需求侧视角下三级公立医院非基本医疗服务分析

目的:为更好地促进多层次医疗服务的开展提供政策建议。方法:基于上海市4家三甲医院非基本医疗服务数据,采用可视化方法对非基本医疗服务发展现状进行分析。结果:（1）在突发公共卫生事件背景下,相对于基本医疗服务,非基本医疗服务的患者需求黏性更大;（2）特需医疗服务的患者需求呈现层次化、多样化趋势;（3）非基本医疗服务和基本医疗服务之间的次均费用差异首先体现在挂号费上,其次是检查化验费等费用。结论:发展非基本医疗服务有利于医院的可持续运营,但发展非基本医疗服务应做好对服务内容的监管工作,商业保险在监管和减轻患者负担方面有较好地应用前景。     

广东省基本医疗服务价格存在的问题与改革建议

通过对广东省基本医疗服务价格现状的分析,发现其现有的基本医疗服务价格存在基本医疗服务价格的非均衡性、价格调整严重滞后、成本核算系统不完善、价格调整与相关部门联动机制不健全、医疗服务价格监管缺位等问题。建议从价格动态调整、完善价格调整相关措施、成本核算以及价格监管等方面加以改革。     

《深圳市医师不良执业行为记分管理办法》施行对医疗服务监管工作的启示

随着卫生体制改革的深入推进,医疗服务监管工作在卫生监督领域中的重要性日益突出。为深化医疗服务市场的监管,2016年初,深圳市卫生和计划生育委员会出台了《深圳市医师不良执业行为记分管理办法(试行)》,以加强医师监管为抓手,提升医疗服务的监管效能。本文介绍了《深圳市医师不良执业行为记分管理办法(试行)》的基本内容及初步运行情况,探讨加强医师监管对整个医疗服务市场发挥的作用,为推进医疗服务监管工作提供借鉴。     

“聪明监管”：基本医疗保险监管的模式和路径选择

监管模式从传统的"命令控制"式转向"聪明监管"是监管改革的普遍趋势。聪明监管的核心内涵是"管得更少,管得更好"。根据"聪明监管"的原则建立和完善我国的基本医疗保险监管体系,需要从监管者、监管内容和监管手段等三个方面加以改进,具体包括重塑基本医疗保险监管框架、建立反医疗欺诈滥用和反浪费的机制、建立医疗质量监管机制、发挥支付方式的激励作用、促进医疗服务提供者之间的竞争、以信息公开的方式促进医疗服务提供方自我监管、建立吊销欺诈医保基金的医生的执业资格证的制度以及培育行业自律组织的自治性并发展其行业自律功能等。     

对公立医院开展特需医疗服务的思考

当前,大部分公立医院都在开展特需医疗服务,诸多问题逐渐浮出水面,如有可能挤占基本医疗和公共卫生服务资源,有可能影响公立医院公益性质的实现等。对此提出两方面建议：一是公立医院要理性看待市场、合理利用政策、规范提供服务;二是政府部门要切实担负起监管职责,加强对公立医院开展特需医疗服务的监管。     

特需医疗“退出”引发业界关注

正继上海公立医院剥离特需医疗服务后,北京也将进一步削减公立医院特需服务。北京市卫生计生委相关负责人表示,既要加强监管,完善绩效考核,让公立医院更多致力于提供基本医疗服务,也要改革公立医院补偿机制,让公立医院不依赖药品、检查和特需医疗服务,就能弥补基本医疗收入亏空,让医生提供基本医疗就能获得体面的收入。从公立医院的性质看,公立医院作为享受国家财政拨款的事业单位,基本职能是提供公益性基本医疗服务;而由外宾门诊、高干门诊发展形成的特需医疗服     

新医改框架下的医疗服务质量监管体系研究

为保证医疗服务质量,促进实现人人享有基本医疗卫生服务的目标,必须完善和重构医疗服务质量监管体系。基于新医改框架下对医疗服务质量的要求,梳理我国医疗服务质量监管体系的历史、现状和突出问题,并根据"监管效果-监管效率"划分监管失灵四个维度,进而提出完善和重构医疗服务质量监管体系的建议。     

江苏省卫生监督机构医疗监督现状调查

目的了解卫生监督机构医疗监督的现状,为深化改革提供依据。方法采用EpiData软件编辑调查表,通过问卷调查、现场考察、调取"江苏省卫生监督信息系统"及《卫生年鉴》数据等方法获取资料,使用SPSS 31.0软件进行统计分析。结果当前江苏省基层卫生监督机构医疗服务监督管理工作职能不明,缺乏有效地运行机制;医疗服务监督管理工作任务繁重,卫生监督机构医疗服务监管能力难以胜任;当前医疗服务市场的监管模式已不能适应现实的需要。结论建议将卫生监督机构并入行政机关,组建专门执法局;整合医疗服务监督执法队伍,提升监管能力;充分发挥医学行业协会职责,加强行业自律;对医疗机构实施综合监督量化分级管理,健全医疗服务市场的监督管理体系。     

