对无锡市社区卫生服务体系的几点思考

无锡市医疗工作的框架是“三级医疗服务”,即企业的保健站（职工医院）、区级医院和市属医院,各级医疗机构间建立合同（特约）关系,逐级转诊;预防工作的框架则是“三级防保网络”,即街道卫生所承担除医疗以外的预防保健如计划免疫、传染病管理等十大任务,区、市防疫站和妇保站分别逐级进行业务指导。然而随着社会和经济的发展,我市现有的卫生服务体系已日益凸显出其不相适应的方面,以下是对我市卫生服务体系的几点思考: 改革现有卫生服务体系的必要性 1、一方面,原有医疗网底——企业职工医院和保健站功能弱化甚至闲置,导致这部分卫生资源的浪费;另一方面由于我市缺少一级（社区）医院,常见病、多发病拥向三级医院,病员无序流动,致使小病大看,“牛刀杀鸡”,不仅使得三级医院无暇履行自身除临床外的教育、科研职能,而且增加了医疗成本,使得有限的医保基金不堪重负而屡屡告急。     

医疗服务价格管理的现状与对策

建立合理的医疗服务价格管理体系,需要合理优化资源配置,在充分发挥市场机制的同时价格部门加强对医疗服务价格监管作用也显得尤为重要。从当前医疗服务价格管理为切入点,调整医院的补偿机制,不断完善医疗价格服务体系,从而彻底破除"以药补医"。通过理顺医药价格,增加政府投入节约成本,加强医疗机构自我约束力、合理分配资源等途径建立一个崭新的补偿和运行机制,运用正确的价格策略来促进中国医疗服务事业的发展。     

浅析公立医院成本核算管理的现状及对策

随着社会经济的快速发展,公众"看病难,看病贵"的呼声促进政府部门加大对公立医院的制约力度。面对当前激烈的医疗市场竞争,建立全方位的成本核算,加强公立医院管理,降低经营成本,提高经济效益,已成为公立医院可持续发展的关键;是公立医院适应市场经济发展的必然趋势;也是医院医疗服务体系进入市场参与市场竞争的必然结果。     

总额预付制度下对医院医保医疗资金的管理分析

随着医保支付制度的改革,"总额预付"逐步实行。因此在总额预付的框架下,不仅增加了医保对医疗行为的激励和约束,同时对医院医保医疗资金核算、管理提出了更高的要求。文章根据相关制度规定及工作实际,将"总额预付"制度下医院医保医疗资金的管理作了详尽分析。     

医院固定资产管理中存在的问题与处理措施

医院是为社会大众提供医疗服务的机构,随着医院的不断发展扩大以及医疗服务的逐渐增多,医院的固定资产也随之增加。因此在医院的日常营运以及医院的发展过程中,固定资产的管理工作也要随之不断地优化。为了能够对医院固定资产管理工作进行详细的研究,文章结合医院固定资产管理的现状,根据其管理过程中所产生的问题,找到切入角度,并以问题为依据提出相关的措施与建议。     

新形势下公立医院经济管理研究

医疗卫生服务体系的全面改革催生了我国公立医院经济管理模式转型与升级的契机,随着新医改方案的确立、医疗体制和医疗保险制度改革的深入,医院财务管理中存在的各种问题日渐显露,如何完善医院财务管理体系,使其在竞争激烈的市场环境中立于不败之地是目前医院财务管理中急需解决的问题。本文就新形势下各大公立医院财务管理的突出问题进行简要分析,并科学提出相应的改革策略,促进医院经济管理向高效化、服务化方向迈进。     

医院应收医疗款的管理

随着医疗改革制度的不断深入和发展,医院的医疗收入等经济指标也得到了大幅度提升,但与此同时各种类型的医疗欠费即应收款项也在不断增加。大额的医疗欠费不但扭解了医疗收入的真实性,而且也造成了医院资产的流失以及经营效率的下降。文章在对医院应收医疗款组成以及形成原因进行分析的基础上,从财务管理及内部控制的角度提出了几点有针对性的管理措施和方法。     

医院成本管理与效益评价

随着医疗服务市场竞争的日益加剧和卫生事业的快速发展,医院在新时期作为独立的经济实体,如何在竞争中立于不败之地,如何在政府投入少、医疗运行成本不断增加的情况下,既要满足日益增长的医疗需求,又要略有盈余,以保证医院持续健康地发展,有力的手段是实行成本管理.     

