地震灾后医疗救助评估与政策研究
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摘要
研究背景
进入21世纪,地震灾害的发生频率及强度较上世纪呈现明显上升趋势,地震会给国家经济建设和人民生命财产安全造成直接和间接的危害及损失,其中地震对人类健康和生存环境的危害是多方面的,包括地震所引起的外伤与疾病、伤残与死亡,家庭的变故与心理损伤,生态与居住的环境变化,财产损失与收入减少,以及其他直接的和间接的、即时的和延缓的不良影响等等。灾害发生后,灾区居民的医疗卫生服务需求发生巨大变化,医疗救助制度的运行环境发生改变,原有的医疗救助制度不再适用于灾后的情况,灾后如何测算后续医疗和救助需求,向需要康复治疗的伤员提供适宜的、符合实际医疗需要的医疗服务和救助成为一个新的重要问题。本研究以灾后紧急救治期后与常态医疗救助之间的过渡期为主要研究对象,对这一阶段面临的问题展开研究。
研究目的
开发适合我国国情的地震灾害调查工具及调查方法,以“汶川地震”为例,通过抽样调查,对地震造成危害进行全面分析,以探讨地震危害的基本特征和规律,为震后医疗救助相关评估提供数据基础,并确定灾后医疗救助工作的重点。在此基础之上,探索地震灾后合理的贫困人口界定方法、医疗救助制度与相关保障制度的衔接方式,合理的医疗救助内容和项目,促使灾区更好地开展医疗救助工作,并为今后建立有效的紧急医疗救助政策和方案提供依据,为今后的相关灾害研究提供方法借鉴。
研究方法
本研究在回顾相关流行病学研究和现况调查的基础上,通过查阅文献、入户问卷调查和访谈等方法获得有关地震危害的相关信息,并通过数理统计及流行病学研究方法对相关信息进行系统分析。并应用logistic多元回归模型及灾后困难人口的现状分析确定困难人口的筛查模型。通过现有医疗救助政策分析及卫生服务包研制等原理对灾后医疗救助政策开发,并利用医疗救助筹资理论及方法对灾后医疗救助参保资助金进行测算。
研究内容
(一)在综合分析相关地震危害研究的基础上,提出地震灾害健康评价体系,主要有以下几个方面：
(1)灾后调查人口的一般情况。
(2)灾后人群的健康状况分析。
(3)灾后人群的卫生服务利用及可及性分析。
(4)灾后人群的心理损伤。
(5)灾后家庭及成员的收入状况及经济损失。
(6)灾后居民对政府公共政策的认知。
(二)通过数理方法及现状分析,确定灾后困难人口的快速筛查的关键因素及模型,并对灾后困难人口进行了测算。
(三)本研究对灾后救助服务包及基本医疗保障制度的衔接这两个影响灾后医疗救助的关键环节进行了研究,以提高灾后困难人口的卫生服务可及性,同时使灾后有限的救助资金达到最大的效益比。在确定困难人口数量及卫生服务需求量的基础上,利用相关卫生筹资原理及公式对救助对象的参保费用进行测算。研究结果
本研究调查时间为2008年8月1日—30日,在四川省、陕西省及甘肃省随机整群抽样了三类受灾程度地区(极重灾区,重灾区,一般灾区)共10个县(市、区),4380户(极重灾区933户、重灾区2175户、一般灾区1272户),共15788人,完成设计调查人数的97.4%。
研究结果显示：地震使灾后居民的卫生服务需要量大幅增加,居民健康状况堪忧,不同灾区的两周患病率都是2008年第四次全国卫生服务调查的1.5倍到2倍；居民的自感健康大多处于“不好”“一般”的状况；灾后居民的疾病谱发生变化,急性传染病发生率在灾后有所升高；极重灾区、重灾区、一般灾区的PTSD发生率分别为：62.5%,11.25%和10.25%；家庭财产损失金额金额较大且不同灾区差异明显：极重灾区城乡合计家庭财产损失金额8.6万元,而重灾区、一般灾区则为0.8万元和0.2万元；极重灾区有51.19%房屋倒塌远远高出重灾区的15.76%和一般灾区的7.97%；极重灾区灾后遇难人员的平均年龄为32.1,主要以青壮年为主,人群总死亡率为1549人/10万；潜在寿命损失年数率(YPLL‰)为44.2‰；潜在工作损失年数率(WYPLL‰)为38.3；潜在价值损失年数率(VYPLL‰)为8.2%o；在极重灾区农村、城镇居民中分别有80.4%、52.8%靠政府救济生活；居民对紧急医疗救助政策及紧急医疗服务的满意度都很高,不同灾区都在80-90%之间,但同时只有20%左右居民对常态医疗救助政策有所了解。通过本研究了解到地震对人类健康的危害是多方面的、严重的,地震造成了严重的直接及潜在经济损失,同时地震危害之间的相互影响还会加重危害的严重性。汶川地震使灾后居民的卫生服务需要量大幅增加,居民的疾病负担加重。同时地震对灾民的心理健康的影响普遍存在,其中精神健康评分及创伤后应激障碍(PTSD)发生率都与受灾程度密切相关。地震灾后还将造成贫困人口的大幅增加,灾后救助工作压力增大。
结论
