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1.
当前公立医院补偿机制问题逐步引起全社会的关注。本文初步分析公立医院财政补偿有限、获利驱动、制度缺陷等补偿机制的现状及由此带来的问题,分析了卫生改革现状和要求,并提出了拓宽补偿渠道、加强制度监管、提高运营效率等完善公立医院补偿机制的建议,以实现公立医院体现公益性的社会目标。  相似文献   

2.
公立医院的公益性属性使其在控制医疗服务价格的同时还需保障医院的正常运营,因此,政府需要以多种形式对公立医院提供补偿。从我国公立医院补偿机制的现状出发,重点梳理了财政补偿、医疗保险基金、医疗服务价格之间的关系,并对比国外公立医院补偿机制,在总结我国公立医院补偿机制现存问题的基础上,对各项补偿之间的联动提出思考与建议。  相似文献   

3.
当前补偿机制扭曲等导致公立医院公益性淡化问题逐步引起全社会的关注。本文初步分析公立医院财政补偿严重不足、公立医院存在趋利倾向、现有制度缺陷等补偿机制的现状及由此导致公立医院公益性淡化问题,分析了社会发展对卫生事业改革提出新要求,并提出了拓宽补偿渠道、加强制度监管、提高运营效率、寻找医院发展与公益性的平衡点等完善补偿机制增强公立医院公益性的建议,以实现增强公立医院公益性的社会目标。  相似文献   

4.
公立医院财政补偿机制改革的思路与方法   总被引:8,自引:0,他引:8  
大量研究显示,目前政府对公立医院财政补偿机制存在的问题主要体现在以下三个方面:①财政补偿总量不足;②财政投入方式不合理,资金使用效率低下;③财政补偿制度不规范。由此可见,财政补偿机制改革的关键就是如何确定财政补偿的总量以及如何进行补偿的实施方案。我们在研究中首先构建了财政补偿机制改革的宏观思路,然后对如何确定财政补偿总量,进行医院收支差额的核算方法进行了探讨。  相似文献   

5.
长期以来,我国医院补偿机制采取以国家财政预算补偿为主及医疗收费补偿为辅的复合型补偿模式。但从80年代开始,政府投入逐年减少。进入90年代,实施医疗保险已成为医疗卫生改革的主方向。作为医疗保险供方的医院,其经营行为直接影响着医疗保险的质量。目前,医院补偿机制中存在的问题对全面实施社会医疗保险有着极为不利的影响,健全医院补偿机制是确保医疗保险顺利实施的关键。一、医院补偿机制中存在的问题1、政府投入不足,市场补偿机制不健全。据1990年全国3000家医院调查,医院业务收入与财政拨款之比为86∶14,并…  相似文献   

6.
构建长效补偿机制是县级公立医院补偿机制改革的根本目标。对公立医院长效补偿机制的内容应该从补偿主体、补偿对象、补偿数量、补偿方式、补偿功能五个方面予以界定。补偿主体是指"谁补偿"公立医院的问题,补偿对象是指对公立医院"补偿什么"的问题,补偿数量是指对公立医院"补偿多少"的问题,补偿方式是指对公立医院"如何补偿"的问题,补偿功能是指对公立医院"为何补偿"的问题。正确解答这些问题,才能建构科学的县级公立医院长效补偿机制。  相似文献   

7.
公立医疗机构的补偿机制是影响到医疗卫生改革能否成功的重大难题,上海市松江区在卫生综合改革中,对于这一问题进行了积极探索和实践。在对公立医院和社区卫生服务中心进行收支两条线管理和建立投入补偿机制的探索和实践中,松江区卫生和财政部门不断跟踪实施效果,及时进行调整,使投入补偿机制更加科学、有效,并建立了公立医院和社区卫生服务中心的不同补偿模式,  相似文献   

