1、1,Demand ofHealth Services,2,Objectives,Mastery of the basic concept掌握基本概念 Mastery of the factors affecting demand and Characteristic of the demand for medical care掌握影响需求的因素及特点 Understanding the method of demand analysis掌握卫生服务需求分析的方法,3,Outline,Basic concept: The purpose of demand analysis(需求分析的意义) D
2、emand versus need as a basis for policy and planning(以需求和需要为基础制定政策和计划) Characteristic of the demand for medical care(医疗服务需求的特点) The factors affecting the patients demand for medical care(影响病人医疗服务需求的因素) The method of demand analysis(需求分析的方法),4,The Purpose of Demand Analysis,Understand the characteris
3、tic of the demand了解需求的特点 Understand the determinates of demand: factors; intensity ; mechanism etc.需求的影响因素及强度、作用机理 Forecasted future utilization预测将来卫生服务需求与利用 Design the planning or policy卫生政策与计划的制定,5,Basic Concept (1),卫生服务要求(want of health services)：指居民希望获得预防保健、增进健康、摆脱疾病、减少致残的主观愿望，不完全是由自身的实际健康状况所决定。
4、 Need of health services :Need generally been defined as the amount of health services that medical experts believe a person should have to remain or become as healthy as possible, based on current medical knowledge.卫生服务需要是指从消费者健康状况出发，在不考虑实际支付能力的情况下，由医学专业人员根据现有的医学知识，分析判断消费者应该获得的卫生服务及卫生服务的数量。,6,Basic
5、 Concept(2),Demand of health services : Condition: desires of using health services ability of payment Law of demand: the lower price, the higher the quantity demands Market demand and individual demand,7,Basic Concept :,change in quantity demanded需求量的变动 changes in demand需求变动,8,Basic Concept :,Margi
6、nal utility: the addition utility gained from one more unit of goods or service边际效用：每增加一个单位产品或服务的消费而获得的效用 Law of decreasing marginal utility: the marginal utility decrease when the quantity of goods or service increase边际效用递减规律,9,Basic Concept(3),health services utilization: Actually occurred amount
7、of health services 卫生服务利用是指实际发生的卫生服务的数量,讨论：,调查前14天内，您是否有身体不适? 半年内您是否患有经医生诊断的慢性疾病? 过去12个月内，您是否因病伤、体检、分娩等原因住过医院？ 过去12个月内，是否有医生诊断您需要住院，而您没住的情况？ 您对现在的社区卫生服务满意吗？如果不满意，最主要原因是什么？附近没有社区卫生服务机构 服务项目少 技术水平低 设备条件差服务态度差 药品种类少 收费不合理 主动服务性差 其它,10,11,Law of demand,12,Summing individual demands to obtain market dema
8、nds,13,Health service needs of HIV/AIDS cases,医疗服务 社会支持 心理服务特别的辅助医疗服务,14,湖南省CDC一份调查结果 (中国艾滋病性病Vol.9 No.5 2003),医疗服务的可获得与需求 1.调查对象（HIV感染者）中83.3%为自费医疗,16.7%有社会保险 2.可用于日常医疗费用的支出 每月100元占30.0%,100199元占53.3% 200500元占16.7% 3.日常求医情况是 20%到医疗机构就医,36.7%自己买药,43.3%不就医 4.对医疗机构的选择中 53.3%认为当地医疗机构不能满足治疗的需要 66.7%愿意到大
9、医院治疗,15,湖南省CDC一份调查结果 (中国艾滋病性病Vol.9 No.5 2003),社会支持需要 90.0%的人希望从医务人员得到医疗保健、安全防护等方面的帮助。 46.7%承认其家庭成员对他的态度有所变化,主要表现是恐惧和嫌弃。已婚者中,配偶对其态度改变的占29.4%。 感染后来自社会的最大压力依次是经济困难占63.3%,社会歧视占36.7%。 53.3%的人家庭经济收入下降了30%以上,下降的原因主要是失去工作(43.7%),就医(25.0%),家庭其他人员因陪护而误工(18.7%),其它原因(12.6%)。,16,HIV感染者和AIDS病人的咨询期望 （上海市计划生育研究所，20
10、04）,咨询服务状况 HIV感染者接受面对面咨询的比例是比较高的,但是90%以上的第1次咨询是发生在感染以后;80%以上首次主动咨询的目的是想多了解AIDS知识“对于今后期望的咨询方式 HIV感染者最希望获得面对面咨询,17,Demand versus need(1),Demand,18,Demand versus need(2),Need as a basis for policy and planning Demand as a basis for policy and planning？,19,Need versus demand as the basis for planning in
11、 medical care,D1,D2,Estimate of medical need,O,Q1,Q0,Q2,Quantity of medical care,Price of medical care,20,Need versus demand as the basis for planning in medical care,The planning based solely on medical need is likely to result in the use of either too few or too many resource Planning according to
12、 demand would reduce the waste of resource and patients time Excess demand Lack of demand,21,Characteristic of the demand for medical care,Consumer information shortage(EXP.大处方、大检查) Passivity of the demand：four steps Extension of benefit Indeterminate individual demand more than one channel of finan
13、cing,2004年,2007年,2009年,受益人次,住院受益面,住院补偿比,0.8亿,4.5亿,7.6亿,3.2%,4.8%,7.4%,24.7%,30.9%,41.5%,新农合受益人次不断增加，保障水平显著提高，09年政策性住院费用报销比例已达到55%,新农合补偿受益情况,23,调查地区妇女保健情况,数据来源第三次国家卫生服务调查分析报告,24,调查地区农民总住院率（%）,25,参合前后农村居民两周内首诊地点分布,26,不同时期不同地区各类人群因病需住院而未住院率（%）,27,不同时期不同地区因病需住院而未住院原因构成（%）,28,The model of the demand for