(1)通过对灾后居民经济状况的数理分析及现状研究,建立了灾后特别困难人口和一般困难人口的筛查模型：一般困难群众为居民中只具有“无收入”或“无住房”或“无生产工具”中一项指标的即可被纳入一般困难群众；特别困难群众为具有“无收入”、“无住房”、“无生产工具”中任意二项指标的居民即为特别困难群众,对不同群众施行分别救助。在此基础上对不同灾区的困难人口进行了测算,测算结果发现：灾后特别困难人口比例在极重灾区为30%左右,重灾区为15%左右,一般灾区为10%左右,与灾前灾区纳入救助体系的困难人口占总人口的5-10%相比灾区困难群众的比例大幅增加。
(2)在对灾后困难居民卫生服务需求研究中发现,灾后困难居民的门诊救助量将大幅增加,根据灾后困难居民的就医需求特点,本研究开发了有针对性灾后医疗救助服务包,并提出在灾后医疗救助与城乡医疗保险衔接过程中,适当增加门诊救助比例,使灾后医疗救助服务包制度得以更好的实施,具体服务包内容为：增加慢性病的门诊救助服务包；为严重伤残等特殊困难群众制定必要的救助服务包；加强对灾区居民的精神健康教育与心理干预。
(3)灾后医疗救助工作应根据灾区不同时期的特点作出适用的调整,实行动态管理,在保证公共财政对医疗救助制度的支持的基础上,加强医疗救助与城乡基本医疗保障体系的衔接。一是制定合理的城镇医保救助资金分配比例。根据救助对象的不同医疗需要,要坚持以住院救助为主,兼顾门诊救助,同时加大对城镇困难群众的临时救助力度；二是加大对新农合的门诊救助力度。对于“五保”户、特别困难群众及因灾严重伤残人员,应取消住院及门诊治疗起付线,在未实行门诊救助的地区,即使保留起付线,不应超过当地低保对象年收入标准的5%。同时可以考虑实行家庭账户定额补助的方法对灾后需要救助服务包的特殊人群实行门诊救助；三是因灾严重伤残人员的特殊救助政策,这部分救助对象中的慢性病人、需要长期维持性及康复性治疗的病人门诊负担较重的特点,给予一定的门诊定额救助,并由民政部门直接与对口医疗单位结算费用；四是不同医疗救助对象实施分类救助,实施不同救助比例。对灾后特别困难群众及特殊救助对象(因灾伤残人员)应逐步达到100%,一般救助对象(一般困难群众)应达到与城镇职工(居民)医疗保险累计实际补偿比70-80%,随着医疗救助资金的增加及困难人口的逐年减少可以逐步提高救助比例。
Background:
As we stepping into the 21st Century, the occurrence frequency and intensity of earthquake has taken on a rising tendency, Earthquake will give national economic construction and people's lives and property caused by direct and indirect damage and loss. Earthquake survival of the environment on human health and the dangers are many, including earthquakes caused by trauma and disease, disability and death, family tragedies and psychological injury, changes in ecology and living environment, property losses and reduced income, and other direct and indirect, immediate and delayed adverse effects and so on. After the disaster, disaster medical and health service needs of residents witnessed tremendous changes, medical aid system operating environment changes, the original medical aid system is no longer applicable post-disaster situation. And how to measure the follow-up medical care and disaster relief needs, the need to provide appropriate rehabilitation of the wounded, in line with the actual medical needs of medical services and rescue has become a new and important issues.
