医疗机构固定资产及差额补助分析

该文通过对3省、3市和3县的医疗机构固定资产和差额补助以及收支情况的分析和比较，发现固定资产投资的多少，直接影响到医院经常性费用分配的数量和比例，为此提出如下建议：卫生事业费分配结构调整，在对医疗机构的固定资产投资方面，主要进行增量的调整；对于规模已经过大的医疗机构可以通过对其存量结构调整，以达到缩减规模和提高效率的目的；实行不含固定资产折旧的成本定价政策，逐步取消差额补助。     

Exploring perceptions,motivations, and practices regarding outsourcing support services by general hospitals in Uganda: A mixed methods study

Research on outsourcing in a developing country using a mixed methods approach can provide insights on outsourcing decisions and practices. This study investigated motivations, practices, perceived benefits, and barriers to outsourcing by general hospitals in Uganda. An explanatory sequential mixed methods design was used. Quantitative data were collected using a self‐administered questionnaire from managers in 32 randomly selected hospitals. Qualitative data were latter collected from eight purposively selected managers using an interview guide. Quantitative data were statistically analyzed using SAS 9.3. Qualitative data were managed using ATLAS ti 7 and coded manually, and content analysis was conducted. Quantitative findings indicate that outsourcing of support services was prevalent (72% of hospitals). The key motivation for outsourcing was to gain access to quality service (68%). Limited availability of service providers was a key challenge during outsourcing (57%). Managers perceive improved productivity and better services as key benefits of outsourcing (90%). The main barrier to outsourcing is limited financing. These findings were confirmed and explained by the qualitative data. Findings and recommendations from this study are critical in developing interventions to encourage effective outsourcing by hospitals in Uganda and other developing countries.     

浅析医院信息化建设的资产管理

目的:阐述在医院信息化建设不断扩大,设备数量、种类大幅增加的情况下,如何加强信息化建设的资产管理,提高资产管理水平.方法:从信息化设备的申请购买、验收入库、维护保养以及折旧报废4个方面对各科室和医院公用的信息化资产管理进行了分析,规范设备管理和技术人员的行为.结果:提高了医院信息化资产的利用率,信息化建设硬件支出减少10％,节约了医院的运行成本.结论:信息化资产管理的措施和方法切实可行,能够提高资产的效益,使医院的投资进入良性循环,为医院可持续发展做出贡献.     

公立医院国有资产管理模式探析

国有资产管理是医院管理的重要内容,本文从国有资产形态这个全新的视角提出了建立公立医院国有资产管理模式。首先阐述了国有资产实物形态和价值形态的关系,指出目前公立医院国有资产管理存在的问题,通过对公立医院国有资产管理的两个形态目标,阐述了发展的公立医院国有资产管理科学模式。     

医院固定资产管理相关问题探讨

实施科学有效的医院固定资产管理,可以确保医院资产安全和保值增值,防止国有资产流失。医院固定资产管理的科学化、规范化、制度化,能够增强医院的核心竞争力,提升医院现代化管理水平。本文就医院固定资产管理的相关问题进行探讨,旨在强化医院管理者做好固定资产管理的意识,切实做好固定资产的管理。     

A Risk-Adjusted Approach to Comparing the Return on Investment in Health Care Programs

The league table approach to rank ordering health care programs according to the incremental cost-effectiveness ratio is a common method to guide policy makers in setting priorities for resource allocation. In the presence of uncertainty, however, ranking programs is complicated by the degree of variability associated with each program. Confidence intervals for cost-effectiveness ratios may be overlapping. Moreover, confidence intervals may include negative ratios and the interpretation of negative cost-effectiveness ratios is ambiguous. We suggest to rank mutually exclusive health care programs according to their rate of return which is defined as the net monetary benefit over the costs of the program. However, how does a program with a higher expected return but higher uncertainty compare to a program with a lower expected return but lower risk? In the present paper we propose a risk-adjusted measure to compare the return on investment in health care programs. Financing a health care program is treated as an investment in a risky asset. The risky asset is combined with a risk-free asset in order to construct a combined portfolio. The weights attributed to the risk-free and risky assets are chosen in such a manner that all programs under consideration exhibit the same degree of uncertainty. We can then compare the performance of the individual programs by constructing a risk-adjusted league table of expected returns.     

公立医院人才可持续发展满意度对管理人员服务绩效的作用机制研究

目的 分析公立医院人才可持续发展满意度影响管理人员服务绩效的条件组态,并探求其影响机制。方法 选取北京市18家三级公立医院617名管理人员进行问卷调查,使用fsQCA 3.0软件进行模糊集定性比较分析。结果 影响公立医院管理人员服务绩效的条件组态分为晋升主导型、管理主导型和综合型三种路径。结论 建议完善晋升管理机制,建立“相对衡量”的绩效评价体系;落实公立医院改革,提高人才可持续发展满意度;引导要素合理配置,推动服务绩效全面提升。     

对某三级甲等医院经营状况的分析

目的:了解某三级甲等医院5年来的经营状况。方法:通过收集该院5年来的相关数据和全国医疗机构2005年度的数据,采用对比分析法了解该院的经营状况。结果:该院平均年收支结余106.93万元,年均收支结余率为0.53%;年均医疗收支结余为-1496.15万元,年均医疗收支结余率为-13.90%;2005年流动比率为49.15%,速动比率为44.75%,资产负债率为49.92%,固定资产收益率为0.16%,流动资产收益率为0.68%。结论:该院药品收入占医药收入的比例低于国家卫生部部属医院的平均水平,药品差价率5年来逐年降低,业务收入低于业务支出,负债结构有待调整,营利能力有待提高。     

Determinants of Thailand household healthcare expenditure: the relevance of permanent resources and other correlates

Several papers in the leading health economics journals modeled the determinants of healthcare expenditure using household survey or family budgets data of developed countries. Past work largely used self‐reported current income as the core determinant, whereas the theoretically correct concept of household resource constraint is permanent or long‐run income (á lá Milton Friedman). This paper strives to rectify the theoretical oversight of using current income by augmenting the model with household asset. Using longitudinal data, we constructed ‘wealth index’ as a distinct covariate to capture the households' tendency to liquidate assets when defraying necessary healthcare liabilities after exhausting cash incomes. (Current income and assets together capture the household expanded resource base). Using 98 632 household observations from Thailand Socio‐Economic Surveys (1994–2000 biennial data cycles) we found, using a double‐hurdle model with dependent errors, that out‐of‐pocket healthcare spending behaves as a technical necessity across income quintiles and household sizes. Pre‐1997 economic shock income elasticities are smaller than the post‐shock estimates across income quintiles for large and small households. Proximity to death, median age, and assets are also among other significant determinants. Our novel findings extend the theoretical consistency of a multi‐level decision model in household healthcare expenditure in the developing Asian country context. Copyright © 2009 John Wiley & Sons, Ltd.     

单病种住院费用分析及绩效管理模式探讨——以结直肠癌手术为例

目的 分析单病种住院费用的构成比例,探索影响住院费用的主要因素.方法 以结直肠癌手术为研究对象,采用回顾性调查研究方法,收集上海某三甲医院2013年1月—2014年12月间,主诊断为结直肠癌并行手术的出院患者的病案首页信息.采用单因素和多元回归对住院总费用的影响因素进行分析.结果 在单病种住院费用的构成中,医用耗材费占比最高,其次为药费、治疗费,护理费占比较低;影响单病种住院费用的主要因素有住院天数、手术方式和疾病转归情况.结论 单病种住院费用构成不合理,医院应进一步加强单病种质量管理,提高医疗质量.