我国医疗体制改革导入公私合作伙伴关系的初步探讨

简述公私合作伙伴关系(PPP)及其在卫生领域的应用,分析英国医院PPP与英国卫生体制的适配性,探讨我国医疗体制改革导入PPP面临的问题及建议。     

我国医疗卫生领域引入PPP模式的问题与对策分析

从法律制度、运作体系、人才建设入手梳理了我国医疗卫生领域引入PPP模式存在的主要问题,并提出了建议,包括:提高对PPP模式的理性认识;加强政府引导,完善相关法律、法规及政策;加强医院PPP项目人才队伍建设。以期为促进我国医疗卫生PPP项目建设提供借鉴。     

公私合作伙伴关系的模式、范围及实施原则

探讨英国及加拿大公私合作伙伴关系的模式、PPP模式服务范围,分析在公用事业领域导入PPP机制的流程及实施原则。     

PACS在清华大学社区医院中的应用

本文介绍了PACS系统在清华大学校医院的应用情况,重点介绍了PACS在医学影像、医院管理、社区医院中的应用价值。PACS系统的应用改变了传统的工作模式,实现了PACS系统与医院信息系统（HIS）无缝连接,影像诊断的效率和质量明显提高,提升了医院的管理水平和竞争力,极大地改善了社区医院的服务水平,其优越性日益显著。     

PACS在清华大学社区医院中的应用

本文介绍了PACS系统在清华大学校医院的应用情况,重点介绍了PACS在医学影像、医院管理、社区医院中的应用价值。PACS系统的应用改变了传统的工作模式,实现了PACS系统与医院信息系统(HIS)无缝连接,影像诊断的效率和质量明显提高,提升了医院的管理水平和竞争力,极大地改善了社区医院的服务水平,其优越性日益显著。     

英国卫生体制背景及其与医院PPP的关系

该文分析英国卫生监管体制及卫生服务体制背景，探讨英国医院PPP与其卫生体制的适配关系。     

以公私合作伙伴关系模式推进公立医院改革的探讨

介绍了公私合作伙伴关系(PPP)模式的概念及内涵,探讨PPP模式在医院产业发展中的应用。认为在深化公立医院改革过程中,采取PPP模式化减部分医院债务,既可减轻地方政府和医院债务的压力,又可调动社会资本的力量来加大、加快医疗卫生建设,并且取得更好的资金使用效率。同时扩大了社会资本的办医空间,符合医改精神,有利于实现多方共赢。     

公立医院建设运营PPP模式思考

笔者从医院管理者的角度,结合近几年来国家提倡和推行公立医院建设运营实施PPP模式,介绍了实施的PPP模式的背景、流程和要点及建设实例。并就如何在新医改政策下,合理引用社会资本方与政府合作,参与医院的建设和后续运营管理进行深层思考。     

基于HALL模型的大型医疗PPP项目建设与运营集成管理框架研究

为缓解政府投资压力,满足多样化的医疗服务需求,引入PPP模式参与医院建设,但是在实践中医疗PPP模式仍然存在一些问题。文章在总结分析医疗建设项目和PPP项目特点的基础上,在HALL三维模型理论的基础上创新性加入空间环境维度,构建四维医疗建设PPP项目建设与运营集成管理框架模型,并对四个维度进行分析,期望能够促进我国医疗PPP的发展,为社会提供优质高效的医疗健康服务。     

英国国民卫生服务体系PFI项目发展现状及借鉴分析

通过访问英国卫生与社会保健部、主流媒体的网站和第三方独立机构发布研究报告以及文献梳理,获取关于英国国民卫生服务体系(NHS)中私人融资计划(PFI)项目信息。再通过对英国PFI项目发展现状的描述,分析存在的主要问题、影响及改进措施,从而为我国卫生健康领域政府与社会资本合作(PPP模式)的开展提供借鉴。     

基于PEST-SWOT整合模型的公立医院PPP适用性分析

随着政府与社会资本合作(Public Private Partnership,PPP)模式在我国医疗卫生领域大量应用,提高供给改善服务的同时也出现了很多困难和挑战。为了解决这些问题,通过PEST-SWOT整合模型,对公立医院应用PPP模式适用性进行分析,从政府和公立医院视角,进行外部环境条件机会与挑战分析和内部因素优势劣势识别,并提出相应的PPP模式应用策略,从而确保PPP项目物有所值,实现项目目标,为公立医院应用PPP模式提供理论依据和参考。     

影响医院建设PPP项目融资因素分析

以金乡县人民医院新院区项目为例,梳理医院PPP建设项目准备阶段影响融资工作的诸多要素,分析可能出现的问题,并且有效加以规范,为相关PPP项目融资运作提供参考。     

Financing and planning of public and private not-for-profit hospitals in the European Union

While much has been written about health care financing in Europe in recent years, discussion has almost entirely focused on revenue. In contrast, there has been remarkably little written on financing of capital investment in European health care systems. Yet major changes are underway in several countries, in particular involving new forms of public-private partnerships (PPP). At the same time, there is growing recognition of the way in which the inherited structure of the health care delivery system constrains the system's ability to adapt to changing circumstances. This paper reports the results of a survey undertaken among key informants in the member states of the European Union to begin to ascertain existing practices and future plans in relation to hospital planning and financing amongst public and private not-for-profit hospitals. The locus of hospital planning decisions reflect the constitutional framework of the country involved, and thus the emphasis on national or local plans. There has been an expansion of private sector involvement, with four basic models identified: private loans direct to the hospital; private loans to a regional health body; a PPP where the private sector's role is to build, design and operate the non-clinical functions of the hospital; and, finally, a PPP, where the private sector's involvement also includes management of the clinical functions of the hospital. It is too early to say whether these approaches will be more successful than the models they are replacing.     