Research Purposes:
Develop research tools and methods for earthquake suitable for situation in China, carry out an all-round analysis on the harm brought by earthquake, via a sampling survey, taking "Wenchuan Earthquake" as an example, and explore basic features and tendency of earthquake, so as to provide data foundation for related evaluation on after-earthquake medical aid. Explore an effective poor population determination method, a means to connect medical aid policies and related insurance policies, reasonable medical aid contents and items, effective and convenient helping procedures as well as methods to collect and pay helping funds, so as to improve medical aid in disaster areas in a better way, provide evidence for the establishment of effective emergency medical aid policies and plans, and to provide reference for future research on related disasters similar to earthquake.
Research Methods:
This research obtains related information about harms which would be brought by earthquake via methods such as literature searching, questionnaire survey report roll survey and interviewing etc., and carries out systematic analysis on related information via methods such as mathematic statistics and research on epidemiology. A logistic multiple regression module as well as a screening module for analysis on current situation of hard population after the earthquake to determine poor population is applied for the first time, then the medical aid grant fund of participating insurance is also calculated via medical aid funding theories and methodologies, and the development on medical aid policies after the earthquake is also carried out via analysis on existing medical aid policies and developing theories on hygiene service packs.
Research Contents:
Ⅰ. Bring forward a health evaluation system on earthquake based on the researched carried out while implementing a comprehensive analysis on harm brought by earthquake, which mainly includes the following aspects:
(1) General conditions of population under survey after the earthquake.
(2) Analysis on health conditions of population after the earthquake.
(3) Utilization and feasibility analysis on hygiene service of population after the earthquake.
(4) Psychological damage on population after the earthquake.
(5) Income situation and economic damage on family and its members after the earthquake.
(6) Recognition on public policy of the government after the earthquake.
Ⅱ. Poor population measurement after the earthquake:Determine key elements and module for a quick screening on poor population after the earthquake, via mathematic methods and current situation analysis.
III. In order to improve the feasibility of hygiene service of poor population after the earthquake, as well as to achieve the maximum efficiency ratio of limited helping funds after the earthquake, we carried out research on two impacts on key cycles in medical aid brought by after-earthquake help service packs and the connection of basic medical insurance policies. Medical aid fund calculation after the earthquake:Carry out the calculation via using related hygiene funding theories and formulas based on the determination on poor population and hygiene service demands.
Research Result:
During the research, random sampling survey on regions based on three damaging degrees (which are namely extreme disaster areas, heavy disaster areas and normal disaster areas) has been carried out in Sichuan province, Shanxi province and Gansu province, which covering 15788 people in 6416 families (among which there are 2969 families in extreme disaster areas,2175 families in heavy disaster areas and 1272 families in normal disaster areas), and the survey has completed 97.4%of the designed population under survey.
The research result shows that:Illness ratios in dual weeks of different disaster areas are 1.5 to 2 times than that of the fourth national hygiene service survey in 2008; the self-felt health of civilians is mostly "bad" or "normal"; diseases of civilians after the earthquake also undertook a comprehensive change, the acute infectious disease ratio also underwent a certain rise after the earthquake; the PTSD rations in extreme disaster areas, heavy disaster areas and normal disaster areas are namely:62.5%,11.25%and 10.25%;obviously different damages in family assets loss in different disaster areas:the family assets loss amount in towns and cities of extreme disaster areas is 86 thousand Yuan, while that of heavily and normal disaster areas is 8 thousand Yuan and 2 thousand Yuan; the house collapsing ratio of 51.19% in extreme disaster areas is much higher than that in heavily and normal disaster areas, which is namely 15.76% and 7.97%;the average age of the death caused by the earthquake in extreme disaster areas is 32.1, most of which is youth people, and the total morality is 1549 persons/100 thousand; the year potential loss level (YPLL%o) is 44.2%o;the work year potential loss level (WYPLL%o) is 38.3; the value year potential loss level (VYPLL‰) is 8.2‰; 80.4%,52.8% of citizens in rural and urban areas in extreme disaster areas live depend on the government relief, meanwhile; Most citizens are very satisfied with emergency medical aid policies and emergency medical services, the satisfaction rate among them in different regions is between 80-90%, while there are only 20% of citizens have a general conception on normal medical aid policies. Damages brought by the earthquake could be comprehensive and serious. The earthquake caused direct economic losses and serious casualties, and the potential loss of life and economy should not be overlooked. Residents of the earthquake disaster has also made a substantial increase in requirements for health services, the impact brought by the earthquake on physiological health of population in disaster areas is very common, and the physiological evaluation and posttraumatic stress disorder (PTSD) are both positively associated with the damaging degree.Earthquake also caused a significant increase in poverty, disaster relief work pressure, although the post-disaster relief and medical assistance notable achievements, but the normal medical aid policy advocacy efforts should be strengthened. Also reminds us that the scientific definition of the population post-disaster problems and the adjustment of post-disaster medical assistance system is the focus of post-disaster work.
