The effect of economic constraints on the health care system in New Zealand.

The New Zealand government, in addition to budget restrictions, has introduced population-based hospital funding to contain hospital costs. Moreover, a health services reorganization to increase area-wide integration and coordination of services on a voluntary basis has been advocated. Diffusion and use of expensive medical technologies have been delayed or thwarted. Private hospitals have increased and provide an outlet for those who are able to escape prolonged waiting for treatment and the deteriorating accommodations in public hospitals.     

不同类型医院门诊患者满意度调查及分析

目的 分析不同类型医院门诊患者满意度的差异,为服务质量提升提出建议。方法 采用方便抽样法对山东省2家专科医院及3家综合医院的1 000名门诊患者进行满意度问卷调查,并应用SPSS 22.0统计软件对调查结果进行描述性分析以及χ2检验、两独立样本t检验、多元线性回归分析。结果 专科医院和综合医院的消费人群差异明显,性别、年龄、受教育程度、职业类别、医保类型、家庭年收入、患者来源差异均有统计学意义（P＜0.05）;门诊患者总体满意度较高（专科:3.72±0.67;综合:3.79±0.79）,但就诊流程评分较低     

Infrared thermography to mass-screen suspected SARS patients with fever

Fever greater than 38 degrees C is a cardinal sign of patients with the severe acute respiratory syndromes (SARS). To reduce the risk of nosocomial cross infections, screening all patients and visitors who visit hospitals and clinics for fever at the entrance of every hospital building has become a standard protocol in Taiwan during the SARS epidemic from mid-April to mid-June 2003. We used a digital infrared thermal imaging (DITI) system (Telesis Spectrum 9000 MB) to conduct mass screening of patients and visitors who entered the hospital to identify those with fever. The DITI system has two components: a sensor head and a PC imaging workstation. The sensor head is an optic-mechanical device which consists of imagining optics for focusing the infrared source information on the infrared detector. The infrared images are further converted into electrical signals, which are then processed for real-time display on the monitor. During the period from April 13 to May 12 2003, 72,327 outpatients and visitors entered Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. A total of 305 febrile patients (0.42%) was detected by infrared thermography. Among them, three probable SARS patients were identified after thorough studies including contact history, laboratory tests and radiology examinations. The findings suggests that infrared thermography was an effective and reliable tool ideal for mass-screening patients with fever in the initial phase of screening for SARS patients at a busy hospital which sees approximately 3,000 outpatients every weekday during the SARS epidemic.     

信息不对称环境下医疗服务患者满意度研究*——以山东省三甲医院为例

目的:以山东省3所三甲医院为例,分析信息不对称环境下医疗服务满意度现状,为完善医院管理与提高服务质量提供决策依据。方法:按照单纯随机抽样方法对门诊患者和住院患者进行现场问卷调查。结果:门诊患者医疗服务满意度从高到低依次为医疗环境与设施、服务态度、服务过程、服务结果、医疗费用和等待时间,住院患者医疗服务满意度从高到低依次为服务态度、服务过程、医疗环境与设施、服务结果、等待时间和医疗费用。结论:在整体水平上,患者满意度相对较高;门诊患者最不满意的项目是等待时间长,住院患者最不满意的项目是医疗费用高。提示医院应有针对性地提高信息不对称环境下患者的医疗服务满意度。     

Dilemmas surrounding the identification of essential rural hospitals.

Criteria are needed for use in designating some rural hospitals as essential so that they may receive state or federal assistance. Three types of criteria are considered in this analysis: hospital volume measures, hospital competitiveness measures, and community need measures. The criteria sets reflect different assumptions about the relationship between need and demand for health services. Analysis of available data reveals that neither hospital volume nor competitiveness is correlated with community need, meaning that different hospitals would be designated as essential under each system. Implications are discussed.     

