远程医疗及有关管理问题

远程医疗及有关管理问题应明作者单位：２１０００２南京，解放军第八一医院远程医疗是远程医学的主要组成部分。简单地说，远程医疗是指依靠现代计算机及通讯技术而实现的异地医疗服务。这种医疗服务最常见的方式包括远程医疗咨询、远程医疗信息传递、远程会诊和远程手术...     

基本医疗保险中异地就医管理研究

异地就医是指基本医疗保险的参保人员在基本医疗保险统筹地区之外就医后在统筹地区申请报销相关医疗费用的行为.它的产生源于基本医疗保险统筹层次过低、医疗卫生资源配置失衡、人口流动增加和居民对健康的重视.目前异地就医管理存在异地就医费用结算滞后、异地就医政策和统筹地就医政策不统一、异地就医过度医疗服务道德风险严重、异地就医管理实施成本高和异地就医引起就医地医院之间的不正当竞争等问题.国家应重视基本医疗保障中的异地就医管理,分步骤,有重点,抓好关键环节来完善异地就医管理.     

我国老年人异地养老意愿及其影响因素研究——基于CHARLS数据的实证分析

[目的]了解我国老年人异地养老意愿,分析其影响因素,为完善异地养老服务体系,优化养老资源配置提供参考。[方法]基于CHARLS数据,以安德森卫生服务利用行为模型为框架,采用逐步回归法,对7535名老年人异地养老意愿及影响因素进行实证研究。[结果]7535名老人中,有异地养老意愿的995人(13.2%)。单因素分析显示,不同教育程度、居住地、居住模式、生活来源、本地医疗服务满意度的老人异地养老意愿差异有统计学意义(P<0.05);Logistic回归分析显示,教育水平、居住地、居住模式、本地医疗服务满意度均为老年人异地养老意愿的影响因素(P<0.05)。[结论]老年人异地养老意愿较低。应充分考虑老年人异地养老意愿的影响因素,细分老年人群,引导多样化异地养老形式;确保医疗资源供给,简化异地就医手续;完善保障政策,提高异地养老老人经济收入,从而提高老年人异地养老意愿。     

异地患者门诊服务策略

异地患者到综合性医院门诊就医,具有指向明确、就诊时间紧、对服务流程要求高等特点。针对这些方面,提出了就医咨询、扩大专家号源、相对优先、提供针对性便民服务和建立网络医疗服务等对策,在实践中取得较好效果。     

军队医院开展基本医疗保险异地就医工作的实践探索

我国基本医疗保险全国联网和异地就医结算工作稳步推进。文章介绍了军队医院在实现异地就医联网结算、做好患者服务、规范诊疗行为的做法,分析了当前异地就医存在的主要问题,结合工作实际,针对异地就医医疗行为监管、完善信息系统、健全联动机制、提升结算效率等方面的问题提出相关建议。     

基本医疗保险异地结算政策对卫生服务利用的影响研究

目的:研究医保异地就医结算政策的实施对卫生服务利用的影响。方法:使用2011年和2013年中国健康与养老追踪调查数据,利用logistic回归分析比较2011年和2013年医保异地就医结算政策实施前后保险办理地点对卫生服务利用的影响。结果:医保异地就医结算政策实施后,卫生服务利用概率显著提高。结论:医保异地结算政策能有效提高医保可接续性,降低人群异地就医障碍,提高卫生服务可及性。     

省内异地就医联网结算服务实践

省内异地就医联网结算是一项全新工作。本文介绍某医院顺应联网结算需求,主动创新、完善服务内涵的具体做法和主要成绩,并针对存在的问题提出建议。     

长三角跨省就医门诊异地联网结算实施1年试点研究

摘要 2018年9月28日开启长三角跨省门诊异地联网结算试点工作以来,截止到2019年10月底,浙、皖、苏和沪等三省一市的试点工作共计为40.62万人次服务, 累计联网结算费用为8 922.6万元。其中,上海市去三省就医的结算人次与三省来上海市就医的人次比例为1:1.8, 由于上海市的高医疗水平, 较之上海市去三省就医的人次, 三省来上海市异地就医的人次更多。但是,长三角跨省门诊异地联网结算并没有造成三省倒灌上海的现象, 是对三省一市都有利的一项政策。 为了让该项政策红利更好地执行到位, 对其发展存在的问题进行了分析, 并试图对问题的破解之法提出了建议。     