Conclusion:
(1) The research is based on related information listed in ChapterⅠ, establishes a screening module on extremely poor population and normally poor population after the earthquake:Particularly difficult to establish a post-disaster problems of population and general population screening model:the general population is the only poor people with "no income" or "no housing" or "no means of production" in an indicator can be incorporated into the general difficulties people; particularly difficult is the people with "no income", "no housing", "no means of production" in any of the residents of two indicators is the special needy people, respectively, for different purposes rescue people.Via implementing mathematic and situation analysis on economic conditions of citizens after the earthquake, and carries out calculations on poor populations in different disaster areas on this basis, and the measuring result turns out to be:The ratio of extremely poor population after the earthquake in extreme disaster areas is around 30%, that in heavy disaster areas is around 15%, while that in normal disaster areas is 10%, comparing with the poor population listed into the helping system in these regions before the earthquake (which accounting for around 5% of the total population), the poor population in disaster areas has increased to a great extent. According to calculation, the medical aiding grant fund participating insurance of Sichuan in 2009 would reach 0.36 billion Yuan, such a huge aiding fund need not only national financial support but funding and donating from the society at the same time.
(2) Difficulties in the post-disaster health service needs of residents found that difficult post-disaster relief amount of out-patient population will increase substantially under the difficult post-disaster medical residents demand characteristics, the research and development of a targeted post-disaster medical assistance service packs, and raised in post-disaster medical Assistance with the process of convergence of urban and rural medical insurance appropriately increase the proportion of out-relief, so that post-disaster medical assistance service pack system to be better implemented, after-earthquake medical aid service packs are also put forward:Increase outpatient services aiding service packs for chronic diseases; work out necessary aiding service packs for special groups such as the heavily injured etc.; enhance spiritual health education and physiological intervene on citizens in disaster areas.
(3) Disaster medical assistance should be based on the characteristics of the disaster area to apply to different periods of adjustment, a dynamic management, public finance in ensuring the support of the medical assistance system, based on strengthening the rural medical aid and basic medical insurance system interface. First, urban health insurance helps the development of rational allocation of funds ratio. According to the medical needs of rescue of different objects, to adhere to the main hospital assistance, taking into account out-relief, while increasing the difficulties of the masses of urban temporary relief efforts, out-patient assistance, patient assistance and the proportion of interim relief allocation of funds ratio for 2 more mature approach:2:1:1; the second is to increase the new rural cooperative efforts of the hospital out-patient relief aid. For the "five guarantees" families, especially poor people and severely disabled persons tolls tolls should be removed from the payment of inpatient and outpatient treatment line, before the implementation of out-relief areas, even if the reservation from the pay line, should not exceed the local subsistence allowances the standard object 5% of annual income. Can also consider implementation of the household account the method of fixed grants disaster relief service pack requires the implementation of out-relief special populations; third is severely disabled persons tolls special assistance policy, which is part of the relief object chronic diseases who require long-term maintenance and outpatient rehabilitation treatment of patients with the characteristics of a heavier burden, giving relief quota of 500 per patient\who\years of relief, the civil affairs department settled directly with the corresponding cost of medical units; Fourth, the implementation of classification of objects of different medical aid assistance, the implementation of various relief ratio. Particularly difficult for people post-disaster relief and special objects (tolls disabled people) should be gradually increased to 100% general relief object (generally poor people) should meet with the urban workers (resident) medical insurance 70-80% of total actual compensation, with the the increase in Medicaid funding and difficulties can be gradually decreasing population increase aid ratio.
(3) Based on data research on damages brought by earthquake, the following suggestions on after-earthquake medical aid service packs are also put forward:Increase outpatient services aiding service packs for chronic diseases; work out necessary aiding service packs for special groups such as the heavily injured etc.; enhance spiritual health education and physiological intervene on citizens in disaster areas.
