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61.
Jin Yong Lee Sang Jun Eun Minsu Ock Hyun Joo Kim Hyeon-Jeong Lee Woo-Seung Son Min-Woo Jo 《Journal of Korean medical science》2015,30(5):523-532
Although primary care has been recognized as an essential element of the healthcare system, the primary healthcare of Korea has not been highly valued. Listening to the voices of physicians who are engaged in primary care should be the first step for improving the level of primary care in Korea. In this study, we conducted a questionnaire survey of general internists to investigate their perspectives regarding primary care, and which included the evaluation of current primary care, perception of the five, key attributes of primary care, and their opinions regarding the management system of chronic diseases. A total of 466 general internists'' responses were used in this analysis. The results showed that primary care is considered to have an important role, according to general internists, although their evaluation of the overall status of primary care in Korea indicated that it is poor. The respondents also indicated that the functions of coordination and comprehensiveness in primary care, which can be integral for treating patients with chronic diseases, are most vulnerable. Given the high level of agreement regarding the need for a new medical management system for chronic diseases, based on physicians'' autonomy and provided by clinics, establishing a policy encouraging the participation of general internists should be emphasized.
Graphical Abstract
相似文献62.
阐述了基本医疗卫生服务支付制度理论,梳理了我国基层医疗卫生机构卫生服务支付制度的现状,并对目前面临的主要问题加以分析.在此基础上,提出了相应的政策建议,一是遵循分类指导原则,调整政府对基层医疗卫生机构的财政支付方式;二是改革基本公共卫生服务经费支付方式,实行按项目付费的后付制;三是改革绩效工资制度,将对医务人员的支付与其服务数量和质量直接挂钩;四是设计以效果为导向的绩效考核指标,逐步提高按绩效支付比例;五是逐步整合医保门诊基金和基本公共卫生服务资金,实行按人头支付. 相似文献
63.
Rituparna Maiti Vikas Bhatia Biswa Mohan Padhy Debasish Hota 《Indian Journal of Community Medicine》2015,40(4):223-232
The concept of defining essential medicines and establishing a list of them was aimed to improve the availability of affordable medicines for the world''s poor. Access to essential medicines is a major determinant of health outcomes. Several countries have made substantial progress towards increasing access to essential medicines, but access to essential medicines in developing countries like India is not adequate. In this review we have tried to present the Indian scenario in respect to availability and accessibility of essential medicines over last one decade. To enhance the credibility of Indian healthcare system, procurement and delivery systems of essential medicines have to be strengthened through government commitment, careful selection, adequate public sector financing, efficient distribution systems, control on taxes and duties, and inculcating a culture of rational use of medicines in current and future prescribers. 相似文献
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66.
国际全科医生制度发展历程:影响因素分析及政策启示 总被引:1,自引:0,他引:1
全科医生制度建设的国际经验可以为中国全科医生制度的建立和发展提供借鉴。本文首先梳理了国民健康服务体制、社会医疗保险体制、商业医疗保险体制等部分典型国家的全科医生制度发展历程,重点分析了全科医生制度建设的影响因素。结果发现,建立和发展全科医生制度的主要影响因素有:经济社会因素、卫生保健体制对卫生体系的控制力、医师对卫生体系的控制力、全科医学服务的激励机制、全科医学的发展程度等。最后,结合近年我国全科医生制度建设的实际提出几点政策启示,一要以满足我国公众健康需求为目标,构建中国特色全科医生制度;二要普及全科医学服务核心价值,为建立全科医生制度提供公众民意基础;三要建立健全促进全科医生制度发展的激励机制,提高全科医生地位;四要积极推动全科与专科医学的专业分工,促进全科医学发展。 相似文献
67.
