CAJ | 학술논문

目的：对河南省疟疾防治工作进行费用—完成分析，从经济学的角度评价低度流行区疟疾防治工作各项措施的质量和有效性。协助有关部门更科学地制定今后的疟疾防治方案。方法：于1994～1995年内通过填表和委托乡村医生对来诊的疑似疟疾病人访问填表的形式，在疟疾流行的固始、商城两县收集政府和社区用于疟防开支的原始资料，回顾性调查每位疑似疟疾病人的治疗费用。对所收集资料进行费用—完成分析。结果：调查6个乡镇，收集两年内疑似疟疾病人12 325例。每例病人的费用平均为27.85元，相当于当地一个农民10天的收入；而政府用于每例病人的费用平均为4.86元。河南省每年用于疟疾防治的经费总投入约为694 434元。在12，325例疑似疟疾病人中仅有2.7%(336/12，325)得到很好的管理，34.9%(4296/12，325)只能得到一般的医疗管理，而近三分之二(62.4%)的病人(7693/12，325)得不到管理。结论：疟疾防治的费用主要由疑似病人及其家庭支出，如果政府经费投入削减，将进一步增加病人的负担，使其延误治疗，导致疟疾再度流行并危及最终控制疟疾目标的实现。
목적： 대하남성학질방치공작진행비용—완성분석，종경제학적각도평개저도류행구학질방치공작각항조시적질량화유효성。협조유관부문경과학지제정금후적학질방치방안。방법： 우1994～1995년내통과전표화위탁향촌의생대래진적의사학질병인방문전표적형식，재학질류행적고시、상성량현수집정부화사구용우학방개지적원시자료，회고성조사매위의사학질병인적치료비용。대소수집자료진행비용—완성분석。결과： 조사6개향진，수집량년내의사학질병인12 325례。매례병인적비용평균위27.85원，상당우당지일개농민10천적수입；이정부용우매례병인적비용평균위4.86원。하남성매년용우학질방치적경비총투입약위694 434원。재12，325례의사학질병인중부유2.7%(336/12，325)득도흔호적관리，34.9%(4296/12，325)지능득도일반적의료관리，이근삼분지이(62.4%)적병인(7693/12，325)득불도관리。결론： 학질방치적비용주요유의사병인급기가정지출，여과정부경비투입삭감，장진일보증가병인적부담，사기연오치료，도치학질재도류행병위급최종공제학질목표적실현。
Objective： To gather evidence for health policy reform, and assist with strategic design of future malaria control within the health sector, we conducted a prospective study of the costs and performance of Henan's malaria control programme. Methods： We measured the quality and efficiency of suspected malaria case-management, the only personal health service component and the most expensive of the 3 products in the Henan programme. We also costed the other two (non-personal) components-vector and blood surveillance. We collected all government costs at every level, enlisted private health care providers-260 village doctors in 6 rural administrative townships, and studied all 12,325 suspected malaria cases in 1994 and 1995. Results： From the patient perspective, the average cost of treatment for suspected malaria was 27.85 yuan(US$3.38),equivalent to 10 days' income for local peasants. By comparision, each case managed cost the government an average of 4.86 yuan(US$0.61).For the whole of Henan province, the average annual government input into the malaria control programme was estimated at 694,434 yuan (US$84,804). Of the 12,325 suspected malaria cases, only 1.1% (131/12,325) received excellent case-management, 36%(4414/12,325) were managed in a mediocre manner and nearly two-thirds or 63% (7780/12,325) were inadequately managed. Conclusion: We note that the cost of malaria control is now largely borne by suspected cases and their families. Further decrease in the government allocation will increase this burden and patients may delay treatment, with a concomitant risk of recrudescent transmission and ultimate breakdown of control. We advocate that strenous efforts should be made to improve the efficiency of case-management if malaria eradication is to be achieved within Henan, and that good stewardship also requires continued government investment in malaria control at the current levels.