上海乡村医生的现状调查

目的了解上海乡村医生队伍的现状及存在的问题,为卫生行政部门进一步完善发展乡村医生队伍提供依据。方法资料来源于上海市宝山区、松江区、崇明县3区(县)卫生局和村卫生室提供的报表,并对3区(县)1017名乡村医生进行问卷调查。结果1017名乡村医生中男492名,女525名,平均年龄50.0岁。24.8%的乡村医生两年内没有进行过相关的岗位培训;53.5%乡村医生没有参加过有关全科医学的培训;53.6%乡村医生愿意到医院等卫生机构进修;64.8%的乡村医生平均月收入为500～1000元,主要的收入来源是医疗基本报酬和劳务收入。结论应尽快加强乡村医生队伍建设,完善乡村医生的培养,建立健全乡村医生的收入和保障体系。     

北京市乡村医生收入满意度及其影响因素分析

目的:调查北京市乡村医生的收入满意度情况,分析其影响因素,并提出相关对策及建议。方法:对北京市5个区县25个乡镇75个村共77名村医进行问卷调查,对5名村医开展个人访谈,运用Logistic回归分析乡村医生收入满意度的影响因素。结果:乡村医生收入水平满意度明显偏低,现实收入水平与期望收入水平之间差距显著,乡村医生的行医年限、对村卫生室管理体制的满意度、对工作量的评价、对养老保险的满意度是收入水平满意度的影响因素。结论:乡村医生收入报酬机制的不完善极大地制约着农村基层人力资源建设与发展,亟需通过完善现行的乡村医生报酬机制和养老保险政策,引导其职业发展来提升乡村医生收入水平与工作积极性,以保障农村卫生工作的稳步发展。     

宜良县乡村医生卫生服务补偿影响因素的逐步回归分析

目的 探索宜良县乡村医生的卫生服务补偿的影响因素,为调整乡村医生的报酬提供科学依据.方法 采用问卷调查表的方式对宜良县的166名乡村医生进行普查.结果 经过多重线性回归分析得出,影响乡村医生的报酬的因素主要是对目前发放的乡村医生报酬合理性的评价、开展疾病预防控制的天数、家庭每年的看病支出、开展医疗活动的区域、进行妇幼保健工作的天数、0～7岁儿童的人数.结论 乡村医生报酬的影响因素是多因素的.     

乡村医生队伍建设可持续发展探析

乡村医生在维护广大农村居民健康方面发挥着难以替代的作用。随着农村经济体制改革和医药卫生体制改革的进一步深化,乡村医生队伍发展出现了新的情况和问题,如医生总量不足、流失严重,医疗技术水平不能满足广大农民的医疗需求,结构不合理。其主要原因是乡村医生工作任务重、收入低,面临的医疗风险高,养老保障不完善等。建议将乡村医生逐步纳入卫生技术人员队伍,提高乡村医生的福利待遇,加大乡村医生培养力度,从而确保农村居民享有安全有效、方便价廉的基本医疗卫生服务。     

安徽省某县乡村医生队伍现状调查及对策建议

目的 分析长丰县乡村医生队伍现状,并对村卫生室建设和乡村医生队伍构建提出建议。方法 2015年12月至2016年1月,制定调查表,通过实地走访登记的方式收集数据,并随机抽取部分乡村医生进行深度访谈,了解乡村医生收入、退休后生活补助情况,并利用SPSS 19.0统计软件进行相关统计分析。结果 年龄老化、学历和收入偏低（高中学历42.83%,初中学历31.67%,月收入多在1 000元左右）、执业资质较低、养老保障缺乏（月退休补贴300元）等仍然是当前乡村医生队伍的主要问题。不同年龄、不同学历的乡村医生在执业资质及培训次数上存在差异（P均<0.05）。结论 应不断提高乡村医生收入水平,完善乡村医生"退出"机制,健全乡村医生培训机制,减轻乡村医生基本公共卫生服务量,加强基本医疗服务能力。     

