Research on optimizing urban basic medical insurance system based on SD method under aging population

目的 中国老龄化趋势日益严峻，其带来的医疗费用快速增长、医保支付压力增大问题凸显。本研究通过对老龄化背景下影响医疗费用与医保支付能力的因素进行研究，构建我国的城镇基本医疗保险系统动力学模型，预测系统行为趋势，模拟分析干预策略对系统行为的影响，为缓解个人医疗负担，确保医保基金平衡发展提供策略依据。 方法 本研究查阅卫生统计年鉴，摘要、国家统计年鉴等资料和相关文献，获得2007-2014年我国城镇基本医保基金收支、医院门诊，住院次均费用、参保人数等数据。 利用文献归纳医疗费用增长与医疗保险支付能力的影响因素和相关主体；用系统分析法分析系统的建模目标、结构和环境，界定我国城镇基本医疗保险系统...Objective The aging of population has experienced a heavy process in China, as a result, the cost of medical care for patients has grown rapidly and medical insurance payment problem has been severe. This paper aimed to analyze the influence factors on medical costs and medical insurance payment ability under the background of aging population, build a system dynamics (SD) model that may provide ...学位：医学硕士院系专业：公共卫生学院_社会医学与卫生事业管理学号：3262014115056

The effect of medical insurance impact on Chinese eiderly~s medical expenses：results from the survey of CLHLS

目的分析中国60岁及以上老年人医疗费用的影响因素，探讨医疗保险类型及其作为主要支付者对老年人医疗费用的影响。方法基于2011-2012年CLHLS调查数据，应用Kruskal-Wallis检验和多元线性回归模型分析老年人医疗费用的影响因素，同时探讨医疗保险类型及其作为主要支付者对老年人医疗费用的影响。结果参加新型农村合作医疗和其他补充医疗保险可显著缓解老年人的医疗费用；从主要支付者分析，虽然参加了医疗保险，但多数老年人医疗费用仍以自付为主；新型农村合作医疗和商业医疗保险作为主要支付者可以缓解老年人医疗费用压力。结论应提高老年人基本医疗保险的参保率和新型农村合作医疗保险的报销比例，发挥基本医疗保险在缓解老年人医疗费用负担中的作用；同时促进老年人商业医疗保险参与，扩大社会医疗救助机构或养老中心的建设，缓解老年人医疗费用负担。Objective To analyze the influence factors of medical expenses of the elderly, explore the effect of different health in- surance on medical expenses and discuss how the medical insurance as the main payment to influence medical expenses. Methods Kruskal- Wallis test and general multivariate linear regression model were used to analyze the influence factors based on the data from CLHLS in 2011 - 2012. Results The participating in the new rural cooperative medical insurance scheme （NCMS） and urban residents basic medical insurance （UR-BMI） were significantly related to the level of the elderly＇s medical fees, medical expenses of the elderly were mainly paid by themselves, the NCMS and commercial medical insurance as the main payment eased the pressure of medical expenses for the elderly. Con- clusions The expanding coverage of basic medical insurance and reimbursement ratio of the NCMS, encouraging the elderly to participate in commercial medical insurance, expanding social assistance institutions or pension institutions could alleviate the pressure on medical expen- ses for the elderly.国家自然科学基金青年项目（No.71403229

The Empirical Research on Public Hospital Financial Management based on? Du Pont Analysis

