医院成本核算的探讨与实践

在目前社会主义市场经济还不成熟,医疗补偿机制还不完全到位,医疗保障制度尚不完善的情况下,医院如何使用有限的资源获得最大的效益,是医院经济管理的核心内容,同时,也是解决当前人民群众反映最强烈的“看病难、看病贵”问题的关键所在.要实现社会效益和经济效益的最大化,就要使医院成本最小化.文章从医疗服务成本的概念和特点,医院成本核算的目的以及成本核算的实践和效果等三个方面,阐述了医院成本核算是提高医疗工作效率的新型管理手段,也是医院实现“优质、低耗、可持续发展”的有效途径.     

医疗保险中的道德风险与防范

在我国，医疗保险中的道德风险问题一直表现得非常突出．医生和患者为了各自利益的最大化而过度提供或过度索取医疗服务。造成了医疗费用不合理的大幅度增长，也带采了医疗资源的大量浪费，同时还恶化了医患关系、降低了社会诚信水平。采用文献研究的方法。通过探讨在医疗保险中道德风险的表现、成因及其影响，旨在对道德风险的防范提出相应的对策措施。     

基于健康寿命损失的事故伤残间接损失统计

事故一旦发生,往往造成人员伤亡和财产损失,事故伤亡不仅导致经济损失,而且导致人员健康寿命的损失。该文首次应用DALY(伤残调整寿命年)来计算2005年我国工矿商贸企业伤亡事故导致的伤残寿命损失,基于国家公布的2005年我国工矿商贸企业事故的基础数据,计算2005年因事故伤亡导致的健康寿命损失至少有3651862人年,折合成静态经济损失约878亿元。通过计算健康寿命损失可以从一个全新的角度发现事故所造成人员伤亡引起的间接损失,为全面分析事故损失,进一步完善事故人员赔偿提供了科学依据。     

Cost of Alzheimer's disease

The progressive deterioration associated with Alzheimer's disease (AD) results in high economic cost to the patients, caregivers, and the society as a whole. Cost-of-AD studies conducted over the last decade have produced discrepant results, mainly as a consequence of the different methodologies employed. The present review is an attempt to present the methodology of the cost studies in AD and provide the reader with the tools necessary for a critical assessment of the results.     

Cost-effectiveness analysis of breast cancer adjuvant treatment: FEC 50 versus FEC 100 (FASG05 study).

BACKGROUND: The aim of the study was to assess the incremental cost-effectiveness ratio (ICER) of the FEC 100 compared with the FEC 50 in the FASG05 trial. MATERIALS AND METHODS: A cost-effectiveness analysis was performed using a multi-state Markov process model. Relevant clinical data introduced into the model were obtained from 10-year follow-up of the clinical trial FASG05. Survival curves for each health state were assessed by survival parametric model. The model allowed assessments from the start of adjuvant chemotherapy until death. The costs of adjuvant treatment and follow-up were estimated. The costs of recurrence were evaluated from the medical records of 146 patients. A prospective survey was performed on a cohort of 87 patients to quantify the resources external to the hospital (including cost of transportation). The inpatient costs were evaluated using the French diagnosis-related groups. The ambulatory costs were assessed using the French nomenclature. Costs were expressed in 2002 Euro (), according to the French societal perspective. The ICER assessed the cost of one additional life year saved. A discount rate of 5% per year was used for cost, and alternatively 0%, 3% and 5% for effectiveness. We validated the results with a probabilistic sensitivity analysis incorporating parametric and non-parametric bootstraps, and with the acceptability curves. RESULTS: The mean total discounting cost of adjuvant treatments was 11 465 for FEC 50 and 13 815 for FEC 100; the mean total discounting cost of recurrences was 14 636 and 13 503, respectively. According to the discount rate of effectiveness, the life expectancy was 16.5, 11.4 and 9.3 years for FEC 50 and 18.4, 12.5 and 10.2 years for FEC 100. The ICER (cost per life year saved) were 642, 1084 and 1460, respectively. The probability according to which FEC 50 is strictly dominated by FEC 100 was 0.15. CONCLUSION: The clinical benefit of FEC 100 generates a negligible cost increase when compared with FEC 50.     

158例胸部手术患者抗菌药物应用调查与分析

本文采用回顾性调查方法,将2002年1月～2003年9月胸部手术病历调出,对其使用抗菌药物的品种,用药频度,相关费用,联合用药,手术类型,切口愈合等情况进行分析评价.结果表明,158例胸部手术患者抗菌药物使用率达100%,涉及7个类别35种;联用抗菌药物达138例,人均使用抗菌药费为2587.75元,总药费与抗菌药费之比为1:0.38;平均疗程为32.28天;术后抗菌药物疗程明显偏长,联用比率偏高,有必要规范抗菌药物的应用.     

脊髓损伤住院病人的医疗和非医疗费用调查分析

目的调查脊髓损伤住院病人的医疗和非医疗费用的支付情况及其主要影响因素.对损伤后疾病负担做出基本估计,为残疾预防,促进与维护健康提供有价值的参考依据.方法以1998-2001年脊髓损伤康复科出院患者的原始资料为依据,自行设计费用调查问卷.资料应用SPSS完成.结果111例脊髓损伤住院病人医疗费用占总费用占58.03%,非医疗费用占41.97%.康复训练费用仅占医疗费用的12.86%.脊髓不完全性损伤费用多,康复治疗效果明显,患者的期望值高,因此住院时间较长.费用来源于公费、肇事责任方的患者平均住院日及费用无明显差异,自费患者住院天数、医疗费用明显减少.在脊髓损伤后非医疗费用中,陪护费占34.26%.结论遏止交通事故,工业伤害,减轻社会的总体负担;要逐步降低康复医院的药品费用的比重,提高康复训练中技术服务价值:应将脊髓损伤纳入重大疾病预防控制工作.     

论“医疗保健价格指数”与“看病贵”

无论是居民感受还是学者研究，多年来我国持续存在看病贵这一社会热点问题。但现行的医疗保健价格指数披露出相反的结论。本文提出用门诊病人次均医药费、出院病人人均医药费指标，来计算医疗保健类价格指数，以更科学、准确地反映患者医药费用负担水平及其变动趋势。     

利用1＋3模式改进医院成本核算

针对全成本核算过程中收入数据统计存在的问题，运用1＋3质量管理模式进行持续改进，通过分析查找根本原因，完善服务流程，建立相关制度，提高执行科室归并的准确性，以此更加准确反映各科室的收入情况，保证全成本核算的质量。     

Genotoxicity studies of glycidol fatty acid ester (glycidol linoleate) and glycidol

Glycidol fatty acid esters (GEs) are found in refined edible oils. Safety concerns have been alleged due to the possible release of glycidol (G), an animal carcinogen.