进入21世纪,地震灾害的发生频率及强度较上世纪呈现明显上升趋势,地震会给国家经济建设和人民生命财产安全造成直接和间接的危害及损失,其中地震对人类健康和生存环境的危害是多方面的,包括地震所引起的外伤与疾病、伤残与死亡,家庭的变故与心理损伤,生态与居住的环境变化,财产损失与收入减少,以及其他直接的和间接的、即时的和延缓的不良影响等等。灾害发生后,灾区居民的医疗卫生服务需求发生巨大变化,医疗救助制度的运行环境发生改变,原有的医疗救助制度不再适用于灾后的情况,灾后如何测算后续医疗和救助需求,向需要康复治疗的伤员提供适宜的、符合实际医疗需要的医疗服务和救助成为一个新的重要问题。本研究以灾后紧急救治期后与常态医疗救助之间的过渡期为主要研究对象,对这一阶段面临的问题展开研究。
研究目的
开发适合我国国情的地震灾害调查工具及调查方法,以“汶川地震”为例,通过抽样调查,对地震造成危害进行全面分析,以探讨地震危害的基本特征和规律,为震后医疗救助相关评估提供数据基础,并确定灾后医疗救助工作的重点。在此基础之上,探索地震灾后合理的贫困人口界定方法、医疗救助制度与相关保障制度的衔接方式,合理的医疗救助内容和项目,促使灾区更好地开展医疗救助工作,并为今后建立有效的紧急医疗救助政策和方案提供依据,为今后的相关灾害研究提供方法借鉴。
研究方法
本研究在回顾相关流行病学研究和现况调查的基础上,通过查阅文献、入户问卷调查和访谈等方法获得有关地震危害的相关信息,并通过数理统计及流行病学研究方法对相关信息进行系统分析。并应用logistic多元回归模型及灾后困难人口的现状分析确定困难人口的筛查模型。通过现有医疗救助政策分析及卫生服务包研制等原理对灾后医疗救助政策开发,并利用医疗救助筹资理论及方法对灾后医疗救助参保资助金进行测算。
研究内容
(一)在综合分析相关地震危害研究的基础上,提出地震灾害健康评价体系,主要有以下几个方面：
(1)灾后调查人口的一般情况。
(2)灾后人群的健康状况分析。
(3)灾后人群的卫生服务利用及可及性分析。
(4)灾后人群的心理损伤。
(5)灾后家庭及成员的收入状况及经济损失。
(6)灾后居民对政府公共政策的认知。
(二)通过数理方法及现状分析,确定灾后困难人口的快速筛查的关键因素及模型,并对灾后困难人口进行了测算。
(三)本研究对灾后救助服务包及基本医疗保障制度的衔接这两个影响灾后医疗救助的关键环节进行了研究,以提高灾后困难人口的卫生服务可及性,同时使灾后有限的救助资金达到最大的效益比。在确定困难人口数量及卫生服务需求量的基础上,利用相关卫生筹资原理及公式对救助对象的参保费用进行测算。研究结果
本研究调查时间为2008年8月1日—30日,在四川省、陕西省及甘肃省随机整群抽样了三类受灾程度地区(极重灾区,重灾区,一般灾区)共10个县(市、区),4380户(极重灾区933户、重灾区2175户、一般灾区1272户),共15788人,完成设计调查人数的97.4%。
研究结果显示：地震使灾后居民的卫生服务需要量大幅增加,居民健康状况堪忧,不同灾区的两周患病率都是2008年第四次全国卫生服务调查的1.5倍到2倍；居民的自感健康大多处于“不好”“一般”的状况；灾后居民的疾病谱发生变化,急性传染病发生率在灾后有所升高；极重灾区、重灾区、一般灾区的PTSD发生率分别为：62.5%,11.25%和10.25%；家庭财产损失金额金额较大且不同灾区差异明显：极重灾区城乡合计家庭财产损失金额8.6万元,而重灾区、一般灾区则为0.8万元和0.2万元；极重灾区有51.19%房屋倒塌远远高出重灾区的15.76%和一般灾区的7.97%；极重灾区灾后遇难人员的平均年龄为32.1,主要以青壮年为主,人群总死亡率为1549人/10万；潜在寿命损失年数率(YPLL‰)为44.2‰；潜在工作损失年数率(WYPLL‰)为38.3；潜在价值损失年数率(VYPLL‰)为8.2%o；在极重灾区农村、城镇居民中分别有80.4%、52.8%靠政府救济生活；居民对紧急医疗救助政策及紧急医疗服务的满意度都很高,不同灾区都在80-90%之间,但同时只有20%左右居民对常态医疗救助政策有所了解。通过本研究了解到地震对人类健康的危害是多方面的、严重的,地震造成了严重的直接及潜在经济损失,同时地震危害之间的相互影响还会加重危害的严重性。汶川地震使灾后居民的卫生服务需要量大幅增加,居民的疾病负担加重。同时地震对灾民的心理健康的影响普遍存在,其中精神健康评分及创伤后应激障碍(PTSD)发生率都与受灾程度密切相关。地震灾后还将造成贫困人口的大幅增加,灾后救助工作压力增大。
结论
