对贫困人口医疗救助应重点关注的问题

医疗救助计划是体现卫生服务的公平性的内容之一，在当前城乡卫生改革中，各级政府和社会各界在关注卫生资源使用效率的同时，应该进一步关注健康及卫生服务的公平性问题。对此，首先应充分满足贫困人口的健康需要，国际上有两种措施即医疗救助和重点疾病干预。所谓医疗救助，可以定义为政府通过提供财务、政策和技术上的支持使贫困人口获得基本的医疗卫生服务，以改善目标人群健康状况的一种运行机制。以世界银行中国卫生Ⅷ项目“特困人口医疗救助计划”为例，提出实行医疗救助政策中需要重点关注的问题。 一、医疗救助与公平原则 医疗救助…     

提高病人满意度促进卫生现代化的实现

党中央提出本世纪中叶我国基本实现现代化的任务，卫生现代化是社会全面现代化的重要组成部分。病人满意度是卫生现代化的研究内容之一。对江苏省37所不同医院的3441名病人满意度进行了调查，通过统计分析，结果显示：江苏省医院服务综合满意度及病人对医生服务、护理服务、后勤服务和工作人员的服务态度的满意度均较高，进一步分析影响医院服务综合满意度的相关因素，医院服务综合满意度与是否知道所患疾病、是否想了解所患疾病、是否希望医务人员共同讨论治疗方案、对医生服务满意度和工作人员的服务态度之间有较大的联系。所以。为了提升医疗服务质量，使病人满意，医院工作人员必须尊重病人的权利，改善服务态度，同时，提高医务人员的医疗技术水平，以促进卫生现代化的实现。     

瑞典医疗风险监管体系的循证评价

目的 循证评价瑞典医疗风险监管体系，为我国医疗风险监测预警机制的建立提供借鉴。方法 检索国内外相关数据库和网络信息资源，搜集有关瑞典医疗风险管理、医疗差错、病人安全和医疗保健方面的文献，语种限定为中文和英文．检索时间截止到2006年10月。应用循证科学的原理和方法。筛选和评价文献质量，进行描述性研究。结果 根据纳入和排除标准，共纳入文献10篇，主要涉及医疗不安全事件、卫生保健、病人安全等内容。瑞典政府十分重视公共卫生，特别是初级保健在保障国民健康上的积极作用。通过实施抗生素合理使用与抗药性监督战略计划（STRAMA），加强药品监管：应用计算机医院管理系统。实行医疗质量管理反馈机制：建立病人安全监测系统等措施减少医疗差错，防范医疗风险，取得较好成效。结论 瑞典卫生保健体系较完善，政府采取了诸多防范措施应对医疗不安全事件，在医疗风险监管方面取得了显著成绩，对建立我国医疗风险监测预警机制具有借鉴意义。     

病人满意度测评指标体系研究

病人满意度测评是对传统医疗质量评价方法的补充和完善。作者遵循一定的原则，对病人满意度指数模型的各个结构变量进行层层分解，设计出具体的医疗机构病人满意度测评指标体系（四级指标体系），并讨论了指标的量化、指标权重的确定及病人满意度计算等方法。     

澳大利亚病人满意度监测的发展及其借鉴

病人是医疗服务的消费者和利益相关者。消费者参与医疗服务质量管理既是他们的基本权利，也是改善服务质量和组织绩效的重要途径。满意度监测是收集消费者反馈的主要方法，也是管理者和提供者与病人和社区建立沟通、合作的有效措施。文章探讨了病人满意度研究在国际上和在澳洲的进展，并提出改善我国满意度调查研究的建议。     

医疗服务价格调整与医疗费用控制的关系研究

因政府、社会和病人无法承受越来越高的医疗费用，以致于控制医疗费用已成为我国卫生政策的核心。现代医院应将医疗服务价格 调整作为切入点，降低医疗成本，用比较低廉的费用提供比较优质的医疗服务。     

患者体验和满意监测的利用价值初探

目的以北京大学医学部住院患者体验和满意监测(PKU-VPSM)工具为例,讨论如何运用患者体验和满意监测信息,使它为社会产生更多的价值。结果患者体验和满意监测可以作为政府监管医院的依据之一,用来完善政府对卫生服务质量的管制,确定优先发展政策;患者体验和满意监测结果可以作为患者做出就医决策的依据之一,帮助患者更加客观地选择医院和科室,维护自身的权益;患者体验和满意监测还可以作为引导医院关注患者安全的手段之一,督促医院采取和维持增进患者安全的措施。建议各地政府选定具有足够学术水平、社会公信力和社会责任感的中立研究机构,专门从事患者体验和满意监测的实践和研究工作,通过持续不断的监测,不断完善监测工具和挖掘监测信息,从而最大限度地发挥患者体验和满意监测的利用价值。     

