Some of the tough decisions required by a national health plan

The goals of providing coverage for everyone in the United States and controlling the growth in national health expenditures require difficult decisions about what medical services to provide. Currently accepted practices vary enormously in the amount of health they produce for a given expenditure. Studies of the health effects of several major interventions in relation to their costs--Pap smears, mammography, coronary care units, bypass surgery, and cholesterol reduction--indicate the kinds of choices to be made.     

中国农村居民不同年度家庭收入与消费支出关系的实证研究

为了说明我国农村居民不同年度家庭收入与消费支出之间的相关关系及其变动情况,采用《中国统计年鉴》2000和2004年的省际截面数据进行了典型相关分析。结果显示,我国农村居民不同年度家庭收入与消费支出有着十分显著的相关关系,工资性收入与消费支出相关指标关系最为密切。2004与2000年相比,农村居民消费由生存性消费逐渐过渡到非生存性消费,但两年中医疗保健支出典型载荷均较低。由于目前农民实际收入水平较低,这些高层次的、非生存性消费需求无法得到实现。因此,为了提高农村居民消费质量,优化消费结构,在其他收入增长空间有限的情况下,提出了增加农民工资性收入的政策建议。     

河北省农村居民生活消费支出倾向分析

按照人们实际支出去向将农村居民消费支出分为食品消费支出、衣着消费支出、家庭设备及服务;肖费支出、医疗保健消费支出、交通通讯消费支出、文教娱乐及服务消费支出、居住消费支出、其他商品及服务消费支出共8项内容,从农村居民生存型消费结构（食品、衣着、居住、文教娱乐）与农村居民享受型消费结构（交通通讯、家庭设备及服务、医疗保健、其他商品及服务）2方面的变化情况探讨了河北省农民居民生活消费支出结构变化状况,得出河北省农村居民生活消费支出逐年增长,生活消费水平逐渐提高,生存型消费有所下降,下降幅度不是很大,主要是食品消费下降所到导致的结果,享受型正在消费缓慢增长,主要表现在交通通讯支出和其他商品及服务支出上。根据河北省2003～2007年农村居民调查资料,对河北省农村居民生活消费支出的8项指标进行定性分析,采用具有消除相关性影响的主成分分析方法分析了河北省农村居民生活消费结构的变化情况,得出河北省生活消费支出从生存性;肖费向享受型消费转变．农村屠民哇活消静水平在不断提高。     

密云水库周边农户收支的调查研究

通过调查密云水库周边地区877户农户家庭收入支出情况,运用主成分分析法和四象限分析法分析农户家庭各项收入和支出的意义。结果表明:旅游收入是密云水库周边地区提升农户收入最重要的部分;林业收入、政府补贴、村干收入、养殖收入和种植收入也是增加农户收入的关键;饲料支出对提高农户支出的影响最大;而农药支出、肥料支出、交通支出、其他资料和气煤支出是控制农户开支的重要内容。     

The health sector's share of the gross national product

Between 1947 and 1987 expenditures for health care in the United States grew 2.5 percent per annum faster than expenditures for other goods and services. The health sector's share of the gross national product rose from well under 5 percent in the late 1940s to more than 11 percent in the late 1980s. The expenditures gap has two components: health care prices rose 1.6 percent per annum more rapidly than other prices, while the quantity of health care grew 0.9 percent per annum faster than other quantities. Many factors, including wages, productivity, technology, and insurance contributed to these trends. No single explanation suffices, and no simple solution is apparent.     

新型农村合作医疗补偿机制对农村老人住院服务利用的影响——基于健康差异的视角

基于健康差异视角,利用福建省农村老年人住院服务利用调研数据,采用日常生活自理能力、工具性日常生活活动能力和认知能力3个指标来评定农村老年人健康状况,并在此基础上通过聚类分析法将农村老人的健康状况分为3个等级,然后再运用两部模型重点考察新型农村合作医疗补偿机制对不同健康水平农村老人住院服务利用的影响及差异。结果表明:乡级医疗机构的报销补偿对农村老人就医选择的影响不存在健康差异,但是高级别医院的报销补偿与补偿封顶线对健康较差的老人的影响更大。另外,新农合补偿机制中乡级医院报销比例与补偿封顶线的提高对老人住院支出有显著影响,且乡级医疗机构报销倾斜对所有健康等级老人的住院医疗支出都有显著影响。     

