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1.
全国卫生工作会议构筑了与我国社会主义市场经济体制相适应的卫生体系的大体框架。各医院应主动适应医疗需求而明确自己的功能定位,适应区域卫生规划,在竞争中发展自己。医院要强化内部管理,抓两个重点和两个关键。两个重点是:①学科建设、医疗质量和服务;②经济运行分析和财务管理。目前要把经济帐理清楚。两个关键是:医院的主体是医生,医院的活力在科室。要重视医院管理人才的培养。  相似文献   

2.
This article aims to describe and assess the Danish case-mix system, the cost accounting applied in setting national tariffs and the introduction of variable, prospective payment in the Danish hospital sector. The tariffs are calculated as a national average from hospital data gathered in a national cost database. However, uncertainty, mainly resulting from the definition of cost centres at the individual hospital, implies that the cost weights may not fully reflect the hospital treatment cost. As variable prospective payment of hospitals currently only applies to 20% of a hospital's budget, the incentives and the effects on productivity, quality and equality are still limited.  相似文献   

3.
The reduction in National Health Service (NHS) expenditure as a share of total health care expenditure, the fragmentation of the NHS into 21 regional systems and the implementation of a 'quasi-market' on the provider side of the system has pressed the government to define and specify, in detail, the set of services that are to be guaranteed by the public sector. To understand whether rationing can be more rational and explicit in the Italian NHS, the following are analysed: (i) the new positive list of drugs, as a major example of limiting and making more rational NHS pharmaceutical coverage; (ii) the Di Bella case, as an example of the difficulties of rational policy-making on sensitive issues; (iii) what Italian people think about health care rationing and priority setting (using the 1998 Eurobarometer Survey);( iv) the criteria defining the set of 'essential services' to be guaranteed to all Italian citizens, which are contained in the recently released National Health Plan. The 'revolution' that has taken place in the pharmaceutical sector shows it is feasible to limit, in an explicit and rational way, the extent of NHS coverage. However, the re-classification of the positive list should be regarded as an exceptional event in the history of Italian social policy. The 'Di Bella' case, on the contrary, shows that limiting NHS coverage can be very unpopular, and that the Italian cultural and social context can be unfavourable for the implementation of hard choices. Public attitude toward rationing seems to confirm that Italians are not familiar with rationing issues. Thus, it is very difficult to predict whether the national government will really go ahead with the implementation of a 'list of essential services' and whether this attempt will be successful. Rationing and priority setting should be discussed in the context of a general debate concerning the future of the Italian NHS.  相似文献   

4.
The Mediterranean diet (MD) has been proposed as a healthy dietary pattern for disease prevention. However, little information exists on the cost and on the environmental impact of such a dietary model. We compared the environmental impact and the costs of the current food consumption pattern of the Italian population and the Mediterranean model in order to investigate its overall sustainability. The environmental impact was calculated on the basis of three indexes, i.e. Carbon, Ecological and Water Footprint. The costs (Euro) per person of the MD and of the current Italian household food expenditure were considered on a weekly basis according to the 2013 data from the Observatory prices and tariffs of the Ministry of Economic Development and the service SMS consumers of the Ministry of Agriculture, Food and Forestry. The MD resulted to produce a lower environmental impact than the current food consumption of the Italian population. The monthly expenditure of the MD is slightly higher in the overall budget compared to the current expenditure allocated to food by the Italian population, but there is a substantial difference in the distribution of budget according to the different food groups.  相似文献   

5.
In recent decades, several countries have reformed their health care systems leading to the devolution of power to a lower governance level and, subsequently, to re-centralisation. Due to the ambiguous results of these policies and the start of the financial crisis of 2008, a wide number of national governments implemented cutback initiatives aimed at controlling health expenditure. The literature shows that the introduction of such initiatives may have produced unintended consequences on health systems’ performance. In order to better understand the power relations and the resulting decision-making processes between national governments and local authorities, it is important to focus on the effects of such expenditure control mechanisms on the inputs of the health systems, i.e. the production factors.This research aims at investigating the effects of a cutback initiative intended to control personnel costs in a federal Beveridge health system through the analysis of resource allocation at the devolved level.The paper is based on a quantitative analysis of data resulting from the financial statements published by the 21 Italian regional health systems from 2012 to 2017.The results show that, although the Italian regional health systems managed to reduce personnel costs – i.e. hitting the target – the control of the total cost dynamic was not fully addressed. Overall, the initiative implemented by the national government had the effect of limiting the decision-making autonomy of regional authorities, pushing them toward shifting resource allocation from personnel to the purchase of services.  相似文献   

