区域性临床医疗与健康档案信息交互共享平台的建立和应用

上海市长宁区在全区逐步完成各医院内部临床诊疗信息系统（CIS系统）、各社区卫生服务中心电子健康档案信息系统（CHSS系统）的基础上,2007年起在区域级层面建立了“区域性医疗卫生数据中心．医疗信息管理与交互平台”。对区域18家医疗卫生机构、42个社区卫生服务站点实施光纤联网。实现了以3T-NET技术为支撑的区域医疗机构间异构的临床诊疗和电子健康档案信息的交互共享;在全区所有医疗机构与社IZp生服务中心及站点的医生工作站上可以按需调阅区域医疗机构病人就诊信息和健康档案信息。同时在平台上,实现了实时反映当前区域医疗机构的门急诊及住院病人信息等基本医疗业务信息,区域居民电子健康档案建设情况统计与分析、慢性病干预管理等基本公共卫生业务信息。实现了对区域内医疗机构财务运行、药品使用、安全状况监管和临床检验检查医疗信息互认共享等多种功能。从一定程度上加强了医院管理、提升了医疗质量、提高了医疗资源的利用和效率,促进了医疗费用的降低。     

我国健康保险业健康管理现状、问题与对策研究

健康管理的成功与否是保险公司的健康保险利润的重要影响因素。当前,我国正处于医疗体制改革的关键时期,健康保险如何与医院开展有效的管理衔接,即"健康保险的健康管理"成为了一项复杂的管理工程。文章分析了我国健康保险业健康管理现状及其面临的问题,如竞争与选择不足、信息系统平台尚未建立、可能来自医疗服务提供方的阻力以及保险公司微观管理能力欠缺等,并提出了试行和逐步推广管理型医疗(保险)方案、积极筹建和完善网络信息平台、政府作为以及创新财务制度等政策建议。     

区域电子健康档案信息共享标准及方案选择探讨

目的：卫生健康信息电子化（eHealth）对促进医疗安全、提高医疗效率及医疗质量的作用逐渐为人们所认识，医疗信息系统之间共享电子健康档案（Electronic Health Records，EHR）需要相关标准的研究。方法：对EHR结构和内容的共享标准进行了广泛调研，评价了这些标准对开发我国EHR共享的作用和影响。结果：对国内区域化电子健康档案共享标准的选择提出了建议。结论：通过区域电子健康档案（EHR）共享将使个体医疗保健更加方便。     

从医疗制度改革看健康教育与健康促进的作用

医疗制度改革（以下简称“医改”）涉及到千家万户。立足国情，引导满足群众的健康需求，是改革的中心所在。而健康教育如何在”医改”中发挥作用，如何拓宽健康教育的范围和领域，已成为我国健康教育工作面临的一个新课题。国内外实践表明，转变观念，以健康为主导，以人为本，以社会为基础，加强健康教育与健康促进工作，变被动治疗为主动预防，将有助于我国医疗制度的改革和科学合理卫生体系的建立。     

健康创想深耕中国——GE医疗助力医改实现可持续健康发展

2011年8月18～19日,中国国际医用仪器设备展览会暨技术交流会（cHlNAHOSPE02011）在北京召开。在这一中国医疗设备行业的盛会上,为贯彻国家“可持续的健康发展”战略,并配合医改的医疗资源均衡化发展、扩大基层医疗覆盖面、关注重点人群提高妇幼保健水平、干预重大疾病等各项政策,GE医疗将多年来成功应用的技术、方案以及重大成果进行集中呈现,“健康创想”以实际行动协助医改的可持续性健康发展。     

基层医院研发公众医疗健康服务平台应用探讨

目前,大多数医院的网站多停留在信息发布阶段,能为患者提供动态、完整的健康资料尚不多见,在提供服务方面功能单一,少有提到跟踪评价体系;而且对各类医疗信息资源缺乏有效的整合,同时也缺乏深层次和有特色的服务;e健通公众医疗健康服务平台是基于独山子石化医院已运行多年的电子病历、医院信息系统、检验系统、影像系统及体检等系统中患者的各类诊疗信息进行实现数字化整合;通过此平台与患者实时分享个人的医疗信息;将健康管理理念通过信息化手段,辐射至医院围墙以外,建立一个居民与医务人员的信息交互平台,实现医患良性互动,健康促进无界限;将医疗服务对象由患者转向社会、医疗服务从被动转变为主动,是改善医疗体验的重要途经之一[1].为患者提供在院诊疗信息、健康监测及评估、多种疾病群医患互动以及对医疗服务的跟踪评价;将医疗资源与区域医疗进行无缝嵌合,实现本地居民的健康档案动态化,使健康管理更具有特色.本文通过e健通公众医疗健康服务平台应用情况,对运行现状和功能模块应用综合分析.实现基于WEB技术的公众健康互动平台[2].     

