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医联体是医改的重要内容,医保支付改革是医联体重要的内生动力。目前医联体与医保改革并不完全合拍,导致医保对患者的引导不足,医联体内生动力机制缺失。为探究新型医联体内医保支付改革方式,本课题组对重庆市医联体现状和医联体内医保支付方式进行研究,指出重庆市医联体内医保支付存在的问题,提出适合重庆市医联体的医保支付改革策略,为医联体的完善提供政策建议。结果显示,重庆市建立了以托管模式、分院模式、县域技术帮扶模式为主的医联体,实行了医保基金市级统筹,建立了多元混合式医保支付模式,减少了转诊的“门槛费”。但仍存在医联体内医保基金不能相互调剂使用、医联体与医保之间缺乏联动、医保支付方式不完善、缺乏相应的绩效考核办法等问题。建议构建紧密型医联体,允许医联体内医保基金相互调剂,健全医疗质量与绩效考核体系、激励约束机制,制定相关医保政策,合理确定预算总额,完善医保支付方式。 相似文献
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合理设计医保支付方式,不仅关系到医保资金管理、医疗质量和广大民众的健康.还会影响整个国民的经济的再分配和发展速度,是保证医保和国民经济健康有序发展的关键一环。通过对美国Medicare支付方式的回顾研究及对几种支付方式的比较分析,旨在为国内医疗保险支付制度的改革提供有益的启示和借鉴。 相似文献
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目的通过对社区卫生服务中心城镇职工基本医疗保险对固定和非固定在同一社区门诊就医的两类人群进行分析,为实现社区有效医保监管和在家庭医师制度下采取适宜的医保支付方式提供依据。方法采用excel和spss软件对社区卫生服务中心城镇职工基本医疗保险门诊结算数据进行分析。结果医保管理部门应加强对社区门诊固定人群的医保监管,实行社区门诊混合型医保支付方式可有效地提高医保基金的使用效率,使家庭医生的服务更加有针对性。结论加强对社区门诊固定人群的监管可有效提高医保监管效率,同时在家庭医生制度下采取社区门诊两类人群的不同医保支付方式是现行医保制度下较为稳妥和有效的,有利于医保基金的合理使用和家庭医生的更好服务。 相似文献
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目的:借助扎根理论,对浙江省基本医疗保险支付制度改革的政策演进模式进行解构,并提出新时期深化改革的策略,为构建现代化高质量的医疗保障体系提供参考。方法:基于1998-2021年浙江省发布的31份医保支付政策文本,对其进行三级编码,构建出政策动态演进的理论模型。结果:依据浙江省医保支付制度改革经历的3个阶段,通过三级编码,最终梳理出与医保支付制度相关的177个概念、33个范畴、13个主范畴和3个核心范畴,整理为契约式管理模式、激励相容管理模式和管理创新模式3条脉络。结论:浙江省持续深化医保支付制度改革进程中,从契约式管理,统一制度规范,到建立激励相容机制,约束医疗双方行为,再到管理创新,保障全民健康。其改革演进模式遵循各阶段下民众切实的医疗保障需求和社会发展的内在规律,进而呈现出不同的改革关注的方向,形成对应的模式。“十四五”期间,应明确以民众健康为中心的改革理念,构建科学合理的支付方式,打造数字化的监管模式,促使医保支付制度更加高效管用,推动医疗保障体系高质量发展。 相似文献
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Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P < 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (>0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P <0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P < 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD. 相似文献
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Jiageng Zhu Jun Li Ruipeng Ji Jianghao Su Mingshun Shen Zhigang Cao 《南京医科大学学报(自然科学版)》2007,21(2):125-128
Objective: To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods: SD rats served as both donors and recipients. 4℃ sodium lactate Ringer's was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava (IVC) inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results: Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion: This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment. 相似文献
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APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES 总被引:13,自引:0,他引:13
Hong Zhao Tie-hu Ye* Zhi-yi Gong Yang Xue Zhang-gang Xue and Wen-qi HuangDepartment of Anesthesiology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing Department of Anesthesiology Zhongshan Hospital Fudan University Shanghai Department of Anesthesiology the First Affiliated Hospital Zhongshan University Guangzhou 《中国医学科学杂志(英文版)》2005,20(1):59-62
FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle… 相似文献
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Xi-zhao Sun Zhi-wei Zhang 《中国医学科学杂志(英文版)》2005,20(3):221-221
Shock wave lithotripsy (SWL) is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it's difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath. 相似文献
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Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction. 相似文献
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INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5 相似文献
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People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia its metabolic origin in Tibetan population.…… 《中国医学科学杂志(英文版)》2007,22(2):F0003-F0003
People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population. 相似文献
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Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea. 相似文献
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In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects. 相似文献
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Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle. 相似文献