論參加醫(yī)療保險的被保險群體的健康管理-外文翻譯

AhealthmanagementresearchontheinsuredgroupwhoparticipateinmedicalinsuranceWangXiguo,BaoHui,ChengYujing,YuBoJournalofUS-ChinaPublicAdministrationⅠ．Asacoastalcity,Wendengisacounty-1evelcitygovernedbyWeihaiMunicipalPeople’sGovernment.Theamountofurbanworkersandresidentswhoparticipateinbasicmedicalinsurancecannearlyreach200000,occupyingmorethan36％ofthetotalpopulationinWendeng.Inrecentyears,Wendenghealthinsuranceinstitutions,takingtheinsuredasthemainbody,haveactivelycarriedouthealthinterventionsandsystematichealthmanagement,whichenablethefundpaymentofhealthinsurancegraduallyshiftfromtreatmenttoprevention,andthekeyworkofbasicmedicalinsurancehasachievedastrategictransformation,whichobtainsgoodresults.Ⅱ．Inrecentyears,wehavekeptcarryingoutthefreehealthcheckupforthehigh-riskgroupwhohaveparticipatedinthemedicalinsurance;wehavewidelyheldhealtheducationseminars,on-siteconsultativemeetingsanddistributedleaflets;wehaveconductedpropagandaaboutthehealtheducationtotheinsuredthroughvariousofmeetings,handlinginsurancematters,settlingmedicalexpensesandcopingwiththeretirement,whichhelpstostrengthentheinsured’shealthinterventions,raisetheirhealthawarenessandbetterimprovetheirbehaviortokeephealthy.ⅰ)Conductingfreehealthcheckupforthehigh-riskgroupandimplementinghealthinterventionsOverthepastfewyears,WendengMedicalInsuranceBusinessUnittookgoodadvantageword文檔可自由復制編輯oftheincreasedvalueandsurplusofbasicmedicalinsurancefundtomakethefreehealthcheckupformorethan20000retireesandolderurbanresidents(thehigh-riskgroup).Thehealthcheckupincludedroutinephysicalexaminationsandotherinspectionssuchasbloodfat,bloodsugar,liverfunction,liver,gallbladder,pancreas,spleen,CDFIforlowerabdomen,chestandelectrocardiogrametc.Additionalcheckswereconductedforthosepersonswhohadhealthproblems,inordertoaccuratelyidentifythediseases.Accordingtothestatisticsofthephysicalexaminationresultsof12406retireesin2008,includingthosewhohavecasehistory,however,only50%peoplehavenohealthproblemssincetheirresultsshownegativesignal;sotospeak,thehealthconditionsoftheinsuredgrouparenotoptimistic.Amongthediseasesthathavebeenfiguredout，theincidenceofhypertension,hyperlipemia,fattyliveranddiabetesmellitusrankthefirst.Mostdiseasesarenewlydiagnosedcases.Fromtheperspectiveofclinicalmedicine,theabove-mentioneddiseasesmostlypossessthecharacteristicthattheincidenceincreaseswiththeage.However,thediseasesofWendenginsuredgroupmainlybelongtothenewlydiagnosedcases,sothatthesepeopleareunderthedangersincetheydontrealizetheirhealthproblems.Iftheinsureddontpayattentiontothesediseases,itwillbringgreatdamagetothehealthoftheinsuredgroupinthefutureandhaveaninestimableimpactandpressureonthemedicalinsurancefund.ⅱ)ActivelycarryingouthealtheducationandestablishinghealthfilesfortheinsuredgroupInordertostrengthenthehealthinterventionsoftheinsuredgroup,WendengMedicalInsuranceBusinessUnitorganizestheexpertsofmedicalandhealthcaretothetownships,enterprisesandcommunities,withprojectors,healtheducationPPTandpromotionalmaterials.Theseexpertshaveheldmorethan60healtheducationseminarsandhealthconsultativeconferences,anddeliveredmorethantenmillioncopiesofpromotionalmaterialsfortheinsured，whichrichentheinsuredsknowledgeofhealthcareanddiseaseprevention,guidetheinsuredtodevelopahealthylifestylestepbystepandenhancethehealthawarenessoftheinsuredgroup.Forthepatientswithchronicdiseasessuchashypertension,hyperlipemia,fattyliverandword文檔可自由復制編輯diabetesmellitusfoundintheinvestigation,WendengMedicalInsuranceBusinessUnitorganizeshealthlectures,opensthetargetedhealthprescriptionfordifferentcases,conductshealthcounselingonebyone,andimplementspracticalhealthinterventionsandsystematichealthmanagement,soastoestablishhealthfilesfortheinsured.SinceJuly2006,wehavebeenformingtheelectronichealthrecordsforeveryinsuredontheWendenghealthinsurancewebsite.TheinsuredcanregisterapasswordontheWendenghealthinsurancewebsite,andcheckthehealthrecordsbyinputtinghissocialsecuritynumber．Thismeasurementprovidestheinsuredgroupwithsystematicandpersonalizedhealthcareservices,whichcanevaluateanindividualshealthconditionandofferthetargetedhealthinstructionaccordingtodifferentcaseswiththeintentionofmakingtheinsuredgroupconsciouslytakeactionstokeep．Ⅲ．After20years’studyonhealthmanagementinUSA,wecancometosuchaconclusionthatthereisasecretconcerninghealthmanagementforanyenterpriseandindividua1namely90％and10％.Specificallyspeaking,90％oftheindividualsandenterprisescanreducethemedicalexpensesto10％oftheoriginalbyadoptinghealthmanagement.10％oftheindividualsandenterprisesdontmakehealthmanagement,andtheirmedicalcostswillincreaseby％oftheoriginal.ⅰ)CarryingouthealthinterventionsfromcontrollingtrivialthingssuchasedibleoilandsalttoimprovetheoverallhealthleveloftheinsuredAmongthephysicalexaminationresultsofthehigh-riskgroupwhoparticipateinmedicalinsurance,theincidenceofhypertension,hyperlipemia,fattyliveranddiabetesmellitusrankthefirst．Thesediseasesintheearlystageonlybringlittlesufferingtothepatients,whichcanbeeasilyignored.However,ifletthediseasesalone,itwillleadtoterriblediseasessuchasarteriosclerosis,coronarydiseases,myocardialinfractionorevencauseseriouscranialvasculardiseasesthatcanmakeapersondisabled.Weshouldfigureouttheseword文檔可自由復制編輯avoidablecommondiseases,controltheusageofedibleoilandsaltindailylife,knowhowtodophysicalexercisesandadjusttheattitudetowardslife．Wenotonlyencouragetheinsuredtostopsmokingandrefrainfromexcessivedrinkingbutalsoputthedevelopmentofhypertension,hyperlipemia,fattyliveranddiabetesmellitusundercontro1.Epidemiologicalsurveyshowsthat60％ofthechronicdiseasesarerelatedtopeopleslifestyle.Themedicalresearchtestifiesthat80％ofcardiovasculardiseases,diabetesand40％oftumorscanbepreventedthroughhealthydiet,regularexercisesandrationalsmokinganddrinking.Ifourpositivehealthinterventionscanmake30-50％ormoreofthehigh-riskgroupwhohavehypertension,hyperlipemia,fattyliveranddiabetesmellitusavoidthecardiovascularcomplication,itcannotbeassessabletoevaluatethetheoreticalsignificance,practicalimportanceandapplicablevalue.ⅱ)EffectivesignificancegainedbyhealthinterventionsThroughthepositivehealthinterventionsfortheinsuredgroup，theawarenessoftheinsuredhasbeenraisedandthefundpaymentofhealthinsurancegraduallyshiftfromtreatmenttoprevention，whichdrivetheundertakingofhealthcareinsurancetowalkintoafavorabledevelopmenttrack.AmongtheurbanareasofWeihalwheretheenvironmentaleconomicandmedicalresourcesarerelativelyclosetoeachother,Wendenghospitalizationratein2008is5.6%.whichisthelowestratesincetheimplementationofmedicalinsurancesformorethan10years.AndthisrateislowerthantherateinthefourthnationalhealthservicessurveyfindingspublicizedbyNationalHealthMinistryinFebruary27,2009,inwhichindicatesthattheannualhospitalizationrateforlocalresidentsin2008is6．