14、medical care,The demand for medical care derived from the demand for health健康需求派生的医疗需求 健康生产函数的一般形式:H = f (M, LS, E; S) 式中H代表消费者的健康，M代表医疗服务，Ls代表消费者选择的生活方式，E代表教育和环境，S代表社会经济因素等。,Factors affecting the demand for medical care医疗保健需求的影响因素 Variations in the demand for medical care are determined by a set of
15、 patient and physician factors.,30,The model of the demand for medical care,Patient factors: Incidence of illness: age, sex, environment etc. actual or perceived illness or desire for preventive medicine Culture-demographic: education, age structure, marital status, relationship and number of person
16、s in the family Economic factor: income, prices, expect price the value of the patients timemedical insurance system,31,Income and demand for medical care,5,D,32,Price and demand for medical care,Quantity,34,Medical insurance and demand for medical care,35,试点县不同年份各级医疗机构住院报销起付线（元）,36,2003年启动试点县各级医疗机构
17、住院补偿方案（补偿比：）,37,Differences between plan in insurance,38,39,The model of the demand for medical care,Physician factors: quality quantity, behaviorQuality quantity: service , technology (equipment, manpower, management and supervise)Behavior:Induced demand theory: supply created demand,40,Equilibrium
18、 price and quantity,Equilibrium price: a price that equates the quantity demanded with the quantity supplied in a market.Equilibrium quantity a quantity of a good, service, or resource that equates the quantity supplied and the quantity demanded at a particular price in a market. The quantity suppli
19、ed and demanded in a market when the equilibrium price prevails,41,Induced demand theory,S1,42,Policy implications for induced demand theory,Increase patient knowledge Obtain additional information: insurance; another physician; committee within hospital Encourage methods of physician reimbursement:
20、 payment,43,Demand function,Qp=f(P.I.P0.T),44,Elasticity of demand for medical care,Elasticity :a measure that relates the percentage change in quantity to the percentage change in price or income that caused it. Elasticity coefficient:the numerical value of elasticity . Price elasticity of demand:i
21、s the ratio of the percentage change in quantity demanded to the percentage change in price that brings about the change in quantity demanded.,45,Price elasticity of demand,Percentage change in quantity demand Elasticity of demand=Percentage change in price ED=(q/q)/( p/p) Elasticity demand :a condi
22、tion existing whenever the percentage response in the quantity demand is greater than the percentage change in the price that caused it .ED1 Inelasticity demand: a condition existing whenever the percentage response in the quantity demand is less than the percentage change in the price that caused i
23、t .ED1 Unit-elasticity demand:ED=1 Perfectly inelasticity:ED=0; Perfectly elasticity:ED=,46,Price elasticity of demand,What determines elasticity of demand: Nature of the goods: necessity Availability of close substitutes Fraction of income absorbed Passage of time Price elasticity of demand and tot
24、al expenditure :ED1,then p ,q,47,Income elasticity of demand,Income elasticity of demand: the relationship between the percentage change in the quantity demanded of a medical care and the percentage change in the consumers income. ED1,48,Cross elasticity of demand,Cross elasticity of demand: the rel
25、ationship between the percentage change in the quantity demanded of a medical care and the percentage change in the price of a different service. CED0: substitute CED0: complement,49,卫生资源配置综合评价模式,作业,作业-准备下章讨论内容 形式：分8个小组，各选一个主题，每个主题有2个小组选择 内容：社区卫生服务供给、中医服务供给、老年人卫生服务供给、流动人口卫生服务供给 方法：现场调查与文献分析相结合,作业建议,需求分析 卫生服务健康与需要：疾病患病情况（患病严重程度、疾病类别、人群结构、变化趋势等。如贫困人口的慢性病患病率 服务利用与需求行为现状：利用服务量、服务内容、就医流向、不同人群服务利用、需要未满足的情况、变化趋势、疾病经济负担、对健康的改善等 问题的总结及原因分析：利用经济学的理论、管理学、心理学、政治学、方法学等 建议,
