杭州地区大型公立医院涉外医疗现状调查

以杭州市三级公立医院为典型调查对象,通过对医院工作者和在杭外籍人士的双重视角的问卷调查,结合文献研究,发现和总结杭州市公立医院涉外医疗服务方面存在以下4个普遍性问题:医生与外籍患者存在沟通障碍,医疗服务信息沟通不到位,服务环境和服务态度还不尽人意,医疗保险及收费体制问题.据此提出了政府完善涉外医疗服务体系的政策建议,包括要创建与国际接轨的医疗服务质量管理规范、收费体制改革及医保管理和涉外医疗服务机构的规划和宣传,以及医院内部关键要素的管理对策.

Abstract：

The study focused on tertiary public hospitals in Hangzhou,investigating the comments of both hospitals workers and foreigners in the city with questionnaires and literature search.The foilowing four problems were identified in the study in the foreigner medical services in Hangzhou:Communication barriers between doctors and foreign patients,insufficient communication of medical service information,poor service environment and service attitude,and payment mechanism for medical insurance and charges.On such basis,the authors recommended policy changes for the government to improve foreigner-oriented medical services,including building the regulations up to intemational customs for medical services,reforms in the payment system,medical insurance management,as well as planning and promotions of foreigner-related service institutions,and management strategies for key elements within the hospital     

我国城市社区高血压患者医疗保险就医管理模式探讨

目的 探讨我国城镇高血压患者适宜的医疗保险就医管理模式,提高医疗保险经办机构的管理水平和管理质量.方法　采用结构式问卷对高血压患者进行问卷调查,对社区卫生服务中心和医疗保险管理中心的相关工作人员进行定性访谈.结果　高血压患者的就医流向主要集中在社区和三级医院;不同地区的高血压患者对现有医疗保险有不同程度的不满意,主要体现在报销手续繁琐、起付线高和报销水平低等方面.讨论试行高血压的单病种支付,实行按人头和病种的总额预付的支付方式;加强社区高血压管理,医疗保险相关政策向社区倾斜;加强各级医疗机构合作,建立和完善高血压患者的规范管理信息网络.

Abstract：

Objective To probe into a doctor-seeking medical management model for China's urban hypertension patients under medical insurance, and enhance the level and quality of medical insurance management. Methods Hypertension patients were surveyed with a structured questionnaire, and the staff at community health centers and medical insurance management centers received qualitative interview. Results The hypertension patients are found to see doctors mostly at community health centers and tertiary hospitals; complaints among hypertension patients for existing medical insurance vary with their areas, mostly targeting on complicated reimbursement procedure, high threshold of medical insurance payment and low level of reimbursement. Recommendation Experiment with the single-disease payment for hypertension, with the total prepayment in per capita and per disease; greater efforts in hypertension control in communities, with more favorable medical insurance policies for communities;elevated collaboration with medical institutions at all levels, and building and standardizing the management information network for hypertension patients.     

公立医院筹资补偿机制的探讨

"为群众提供安全、有效、方便、价廉的医疗卫生服务"是<公立医院改革试点指导意见>提出的公立医院医疗卫生服务的总体目标,这一目标的实现仅靠改革公立医院内部运行机制是很难奏效的.公立医院的投入机制、区域医疗卫生服务体系的布局、医院所在地的经济与产业状况、医疗保障(险)的支付额度与支付审批程序等众多因素直接影响医院的投入与产出.本文从我国医院的投入补偿机制入手,分析了医院投入与产出的特征,提出建立基于公益性绩效的公立医院投入补偿的观点,为进一步完善公立医院的管理体制、形成以公益性为导向的公立医院运行机制提供参考依据.

Abstract：

Access of safe, effective, convenient and affordable medical and health care services to the people is set as the goal of public hospitals health services as stated in the "Guidelines for Public Hospitals Pilot Reform". Such a goal, however, can hardly be achieved by mechanism changes within the public hospitals. The input and output of public hospitals rely critically on such factors as the input mechanism, regional pattern of healthcare system, the economic and industrial conditions of the region,payment quota and payment approval procedures of medical insurance. This paper set off from the input compensation mechanism of public hospitals in China and analyzed the input and output characteristics of the hospitals. Furthermore, the paper proposed to establish an input compensation mechanism based on public welfare performance for such hospitals. This provided further reference for improving the management of public hospitals and building a public welfare-oriented operation mechanism of public hospitals.     

