在线医生社区中关注关系网络形成机理研究

目的:对在线医生社区中关注关系网络进行研究,探究其形成的内在机理,并为社区管理提供建议。方法:以丁香园骨科论坛为研究对象,采用指数随机图模型分析用户属性和网络结构对医生用户间关注关系网络形成的影响机理,利用R-statnet工具进行模型参数估计和显著性检验。结果:研究表明,关注关系网络具有互惠性和传递性特征;用户属性中,发帖数、社区等级、粉丝数、积分数等因素可以促进关注关系网络的形成;在线医生社区可以促进医疗信息资源由医疗资源发达地区流向医疗资源欠发达地区。结论:本文丰富了在线医生社区中关注关系网络形成机理的研究,并对在线医生社区的管理有一定的启示作用。     

深圳实施新版医疗服务价格后政府对非营利医疗机构管理的思考

深圳市在执行新版医疗服务价格后,由于价格制定、政府的补贴等方面存在的问题,使得非营利医疗机构经营面临困难.文章着重就制定医疗服务价格的方法、核算非营利医疗机构的经营成本,加大政府投入以及建立社会捐赠机制提出了思考,希冀得以促进非营利医疗机构健康有序的发展.     

基于SWOT分析的我国在线健康社区发展研究

结合SWOT分析法,文章阐述了我国在线健康社区的优势(患者可享受到方便及时的优质医疗服务、降低就医成本、提供个性化服务等)、劣势(存在用户信息泄露、服务面临资质和质量风险)、机会(政府重视并大力支持、用户健康需求增加、互联网技术的促进作用等)、威胁(监管滞后、用户观念尚未完全转变、市场竞争激烈),并提出相应对策建议,以...     

治理语境下农村健康社区建设的进路分析

健康社区是一个包括健康人群、健康环境和健康社会有机结合的整体。建设农村健康社区对于促进农村社会和谐,实现农村公共卫生和基本医疗服务均等化,提升农村社区居民的健康保障水平具有重大的现实意义。目前,农村健康社区建设面临一系列问题和挑战。针对这些问题进行分析,以治理理论为视角,提出农村健康社区建设的进路。     

医疗健康类App用户粘性行为的实证研究

目的了解医疗健康类App用户粘性的行为特征和影响因素,为移动医疗/移动健康提供用户积累、习惯培养、行为激励等方面的决策依据。方法通过在线问卷调查,共调查2 901例医疗健康类App用户;应用图表刻画6类粘性行为特征,采用卡方检验、单因素方差分析和多分类Logistic回归分析其影响因素。结果 25~45岁年龄或大专以上学历用户具有更高的App用户粘性;社会影响、电子健康素养、感知易用性、感知有用性与App用户粘性呈正相关,感知风险高会增加不确定持续使用;社会影响对用户粘性的影响超过感知有用性;结论 6类粘性行为转化的重要影响因素不一,可基于粘性类型针对性地进行用户细分、产品设计和习惯培养。医疗健康类App应不仅被当作移动信息产品去设计和运营,还需撬动整个医疗健康服务生态系统的优化和重建才能获得持续发展。     

农村健康社区的构建：困境与对策

健康社区是一个包括健康人群、健康环境和健康社会有机结合的整体。建设农村健康社区对于促进农村社会和谐,实现农村公共卫生和基本医疗服务均等化,提升农村社区居民的健康保障水平具有重大的现实意义。目前,构建农村健康社区遭遇一系列困境。针对这些困境进行分析,尝试性地提出走出困境的对策。     

医疗废物集中处置的产品属性和定价原理研究

医疗废物集中处置的产品属性是准公共产品,消费上的非竞争性特性决定了其供给只能由政府完成;受益上的排他性特性决定了其供给成本可以通过价格机制补偿.对医疗废物集中处置进行边际成本定价.同时予以集中处置中心一定的补贴,可以兼顾经济效率与社会公平.     

