完善某医疗机构追讨住院患者医疗欠费工作及效果分析

目的：规范某医疗机构住院患者欠费的追讨工作，以最大限度地减少无法核销的医疗欠费。方法：对某医疗机构住院部汇总的医疗欠费情况进行梳理，针对存在问题提出完善追讨住院患者欠费工作的建议。结果：通过加强相关科室与人员的培训和管理，提高信息化管理水平；明确各部门职责，加强部门间合作；寻求政府政策支持等，做好某医疗机构住院患者欠费的追讨工作。结论：通过完善病人信息，某医疗机构2019年有效减少无法核销的医疗欠费，后期还应加强培训，明确各部门职责和加强部门间合作以进一步减少无法核销的医疗欠费。     

乡镇卫生院医生工作偏好——基于三省离散选择实验的分析

目的：分析乡镇卫生院医生工作偏好,为基层吸引与留住卫生人才提供政策参考。方法：应用离散选择实验设计问卷,抽取山东、安徽、陕西三省共238名乡镇卫生院医生进行问卷调查,应用条件logit回归分析医生工作偏好。结果：乡镇卫生院医生关注的工作属性依次为：收入水平、子女教育条件、编制、工作地点、培训机会和晋升年限。月收入8 000元与2 000元相比,OR值为7.0。子女教育条件和编制的货币价值分别为3 857元和3 294元。月收入提高至8 000元可将乡镇卫生院医生的离职意愿由35%降至8%左右。提供好的子女教育条件和编制均可以将医生的离职意愿降至5%左右。乡镇卫生院有编制的岗位与县城临时聘用岗位对于医生的吸引力相当。结论：收入仍然是乡镇卫生院医生最关注的工作属性,改善基层卫生机构职工的子女教育条件和提供编制,将有利于吸引与留住卫生人才。     

基于史密斯模型视角下对住院医师规范化培训政策执行分析

采用史密斯模型的4个维度理想化政策、执行机构、目标群体、政策环境,分析目前住院医师规范化培训的执行现状,发现该制度理想化程度较高,对于政策的目标群体的预期目标取得了一定的成绩,但在政策的各执行机构的存在诸多问题亟待解决,许多问题欠缺细致和规范,相关部门应给予重视并加以完善和改进。     

基于医院信息管理系统平台加强患者欠费管理

目的：探索医院住院患者欠费管理的有效措施,避免医疗风险,规范账务管理。方法通过分析医院住院患者欠费管理的现状,利用HIS平台的医护工作站、费用管理系统、医信通系统及自行开发的子系统,从临床科室、经济管理科、财务部门和管理部门的角度改进管理方法,及时向科室和机关反馈住院患者欠费信息,督促欠费患者及时结账,完善会计核算制度。结果加大出院患者欠费管理力度,收费及核算流程更加优化,医院财务会计账目更加全面,减少因住院患者欠费给医院带来的经济损失。结论利用信息化平台加强医院患者欠费管理是一种行之有效的手段。     

基本医疗保险“欺诈骗保”现象的影响因素及路径研究——基于我国31个省级案例的清晰集定性比较分析

目的：探索欺诈骗保现象发生的关键因素和路径,为我国医保基金监管改革和欺诈骗保现象的治理提供依据。方法：基于史密斯政策执行理论,利用国家审计署、国家医保局公布的110起典型案件,通过清晰集定性比较分析方法,分析欺诈骗保的关键因素和路径。结果：我国欺诈骗保主体和手段主要包括经办机构超范围支付、公立医院自立收费项目或提高收费标准、民营医院和基层卫生机构虚构住院、定点药店上传虚假销售记录以及参保人重复报销等。当地监管政策制定情况、民营和基层医疗机构、居民收入水平、主政官员工作经历、监管技术水平以及医保基金充裕程度是影响骗保现象发生的前因条件,并形成了目标群体妨碍、执行机构失守、政策表面执行和强监管—高发现的骗保路径。结论：目标群体妨碍是我国欺诈骗保发生的重要主体和路径,应加强经济水平较低地区的民营和基层医疗机构治理。执行机构失守从主动和被动两方面加剧了欺诈骗保发生,需通过完善医保监管体制和监管技术方式以提高监管机构能力和水平,避免政策表面执行等问题。     