医疗保险异地就医管理政策的案例分析

目的 :通过对异地医疗保险(以下简称"医保")就医人员问卷调查情况的分析,找出医院在对异地就医管理模式中所存在的矛盾,为三级甲等医院改善异地就医患者管理的模式提出政策性建议。方法 :调查数据采用Epi Data 3.02软件建立数据库,使用SPSS 19.0、Excel等工具进行描述性统计分析。结果 :医保异地就医人员对异地医疗保险政策甚少了解。医保异地就医政策、报销范围的不统一,也给医院对异地医保管理带来困难。结论 :建议建立标准化的异地就医管理规范及建立医院与异地就医费用网络结算平台。     

关于与泛珠三角区域建立医保人员异地就医结算的设想

"9+2"区域是指泛珠三角区域.我国三大医保主要是指城镇职工基本医疗保险、城镇居民基本医疗保险和新型农村合作医疗.按现行医保制度规定,参保人员异地就医,需先在参保地申请并指定异地就医的医疗机构,医药费用回参保地报销.随着人口流动的加剧,特别是异地工作的农民工,报销十分不便.异地医保就医结算问题不解决,将制约市场经济下的人才流动,进而影响地区经济发展,应尽快推行"异地就医、联网结算"模式.总体思路:整体规划,分步实施,联网结算.整体规划的前提是实现区域内联网结算(一卡通).推行异地就医结算改革需分3步走: (1)省区间协议确定互相认可的定点医院; (2)委托代理异地就医服务及结算; (3)联网管理,实现"一卡通".     

省异地医保联网结算系统的建设方案和实现

目的:通过建设广东省异地医保联网结算系统,解决参保人异地就医结算耗费时间长、报销手续繁琐的问题。方法:架设专用网络,对硬件和软件接口进行改造,使之满足系统要求。结果:该系统实现对参保人异地就医实时结算,有效地解决了异地就医难的问题。结论:异地医保联网结算系统是行之有效的,验证系统有广泛的适用性,对实现区域医疗起了很好的示范作用。     

Availability of comprehensive women's health care through Department of Veterans Affairs Medical Center.

Despite increased numbers of women veterans, little is known about health services delivery to women across the Department of Veterans Affairs (VA). To assess VA availability of women's health services, we surveyed the senior clinician at each VA site serving 400 or more women veterans. We found that virtually all sites have developed arrangements, either directly or through off-site contracts, to ensure availability of comprehensive women's health care. On-site care, however, is routinely available only for basic services. Future work should evaluate cost and quality trade-offs between using non-VA sites to increase specialized service availability and using VA sites to enhance continuity of care.     

异地就医与医保、农保接口解决方案及其实现

为适应医保改革的需要，开展参保人员异地就医结算是医院面临要解决的问题。本文阐述我院异地医保接口的解决方案及其实现。     

Regulation in the public health sector in Brazil: the (mis) direction of hospital care provision

Health care regulation is a fundamental action in order to achieve effectiveness in health system. This article analyses SUS [Unified Health System] main regulatory framework, in relation to historical patterns of health service delivery, observed between 1996 and 2006. Despite all those political and organizational changes required by the Brazilian health sector reform process to implement SUS, which progressed, evidences and empirical data suggest that the agreed regulatory frameworks are weak and fragile and they did not change historical patterns and the main characteristics of SUS health care. This article suggests one possible explanatory reason for this behaviour, that needs to be empirically analysed: interest groups acting inside the Brazilian health system, on behalf of social insurance health care network, could capture the regulatory process, taking public resources to this network which maintain the same pattern of heath care services for decades, jeopardizing SUS implementation and the relevant health service delivery for the Brazilian society.     

异地就诊医保核算监督机制的完善对于医保体系高效化管理的意义

目的 探讨异地医保稽核制度的完善对于提高医保体系效率的意义.方法 通过对我国现行异地医保的稽核方式存在的漏洞和弊端进行分析,同时提出加强监督的相关建议.结果 目前异地医保稽核方式存在着实施困难、网络不健全、各地区之间合作性差,合作标准不统一等弊端,需要不断加强网络建设、建立全国性的医疗记录登记、实施全国统一的医保政策、甚至建立统一的医保体系等是进一步加强医保监督机制的有效措施.结论 健全的监督机制对于提高异地就医结算的的审核效率、审核意义重大.     