(1)通过对灾后居民经济状况的数理分析及现状研究,建立了灾后特别困难人口和一般困难人口的筛查模型：一般困难群众为居民中只具有“无收入”或“无住房”或“无生产工具”中一项指标的即可被纳入一般困难群众；特别困难群众为具有“无收入”、“无住房”、“无生产工具”中任意二项指标的居民即为特别困难群众,对不同群众施行分别救助。在此基础上对不同灾区的困难人口进行了测算,测算结果发现：灾后特别困难人口比例在极重灾区为30%左右,重灾区为15%左右,一般灾区为10%左右,与灾前灾区纳入救助体系的困难人口占总人口的5-10%相比灾区困难群众的比例大幅增加。
(2)在对灾后困难居民卫生服务需求研究中发现,灾后困难居民的门诊救助量将大幅增加,根据灾后困难居民的就医需求特点,本研究开发了有针对性灾后医疗救助服务包,并提出在灾后医疗救助与城乡医疗保险衔接过程中,适当增加门诊救助比例,使灾后医疗救助服务包制度得以更好的实施,具体服务包内容为：增加慢性病的门诊救助服务包；为严重伤残等特殊困难群众制定必要的救助服务包；加强对灾区居民的精神健康教育与心理干预。
(3)灾后医疗救助工作应根据灾区不同时期的特点作出适用的调整,实行动态管理,在保证公共财政对医疗救助制度的支持的基础上,加强医疗救助与城乡基本医疗保障体系的衔接。一是制定合理的城镇医保救助资金分配比例。根据救助对象的不同医疗需要,要坚持以住院救助为主,兼顾门诊救助,同时加大对城镇困难群众的临时救助力度；二是加大对新农合的门诊救助力度。对于“五保”户、特别困难群众及因灾严重伤残人员,应取消住院及门诊治疗起付线,在未实行门诊救助的地区,即使保留起付线,不应超过当地低保对象年收入标准的5%。同时可以考虑实行家庭账户定额补助的方法对灾后需要救助服务包的特殊人群实行门诊救助；三是因灾严重伤残人员的特殊救助政策,这部分救助对象中的慢性病人、需要长期维持性及康复性治疗的病人门诊负担较重的特点,给予一定的门诊定额救助,并由民政部门直接与对口医疗单位结算费用；四是不同医疗救助对象实施分类救助,实施不同救助比例。对灾后特别困难群众及特殊救助对象(因灾伤残人员)应逐步达到100%,一般救助对象(一般困难群众)应达到与城镇职工(居民)医疗保险累计实际补偿比70-80%,随着医疗救助资金的增加及困难人口的逐年减少可以逐步提高救助比例。
Background:
As we stepping into the 21st Century, the occurrence frequency and intensity of earthquake has taken on a rising tendency, Earthquake will give national economic construction and people's lives and property caused by direct and indirect damage and loss. Earthquake survival of the environment on human health and the dangers are many, including earthquakes caused by trauma and disease, disability and death, family tragedies and psychological injury, changes in ecology and living environment, property losses and reduced income, and other direct and indirect, immediate and delayed adverse effects and so on. After the disaster, disaster medical and health service needs of residents witnessed tremendous changes, medical aid system operating environment changes, the original medical aid system is no longer applicable post-disaster situation. And how to measure the follow-up medical care and disaster relief needs, the need to provide appropriate rehabilitation of the wounded, in line with the actual medical needs of medical services and rescue has become a new and important issues.