简析医院改造工程项目的管理流程

随着我国经济的发展,城市化进程日益加快,人们对于医疗服务的需求量持续增加,各个医院患者数量逐渐增长。与此同时,部分医院原有的医疗基础设施条件已经无法满足患者就医的基本需求,为此各类医院改造工程项目陆续开工建设,与常规的工程不同,医院改造工程项目对管理流程以及管理水平均有比较高的要求,为此医院应当结合自身项目的实际情况,设计科学的管理流程,加强对改造环节的控制,确保相关工程的高质量的完成,以此来促进医疗服务水平的全面提高。     

医院预算管理存在的问题与对策

随着医疗体制改革的不断深入,如何提高医院的管理水平,提升医院的医疗服务水平,是医院亟须解决的问题.预算管理是医院管理中至关重要的一个环节,从整体上来看,医院的预算管理与企业相比还存在较大的差距,希望医院管理者能充分重视预算管理,提高医院的经营管理效率.     

非理性就医对医保费用管理的挑战及应对策略

目的分析参保患者非理性就医现象,积极探索应对策略,为控制不合理增长的医疗费用提供参考。方法结合我院医保工作中对医保基金正确合理使用的管理及参保患者的就医情况,分析近年来参保患者非理性就医的现象、原因及结果,探索应对策略,总结规范化管理的措施。结果小病大治、大病贵治、无病保养等是非理性就医的主要表现,严重影响医保费用的管理,助推了过度医疗和医疗费用的不合理增长。结论应落实国家医药卫生体制改革,完善配套的医疗保险政策,深化医院医保费用管理,科学控制基本医疗付费总额,控制医疗费用不合理增长,从而保障医保基金的安全使用。     

基于政策导向的医用耗材管理

《关于深化医药卫生体制改革的意见》和《全国医疗服务价格项目规范（试行）》两政策对医院来说,都是更大的挑战。基于这些政策导向,就必须加强医用耗材管理,规范医用耗材的使用。为此,应控制高端产品的适用范围;引进ERP系统,同时对高值耗材实行条码化管理,确保医用耗材的实耗实销。将政策导向贯彻到医用耗材管理中,实现账物相符,收支平衡,杜绝内耗,在保证医护质量的情况下,合理使用医用耗材,保证患者费用合理,控制医疗费用的不合理增长,确保医院成本效益合理。     

Price Discrimination in Public Healthcare

Could a public healthcare system use price discrimination—paying medical service providers different fees, depending on the service provider's quality—lead to improvements in social welfare? We show that differentiating medical fees by quality increases social welfare relative to uniform pricing (i.e. quality‐invariant fee schedules) whenever hospitals and doctors have private information about their own ability. We also show that by moving from uniform to differentiated medical fees, the public healthcare system can effectively incentivise good doctors and hospitals (i.e. low‐cost‐types) to provide even higher levels of quality than they would under complete information. In the socially optimal quality‐differentiated medical fee system, low‐cost‐type medical‐service providers enjoy a rent due to their informational advantage. Informational rent is socially beneficial because it gives service providers a strong incentive to invest in the extra training required to deliver high‐quality services at low cost, providing yet another efficiency gain from quality‐differentiated medical fees.     

Cost and time savings from a rapid access model of care using transient elastography to screen and triage patients with chronic Hepatitis C infection

Background:

Treatment uptake amongst patients with chronic Hepatitis C virus (HCV) in Australia is relatively low. New approaches to assessment have the potential to reduce public waiting lists, improve access to treatment, and to reduce healthcare costs.

Aim:

To describe the costs to the public hospital system and waiting time associated with a novel integrated rapid access to assessment and treatment (RAAT) model of care that utilizes Transient Elastography (TE) as a specialist outpatient-based approach for a streamlined assessment of patients with chronic HCV, compared to conventional outpatient management with liver biopsy (LB).

Methods:

Time from first medical review to treatment plan and costs associated with detection of fibrosis were recorded for patients receiving RAAT during a 3-month period, and for a similar historical cohort managed conventionally with LB. Costs related to medical and multidisciplinary team reviews and the TE/LB test itself were included.

Results:

Patients receiving RAAT had lower costs (n?=?27, median AU$2716) and shorter time to treatment (median?=?194 days) than for conventional management (n?=?13, median $5005, 420 days; p?Conclusions:

Based on real world audit data, this evaluation suggests TE, used as part of a new RAAT model of care, is cost saving to the health system in the short-term and reduces waiting times. The analysis reported here was intended to assess the costs related to detection of fibrosis, and is limited by the small sample size and potential selection bias. Future research should undertake a full economic evaluation at a whole of service level, to consider a more comprehensive and longer-term assessment of the costs and benefits associated with HCV management.     

The direct medical cost of rheumatoid arthritis in Hong Kong

Summary

Rheumatoid arthritis (RA) is an autoimmune disorder of unknown aetiology. Both treatment and rehabilitation for RA are costly. Knowledge of the cost of management of RA is important for better planning for allocation of medical resources, and the present study aimed to evaluate and describe the direct medical cost of the management of RA from the perspective of a public health organisation in Hong Kong.