6.
After the approval of the law on voluntary abortion in Italy, the Italian health care system started to practice voluntary abortion before the third month of pregnancy. Since 1980, the Italian Institute of Statistics (ISTAT) has collected data on the abortion frequency per month and per administrative local areas. Although a preliminary analysis of the data showed that, after an initial increase, the number of abortions progressively lowered over years, there is no insight on the existence of periodicity in the time series and on the local effects related to the regional habits and social environments. The aim of our study is therefore to extract local trends and periodicity from the data collected by ISTAT, by combining a 'structural model' of the time series and Bayesian statistics. This paper describes both the adopted stochastic model and its Bayesian estimation through a Markov chain Monte Carlo approach on the Italian abortion data. Abortion data are analysed both at national level and in each of the 95 Italian local areas. At the national level this analysis allows extraction of a trend component that clearly shows that the voluntary abortion trend has decreased constantly since June-July 1983 until the end of the study. The periodic component shows an astonishing regularity too, suggesting that the Italian people have a seasonal preference for voluntary abortion. In particular, abortions are concentrated in the central part of the year (April-August). Finally, at the local level this analysis allows us to find similarities/differences between different areas in trends and/or in seasonal preferences.  相似文献   

7.
中国医院信息系统发展前瞻性研究   总被引:9,自引:1,他引:8  
计算机软、硬件技术及知识的广泛普及,医院引进和重视计算机在医院的应用与管理,为开发中国医院信息系统创造了有利的条件。目前,各医院应用的计算机软件系统多为局部系统,功能不全,设计落后,全国联网困难。为此,应做好软件和硬件的通用配套,多媒体电子病案及与之相辅相成的收费管理,全自动化数质量控制的医院信息系统发展方向,建立相适应的法律规定,全面普及计算机应用的知识与技术。  相似文献   

8.
区域医疗信息化中的医疗数据交换平台   总被引:1,自引:1,他引:0  
目的:运用先进的信息技术解决医疗信息化过程中的区域医疗数据交换问题,搭建适应于广域网络、异构软硬件环境的区域医疗数据交换平台。方法:通过ICE开放源代码中间件,按照数据注册一发布模型.设置区域数据交换中心,实现市级医疗单位间各系统的数据交换共享。结果:实现了市级医疗单位部分系统的数据交换共享,为区域医疗信息系统深入应用的具体实践进行了尝试。结论:区域医疗数据交换平台的结构设计被证明是可行、可靠和有效的.为构建全民健康电子信息档案打下坚实基础。  相似文献   

9.
The Italian National Health System (NHS), established in 1978, follows a model similar to the Beveridge model developed by the British NHS (Beveridge 1942; Musgrove 2000). Like the British NHS, healthcare coverage for the Italian population is provided and financed by the government through taxes. Universal coverage provides uniform healthcare access to citizens and is the characteristic usually considered the added value of a welfare system financed by tax revenues. Nonetheless, in Italy the strong policy of decentralization, which has been taking place since the early 1990s, has gradually shifted powers from the state to the 21 Italian regions. Consequently, the state now retains limited supervisory control and continues to have overall responsibility for the NHS in order to ensure uniform and essential levels of health services across the country. In this context, it has become essential, both for the ministry and for regions, to adopt a common performance evaluation system (PES). This article reports the definition, implementation, and first evidences of a pilot PES at a national level. It shows how this PES can be viewed as a strategic tool supporting the Ministry of Health (MoH) in ensuring uniform levels of care for the population and assisting regional managers to evaluate performance in benchmarking. Finally, lessons for other health systems, based on the Italian experience, are provided.  相似文献   

10.
PURPOSE: Health care, one of the most dynamic sectors in Italy, is studied with a particular focus on outsourcing non-core activities such as facility management (FM) services. The project's goals are to define national standards to balance and control facility service evolution, and to drive FM services towards organisational excellence. The authors, in cooperation with a pool of facility service providers and hospitals managers, studied cleaning services--one of the most critical areas. DESIGN/METHODOLOGY/APPROACH: This article describes the research steps and findings following definition and publication of the Italian standard and its application to an international benchmarking process. The method chosen for developing the Italian standard was to merge technical, strategic and organisational aspects with the goal of standardising the contracting system, giving service providers the chance to improve efficiency and quality, while helping healthcare organisations gain from a better, more reliable and less expensive service. FINDINGS: The Italian standard not only improved services but also provided adequate control systems for outsourcing organisations. In this win-win context, it is hoped to continually drive FM services towards organisational excellence. RESEARCH LIMITATIONS/IMPLICATIONS: This study is specific to the Italian national healthcare system. However, the strategic dynamics described are common to many other contexts. PRACTICAL IMPLICATIONS: A systematic method for improving hospital FM services is presented. ORIGINALITY/VALUE: The authors believe that lessons learned from their Italian case study can be used to better understand and drive similar services in other countries or in other FM service outsourcing sectors.  相似文献   

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