赔偿性神经症评定量表的编制与信效度分析

目的 编制并检验赔偿性神经症评定量表的信效度,为该病症与普通神经症及诈病的诊断与鉴别提供客观量化评定依据.方法 根据赔偿性神经症的起病及其相关因素、临床病症特点、检查中的表现、治疗与转归等,编制赔偿性神经症评定量表,对相关被试进行初试、修改及条目筛选后,再用于有赔偿因素的司法精神鉴定案例和有精神应激事件的普通神经症患者,其中普通神经症116例,赔偿性神经症58例,伪装组66例.结果 (1)量表总分对普通神经症、赔偿性神经症和伪装组的划界分分别为<36分、36～52分、>52分.(2)全量表的Cronnbach's α系数为0.940,Guttman分半信度为0.944,重测相关在0.820以上,评分者相关在0.812以上.(3)与专家诊断比较,判断总准确率88.3%,对赔偿性神经症判定的特异性91.2%,灵敏度79.3%.结论 赔偿性神经症评定量表符合心理测量学的基本要求,能为赔偿性神经症与普通神经症及伪装的区分鉴别提供相对客观量化的评定依据.     

新医改背景下的单病种限价制度分析

目前推行的“单病种限价制度”,在一定程度上缓解了看病难、看病贵的问题,减轻了患者就医负担,为全民病有所医做出了努力。虽然该制度还存在一定的弊端,但新的医改方案肯定了它的价值。为了推广该制度,需要从加强医院内部和第三方（社保机构）的质量监管,以及强化政府的责任,建立公立医院的补偿机制等方面进行完善。     

基于系统动力学的医疗卫生人力动员补偿探析

运用系统动力学方法建立医疗卫生人力动员补偿的系统动力学模型,研究医疗卫生人力动员补偿对医疗卫生人力动员速度和成本的影响,为建立高效的激励与补偿机制提供借鉴。通过仿真发现医疗卫生人力动员补偿是影响动员效率的重要因素,应当建立完善的医疗卫生人力动员激励和补偿机制。     

浅析药品“零加成”政策的实施

本文回顾了药品加成政策的出台与取消,介绍了药品“零加成”政策的实施情况与成效,在分析药品“零加成”政策实施存在问题的基础上,针对存在的问题提出相应的建议.     

河南某县新型农村合作医疗住院补偿情况分析

目的:了解新型农村合作医疗参合农民住院流向、费用及补偿情况,为制定和改善新型农村合作医疗补偿政策提供依据。方法:收集河南某县2007-2009年参合农民住院补偿数据,用SPSS12.0软件进行数据录入处理分析。结果:该县2007-2009年新型农村合作医疗的住院补偿人次、住院总费用、次均费用、补偿总费用、次均补偿费用、补偿比等均不断提高,且病人流向和补偿基金逐年向县级和县级以上级别医疗机构倾斜。结论:该县的新型农村合作医疗取得了良好的效果,但基层医疗机构资源使用率低下,住院总费用增长过快,需重点加强基层医疗卫生机构能力建设,进一步优化新农合住院补偿方案,合理控制医疗费用的增长。     

村卫生室实施基本药物制度存在的主要问题及对策

随着国家基本药物制度在村卫生室的实施,一些突出的问题逐步显现出来.本文从基本药物的“零差率”补偿、可获得性及合理使用等方面对村卫生室实施基本药物制度过程中存在的主要问题,包括政府补偿不到位、基本药物遴选不规范、配送不及时、不合理用药现象严重等进行探讨,针对这些问题产生的原因提出了促进国家基本药物制度在村卫生室实施的政策建议.     

The association of compensation on longer term health status for people with musculoskeletal injuries following road traffic crashes: emergency department inception cohort study

Objective

To compare the health status of people claiming compensation for injuries sustained in road traffic crashes (RTC), with people who do not claim compensation.

Design

Prospective cohort study.

Setting

Australian Capital Territory, Australia and a fault based common law compensation scheme.

Subjects

People presenting to the emergency department with mild to moderate musculoskeletal injury following RTC.

Main outcome measures

Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure, Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI). These measures are recorded immediately post crash, at 6 and 12 months post crash.

Results

95 people participated in the study and were enrolled a mean of 8.6 (median 8) days following the crash. 86% were followed up to 12 months after injury. Mean age was 37 years, 61% were female and 91% were employed at the time of their injury. 33% ultimately claimed compensation, and 25% engaged a lawyer.There were no major differences in baseline personal characteristics or injury related factors between the groups. As expected, involvement as a passenger and in multiple vehicle crashes, were more frequent in the group claiming compensation.Over the duration of the study claiming compensation was associated with lower SF-36 PCS (−5.5 (95%CI −8.6 to −2.4), p = 0.001), greater HADS-Anxiety (1.7 (95%CI 0.2-3.3), p = 0.048), and worse FRI (11.2 (95%CI 3.9-18.5), p = 0.003).There was a highly significant improvement in health status between baseline and 6 months after injury, but no further significant change between 6 and 12 months after injury. There was no difference in rate of improvement between the groups.Claiming compensation and psychological factors were independent predictors of worse health status at 12 months.

Conclusion

In this study the group claiming compensation had overall worse health status following mild to moderate musculoskeletal injuries over the course of the study. There was no difference in rate of improvement between the groups. However, it is not possible to determine whether this negative effect was due to claiming compensation itself or the presence of other unmeasured factors.     

标准大骨瓣减压术中硬脑膜减张程度的量化研究

目的探讨与标准大骨瓣容积代偿相匹配的硬脑膜减张程度。方法通过对20例标准大骨瓣减压术患者减压窗的测量,算出成人平均容积代偿容积。通过尸体颅骨,模拟硬脑膜张力性缺损的过程,求出此容积引起硬脑膜张力性缺损的程度(面积用cm2表示),以此来量化硬脑膜减张程度。结果成人标准大骨瓣减压术平均容积代偿为81ml,其引起硬脑膜张力性缺损的面积为26.5cm2。影响因素包括:年龄、骨瓣范围、脑萎缩程度、迟发颅内血肿、脑水肿、脑梗塞程度、头皮张力等。结论硬脑膜减张缝合时,最佳硬脑膜减张程度为硬脑膜修补面积26.5cm2,实际工作中应结合容积代偿的影响因素略做增减。     

某区新型农村合作医疗住院补偿现状研究

目的探讨东川区新型农村合作医疗制度住院补偿方案,为该区调整和完善住院补偿方案提供参考依据。方法采用流行病学现场研究方法进行研究。结果东川区实际住院补偿比与规定存在差距,实际补偿为省级13．0％（规定30％）、市级16．0％（规定30％）、区级35．3％（规定45％）、乡级44．7％（规定55％分）;2006、2007年减免人次及减免费用比例均以区级医疗机构最高,均高于63．24％。结论东川区现行新农合制度住院补偿方案基本合理,值得借鉴和推广,建议在不断调整和完善的基础上继续深入实施。     

关于新型农村合作医疗大病补偿模式的思考

在界定新型农村合作医疗中的“大病”概念的基础上,分析过分强调大病补偿可能会导致重治轻防、农民受益面过窄、资源配置浪费等问题,进而提出新型农村合作医疗制度应当长远地利用农村社区资源,以基本医疗和预防为主,大病救助为辅,逐步由政府的全面代理推向农民和社会自理。