合理控制医药费用促进合作医疗平稳运行

近年来，我国新型农村合作医疗医药费用呈逐年快速上涨趋势。为了切实维护参合农民的利益，使农民在新型农村合作医疗制度中真正得到实惠，保证合作医疗基金的安全运行，就必须建立健全控制医药费用不合理上涨的有效机制。文章从医疗服务的供方、需方及药品流通3个角度分析不合理医药费用过快上涨的原因，并探讨医药费用过快上涨的控制机制，为尽快完善新型农村合作医疗制度提供科学参考依据。     

降低医疗开支减轻人群负担

随着经济发展、技术进步、基本医疗保障制度发展，医疗费用都会有一定幅度增长。但医药费用的上涨必须与经济发展水平相协调，与政府财政、基本医疗保障和个人的承受能力相适应。短时间内医药费用过快上涨，将会影响民众的切身利益。     

福建让医药费用零增长

福建从2005年拉开控制医药费用增长的“战幕”，通过政府干预，“勒住”医药费用过快上涨“这匹野马的缰绳”。到去年年底，实现费用“零增长”目标。     

新农合医药费用不合理增长成因及控制对策分析

新农合制度实施6年以来,各地新农合定点医疗机构的医药费用上涨过快,农民群众医药费用负担居高不下,也给新农合基金带来较大的压力。该文分析了医药费用上涨过快的成因,主要是财政对医疗机构投入不到位,药品、卫生材料定价机制不合理,医疗机构内部收入分配体制不完善,医疗机构因不合理用药、过度服务、放宽住院指征、乱收费、高收费等因素导致的医药费用过快增长。作者结合南江县实际,提出通过加大财政投入、改革药品材料定价机制、加快医疗机构分配体制改革、规范医疗机构内部管理、实行人均医药费用指标控制、加快新农合付费方式改革等一些行之有效的措施控制医药费用增长,确保参合农民利益和新农合基金安全。     

降低医疗开支 减轻人群负担

随着经济发展、技术进步、基本医疗保障制度发展,医疗费用都会有一定幅度增长。但医药费用的上涨必须与经济发展水平相协调,与政府财政、基本医疗保障和个人的承受能力相适应。短时间内医药费用过快上涨,将会影响民众的切身利益。     

医药费用过快增长的成因及对策

目前医药费用过快增长已引起社会普遍关注，本文分析了医药费用过快增长的成因并提出了遏制医药费用过快增长的对策。     

关于加强政府卫生投入与控制医药费用的探讨

医药卫生体制改革关乎国民健康、经济发展和社会稳定。政府卫生投入有利于促进人群健康及健康公平。医药费用上涨过快是政府和城乡居民共同关心的热点话题。该文通过研究政府卫生投入与医药费用控制关系,探索如何增加和改变政府卫生投入总量、结构和方式,抑制医药费用的过快增长,从投入与控制两个方面提出对策建议。     

六安市四院加强规范常见病按病种付费

为进一步推进新农合支付方式改革，控制医药费用过快上涨，提高新农合基金使用效率和保障效能。六安市四院召开专题会议，进一步讨论落实新农合常见病按病种付费管理工作。     

空制费用，今年一项重点工作

卫生部陈竺部长在2011年全国卫生工作会议上指出：“短时间内医药费用过快上涨，将会影响群众的切身利益，影响群众对于医改的感受”。不难看出，控制费用将成为2011年卫生工作重点任务之一。     

遏制医药费用增长过快必须全方位深化改革

遏制医药费用增长过快必须全方位深化改革广州军区广州总医院（５１００１０）张志英，谢恒，徐业成遏制医药费用增长过快是近两三年来全国上下议论的中心。不少医疗卫生管理人员提出了许多建设性的意见。各级政府也非常重视，采取了一些积极措施，如上海市实施的医药费用...     

"以药补医"机制的现象分析及可控策略

为探讨有关“以药补医”机制的改革策略，对山东省城市综合性医院的“以药补医”状况进行了综合分析，结果发现：1999～2003年间，山东省城市综合性医院中，医院对药品收入一直有着较大的依赖性；药品结余率和医疗亏损率总体上均呈上升趋势，这揭示必须尽快解决医疗亏损、“以药补医”问题．为此，对“以药补医”机制的“合理”与“不合理”及有关的解决策略进行了深入讨论，并提出了相应的建议、     

社区高血压规范化管理效果评价

目的:评价社区高血压患者规范管理的效果.方法:在社区对筛查出的13 444例高血压患者建立慢性病档案,通过临床评估,根据危险程度,实行分级随访,规范管理.结果:经过1年规范化管理后,管理对象的高血压知晓率、治疗率和高血压控制率,由1年前的87.09%、64.94%和5.39%,分别上升到100%、100% 和47.99%,差异有统计学意义(P均＜0.01).结论:规范管理能有效改善高血压患者的不良生活方式,增强服药依从性,良好控制血压,减少并发症,提高生命质量,社区综合防治是提高高血压人群防治效果的有效途径.     

Educating the dietitians of the future

The role and sphere of influence of dietitians has expanded markedly over the last decade, and education and training of dietitians must similarly expand in order to prepare them for their current and future work. The educational initiatives which have been put in place in both pre- and post-registration training in order to facilitate this process are described, together with proposals for changes in the structure and content of dietetics pre-registration training in the UK.     