目的:分析公立医院的财务管理现状,为进一步提高我市公立医院财务精细化管理水平、实现医院财务目标提供基础。方法:基于传统杜邦分析法建立公立医院杜邦分析体系及财务指标关系,选取厦门市A、B、C 3家有代表性的公立医院,应用杜邦分析法对其财务管理能力进行实证分析。结果 A、B、C 3家公立医院的年均净资产收益率分别为6.87%、4.04%、4.36%,超过年均银行1年期存款利率。其中A医院的净资产收益率较B、C医院高,C医院受权益乘数的驱动作用,净资产收益率较B医院平均高出0.32%,但3家医院的净资产收益率整体均下降。进一步分析业务收益率发现,业务收支结余增长幅度低于业务收入增长幅度,其中专用材料支出的大幅度增长导致业务收支结余增加缓慢。结论:公立医院的财务管理能力整体较好,在保持一定资产盈利水平的同时,能调整资金结构和控制财务风险。但还需要适当利用外部资金投入,加强医院成本控制,尤其是专业材料的支出,进一步提升运营水平和业务获利能力。Objective To analyze the status of financial management in public hospital,provide the basis for further improving refined management level and finally realize the goal of public hospital financial management. Methods Du Pont analysis system of public hospital and relationship between financial indicators were established based on traditional Du Pont analysis method. Three public hospitals were purposively chosen,and then an empirical study on financial management ability was conducted by applying Du Pont analysis. Results The annual net assets income rates were 6. 87%,4. 04%,4. 36%,respectively. All of them were larger than one-year deposit rate. Moreover,Hospital A was higher than hospital B and hospital C. Hospital C was 0. 32% higher than that of B hospital under the driving effects of rights multiple. However,all three hospitals' net assets income rate showed a descending tendency. Further analyzing return ratio of business it could be obtained that the increase of business revenue and expenditure surplus was less than that of business revenue. A major reason was that special? material expenditure increased rapidly. Conclusion Three hospitals' financial management ability was generally well,they could adjust the capital structure and control the financial risk while maintaining assets profitability. In spite of that,they still needed to use external funding appropriately,strengthen cost control special material expenditure and further improve capital operating level as well as business profitability.上海交通大学中国医院发展研究院招标课题“建立符合国情的现代医院管理制度系列研究”——公立医院财务制度研究(编号:SJYF2014XD007A);; 中国卫生经济学会中标课题“公立医院改革对公立医院经济运行及现行医院财务会计制度的影响研究”(编号:卫学字(2015)12号

巴戟天多糖的分离与纯化新方法

以巴戟天(Morinda officinalisHow)为原料,运用多种理化方法,提取纯化巴戟天粗多糖,经红外吸收光谱比较和鉴定确认提取物中有多糖特征吸收.采用苯酚—硫酸法测定多糖含量,以多糖的纯度和提取率为主要指标,对提取方法进行优化.结果表明,用乙醇-水提取法进行提取,用Sevag法除蛋白,氯化十六烷基吡啶(CPC)结合醇沉法进行纯化.正交实验结果表明提取纯化巴戟多糖最隹条件是乙醇浓度为85%,CPC浓度为0.4%,粗多糖浓度为10%的条件下,纯化多糖的纯度为89.7%,多糖的提取率为10.2%

老龄化背景下我国医疗保险制度的系统动力学研究

目的建立老龄化背景下我国医疗保险系统动力学模型,观察医疗保险收支和个人支付医疗费用发展趋势,以及干预行为对系统的影响,为实现在维持医保基金平衡的基础上,最大程度地降低患者医疗费用负担提供政策建议。方法通过文献分析法、系统分析法确定医保系统主体。依据系统动力学方法,构建系统模型并进行仿真模拟。结果城镇基本医保基金收入与支出呈逐年增长趋势,医保基金结余逐年减少,至2025年医保基金结余为-239. 6亿元,个人支付费用为3620. 0元。结论模型能较为客观的模拟系统结构与行为规律,可用于医保费用的预测与政策干预。提高社区门诊和住院比例、提高政府对城镇居民医保费用的筹资标准、人口赡养比、离退休人口缴纳医保费用可有效降低个人的支付费用负担,促进医保系统的可持续发展。国家自然科学基金项目(71874147);;福建省自然科学基金面上项目(2017J01133

信息反馈对城市居民节水态度行为的影响

本研究旨在探究节水技巧信息反馈和社会情绪对节水态度行为的影响。分为两个研究,无反馈方式下,节水技巧信息框架对节水态度行为的影响和有反馈方式下,节水技巧信息框架和社会情绪对节水态度行为的影响,每个研究包含两种信息框架作为不同反馈方式的实验设计,参与实验的被试共计335人。结论:(1)信息框架对节水态度行为的影响,体现在反馈方式有或无的实验对照中;(2)消极框架下被试节水态度行为的分数略高于积极框架下&nbsp;</p