泰国医院评审对我国医院评审的启示

2009年．《基本医疗服务监管体系比较研究》课题组根据WH0的建议赴泰国对该国医疗质量监管体系进行现场调研。在泰国的医疗质量监管体系中．医院评审是最主要的手段。不管是泰国卫生部的官员，还是医疗保险经办机构的官员．还是各级医疗机构的管理者均认为．在一个国家中．决定医疗质量的因素很多，医疗服务筹资水平、支付方式、医务人员的数量和质量、相关法律和技术规范的完善程度、医疗机构内部的管理水平等等．对医疗质量均有明显的影响．     

在公立医院改革中加强医疗服务监管

医疗服务监管该管什么、怎么管、由谁来管？怎样处理公立医院改革与监管的关系？在日前召开的全国医疗服务监管工作会议上,卫生部副部长马哓伟的一番论述让这些问题逐渐清晰。马哓伟指出,医疗服务监管工作主要有两个方面的职能,一方面组织开展对医疗机构医疗服务的监管,另一方面是推进公立医院改革试点工作。医疗服务监管还要进一步做大、做强。     

Gesundheitsökonomie und HTA

For a comprehensive health technology assessment (HTA), health economic studies are analysed as well as medical studies. Significance and effects of HTA are rather different in European countries. In Germany HTA is conducted by two official agencies: DIMDI and IQWiG. While DIMDI requires health economic assessments, IQWiG is prohibited from considering economic aspects by law (pure assessment of benefits). For the health economic assessment in HTA reports mainly secondary scientific evidence is exploited, i.e. primarily cost effectiveness and cost utility analyses. The study perspective, the study alternatives and the modelling methods are of great importance for the evaluation and have to be justified in depth. The cost effectiveness ratio and the budget impact are the most important results of the health economic assessment, which is the basis for the appraisal by the health care authorities. For this decision medical, utilitarian or other aspects like the avoidance of unwanted distribution effects are considered. On the other hand often only a few studies are available for the decision making when the appraisal has to be done. This problem might be less relevant in the near future as the number of HTAs and the number of health economic evaluations increases.     

Health technology assessment in Germany. Status, challenges, and development

The objectives of this paper are to describe the status and development of health technology regulation with regard to coverage decisions and utilization, and to analyze the current situation of health technology assessment (HTA) in Germany. The relevant literature for controlling health technologies was identified by searching the literature and databases and through personal contacts. The literature was analyzed with regard to the different sectors in the healthcare system. For the analysis of the current state of HTA in Germany, a national survey was carried out. In addition, the names of topics under assessment were collected. The results show that coverage decisions in the ambulatory sector appear to be much more regulated than those in the inpatient sector. The same is true for diffusion and usage of technologies. The strict separation of the hospital and the ambulatory care sector in Germany constitutes a barrier to regulation and to making HTA an effective instrument in Germany. Until recently, HTA in Germany focused on biotechnology, such as gene technology. Recently the German Scientific Working Group of Technology Assessment in Health Care has adopted a systematic methodology to undertake HTAs. It can be concluded that regulation of health technologies in Germany is characterized by inconsistencies ranging from strict regulation in the ambulatory sector to almost no regulation in the rehabilitation sector. Increasing interest in HTA, in conjunction with a high priority assigned to evaluation of health technologies by the newly elected government, is likely to improve this situation in the future.     

法国、德国、荷兰卫生技术评估发展历程及思考

在法国,由政府财政支持的独立性全国性卫生技术评估机构进行药品、服务、仪器设备等各项卫生技术的评估工作,其研究结果是重要的决策工具。在德国,卫生技术评估被卫生体系中各方广泛利用,针对各种不同类型技术,从不同角度出发,为政府、立法、保险等提供服务,是门诊服务中重要的决策工具。荷兰卫生技术评估曾经对政策有较强影响,但随着医保组织的退出,评估向学术研究发展,对政策的影响有所削弱。     

四川省互联网医疗服务监管平台建设及思考

随着“互联网+”战略的不断推进,医疗卫生领域的互联网技术运用日益成熟。以四川省互联网医疗服务监管平台为研究对象,结合传统医疗监管模式存在的针对性不强、监管局限以及监管滞后等问题,从设计监管理念、监管模式、平台服务以及监管要点等方面对政府监管方式进行了阐述。同时,对未来监管平台建设提出完善医师多点执业、强化医疗平台责任、构建多元共治体系、打造统一的卫生行政执法平台等建议。     

