推荐

正对于商业保险公司而言,即使是政府作为其主要客户,它们也并非没有风险。这些公司通常要承担医疗成本上涨的所有风险。运作医保项目将肯定是一笔大生意,但是否能以此获得巨大利润,还远远不能肯定。美国医改:向左走,向右走?过去三个月以来,美国的政客们一直为奥巴马医改网站的差劲表现而争论不休。创建新的在线交流方式,以医疗改革方案为基础,向千百万没有保险的人提供廉价医保,是迄今为止奥巴马医改政策最引入注目所在。在未来几年,随着越来越多美国人需要依靠政府支付他们的医疗费用,更多人会选择将他们的公共医保基金交给私人保险机构管理。理论上,享受医疗保险和补助的患者,     

探讨现行医保结算方式下公立医院的财务管理

随着基本医疗保险制度的全面覆盖,政府在医疗体制方面改革的深入,有限的医保基金无法满足医疗费用增长的矛盾日渐突出.为了控制医保医疗费用不合理增长必须加强现行医保结算方式下公立医院的财务管理工作,提升财务管理水平.面对基本医疗保险支付方式的变革给公立医院财务管理带来的影响和挑战,医院财务部门必须熟练掌握医保政策,优化业务流...     

奥巴马医改困境和对策分析

美国是当今世界唯一没有实现医保全民覆盖的发达国家,但居高不下的医疗支出、过快的费用增长速度、人们对卫生服务的满意度低等问题,严重制约了美国卫生事业的发展,改革势在必行。奥巴马医改在其竞选时就受到广泛关注和支持,然而在改革后又广受非议,在美国现行体制下发现医改与文化、政治等因素的相互关系,这对世界各国都有重要的借鉴意义。     

医保管理纳入医院质量与安全管理成效

本文以医保管理纳入医院质量与安全管理成效为主要内容进行阐述,结合当下医保管理融入到医院质量与安全管理体系中和医保管理纳入到医院质量与安全管理成效分析为主要依据,从建立医保质量监督管理组织机构、提升医保管理队伍建设进程、设置规范化医保流程、强化医保管理、医疗费用以上升趋势增长、医保拒付金额下降、医疗自费比例下降这几方面进行深入探讨和分析,其目的在于加强医保管理在医院质量与安全管理成效中价值,旨在为相关研究提供参考资料。     

公立医院医疗保险费用监管问题及对策

对当前公立医院医疗保险费用监管过程中存在的典型问题进行分析,加强医保费用控管,加强医疗系统征信建设,落实实名制就医管理规定;推进医护人员医德建设,加大宣传教育力度;针对医保监管体制机制不顺畅问题:开展医保医师制度试点;着手改革现行医保费用结算方式;针对医保监管不及时、不到位问题加强医保费用风险动态监测;针对信息管理平台建设滞后问题:运用"互联网+"手段,启用医疗保险费用"动态监控、智能审核、实时更新"才能实现医疗保险监管的目标。     

加强医院医保资金财务管理浅析

随着国务院对医疗体制的改革的重视,随着新医疗制度的实施,医疗保险将会全面覆盖到全国的人民,医保资金的数额也将不断增加,管理难度也增加.本文针对目前医院医保资金管理中存在的问题进行剖析,并提出相关建议,希望能对加强医保资金管理提供帮助.     

新医疗体制下医院医保财务管理的改革措施

新医疗体制不断改革和完善,对医院财务管理活动也提出了更加严格的要求,医院医保财务管理面临着新的形势和挑战。本文分析了目前医院医保财务管理中存在的问题,提出了一些改革措施,以供参考。     

美国医疗保险改革的政治经济学解读

美国新医保法案的通过是奥巴马政府的胜利,也标志着民主党百年努力结果的初步实现.然而,医疗改革进程的推进却波折不断,凸显出多元利益的博弈、不同价值观念的分歧以及政治体制方面的障碍.在这些因素的影响和作用下,医保改革最终能否解决美国福利制度的难题还有待观察.     