基于UTAUT模型的用户移动医疗服务行为意愿研究

目的 通过实证研究患者用户信任、绩效期望等影响因素对移动医疗服务行为意愿的影响,为移动医疗服务的更广泛使用和普及提供解决办法和定量依据。方法 采用随机抽样的方式对1 214名医院患者和移动医疗服务用户进行在线问卷调查,通过结构方程建模,进行偏最小二乘法和Bootstrapping计算验证。结果 （1）影响移动医疗服务行为意愿总效应最大的变量是患者或用户信任,其次是绩效期望,但是绩效期望的直接影响大于信任,信任还通过努力期望和绩效期望2个中介变量间接影响行为意愿;（2）努力期望、促进条件以及社会影响也都显著影响移动医疗服务行为意愿。结论一是移动医疗服务提供方应重点关注用户需求,做到诚信经营,不仅要让用户产生信任,而且还要让用户信任水平逐步提升;二是改善服务质量,提高用户对健康绩效的期望;三是加强移动医疗服务系统的易用性和相关配套设施的支持。最终达到提升用户移动医疗服务行为意愿的目的。     

在线医疗服务平台医生采纳行为及影响因素研究

目的:随着互联网技术的快速发展,在线医疗服务平台受到重视和推广,但调查显示医生对在线医疗服务平台的使用率偏低。本研究利用整合技术采纳与使用统一理论,研究医生对在线医疗服务平台的采纳意愿及影响因素。方法:通过调查问卷收集数据,并利用SPSS和AMOS进行统计分析和结构方程建模。结果:绩效期望、努力期望、社会影响、便利条件对医生的使用意愿具有显著正向影响,使用意愿显著影响使用行为。结论:在线医疗服务平台不仅要通过宣传推广改进医生的技术感知,还要根据医生的需求提供有针对性的服务,从而改进技术匹配度,促进医生的采纳。     

以智慧健康社区建设为切入的家庭医生团队网格化管理实践探索

成都市温江区柳城街道社区卫生服务中心以智慧健康社区建设为切入点,融入智慧蓉城社会治理体系,拓展居民健康档案信息和相关医疗健康数据应用范围。创新成立5个“1+1+N”家庭医生网格化管理团队;加强宣传,营造浓厚全民建档氛围;整合信息资源,全面摸清健康基线;加强人员培训,为入户建档做好前期准备;家医融入“微网实格”,提供线上线下健康服务;分层分类管理;增设家庭医生健康驿站。上述做法增加了该中心建档率、体检率、健康管理率等等。笔者体会,医社联动、多方聚力是智慧健康社区建设的基石,精细化建档是推进智慧健康社区建设的有效途径,持续创新服务是推进智慧健康社区建设的内生动力,为居民健康管理与疾病及时检测提供多元化选择则,是下一步智慧健康社区建设的重点。     

Are tax subsidies for private medical insurance self-financing? Evidence from a microsimulation model

This paper develops an empirical strategy to estimate whether subsidies to private medical insurance are self-financing in countries where public and private insurance coexist and the latter covers the same treatments as the former. We construct a simulation routine based on a micro-econometric discrete choice model that allows us to evaluate the impact of premium changes on the utilization of outpatient and inpatient health care services. As an application, we estimate the budgetary effects of scrapping a subsidy from the purchase of individual private policies, using micro-data from Catalonia. Our results suggest that the subsidy is not self-financing. This result is driven by the fact that private medical insurance holders make concurrent use of public and private services, and by the price inelasticity of the demand for private policies.     

Corporate management of quality in employee health plans

As large companies move their employees into managed care, they must concern themselves with the quality and price of their employees' health care. Based on a survey of Fortune 500 companies, we show that most are integrating several aspects of quality into their purchasing and contracting decisions by focusing on three dimensions--customer service, network composition, and clinical quality. Companies focus on the customer service dimension while the medical community emphasizes clinical quality.     

优化卫生资源配置 控制医疗费用过快增长

目前,在我国迫切需要加强卫生资源宏观管理,提高医疗机构微观效率,增加财政补助,控制医院收入增长,对药品实行统一集中采购。通过这些措施,控制医疗费用。只有在低费用的基础上,我们才能建立以个人责任为基础、具有较强费用控制机制的医疗保障制度;只有这些措施互相配合,综合作用,才能降低医疗费用;只有提供基本、低价、有效的医疗服务,才能真正实现医疗保障的“低水平、广覆盖”。     

Providing effective and preferred care closer to home: a realist review of intermediate care

Intermediate care is one of the number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory‐driven (realist) review conducted in 2011–2012. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service user, professional and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision‐making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision‐making and care co‐ordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between integrated organisational processes and integrated professional practice.     