Challenges with Delivering Gender-Specific and Comprehensive Primary Care to Women Veterans

BackgroundThe growing presence of women veterans in Veterans Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a WH clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see patients for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services into women veterans' primary care services.MethodsWe conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics.ResultsInductive thematic analysis identified six themes: 1) Time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics.ConclusionAlthough adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high-quality, comprehensive primary and gender-specific care. The nature of these barriers is multifactorial and multilevel in nature, and may therefore require special policy and practice action.     

Access to specialty care and medical services in community health centers

Although community health centers (CHCs) provide primary health services to the medically underserved and poor, limited access to off-site specialty services may lead to poorer outcomes among underinsured CHC patients. This study evaluates access to specialty health services for patients receiving care in CHCs, using a survey of medical directors of all federally qualified CHCs in the United States in 2004. Respondents reported that uninsured patients had greater difficulty obtaining access to off-site specialty services, including referrals and diagnostic testing, than did patients with Medicaid, Medicare, or private insurance.     

Service Utilization,Expenditures, and Success in a Well-Established System of Care for Young People with Serious Emotional Disorders

A major challenge in the implementation of systems of care is creating mechanisms to pay for services that are provided across social services systems and by multiple agencies. Using a managed care approach to coordinate service provision may be one way to effectively bridge the gap across agencies while also providing quality care. The authors explore the benefits of a managed care approach to service delivery within a well established system of care by describing the treatment planning process used by the system of care; describing the type and patterns of services provided to young people; and by describing the process used to bill for services. The authors also examine the impact of client and service characteristics on overall expenditures as well as the effect that patterns of service utilization and expenditures of care have on the likelihood that young people and their families will successfully meet their clinical objectives.     

Medical and psychosocial services in drug abuse treatment: do stronger linkages promote client utilization?

OBJECTIVE: To examine the extent to which linkage mechanisms (on-site delivery, external arrangements, case management, and transportation assistance) are associated with increased utilization of medical and psychosocial services in outpatient drug abuse treatment units. DATA SOURCES: Survey of administrative directors and clinical supervisors from a nationally representative sample of 597 outpatient drug abuse treatment units in 1995. STUDY DESIGN: We generated separate two-stage multivariate generalized linear models to evaluate the correlation of on-site service delivery, formal external arrangements (joint program/venture or contract), referral agreements, case management, and transportation with the percentage of clients reported to have utilized eight services: physical examinations, routine medical care, tuberculosis screening, HIV treatment, mental health care, employment counseling, housing assistance, and financial counseling services. PRINCIPAL FINDINGS: On-site service delivery and transportation assistance were significantly associated with higher levels of client utilization of ancillary services. Referral agreements and formal external arrangements had no detectable relationship to most service utilization. On-site case management was related to increased clients' use of routine medical care, financial counseling, and housing assistance, but off-site case management was not correlated with utilization of most services. CONCLUSIONS: On-site service delivery appears to be the most reliable mechanism to link drug abuse treatment clients to ancillary services, while referral agreements and formal external mechanisms offer little detectable advantage over ad hoc referral. On-site case management might facilitate utilization of some services, but transportation seems a more important linkage mechanism overall. These findings imply that initiatives and policies to promote linkage of such clients to medical and psychosocial services should emphasize on-site service delivery, transportation and, for some services, on-site case management.     

Drinking patterns, health care utilization, and costs among HMO primary care patients

A survey of 8,034 primary care patients in a health maintenance organization examined the relationship between alcohol consumption and health care costs and service use. Costs were estimated from service use data for 1 year before and 2 years after study enrollment. No strong, consistent relationships were identified between multiple indicators of drinking patterns and either health care costs or service use. Compared with total costs among very light drinkers, former drinkers were higher, lifetime abstainers were similar, and persons in the higher drinking levels tended to have lower but not significantly different costs. Drinking patterns did not appear to be an important predictor of short-term health care costs or service use in this setting. Further study of former drinkers is warranted to examine the role of alcohol-related illnesses in the decision to quit drinking.