基于灰色关联理论的财政支农支出和农民收入变迁研究

依据2009年《中国统计年鉴》和《中国农村统计年鉴》相关数据,选取工资性收入、家庭经营纯收入、转移性和财产性收入、支援农村生产支出等7个指标,运用灰色关联理论对我国“八五”“九五”和“十五”期间农民纯收入与各项收入、国家财政支农总支出与各项财政支农支出与农民纯收入与各项财政支农支出的灰色关联度变迁情况进行分析与评价。结果表明,各时期与家庭经营纯收入的灰色关联度呈现下降的态势;从总体上看,国家财政支农总支出与农业基本建设支出及支援农村生产支出的灰色关联度有下降的趋势,财政支农总支出与农业科技3项费用和农村救济费的灰色关联度呈现上升的趋势;支援农村生产支出对农民收入的影响程度呈现出下降趋势,农业基本建设支出对农民收入的影响程度表现出增强的趋势,救济费在促进农民增收中的积极作用有待进一步增强,农民收入的增长对农业科学技术的依赖性呈现出增强的态势。最后提出了建立稳定的财政支农资金增长机制、坚持对财政支农资金结构实行动态调整等相关政策建议。     

Who will pay for medical education in our teaching hospitals?

Although most medical educators believe that education, research, and patient care are inseparable and essential to their academic mission, the educational component of this triad has never been given adequate, earmarked support. To fund educational programs, medical centers first relied on research grants and later on third-party payments intended for patient care. However, research money has long since ceased to be available for other purposes and recent federal cost containment measures have started to reduce payments for patient care. Teaching hospitals are threatened with loss of support not only for education, but for their capital improvements and care of the poor. Many institutions are now hoping to generate new income through business deals with for-profit health care corporations, but this effort probably will also fail and may compromise professional traditions. Teaching hospitals serve the public interest and will have to depend, at least in part, on public subsidy of their unavoidable extra costs.     

Rural health care in Mexico?

A very large percentage of Mexico's population living in rural areas lacks resources for health care. Any new effort to provide such care must emphasize the health of the infant population because of the high percentage of infants in the country. Plans made at the national level have not been correlated with the conditions that exist in rural areas. For example, the majority of university programs are oriented toward urban medical practice, and the construction of more schools of medicine to solve the problem of doctors in rural areas is based on a mistaken premise. This problem has not been solved even in developed countries such as the United States where, as in Mexico, graduates in medicine migrate to the cities where optimal conditions are met for practicing the type of medicine for which they have been trained. Furthermore, it is both expensive and illogical to maintain urban doctors in rural areas where they cannot practice their profession for lack of resources; to do so is to deny the purpose of their education (27). Conventional schools of medicine, for reasons of investment and of structure, should teach only very selected groups of students who, on finishing their training, are fully capacitated to practice specialized medicine. A different system is required if we are to provide adequate health care in the rural communities. A system such as that described herein, adapted to the real need of rural communities, would avoid the necessity to create dysfunctional bureaucracies and would not destroy those institutions which have proved useful in the past. This study should be considered as one of the many pilot programs that should be initiated in order to determine the type of program that would best solve the problem of health care in rural Mexico. Other programs already being considered at the National Autonomous University of Mexico include the A36 plan of the Faculty of Medicine, now in operation; the work of C. Biro carried out in Netzahualcoyotl City (both focused on providing medical care to the urban poor); and the Open University program. Unless an efficient program designed to meet the needs of rural communities is quickly put into operation, Mexico will, in the near future, be facing the same problems now confronting Southeast Asia.     

湖南省公共医疗卫生支出效率及其影响因素实证分析

利用DEA-Tobit两阶段分析法，计算出2009-2013年5年间湖南省14个地级市政府公共医疗卫生支出的综合技术效率值、纯技术效率值、规模效率值三种效率值，分析出湖南省各地级市政府公共医疗卫生支出所处规模报酬阶段，并对反映卫生支出资金配置的综合技术效率水平的外部影响因素加以回归分析.结果发现：湖南省各地区公共医疗卫生效率水平整体水平偏低并且存在明显的差异性，除长沙以外的其他地级市政府公共医疗卫生支出均处于不同程度的非充分效率水平.湖南省各地区人均生产总值及城市化水平对公共医疗卫生支出效率有显著的促进作用.教育水平、人口密度、居民人均可支配收入对湖南省公共医疗卫生支出效率的提高有阻碍作用.     

