浅论私立基层医疗机构发展与监管中的若干问题

在国民基本医疗服务体系的实际构建中，私立基层医疗机构纳入这一体系可能存在困难，如不能纳入，则其发展前景堪忧：应允许私立营利性基层医疗机构纳入该体系，并在税收和补贴等问题上制定合理政策鼓励其发展。在医疗机构监管的各环节上应对公、私立基层医疗机构切实做到一视同仁；目前私立医疗机构监管立法中存在的几个漏洞亟待填补；基本医疗服务购买合同若运用得当，将是针对基层私立医疗机构的一种有效的监管工具。     

重庆——加强医保基金联动监管

多元化监管是在医疗服务领域,探索综合监管制度完善的创新方式,是提升监管效能的有力手段。重庆市被列入医疗服务多元化监管试点地区以来,从机构自治、行业自律、政府监管、社会监督4个方面全面发力,探索构建医疗服务多元化监管格局。2019年4月,重庆市政府办公厅印发《关于改革完善医疗卫生行业综合监管制度的实施意见》,重庆市卫生健康委立即组织开展卫生健康行政部门、医疗机构和行业协会多层次参与的广泛研讨,部署在医疗服务领域推进多元化监管的工作重点和举措.     

医疗服务监管的国际经验及启示

医疗服务监管有着经济、社会和组织方面的成因,其目标包括改进医疗服务绩效,保障医疗服务的质量和安全,建立医疗机构及从业人员的责任机制。监管的范围可分为水平监管和垂直监管,应努力避免监管碎片化的倾向,监管的模式可分为威慑性监管、遵从性监管和回应性监管等模式。应及时制定医疗服务监管规则,通过绩效监控、巡查和调查三类方法搜集医疗服务监管信息,并选择适宜的监管手段进行执法,从而有效建构我国的医疗服务监管制度。     

第三方购买机制、医疗费用控制与新型农村合作医疗的可持续发展——以云南省玉龙县为例

新型农村合作医疗能否取得可持续性发展,在很大程度上取决于农村医疗服务费用的上涨是否得到控制。建立第三方购买机制,加强对医疗机构服务的审核和监督,有利于控制医疗费用增长,引导医疗机构的服务行为,但是,新型农村合作医疗在政策实施中并没有充分发挥第三方购买者的职能。以云南省玉龙县新型农村合作医疗为例,重点分析县乡两级医疗机构的收入来源结构,以说明这一问题。     

厦门市医疗费用结算办法对定点医疗的影响及体会

厦门市定点医疗机构承担着全市40多万参保人员的医疗任务,在医疗服务过程中始终处于主导地位。其管理工作是否到位,管理措施是否确实可行,直接关系到医疗费用是否能得到有效控制,关系到参保人员能否得到良好的医疗服务,对医疗保险制度改革起着关键性作用。为此,我们将定点医疗机构作为此次医疗费用结算调查研究的重点,以进一步了解和研究定点医疗机构对医疗费用定额结算的反映和建议。     

浅谈市场经济下医疗服务价格的量和度

价格是市场的核心,价格是价值的货币表现,它的调节手段与导向作用,对市场经济活动和资源配置起到重要的作用。医院的经营活力,在很大程度上取决于医疗服务过程中所耗费的物化劳动和活劳动的价值能否得到合理的补偿,除国家财政给予医院一定的补助外,医疗服务的价格是其价值补偿的主要部分。因此,在市场经济的条件下,把握医疗服务价格的量和度,主要是要准确把握医疗服务价值的量和度。     

四川:“三监管”瞄准全程动态精准

<正>建立严格有效的医疗卫生行业综合监管制度是推进、深化医改的重大决策部署。四川省利用大数据和信息化手段,以医疗机构及人员资质、医疗服务效率、医疗费用合理性等为监控重点,推进医疗机构、医务人员、医疗行为综合监管(以下简称医疗"三监管"),实现对医疗行业的全程、动态、精准监管,探索建立医疗服务监管"四川模式"。     

“互联网+医疗”的监管问题与对策探析

“互联网+医疗”服务模式不仅打破了传统医疗模式下医疗机构间的信息沟通壁垒,也为化解有限医疗资源与保障公民健康权之间的矛盾提供了新思路。但在“互联网+医疗”服务不断发展的过程中,其存在的监管问题也随之凸显。系统性分析了我国互联网+医疗领域存在的患者隐私权难以保障、立法滞后、监管主体及责任不明确等现实问题,针对性提出了对患者身份信息“去标识化”、严格“互联网+医疗”行业准入以及明确监管主体责任等措施,以期促进“互联网+医疗”领域健康、可持续发展。     

医疗广告政府监管实践与对策分析

[摘要]医疗广告作为医疗服务机构对社会宣传、介绍医疗机构或医疗服务的重要手段，也是广大老百姓“认识、了解”医疗服务机构及其提供的医疗服务的重要途径。医疗广告的真实、合法、健康与否对老百姓选择接受何种医疗机构、何种医疗服务质量有着重大的影响。因此要求政府对医疗广告的监管要较其他商品的监管更加严格。作者分析了当前医疗广告及其政府监管的发生、发展原因；深入、详细地分析了医疗广告与医疗机构、媒体、广大消费者以及政府监管部门间的关系，并运用政府管制理论、政府职能理论、声誉制度等对政府对医疗广告的监管进行了系统分析，提出了优化统筹等建设性意见，探讨了政府对医疗广告监管的有效措施，以期进一步规范医疗机构的经营行为，净化医疗广告市场，为广大人民群众营造一个安全放心的就医环境。     

准确把握医疗领域中的竞争与合作关系

既要发挥竞争机制在促进医学技术进步,调动人员积极性方面的积极作用,也要防止和抑制医疗机构出现过强的创收行为,导致医药费用快速攀升,加重全社会负担。近年来,有关医疗服务领域中竞争、垄断等问题的讨论始终是医药卫生改革的热点问题。不少人认为,只要降低市场准入门槛,扩大服务规模,增加服务供给,就可以解决医疗服务质量、价格甚至是监管等一系列问题。于是,有的地方在改革实践中,过分迷信竞争的作用,没能客观全面看     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.