医院实行减免收费的账务处理

医院实行减免收费时在会计核算上应区别不同情况进行账务处理,同时增加“药品减免”和“医疗减免”两个会计科目。1门诊减免收费的账务处理当门诊收费处报来某日门诊收入日报表时,作会计分录如下:(1)药品减免时:借:现金或银行存款药品减免贷:药品收入-门诊收入(2)医疗减免时:借:现金或银行存款医疗减免贷:医疗收入-门诊收入2住院减免收费的账务处理住院病人减免分2种情况进行账务处理:第一种情况是调低收费标准减免的账务处理;第二种情况是对特困病人出院结算时一次性减免的账务处理。(1)医院调低收费标准对病人减免的账务处理:当住院处报来…     

陕西省惠民医院和扶贫病房现状调研

通过对陕西省“惠民医院”和“扶贫病房”现状的调查,了解陕西省惠民医院(扶贫病房)运行状况,包括提供惠民服务对象的组成、具体减免措施、减免金额和扶贫病床的患者对住院服务反应性的评价以及医院管理者、医务人员对设立惠民医院(扶贫病房)的看法等,对运行中存在问题进行分析,并探讨解决问题途径,提出相关政策建议。     

陕西省推行扶贫病房存在的问题及对策

为切实解决群众“看病难、看病贵”问题,陕西省决定从2005年12月1日开始,率先在卫生厅直属的7家医疗机构设立扶贫病房,享受对象主要是未享受医保的城市下岗职工、低保人群和农村五保户、特困户。目前,陕西省直医疗机构开设扶贫病床274张,减免金额115.07万元,人均减免医疗费用621.33元,在一定程度上缓解了贫困人群“看病难、看病贵”问题。但是工作中还存在不少困难和问题,有些方面还比较突出,亟待改进。一、存在的问题(一)扶贫病房工作进展不平衡。陕西省直7家医疗机构基本都能按照要求,拿出普通病床总数的10%作为扶贫病床,但在实际收治扶贫…     

主题报告亮点精读

选择医院建立平价病房高强部长提出,各地市应选择部分公立综合医院,建立平价医院或平价病房,主要为参加合作医疗的农民、城市下岗职工、失业人员、低保人员、进城务工人员及老人、儿童服务。对平价医院实行预算式全额管理,收入上缴, 支出由政府核拨。     

健康快读

国内中国将严格控制大型医院发展规模建立平价医院卫生部长高强在2006年1月7日召开的2006年全国卫生工作会议上表示,卫生部将从严控制公立大型医院建设规模和发展速度,建立平价医院或平价病房,对于危重病人和需要救助的病人,要坚持先救治后结算的原则,绝不允许见死不救。卫生部拟规定活人捐器官必须先听证2005年12月22日,卫生部制定了《人体器官移植技术临床应用管理暂行办法(征求意见稿)》。规定要求,开展人体器官移植手术的三级医院要具有器官移植临床应用能力的执业医师和相适应的专业技术人员;有开展器官移植相适应的设备、设施;有人体…     

优生专科病房在围产保健中的作用

<正> 我院优生专科病房于1985年9月正式开设。两年来,收治本市及附近市、县患者236人次。这对保证第二代素质,实行计划生育基本国策有一定意义。一、优生专科病房的病员概况优生专科病房收治的236名病人中,需要入院行产前诊断者或产前诊断后需要观察妊娠经过及生产结果者35人次,占14.8%;因产史不良或其它高危因素需要施行胎儿监护和胎儿保健者191人次,占80.9%;妊娠合并他科疾     

医院内发生绿脓杆菌交叉感染的调查

绿脓杆菌作为条件致病菌,在临床上引起的感染日趋增多,引起医院内感染中也有相当比例。本文对1993年9～10月在我院外一病房发生的一起绿脓杆菌所致的院内交叉感染的流行情况作了调查,报告如下: 1.材料与方法 (1)资料来源:根据现场调查和查阅病历资料 (2)病原学检查 标本来源:采取外科病房中外伤病人创面分泌物和手标本,同病房部分病人切口分泌物及手标本,病房医务人员的手样标本,外环境可疑物（病房空气细菌培养、换药室细菌培养、桌面、敷料、器械等）。 采样方法:采用棉拭子涂擦法及普通营养琼脂培养皿暴露法。 (3)实验方法:根据常规培养方法,进行绿脓杆菌的分离和培养。 2.结果     

ICU病房患者医院感染的调查及危险因素分析

目的 :调查分析外科 ICU病房医院感染情况和危险因素。方法 :查阅 2 0 0 0～ 2 0 0 1年我院外科 ICU病房收治的 6 2 0例患者的临床资料 ,对医院感染各项危险因素进行单因素分析。结果 :ICU病房医院感染率为 14 .35 % ,感染部位依次是上呼吸道、胃肠道、泌尿、皮肤及其他。病菌以 G- 菌为主 ,不动杆菌最常见 (19.4 8% ) ,G 菌比例逐渐增高。停留时间长、同室人数多、应用皮质激素、呼吸机使用、留置导管、术后拔管时间晚、滥用抗生素等都是外科 ICU病房医院感染的危险因素。结论 :ICU病房仍需加强预防医院感染     

