医疗机构信用文化建设探讨

医疗机构信用文化建设对加强医疗机构信用管理和行业诚信作风建设具有基础性和决定性作用.本文从信用理念培养、信用状况监管、信用水平评价和评价结果应用四个方面,就如何加强医疗机构信用文化建设进行探讨,以期为医疗机构信用体系的建设提供研究视角和参考.     

某市某区民营医疗机构医疗卫生监督信用试评价结果分析

目的通过对某区民营医疗机构医疗卫生信用等级进行试评价,分析信用评价中存在的问题,积极探索卫生监督执法领域开展信用监管的路径和方法。方法归集2019年—2020年期间该区民营医疗机构行政行为决定文书信息,根据医疗卫生监督执法信用评价规则,对该区民营医疗机构信用等级进行试评价。结果某区民营医疗机构共136家,其中A级62家(占比45.59%)、B级23家(占比16.92%)、C级15家(占比11.02%)、D级11家(占比8.09%)、M级25家(占比18.39%)。结论建设完善国家卫生健康委信用信息管理平台,完善事前、事中、事后监督执法领域信用监管措施,综合运用"互联网+监管"举措规范医疗机构诚信执业,提高监督执法能力和水平。     

定点医疗机构信用管理在医保基金监管中的重要性与实现策略

我国医保基金安全面临重大挑战,而当前的医保基金监管体系存在局限性,对此,我国提出将信用管理引入医保基金监管。信用管理可对现有医保基金监管体系形成有效补充,能够拓展医保监管内容,引导医疗机构合理使用医保基金;延伸医保监管时效,保证基金监管力度;补充医保监管手段,引导医疗机构自觉约束服务行为。为最大化实现信用管理的目标,需构建起一套适用于定点医疗机构的信用评分指标体系,以及综合多指标来源的信用监测及评价体系,并在此基础上明确信用结果在医疗机构监管中的作用和流程,使信用管理起到守信激励和失信惩戒的效力,最终形成完善的医保信用管理制度体系,保障信用管理体系对定点医疗机构发挥最大作用。     

社会契约视角下公立医疗机构信用评价指标体系研究

目的评价公立医疗机构信用管理和诚信服务水平。方法对医疗机构信用评价及监管体系的应用及影响因素进行分析,在全国范围内遴选了32位医院管理、卫生行政管理、公共卫生管理等方面的专家,通过德尔菲法进行两轮专家咨询,并据此构建医疗机构信用评价指标体系,同时选择3家样本医院开展试评价。结果3家试点医院总得分分别为93.10分、87.24分、95.30分,诚信收费和诚信诊疗部分和标准分值差距最大。结论试点医院的总体信用管理和诚信服务水平良好,收费部分的平均得分和标准值相差较大,显示在医疗机构复杂庞大的社会契约体系中,医院、医保、患者、财政等利益主体之间的费用契约仍不够有效。     

建立医疗服务诚信体系的思考

构建医疗服务的诚信体系是医疗机构适应市场经济发展的极为重要的基础内容和重点工作。医疗服务的诚信体系的核心是“以病人为中心”和“全心全意为病人服务”。医疗服务的诚信体系包括诚信观念、诚信行为和诚信环境。医疗信用和服务信用是医疗服务诚信体系的重要内涵。其基石应该是医务人员的职业道德、社会公德。法制建设是医疗服务诚信体系的根本性支撑。因此 ,必须走德、法并举之路。     

医疗机构信用现状、成因及对策初探

医疗机构失信行为日趋增多,公众对医疗机构信任度随之大打折扣。造成医疗机构失信的原因主要有法律法规不完善、监管力度不大、社会诚信观念淡薄、医患双方信息不对称、经济利益驱动、失信成本过低、征信服务不足等。针对以上信用问题,建议采用:①完善信用法律体系;②加大行政监管力度;③健全失信联合惩戒机制,增加失信成本;④推动征信服务的发展;⑤加强诚信意识宣传教育,创建崇尚诚信的社会大环境;⑥医疗机构树立诚信意识,加强信用自律等方式,对医疗机构失信问题进行治理。     