合理解决乡村医生报酬促进村级卫生事业发展

巩固和发展村级卫生组织,一个关键的问题是合理解决乡村医生报酬,调动乡村医生办医的积极性。青岛市平度县在总结过去经验教训的基础上,全县建立了农村卫生基金(以下简称基金),合理解决了乡村医生报酬,稳定了乡村医生队伍,促进了村级卫生事业的发展。     

培训乡村医生的困扰及对策

1.困扰因素 (1)乡村医生持消极态度。现在在职的乡村医生年龄一般都在40岁上下,这些人家里有老有小,又有责任田,家庭负担较重,脱产学习客观上存在一定的困难;有的地方集体不能解决报酬。参加业务学习既要减少收入,又要自己负担学费,因而积极性不高;一些个体开业的乡村医生片面追求经济效益,缺少为人民健康高度负责的精神,只顾眼     

乡村医生收入状况调查方法探讨

目的：比较分析获取乡村医生收入状况的不同途径，寻求能够客观描述其收入状况的方式。方法：通过现场观察和访谈，获得乡村医生处方行为、村卫生室门诊工作量及村医收入自评情况等资料。结果：不同途径所得的村医收入存在较大差异，根据门诊量并结合抽样处方费用得到的收入最为可靠；被调查的乡村医生的从医报酬为3000元／月左右。结论：在实际研究中，可采取多种途径测算村医收入，根据村卫生室门诊工作量和药品购进量测算较访谈和报表资料能更真实地反应收入状况。     

村卫生室资金来源与使用

高邮市位于江苏中部,辖33个乡镇,669个行政村。总人口83.2万,农村人口69.5万。1996年全市国内生产总值43亿元,农民年人均纯收入2845元。设村卫生室615个,其中甲级卫生室500个,占81.3％。乡村医生1265人,有证书880人,男714人,女551人。 1996年全市村卫生室“人头费”支出总额317.21万元,乡村医生年人均报酬2508元(实际收入可收还要略高一些)。同年村干部年人均工资2077元(乡镇定补标准平均数,不包括奖金收入),低于乡村医生年收入。从各乡镇情况看,乡村医生年报酬高于村干部的有16个乡镇,占48.5％;与村干部相当的有11个乡镇,占33.3％;低于村干部的有6个乡镇,占18.2％。说明绝大部分乡村医生工资报     

乡村医生报酬支付形式及评价

1.乡村医生报酬支付形式、 (1)村集体支付全额工资形式:由村民委员会统一解决乡村医生报酬,乡村医生同村干部一样享受全额工资。其工资定额一般由村民委员会或村民议事组织协商确定。实行这种形式的村卫生室都是村集体举办。村卫生室的各项工作都是在村民委员会的领导下进行的,村卫生室的房屋、设备、固定资产和流动资金全部由村集体提供。     

上海某区社区医院政府财政补助现况调查

目的研究政府财政补助在社区医院经济补偿结构中的现状。方法本文利用上海2003-2005年度某区城镇及农村23家社区医院的财务数据进行分析。结果(1)社区医院政府财政补助占医院毛收入比重较低,社区医院政府财政补助绝对值年平均增长率既落后于政府财政收入增长速度,也远落后于地区GDP增长速度。(2)社区医院政府财政补助在医院纯收入构成中具有十分重要位置。(3)目前在排除药品收入条件下,政府财政补助无法对社区医院医疗亏损给予足额补偿。(4)农村卫生院政府财政补助和药品收支结余均低于城区社区医院,且农村卫生院的药品收支结余数值低于财政补助。结论政府的财政补助应倾向社区医院提供的公共产品与准公共产品服务,政府财政补助只能补助社区医院政策性亏损,不能补贴经营性亏损。     