公共财政支出与农民增收的实证分析

从公共财政支出视角来看,制约农民收入增长的因素主要有：（1）落后的基础教育,制约了农民智力素质的提升;（2）落后的交通环境和市场交易环境袁使农村发展面临较高的成本;（3）水利设施严重不足,降低了民族地区农村抵御自然灾害的能力,使农业生产面临较大风险。从理论上来看,公共财政支出对农民收入的影响是通过两大途径发挥作用的：（1）通过社会支出提高农民的健康水平和知识水平,从而增加农民的人力资本积累,增强农民的自我发展能力,提升农民获得更多收入的机会和能力,而且社会支出还通过再分配途径为那些收入特别低下的农民提升社会保障;（2）通过投资于农业、农村基础设施和农业科技,从而促进农业经济增长。利用我国1978-2009年有关统计资料进行实证分析,结果表明,公共财政支出对农业增收有较大影响。因此,促进农民增收、缩小城乡差异的一个重要途径就是加大对农业的财政支持。     

地方政府财政支出的民生化进程与农村居民消费——基于总量和分类支出视角下的理论分析与实证检验

基于总量和分类支出的视角,从宏观层面对地方政府民生财政支出与农村居民消费进行理论分析,并采用1998~2011年中国大陆31个省市面板数据加以实证检验,研究结果表明：地方政府民生财政支出确实有效地促进了农村居民消费,尤其是对以教育文化娱乐、医疗保健等为主的发展享受性消费的挤入程度要大于以衣食住为主的基本生存性消费;但在民生财政具体分类支出方面影响却存在着差异,即教育和医疗卫生支出对农村居民消费产生显著的挤入效应,而文化和社会保障等支出影响微弱。因此,在稳步扩大民生财政支出比重的同时,应注重优化民生财政支出结构,增加农村居民收入等,全面提高农村居民消费水平。     

The rural crisis in Minnesota: Identifying social and economic vulnerability and new directions for the future

The rural crisis of the 1980s is described in terms of the economic and social vulnerability of rural farm areas. The crisis is shown spreading from farms through families to rural communities, schools, churches, counties and beyond. Rural communities are shown to be undergoing dramatic and non-cyclical change. Criteria are defined to identify rural counties vulnerable to further economic losses and include: dependence on agriculture for jobs, inadequate off farm income, population losses, declines in residential and commercial property value, and county fiscal crises due to loss of the tax base, delinquincies, and additional federal and state program changes and cutbacks. Social and economic distress are so extensive as to overwhelm conventional emergency intervention efforts to provide food, shelter, access to health care, and professional counseling. Peer support programs have been found to be effective at reaching farm families and helping them seek out the assistance of farm financial advisors, counselors, food shelves, and public assistance. Emerging attempts to link politically contending parties are discussed, specifically the Reinvest in Minnesota Coalition and the Rural Strategy Task Force consisting of major farm, church, and lending organizations. A strategy process and stakeholder analysis for local communities are presented together with recommendations for action that include creating a rural trend watch capability.     

Medical problems of the developing countries

There can be no immediate solution to the medical problems of the developing countries. Priorities are demanded, and it must be acknowledged that in allocation of medical priorities certain compromises are required. It can be hoped that the least detrimental compromises will be selected. Careful planning of health services and also of training programs for various medical personnel must not rely on what exists in developed countries, because those facilities and programs may be completely inappropriate to other situation. At the same time as inroads are made into the preventable conditions which now claim thousands of young lives, programs of birth control and improvement of agricultural methods must be emphasized. The reduced morbidity and mortality which results from immunization against childhood infectious diseases, smallpox, and tuberculosis must be borne in mind in overall planning for schools and general health services. Inexpensive and practical programs that could be managed by medical personnel who are not highly trained should be considered. As the benefits of technical development gradually reach the urbanizing population living under poor social and hygienic conditions, changes in the disease picture must be anticipated. Those involved with planning and training must understand various cultural influences so that the transition period can be made as painless as possible. Certain seemingly attractive Western procedures should be guarded against if they are not practical. For instance, a common tendency is to build large modern hospitals throughout the land with disregard for the fact that these hospitals cannot possibly be staffed, equipped, or maintained because of shortages of trained people and available funds (14). This has been called an "edifice complex" and is unfortunately found in many developing regions, stimulated often by ill-considered advice from overseas experts. At the same time as medical services are being improved, it is extremely important to document the improvements by means of carefully recorded statistics. Guidance in necessary methods for documentation should be sought early in the development of medical care (15). Obviously it is vital to determine what and where the major medical problems are so that programs will.be designed to attack them. Once the problems are sorted out, available resources can be allocated and preventive measures and health education can be aimed at specific aspects of public health. Many general statements have been made to describe the medical problems in the developing countries of the world. There is a need to particularize the problems and approach the specific manifestations of disease with knowledge of local conditions and resources. Accepted textbook solutions no longer apply in the field, and the ultimate solution may be along lines which are completely unique and nontraditional. To break the usual rules may be the only practical means to solve the problem at hand, and modified common sense must often replace modern technology. The practical variations on the general theme described here make medical work in developing countries interesting, exciting, and rewarding.     

