医疗"红包"何时休

医疗“红包”作为一种社会现象，由来已久，根深蒂固，公众对部分医务人员药品回扣、开单提成、收受“红包”以及服务质量低下等不正之风和医疗费用增长现象反映强烈。虽然在医疗服务中收取和索要“红包”的现象多表现在个别医生身上。但它加重了患者费用负担，严重影响医疗机构的形象，败坏医德医风，损害党同人民群众的联系。     

杜绝"红包"现象的有效措施和途径

“红包”现象是影响医院医德医风建设的一个较为突出的问题,我院通过加强医德医风教育、建立健全监督机制、严格实行奖惩制度、改善职工生活待遇、改革医院内部管理、电话随访跟踪等一系列行之有效的措施和途径,较好地遏制了“红包”现象的产生。     

医疗体制改革"雷区"待避

目前，我国医疗市场存在着不平衡的状态，看病难、医疗费用过高、医生收“红包”等现象处处表明了医疗市场的不完善。这一切归根结底是体制的问题。     

"红包"现象的经济学分析

近年来，患者到大医院看病，常要给医生送“红包”。患者并非情愿送，医生也非心安理得收，卫生行政部门更是一直反对，但“红包”现象仍屡禁不止，原因何在？     

综合治理 有效遏制“红包”现象

医疗卫生行业的“红包”现象长期以来一直是社会关注的焦点和热点问题。“红包”现象难以治理有着多方面的原因。查处“红包”问题时往往雷声大、雨点小、呼声高、动手少是一个重要原因。我院在综合治理的基础上，持之以恒的认真查处“红包”现象，收到了一定的成效。我们的主要体会是：     

八项制度管理“红包”和回扣

2007年初，射阳县中医院以创建“无红包医院”活动为载体，推动行风建设，赢得了社会的好评。医德医风、医疗服务质量等综合满意度同比上升0．2个百分点，门急诊人次同比上升38．7％，住院人次同比上升8．2％，业务收入同比上升10．9％。在创建“无红包医院”过程中，射阳县中医院结合实际情况，制定了切实可行的收受“红包”、回扣责任追究八项制度，以强有力的制度约束医务人员自觉拒收“红包”和药品回扣。一是实行保证金制度。每个医务人员都要交纳拒收“红包”、回扣保证金，年终视执行情况，予以扣除或退还。二是代充医药费制度。患者或其亲属执意相送又无法退回的“红包”，交到患者住院账户，抵充医药费用。     

龙岩：强化纠风工作

福建省龙岩市各医院把规范用药、完善制度作为制约医药购销和医疗服务中的不正之风，从源头上治理腐败的重要手段，同时加强监督检查，遏制“红包”、回扣、“开单提成”现象。     

再析“红包”现象

“红包”现象是卫生系统医德医风建设中的顽症。它不仅严重玷污了“白衣天使”的神圣职业，扭曲了社会主义的医患关系，而且污染了社会风尚，在一定范围内影响了社会对卫生改革的正确评价和接受程度。“红包”现象已引起了各级领导的高度重视。卫生部孙隆椿副部长明确指出：卫生系统今年纠风重点仍是“红包”。“红包”之所以能在救死扶伤、实行革命人道主义的圣洁殿堂中游荡，究其原因主要有以下三个方面：（一）医疗卫生服务的物质生产力低下，健康投入下降，供需矛盾突出，是产生“红包”现象的基本经济根源。建国以来，医疗卫生事业虽然…     

“红包”乱象

苏凯（化名）和陈楠（化名）是同期进入外科工作的医生，两人工作出色，均是科内的骨干，找他们做手术的患者络绎不绝。尽管医院三令五申禁止医生收“红包”，但医生收“红包”的现象依然屡见不鲜，这在外科尤为明显。以陈楠为例，几乎每台手术都会有患者或家属给他送“红包”，     

系统内外专家谈卫生行风

“红包”、回扣等现象虽非卫生系统所特有，但近年来，医疗卫生行业的这种现象备受社会关注。结合我省纠正医药购销和医疗服务中的不正之风。卫生厅纪检组召开了多次座谈会，广泛征求行业内外、系统上下的意见和建议。本文收录了座谈会上，省纪委、省监察厅、省检察院，各级卫生行政部门和医疗卫生单位的管理干部、纪检干部。医学专家等对“红包”、回扣等医药购销和医疗服务中不正之风的认识，也欢迎读者参与讨论。     

"看病难、看病贵"的思考

分析了“看病难、看病责”的主要原因，提出解决问题的对策建议：一是要建立并完善城市与农村医疗保险制度和社会救助机制；二是要增强医疗机构筹资能力，提高医疗服务水平；三是要完善科学的医疗体系与收费方法；四是要加大医药分开核算的考核力度，改革药品流通体制；五是要及时实施区域卫生规划，优化卫生资源配置；六是要加强法制建设，提高医务人员职业道德素质。     

面向“互联网+医疗健康”的医药电商服务业务流程分析

为缓解医药健康市场专业性不强、质量难以控制和未与医药系统对接等问题,本文构建了面向“互联网+医疗健康”的医药电子商务服务运营模式,探索一种将医疗服务、医保服务、医药服务、物流服务融合的新型医药电商服务模式,并借助统一建模语言UML对业务流程良好的表现力进行“互联网+医疗健康”医药电商服务流程建模与分析,以期助推“互联网+”医药行业的深度融合,促进我国医药电商领域的进一步发展。     

Changes necessary for continuing health reform: I. The "external" change

The article analyzes the need to obtain support from all actors if the reform of the health system is to be finalized. The relevant groups are the government, professional groups, workers, the population, civil servants, managers and firms with interests in the health field. It is necessary to develop a social marketing strategy that reinforces and broadens the current supports to change. Basic elements would be: Develop new service to satisfy users' needs; orient the services to defined "market" segments; position new services or "re-position" the existing ones in order to communicate their advantages; develop a plan of marketing based on promotion, prize and place focused on the role of health professionals as the main service sellers.     