重症监护病房(ICu)服务效果评定——处理措施计分制度

收治危重病人的重症监护病房(Intensive Care Unit, ICU)是由60年代的冠心病和外科术后加强监护病房逐步发展形成的。世界各大城市的许多综合医院中已普遍开设了独立的ICU部门或科室:以美国为例,60年代时,城市医院设有冠心病监护室(CCU)     

平价医院:还有多少"难点"

自1月7日，全国卫生工作会议提出，各地要将一定数量的公立医院作为“转换机制”的试点，建立平价医院或平价病房。消息传出后，社会对此议论不断。此后不久，卫生部又在下发的“2006年全国卫生工作会议文件通知”中，将“平价医院、平价病房”改为“济困医院、济困病房”，主要为参加新型农村合作医疗的农民、城市下岗职工、失业人员、低保人员、进城务工人员及老人、儿童服务。对济困医院实行预算管理，收入上缴、支出由政府核拨。     

Private choices,public costs: Evaluating cost-shifting between private and public health sectors in New Zealand

New Zealand’s dual public-private health system allows individuals to purchase health services from the private sector rather than relying solely upon publicly-funded services. However, financial boundaries between the public and private sectors are not well defined and patients receiving privately-funded care may subsequently seek follow-up care within the public health system, in effect shifting costs to the public sector. This study evaluates this phenomenon, examining whether cost-shifting between the private and public hospital systems is a significant issue in New Zealand.We used inpatient discharge data from 2013/14 to identify private events with a subsequent admission to a public hospital within seven days of discharge. We examined the frequency of subsequent public admissions, the demographic and clinical characteristics of the patients and estimated the direct costs of inpatient care incurred by the public health system.Approximately 2% of private inpatient events had a subsequent admission to a public hospital. Overall, the costs to the public system amounted to NZ$11.5 million, with a median cost of NZ$2800. At least a third of subsequent admissions were related to complications of a medical procedure.Although only a small proportion of private events had a subsequent public admission, the public health system incurred significant costs, highlighting the need for greater understanding and discussion around the interface between the public and private health systems.     

Hospital sector choice and support for public hospital care in New Zealand: Results from a labeled discrete choice survey

This study uses a discrete choice experiment (DCE) to measure patients’ preferences for public and private hospital care in New Zealand. A labeled DCE was administered to 583 members of the general public, with the choice between a public and private hospital for a non-urgent surgery. The results suggest that cost of surgery, waiting times for surgery, option to select a surgeon, convenience, and conditions of the hospital ward are important considerations for patients. The most important determinant of hospital choice was whether it was a public or private hospital, with respondents far more likely to choose a public hospital than a private hospital. The results have implications for government policy toward using private hospitals to clear waiting lists in public hospitals, with these results suggesting the public might not be indifferent to policies that treat private hospitals as substitutes for public hospitals.     

The effect of type of hospital and health insurance on hospital length of stay in Irbid, North Jordan

The study aimed at examining the effects of type of hospital and health insurance status on hospital length of stay for three identified medical and surgical conditions. Medical records of 520 patients for the year 1991 were reviewed in one public and one private hospital. Comparison of hospital length of stay for the private (n = 185) versus public sector patients (n = 335) was carried out. The effect of presence of health insurance (n = 189) and the lack of it (n = 325) was also studied. It was found that the average length of stay in the public hospital was significantly longer than the private one (3.3 versus 2.7 days). In addition, insured patients had significantly longer hospital length of stay (3.3 versus 3.0 days). The results of the multi-variate analysis showed that after socioeconomic factors and clinical conditions of patients were adjusted for, the influence of hospital type and health insurance on hospital length of stay was about one day. The paper also discusses the need to base hospital cost-containment strategies on studies of hospital behaviour and performance.     

Variation in exemptions to school immunization requirements among New York State private and public schools

Background and objectivesSchool immunization requirements have ensured high vaccination rates and have helped to control vaccine-preventable diseases. However, vaccine exemptions have increased in the last decade. This study compared New York State private versus public schools with respect to medical and religious exemption rates.MethodsThis retrospective study utilizes New York State Department of Health Immunization Survey data from the 2003 through 2012 academic years. Schools were categorized as private or public, the former further categorized by religious affiliation. Rates of medical and religious vaccine exemptions were compared by school category.ResultsFrom 2003 to 2012, religious exemptions increased in private and public schools from 0.63% to 1.35% and 0.17% to 0.29% (Spearman's R: 0.89 and 0.81), respectively. Among private schools, increases in religious exemption rates during the study period were observed in Catholic/Eastern Orthodox, Protestant/Other Christian, Jewish, and secular schools (Spearman's R = 0.66, 0.99, 0.89, and 0.93), respectively. Exemption rate ratios in private schools compared to public schools were 1.39 (95% CI 1.15–1.68) for medical and 3.94 (95% CI: 3.20–4.86) for religious exemptions. Among private school students, all school types except for Catholic/Eastern Orthodox and Episcopal affiliates were more likely to report religious exemptions compared to children in public schools.ConclusionsMedical and religious exemption rates increased over time and higher rates were observed among New York State private schools compared to public schools. Low exemption rates are critical to minimize disease outbreaks in the schools and their community.     