临床医生参与艾滋病/性病相关的行为干预探讨

目的：探讨在艾滋病/性病相关的行为干预中,临床医生干预的作用及意义,方法：通过临床医生参与艾滋病/性病行为干预的调查,结合参考文献：进行理论分析.结果：临床医生都有机会接触艾滋病/性病患者,在人数、医学知识、信任度以及与患者接触的便利程度等方面都具有参与行为干预的优势,但医疗任务繁重,进行行为干预在政策制度及环境条件等方面还存在一定的困难.结论：临床医生基于自身的独特优势,应通过技能培训、制度改革、转变观念和提供支持等策略的实施.积极参与行为干预,控制艾滋病/性病的蔓延.     

癫痫儿童睡眠障碍的研究进展

癫痫是一种儿童常见神经系统疾病,由脑部神经元高度同步化异常放电所致,以持久性的致痫倾向为特征。儿童癫痫和睡眠障碍相互影响,形成恶性循环。然而,目前临床医生对癫痫儿童的睡眠障碍重视不足,缺乏有效诊治。因此,本文就儿童癫痫和睡眠的相互影响、癫痫儿童常见的睡眠障碍,以及评估和治疗的方法进行论述,期望为癫痫儿童睡眠障碍的早期识别和综合诊治提供参考。     

上海浦东新区全科医生家庭责任制认同度的实证研究

目的：研究浦东全科医生家庭责任制度的认同度及影响因素,为家庭医生制度的进一步推广提供可行性建议。方法：对浦东试点街镇的597例患者和120名医生就全科医生的认同参与情况进行问卷调查。结果：患者和医生对全科医生家庭职责制的认同度普遍不高,仅有50.4%的医生和78.5%的患者支持全科医生制度的推行。全科医生对报酬收入（6.1%）、奖惩制度（16.8%）、福利保障（19.1%）满意度较低,但对领导素质、人际关系和单位管理状况等满意度普遍较高。结论：浦东全科医生的社会认同度、职业认同度明显较低,需要加强舆论宣传引导力度、加大相关配套政策支持力度、加强人才队伍建设和提升全科医生的服务能力,这是进一步推广全科医生责任制的关键和有力保障。     

2008年外科患者欠费情况分析

目的:通过分析外科患者欠费产生原因,减少欠费.方法:对2008年外科住院患者欠费情况,进行统计分析.结果:与贫困、纠纷、意外事故、恶意欠费有关.结论:医院应加强对外科的扶持力度,科室应完善管理机制,加强各科室协调和沟通并提高医疗服务水平.     

ICU病员欠费原因分析及对策

社会及现代医学的发展，推动了各医院重症监护病房（ICU）发展，同时ICU欠费问题也引起广泛关注，对ICU病员欠费原因进行分析，探讨通过政府政策干预，使危重病员既能得到及时有效救治，又能保证医院经济利益不受损失。     

Private and public medicine: a comparison of quality perceptions

How do physicians and patients perceive the quality of medical services offered? Is this perception the same in the private and public sector? On the basis of a survey conducted in Greece on a 2 x 2 design with 20 respondents in each cell, several interesting characteristics were identified. Patients in the public sector attribute greater importance to resources of a medical and technical nature and do not seem particularly concerned about the contextual or environmental features of a hospital. Private patients are expecting a more holistic approach to their treatment and expect some attention to be directed to their emotional needs. Private surgeons are worried about the limited basic resources in private hospitals and their inability to satisfy the non-clinical needs of their patients. Important lessons may be drawn for policy makers in terms of priorities and resource allocation in.     