患者体验和满意监测的利用价值初探

目的以北京大学医学部住院患者体验和满意监测(PKU-VPSM)工具为例,讨论如何运用患者体验和满意监测信息,使它为社会产生更多的价值。结果患者体验和满意监测可以作为政府监管医院的依据之一,用来完善政府对卫生服务质量的管制,确定优先发展政策;患者体验和满意监测结果可以作为患者做出就医决策的依据之一,帮助患者更加客观地选择医院和科室,维护自身的权益;患者体验和满意监测还可以作为引导医院关注患者安全的手段之一,督促医院采取和维持增进患者安全的措施。建议各地政府选定具有足够学术水平、社会公信力和社会责任感的中立研究机构,专门从事患者体验和满意监测的实践和研究工作,通过持续不断的监测,不断完善监测工具和挖掘监测信息,从而最大限度地发挥患者体验和满意监测的利用价值。     

建立多层次的医疗保障体系对医疗改革的促进作用

针对当前的医疗改革形势，政府可以采取降低基本医疗层次，扩大基本医疗保险的覆盖 面，建立医疗意外保险等形式的商业保险，建立和完善社会医疗救助和政府健康保障基金等多层次 的医疗保障体制，整合社会卫生资源和解决卫生服务资金的来源问题，使之更加有效地提高卫生资 源的利用率，从而更好地解决群众看病难、看病贵的问题。     

不同时期卫生经济政策对医院经济运行影响的研究

我国医院经济管理起源于上世纪80年代初，开始大多借鉴企业的管理办法，进入90年代后，各项改革措施逐渐完善，卫生经济政策也逐步配套，特别是1996年全国卫生工作会议以后，出台了一系列卫生经济政策，如：卫生事业费补助政策、城镇医疗体制改革、医疗保险制度改革、药品集中招标采购、医疗药品分开管理、分别核算等。这些政策和措施的出台对城市医院经济运行产生了哪些影响？笔者结合镇江市区七家医院自1990年以来的经济运行状况，进行了深入的调查和分析。     

北京某医院住院病人满意度和体验的中澳比较

介绍了北京某医院引进澳大利亚病人满意度监测方法．及其在试验阶段的初步结果．并与澳大利亚的病人满意度监测结果进行比较分析。在工具引进过程中．采用了测量工具开发模型．遵循心理测量学的基本原则．并利用相关利益集团参与的方法检验测量工具的适用性。结果发现．经过对测量工具的开发研究．澳大利亚的病人满意度监测工具可以适用于中国的医院。最后提出进一步完善的建议。     

北京两所医院运用VPSM进行住院病人满意和体验调查的结果比较

目的采用澳大利亚的病人满意和体验监测工具(VPSM),对住院病人满意度进行测量,检验该工具在中国医院质量改进过程中的适用性,并提示中国医疗服务质量的改进重点。方法北京两所医院按照VPSM方法学,独立地测量住院病人的满意和体验。结果统计学检验结果显示,两医院间满意度和各质量指数差别无显著性。两医院的结果均低于澳大利亚的测量结果,不排除被调查病人性别和年龄结构的影响。讨论VPSM在北京两医院的测量结果显示了其测量的稳定性及对医疗服务管理中薄弱环节的展示功能,是辅助医疗服务质量改进工作的有力工具。在机构间或国际间比较时,应该考虑到病人年龄、性别和付费方式的影响。     

Psychiatric patient: the most vulnerable traveller

Authors analyse questions of medical evacuation of the psychotic patient from abroad to homeland. This task can be considered the most difficult problem for the attending physician and the escorting medical team as well. The main challenge is to recognise the psychotic patient in a foreign country with a different health-care system and to overcome the language barrier and the different cultural background. The second issue is to prepare the patients - who are usually in a poor condition - for the medical evacuation by commercial aircraft. Another important issue is to take the patient through the strict security control. All of these (partially unsolved) problems make the mentally ill patient defenceless. Although the repatriation of a mentally ill patient is vital and urgent, travel insurance policy mostly excludes to cover the cost of treatment and repatriation. The high cost of treatment and repatriation of the patient should be paid by the patient or the family, who are often in the position of insolvency. In this paper authors present the history of a patient and give a brief review on travel-related mental disorders, the epidemiology of mental alterations during travel as well as the problems of appropriate evacuation. Authors conclude that there is a need for a better approach of the airport authorities and insurance decision makers to the mentally ill patient travelling abroad.     

The Second Computer Assisted Telephone Interview (CATI) Forum: the state of play of CATI survey methods in Australia

Computer Assisted Telephone Interview (CATI) systems are recognised in Australia and internationally for their ability to provide timely and relevant data on the health of the population. The Second CATI Population Health Surveys Forum highlighted the importance of this system for surveillance and using this information to determine priority health issues, develop strategies, monitor effectiveness of interventions, and influence health policy. A national CATI data collection strategy is required to determine priorities for health surveillance. Several development and technical issues need to be addressed for such a national strategy to provide a coordinated approach to health surveillance.     