完善医疗保障制度实现全民医保

介绍了上海医疗保障体系的概况和实施成效,分析存在的问题和面临的挑战,提出完善医疗保障体系的总体目标和重点任务.上海已初步形成"三纵三横"的医疗保障制度体系,为减轻参保人员医疗费用负担、推动经济社会发展起到了积极作用,已基本实现国家医改意见中提出的基本医疗保障制度建设近期目标.为进一步贯彻落实国家医改要求,上海将通过整合各类制度、缩小待遇差距、完善医保管理、建立老年护理保障制度等举措进一步完善医疗保障体系,力争2012年户籍人口医疗保障制度覆盖率达到98%,常住人口覆盖率达到90%.

Abstract：

The paper introduces an overview of Shanghai medical security system, analyzes its effectiveness and challenges, and put forward overall goals and key tasks in the future. Shanghai has formed a multiple, medical security system and basically achieved the short-term goal of medical security system establishment which was requested to put forward in national health system reform. Shanghai medical insurance system has played a positive role in promoting economic and social development and reducing the burden of medical expenses. To further implement requirements of national health system reform, Shanghai will be conducting the integration of different schemes , narrow down the gap of benefit packages, improvement of health care management and the initiatives of nursing care insurance to further improve the medical security system, and strive to cover 98% of household population and 90% resident population in 2012.     

北京三级医院医疗质量推荐指标体系的构建

通过分析北京市多家医院的医疗质量评价指标,针对综合医院和专科医院的不同情况,结合文件、文献研究与现场考察、专家咨询,以病人诊疗过程为切入点,围绕"维护病人利益、保障病人安全、提高医疗质量",探索如何构建并优化一套医疗质量评价推荐性指标体系,重点介绍了推荐性指标体系的框架、指标遴选的原则等,并对推荐性指标体系构建的相关问题做了讨论.

Abstract：

To explore how to create and optimize a promotion index system of medical quality evaluation, this article focuses on the hospital visiting process from patients, using analyzing collected those index system from couples of Grade Ⅲ hospitals in Beijing, and combining the results of literal study, field study and specialist consult, according to the different situation of general hospitals and specially hospitals, with the spirit of "maintaining the patients benefits, safeguarding the patients safety,and enhancing the medical quality", introduces the framework of the promotion index system, the rules to select the indicator, and so on, and discusses several problerns related to creating the index system.     

上海市医疗机构设置规划研究

在分析上海市医疗资源配置、需求与利用现状的基础上,结合未来发展需求,探讨了上海市"十二五"期间医疗资源配置的总体目标、原则、规划重点及各级卫生行政部门的主导作用.

Abstract：

Based on the current status of allocation, demands and utilization of medical care resources and the needs for future development in Shanghai, the overall objectives, principles, key plans of allocation of medical care resources in the 12th Five-years Plan in Shanghai and the leading role of health bureaus at all levels were discussed.     

深圳市公立医院法人治理改革探索

分析了目前公立医院体制机制方面存在的问题,按照"政事分开、管办分开、医药分开、营利性与非营利性分开"的改革原则,制定了公立医院法人治理改革实施路径.一是建立公立医院管理委员会,统筹政府办医保障职能;建立公立医院管理机构,提高举办医院的行政管理水平;转变卫生行政部门职能,形成多元化办医格局.二是建立分级决策机制、自主经营制度及多元监管制度,解决政事分开问题.三是研究制定公立医院章程,促进公立医院向法定机构转变,通过法制化巩固法人治理改革成果.

Abstract：

Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of "Separation of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals", the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means.     

湖北省6家公立医院的经济运行现状分析

目的 了解湖北省公立医院的经济运行现状,分析其对公立医院公益性的影响.方法 采用现场调查的方法收集数据,结合相关统计资料对湖北省公立医院的经济运行现状进行分析.结果 湖北省公立医院的财务收支不断增加并趋于平衡;政府财政补助有限,90%以上的公立医院收入来源于医疗收入和药品收入;公立医院人均业务收入呈逐年增长的趋势;湖北省公立医院的资产负债率相对较高.结论 宏观经济体制和卫生政策的变革、经济利益的诱导阻碍了公立医院公益性的实现.完善公立医院的财政补偿机制,规范公立医院的财务管理机制.