威海市农村居民门诊就诊流向及费用变化研究

根据威海市居民健康状况调查资料。研究不同社会经济特征农村居民的门诊就诊流向以及不同级别医院的次均就诊费用。发现农村居民就诊流向不尽合理．次均就诊费用随医院级别的升高而上涨。建议大力发展农村社区卫生服务，增强合作医疗的保障力度，引导居民就诊流向合理发展，从而降低门诊费用．减轻居民的疾病经济负担。     

DIFFERENCES BETWEEN METROPOLITAN AND COUNTRY PUBLIC HOSPITAL ALLIED HEALTH SERVICES

ABSTRACT: This paper compares patient and episode characteristics in allied health services delivered in country and metropolitan hospitals. Eight public hospitals (46 allied health services) participated in the study (three country and five metropolitan sites, situated in South Australia, Queensland and Tasmania). Standardised rates of patient throughput were similar for country and metropolitan allied health services, despite smaller numbers of country staff providing services to larger geographical areas. Although the differences were not significant, country patients were generally older and had more chronic conditions than metropolitan patients. Fewer country patients than metropolitan patients were eligible for rebates in the private sector. In addition, fewer alternative services were available in country communities, which heightened the role of the public hospital outpatients services within the community. This paper provides an argument for similar funding arrangements for country and metropolitan ambulatory allied health services.     

门诊患者满意度调查分析

目的:了解门诊患者真实就医体验,为改善医疗服务提供决策依据.方法:采用问卷调查方法,两次调查结果对比分析.讨论:患者满意度是衡量医院服务质量好坏的晴雨表;公共交通抵达医院的便捷度是影响患者就医体验和择医意愿的重要因素;“质优、价廉、便捷、人性化”的医疗服务是患者始终的期待.     

我国三级公立医院科研数据信息服务管理模式探究

目的了解我国三级公立医院科研数据信息服务的内容及特点,为医院科研数据管理与利用提供参考。方法访问各医院官方网站,结合文献研究,梳理各医院提供科研数据信息服务现状。结果最终纳入22家医院,有3家提供信息系统数据提取申请服务,2家支持电子数据采集服务,18家开展临床科研大数据平台（含专科专病数据库）服务。其中1家医院既有信息系统数据提取申请服务,又有临床科研大数据平台。结论三级公立医院科研数据信息服务的主要方式包括信息系统数据提取、电子数据采集以及临床科研大数据平台（含专科专病数据库）等,但也面临挑战。可从建立完善的科研数据信息服务管理制度,以项目管理模式开展科研数据信息服务,提高科研数据信息服务人员满意度等方面持续改进。     

Who gets what? utilization of health services in Indonesia

An evaluation of health service utilization patterns was carried out in five rural districts and a number of urban areas in Indonesia. The study was part of a larger effort to develop economically-related information about the health care services. Utilization levels were then related to such selected population variables as distance from health facilities, insurance status and income. The annual contact rate, curative plus preventive, with all public sector facilities was found to be 0.8 per capita. The geographic catchment areas of the facilities were also found to be very limited. The insured population (civil servants and their families) used services about four times more frequently, on average, than did the rest of the population. In one provincial study, the top 9 per cent of income earners made up one-third of all hospital inpatients, one-half of all hospital outpatients, and one-quarter of all health centre visitors. The implications of these results for equity and efficiency are discussed.     

A proposal to redistribute the cost of hospital charity care

Policy analysts debate whether providers of hospital services should share the responsibility of financing care for those who cannot pay for it. Many nonprofit and public hospitals, meanwhile, find it necessary to fund some of the services they deliver. A proposal to redistribute the costs of charity care more equitably is offered, taking into account the benefits an institution receives and its ability to pay. Hospitals would be required to quantify the charity care they provide and to make this information publicly available; in reviewing the information, legislatures are encouraged to set priorities on how much unmet need each state and each hospital should finance.     