试论如何避免定点医院医保财务风险

定点医院作为我国医疗服务体系的重要内容,在国家医疗保险工作管理等方面起着重要的作用。医疗体制的不断改革给定点医院的医保工作管理提出了新的更高标准的要求,需要定点医院重视相关内容并对医保财务管理进行有效改革,从而为人们提供更加高质量的服务。本文通过对重视定点医院医保财务风险的意义,以及当前定点医院在医保财务管理与会计核算等方面存在的问题进行分析,根据实际特点与现状提出了相应的促进定点医院医保财务风险防范的策略。     

浅谈完善医疗机构医保现场结算

随着社会保险体制的建立和完善,医疗机构医保现场结算能简化医保待遇支付程序,方便参保人员看病就医,减轻参保人员医疗费用负担,提高医疗保险管理服务水平,达到方便群众、规范管理目的。本文探讨如何完善和提高医疗机构医保现场结算工作入手,着重分析了目前影响医疗机构医保现场报销效率的因素,并提出了相应的对策,以使医疗保险基金的保障功能得以充分发挥,从而为医疗保险制度改革做好坚强的后盾。     

A critical review of primary health care reform in Bulgaria: impact on consumers

The Health Care System in Bulgaria is in a period of transition and is undergoing profound changes in financing, organization and ownership. A priority of this reform is to shift the focus of healthcare to the primary sector and to emphasize general practice. New legislation in support of this health care reform has been passed over the last few years. However, this legislation, although consistent with the global aims to be achieved, has proven to be contradictory in terms of its practical implementation. This has had a negative impact on health care consumers’ interests and rights. This paper evaluates the effects of primary health care reform in Bulgaria from the perspective of patient satisfaction. For this purpose, a major task to be fulfilled is to identify the contradictions emerging between the legislation outlining the reforms and the realities of practical implementation with respect to its impact on consumers. The methods applied include: a review of the legislation, a review of the practical progression of the reform process, and an assessment of the new developments in health care consumers’ interests and rights. Considerable contradictions have been found between the legal framework of health care reform in primary care and existing experiences, traditions and expectations. The legislation is inconsistent with the existing realities of healthcare provision. This is leading to turmoil in the health care system during its present transformation and is infringing upon consumers’ rights. Problems emerging in the process of reform need to be identified, and solutions need to be found and worked out as the reforms progress. An assessment system has to be developed to monitor the overall reform process and to evaluate the effectiveness and efficiency of the changes introduced. The impact on consumer and patient satisfaction should be an area of prime concern during these assessments.     

德国长期照护保险制度研究及其启示

随着全人口老龄化的日趋严重,长期照护服务的意义由于其使用者需求和支出上的增长而日趋重要,德国实行的长期照护保险制度为解决这一问题提供了新的视角与尝试。本文分析了德国实行这一制度的初衷与成因,系统阐述了这一制度的内容及实施结果,以期为我国老年人长期照护的养老服务体系的政策设计及实施提供有益的启示与借鉴。     

Bedarfsgerechte Steuerung der Gesundheitsversorgung — Chancen und Hindernisse

On 2 July 2018, the German Council of Health Experts handed over its current report entitled, “Demand-oriented health care management” to the Federal Ministry of Health. The pronounced separation of outpatient and inpatient care, and distinction between private and public health insurance, is typical of the German system. Experts’ recommendations include improved coordination of outpatient and inpatient services, monistic hospital financing and family doctor-centred patient care. The main criticism of the report is that it lacks a regulatory concept with competitive management structures.     

整合照料视角下的老年家庭照护床位政策研究

作为嵌入式养老的创新模式，家庭照护床位是解决当前养老服务困境，推动养老服务体系高质量发展、精细化治理的重要举措。然而，当前的试点仍存在需求不足、供给乏力的双重困境。究其原因，主要在于对家庭照护床位认识不清、理解错位；政策实施中尚未有效解决社区居家养老服务资源碎片化问题，资源整合定位不准、整合层次低。基于此，本文提出回归家庭照护床位政策本色，强调其准市场化服务属性，明确其补充、协调、整合的功能定位，探索以街镇-社区为基点、以“养老管家”为媒介、以智能科技为支撑、以老年人住所为场域、以老年人个体为中心的服务终端功能性整合路径，完善配套激励相容机制、支付保障机制，推动实现 “医-养-康-护”一体化居家养老。     

The Power of Social Network Construction and Analysis for Knowledge Discovery in the Medical Referral Process

The social network model is powerful enough to provide for the analysis and study of a variety of application domains from daily life, including health care and health informatics. After the widespread appearance of automated tools capable of deriving and analyzing social networks, social network analysis (SNA) and mining in the health care domain has recently received considerable attention for its key role in understanding how various bodies within the health care system form communities and how they are socially connected with each other. This understanding helps enhance the organizational structures and process flows, among others. In this article, we show how SNA techniques can solve issues in the medical referral system in the Canadian health care system and the like, by analyzing the social network of general practitioners (GPs) and specialists (SPs). One of the main targets is to optimize the communication between GPs and SPs with hopes of decreasing the waiting time of patients to be seen by SPs. Various SNA and mining techniques are described and analyzed, backed by reporting some experimental results.     