Research Purposes:
Develop research tools and methods for earthquake suitable for situation in China, carry out an all-round analysis on the harm brought by earthquake, via a sampling survey, taking "Wenchuan Earthquake" as an example, and explore basic features and tendency of earthquake, so as to provide data foundation for related evaluation on after-earthquake medical aid. Explore an effective poor population determination method, a means to connect medical aid policies and related insurance policies, reasonable medical aid contents and items, effective and convenient helping procedures as well as methods to collect and pay helping funds, so as to improve medical aid in disaster areas in a better way, provide evidence for the establishment of effective emergency medical aid policies and plans, and to provide reference for future research on related disasters similar to earthquake.
Research Methods:
This research obtains related information about harms which would be brought by earthquake via methods such as literature searching, questionnaire survey report roll survey and interviewing etc., and carries out systematic analysis on related information via methods such as mathematic statistics and research on epidemiology. A logistic multiple regression module as well as a screening module for analysis on current situation of hard population after the earthquake to determine poor population is applied for the first time, then the medical aid grant fund of participating insurance is also calculated via medical aid funding theories and methodologies, and the development on medical aid policies after the earthquake is also carried out via analysis on existing medical aid policies and developing theories on hygiene service packs.
Research Contents:
Ⅰ. Bring forward a health evaluation system on earthquake based on the researched carried out while implementing a comprehensive analysis on harm brought by earthquake, which mainly includes the following aspects:
(1) General conditions of population under survey after the earthquake.
(2) Analysis on health conditions of population after the earthquake.
(3) Utilization and feasibility analysis on hygiene service of population after the earthquake.
(4) Psychological damage on population after the earthquake.
(5) Income situation and economic damage on family and its members after the earthquake.
(6) Recognition on public policy of the government after the earthquake.
Ⅱ. Poor population measurement after the earthquake:Determine key elements and module for a quick screening on poor population after the earthquake, via mathematic methods and current situation analysis.
III. In order to improve the feasibility of hygiene service of poor population after the earthquake, as well as to achieve the maximum efficiency ratio of limited helping funds after the earthquake, we carried out research on two impacts on key cycles in medical aid brought by after-earthquake help service packs and the connection of basic medical insurance policies. Medical aid fund calculation after the earthquake:Carry out the calculation via using related hygiene funding theories and formulas based on the determination on poor population and hygiene service demands.
Research Result:
During the research, random sampling survey on regions based on three damaging degrees (which are namely extreme disaster areas, heavy disaster areas and normal disaster areas) has been carried out in Sichuan province, Shanxi province and Gansu province, which covering 15788 people in 6416 families (among which there are 2969 families in extreme disaster areas,2175 families in heavy disaster areas and 1272 families in normal disaster areas), and the survey has completed 97.4%of the designed population under survey.
The research result shows that:Illness ratios in dual weeks of different disaster areas are 1.5 to 2 times than that of the fourth national hygiene service survey in 2008; the self-felt health of civilians is mostly "bad" or "normal"; diseases of civilians after the earthquake also undertook a comprehensive change, the acute infectious disease ratio also underwent a certain rise after the earthquake; the PTSD rations in extreme disaster areas, heavy disaster areas and normal disaster areas are namely:62.5%,11.25%and 10.25%;obviously different damages in family assets loss in different disaster areas:the family assets loss amount in towns and cities of extreme disaster areas is 86 thousand Yuan, while that of heavily and normal disaster areas is 8 thousand Yuan and 2 thousand Yuan; the house collapsing ratio of 51.19% in extreme disaster areas is much higher than that in heavily and normal disaster areas, which is namely 15.76% and 7.97%;the average age of the death caused by the earthquake in extreme disaster areas is 32.1, most of which is youth people, and the total morality is 1549 persons/100 thousand; the year potential loss level (YPLL%o) is 44.2%o;the work year potential loss level (WYPLL%o) is 38.3; the value year potential loss level (VYPLL‰) is 8.2‰; 80.4%,52.8% of citizens in rural and urban areas in extreme disaster areas live depend on the government relief, meanwhile; Most citizens are very satisfied with emergency medical aid policies and emergency medical services, the satisfaction rate among them in different regions is between 80-90%, while there are only 20% of citizens have a general conception on normal medical aid policies. Damages brought by the earthquake could be comprehensive and serious. The earthquake caused direct economic losses and serious casualties, and the potential loss of life and economy should not be overlooked. Residents of the earthquake disaster has also made a substantial increase in requirements for health services, the impact brought by the earthquake on physiological health of population in disaster areas is very common, and the physiological evaluation and posttraumatic stress disorder (PTSD) are both positively associated with the damaging degree.Earthquake also caused a significant increase in poverty, disaster relief work pressure, although the post-disaster relief and medical assistance notable achievements, but the normal medical aid policy advocacy efforts should be strengthened. Also reminds us that the scientific definition of the population post-disaster problems and the adjustment of post-disaster medical assistance system is the focus of post-disaster work.