慈铭首推国企员工目标健康管理计划

近日,由中国医师协会HMO、国企杂志社联合主办,慈铭体检集团承办的”20,09国企健康投资与健康保障沙龙”活动启动。会上．专家与30多位国企老总就”健康投资与健康保障”以及“员工目标健康管理计划“内容进行了交流与研讨。据了解计划通过员工体检、健康电子档案建立、慢性病干预、就医转诊等为企业节约人力资源的损失,并可以每年节约20％医疗费用的支出．并同时提高生产率、给员工最具人性化的福利待遇。     

农村贫困地区健康促进活动的经济学评价

通过对羊场村开展“以健康教育计划为基础、纠正不良卫生习惯为目的”的健康促进活动，分析了农村贫困地区开展健康教育的效果，并重点从经济学角度对缓解贫困、医疗费用及其控制、健康成本、病种成本四个方面进行分析评价。     

建立肿瘤专科健康体检中主的设想之我见

随着社会的进步和人民生活水平的提高，人们对健康的需求与渴望越来越高，医疗消费者的需求心理也随之发生变化，人们对健康有了新的追求和目标，不再是因病就医。“有病没病先查查，有病早治，没病早防”，已经成为越来越多人的健康理念，“健康体检”已经成为一种健康消费形式。本文立足于癌症早期发现、早期治疗，谈谈建立肿瘤专科健康体检中心的必要性和可行性。     

“互联网+”时代肺结核患者健康管理模式探讨

目的：探讨“互联网+”对肺结核患者健康管理的影响,探索患者健康管理新模式。方法：选取肺结核患者102例作为实验组,87例为对照组,分别采用“互联网+”管理模式和传统DOTS （直接面试下的督导服药）模式对患者进行健康管理。结果：采用“互联网+”管理模式的患者依从性（规则服药率、及时复诊率）与DOTS模式相比,差异无统计学意义（P>0.05）;与传统DOTS管理模式相比,“互联网+”管理模式大幅节省了患者的时间成本,减轻了社区人员工作量,节省了区级考核成本,降低了肺结核社区传播风险,有利于保护患者隐私。结论：“互联网+”时代采用“互联网+”管理模式对肺结核患者进行健康管理,取得了良好效果和经济学效益,值得推广使用。     

广西卫生事业发展现状分析

从健康水平、妇幼保健、卫生机构、卫生人力、卫生床位、医疗服务、传染病疫情、卫生经费等多角度分析广西卫生事业发展现状,并与全国平均水平进行比较。结果表明,近年来广西卫生事业发展水平不断提升,居民主要健康指标总体优于全国平均水平;卫生资源总量持续增加;社会资本办医成效显著,民营医院发展迅速;卫生筹资结构在不断优化,个人卫生负担有所减轻。但也面临妇幼保健体系有待完善、卫生人均量不足、基层医疗卫生资源利用不足、医疗费用持续上涨、法定传染病报告发病率上升、社会卫生筹资不足以及农村居民人均医疗保健支出增长过快等问题。因此,广西卫生事业发展综合水平还有待进一步提升。     

社区慢性病管理引入商业医疗保险的可行性分析

目前,慢性病已经成为危害城镇居民身体健康,造成居民疾病经济负担加重的重要因素。城镇居民基本医疗保险不能满足人们对较高层次卫生服务和医疗保障的需求,尤其是对慢性病医疗保障的需求。而商业医疗保险可以作为医疗保障体系的有效补充。社区慢性病管理引入商业医疗保险不仅在政策上可行,而且可以达到医疗机构、居民和保险机构的“三赢”。     

《阿斯塔纳宣言》与我国慢性病防控

2018年是《阿拉木图宣言》发布40周年，WHO于10月25日发布了新的《阿斯塔纳宣言》，其中重申并进一步发展了基本卫生保健理念和核心要素，还提出践行基本卫生保健理念将有助于应对各国目前不断增加的慢性病疾病负担。本文通过对我国慢性病防控政策与实践的分析，提出一直强调的“政府主导、部门协作、动员社会、全民参与”正是对基本卫生保健理念的应用，而《阿斯塔纳宣言》也将对中国慢性病防控带来新的重要启示。     