Does it matter who you are or what you gain? an experimental study of preferences for resource allocation

Using an experimental conjoint-analysis like approach, preferences for resource allocation were studied. An interactive survey was developed which was published in the World Wide Web. A convenience sample of undergraduate students participated in the study. Subjects were confronted with nine pairwise scenarios describing hypothetical patient groups in need of life-saving treatments. The patient groups presented differed in terms of their health-related lifestyle, socioeconomic status, age, life expectancy, quality of life after treatment and whether they had received extensive medical care in the past. Participants were asked to allocate a finite budget to each patient group. All attributes used in this study significantly influenced respondents' preferences on how to allocate the budget between patient groups. The general importance of attributes used in the QALY approach is supported by this study with quality of life being a central criterion. The distributional patterns observed were, however, different from those expected when rigorously adhering to the QALY framework: In only a very small fraction of allocations subjects distributed the entire budget strictly on the patient group expecting the highest QALY gain. The vast majority of responders was willing to trade efficiency for a more equal distribution of resources. The approach described can be used to analyze the importance people place on different attributes in resource allocation decisions and to study preferences for the final distribution of resources.     

Hastening death in end-of-life care: A survey of doctors

The application of medical technology to prolong life at the expense of quality of life is widely debated in end-of-life care. A national survey of 3733 UK doctors reporting on the care of 2923 people who had died under their care is reported here. Results show that there was no time to make an ‘end-of-life decision’ (deciding to provide, withdraw or withhold treatment) for 8.5% of those reporting deaths. A further 55.2% reported decisions which they estimated would not hasten death and 28.9% reported decisions they had expected to hasten death. A further 7.4% reported deaths where they had to some degree intended to hasten death. Where patients or someone else had made a request for a hastened death, doctors were more likely to report expecting or at least partly intending to hasten death. Doctors usually made these decisions in consultation with colleagues, relatives and, where feasible, with patients. Intensive care specialists were particularly likely to report a degree of intention to hasten the end of life and to have treated patients lacking the capacity to discuss these decisions. Palliative medicine specialists were the least likely to report decisions they expected or at least partly intended to end life, in spite of reporting a high incidence of requests from their patients for a hastened death. Doctors with strong religious beliefs or who opposed the legalisation of assisted dying were unlikely to report such decisions. Elderly women and those with dementia are groups considered vulnerable in societies where a permissive approach is taken to hastening death in end-of-life care, but doctors describing these deaths were no more likely to report decisions which they expected or at least partly intended to end life. The survey suggests that concerns about the sanctity of life, as well as estimates of the quality of life, enter clinical decision-making.     

A survey of physicians' uses/opinions regarding nutrition education resources

Since physicians are one of the public's main sources of nutrition information, a study was conducted to investigate physicians' sources of nutrition knowledge, patient education resources, and opinions about potential nutrition services. A questionnaire was mailed to a random sample of family physicians. The response rate was 53% (n = 255). Fifty-three per cent of respondents ranked their personal knowledge and training as their most frequent source of nutrition information. The most widely reported sources of patient education resources were Health and Welfare Canada and industry. Physicians ranked resources from Health and Welfare Canada as highest for quality characteristics, and industry information as lowest. Pamphlets were ranked as the most/very useful patient service (70%), and physician reimbursement as the most useful physician service (59%). One-quarter of physicians asked for patient information on heart disease. The results of this study suggest physician reimbursement for nutrition education needs to be addressed by health insurance plans if physicians are to be expected to provide nutrition intervention. Further nutrition training for physicians should be conducted through medical education, continuing education and medical journals.     

Medical students' illness-related cognitions

Medical Education 2011: 45: 1241–1250 Context Doctors do not follow guidance when managing their own health and illness. This behaviour may start at medical school. This study aimed to investigate whether inappropriate responses to illness are an issue for medical students and, if so, to identify the determinants of students’ responses to illness. Methods We undertook a qualitative study using framework analysis to explore the views of medical students at two UK medical schools. Results Eight focus groups carried out with 35 medical students identified four main themes in students’ cognitions about their intended behaviour: not using usual patient pathways; informal consultation; self‐treatment, and keeping going when ill. The reasons or assumptions underlying these beliefs referred to: time and resources, including wider issues such as responsibility to colleagues; stigma and attitudes of others including regulatory bodies; beliefs about themselves in terms of taking on the patient role and issues relating to coping and self‐sufficiency; the behaviour and attitudes of peers; patient safety considerations; patients’ views about sick doctors; barriers to accessing care; the ease of self‐care, and uncertainty about ability to self‐care. Conclusions Many different factors related to medical students’ beliefs about illness. Conflicts occur among student needs to be seen as competent and dedicated to medicine, to protect personal privacy, to maintain convenience, and to seek care appropriately in order to be fair on colleagues and protect the public. These conflicts were complicated by perceptions of the system, peers and doctors as unsupportive of ill health except by facilitating informal access to care. Beliefs underlying intentions are similar between doctors and medical students, but further research is needed to fully determine how and when these beliefs are formed.     