Conclusion:
(1) The research is based on related information listed in ChapterⅠ, establishes a screening module on extremely poor population and normally poor population after the earthquake:Particularly difficult to establish a post-disaster problems of population and general population screening model:the general population is the only poor people with "no income" or "no housing" or "no means of production" in an indicator can be incorporated into the general difficulties people; particularly difficult is the people with "no income", "no housing", "no means of production" in any of the residents of two indicators is the special needy people, respectively, for different purposes rescue people.Via implementing mathematic and situation analysis on economic conditions of citizens after the earthquake, and carries out calculations on poor populations in different disaster areas on this basis, and the measuring result turns out to be:The ratio of extremely poor population after the earthquake in extreme disaster areas is around 30%, that in heavy disaster areas is around 15%, while that in normal disaster areas is 10%, comparing with the poor population listed into the helping system in these regions before the earthquake (which accounting for around 5% of the total population), the poor population in disaster areas has increased to a great extent. According to calculation, the medical aiding grant fund participating insurance of Sichuan in 2009 would reach 0.36 billion Yuan, such a huge aiding fund need not only national financial support but funding and donating from the society at the same time.
(2) Difficulties in the post-disaster health service needs of residents found that difficult post-disaster relief amount of out-patient population will increase substantially under the difficult post-disaster medical residents demand characteristics, the research and development of a targeted post-disaster medical assistance service packs, and raised in post-disaster medical Assistance with the process of convergence of urban and rural medical insurance appropriately increase the proportion of out-relief, so that post-disaster medical assistance service pack system to be better implemented, after-earthquake medical aid service packs are also put forward:Increase outpatient services aiding service packs for chronic diseases; work out necessary aiding service packs for special groups such as the heavily injured etc.; enhance spiritual health education and physiological intervene on citizens in disaster areas.
(3) Disaster medical assistance should be based on the characteristics of the disaster area to apply to different periods of adjustment, a dynamic management, public finance in ensuring the support of the medical assistance system, based on strengthening the rural medical aid and basic medical insurance system interface. First, urban health insurance helps the development of rational allocation of funds ratio. According to the medical needs of rescue of different objects, to adhere to the main hospital assistance, taking into account out-relief, while increasing the difficulties of the masses of urban temporary relief efforts, out-patient assistance, patient assistance and the proportion of interim relief allocation of funds ratio for 2 more mature approach:2:1:1; the second is to increase the new rural cooperative efforts of the hospital out-patient relief aid. For the "five guarantees" families, especially poor people and severely disabled persons tolls tolls should be removed from the payment of inpatient and outpatient treatment line, before the implementation of out-relief areas, even if the reservation from the pay line, should not exceed the local subsistence allowances the standard object 5% of annual income. Can also consider implementation of the household account the method of fixed grants disaster relief service pack requires the implementation of out-relief special populations; third is severely disabled persons tolls special assistance policy, which is part of the relief object chronic diseases who require long-term maintenance and outpatient rehabilitation treatment of patients with the characteristics of a heavier burden, giving relief quota of 500 per patient\who\years of relief, the civil affairs department settled directly with the corresponding cost of medical units; Fourth, the implementation of classification of objects of different medical aid assistance, the implementation of various relief ratio. Particularly difficult for people post-disaster relief and special objects (tolls disabled people) should be gradually increased to 100% general relief object (generally poor people) should meet with the urban workers (resident) medical insurance 70-80% of total actual compensation, with the the increase in Medicaid funding and difficulties can be gradually decreasing population increase aid ratio.
(3) Based on data research on damages brought by earthquake, the following suggestions on after-earthquake medical aid service packs are also put forward:Increase outpatient services aiding service packs for chronic diseases; work out necessary aiding service packs for special groups such as the heavily injured etc.; enhance spiritual health education and physiological intervene on citizens in disaster areas.
引文
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