8.
姜天一 《中国卫生》2010,(10):17-19
随着医改进程的不断深入,一些体制、机制问题逐渐暴露出来,而补偿机制的改革一直是医改要解决的诸多问题的重中之重。随着政府“加强监管、加大对公立医院投入、改革公立医院补偿机制、建立公立医院绩效考核和激励制度”的要求越来越明晰,各地卫生行政部门已经开始根据自身情况,着手进行大胆的制度创新,改革医疗机构补偿机制。  相似文献   

9.
国家医改对公立医院补偿机制的影响及对策   总被引:2,自引:0,他引:2  
新医改方案的出台,带来医疗卫生领域利益格局的重新调整。本文在分析当前公立非营利医院补偿机制问题的基础上,探讨了新医改方案对我国公立非营利性补偿机制的影响,提出相应对策。  相似文献   

10.
如何构建基于公益性的财政补偿及其核算体系是公立医院改革亟待解决的问题。本文从基本概念入手,通过文献分析与研究,对我国公立医院财政补偿的现状及存在的问题、财政补偿机制进行了综述,评论了现有文献的研究情况并提出了完善财政补偿的建议,为进一步研究提供参考。  相似文献   

11.
BACKGROUND. Rapidly changing Medicare reimbursement policies since 1983 have affected every primary care physician. This study has attempted to quantify the attitudes and behaviors of Ohio primary care physicians toward these changes. METHODS. In Ohio, 1758 primary care physicians were surveyed by a mailed questionnaire about their attitudes toward recent changes in Medicare reimbursement policies and the resulting changes in their practices. RESULTS. More than 80% of respondents termed most Medicare policies as "objectionable" or "very objectionable." Fifty percent were limiting the number of Medicare patients in their practices. Family physicians and physicians who perceived their income to have decreased and their staff workload to have increased were also more likely to limit the number of Medicare patients in their practices. CONCLUSIONS. Ohio primary care physicians have a negative opinion of Medicare reimbursement policies and have limited their practices significantly as a result.  相似文献   

12.
Since 1994 seven substitution funds of the German statutory health insurance have offered their mandatorily insured members to choose cost reimbursement in place of benefits in kind for a limited testing period. Participants of the cost reimbursement arrangement are considered private patients and are billed accordingly. However, these bills are only in part reimbursed. This study investigates the expectations participants had with respect to the cost reimbursement arrangement as well as the experiences they made. For this purpose a survey among the participants was carried out using a self-administered questionnaire. Most of the 1390 respondents were satisfied with the cost reimbursement arrangement. Organisational, personal and medical advantages which the majority of participants expected were mostly fulfilled. Especially elderly members chose the cost reimbursement arrangement and often made the experience that their doctors spent more time talking to them. The necessary co-payments had hardly any impact on the positive judgment; most participants had an extra private insurance to close the gap of coverage. The results also show that transparency, control of costs and cost-consciousness of patients are improved by the cost reimbursement method. With respect to the preferences of the insured, the results of this study plead for keeping up the offer of cost reimbursement as an alternative to benefits in kind. However, the influence of sickness funds on the care process as well as the equity of care may be negatively affected.  相似文献   

13.
The United States must soon address long-term care policy. Policymakers have sought cost containment through reimbursement policies that contain incentives for efficiency. Nursing facility administrators were surveyed twice following a significant change in Maine's Medicaid reimbursement policy to determine the effects of the change on their managerial practices. The administrators responded to some of the policy changes as profit maximizers, including instituting cost controls and benefiting from incentives. In other areas, such as staffing, staff pay, and accepting heavy care patients, the administrators did not seem to behave entirely as expected. Insights from organizational theory are useful for explaining some of the other behaviors. As long-term care reform is undertaken, a policy framework should include aspects of the internal environment of nursing facilities, such as administrator goals and organizational structure and mission.  相似文献   

14.
The maximum amount physicians can charge Medicare patients for Part B services depends on Medicare reimbursement rates and on federal and state restrictions regarding balance billing. This study evaluates whether Part B payment rates, state restrictions on balance billing beyond the federal limit, and physician balance billing influence how beneficiaries rate the quality of their doctor’s care. Using nationally representative data from the 2001 to 2003 Medicare Current Beneficiary Survey, this paper finds strong evidence that Medicare reimbursement rates, and state balance billing restrictions influence a wide range of perceived care quality measures. Lower Medicare reimbursement and restrictions on physicians’ ability to balance bill significantly reduce the perceived quality of care under Part B.  相似文献   