Changes in billing for nutrition support services and dietetics staff resources between 1984 and 1986

Changes in hospital funding resulting from the Prospective Payment System have been recognized as a major force in hospitals in the 1980s. The Dietitians in Nutrition Support (DNS) Practice Group examined these changes using a survey sent to 1,000 clinical nutrition managers at American Hospital Association (AHA) hospitals. The goals of the survey were (a) to evaluate changes in billing for nutrition services and (b) to evaluate changes in resources available to dietetics staff members. Although income from nutrition services to inpatients had increased only 18% since 1984, 45% of respondents reported an increase in payment for outpatient services. Prior to 1984, larger hospitals reported screening for malnutrition more often than smaller hospitals, and the responsibility for screening was handled more often by dietetic technicians than by RDs. Larger hospitals also reported establishment of a home nutrition support company more often than smaller hospitals. Computer and academic course costs were paid more frequently by nonprofit and tertiary hospitals. Although the number of hospitals billing for nutrition services to patients was small, most reported receiving payment. We conclude that charges for nutrition services by dietitians to outpatients have increased, and that most dietitians who bill for services receive payment. Academic and technological resources for RDs have increased in general, though smaller primary-care and for-profit hospitals report such supports less consistently than larger, tertiary-care, and not-for-profit hospitals.     

患者健康生活方式指导服务满意度现状与影响因素分析

目的了解我国三级公立医院患者健康生活方式指导服务满意度现状及影响因素。方法选取全国31个省（自治区、直辖市）及新疆生产建设兵团共143家三级公立医院门诊和住院患者进行调查。采用SPSS 25.0软件对数据进行统计学分析。结果96.19%的门诊患者和98.71%的住院患者对所接受的健康生活方式指导服务满意。患者健康生活方式指导服务供需契合度高。户口类型、家庭实际年收入、医保类型、医院主管单位等是门诊患者满意度的影响因素。医院所在地区、主管单位、性别、家庭实际年收入等是住院患者满意度的影响因素。结论医院应注重健康生活方式指导服务的多样性和针对性,既要注重服务细节,又要具有针对性。     

某大型军队医院人员编配方法探讨

本文在军队医院编制体制的文献回顾的基础上,确定人员编配应遵循的原则和依据;通过专家咨询法和皮尔生长曲线模型、三次指数平滑等数理统计方法,预测某大型军队医院的展开床位数、门诊量和住院人数,并结合医院不同类型卫生人员实际工作特点,测算该院人员的理论编配值。通过对该院卫生人员理论配置值和实际配置值之间的比较,分析医院各类卫生人员配置的合理程度,并对今后定编工作提出相应的建议。     

简短戒烟干预在北京市各级综合医院门诊应用的效果

目的评价简短戒烟干预技术在北京市各级综合医院门诊应用的效果。方法方便抽取北京市一级、二级、三级综合医院各1家,在一级医院全科及中医科门诊、二级和三级医院呼吸内科门诊开展为期4周的研究,期间所有门诊患者为调查对象。在门诊后1周内,对现在吸烟患者采用电话调查形式进行随访,了解简短戒烟干预技术的应用效果。结果研究共调查门诊患者2460人,其中278人现在吸烟,占11．3％。门诊后1周内成功随访了122名现在吸烟患者,成功随访率43．9％。成功随访者中14．8％的现在吸烟患者因1次简短戒烟干预发生戒烟意愿的正向改变,且具有统计学意义（z=3．551,P〈0．01）。其中,三级医院的此种改变有统计学意义（Z=3．035,P〈0．01）。有戒烟服务需求的门诊患者简短戒烟干预前后戒烟意愿的改变有统计学意义（Z=3．420,P〈0．01）。结论综合医院门诊应用简短戒烟干预技术有效果,三级医院干预效果更好。对有戒烟服务需求的门诊患者实施简短戒烟干预,效果更好。     

Home health care referrals following hospital discharge: communication in health services delivery

Interinstitutional communication in the delivery of health services is fundamental to continuity of patient care. The purpose of this investigation was to describe the information transferred in the formal home care referral of elderly clients by hospitals and to describe selected organizational and medical condition characteristics that may affect referral content. Results indicated that approximately half of the information recommended by the literature was actually transmitted in the referral form. This information was composed primarily of background and medical data with some nursing care and almost no psychosocial data. More data were transferred when standardized written forms were used, when smaller hospitals provided the information, and when the home health agency was affiliated with the hospital.     