Modelling the effectiveness of financing policies to address underutilization of children's health services in Nepal

OBJECTIVE: To estimate the price responsiveness of utilization of formal children's health-care services in Nepal and to use this information to model the impact on utilization of subsidies or increases in user fees. METHODS: A total of 8112 individual observations (of children aged < 15 years) from 2847 households in 274 communities were obtained from the 1996 Nepal Living Standards Survey. A logit model was applied to determine the net impact of price on a parent or caregiver's decision to seek care for a given instance of illness. The model's coefficients were used to calculate the price responsiveness of utilization decisions. FINDINGS: Parents or caregivers reported that 9.7% of children (788/8112) had been ill or injured in the previous month. Parents reported that they had sought care in 566 (71.8%) of these cases; care was most frequently sought from public providers. The price elasticity of demand for children's health-care services in the formal sector was estimated at -0.16. As prices rise, the demand curve exhibits continuous and declining price elasticity. Overall, a 100% subsidy of user fees would increase current utilization rates by 56%, while a 100% increase in fees would lead to a drop in utilization of only 12%. The differential in utilization across income groups was substantial after changes in fees were implemented. CONCLUSION: While the effect of price on the utilization of children's health-care services in Nepal is statistically significant, the size of the impact is modest. Policies to subsidize fees could increase utilization substantially, while fee increases would lead to modest declines in utilization and generate increased revenue.     

卫生事业费分配结构调整的政策思考

本文在对三省、三市和三县的卫生事业费调查研究和分析的基础上，对卫生事业费分配结构调整提出了以下改革思路：卫生事业费应考虑国民经济、人口和物价指数三个因素，保证其实际增长与国民经济同步增长对卫生院和合作医疗补助费所占的比重，结合农村地区卫生服务改革和医疗制度建立，应逐步上升，而医院经费结合医疗服务价格的调整等可逐年降低比重；控制卫生服务机构规模，提高卫生资源的利用效率；对贫困地区仍须坚持实行差额补助和专项拨款的政策     

浅论私立基层医疗机构发展与监管中的若干问题

在国民基本医疗服务体系的实际构建中，私立基层医疗机构纳入这一体系可能存在困难，如不能纳入，则其发展前景堪忧：应允许私立营利性基层医疗机构纳入该体系，并在税收和补贴等问题上制定合理政策鼓励其发展。在医疗机构监管的各环节上应对公、私立基层医疗机构切实做到一视同仁；目前私立医疗机构监管立法中存在的几个漏洞亟待填补；基本医疗服务购买合同若运用得当，将是针对基层私立医疗机构的一种有效的监管工具。     

药品采购模式现况调查分析

目的：以济南市为例,了解城区社区卫生服务机构药品采购模式.方法：对济南市101家社区卫生服务机构进行调查分析.结果：药品在社区卫生服务机构经济运行中占有重要地位;药品采购模式多样化,独立采购模式占主导地位;药品零售价格相对较高,“跑方”现象严重.结论：归纳了济南市社区卫生服务机构药品采购管理的特点,明确了目前社区卫生服务机构药品采购模式存在的问题,提出了相应的对策.     

社会资本与社会医学新发展观

社会资本是近年来广泛应用于政治、经济、社会发展领域的理论,其核心是基于信任的互惠合作网络的建立和对公共事务的自愿参与,以及由此派生出的共同的价值观、行为规范等。将社会资本理论引入社会医学学科,并与社会医学的热点研究领域如社会因素与健康、社区卫生服务发展、新型农村合作医疗筹资、社区开发策略等有机结合,从而为社会医学学科的发展开拓新的思路、注入新的活力。     

对我院乙类大型医用设备售后服务能分析评价

目的分析我院乙类大型医用设备售后服务的现状,探讨合理的售后服务采购原则。方法汇总分析我院13台乙类大型医用设备售后服务的采购、执行情况。结果任用乙类大型医用设备保修服务采购率92．30％（12／13）,原厂保修服务采购率83．33％（10／12）;采购保修服务设备的开机率明显高于单次付费维修设备;所签订保修服务合吲的内容均包含人工、备件及开机保证;合同价格占设备原值的百分比为4．54％一11．06％。结论良好的保修服务是设备正常运行的保证,生产厂家是保修服务的主要提供者,合格的第三方机构也可以提供优质的保修服务,合理的保修服务价格评价是必要手段。