8％(ofwhich，urbanareasis7.1%andruralareasis6.8%.Inthefirstsixmonthsof2009,wehaveconductedthehealthrecheckbyrandomsamplingfortheinsuredgroupwhohavebeencheckedin2006andundergonethehealthinterventions．Theresultsshowthattheincidenceofhyperlipemiais15.2%,1owerthanthenationalaverageof18.6%.Andtheincidenceofotherdiseaseshasreducedtosome．Duetotheoverallraiseofhealthlevelfortheinsuredgroupandscientificandstrictfundmanagementofmedicalinsurance,thesupportingabilityofWendengmedicalinsurancefundbecomesmoreandmorestronger,andthesecurityleveloftheinsuredgroupisincreasing，word文檔可自由復制編輯comparedwithotherareasofWeihaicitywheretherearealmostthesamemedicalresources,paymentratioandradixnumber.AmongthecityofWeihai,theproportionoftheinsuredspersonalaccountinWendengisthehighest,andithasthelowestbaselineforhospitalizationandhighestseriousillnessreliefamountandpaymentproportion.Wendengcityistheearliestonetocompletelysettletheproblemofthebasicmedicalinsuranceforretireesfrombankruptbusinessesandenterpriseswithoperationaldifficulties,andWendengisalsothefirstonetoimplementthebasicmedicalinsuranceforurbanresidentsinShandongProvince.3、Healtheducationneedsthewholesociety’sparticipationWiththedevelopmentof20years,healtheducationintheUnitedStatesandotherwesterndevelopedcountrieshasevolvedintoacompleteandrelativelyscientificservicesystem.However,healtheducationinChina,especiallythevastruralareashavenotyetreceiveddueattentions.TheepidemiologyofChinashowsthateveryhealthyadultshouldconsumenomorethan25gramsofedibleoilforaday,butthenationalaverageamountis44gramsaccordingtothenationalsurvey.Thecitizensinsomerichcitiescaneventake83gramsforeachpersoneveryday,farmorethanareasonableintake.Thescienceprovesthatifonepersonabsorbsmorethan5gramsoffateveryday,hisweightwillannuallyincreaseby10kgintenyears.High-temperaturecookingandfryingcommonlyusedincateringindustrynotonlyleadtothehighproportionofcalories，butalsohaveagreatinfluenceonthedietbalanceoftheresidentsandproducecarcinogenicsubstance,namelypropenamide.ChineseNutritionSocietyrecommendstheintakeamountofsaltforonepersoneverydayshouldbenomorethan6grams,whilethenationalsurveyofChineseresidentsreportsthattheaveragedailyintakeis12grams,whichistwicethanthestandardamount.SinceWendengisaseasidecity,thecitizensalwaysconsumemoresalt.Butexcessivesaltwillcausewaterandsodiumretentioninthebody,andtheincreaseofbloodvolumewillraisethelateralpressureofbloodvesselwalls,whichisthemainreasonforhypertensionandarteriosclerosis.Theabove-mentionedinformationcanberegardedasveryimportantknowledgeforpeopletokeephealthy.Accordingtoourinvestigation,therateofhealthawarenessintheintellectualsandcadresisverylow,nottomentionthegeneralpopulation.Howtomakepeopleawareoftheproperwayoflifeshouldbeachievedbythehealtheducation.Healtheducationshouldnotbelimitedonlytohigh-riskgroupandtheelderlyword文檔可自由復制編輯people,butshouldincludealltheresidents.Weshouldestablishasoundandpracticablewayoftheimplementationofnationalhealtheducation,andcarryoutsystematichealtheducationclassesfromkindergarten,whichm