总额预付制与医院医保管理

医保费用的支付方式是控制医疗费用增长、提高医疗服务的重要手段.文章从总额预付制对医院医保管理的角度出发,探索总额预付制在实际工作中的综合运用,切实减轻患者负担,保证医疗服务质量,减少医患矛盾纠纷,调动医院积极性,加强医院内部管理,切实控制医疗费用的增长,提高基金使用效率.     

医保总额预付制运行效果研究——基于北京市4家医院的微观数据

医保支付制度改革已经成为医改的重要内容,而推行总额预付制是主要的改革方式。本文以北京市4家总额预付试点医院的数据为例,重点从医疗服务量、次均医药费用、总费用、医疗费用结构、平均住院日、医保病人自付比例6个方面的变化分析实施总额预付制后的效果和影响,为进一步完善总额预付制提供参考。     

总额预付制下医院医保管理探索*

医保总额预付制对医院的费用控制、医疗服务行为产生重要影响。分析江门市医保总额预付制对某大型三甲医院运行情况的影响,介绍了该院采取多部门联动医保管理、抓好用药耗材管理、实施临床路径管理、开展日间手术和借助医联体提高转诊效率等做法,为改进医院医保管理提供思路与借鉴。     

医保总额预付制实施的现状及存在问题分析

简析目前我国部分地区总额预付制实施情况,进而从医疗费用、医疗数量与医疗质量,医院、医疗保险基金管理机构与患者,医疗服务效率与医疗资源配置三个角度出发分析总额预付制的不足并提出多部门的协同合作以期达到不断完善总额预付制,使其发展成为适合我国特色的医保付费方式。     

顺应医保支付方式改革的探索与实践

以总额预付制为主的综合医保支付方式的实施,对医院医保管理提出了更高的要求,苏州大学附属第二医院通过制度保障、转变管理理念,精细化费用管理、规范医师的医疗行为、控制医院成本等系列措施来控制医疗费用的不合理增长,同时也减轻患者的经济负担.     

上海市三级综合医院总额预付制相关指标分析

目的：通过分析上海市三级综合医院相关指标,了解实行总额预付制后医疗服务质量和效率的变化。方法采集2010-2012年上海市14家三级医院医疗服务质量和效率的相关指标,分析实施总额预付制后,医疗费用、平均住院日、药占比、门急诊人次、出院人次、手术人次等指标的变化。结果实施总额预付制后,医疗费用控制较好,平均住院日、药占比下降;门急诊人次、出院人次、手术人次中医保患者和非医保患者所占比例出现不同。结论总额预付制实施总体效果较好,在提高医疗服务效率的同时,保证服务质量不受影响有待进一步研究。     

总额预付制实施前后北京市门诊医保患者次均费用对比分析

目的对比分析总额预付制实施前后门诊医保患者次均费用的变化情况,评价总额预付制的实施效果,寻找存在的问题。方法选取实施前后门诊次均费用、门诊药品次均费用、门诊材料次均费用和门诊检查次均费用等数据,采用t检验等统计方法进行分析。结果总额预付制实施后门诊医保患者次均费用比实施前下降23.15%,具有统计学意义（P<0.05）,其他各项费用均有所降低。结论总额预付制作为目前控制医疗费用快速增长的方式之一,可以促进医疗资源的合理配置,避免了医保基金的不合理支出,值得推广和借鉴。     

浅谈医保总额预付制对医院管理的影响

作为国家医改的重要内容之一,医保总额预付制的施行有效实现了医保基金的收支平衡,但是,立足于精细化管理,仍有必要思考施行后医院管理面临的新挑战,这不仅影响到医保预付总额、治疗费用和治疗效果的综合效用,同时也影响到医院医疗资源利用效率的提高。     

医保费用总额预付制支付方式的实施效果实证分析

目的:对比分析哈尔滨市在全面实施医保费用年度总额预付制支付方式前后的相关指标变化,评价总额预付制支付方式的实施效果,对医保支付政策的更好实施提出合理化建议。方法:运用SPSS软件进行数据汇总统计,描述性分析比较市医保在医保总额预付制实施前后医保住院患者相关指标的情况。结果:该市在医保总额预付制实施两年后,医保住院患者量,患者的住院次均费用等指标均有明显变化。整体市医保次均住院费用及医保次均支付费用呈负增长。结论:实施医保总额预付制后,患者的次均费用的控制效果显著,但也暴露出了一些问题,需要在政策及方式和方法上有相应的调整,以便适应国家医疗改革的深入开展,缓解人民群众"看病难、看病贵"的现状。     

军队医疗机构实行医保总额预付制的卫生经济学分析

2009年上海市医保局在三级医院开始试行"医保总额预付制"。本文从卫生经济学角度,分析施行总额预付制后医院对卫生服务提供进行的调整,分析军队医疗机构实行总额预付制面临的挑战,提出医院应及时转变观念,从提高医疗质量,加强成本核算,实现医保管理信息化、精细化等方面着手,科学合理控费,主动适应和推进医疗改革的进程。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.