Voting with their feet: public hospitals, health reform, and patient choices.

OBJECTIVES: This study identified public hospital patients' preferences under managed care and health reform. METHODS: A cross-sectional survey of 348 ambulatory public hospital patients was conducted. RESULTS: Patients reported a high degree of loyalty to the public hospital given several hypothetical reform scenarios. Those patients who stated they would remain at the hospital increased (from 74.2% to 85.5%) when care elsewhere required copayment for medications and physician visits. CONCLUSIONS: Patients at one public hospital reported a high likelihood of remaining in the public system, and this likelihood increased when copayment for services was required elsewhere.     

Affording what's free and paying for choice: comparing the cost of public and private hospitalizations in urban Kerala

OBJECTIVE: To assess the cost of public and private hospitalizations in urban Kerala and discuss policy implications of social disparities in the economic burden of hospital care. METHODS: The NSSO survey on health care (1995-1996) for urban Kerala was analysed with regards to expenditure incurred by hospital episodes. Multilevel linear models were built to assess factors associated with levels of health expenditure. FINDINGS: Hospital care involves paying admission fees in 68% of cases of hospitalizations (98% in private and 20% in public sector) in urban Kerala. Poor households and those headed by casual workers show significantly lower levels of health expenditure and a higher proportion of health-related loss of income than other social groups. Although there is significant expenditure in both sectors for these groups, hospitalization on free public wards is associated with lower expenditure than other options. Factors linked with higher expenditure are: duration of stay; hospitalizations on paying public wards and in the private sector; hospitalizations for above poverty line households and hospitalizations for chronic illnesses. Expenditure for services bought from outside the hospital is important in the public sector. CONCLUSION: Hospitalization incurs significant expenditure in urban Kerala. Greater availability of free medical services in the public sector and financial protection against the cost of hospitalization are warranted.     

Is reimbursement for childhood immunizations adequate? evidence from two rural areas in colorado.

OBJECTIVE: To assess adequacy of reimbursement for childhood vaccinations in two rural regions in Colorado, the authors measured medical practice costs of providing childhood vaccinations and compared them with reimbursement. METHODS: A "time-motion" method was used to measure labor costs of providing vaccinations in 13 private and public practices. Practices reported non-labor costs. The authors determined reimbursement by record review. RESULTS: The average vaccine delivery cost per dose (excluding vaccine cost) ranged from $4.69 for community health centers to $5.60 for private practices. Average reimbursement exceeded average delivery costs for all vaccines and contributed to overhead in private practices. Average reimbursement was less than total cost (vaccine-delivery costs + overhead) in private practices for most vaccines in one region with significant managed care penetration. Reimbursement to public providers was less than the average vaccine delivery costs. CONCLUSIONS: Current reimbursement may not be adequate to induce private practices to provide childhood vaccinations, particularly in areas with substantial managed care penetration.     

Nonmedical exemptions to immunization requirements in California: A 16-year longitudinal analysis of trends and associated community factors

Background

Rates of nonmedical exemptions to kindergarten-entry immunization requirements have increased over the past 2 decades, especially in states that permit philosophical exemptions and/or have easier administrative policies for obtaining nonmedical exemptions. We evaluated trends in school personal belief exemption rates over the period 1994–2009 in California, and associated school and community characteristics.

Methods

We used data on personal belief exemptions from 6392 public and private elementary schools from the California Department of Public Health, as well as census tract and school demographic data. Generalized estimating equations were used to model annual mean increases in personal belief exemption rates, and to identify school and community characteristics associated with personal belief exemption rates.

Results

Over the study period, the average school personal belief exemption rate increased from 0.6% in 1994 to 2.3% in 2009, an average of 9.2% (95% CI: 8.8–9.6%) per year. The average personal belief exemption rate among private schools over the entire study period was 1.77 (95% CI: 1.55–2.01) times that among public schools. The annual rate of increase was slightly higher among private schools (10.1%, 95% CI: 9.1–11.1%) than among public schools (8.8%, 95% CI: 8.4–9.2%). Schools located within census tracts classified as rural had 1.66 (95% CI: 1.26–2.08) times higher personal belief exemption rates than schools located within urban census tracts. Exemption rates were also associated with race, population density, education, and income.

Conclusions

This study confirms concerns about increasing rates of nonmedical exemptions to kindergarten vaccine requirements within the state of California, using data collected over a 16-year period.