我国公立医院导入PPP机制的思考

思考我国公立医院导入PPP机制的适配性,对物有所值的认识,分析PPP机制与我国公立医院体制的冲突和对策。     

Public‐private partnerships in non‐profit hospitals: Case study of China

The gap between supply and demand for health care services is expanding rapidly in China. In order to resolve this problem, the government has implemented supply‐side reforms in the health care sector by inviting private capital to increase supply quantity and improve quality. However, health care institutions have high complexity and particular needs, while non‐profit hospitals have very strong public interests. This gives rise to complications in the implementation of public‐private partnerships (PPPs) for health care services. In this paper, the authors have selected one case each from three different models of non‐profit hospital PPP projects in the national PPP project database, operated by the Ministry of Finance, and compared how these projects were operated to identify the differences among them. A content analysis of the vital project documents is the primary analysis technique used for this comparison. Key issues investigated include reasons for model selection, requirements for private sectors and market competition level in different models, risk identification and sharing, design of payment mechanism, operation supervision, and performance appraisal of the project. Based on the comparison, some key lessons and recommendations are discussed to act as a useful reference for future non‐profit hospital PPP projects in China.     

Purchaser and provider relations in the UK: a perspective from the private sector

Gives an overview of the major features of the general changes in the UK health care system, and describes how PPP healthcare is taking advantage of those changes in developing and implementing strategies for relations with both hospitals and specialists. Notes that similar issues are faced by public sector purchasers. Points out that many of the initiatives described are being adopted, in one form or another, in health care industries across the world. Suggests that new insights or understandings may be found by seeing and considering those issues and initiatives in the context of health care economies.     

公私伙伴关系促进医疗服务供给侧改革的国际经验及其启示

基于公私伙伴关系(PPP)的相关理论与概念,本文从管理理念的变革,财政预算的压力,技术创新与服务模式的转变及健康服务业的发展等方面系统阐述了PPP模式在医疗服务领域的发展动力,并结合国际社会在医疗服务领域引入PPP模式的实践,总结了部分国家在改革实践中所取得的效果与存在的风险;研究发现,在医疗服务领域引入PPP模式对促进政府职能转变,缓解政府的筹资压力,特别是推进医疗服务供给侧的结构性改革,提升医疗服务系统对消费者需求的反应性,实现其"物有所值"的最大化等具有一定的促进作用与现实意义;但是,在实践中要处理好政府角色的定位,趋利行为与公益性,垄断与监管等方面的关系。相关的启示是,在深化医改的实践中要树立开放、包容、共享的创新发展理念,并进一步完善相关的政策法规,提升监督管理能力。     

Is there a financial incentive to immigrate? Examining of the health worker salary gap between India and popular destination countries

Background

International migration is one of the factors resulting in the shortage of Human Resources for Health (HRH) in India. Literature suggests that migration is fuelled by the prospect of higher salaries available abroad. The extent of these salary differentials are unknown, and this study seeks to examine the salaries of selected HRH in India and four popular destination countries (United States of America, United Kingdom, Canada and the United Arab Emirates), whilst accounting for the in-country cost of living. This study will therefore determine truer financial incentives for Indian HRH to migrate abroad.

Methods

A purchasing power parity (PPP) ratio is employed to equalise the international price of buying a representative basket of commonly bought goods (including food, entertainment, fuel and utilities). Using the PPP index, real differences in salaries are directly compared for selected work categories and different levels of work experience in the four respective countries.

Results

Nurses in the USA can earn up to 82.7% more than their Indian counterparts. Nurses in Canada and the UAE reveal more modest salary differentials, yet still significant better off by up to 28 and 20% respectively. Only nurses in the UK are potentially materially worse off than nurses working in India. We observe significant potential PPP gains of up to 57.4, 99.1 and 94.4% for medical doctors in the USA, Canada and the UAE respectively. Medical specialists potentially experience the greatest income disparities with anaesthetists potentially earning up to 600% more than their counterparts in India. Radiologists operating in the UK and general surgeons working in the USA can potentially earn more than double that of their counterparts working in India. We observe more modest positive or negligible PPP gains in other selected countries for health specialists.

Conclusion

Even when considering the differences in the cost of living, the financial incentive for selected cadres of Indian HRH to seek work abroad remains strong. The migration of Indian HRH to countries offering superior salaries makes it difficult for India to retain experienced health personal and compromises government efforts to render health care more accessible across the country.

     

The effect of physician gender on length of patient consultations: observational findings from the UK hospital setting and synthesis with existing studies

Objectives

To investigate the effect of physician gender on consultation length in UK hospital outpatient clinics and compare this, through meta-analysis, with previous studies outside the UK.

Design

Observational data on clinic times were analysed and findings were combined in a meta-analysis with existing studies investigating the effect of physician gender on consultation length.

Setting

UK hospital practice.

Participants

A total of 174 observations of outpatient consultations with 10 hospital specialists (consultants) from different specialties in two UK hospital trusts.

Main outcome measures

Clinic times were recorded and analysis of consultation length was undertaken with physician gender as a covariate. Data were then synthesised through meta-analysis with 10 existing studies in this field.

Results

No statistically significant difference was found in the length of consultations for male and female doctors in these UK hospital settings. When pooled with existing studies, consultations with women doctors were found to be approximately two minutes longer than with men (p = 0.01).

Conclusions

Findings from this analysis of clinic consultations in the UK National Health Service do not support previous studies, which were undertaken predominantly in North America and primary care settings. Overall, meta-analysis suggests doctors’ gender may influence consultation length. Gender differences in communication should be considered in training clinicians and in overall clinical practice.