现行《医院会计制度》和《医院财务制度》会计信息质量研究

随着我国市场经济体制和医药卫生体制改革的不断深入、医院本身业务活动的复杂性以及医院多种形式改革的深化,现行的《医院会计制度》和《医院财务制度》在运作过程中显示出许多不足及局限性,已不能满足新形势的要求。文章采用文献综述的方法,对现行《制度》的研究现状及医院会计信息质量存在的问题进行了总结和归纳,为进一步完善非营利性医院财务信息体系打下基础。     

Beyond "medical tourism": Canadian companies marketing medical travel

ABSTRACT: BACKGROUND: Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, "Liberation therapy" for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. METHODS: Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. RESULTS: Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other businesses market regional, cross-border health services available in the United States and intranational travel to clinics in Canada. In contrast to medical tourism companies, they do not market holiday tours in addition to medical care. Two companies occupy a narrow market niche and promote testing for CCSVI and "Liberation therapy" for multiple sclerosis. Three additional companies offer bariatric surgery and cosmetic surgery at facilities in Mexico. Four businesses offer health insurance products intended to cover the cost of obtaining privately financed health care in the U.S. These businesses also help their clients arrange treatment beyond Canada's borders. Finally, one medical travel company based in Canada markets health services primarily to U.S. citizens. CONCLUSIONS: This article uses content analysis of websites of Canadian companies marketing medical travel to provide insight into Canada's medical travel industry. The article reveals a complex marketplace with different types of companies taking distinct approaches to marketing medical travel.     

论新医改“政府主导”的实现路径

现阶段医疗卫生的问题集中反映在民众"看病难、看病贵"的现象上,其实质就是医疗成本的上升。进入21世纪,我国卫生总费用的平均年增长速度都保持在15%左右,市场机制的导入本来能够提高制度的运作效率,然而医疗服务缺乏相应的有效引导和监督,导致了医疗领域的服务扭曲和低效率,极大的增加了医疗费用及城乡居民的医疗负担。但是实际上问题的症结并不在于市场机制的调节,而是在于市场化在某些领域的不彻底改革以及政府在一些领域的管理不到位,加强政府的管理和监督职能是医疗改革成功的关键。     

我国药品价格虚高利益主体的利益分布及成因分析

目的:探讨现有药价虚高、药品市场混乱和药品定价政策缺乏科学性等深层次原因,为解决“药品价格虚高”问题中所涉及的机制转化提供理论和方法学依据。方法:依据卫生统计学和卫生经济学等理论分析“药品价格虚高”问题的深层次原因。结果:药品是特殊的商品,表现在它具有其独特的需求结构,患者在接受医疗服务和药品时处于被动和从属地位,医生是患者的代理人,由于利益的驱动,医生往往会代理失灵。结论:对“药品价格虚高”问题的现况进行科学分析,有利于下一步继续构建系统动力学模型。     

关于“政府购买城市社区公共卫生服务”的供方调查

目的：了解安徽省社区卫生服务机构开展政府购买公共卫生服务的现状、存在问题和原因,以及有关意愿。方法：问卷调查,结合现场调研和访谈。结果：部分公共卫生服务项目开展的较好,但由于社区卫生服务机构的能力有限、部分公共卫生职能没有下沉社区等原因,社区公共卫生职能需要进一步完善。结论：要利用市场机制促进政府购买公共卫生服务、加强社区公共卫生技术人员培养、协调适宜公共卫生服务下沉至社区、加强社会宣传力度。     

The allure of the private practitioner: is this the only alternative for the urban poor in India?

The main objective of the study has been to identify trajectories of health seeking behaviour of the urban poor, particularly their use of the private health sector, with the aim to identify strategies to improve quality of health care for this burgeoning population. This article presents findings from a slum settlement in Delhi where ethnographic sub-studies were carried out over two years among private health providers and selected households alongside a survey of household expenditure patterns. The primary research tools were in-depth interviews with practitioners and key informants as well as observations of clinical interactions. Illness narratives and case studies were documented over two years. The software package q.s.r. Nvivo was used for coding and content analysis. It was found that almost 90% of the respondents exclusively depend on local unlicensed and unregistered practitioners for basic primary health care. Long distances, time-consuming procedures, rude behaviour and, in many cases, bribes that had to be paid to staff in the hospitals were cited as major deterrents to utilising government facilities. Despite the public health consequences of inappropriate treatment protocols and misuse of drugs by these untrained private providers, in the absence of a structured urban primary health care system in the country, they seem to be the only alternative for the burgeoning urban poor in vast metros such as Delhi.     

基于“三方四体”的健康保险系统运营的博弈分析

从商业健康保险相关理论入手,分析归纳各个主体行为。目的在于在此基础上建立博弈模型,重点对政府-健康保险公司和健康保险公司-健康服务提供者两个博弈模型进行分析;研究表明政府要介入到健康保险市场进行监管,主要是对健康保险公司进行监管;研究说明在整个市场中,健康保险公司和健康服务提供者的最佳选择就是合作,以达到"共赢";指出健康保险系统是一个有机整体,其正常有效运作管理要靠"三方四体"协同合作。