某院医疗欠费管理探讨

医疗欠费是医院在提供医疗服务中所形成的应收而未收的款项。医疗欠费不仅制约医院可持续发展,而且影响医院服务质量和水平。对医疗欠费成因进行分析,基于患者诊疗全过程,梳理医院医疗欠费管理风险点并加以控制,建立了医疗欠费精细化管控体系,为有效防范医疗欠费、保障医院良性发展提供了思路。     

珠海市人民医院2002～2008年医疗欠费状况和原因分析

目的研究珠海市人民医院医疗欠费形成的原因、主要类别,寻求减少医疗欠费、追讨医疗欠费的方法和措施。方法回顾性的分析珠海市人民医院医院近六年1 365例医疗欠费的情况。结果医疗欠费在当前费用支付机制下形势严峻,欠费发生率为实际住院患者的1.2%,医疗欠费已经成为制约医院发展的重要原因之一,医疗欠费的发生既有外因、也有内因。结论建立政府、社会、医院、患方共同防范医疗欠费的机制刻不容缓,患者自律、医院提升医疗服务质量和加强内部监管、政府加大投入和理顺机制体制以及打击恶意欠费力度、社会广泛参与和建立新型就医观念是减少、遏止医疗欠费的重要措施和手段。     

Does experience improve hospital performance in treating patients with AIDS?

This paper examines how experience affects hospital performance in treating patients with AIDS. The most common life-threatening medical complication of AIDS is Pneumocystis carinii pneumonia (PCP). Studies of patients with PCP demonstrate that patients who received care at hospitals that were more experienced with AIDS had lower immediate mortality. These higher volume medical facilities did not use more resources but used resources more efficiently and provided better medical care. Better outcomes for experienced providers suggest three policy implications for improving quality of patient care: (1) create regionalized centers where large numbers of patients with a particular illness are treated; (2) encourage low volume providers to rapidly increase their experience; or (3) establish targeted educational programs for low volume providers. Historical review of experience with other medical problems such as tuberculosis indicate that one policy option, creating regional medical centers, did not have the desired effect of better patient outcomes. These facts support policies to provide targeted educational programs and opportunities for low volume facilities to rapidly increase their familiarity with AIDS. Outcomes could be improved by such policies.     

西部地区卫生人力资源存在的问题及对策

目的我国西部贫困地区严重短缺"合格的职业卫生工作者",该研究旨在了解西部地区卫生人力资源现状及存在的问题,从激励机制上探讨卫生工作者面临的问题,并提出相关对策,为引进更多卫生人才到此类地区工作制定相关政策提供依据。方法采用问卷调查与定性访谈,对西部地区4个省(区)的县级医院、乡镇卫生院和村卫生室卫生人员进行调查,对相关卫生政策制定者进行深度访谈。结果卫生工作者学历以中专、大专居多,职称以初级职称为主,岗位以临床医生与护士居多且医生多于护士。西部地区县、乡镇及村卫生室普遍缺乏卫生工作者,培训机会少、待遇低等诸多因素造成该地区卫生人才流失。结论 (1)在需要引进卫生人才的偏远地区提高非编制聘用的工资待遇标准,增加卫生工作人员的培训机会。(2)重点解决村一级卫生机构的功能问题和可持续发展,继续加强职业道德和医学道德的宣传。(3)解决卫生人力政策与其他相关政策之间的矛盾,使其和谐共处发展。