医疗机构多元化综合监管的宿迁实践

目的：探讨多元化综合监管医疗机构的具体操作方式。方法：宿迁市试行宣誓承诺、信用约束和第三方评价等监管方式,研究和探讨医疗机构多元化监督管理的有效途径。结果：试行两年来取得明显效果。结论：多元化监督管理新模式是对医疗机构进行科学公正评价和奖惩的依据,促使医疗机构和医务人员高度重视规范管理和自律行为。     

公立医疗机构信用内涵及其特征探究

信用评价是近年来国家及地方各级政府大力推进的一项工作。2019年底,国务院办公厅印发《关于加快推进社会信用体系建设构建以信用为基础的新型监管机制的指导意见》,要求以加强信用监管为着力点,创新监管理念、监管制度和监管方式,建立健全贯穿市场主体全生命周期,衔接事前、事中、事后全监管环节的新型监管机制。公立医疗机构是我国医疗健康服务的主体,服务人群广泛,关系千家万户,是社会的重要窗口,也是社会信用体系建设的主战场。公立医疗机构信用体系建设是社会信用体系建设的重要内容,是医疗行业监管机制创新的要求,也是深化医改、促进发展的有力举措。     

医保基金监管信用体系建设试点工作现况研究*

目的：调研 6个试点地区，公开收集相关文件，总结现行信用管理指标体系，各试点地区逐步探索出一套基本符合医保基金管理要求的信用管理办法。方法：采用文献分析、实地调研和专家、关键人访谈等方法，整理分析所有已落实医药机构信用体系建设的试点地区实施方案。结果：各地区对 《医疗保障基金监管信用评价指标操作手册 （定点医疗机构/A 类）》 指标采纳情况存在差异。现行试点地区存在评价指标建设情况不一、评价指标法律依据不足、地方系统平台协同不足的问题。结论：建议优化各项指标，引导各地区在管理方向和基本要素逐步趋同；加强顶层设计与法律依据；建设以省级为单位的信息化平台。     

2013年度全国卫生产业信用体系建设大会将于9月13日在天津开幕

为推进全国卫生产业信用等级评价工作,推广卫生产业优秀诚信企业、医疗机构,推动卫生产业诚信建设体系的完善,搭建诚信卫生企业和医疗机构、科研单位、政府职能部门的长效交流平台,由全国卫生产业企业管理协会主办的"2013年度全国卫生产业信用体系建设大会"将于2013年9月13-16日在天津召开。     

妇幼保健机构信用等级评价指标体系的构建

目的建立适用于我国妇幼保健机构的信用等级评价指标体系,为推进妇幼保健机构信用等级评价工作提供参考。方法综合运用文献分析法、专家咨询访谈、课题组研讨等方式构建初步指标体系,通过两轮德尔菲专家调查形成最终指标并赋予权重。结果建立了主要包含7个一级指标、38个二级指标的妇幼保健机构信用等级评价指标体系。结论研究建立的妇幼保健机构信用等级评价指标体系专家权威性、协调性、一致性结果较好,具有较高的推广价值。     

Building China's municipal healthcare performance evaluation system: a Tuscan perspective

Regional healthcare performance evaluation systems can help optimize healthcare resources on regional basis and improve the performance of healthcare services provided. The Tuscany region in Italy is a good example of an institution which meets these requirements. China has yet to build such a system based on international experience. In this paper, based on comparative studies between Tuscany and China, we propose that the managing institutions in China's experimental cities can select and commission a third-party agency to, respectively, evaluate the performance of their affiliated hospitals and community health service centers. Following some features of the Tuscan experience, the Chinese municipal healthcare performance evaluation system can be built by focusing on the selection of an appropriate performance evaluation agency, the design of an adequate performance evaluation mechanism and the formulation of a complete set of laws, rules and regulations. When a performance evaluation system at city level is formed, the provincial government can extend the successful experience to other cities.     