卫生技术评估国内外研究现状及应用

卫生技术评估（Health technology assessment，HTA）主要评估某项卫生技术的有效性、安全性、经济性和社会影响。它被广泛应用于卫生保健领域和医疗服务系统，其研究成果是卫生决策的重要依据。但HTA在我国的发展时间较短，仍属新领域，本文将对HTA的有关内容做一简要介绍，旨在推广这一新型评估技术的应用。     

金砖五国卫生技术评估应用比较研究

卫生技术评估(HTA)能够为医疗卫生服务提供可靠决策依据。结合文献及国内外卫生技术评估网站的相关资料,从HTA的机构设置、职责范围、资金来源、流程等方面,对金砖五国HTA情况进行梳理和比较分析发现,金砖五国HTA发展水平不一,各国处于HTA发展的不同阶段。其中,巴西和中国的HTA体系发展较为完善,南非发展较为缓慢。金砖五国的HTA发展面临着缺乏专业知识、医疗卫生体系不健全等挑战,需加快发展步伐;巴西、中国仍需进一步加大政府投入,完善HTA体系建设评估指南,提升HTA研究能力;印度应扩大HTA评估网络,提高评估流程的透明度和客观性;南非需加快建立HTA机构。     

Health technology assessment and the regulation of medical devices and procedures in Quebec. Synergy, collusion, or collision?

In this paper, we discuss the complex relationship between health technology assessment (HTA) and the regulation of medical devices and procedures. The relationship is first examined through a conceptual framework describing the itinerary from research to three levels of policy making: micro (standards of medical practice), meso (institutional rules), and macro (health policies). Four reports from the Quebec Health Technology Assessment Council (CETS) are used to illustrate how HTA activities can influence the regulatory mechanisms operating at each decision-making level. We then discuss the skillful balancing act required from HTA agencies to constantly negotiate the right distance from the regulatory process at which to operate. We propose that HTA agencies should not be incorporated into any regulatory, auditing, or monitoring process. Finally, the relationship between health technology assessment and health care reform is discussed. It is suggested that HTA activities will contribute most during the data-driven preparation and consolidation phases of a reform process. The fast pace of events and the political turmoil characteristic of the implementation phase provide a less receptive environment for HTA contributions.     

Health technology assessment in The Netherlands

The Dutch healthcare system is not a single overall plan, but has evolved from a constantly changing mix of institutions, regulations, and responsibilities. The resulting system provides high-quality care with reasonable efficiency and equal distribution over the population. Every Dutch citizen is entitled to health care. Health insurance is provided by a mix of compulsory national insurance and public and private insurance schemes. Hospitals generally have a private legal basis but are heavily regulated. Supraregional planning of high-tech medical services is also regulated. Hospitals function under fixed, prospective budgets with regulation of capital investments. Independent general practitioners serve a gatekeeper role for specialist and hospital services and are paid by capitation or fee for service. Specialists are paid by fee for service. All physicians' fees are controlled by the Ministry of Economic Affairs. Coverage of benefits is an important method of controlling the cost of services. There is increasing concern about health care quality. Health technology assessment (HTA) has become increasingly visible during the last 15 years. A special national fund for HTA, set up in 1988, has led to many formal and informal changes. HTA has evolved from a research activity into policy research for improving health care on the national level. In 1993 the government stated formally that enhancing effectiveness in health care was one of its prime targets and that HTA would be a prime tool for this purpose. The most important current issue is coordination of HTA activities, which is now undertaken by a new platform representing the important actors in health care and HTA.     

Das Deutsche Netzwerk Evidenzbasierte Medizin — DNEbM

The German Network for Evidence-based Medicine (DNEbM) was founded in October 2000. A major impetus for the development of evidence-based medicine (EBM) in Germany came in the mid-1990s from the German Cochrane Initiative, which referred to the principles and activities of the international Cochrane Collaboration. The Network's primary mission is to establish a competence and reference centre for all aspects of evidence-based medicine. Central to this mission is to encourage projects that are concerned with scientific and methodological problems, aspects of professional development and the question of how to translate EBM into clinical practice. With currently more than 600 individual members the DNEbM is the most important society concerned with EBM in the German-speaking region in Europe. Until now, the DNEbM has initiated the development of curricula for EBM and health technology assessment (HTA) for undergraduate and continuing medical education. In addition, position papers regarding hot topics such as prostate cancer screening with PSA or registration of randomised controlled trials were published. The Network's HTA section comprises experts from universities, institutes, health care administration and industry. Currently, the HTA section is developing an Internet-based course for users and doers of HTA reports in Germany.     

泰国卫生技术评估机制建设现状及启示

文章介绍了泰国卫生技术评估的发展历程、具体应用、机构建设,以及运行机制和规范化评估工具。启示我国在国家级HTA机构发展良好的基础上,应鼓励各地区设立和发展HTA机构;建立完整规范的决策转化机制;逐步建设形成适合我国的卫生技术评估规范化工具;建设HTA数据共享平台,以不断提升我国卫生技术评估能力。