中国家庭医生签约服务中激励机制对医生行为影响的理论研究

背景　推进家庭医生签约服务是转变中国基层医疗卫生服务模式的重要举措,是深化医药卫生体制改革的重要任务,也是实现“健康中国2030”战略的基石。合理的激励机制是家庭医生发挥自身能动性的重要保证因素,但是目前家庭医生的激励机制,尤其是医疗保险补偿方式的转变,对其行为的影响尚缺乏相关理论分析。目的　以医生代理理论为支撑,构建符合中国国情的家庭医生行为理论分析框架和模型。方法　以医生代理理论为基础,构建家庭医生在不同医保支付方式下,尤其是按项目付费和按人头付费并存的情况下医生行为分析模型。结果　按项目付费时,道德风险不可避免,医生没有任何动机来抑制患者因道德风险而产生的额外需求;按人头付费后家庭医生的总利润会提高,但是从患者健康中得到的效用值会下降;推行总额预付的前提是设计合理的医疗服务数量和质量,否则家庭医生就会有选择患者的动机。中国家庭医生的收入主要来源于按项目付费方式的医疗收入和按人头签约得到的服务费,提高签约服务费占收入比例可以提高家庭医生的服务质量,但是由于收入中占较大比例的是按项目付费获得的收入,收入的增加不一定能够对患者的质量提供正向影响。结论　中国的基层医疗卫生机构家庭医生的支付方式应该逐步转变为按人头付费,目前可以通过逐步提高家庭医生签约服务费占收入比例的方式,激励家庭医生提供更高质量的医疗服务。     

More doctors: what will they cost? Physician income as supply expands

During the 1970s, expenditure for physicians' services rose by $12.7 billion (in 1979 dollars), but only about one fifty of this amount could be attributed to an increase in number of physicians relative to population. Other factors, chiefly demographic changes and greater insurance coverage, were responsible for the bulk of higher expenditures. Despite the growth in number of physicians, real income of individual physicians remained virtually constant. Maintenance of real income was not, however, appreciably dependent on physicians inducing an unwarranted demand for their services. We predict that as the physician supply expands by 25% to 35% during the 1980s, real payments to physicians will increase by some $14 to $20 billion (1979) dollars. As in the past decade, however, only about one fifth of the amount will be attributable to an increase in physician supply. Gross income of individual physicians is likely to ri se by 10% to 15% (in 1979 dollars) over the decade, but net income probably will show little increase or may even fall slightly.     

No evidence of an emerging physician surplus. An analysis of change in physicians' work load and income

Analysis of physicians' work patterns and income between 1982 and 1987 provides strong evidence that the demand for physicians' services has risen at least as quickly as physician supply. Aggregate hours spent by US physicians who provide patient care rose by 21%, and aggregate real net income rose by more than 30% during a period in which the supply of physicians grew by only 16%. The aggregate number of visits rose by only 9%, indicating that the time spent per patient encounter rose sharply, presumably as a result of technological change and the increased complexity of care. Recently released data for 1988 are consistent with these trends. Our findings are inconsistent with the prediction by the Graduate Medical Education National Advisory Committee that there would be a large physician surplus by the year 1990. Moreover, if the upward trend in demand for physicians' services continues, as seems probable, a physician surplus should not develop in the foreseeable future. Only extensive rationing of beneficial services would be expected to alter this projection.     

Physicians' perception of personal risk of HIV infection and AIDS through occupational exposure.

Physicians' response to acquired immune deficiency syndrome (AIDS) is poorly understood and often attributed to fear of human immunodeficiency virus (HIV) infection through occupational exposure. We surveyed 268 physicians from three geographic regions in North American with different specialties and responsibilities for HIV-positive patients. An important difference was found between the published risk and the physicians' perceived risk of infection after a single occupational exposure. Almost half of the respondents stated that they feared contracting AIDS more than other diseases. The physicians who perceived themselves to be at high physical risk were more likely than the others to report that AIDS had changed the way they interact with their patients (r = 0.26, p less than 0.001). No relation was found between the perception of physical risk and the number of HIV-infected patients (r = -0.07, p = 0.15). However, the perception of social risk showed a small inverse correlation (r = -0.15, p less than 0.02), in which the physicians with more HIV-infected patients reported less concern about negative social consequences. The physicians who perceived themselves to be at high personal risk were more likely than the others to report that surgeons have the right to refuse patients who do not wish to undergo HIV antibody testing (r = -0.16, p less than 0.01 for physical risk; r = -0.29, p less than 0.001 for social risk). Multiple regression analyses indicated that physicians' perception of physical risk was not related to age or sex but was modestly related to income source. The perception of social risk was related to sex and income source. Physicians' perception of personal risk is a crucial, yet often unacknowledged, component of the fight against AIDS. Our findings suggest that lack of attention to this issue is seriously compromising initiatives designed to facilitate physician participation in AIDS care.     