卫生专业技术资格评审影响因素研究

目的 分析卫生专业技术资格评审结果的影响因素.方法 对2010年北京部分三级甲等医院及科研机构的评审数据,分申报级别进行Logistic单因素回归分析.结果 级职评审结果与年龄,专业类别,工作经历,参评学历,考试成绩,论文总数,参评论文质量水平,参评论文是否真实、客观,专业技术工作情况等有关.结论 评审过程基本上客观、公正,评审结果能反映申报入的能力和水平.     

安徽省不同区域县区级妇幼保健机构能力综合评价比较

目的通过对安徽省妇幼保健机构综合情况的调查,了解安徽省区域间妇幼保健机构综合能力现状和差异,为制定相关政策提供依据。方法应用全国统一的＂妇幼保健机构资源与运营情况调查表＂和《全国妇幼卫生机构管理信息网络报告系统》调查101家县、区级妇幼保健机构。根据建立的保健机构综合评价模型计算各单位综合得分。按照安徽省行政区划,将其分为皖南、皖中、皖北三个地区,使用统一问卷进行调查;采用定量与定性相结合的方法对三地区妇幼保健机构综合能力进行评价。结果各区域妇幼保健机构综合评价得分中,皖中地区得分最高（64.46分）,皖北地区得分最低（59.89分）,三个地区妇幼保健机构综合评价总分,差异无统计学意义（P〉0.05）;皖南、皖中地区妇幼保健机构综合资源、人力资源、设备资源等指标得分较皖北地区高。结论安徽省县级妇幼保健机构发展不平衡,应基于各地区社会发展水平,加快人才队伍建设,全面提升服务能力和水平。     

Assessing the educational needs of community sexual healthcare practitioners

There is wide variation in the quality and nature of community sexual health service delivery in the UK, which has led to a number of professional and Government-led directives to improve service provision. One key target is the provision of appropriate training and updating of staff in order to maintain an appropriate skill level. To identify the educational development needs of community sexual health nursing and medical staff, preparatory to commissioning appropriate educational provision, a training needs analysis survey was conducted. This involved using a customised psychometrically valid and reliable instrument, which was administered to all relevant staff for self-completion. Fifty-four (67.5%) of all doctors and nurses working in a community sexual health directorate responded. For the whole sample, the following categories of development need were identified: professional development; research; legal issues; clinical practice; and communication/interpersonal skills. When the nursing and medical subsamples were analysed separately, the same generic training needs emerged, although the nurses and doctors identified 22 and 25 significant training needs, respectively. The reported skills deficits cluster into super-ordinate groups which resonate with other available literature. This suggests that each category could be reliably used to inform a short course or series of modules, either for the whole sample or for each professional group. The results also suggest that the instrument is viable for use with healthcare professionals working in this specialty. Consequently, if this approach to identifying skill deficits was adopted, limited educational budgets could be used to provide courses which would meet the real training needs of staff, and if offered as a shared learning opportunity, could promote multidisciplinary team-working. In this way, improved local healthcare provision could be readily realised, with the potential for reducing current variations in the quality of community sexual health provision.     

新冠肺炎疫情下我国农村基层卫生防控能力建设分析

在新冠肺炎的疫情防控中,基层医疗卫生机构对社区防控和关口前移产生重要基础作用。但针对农村基层而言,还存在着人员结构老化、人员素质较低、防控意识不足、信息化基础薄弱等问题。为进一步推动我国农村基层卫生防控能力建设,未来建议加大专业人才队伍建设、将公共卫生机构纳入县域医共体网络、完善农村联防联控体系建设、建立健全信息化互联互通平台、加强对群众的健康教育与宣传、促进地方典型经验的交流。     

Toward human resource management in inter-professional health practice: linking organizational culture, group identity and individual autonomy