Exploring health care reform in a changing Europe: Lessons from Greece

Abstract

The economic crisis is the major theme in the Eurozone and its impact on public health and outcomes is largely discussed. Under this pressure, concerns of further inequalities exist that may have an impact on the burden of several diseases in certain European countries. In this context, Greece is currently an issue of top interest in any international economic discussion. Although the background of the recession has been largely discussed as a political crisis, its health effects on the population, as well as the key role of primary care and general practice/family medicine in health care reform remain to be explored. Serving both the worldwide trend of orienting health care systems towards strengthened primary care and the inner need for minimizing the demand and lessening the burden from the dysfunctional and costly hospital-care system, the economic crisis sets the perfect timing for prioritizing primary health care. In this article a unique window of opportunity for health care reform in Greece is examined, attempting to establish the axes of an example of how health care system can be reshaped amidst the economic crisis. Equity, quality, value framework, medical professionalism, information technology and decentralization emerge as topics of central interest. There is no doubt that Europe is transitioning under challenging social, economic and public health perspectives. However, taking Greece as an example, the current economic situation sets a good timing for health care reform and the key messages of this paper could be used by other countries facing similar problems.     

Time spent on health‐related activities by senior Australians with chronic diseases: what is the role of multimorbidity and comorbidity?

Objective: To examine the effect of various morbidity clusters of chronic diseases on health‐related time use and to explore factors associated with heavy time burden (more than 30 hours/month) of health‐related activities. Methods: Using a national survey, data were collected from 2,540 senior Australians. Natural clusters were identified using cluster analysis and clinical clusters using clinical expert opinion. We undertook a set of linear regressions to model people's time use, and logistic regressions to model heavy time burden. Results: Time use increases with the number of chronic diseases. Six of the 12 diseases are significantly associated with higher time use, with the highest effect for diabetes followed by depression; 18% reported a heavy time burden, with diabetes again being the most significant disease. Clusters and dominant comorbid groupings do not contribute to predicting time use or time burden. Conclusions: Total number of diseases and specific diseases are useful determinants of time use and heavy time burden. Dominant groupings and disease clusters do not predict time use. Implications: In considering time demands on patients and the need for care co‐ordination, care providers need to be aware of how many and what specific diseases the patient faces.     

21世纪全面开展初级卫生保健的思考与建议

从我国当前的国力和国际经验来看,我国在21世纪仍然特别需要采取低成本、广覆盖与高产出的卫生发展战略,需要富有远见和创新精神的卫生制度设计。通过立法保障和普及初级卫生保健,保证城乡居民公平享有基本卫生服务,保障全体公民的基本健康权利,是解决当前广大群众“看病难、看病贵”问题的可行策略,是符合我国国情、尽快改善卫生公平性、控制医疗费用过快上涨和提高人民健康水平的最佳制度选择,也是推动卫生改革和体制创新的关键举措。建议通过立法构建我国21世纪初级卫生保健体系,将卫生工作的重点从医疗服务转到疾病预防,将卫生资源从过度的医院服务转向普及基层的初级卫生保健服务,并对相关的社会、环境、行为和心理等健康危险因素进行干预。在大力控制传染病、地方病的同时,尽快建立控制慢性非传染性疾病的能力,防止国家、社会和家庭在未来付出更高的健康损失和经济代价;建议我国未来的卫生服务大体上由“两层服务体系”提供,即初级卫生保健层次和转诊服务层次,逐步实现居民人人享有的“双重健康保障”,即:所有公民享有基本卫生服务和基本医疗保险。     

Proposal to reimburse occupational medicine disease and injury claims through third party health insurance

The current system of compensation for the medical costs of occupational illnesses and injuries, a component of health insurance coverage for most workers in the United States, has recently come under scrutiny in the national health care reform debate. The cost of treatment of these conditions is significant, and there exist numerous disincentives for physicians and patients to use the workers' compensation system. Physicians who treat workers with occupationally related diseases may find compensation for a condition is disputed at the same time that it is excluded from payment by third party insurance coverage, leaving the patient selectively uninsured for at least some medical care services. In addition, most workers' compensation programs have been designed in a way that discourages efficient resource use by providers and claimants. We propose allowing health care providers to bill third party health insurers for all care, including work-related diseases and injuries. Insurers, in turn, would bill workers' compensation programs for associated treatment costs. The potential advantages of such a system include reductions in inefficiency and unfair burdens placed on providers and patients, in reporting bias, and in administrative costs balanced against the risks of insurers excluding workers in high risk occupations from obtaining low cost health insurance and shifting away from employers the administrative burden for workers' compensation.     