15.
The values and rewards that animate community practice are not clearly visible to those in traditional medical training programs. Flexnerian education explicitly chose to exclude practitioners in favor of full-time faculties. Academic health centers today are organized to take maximum advantage of a reimbursement system that has been described as perverse; perhaps one of the perversities is that the values embedded in the reimbursement system (reimbursement driven by discrete services rather than overall health or function) have been internalized by trainees and their institutions, and other things valuable to patients and communities (longitudinal care, coordinated care, and appropriateness of care) have become invisible.  相似文献   

16.
17.
To investigate how clinical fieldwork educators and academic fieldwork coordinators view the impact of the changing health care environment on student fieldwork education, current practice, and future of the profession, a 48-item questionnaire assessing the influence of recent changes in the health care system on fieldwork education was sent to 125 occupational therapy fieldwork educators and coordinators (response rate 62.4%). Differences between fieldwork educators and coordinators were analyzed statistically using nonparametric methods. Alpha level was set at p < 0.01 for all statistical comparisons. Fieldwork educators and coordinators agreed productivity expectations, number of hours worked, and time spent in documentation have increased, while job security, time for continuing education, and quality of patient care under the current reimbursement system have decreased, but diverged on several other issues. Fieldwork educators believed reimbursement issues did not affect their ability to accept fieldwork students, whereas academic coordinators believed declining reimbursement had negatively affected fieldwork educators' ability to accept students. Factors thought to facilitate the fieldwork shortage included cost reductions, changes in reimbursement, and increased productivity demands on clinicians.  相似文献   

18.
The Medicaid reimbursement system has long been the domain of state actuaries and payment specialists. But it's fast becoming a battering ram for managed care as states gain federal approval to put their billion-dollar programs into the hands of risk-taking HMOs.  相似文献   

19.
PURPOSE This qualitative study examined the barriers to adopting depression care management among 42 primary care clinicians in 30 practices.METHODS The RESPECT-Depression trial worked collaboratively with 5 large health care organizations (and 60 primary care practices) to implement and disseminate an evidence-based intervention. This study used semistructured interviews with 42 primary care clinicians from 30 practice sites, 18 care managers, and 7 mental health professionals to explore experience and perceptions with depression care management for patients. Subject selection in 4 waves of interviews was driven by themes emerging from ongoing data analysis.RESULTS Primary care clinicians reported broad appreciation of the benefits of depression care management for their patients. Lack of reimbursement and the competing demands of primary care were often cited as barriers. These clinicians at many levels of initial enthusiasm for care management increased their enthusiasm after experiencing care management through the project. Psychiatric oversight of the care manager with suggestions for the clinicians was widely seen as important and appropriate by clinicians, care managers, and psychiatrists. Clinicians and care managers emphasized the importance of establishing effective communication among themselves, as well as maintaining a consistent and continuous relationship with the patients. The clinicians were selective in which patients they referred for care management, and there was wide variation in opinion about which patients were optimal candidates. Care managers were able to operate both from within a practice and more centrally when specific attention was given to negotiating communication strategies with a clinician.CONCLUSIONS Care management for depression is an attractive option for most primary care clinicians. Lack of reimbursement remains the single greatest obstacle to more widespread adoption.  相似文献   

20.
Managed care has greatly influenced the health care industry, particularly with regard to reimbursement for medical services. Managed care has had and continues to have a significant impact on reimbursement for physician services. When contractual relations with managed care companies are initiated and managed by medical practice administrators, the result can be beneficial to a physician practice's financial bottom line. This article discusses the necessity to develop effective working relationships with managed care companies and suggests strategies for establishing fee schedules and negotiating reimbursement contracts.  相似文献   

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