The literature on team and inter-professional care practice describes numerous barriers to the institutionalization of inter-professional healthcare. Responses to slow institutionalization of inter-professional healthcare practice have failed to describe change variables and to identify change agents relevant to inter-professional healthcare practice. The purpose of this paper is to (1) describe individual and organizational level barriers to collaborative practice in healthcare; (2) identify change variables relevant to the institutionalization of inter-professional practice at individual and organizational levels of analysis; and (3) identify human resource professionals as change agents and describe how the strategic use of the human resource function could transform individual and organizational level change variables and therefore facilitate the healthcare system's shift toward inter-professional practice. A proposed program of institutionalization includes the following components: a strategic plan to align human resource functions with organizational level inter-professional healthcare strategies, activities to enhance professional competencies and the organizational position of human resource personnel, activities to integrate inter-professional healthcare practices into the daily routines of institutional and individual providers, activities to stand up health provider champions as permanent leaders of inter-professional teams with human resource professionals as consultants and activities to bring all key players to the table including health providers.     

对我国城市健康养老评价指标体系的分析与思考

[目的]通过对《全球老年友好城市建设指南》(简称《指南》)和《“健康中国2030”规划纲要》(简称《纲要》)中的指标体系以及国内与城市健康养老评价指标体系相关的文献及资料进行分析、归纳和总结,为构建一套既符合国际标准又适应中国国情的城市健康养老评价指标体系提供借鉴。[方法]采用“老年友好城市、健康城市、康养城市、长寿之乡、指标”等作为关键词,基于中国知网、万方数据库,以及政府官网和国家卫生健康委员会网站等,搜索国内与城市健康养老评价指标相关的文献和资料。[结果]《指南》和《纲要》中的指标均涉及健康生活、健康服务和健康环境3个方面;同时,二者也存在一定的差异:《指南》侧重于从微观角度评价老年人群的住、行、环境、社会参与、尊重和包容、就业、信息交流和健康服务等8个方面;《纲要》则侧重于从宏观角度评价全体人群的健康水平、健康生活、健康服务与保障、健康环境和健康产业等5个方面。同时,通过对纳入的21篇文献的分析可知,我国有关老年友好城市评价指标体系构建的研究相对较少,尚未在全国范围内建立起一套系统完整的指标体系;现有的健康城市、康养城市和长寿之乡指标体系均基于我国国情构建,可以借鉴其中城市健康和养老方面的相关指标。[结论]未来在构建城市健康养老评价指标体系时,应以《指南》和《纲要》为指导,并结合我国既有的相关指标体系,该指标体系应该是科学全面的、既与国际接轨又符合中国国情需要的城市健康养老评价指标体系。     

A Comparison of Outpatient Healthcare Expenditures Between Public and Private Medical Institutions in Urban China: An Instrumental Variable Approach

The growth of healthcare expenditure provokes constant comments and discussions, as countries battle the issues on cost containment and cost effectiveness. Prior to 1978, medical institutions in China were either state‐owned or were collective public hospitals. Since 1978, China has been trying to rebuild its healthcare system, which was destroyed during the ‘cultural revolution’, allowing private medical institutions to deliver healthcare services. As a result, private medical institutions have grown from 0% to 28.57% between 1978 and 2010. In this context, we compare outpatient healthcare expenditures between public and private medical institutions. The central problem of this comparison is that the choice of medical institution is endogenous. So we apply an instrumental variable (IV) framework utilizing geographic information (whether the closest medical institution is private) as the instrument while controlling for severity of health and other relevant confounding factors. Using China's Urban Resident Basic Medical Insurance Survey 2008–2010, we found that there is no difference in expenditure between public and private medical institutions when IV framework is used. Our econometric tests suggest that our IV model is specified appropriately. However, the ordinary least square model, which is inconsistent in the presence of endogenous regressor(s), reveals that public medical institutions are more expensive. Copyright © 2013 John Wiley & Sons, Ltd.