我国农业财政投入对农民收入增长效应的实证分析

为探讨财政农业投入与农民收入的关系,根据1978～2006年经济数据,利用协整理论分析了财政支农与农民收入的关系,并得到了计量回归模型,回归结果表明,支援农业生产和各项农业事业费、农业科技三项费用对增加农民收入起到有利作用,而农业基本建设支出和农村救济费阻碍了农民收入增加。然后对变量间的脉冲响应进行分析,结果表明,支持农业生产和各项农业事业费的支出变化对农民纯收入有正的冲击,并且从第2年开始冲击越来越大;农业基本建设支出和农村救济费开始反应为正,持续到将近第3年发生波动;农业科技三项费用对农民收入的脉冲响应开始为负,并持续了大约5个时期,然后才转为正的冲击。最后结合我国财政支农的一些特征,得出我国财政支农的规模、比重以及结构严重不合理的结论。     

基于不确定性视角中国城乡居民消费行为的差异分析

利用1988—2012年《中国统计年鉴》的宏观数据,用调整离差率对收入不确定性和支出不确定性进行测算,在分析我国居民所面临的不确定性因素及其对城乡居民消费行为的影响路径基础上,建立引入不确定性的消费函数扩展模型,实证研究2类不确定性因素对我国城乡居民消费行为的影响,重点比较分析其对城乡居民消费行为影响的差异。结果表明:收入不确定性和支出不确定性对城镇居民消费行为皆具有正向影响,而对农村居民消费行为具有负向影响,且收入不确定性对农村居民消费的影响大于城镇居民,支出不确定性对我国城镇居民消费的影响大于农村居民。     

天津市农村居民消费支出变化特点及趋势

农村居民消费支出水平和结构的变化,可在一定程度上反映农村居民的生活质量和生活水平的状况。以天津市为例,根据2002—2012年天津市农村居民消费统计数据,从消费水平和消费结构两个角度对农村居民的消费变化特点和趋势进行了分析。从消费水平上看,近10年天津市农村居民总体消费水平呈现快速增长态势,10年间增长了2.85倍,平均年增长率达到14%以上;从消费结构上看,人均食品、衣着、居住的生存型消费支出都趋于下降或持平的状态,但三者之和所占支出比例超过了60%,而人均家庭设备及用品、交通通信、文教娱乐和医疗保健等享受型消费支出出现了快速增长的势头。     

Information technology in the Costa Rican dairy sector: A key instrument in extension and on-farm research

Can computer and information technology (IT), widely used in the development of livestock health and production, be of any benefit for Third World farmers and institutions? And if so, how can they be implemented on a large scale? The authors try to answer these and related questions based on experiences with computerized dairy herd health and production programs in Costa Rica. They conclude that IT is becoming a key instrument in the planning and operation of modern extension services and on-farm research for meeting the farmers' increasing needs for information and for enhancing their ability to manage the available resources efficiently. IT enables private sector extension services provided by farmer groups and advisors to give farmers access to information that they previously lacked. These services facilitate bottom-up planning. Where IT does not allow the farmer or extension agent to solve the problem, IT can be used to articulate the problem for researchers or policy makers to address. For low-resource smallholders, access to IT can be provided through local farmer organizations. At the institutional level, IT is giving a strong impulse to the improvement of on-farm research, teaching programs, institutional and disciplinary cooperation, regional networking, and to a better linkage with the productive sector.     

农民消费现状及主要特征分析

近年来,农村经济快速发展,农民收入增加,农民消费状况有所改善。农民衣着消费金额增加且比重下降,人均居住消费支出不断增加,教育支出和医疗保健支出受到政策影响有所减少,交通消费价格指数和文化娱乐消费价格指数有所上升,农民生活质量提高,消费结构趋于合理。     

Integrated delivery of primary health care for humans and animals

Partially because of the high cost of developing and maintaining cold chains, systems needed to keep heat-labile vaccines under adequate refrigeration from their points of manufacture to their administration in the field, the Joint WHO/FAO Expert Committee on Zoonoses (i.e., the approximately four fifths of all described human infections that people share with other vertebrate animals) recommended in 1982 operation of common cold chains by health and veterinary services in rural areas. Following this recommendation, a 1984 pilot level initiative in medical-veterinary intersectoral cooperation should be regarded as a practical way to deliver human primary health care to currently neglected African pastoralists, and as a potential core program for development efforts overall within arid and semiarid areas of the African continent.