Factors associated with caregiver burden among adult (19–64 years) informal caregivers – An analysis from Dutch Municipal Health Service data

Due to the ageing population and the rising prevalence of chronic diseases, it is expected that the demand on informal caregivers will increase. Many informal caregivers experience burden, which can have negative consequences for their own health and that of the care recipient. To prevent caregiver burden, it is important to investigate factors associated with this burden. We aimed to identify factors associated with caregiver burden in adult informal caregivers. Among a sample of adult informal caregivers (n = 1,100) of the Dutch region of Zaanstreek‐Waterland, perceived caregiver burden, demographic factors, caregiving situation, health‐related factors and socio‐financial factors were measured as part of the national Health Survey in 2016. Using univariate and multivariate logistic regression analysis, for which a backward selection method was applied, associations with caregiver burden were studied. In the multivariate model, time spent providing informal care was significantly associated with perceived caregiver burden, with an odds ratio (OR) [95% confidence interval] of 7.52 [3.93–14.39] for those spending >16 hr compared to 1–2 hr on informal care. Also providing care to their child(ren) (OR: 2.55 [1.51–4.31]), poor perceived health (OR: 1.80 [1.20–2.68]) and loneliness of the caregiver (OR: 2.05 [1.41–2.99]) were significantly associated with caregiver burden. To possibly prevent and reduce informal caregiver burden, factors associated with such burden should be intervened on. As such, special attention should be paid to caregivers who provide many hours of care or provide care to their child(ren), as well as those who have a poor perceived health themselves and/or experience feelings of loneliness.     

The economic burden of excessive sugar consumption in Canada: should the scope of preventive action be broadened?

ObjectiveExcessive sugar consumption is an established risk factor for various chronic diseases (CDs). No earlier study has quantified its economic burden in terms of health care costs for treatment and management of CDs, and costs associated with lost productivity and premature mortality. This information, however, is essential to public health decision-makers when planning and prioritizing interventions. The present study aimed to estimate the economic burden of excessive free sugar consumption in Canada.MethodsFree sugars refer to all monosaccharides and disaccharides added to foods plus sugars naturally present in honey, syrups, and fruit juice. Based on free sugar consumption reported in the 2015 Canadian Community Health Survey–Nutrition and established risk estimates for 16 main CDs, we calculated the avoidable direct health care costs and indirect costs.ResultsIf Canadians were to comply with the free sugar recommendation (consumption below 10% of total energy intake (TEI)), an estimated $2.5 billion (95% CI: 1.5, 3.6) in direct health care and indirect costs could have been avoided in 2019. For the stricter recommendation (consumption below 5% of TEI), this was $5.0 billion (95% CI: 3.1, 6.9).ConclusionExcessive free sugar in our diet has an enormous economic burden that is larger than that of any food group and 3 to 6 times that of sugar-sweetened beverages (SSBs). Public health interventions to reduce sugar consumption should therefore consider going beyond taxation of SSBs to target a broader set of products, in order to more effectively reduce the public health and economic burden of CDs.     

Public health in India: issues and challenges

Health is determined not only by medical care but also by determinants outside the medical sector. Public health approach is to deal with all these determinants of health which requires multi sectoral collaboration and inter-disciplinary coordination. Although there have been major improvements in public health since 1950s, India is passing through demographic and environmental transition which is adding to burden of diseases. There is triple burden of diseases, viz. communicable, non-communicable and emerging infectious diseases. This high burden of disease, disability and death can only be addressed through an effective public health system. However, the growth of public health in India has been very slow due to low public expenditure on health, very few public health institutes in India and inadequate national standards for public health education. Recent years have seen efforts towards strengthening public health in India in the form of launch of NRHM, upgradation of health care infrastructure as per IPHS, initiation of more public health courses in some medical colleges and public health institutions and strengthening of public health functional capacity of states and districts under IDSP.