城乡儿童不同支付方式住院医疗费用比较及其影响因素分析

目的比较参加城镇居民医疗保险（参保）和新型农村合作医疗（参合）患儿的住院医疗费用,分析不同支付方式医疗费用的影响因素,为完善覆盖城乡居民的医疗保障体系提供参考。方法选择唐山市滦县2011年度住院的0～14岁参保患儿（n=387）和参合住院患儿（n=3134）,收集患儿的个体情况和临床资料,采用单因素和多元回归统计学方法分析住院医疗费用及不同支付方式医疗费用的影响因素。结果参保儿童平均住院费用为1632．12元,显著高于参合儿童的932．84元,差异有统计学意义（P〈0．05）。参保和参合患儿的药费分别占住院医疗费用的57．5％和59．8％;统筹支付费用分别占61．6％和59．5％,个人支付费用分别占38．4％和40．5％。个人因素（年龄、住院日、入院情况）和社会因素（医院级别、收入水平、医保类型）是患儿住院医疗费用及不同支付费用的共同影响因素。结论降低医疗费用主要应控制社会因素,逐步完善不同级别医院的统筹支付比例,以建立城乡统筹的全民医疗保障。     

从疾病保险到健康保险

环顾全球疾病医疗行业，疾病风险引发的经济、社会和政治风险，是疾病风险具有很强外部性的直接证据。面临这一挑战，全世界已有165个国家通过制度安排来面对疾病风险。而我国医疗保险的覆盖面在2008年也已得到进一步的扩大，职工的医疗保险也得到进一步的发展，在50％以上的城市已启动了居民医疗保险，与此同时医疗保险中的财政补助也已加大力度，居民医疗保险的中央财政补助增加了一倍，各级财政进一步加大了对新农合投入。考虑到我国的具体国情，国家应以筹资模式转变作为改革的突破口，加大公共投入比例，推动管理模式、服务模式、就医模式、发展模式的转变。     

我国公立医院财政补偿机制的历史演进与发展趋势研究

政府应为一定数量的公立医院,承担其大部分筹资,并完善监管政策,促使其落实社会责任。在社会医疗保险制度下,公立医院仍有部分支出不能由社会医疗保险支付,需要财政补助保障。财政补偿应与公立医院公益性绩效评价相联系,公益性在医院绩效体系中的反映,主要包含在医疗服务的数量、质量、效率、均次费用和社会满意度等方面。     

A model to evaluate whether a community can support a physician

A major concern to the rural citizens of the United States is the availability of health care in their community. Community leaders and physicians considering locating in rural communities need a method by which they can evaluate a community's potential for supporting a physician. A detailed survey was conducted in 1986 of 25 physicians' practices in rural Oklahoma. Data were collected from the physicians on their number of patient visits and practice costs in 1985. Using this information, the authors designed a model to project the economic feasibility of establishing a physician practice in a specific community. This model can be used to project the number of physician visits a community can generate, the costs to establish and maintain a clinic, and the gross and net income of the practice.     

The new health insurance rebate: an inefficient way of assisting public hospitals

Private health insurance subsidy is now estimated to cost $2.19 billion; government support for private health care includes a further $1.2 billion of Medicare benefits expenditure in hospitals. The subsidy cannot be justified on efficiency grounds, as, on the basis of available evidence and taking casemix into account, public hospitals are more efficient than private hospitals. The original stated objective of the subsidy was to "take pressure off public hospitals". If the insurance subsidy and the Medicare Benefit Schedule rebate expenditure were applied to purchasing public hospital treatment at full average cost, 58% of current private sector demand could be accommodated. If 10% of the demand were met at marginal cost, this would increase to 65%. The objective of "taking pressure off public hospitals" could be more efficiently achieved by direct funding of public hospitals rather than through subsidies for private health insurance.