Supervising the Intern Who Inherits a Case: Making the Most of the Change

Transfer of patients to interns, while frequent in training sites, is often viewed negatively. However, transfer affords positive opportunities for therapy, training, and supervision. It provides a window into patients' experiences of loss, change, attachment style, capacity for working alliance, and affect tolerance. For supervisors and interns, an opportunity exists for deeper understanding of the patient, the therapeutic relationship, alliance building and the usefulness of ongoing feedback both in therapy and supervision. Dilemmas for intern therapists include narcissistic vulnerability and sibling dynamics. With case illustrations, countertransference issues for interns and supervisors are identified and suggestions are offered for addressing transfer in supervision.     

社会支持干预对改善肢体残疾人心理健康状况的研究

目的对上海市某社区肢体残疾人的心理健康问题进行社会支持干预,并分析结果。方法采用社会支持评定量表（SSRS）,90项症状自评量表（SCL-90）对上海市闸北区筛选出的80名肢体残疾人进行社会支持的干预前后对照分析。结果增强社会支持的社区干预方案可以提高社区肢体残疾人的社会支持程度,并改善其心理健康。结论肢体残疾人的社会支持干预方案适合在社区运行且有必要在社区大力推广。     

社区肢残人辅助器具使用全科医学照顾干预效果分析

目的了解社区肢残人辅助器具需求及使用状况,并对全科医学照顾干预作效果分析。方法全科医生采用入户面访对调查对象进行前后二次问卷调查,问卷调查内容包括：一般的人口学资料、残疾程度及生活自理能力、辅助用品使用情况等相关内容并对全科医学照顾干预前后二次数据进行卡方检验及相关资料分析。结果全科医学照顾干预后比干预前肢体残疾人士使用辅助器具上升了9．68个百分点,使用辅助器具局部症状改善或治愈以及跌倒人数干预前后有统计意义（P〈0．01）,肢体残疾人生活自理能力干预前后对照有统计意义（P〈0．05）。结论适合个性化的肢残人士器具使用服务提升了残疾人“人人享有康复服务”社区卫生服务平台,提高肢残人士器具使用率和干预评估是提高肢残人士生活自理能力的有效措施。     

Enter the world of the microcomputer

Step aside prejudices and fear, it is time for all medical group managers to find a friend in the microcomputer. This useful tool can eliminate the drudgery of number crunching and help solve the many practical financial and operational problems daily confronting the manager. The purchase of a $4,000 microcomputer system may at first seem ridiculous when a $100,000 system is already in use, but the software available for a microcomputer can offer specific applications for day-to-day management activities for which a " supercomputer " may not be well suited. The electronic spreadsheet applications for medical group financial management available through a microcomputer are explored here in detail.     

Anticipating the Need for Healthcare Resources Following the Escalation of the COVID-19 Outbreak in the Republic of Kazakhstan

ObjectivesThe lack of advance planning in a public health emergency can lead to wasted resources and inadvertent loss of lives. This study is aimed at forecasting the needs for healthcare resources following the expansion of the coronavirus disease 2019 (COVID-19) outbreak in the Republic of Kazakhstan, focusing on hospital beds, equipment, and the professional workforce in light of the developing epidemiological situation and the data on resources currently available.MethodsWe constructed a forecast model of the epidemiological scenario via the classic susceptible-exposed-infected-removed (SEIR) approach. The World Health Organization’s COVID-19 Essential Supplies Forecasting Tool was used to evaluate the healthcare resources needed for the next 12 weeks.ResultsOver the forecast period, there will be 104 713.7 hospital admissions due to severe disease and 34 904.5 hospital admissions due to critical disease. This will require 47 247.7 beds for severe disease and 1929.9 beds for critical disease at the peak of the COVID-19 outbreak. There will also be high needs for all categories of healthcare workers and for both diagnostic and treatment equipment. Thus, Republic of Kazakhstan faces the need for a rapid increase in available healthcare resources and/or for finding ways to redistribute resources effectively.ConclusionsRepublic of Kazakhstan will be able to reduce the rates of infections and deaths among its population by developing and following a consistent strategy targeting COVID-19 in a number of inter-related directions.     

临床实习学生管理存在的问题及解决办法的探讨

分析医学生在临床实习阶段存在的问题，提出加强对临床实习学生管理的对策和建议： 规范教学管理，重视教学基地建设；重视对学生的思想教育，完善实习学生管理制度；改善教学条 件，提高教学效果；调整实习制度和考研制度等。     

Reconstruction of the ingestion doses received by the population evacuated from the settlements in the 30-km zone around the Chernobyl reactor.

As a consequence of the Chernobyl accident, about 50,000 people were evacuated from the settlements in the 30-km zone around the reactor in the period 3-11 d after the accident. As no countermeasures were implemented in the early phase, people continued to consume milk and some leafy vegetables. In this paper, average effective ingestion doses are modeled for evacuees. Input data for the assessment are the 137Cs activity per unit area, the ratios of the radionuclides relative to 137Cs, the mean day of evacuation, and intake rates for milk and green vegetables. The transfer of radionuclides from deposition to humans is estimated by modeling radionuclide interception by vegetation, weathering, and the time-dependent transfer of radionuclides to milk taking into account site-specific agricultural practices. Depending on the evacuation day and site, the estimated ingestion doses for the settlements are in the range of 20 to 1,300 mSv and 3 to 180 mSv for infants and adults, respectively. 131I is by far the most important isotope, the ingestion dose due to 133I is more than one order of magnitude lower. The most exposed organ is the thyroid, inducing more than 80% and 50% of the ingestion dose for infants and adults. The ingestion doses are compared to the doses due to inhalation and external exposure. The internal dose exceeds the external by a factor of about 2-10 for adults and 2-40 for 1-y-old infants depending on site and evacuation day. The thyroid doses assessed for the evacuees are consistent with results achieved in studies performed in areas outside the 30-km zone.