measure patients' experience of primary care in the Tibet Autonomous Region. Township health center has the best primary care performance compared with other healthcare settings, and township health center should play a key role in providing primary care in Tibet.


Assuntos
Atenção Primária à Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tibet
13.
PLoS One ; 8(1): e53062, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23326382

RESUMO

BACKGROUND: The New Cooperative Medical Scheme (NCMS) provides health insurance coverage for rural populations in China. This study aimed to evaluate changes in household catastrophic health expenditure (CHE) due to chronic disease before and after the reimbursement policies for services of chronic disease were implemented to provide additional financial support. METHODS: The study used data from the household surveys conducted in Shandong Province and Ningxia Hui Autonomous Region in 2006 and 2008. The study sample in village-level units was divided into two groups: 36 villages which implemented the NCMS reimbursement policies for chronic diseases as the intervention group, and 72 villages which did not as the control group. Health care expenditure of more than 40% of household's non-food expenditure was defined as a household with CHE (i.e., impoverishment). The conceptual framework was established based on the Andersen socio-behavioral model of health care utilization to explore how the NCMS reimbursement policies impacted health expenditures. A difference-in-difference model was employed to compare the change in the proportion of households incurring CHE due to chronic disease between the two groups over time. RESULTS: The households that participated in the NCMS were less likely to become impoverished (P<0.05). In addition, the households with both male household head and higher income level were protective factors to prevent CHE (P<0.05). Young households with preschool children suffered less from CHE (P<0.05). The effect of the NCMS reimbursement policies for chronic disease on the CHE was negative, yet not statistically significant (p = 0.814). CONCLUSIONS: The NCMS coverage showed financial protection for households with chronic disease. However, the NCMS reimbursement policies should be strengthened in the future.


Assuntos
Doença Crônica/economia , Serviços de Saúde Comunitária/economia , Efeitos Psicossociais da Doença , Financiamento Governamental/economia , Serviços de Saúde Rural/economia , Algoritmos , China , Serviços de Saúde Comunitária/estatística & dados numéricos , Características da Família , Feminino , Humanos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Masculino , Modelos Econômicos , Saúde da População Rural/economia , Saúde da População Rural/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos
14.
Health Policy Plan ; 24(5): 324-34, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19429698

RESUMO

This paper examines the determinants that influence health care demand decisions in rural areas of Gansu province, China. This represents the first effort to identify and quantify the effect of price of care on choice of provider in China, and is the first quantitative examination of this topic focusing on poor rural areas in China. In the three-tier health care system in rural China, we further distinguish the public village clinics and private village clinics using a mixed multinomial logit model. The results show that price and distance play significant roles in choice of health care provider. The price elasticity of demand for outpatients is higher for low-income groups than for high-income groups. When outpatients have particular concerns about provider quality or reputation, or when their health status is poor, distance tends to matter less, i.e. they are willing to travel further in order to obtain better treatment for their illness. Insurance status has a significant impact on the choice of public village clinics relative to self-treatment. Furthermore, age and the attributes of illness are also statistically significant factors. We discuss the policy implications of the results for meeting the health care needs of the poor in rural China.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Serviços de Saúde Rural , China , Custos de Cuidados de Saúde , Política de Saúde , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Modelos Econométricos , Serviços de Saúde Rural/economia
15.
Zhonghua Liu Xing Bing Xue Za Zhi ; 29(9): 865-8, 2008 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-19173845

RESUMO

OBJECTIVE: To determine the value and the optimal cutoff point of waist circumference (WC) in screening diabetes mellitus (DM) and to provide evidence for DM prevention and identifying population at risk in mid-western rural areas of Shandong province. METHODS: A sample consisting 16 341 rural residents was selected and studied. All participants were physically examined on height, weight, WC and fasting plasma glucose (FPG). Oral glucose tolerance test (OGTT) was performed for subjects with FPG valued from 6.1 to 7.0 mmol/L. DM was defined according to the criteria set by WHO in 1999. Area under the curve (AUC), sensitivity, specificity and Youden index were computed based on the receiver operating characteristic (ROC) curve analysis. Optimal cutoff point was determined by the maximum of Youden index. RESULTS: The prevalence rates of DM for males and females increased along with the rise of WC (trend test chi2 = 72.01, 122.65, P < 0.01). It appeared significantly higher in those with WC > or = 85 cm in females and > or = 80 cm in males, with those WC < 85 cm for females and < 80 cm for males, in particular. AUCs were 0.639 and 0.655 for males and females respectively and both had significant differences (t = 7.22, 11.07, P < 0.01). However, the AUCs did not show significant difference (t = 0.70, P > 0.05) between males and females. The Youden index reached maximum when WC approached 85 cm for females (24.90%) and 80 cm for males (24.39%). The sensitivity and specificity were 58.04% and 66.86% for males, and 67.08% and 57.31% for females. CONCLUSION: WC seemed to be an effective indicator for screening the DM. The optimal cutoff point of WC would be 85 cm for females and 80 cm for males in screening DM and defining the population at risk in this area.


Assuntos
Diabetes Mellitus/diagnóstico , Circunferência da Cintura , Adulto , Idoso , Glicemia/análise , Pressão Sanguínea , Índice de Massa Corporal , China , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Valores de Referência , População Rural , Sensibilidade e Especificidade
16.
Int J Health Plann Manage ; 19 Suppl 1: S63-78, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15686061

RESUMO

One quarter of all TB cases occur in China, which, during the past 20 years has moved from a planned economy to a socialist market economy. In the health sector, an important proportion of the financing originates from user payment. TB control is not an exception and different programmatic models are in place. This study examines, using a case study approach, three different TB programmes, one supposed to provide free service, one subsidized service and one with full cost recovery. The aim was to better understand the driving forces for programme performance in terms of case detection, case management and patient payments. The study found for all models that control and case management approaches were, to some extent, adapted to generate maximum income to the providers. The drive for income led to fewer cases detected, administration of unnecessary procedures and drugs, and a higher than necessary cost to the patients. The latter possibly leading to exclusion of poor people from the services. If user charges are to stay, TB control programmes need to be designed to take advantage of the financial incentives to improve performance. The referral system needs to be restructured, not to provide disincentives for good practices.


Assuntos
Controle de Doenças Transmissíveis/economia , Tuberculose/prevenção & controle , China , Controle de Doenças Transmissíveis/organização & administração , Humanos , Motivação , Política , Saúde Pública , Tuberculose/tratamento farmacológico , Tuberculose/economia
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