公立医院内部运行机制存在的问题及对策探讨

建立并完善公立医院内部运行机制是现代医院管理制度的重要内容。以某三级甲等医院作为目标医院调研分析公立医院内部运行机制运行现状及存在的主要问题,根据这些问题提出了相应对策建议,为促进公立医院内部运行机制创新与完善提供参考。     

公共卫生绩效考核的实践探索--以宁波市鄞州二院医共体姜山分院为例

文章以宁波市鄞州二院医共体姜山分院为例,梳理该分院公共卫生科室绩效考核的实践结果显示,从公共卫生医务人员复杂的劳务工作中,寻找可以衡量的案件为主要改革内容的绩效考核,取得了显著成效,期望能为完善公共卫生绩效考核提供经验借鉴。     

Incentives to patients versus incentives to health care providers: The users' perspective

In theory, health care providers may adapt their professional behavior to the financial incentives resulting from their remuneration. Our research question is whether the users of health care services anticipate such behavior from their general practitioner (GP) and, if they do, what consequences such anticipation has on their preferences regarding financial incentives. Our theoretical model explains users' preferences for one or another incentives scheme, disentangling the financial motives (incentives amounts, wealth) from the behavioral ones (perceived GPs' sensitivity to incentives). We empirically test our theoretical predictions using data from a survey that elicits individual preferences for either patient or provider hypothetical incentives in France. The empirical results confirm the theoretical ones: users tend to prefer incentives to patients rather than to GPs when the amount of GP incentives is high, when the amount of patient incentives is low, when they anticipate that their GP's medical decisions are affected by financial incentives or when their wealth is high. Otherwise, they prefer their GP to face financial incentives.     

Cancelled Procedures in the English NHS: Evidence from the 2010 Tariff Reform

This paper explores the role of incentives in the English National Health Service. Until financial year 2009/2010, elective procedures that were cancelled after admission received a fixed reimbursement associated with a specific healthcare resource group code. We investigate whether this induced trusts to admit and then cancel, rather than cancel before admission and/or to cancel low fee over high fee work. As the tariff was ended in April 2010, we conduct an interrupted time series analysis to examine if their behaviour was affected after the tariff removal. The results indicate a small, yet statistically significant, decline in the probability of a last minute cancellation in the post‐tariff period, especially for certain types of patients and diagnoses. Copyright © 2017 John Wiley & Sons, Ltd.     

The Economics of Medicare Accountable Care Organizations

Background

Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs.

Objective

To examine whether the current Medicare ACOs are likely to be successful.

Discussion

Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful.

Conclusion

The question remains whether Medicare ACOs can achieve the Triple Aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs.     

Can performance‐based financing help reaching the poor with maternal and child health services? The experience of rural Rwanda

More than 20 countries in Africa are scaling up performance‐based financing (PBF), but its impact on equity in access to health services remains to be documented. This paper draws on evidence from Rwanda to examine the capacity of PBF to ensure equal access to key health interventions especially in rural areas where most of the poor live. Specifically, it focuses on maternal and child health services, distinguishing two wealth groups, and uses data from a rigorous impact evaluation. Difference‐in‐difference technique is used, and different model specifications are tested: control for unobserved heterogeneity and common random error using linear probability model, seemingly unrelated regression equations, and clustering and fixed effects. Results suggest that in Rwanda, PBF improved efficiency rather than equity for most health services. We find that PBF achieved efficiency gains by improving access to health services for those easier to reach, generally the relatively more affluent. It turns out to be less effective in reaching the poorest. Our results illustrate the advantages of rigorous randomized impact evaluation data as results published earlier using a nationally representative survey (Demographic and Health Survey) were not able to capture the pro‐rich nature of the PBF scheme in Rwanda. Our paper advocates for building mechanisms targeting the vulnerable groups in PBF strategies. It also highlights the need to understand the impact of PBF together with the specific development of health insurance coverage and the organization of the health system.     

基于临床工作量与工作质量某院绩效工资考核

基于绩效考核的薪酬分配作为现代医院绩效管理的重要组成部分,是实现医院长远规划和战略目标的重要举措。随着我国医疗体制改革的深入,各大医院也纷纷转变分配机制。文章结合新医改要求,具体介绍某专科医院通过对临床工作量和工作质量的考核进行绩效工资分配的经验,并结合多年的实践操作进行总结思考。