Gesundheitsfonds — effizientere Steuerung des Gesundheitssystems?

In 2009 the German central health fund was implemented. It was the result of a political compromise. One political party intended to equalise the risk structure among 130 different health care funds, and the other wanted to intensify competition and to improve efficiency among the different health insurances. The fund is flanked by a health-based risk adjustment and is aimed at sustainably ensuring the funding of the statutory health insurance system. It also constitutes the basis for competition among statutory health care funds, securing quality and efficiency in health care provision. To cover additional expenditures, health insurers had to charge flatrate premiums. A new law, which will come into effect in January 2015, will oblige health insurers to charge income related contributions. It is not clear how this will change competition among insurers. The federal government will not need to finance subsidies to low income individuals anymore. Income redistribution will only take place within the public health insurance system, exempting the privately insured and public servants from supporting low income individuals. The authors claim that the health care fund will not succeed in its aim of securing a sustainable financial basis for the statutory health insurance system. Most of the authors argue that there is no evidence of greater efficiency thus far, and they offer proposals on how to achieve improved performance.     

The algebra of health concerns: implications of consumer perception of health loss,illness and the breakdown of the health system on anxiety

The current and expected future state of the American health care system creates much concern and anxiety at the national and individual level among Americans. This study is in response to the call of the Institute of Medicine to further study the lack of confidence among Americans about their future ability to receive high‐quality health care. This study compares perceived anxiety and its amelioration as a result of three possible health situations: illness with infectious disease, losing one's health and a breakdown of the health care system. This empirical study was conducted within the framework of conjoint analysis. We conducted an experimental design of ideas, identified attributes that increased or reduced anxiety in each of the three health‐related situations and then segmented consumers on the basis of their patterns of reactions to the attributes. We found that the highest anxiety was attributed to the breakdown of the health care system. The segmentation further suggested that the anxiety emerging from the breakdown of society's health care system generated a different extent of anxiety than that which emerged from one's illness or one's loss of own health. The attributes that drove anxiety across the health situations were, surprisingly, charities, one's company, the local hospital and supplemental insurance. Attributes that reduced anxiety differed among segments. The attributes were found to be: close friends, family, distribution of information by authorities and the belief in God. At a practical level, these data and patterns of response allow health care policy makers to enhance the coping ability of patients by understanding the nature of what reduces the anxiety of individual types of patients. The approach in this study provides a person‐centred system for communication and anxiety reduction that can be implemented as part of a public health policy.     

Martin Grosky and Sally Sheard, eds. Financing Medicine: The British Experience since 1750

To what extent is a society responsible for providing healthcare to its members? What is the best manner for funding a sustainablehealth care system? This new volume of loosely connected essaysattempts to answer these lofty questions through close examinationof critical moments within the British medical experience overa 225 year period. The works are arranged chronologically and by subject, tracingthe     

养老护理人员胜任素质指标体系构建与应用——基于396名养老护理人员的调查

随着我国人口老龄化步伐的加快,如何完善养老服务体系,提供社会化、多层次养老服务成为我国当前亟待解决的社会热点问题。提高养老护理人员素质和保障服务水平,是推进我国养老服务体系发展的关键。构建养老护理人员胜任素质指标体系,能够为政府部门制定养老护理人员培育政策及其职业生涯发展提供指导、为加强养老服务人力资源开发与管理提供科学的依据。以胜任素质模型为理论依据,运用文献回顾、行为事件访谈法编制养老护理人员调查量表,针对济南、青岛6家养老机构396名养老护理人员的问卷调查数据,采用探索性因子分析和结构方程模型,构建并检验了养老护理人员的胜任素质指标体系。研究结果表明:养老护理人员胜任素质指标体系主要由护理基本知识、照护技能、个人特质、职业道德与认同感4个维度的26项胜任素质特征构成。从每个维度的影响效应分析,影响最大的是照护技能,其后依次为护理基本知识、个人特质、职业道德与认同感。基于该指标体系,分别从完善养老护理人员的招聘选拔机制、培训机制、考核激励机制三方面提出了拓宽招聘渠道扩大招聘群体、设置合理选拨标准、加强培训内容开发、增设培训可选择方案及实景模拟评价方式等养老护理人员胜任素质提升路径。     

基于J2ME和PHP技术的移动计算应用解决方案

对以蜂窝网作为承栽网络的移动计算应用平台进行了分析，针对现有J2ME开发平台的复杂性，提出了一种以PHP／PHP JSP作为中间件的完整、高效及便于开发的应用解决方案，同时对相关的技术难点尤其是缓存技术进行了探讨，给出了典型算法。最后给出了一个应用实例——个人健康顾问系统。