The Family Smoking Prevention and Tobacco Control Act (FSPTCA) give the U.S. Food and Drug Administration (FDA) unprecedented power to regulate tobacco products. One of the most significant provisions of the law allows state and local governments to adopt and enforce tobacco control legislation restricting the time, place, and manner (but not the content) of tobacco advertising. However, there is still reluctance among states and localities for mass adoption of laws due to challenges associated with legal feasibility and lack of U.S.-based evidence in effectiveness. The Center for Public Health Systems Science conducted interviews with key tobacco control contacts in 48 states at two time points (2012 and 2014) since the passage of the FSPTCA to assess the influence of the law on point-of-sale policy development in their state tobacco programs. Logistic regression results show that point-of-sale policy importance is growing post-FSPTCA, and that key influencers of this importance are states'' tobacco control histories and environments, including that related to excise taxes and smoke free air policies. The adoption of smokefree and tax policies has become commonplace across the U.S., and the quality and extent of these laws and prevailing political will increasingly impact the ability of states to work in emerging tobacco control policy areas including those directed at the point of sale. 相似文献
68.
Objectives
Since the Cabinet’s decision concerning the Basic Policies 2005, the Japanese government has implemented specific measures to suppress increases in national medical care expenditure. However, we believe that the economic significance of medical care should be quantified in terms of its economic impact on national medical care expenditure. No one has examined the economic impact of all medical institutions in Japan using data from a statement of profits and losses. We used an input–output analysis to quantitatively estimate economic impact of medical care and examined its estimation range with a probabilistic sensitivity analysis.Methods
To estimate the economic impact and economic impact multipliers of all medical institutions in Japan, an input–output analysis model was developed using an input–output table, statement of profits and losses, margin rates, employee income rates, consumption propensity and an equilibrium output model. Probabilistic sensitivity analysis was conducted using a Monte Carlo simulation.Results
Economic impact of medical care in all medical institutions was ¥72,107.4 billion ($661.5 billion). This impact yielded a 2.78-fold return of medical care expenditure with a 95 % confidence interval ranging from 2.74 to 2.90.Conclusion
Economic impact of medical care in Japan was two to three times the medical care expenditure (per unit). Production inducement of medical care is comparable to other industrial sectors that are highly influential toward the economy. The contribution to medical care should be evaluated more explicitly in national medical care expenditure policies. 相似文献69.
Background
China has made remarkable efforts and achievements since its health reform in 2009, yet there are substantial knowledge gaps in the quality of primary health care (PHC) in China. We aimed to assess the quality of PHC in China by analysing hospital admission rates among diabetics, a frequently used quality indicator for PHC.Methods
We obtained data from a nationwide longitudinal survey for 1006, 1472, and 1771 participants with diabetes who were surveyed as part of China Health and Retirement Longitudinal Study in 2011, 2013, and 2015, respectively. We described and analysed primary care coverage and hospital admission rates (proportion of patients with diabetes who were admitted to hospital) to assess the quality of PHC in eastern, central, and western China. Primary care coverage included proportion of patients who received diabetes-related health education, examinations, and treatments. We used logistic regressions to model the changes of primary care coverage and hospital admission rates in 2011–15 by adjusting for sociodemographic variables. Ethical approval is not applicable in this study as we use anonymised secondary data.Findings
Health education coverage decreased significantly in 2011–15 (76·17% in 2011, 73·15% in 2013, and 70·15% in 2015; OR 0·747 [95% CI 0·62–0·90]) whereas the proportion of patients who received diabetic-related examinations and medical treatments remained largely unchanged (78·88% in 2011, 78·35% in 2013, and 81·45% in 2015; OR 1·18 [95% CI 0·95–1·45]). Moreover, the proportion of patients who received diabetic-related examinations in the west was lower than that in the east (OR 0·52 [0·35–0·76]). Diabetes-related hospital admission rates increased from 4·01% in 2011 to 6·08% in 2013 (OR 1·47 [0·97–2·22]), and recurrent hospital admission rates increased from 18·87% in 2011 to 28·45% in 2015 (OR 1·78 [1·44–2·20]). Both diabetes-related admission rates (OR 1·80 [1·13–2·87]) and recurrent hospital admission rates (OR 1·92 [1·50–2·45]) were higher in the west than in the east.Interpretation
Judging by the patient-reported process and outcome indicators studied, quality of PHC has not improved in China between 2011–2015. Continuous evidence-based monitoring, evaluation and reporting of PHC quality are crucial for accomplishing the goals of health-care system reform in China.70.