The effect of centralization of health care services on travel time and its equality

ObjectivesTo analyze the regional variations in travel time between patient residences and medical facilities for the treatment of ischemic heart disease and breast cancer, and to simulate the effects of health care services centralization on travel time and equality of access.MethodsWe used medical insurance claims data for inpatients and outpatients for the two target diseases that had been filed between September 2008 and May 2009 in Kyoto Prefecture, Japan. Using a geographical information system, patient travel times were calculated based on the driving distance between patient residences and hospitals via highways and toll roads. Locations of residences and hospital locations were identified using postal codes. We then conducted a simulation analysis of centralization of health care services to designated regional core hospitals. The simulated changes in potential spatial access to care were examined.ResultsInequalities in access to care were examined using Gini coefficients, which ranged from 0.4109 to 0.4574. Simulations of health care services centralization showed reduced travel time for most patients and overall improvements in equality of access, except in breast cancer outpatients.ConclusionOur findings may contribute to the decision-making process in policies aimed at improving the potential spatial access to health care services.     

上海市级医院国际化发展现况研究

目的通过梳理近年来上海市级医院的国际化发展现况及发展中遇到的问题,为上海市级医院国际化发展提供政策建议。方法采用问卷调查的方法向上海申康医院发展中心管理范围的市级医院收集2016—2018年国际化发展现状,采用专家访谈的方式收集这些医院国际化发展中遇到的问题。结果上海26家市级医院整体的涉外医疗规模较小,但涉外门急诊量及涉外手术量增加明显;均通过开展形式多样的国际交流活动推动学科建设和人才培养。但存在缺乏整体的国际化发展规划、国际化人才储备不足、国际影响力有待提升等问题。结论通过对上海市级医院的国际化发展现况分析,建议建立市级医院国际化发展评价体系、培养引进国际高端医疗人才及搭建国际交流平台。     

Prevalence of eating difficulties and malnutrition among persons within hospital care and special accommodations

Objectives: The aim of this study was to explore the prevalence of eating difficulties and malnutrition among persons in hospital care and in special accommodations.Design: The cross-sectional observational study was performed in Nov. 2005.Setting: Hospitals and special accommodations.Participants: Out of 2945 persons, 2600 (88%) agreed to participate (1726 from special accommodations and 874 from hospitals). In total all special accommodations in six municipalities and six hospitals were involved.Measurements: Risk of undernutrition was estimated as at least two of: body mass index below recommendation, weight loss and/or eating difficulties. Overweight was graded based on body mass index (if 69 years or younger: 25 or above: if 70 years or older: 27 or above).Results: The mean age of those living in hospitals was 69 years and 53% were women, while the corresponding figures for those in special accommodations were 85 years and 69% women. In hospitals and special accommodations, eating difficulties were common (49% and 56% respectively) and about one quarter had a body mass index (BMI) below the limits (20% and 30% respectively) and one-third above the limit (39% and 30% respectively) thus only about 40% had a BMI within the limits. Both in hospitals and in special accommodations 27% were considered to have a moderate or high risk of undernutrition. Conclusion: Only about 40% in special accommodations and hospital care have a BMI within the recommended limits. As both low and high BMI are frequent in both settings, the focus of care should not only be on undernutrition but also on overweight. Using the Swedish criteria for defining risk of undernutrition seems to give a slightly lower prevalence than has been shown in previous Swedish studies, but this can be due to an underestimation of the occurrence of eating difficulties.