Abstract：

Objective To understand the current economical operation of public hospitals in Hubei province and its effect on their public welfare performance. Methods To collect data in field survey and to analyze the current economic situation of such hospitals in the province based on relevant statistics.Results Financial revenue and expenditure of these hospitals keep rising and achieving a balance in general; for the insufficient government financial subsidy, 90% of the revenue of such hospitals come from their medical services and drugs sold; the per capita revenue of these public hospitals maintains a yearly rising trend; their asset-liability ratio was relatively high. Conclusions The public welfare performance of these hospitals tends to be impeded by the reform on the macro economic system and health policy changes, on top of the attraction of economic interests. Improving the government subsidy mechanism for public hospitals and standardizing the financial management mechanism of public hospitals.     

安徽省8所公立医院医务人员对改革的认知分析

通过对安徽省8所二三级公立医院进行专题问卷调查,分析了不同级别医院、不同岗位、不同职务、不同职称、不同年龄的1140名医务人员对医药卫生体制改革政策知晓情况、对公立医院改革重点问题的赞同情况、参与改革的意愿情况以及影响其改革意愿的相关因素,提出对公立医院改革宣传仍需加强、改革补偿机制以明确政府职责、探索注册医师多点执业的合理模式、鼓励社会资本办医并保证其"非营利性"、完善绩效考核制度以提高医务人员改革积极性等建议,旨在为卫生行政主管部门决策提供依据和参考.

Abstract：

A total of 1140 medical workers from 8 public hospitals of secondary and tertiary levels in Anhui were surveyed with questionnaire. Their knowledge of the reform, acknowledgement of key points of the reform, desire of participating in the reform and other factors that may influence the reform were investigated as categorized by their hospital, position, title and age. This study comes up with such recommendations as reinforcing communications on public hospital reform, reforming the compensation mechanism to clarify government responsibilities, probing into a better model for multi-institution practice of certified physicians, and encouraging private capital to participate in medical service while ensuring its "non-profit" nature, and improving the performance appraisal mechanism to ensure incentives of medical workers. These recommendations aim to enable the health administrators in their decision making.     

医疗保险制度改革对医院的挑战

随着城镇职工基本医疗保险制度的出台,对医院来讲,机遇与挑战同在：一方面医疗保险资金为医院提供了卫生资源的主要来源;另一方面病人消费意识的增强和医院之间的竞争使其面临前所未有的挑战。医院为了尽快适应这一改革,必须正确定位于医疗市场,坚持两个战略目标。     

医疗保险总额预付试点三级医院患者就医感受调查

目的调查上海市实行医疗保险总额预付的三级医院中患者的就医感受。方法应用结构式调查问卷对上海市10家实行医疗保险总额预付的三级医院的699名患者进行面对面访谈,数据分析主要采用描述性统计。结果城保患者对门诊医生明显减少处方金额（或处方天数）的感受强于非城保患者,城保和非城保患者的住院就医感受差异无显著统计学意义。结论医疗保险总额预付对上海市三级医院患者就医感受总体效应似偏弱,而且有限的影响主要集中于门诊而非住院环节。     

落实医保政策 规范医保管理 提供优质服务

医保政策是否能够顺利地在医院落实，取决于医院对医疗保险工作的管理程度。因此医院必须重视对医保的管理。要适应医疗保险制度改革，转变观念，在医保管理工作中不断摸索经验．宣传政策、加强培训、强化管理、健全制度，努力为参保患者提供价廉质优的服务。     

医院与医疗保险协调发展的动因分析与政策选择

该文结合上海的实情,从医院管理者的角度,回顾性分析上海医院与医疗保险制度改革平稳过渡、协调发展的动因关系;介绍实施市卫生局的各项配套政策后,医院强化自主管理的措施和行动;研究医院与医疗保险可持续协调发展的政策途径,探讨21世纪医院管理发展的趋势。     