A retrospective study was performed of RA patients at the Prince of Wales Hospital in Hong Kong. The study cohort consisted of randomly selected RA patients from the 1st January 2002 to the 31st December 2002. Cost items studied included hospital stay, outpatient clinic visits, diagnostic tests, medications, auxiliary care, and cost for management and prophylaxis of side effects induced by the drugs for RA management.

A total of 147 patients were included in the study. The average age and duration of disease of the subjects was 54.7 years (standard deviation 10.9 years) and 12.6 years (standard deviation 7.0 years), respectively. The annual direct medical cost per RA patient was HK$18,657 (US$1 = HK$7.8). Inpatient care contributed the highest proportion of the total cost (43.8%). The annual direct medical cost for the management of RA in Hong Kong was HK$443 million, which comprised 1.4% of the total healthcare budget in the year 2002.

The cost of RA has an economic impact on the healthcare budget in Hong Kong. Early and more aggressive measures could reduce the need for hospitalisation and hence reduce costs.     

Cost of hospital care for elderly at risk of falling

The variables that relate to cost of hospital care for a large sample of elderly patients at risk for falling are examined. The chief predictors of cost of hospitalization were medical, pharmacy, and nursing interventions. Use of nursing interventions, on average, raised the median hospital cost less than use of medical or pharmacy interventions. Using a standardized nursing language with the hospital's information system can provide nurses with information that demonstrates the cost effectiveness of their interventions.     

患者满意度调查对医院管理的作用

目的通过住院患者对医护人员服务态度、医疗护理质量、住院环境、是否存在滥收费现象及心理指导的满意度调查,研究患者满意度调查对医院管理的作用。方法对2009年1～2月与11～12月接受满意度调查的住院患者进行回顾性分析。结果患者满意度调查开展前后,实验组医护人员操作、医护人员服务态度、病区环境、是否存在滥收费及心理指导等方面内容评分均高于对照组,两组比较差异有统计学意义(P<0.05);且实验组投诉率较低。结论患者满意度调查可以提高患者对医院的满意度,降低投诉率,及时发现工作中存在的问题。医院应注意提高医护人员的操作及服务态度,杜绝滥收费现象,并定期对患者进行心理指导,加强患者对医院的信任,利于医院的管理。     

Medical costs in patients with heart failure after acute heart failure events: one-year follow-up study

Aims: This study investigated annual medical costs using real-world data focusing on acute heart failure.

Methods: The data were retrospectively collected from six tertiary hospitals in South Korea. Overall, 330 patients who were hospitalized for acute heart failure between January 2011 and July 2012 were selected. Data were collected on their follow-up medical visits for 1 year, including medical costs incurred toward treatment. Those who died within the observational period or who had no records of follow-up visits were excluded. Annual per patient medical costs were estimated according to the type of medical services, and factors contributing to the costs using Gamma Generalized Linear Models (GLM) with log link were analyzed.

Results: On average, total annual medical costs for each patient were USD 6,199 (±9,675), with hospitalization accounting for 95% of the total expenses. Hospitalization cost USD 5,904 (±9,666) per patient. Those who are re-admitted have 88.5% higher medical expenditure than those who have not been re-admitted in 1 year, and patients using intensive care units have 19.6% higher expenditure than those who do not. When the number of hospital days increased by 1?day, medical expenses increased by 6.7%.

Limitations: Outpatient drug costs were not included. There is a possibility that medical expenses for AHF may have been under-estimated.

Conclusion: It was found that hospitalization resulted in substantial costs for treatment of heart failure in South Korea, especially in patients with an acute heart failure event. Prevention strategies and appropriate management programs that would reduce both frequency of hospitalization and length of stay for patients with the underlying risk of heart failure are needed.     

浅谈综合性医科大学附属医院科研管理人员应具备的素质

科研水平是综合性医科大学附属医院的核心竞争力，附属医院科研管理人员的素质关系到医院科研工作的发展。为更好地从事工作，科研管理人员在具备较强业务素质同时，应牢固树立全心全意为科研人员服务意识，高度的责任意识，创新意识和廉洁自律的意识。     

医疗保险单病种付费政策的经济学分析

实行单病种付费制度目的在于促进有效利用有限卫生资源,并充分发挥其最大社会效益、提高医疗服务质量、控制不合理医疗费用的增长,达到更加公平地分配我国卫生资源,提高公民健康水平的最终目的。我们研究发现,单病种付费制度并不能有效节约医疗资源和降低医疗费用,单病种付费制度虽能对控制医疗费用起到积极作用,但是仍然需要进一步研究有效的医疗保险制度。