Stakeholder views on the role of spiritual care in Australian hospitals: An exploratory study

Research increasingly demonstrates the contribution of spiritual care to patient experience, wellbeing and health outcomes. Responsiveness to spiritual needs is recognised as a legitimate component of quality health care. Yet there is no consistent approach to the models and governance of spiritual care across hospitals in Australia. This is consistent with the situation in other developed countries where there is increased attention to identifying best practice models for spiritual care in health. This study explores the views of stakeholders in Australian hospitals to the role of spiritual care in hospitals. A self-completion questionnaire comprising open and closed questions was distributed using a snowball sampling process. Analysis of 477 complete questionnaires indicated high levels of agreement with ten policy statements and six policy objectives. Perceived barriers to spiritual care related to: terminology and roles, education and training, resources, and models of care. Responses identified the issues to inform a national policy agenda including attention to governance and policy structures and clear delineation of roles and scope of practice with aligned education and training models. The inclusion of spiritual care as a significant pathway for the provision of patient-centred care is noted. Further exploration of the contribution of spiritual care to wellbeing, health outcomes and patient experience is invited.     

Patients and doctors: reformulating the UK health policy community?

The rise of the active health care consumer in the United Kingdom requires a reformulation not only of the traditional relationship between patients and doctors, but also of the macro-politics of health which reflect and service that relationship. Market and democratic themes have supplied an ideological impetus to the pressures for change. The well-publicised problems of medical self-regulation have given them practical political expression. However, the response from the policy community still reflects the dominant partners within it, medicine and the state. What neither partner has recognised is that the functionality of the policy community has been undermined by the different and issue-based challenges to the traditional patient-doctor relationship. As a result, the state is likely to remain the lead player in an increasingly unstable politics of health where consumerist issues are on the policy agenda, but patient groups are still excluded from the policy community.     

Migrants' health and access to healthcare in the Czech Republic

The article is dealing with current state of Czech health policy in relation to migration. Overall migration information, available data on migrants' health status as well as accessibility of healthcare are provided. Some health risks connected with migration are mentioned and discussed. Authors concluded that the most urgent problem of Czech health policy in relation to migrants remains the insufficient guarantee of legal entitlement to health care. This concerns a large group of migrants with long-term residence, since the current legal regulation is disadvantageous to migrants coming from countries outside the EU.     

A systematic review of the literature on home monitoring for patients with heart failure

We conducted a systematic review of the literature for assessing the value of home monitoring for heart failure (HF) patients. The abstracts of 383 articles were read. We excluded those in which either no home monitoring was done or only the technical aspects of the telemedicine application were described. Forty-two studies met the selection criteria. We classified the results into feasibility (technical and institutional) and impact (on the clinical process, on patient health, on accessibility and acceptability of the health system, and on the economy). Evaluating the articles showed that home monitoring in HF patients is viable, given that: (1) it appears to be technically effective for following the patient remotely; (2) it appears to be easy to use, and it is widely accepted by patients and health professionals; and (3) it appears to be economically viable. Furthermore, home monitoring of HF patients has been shown to have a positive impact on: (1) the clinical process, supported by a significant improvement of patient follow-up by adjustment of treatment, diet or behaviour, as well as hospital readmissions and emergency visits reduction; (2) the patient's health, supported by a relevant improvement in quality of life, a reduction of days in hospital, and a decrease in mortality; and (3) costs resulting from the use of health resources.     

Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) in the Asia Pacific region (Round Table Forum)

Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important in an era of rising costs, patient safety concerns and evidence-based health care. CE and EBM research in the Asia Pacific region have grown significantly. However, there are three main challenges such as linking evidence to practice and policy; developing a strong collaborative network; and a need for resources and technical expertise to produce evidence.The Cochrane Collaboration is a possible solution to resolve above challenges identified, particularly the challenge of transforming evidence to practice. In addition, training can be carried out to enhance technical expertise in the region and there is also the promising potential that collaborations could extend beyond systematic reviews. To improve the adoption of evidence-based health policy, selection of the best evidence for the right audience and focusing on the relevant issues through appropriate methodology are essential. Information on effectiveness and cost effectiveness needs to be highlighted for policy makers.The way forward to strengthen research and capacity building is to establish the Asia Pacific Consortium for CE and EBM. The consortium would help to create mutually rewarding scientific research and collaborations that will augur well for advances in CE and EBM.     

绵阳城区理发美容业公共用品卫生监测结果分析

[目的]了解绵阳城区理发美容业的卫生状况,给广大消费者营造一个放心的消费环境,为政府制定卫生政策提供科学依据。[方法]按照《公共场所卫生监测技术规范》进行采样和《公共场所卫生标准检验方法》检验。按照《理发店、美容店卫生标准》GB9666-1996进行评判,指标中任何一项不合格即为不合格样品。[结果]绵阳城区2009年共监测理发美容业572家,合格281家,合格率为49.12%;共检测样品1778件,合格1298件,总合格率73.00%;绵阳城区美容专营店的公共用品消毒合格率明显高于兼营店和理发专营店,其中美容专营店、兼营店和理发专营店合格率分别为85.76%、76.28%和62.11%;公共用品毛巾的合格率最低为51.01%,床单64.93%,面膜碗70.47%,梳子94.99%,剪刀97.35%。[结论]绵阳城区理发美容业公共用品合格率较低,微生物污染严重,应采取综合措施,加强对理发美容业的卫生监督管理和公共用品的消毒,保障群众的身体健康。