医院要适应医疗保险制度改革

介绍了海南经济特区城镇从业人员医疗保险制度改革的情况;论述了医疗保险制度的建立给医院带来 新的挑战以及医院适应医疗保险制度改革的对策。     

医疗保险制度改革对医疗服务市场的冲击和影响

我国医疗保险制度改革 ,必须适应市场经济的发展 ,必须引入竞争机制。它对医疗服务市场的冲击和影响体现在 :社会医疗保险机构制定适合市场经济发展的医疗保险制度来发展和规范医疗服务市场 ,同时加强监督力度和进行定期考核 ;定点医院之间、定点药店之间、定点医院和定点药店之间展开激烈竞争 ;定点医疗机构与医保病人的关系影响医疗机构的存在与发展。通过激烈的竞争以实现医疗保险制度改革的总目标 :用比较低廉的费用提供比较优质的服务。     

外来孕妇保健服务利用及影响因素调研

目的:了解上海市外来孕妇对保健服务的利用情况和影响因素。方法:2009年6～7月对上海市19个区县的450名外来孕妇进行现状调查。结果:被调查孕妇中,86.00%已经建册,91.11%进行了产检,75.56%将来准备在二、三级医院分娩,72.89%准备在上海分娩。从影响因素看,影响孕期保健服务利用的主要有丈夫户籍、收入和医保,丈夫为上海户籍、家庭月收入高和享有医保的孕妇更愿意选择在上海和二、三级医院分娩;外来孕妇选择医院时首先考虑医疗质量(占68.56%),但"规范产检"受到经济收入的影响。研究显示,孕期保健服务的利用与孕妇年龄、妊娠史、孕妇本人及丈夫的文化程度无相关性。结论:目前上海市通过多种形式的健康教育和平价优惠政策推广,使得不同年龄、不同文化程度和生育经历的孕妇之间对孕产期服务利用差距逐渐缩小,但仍需进一步提高医疗质量,并加大保健服务的宣传力度,为外来人口提供更加安全、高质量、公平的保健服务。     

金杨社区养老机构医护人员现状及对影响医养融合因素的调查分析*

目的探索异地医保直接结算住院费用与本市城镇职工医疗保险住院费用的差异以及对异地医保总费用影响较大的因素。方法使用倾向评分匹配法等方法选取案例医院2018年度异地医保直接结算及本市职工医保两组费用数据各120例,使用t检验的方法比较两组数据的差异,使用多元线性回归的方法寻找对总费用影响较大的细分费用。结果 t检验结果表明,异地医保住院直接结算费用有7个细分项目,显著多于本市医保住院的相应费用,多元线性回归分析结果显示,异地医保的医保支付细分项目中,手术费、其他材料费、治疗费、检查费和其他费用这5项对总费用有着较为明显的影响。结论应在分析异地医保直接结算费用较高原因的基础上,以影响较大的细分费用为切入口,设法开展多项医保费用管理措施。     

上海市1990～2002年医院医疗工作量变化情况分析

[目的 ]　了解上海市医院医疗工作量情况 ,为卫生部门和医院管理者明确各级医疗机构的功能定位 ,加快卫生事业发展提供参考依据。　 [方法 ]　采用回顾性调查的方法 ,分析上海市 1990～ 2 0 0 2年医院医疗工作量变化情况。　 [结果 ]　本市医院医疗工作量从 90年代中期开始稳步提高 ,医保政策对医院医疗工作量影响显著 ,医疗服务体系构架的变化对病人的就医流向产生很大影响。　 [结论 ]　要进一步完善城镇职工基本医疗保险制度 ,深化医院综合改革 ,加快构建新型医疗服务体系。     

新时代医院医保管理创新性理论与精细化管理实践研究

该研究提出实行院内医保精细化管理,通过信息系统进行监控;建立医保查房机制,宣传医保政策规定;搭建医、保、患三方平台。通过3个医院医保管理举措共同构建出该院医保管理体系,优化费用结构,保障患者权益,降低患者就医负担,创造更优质的社会效能。从而得出医院医保办不仅仅是患者就医的保障和向导,还是"医院与医保经办机构加强联系沟通的纽带和桥梁",更是医患之间关系的维护者,在医保政策不断变换的当下,及时适应相关政策,灵活机动,有针对性采取相应措施保障三方利益。